1. Cox, Sharon MSN, BSN

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Q Our leadership team is struggling with a system for staff evaluations and feedback, as well as discipline. I sense a rift developing with human resources (HR) and hope we can move past this to best practices. Any ideas?

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According to recent research on feedback, the best option for offering meaningful feedback is to "catch people doing something right." With advances in neuroscience, we now know that criticism doesn't enable learning but inhibits it. We "learn the most from someone who pays attention to what is working within us and helps us cultivate it."1 A famous football coach once turned a franchise around by showing players slow-motion films of what they did well and building on that.1


On the issue of performance appraisals, for years there's been significant dissatisfaction (over 90%) with performance management systems. We'd never maintain a clinical practice with that kind of outcome, and thankfully the trend is to do away with the formal performance review as we've known it.2 This age-old practice has been problematic for many reasons, and the latest finding on rater reliability is perhaps the final nail in the coffin. Research shows that we aren't reliable raters of others; over half of our rating reflects more about us than the person we're rating. This is called the idiosyncratic rater effect, which demonstrates that much of what we were sure of is simply not the case.3


An HR director at a Midwestern health system championed a cross-functional task force to update their system.4 They did away with ratings and now use regular check-ins and guided conversations with staff. The emphasis is on current and future behavior rather than the past. They're changing management practices regarding how they handle mandatory staff requirements as well, moving from a parent/child approach to one of partnership to enhance their Magnet(R) culture.5


Another organization had similar success by updating their approach to discipline, moving away from a 1950s model that escalates punishment as a means of behavior change to positive or nonpunitive discipline.6 This policy puts the onus on the employee to take ownership for behavior change and takes the manager out of the policing role. Over the next year, they saw a noticeable improvement in staff satisfaction scores and retention.7


It's incumbent upon nursing leaders who are committed to evidence-based practice to evaluate management practices through a similar lens. Policies that are paternalistic, reflect distrust in staff, or run counter to culture norms need thoughtful review. The management practices mentioned in your question are the most important in creating a culture of ownership, so stay with those issues.


Offset that "rift with HR" by partnering with them to create a management book club to allow for a shared understanding of best practices from business literature. Start with what the group feels is most problematic since this will sustain momentum for change. Use the discontent in your team as a catalyst to update your management practices and you'll see how rewarding this work can be.




1. Buckingham M, Goodall A. The feedback fallacy. Harvard Business Review. 2019. [Context Link]


2. Smith A. More employers ditch performance appraisals. SHRM. 2018. [Context Link]


3. Buckingham M, Goodall A. Nine Lies About Work. Boston, MA: Harvard Business Review Press; 2019:142. [Context Link]


4. Coens T, Jenkins M. Abolishing Performance Appraisals. San Francisco, CA: Berrett-Koehler; 2000:53-70. [Context Link]


5. Personal conversation with Hallie Custer, director of human resources, Parkview Health System. April 9, 2019. [Context Link]


6. Grote D. Discipline Without Punishment. New York, NY: AMACOM; 2006:143-167. [Context Link]


7. Cox S. Enough Already...Start Doing What Works at Work. Philadelphia, PA: Lippincott Williams and Wilkins; 2015. [Context Link]