The Relationships Among Professional Performance Ratings, Clinical Decisions, and Clinical Outcomes in Psychiatry

When training backgrounds, ratings, and clinical practices among Navy psychiatrists were considered, a definite profile between rated competence and performance emerged. Doctors rated as highly competent were generally older and had more experience since training than did doctors with low-rated competence. High ratings were associated also with the ability of doctors to manage patients with relatively few drugs and few physical restraints. With respect to differences in management or major diagnostic groups, it appeared that ratings reflected agreement between clinical practices and administrative policies. Generally, it is assumed that fewer clinical hours and decisions should affect the character and behavior disorder group as compared with other diagnostic categories. High competence ratings were characteristic of doctors who followed this dictum. Although posthospital outcomes were not significantly related to ratings in the small samples of this study, a trend in this direction was evident. Ratings on the Professional Performance Report (PPR) appear to reflect the ability of the doctor to function well in a large organization while practicing effective patient management.