Insight is an important feature of professional performance. It can enable us to move from blind repetition to understanding and mastery. It can promote more realistic, creative and effective ways of managing our performance (Adapted from Schafer 2004). This is because once we have insight into a problem we can draw on experience and generate the energy to solve it (Cartwright 2007).

Barrows and Neely (2011) have written about what they call “The insight gap" - the relationship between insight and performance. They suggest that effective performance management requires both analysis and insight.

Holden et al (2012) found that underperformance in GPs correlated with lack of insight and professional isolation. This meant that they were not in a position to receive feedback or correct their deficiencies. Holden and his colleagues developed a list of characteristics of isolation and lack of insight based on these cases so that the factors contributing to them could be identified and understood when assessing doctors with performance concerns.

Here is the list of these characteristics. To what extent do you think they apply to the healthcare professionals you work with?



Very common characteristics:

  • Have no involvement in any primary care trust, commissioning, or local medical   committee activities, or in education, training, audit, or research
  • Attend medical meeting infrequently. Avoid situations where their views may be challenged. Are unable to move with the times and keep up to date. Make scant contribution dialogue and are usually negative in opinions

Common characteristics:

  • Take little time off and seldom take a holiday
  • Are withdrawn from staff, patients, and peers
  • Are non-principles or locums
  • Are solo workers
  • Have poor social skills or reputations as clearly unpopular doctors
  • Have chronic ill health, physical or mental or both, including burnout

Occasional characteristics:

  • Work beyond retirement age
  • Are overwhelmed by demands or the job, and may be “obsessional” types who work too hard



Very common characteristics:

  • Rarely seek help from others; don’t work collaboratively with others
  • Are overly defensive of their way of doing things
  • Have no desire or ability to correct problems
  • Do not realise that they are out of step or why, including when trying to represent others, such as in the local media
  • Have had a second or subsequent referral to the primary care trust performance group, NCAS, GMC, or similar or have had a first major professional adverse event
  • Are unable to see that something is wrong on a systematic basis; don’t see patterns beyond the immediately obvious
  • Maintain archaic prescribing patterns, especially in initiating drugs
  • Are unpopular with nurses and staff and gratuitously rude about others
  • Have been the subject of several complaints

Common characteristics:

  • Are reckless mavericks; are other confrontational in encounters

Occasional characteristics:

  • Refuse to use a computer


Insight and health

Think of a time when a minor health issue might have impacted on your performance. What did you do about this? Would colleagues have said that you demonstrated insight?

Have you come across colleagues who appear to lack insight about the effects of their health on their performance? How could this be addressed? Whose responsibility is it?