PA Feedback and Performance Reviews

Feedback and performance reviews play a crucial role in setting expectations, clarifying goals, and fostering open communication within your practice.

They serve as a valuable opportunity to align the objectives of your PAs with the broader goals of the clinic. By establishing clear expectations and outlining measurable milestones, you can create a pathway for professional development and growth, and encourage long-term retention of the PA.

Feedback on PA performance can be formal or informal.

Formal process is where a meeting is setup between employer and PA, whereas an informal process involves quick checkins (e.g. after clinic or after the week) to discuss what is going well, what isn’t going well, and what can be improved.

One of the most significant advantages of regular feedback and performance reviews is the opportunity they provide to identify strengths and areas for improvement. The PA also has an opportunity to self-reflect and provide insight into their own growth and learning.

By offering constructive feedback, you enable the PA to build on their existing strengths and talents while addressing any potential areas of growth in clinical practice.

I. Why PA Performance Reviews are important

A Performance Review, also known as a performance appraisal or evaluation, is a formal process in which an employer assesses an employee's job performance, achievements, strengths, areas for improvement, and overall contribution to the practice/department.

It is a structured assessment that provides feedback on the employee's performance, helps set goals, and identifies areas where additional support or development may be needed.

Performance Reviews provide opportunities to:

1. Provide constructive feedback on PA performance: highlighting areas of strength and areas of improvement. This feedback helps the PA understand how they are performing in their role and what they can do to enhance their effectiveness.

2. Set goals and expectations: This may include setting goals for knowledge and skill acquisition. Ideally this should be a collaborative process where both the employer and PA set goals. These milestones are revisisted at future performance reviews and service as a benchmark at which progress can be measured.

   • Establish Goals/Milestones for the PA and the clinic: can include mastering specific clinical skills, improved efficiency with patient encounters, developing an efficient workflow with EMR, completing advanced training, taking on a Quality Improvement (QI) or research project, taking on teaching responsibilities with medical learners, etc.

   • Formal tracking of milestones and productivity: Having the PA meet certain metrics (aka key performance indicators) that measure performance productivity e.g. # of patients seen, decreased wait times, increasing appointment availability, length of stay since PA introduction)

3. Identify training needs: Employers can help the PA identify any skill or knowledge gaps to improve PA performance and growth. This can include courses, attending teaching rounds, conferences, workshops, 1-on-1 mentoring with a supervising physician, and more. Click here to read more about investing in CME for PAs.

4. Recognize achievements: Performance reviews also allow for recognition and appreciation for the PA’s accomplishments, contributions and milestones. Celebrate their successes and the positive impact they have had on patient care. This can boost morale, reinforce positive behavior and motivate to continue performing at a high level.

5. Support Decision-Making: Performance reviews can play a role in decisions related to promotions, salary adjustments, bonuses and other forms of recognition or awards.

II. Structure & Timing of PA Performance Reviews

a) Duration and Timing of a Performance Review

Typically, performance review meetings can take between 15 to 45 minutes. It’s best to have this scheduled ahead of time in-person or over conference call. The PA should receive 2-3 weeks notice of the PA performance review.

Formal Performance reviews can be biweekly, monthly, quarterly, semi-annually or annual.

We suggest informal check-ins every two weeks with a new PA hire until the PA is performing at a comfortable pace.

Once the PA is more established, touch base quarterly or every 6 months. Touch base can be formal or informal, but ideally should take place once a quarter.

b) Who is involved in a PA performance review?

Ideally it should be the supervising physician(s) and the PA.

In hospital settings, this can also include clinical managers who touch base with supervising physicians or chief of staff of the department, and pass on feedback to the PA.

c) Optional: Completion of a Goal Setting Sheet

In hospital settings, it is common for managers to send a Word document for the PA to complete ahead of time with the different talking points of the performance review. This is submitted to the employer/management prior to the start of the meeting.

This is an optional step, but having a “goal setting worksheet” completed ahead of time serves as a “meeting agenda”, as well as an opportunity for the PA to self-reflect on accomplishments within a given time period (month, quarter, bi-annually, annual).

d) Outline of a Sample PA Performance Review Meeting

1. Welcome and Introduction: Welcome the PA and explain the purpose and structure of the performance review
   

2. Discuss PA’s goals: Have the PA touch base on goals set at previous performance review (if applicable), and reflect on progress made towards achieving goals. Celebrate any successes or milestones reached.
   

3. Job Performance Assessment: Encourage the PA reflect and share perspective on their job performance and development based on: a

   • key clinical responsibilities, skills, and competencies (use CanMEDS-PA as reference or mission statement/values of the hospital/organization)

   • communication and collaboration skills within the healthcare team

   • interaction and rapport building with patients.

   The employer can then provide.
   

4. Open Discussion and Feedback: In a two-way dialogue, address any concerns or challenges the PA’s may be facing. This is also a good opportunity to discuss new goals or milestones the PA will be working towards.
   
   This should serve as a catalyst to:

   1. Discuss specific accomplishments, strengths and areas of improvement.

   2. Reinforce and encourage positive practices and accomplishments

   3. Provide specific feedback and examples to support assessment of PA job performance.

   4. Identify obstacles to PA practice (e.g. not yet established medical directives, etc.)

   5. offer guidance and resources to enhance clinical proficiency (e.g. by engaging in continuing medical education (CME) or continuing professional development (CPD) activities including additional training, development, coursework, conferences, workshops, 1-on-1 mentoring or opportunities for shadowing).
      

5. Performance Review Summary and Next Steps: Summarize key points discussed. Reiterate the goals, action plans and timelines established. Here you can also clarify the process of ongoing feedback and support.
   
   Express appreciation for the PA’s dedication and commitment, and reaffirm the practice’s support for their professional growth and success.

III. Providing Constructive Feedback

The art of delivering constructive feedback lies in its ability to motivate and inspire growth. When providing feedback to the PA, focus on specific behaviors, actions, or outcomes.

1. Start by highlighting the positive aspects of their performance. Acknowledge their achievements and strengths. This sets a positive tone for the conversation and reinforces their value to the team.

   • Example: "Firstly, I want to recognize the exceptional dedication you've shown in providing quality patient care. Your thoroughness and attention to detail in diagnosing and treating patients have been consistently commendable."
     

2. Be specific and descriptive about the areas for improvement: Clearly articulate the behavior or action that requires improvement. Provide specific examples to illustrate the issue, ensuring that your feedback is grounded in observable facts.

   • Example: "However, I have noticed that there have been instances where your documentation of patient encounters could benefit from more detail. For example, in the case of Mrs. Smith, the notes didn't capture all the pertinent information regarding her symptoms and treatment plan."
     

3. Explain how this impacts patient care: Help the PA understand how their behavior or action impacts patient care, team dynamics, or the overall effectiveness of the practice. Highlight the consequences of the behavior in a constructive manner.

   • Example: "Accurate and detailed documentation is crucial for ensuring continuity of care and facilitating effective communication among healthcare providers. When important details are missing, it can lead to misunderstandings or gaps in patient treatment plans."
     

4. Offer suggestions and solutions: Provide specific recommendations on how the PA can improve or address the identified issue. Be constructive and offer actionable steps that they can take to enhance their performance.

   • Example: "To enhance your documentation skills, I suggest incorporating a structured note-taking template that prompts you to capture comprehensive information during patient encounters. Additionally, you can consider allocating a few extra minutes after each appointment to review and revise your notes for completeness and accuracy."
     

5. Encourage dialogue and active listening: Create a safe space for the PA to share their perspective, concerns, or ideas. Encourage them to ask questions and actively listen to their input.

   • Example: "I want to hear your thoughts on this matter. Do you have any challenges or questions regarding documentation that we can address together? I value your insights and want to ensure we find a solution that works best for you and our patients.”
     

6. Follow-up and support: Conclude the feedback conversation by summarizing the key points discussed and outlining any follow-up actions or support that will be provided. Reinforce your commitment to the PA's professional development.

   • Example: "In summary, improving documentation practices will contribute to even better patient care. I will provide you with additional resources, such as sample templates and training materials, to support you in this area. Let's schedule a follow-up meeting in two weeks to discuss your progress and address any further questions you may have."

It's important to remember that feedback should always be delivered in a respectful and supportive manner.

Approach the conversation with empathy and a genuine desire to help your PA grow professionally.

IV. Examples of PA Metrics, Goals and Milestones

Remember, the choice of metrics should align with the PA's role, the goals of the practice, and any specific performance expectations established. It's important to select metrics that are meaningful, measurable, and provide actionable insights for productivity enhancement and professional growth.

1. Patient Encounter Metrics: Number of patient encounters per day/week/month: This metric tracks the volume of patients seen by the PA, reflecting their productivity and workload.

2. Average time spent per patient encounter: This metric measures the PA's efficiency in delivering quality care within a reasonable timeframe.

3. Patient satisfaction scores: Surveys or feedback from patients can gauge the PA's effectiveness in meeting patient needs and providing a positive experience.

4. Clinical Outcomes Metrics:

   • Patient outcomes and follow-up rates: Tracking patient outcomes, such as improvements in health conditions or reduced hospital readmissions, demonstrates the PA's impact on patient care.

   • Compliance with clinical guidelines and protocols: Monitoring adherence to evidence-based guidelines reflects the PA's commitment to providing high-quality and standardized care.

5. Revenue Generation Metrics:

   • Revenue generated through billed services: Tracking the revenue generated by the PA's services provides insights into their financial impact on the practice (in a fee for service or rostered setting).

6. Continuing Education and Professional Development Metrics:

   • Completion of continuing education courses or certifications: Tracking the PA's participation in educational activities demonstrates their commitment to staying current in their field and enhancing their knowledge.

   • Professional presentations or publications: Monitoring the PA's involvement in presenting at conferences or publishing in reputable journals indicates their contributions to the broader healthcare community.

   • Participation in workshops or skill development programs: Tracking attendance and engagement in workshops or programs focused on specific clinical skills or professional growth areas reflects the PA's dedication to ongoing development.

7. Interprofessional collaboration and feedback: Gathering feedback from colleagues and other healthcare team members on the PA's communication, teamwork, and collaboration skills provides insights into their professional development in these areas.

V. Measuring Impact of a PA on Department-Wide Metrics

This may be an indirect way to see if integration of a PA impacts department or practice-wide metrics. You can compare numbers before and after a PA was introduced.

• Emergency Medicine Metrics

  • Arrival to Provider time: time it takes for a patient to be seen by a health care provider (MD, PA, NP), reflecting efficiency of the initial evaluation process

  • Door to Provider Time: time it takes for a patient to be evaluated by an HCP after arriving at the emergency department

  • Length of Stay (LOS): total time spent in hospital from arrival to discharge or admission

  • Patient Flow throughput: Overall time it takes for patients to move from emergency department including registration, triage, evaluation, treatment and disposition

  • Left without being seen (LWBS) Rate: The percentage of patients who leave the ED before medial evaluation or treatment, indicating access and wait time challenges.

• Family Medicine Metrics

  1) Patient Access and Appointments:

  • Wait Time for Routine Appointments: The average time patients wait for a non-urgent appointment.

  • Same-Day Appointment Availability: The percentage of appointments available for patients on the same day they request them.

  • Appointment Utilization: The percentage of available appointment slots that are filled by patients.

  2) Patient Engagement and Experience:

  • Patient Satisfaction Surveys: Surveys conducted to assess patients' satisfaction with their experience at the practice, including aspects like communication, accessibility, and staff interactions.

  3) Preventive Care and Health Promotion:

  • Vaccination Rates: The percentage of eligible patients who receive recommended vaccinations, such as influenza or pneumococcal vaccines.

  • Cancer Screening Rates: The percentage of eligible patients who undergo recommended cancer screenings, such as mammograms or colonoscopies.

  • Chronic Disease Management: Tracking the percentage of patients with chronic conditions who receive appropriate monitoring, screenings, and interventions according to evidence-based guidelines.

  5) Practice Efficiency and Workflow:

  • Average Visit Duration: The average length of time patients spend with the healthcare provider during a visit.

  • Provider Schedule Utilization: The percentage of provider schedule slots that are utilized and filled with patient appointments.

  • No-Show and Cancellation Rates: Tracking the percentage of appointments missed or canceled by patients.

  • For Rostered Practices: Size of the patient roster before and after a PA is introduced.

• Surgical Specialty Metrics

  Patients seen in Outpatient/Ambulatory Clinic:

  • Volume of patients seen by the PA (distinguishing between consult, follow-up, re-assessment, pre-op)

  • Duration of appointments/time in clinic (as a reflection of offloading physician time)

  • Procedures performed (number and type)

Final notes

Regular feedback sessions and structured performance reviews create a culture of open communication, collaboration, and growth. By focusing on specific metrics and milestones, you can objectively assess your PA's performance while nurturing their professional development.

Remember, constructive feedback delivered in a supportive manner is the key to unlocking your PA's full potential. By providing regular feedback, setting clear expectations, and acknowledging achievements, you inspire motivation and continuous improvement.