Mar 27, 2018

eNewsletter Article: Advancing patient care through “full circle” physician performance feedback

In a rapidly-evolving healthcare landscape, improving relationships with patients, colleagues and co-workers is of paramount importance. Yet, how does a healthcare professional know how to become a better colleague, co-worker, and care provider?

A vital resource for physicians is Multi-Source Feedback. This involves gathering input from a statistically significant cohort of physician colleagues, other health professionals and patients. The physician participant then receives aggregated feedback to improve their practice.

How does Multi-Source Feedback work?

Multi-Source Feedback (MSF) is a process originally developed in the industrial sector[1][2] . Recognizing the importance of providing physicians with feedback on their professional behaviours, regulatory authorities, professional organizations and health systems began adopting MSF for physicians.

MSF consists of four stages:

  1. The data about a physician’s observable workplace behaviours are collected through questionnaires from those interacting with the individual and include a self assessment questionnaire
  2. The data about the physician are separately aggregated by source (e.g., physician colleagues, patients, non-physician co-workers) for anonymity and confidentiality
  3. The aggregated data, along with self-assessment data, are provided to the individual in a report for reflection upon strengths and opportunities for improvement
  4. The physician meets with a trusted individual to review the data, have a feedback conversation and develop an action plan[3]

Just receiving the data is not enough to enable meaningful practice changes. Research in both industry and medical education shows that simply receiving a report on one’s performance, even when gaps are apparent, is often insufficient to promote learning or a change in practice[4][5][6][7] . Significant practice improvements in response to performance data require a facilitated feedback conversation, coaching for change and the development of an action plan.

MSF in action

One program based on this approach has been developed by the Medical Council of Canada (MCC). Leveraging its assessment expertise and best practices, the MCC has launched a national MSF program. At its core, the new program is about providing physicians with meaningful and actionable feedback to improve patient care.

The program is built around the Physician Achievement Review evaluation tool that was first developed by the College of Physicians & Surgeons of Alberta (CPSA) in partnership with researchers at the University of Calgary. With the intellectual property now transferred to the MCC, the revamped tool and process have been renamed “MCC 360”.

MCC 360 was designed based on CanMEDS, the Royal College of Physicians and Surgeons of Canada’s physician competency framework. It provides participant physicians with narrative, open-text feedback from their raters, including patients, on where they can improve. The program also features a robust research agenda, to help with continual investment and renewal in the evaluation tool.

On a broader scale, the program’s governance structure is designed to help mobilize a national movement toward improving medicine and patient care. The MCC 360 Governance Committee is composed of regulators and educators, as well as physician quality assurance and improvement programs.

The MCC 360 was launched just a few years ago with the goal of making a significant impact on continuing professional development and in-practice assessment in medicine. “Physicians will want to participate”, says Dr. Karen Mazurek, Chair of the MCC 360 Governance Committee and Deputy Registrar of the CPSA, “because the feedback that they’ll get will be helpful to them in providing good care to their patients.”

How MSF fits within the Canadian medical community

The practice of using data with feedback to guide learning and practice improvement is an integral CPD component with the College of Family Physicians of Canada (CFPC) and the Royal College of Physicians and Surgeons of Canada (RCPSC).

From a regulatory perspective, the Federation of Medical Regulatory Authorities of Canada (FMRAC) has formally recognized the role that performance and practice assessment play in ongoing practice improvement and, in 2015, initiated the Physician Practice Improvement (PPI) framework. MSF processes fit readily into the PPI cycle for physicians, providing them with assessment data to use in creating and implementing a learning plan and evaluating outcomes.

MSF is one assessment tool in a broader “performance assessment toolbox”. Physicians may receive data from other sources, such as medical record audits and population metrics, about their medical expert role. Taken together, MSF and assessments of medical expertise can provide physicians with a more extensive and authentic overview of their performance, a rich data source for identifying their practice strengths and areas in which they could be doing better, and for developing plans for improvement.

“To be a physician is so much more than just being a medical expert,” explains Dr. Mazurek. “My vision is that every physician in our country will participate in this kind of 360-degree process at one or more points in their careers.”

For more information regarding the MCC 360, please visit

Saegis also offers several programs that can help physicians improve their performance including “Successful Patient Interactions”, “Effective Team Interactions” and programs specifically for healthcare leaders focused on settig the conditions for a better organizational culture. To learn more, click here.


[1] Bracken DW, Rose DS, Church AH. (2016). The evolution and devolution of 360° feedback. Industrial and Organizational Psychology 9(4): 761-794. 

[2] Bracken DW, Church AH. (2013). The "new" performance management paradigm: Capitalizing on the unrealized potential of 360 degree feedback. People and Strategy 36(2): 34-40.

[3] Lockyer JM (2017). Multisource feedback. In: Holmboe ES, Durning SJ, Hawkins RE (eds) Practical Guide to the Evaluation of Clinical Competence, 2nd ed. Philadelphia, PA: Elsevier, pp. 204-214.

[4] Bracken DW, Rose DS (2011). When does 360-degree feedback create behavior change? And how would we know it when it does? Journal of Business and Psychology 26(2): 183-192.

[5] Ferguson J, Wakeling J, Bowie P (2014). Factors influencing the effectiveness of multisource feedback in improving the professional practice of medical doctors: a systematic review. BMC Medical Education 14:76.

[6] Sargeant J, Holmboe E (2017). Feedback and coaching in clinical teaching and learning. In: Holmboe ES, Durning SJ, Hawkins RE (eds.) Practical Guide to the Evaluation of Clinical Competence, 2nd ed. Philadelphia, PA: Elsevier, pp. 256-269.

[7] Sargeant J, Mann K, Ferrier S (2005). Exploring family physicians’ reactions to multisource feedback: perceptions of credibility and usefulness. Medical Education 39:497-450.


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