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J Oncol Pract. 2006 November; 2(6): 307.
PMCID: PMC2793648

Performance Evaluations: Honesty Is the Best Policy

After working more than a dozen years at the Center for Cancer and Blood Disorders in Fort Worth, Texas, human resources director Tammy Mask thought she knew the drill when it came to employee evaluations. Traditionally, they were a twofer: performance review and pay raise, all in one fell swoop.

Not any more. Performance evaluations are time-consuming, detail-loaded, example-yielding, and candor-filled assessments that typically take two sessions to complete. “We call it ‘brutal honesty,’” explains Mask. “And I really, really like it.” Is such a drawn-out approach really necessary? Absolutely, she says, and the efforts are paying off. “It works, it makes us better, and it lets us know how to improve.”

When CEO Barry Russo took the helm of the Center for Cancer and Blood Disorders, he had a formidable challenge ahead—the center expanded into a 54,000-square-foot facility, presumably becoming one of, if not the most extensive community cancer care centers in North Texas. And while changes in building space were taking place, so was a way of thinking, by way of performance evaluations.

“We work on goals all year long,” Mask explains. Following an annual review, employees are asked to come back, after taking a couple of days “to think about it.” They are encouraged to respond about why they agree (or disagree) with a particular assessment. This communication tool advocated by Russo comes at a time when the Cancer Quality Alliance aims to ensure high standards of care. And, as ASCO past-president Sandra Horning, MD, has observed, the definition of quality (the “what”) is only a first step. It is “the how” that is especially daunting.

The “how” is where Russo is placing intense focus. Over the course of the year, supervisors schedule “goal meetings,” during which employees and bosses jointly set job performance objectives. By the time the annual performance evaluation rolls around, these meetings “should ensure that there are no surprises,” says Russo. Historically, some employees would counter criticisms with the objection, “You never told me that before!” Predictably, negative feelings would surface.

In a scoring system from 1 to 5, goals for each employee are ranked in terms of attainment. However, under Russo's system, the numerical ratings are to be accompanied by actual examples. Managers are called upon to write their workplace observations frequently and persistently. He takes such notes daily. So if an employee seems to be having trouble morphing into a team player, specific incidents and apparent obstacles to that transformation need to be discussed, eschewing need for the time-worn catch phrase, “You need to be more of a team player.”

Even so, Russo acknowledges that not everyone likes hearing the fine points of why they did not get top ratings. However, even that kind of prickly situation can end up benefiting both sides. Generally, such people beat a path to the exit, he points out. “They find out this isn't the culture that fits them, and that is okay. People need to be where they fit.”

And sugar-coated critiques can be a danger zone, possibly providing fodder for a later legal dispute. “This common practice provides ammunition to attorneys representing employees in wrongful discharge, discrimination, and other employment law cases,” notes attorney Kathy Peck of Williams, Zografos & Peck in Lake Oswego, Oregon. Peck meets with medical groups and gives them presentations that include talks on the pitfalls of being a “soft supervisor.”

By following what her law firm calls the “golden rules of effective discipline,” health care providers can stay in safer territory. These rules basically call for a message to be given to an errant employee in a clear but positive way. “When this message is coupled with a sincere expression of confidence in the employee's ability to meet the challenge, it is more likely to produce positive results,” she says.

Mask, of the Fort Worth Center, says even the toughest performance reviews can actually boost her spirits. “I have a better feel for how I am doing,” she says, adding that the Russo-style critiques highlight her personal strengths.

For instance, Mask tries to have an unflagging positivity at work, and she believes it is infectious. “In oncology, it is hard,” she says, hard on patients and their families, as well as employees. “I want everyone, even the people in billing, smiling and saying hello to anyone who is here. So when I walk anywhere, I do that.”

For anyone who doubts that a daily smile can have more impact than the camaraderie of a company picnic, author Jim Collins, who profiled 11 exceptional companies in the book “Good to Great,” asserts that “hoopla” and “bravado” can be over-rated.

“Stop and think about it a minute. What do the right people want more than anything else? They want to be part of a winning team. They want to contribute to producing visible, tangible results. They want to feel the excitement of being involved in something that just flat-out works,” he states in the book.

That's a view shared by Terry Steiner, who was recently named human resources director at New Hampshire Oncology-Hematology PA, in Hooksett, New Hampshire, after more than 15 years as an employee. Some might argue that pulling up a chair with a supervisor and having a brief discussion of past-year performance saves valuable work-related time. To those individuals, Steiner has this to say: “It's just the opposite. I think this is something that more time needs to be put into.”

Articles from Journal of Oncology Practice are provided here courtesy of American Society of Clinical Oncology