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Performance Management

Performance management is one of the more challenging aspects of medical practice management. While good performance should always be a priority and not forgotten, this factsheet focuses on the management of poorly performing employees and provides you an outline of a suggested management process.

Tuesday, 18 July 2023

Quick guide

  • When managing performance, it is preferable to start with an informal process whenever possible and document all discussions.
  • If undertaking a formal process, documentation is imperative.
  • Some issues require immediate disciplinary action, such as illegal activity or bullying or any matter that threatens the safety of others. These are conduct issues, not performance issues, and are dealt with differently.

Managing poor performance in medical practices

Performance management is one of the more challenging aspects of medical practice management. Rewarding good performance should always be a priority and not forgotten. However, the focus of this factsheet is on the management of poorly performing employees.

You should comply with any policy that your practice has in place about managing performance. If your practice does not have a policy, you may wish to follow the below suggested process.

Performance management process

You should manage poor performance as soon as possible. If issues are left unchecked, they can become increasingly difficult to address. The performance management process should focus on a particular issue, not a suite of problems. You should be able to support the discussion with specific examples and where possible evidence of the issue.

The best way to do this is to make a file note every time an issue occurs; these examples can then be used for future performance conversations.

Where possible, managing performance should commence with an informal process.

Informal process

The informal process involves speaking with an employee as soon as possible after you become aware of an issue, explain your performance concerns and your expectations for future performance. This can be casual, over a coffee for example or you may choose to start with a meeting in your office or similar. In addition to documenting incidents as they occur you should also document informal discussions and keep a copy in the employment file of the staff member.

File note template for performance conversations (informal and formal)

  • Date and time of discussion
  • Who was present at the discussion?
  • What was the issue?
  • What is expected of the staff member?
  • How did the staff member respond?
  • What actions were decided upon following the discussion?
  • Timeframe

Formal process

If informal performance management has not achieved an acceptable and long-lasting outcome, you should arrange a formal performance management meeting with the employee as soon as practical.

Step 1 - Plan

You may wish to prepare a draft performance improvement plan which explains the employee’s performance deficiencies and the practice’s performance expectations. This can assist you to stay on track during the meeting. You can find a helpful template from the Fair Work Commission.

Step 2 – Arrange meeting

You should:

  • let the employee know that you would like to meet with them to discuss performance concerns
  • let the employee know when you would like to meet with them. There is no specific amount of notice you have to give before the meeting, but you should allow the employee sufficient time to organise themselves for the meeting (including organising a support person if they wish)
  • offer the employee the opportunity to bring a support person to the meeting. An employee has a right to a support person, not necessarily the support person of the employee’s choosing. For example, you do not have to delay a meeting for six weeks because the employee’s preferred support person is on leave.

The meeting should occur in a private location where the meeting will not be interrupted. It can be useful to have a ‘note taker’ in the meeting.

Step 3 - Meeting

At the start of the meeting, you should explain the role of a support person. Their main role is to provide emotional support and reassurance. The support person does not have a right to represent the employee during the meeting or to answer questions on the employee’s behalf. If you form the view that the support person may be able to assist, you can allow them to do so.

During the meeting, you should:

  • let the employee know your performance concerns – be as specific as possible and provide actual examples of your concerns
  • confirm that the employee has received the relevant policies and understands them
  • tell the employee what you expect of them – be reasonable and be as specific as possible
  • give the employee a timeframe in which to improve their performance
  • ask the employee if there is anything else they would like you to consider and properly consider anything that they say (for example, the employee may say they have not had appropriate training or that they are experiencing some personal difficulties or a health issue)
  • offer any additional training or support that the employee may require
  • let the employee know the consequences if their performance does not improve (for example, they may receive a written warning or may be dismissed)
  • seek the employee’s response to your performance concerns. If the employee wishes to consider the issues before responding, you can either adjourn the meeting or put your concerns in writing for the employee’s written response.

Step 4 – Follow up

Following the meeting, you should:

  • give the employee a written warning if appropriate
  • confirm the content of your discussion in writing, in either a performance improvement plan or by letter
  • make a file note of the meeting for your records.

Give the employee a genuine opportunity to improve their performance. This may include providing additional training or support to enable them to perform in accordance with your expectations.

If performance issues arise between the first meeting and the review meeting, manage them immediately. Don’t wait to bring them up in the review meeting.

At the review meeting, consider whether the employee’s performance is meeting your expectations.

  • If the employee’s performance is meeting your expectations, tell the employee that the process has ended but their performance will continue to be monitored and the process will recommence if necessary.
  • If the employee’s performance is still not meeting your expectations, consider providing a further written warning and continue the performance improvement program. A further written warning may be appropriate if there has been a decline in the employee’s performance or no improvement. It may not be appropriate if there has been an improvement but not enough improvement. Set another review meeting. You may need to repeat this step a number of times depending on the performance issue and the content of the warning letter.

Conduct issues

Conduct issues include serious employment breaches such as theft, assault, sexual harassment or bullying. Conduct issues generally require a formal investigation and disciplinary process.

For more information or immediate medico-legal advice, call us on 1800 128 268, 24/7 in emergencies.

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Psychiatrist’s relationship with former patient still inappropriate five years after treating relationship ceased (PDF)


IMPORTANT: This publication is not comprehensive and does not constitute legal or medical advice. You should seek legal or other professional advice before relying on any content, and practise proper clinical decision making with regard to the individual circumstances. Persons implementing any recommendations contained in this publication must exercise their own independent skill or judgement or seek appropriate professional advice relevant to their own particular practice. Compliance with any recommendations will not in any way guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional or practice. Avant is not responsible to you or anyone else for any loss suffered in connection with the use of this information. Information is only current at the date initially published. © Avant Mutual Group Limited 2023 fact-067 07/23 (DT-3267)

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