Gripes turn to gratitude over staff evaluations
Agency listens, changes annual review system
Managers at a Richmond, VA, rehabilitation hospital decided to find out what was behind the staff’s complaints about the performance evaluation system. The chief gripe was inconsistency, which some employees claimed led to evaluation reports that were too subjective.
"For example, some managers would solicit feedback from peers or other employees who worked with a staff member, and other managers would not because the system didn’t specify that it had to happen," says Dianne Jewell, MS, PT, CCS, director of quality management for Rich mond’s Sheltering Arms Physical Rehabilitation Hospital.
Employees also disliked the rating system, which used numbers to rate performance. The employee’s raise was tied to the overall numerical rating, and some people questioned whether the ratings were being inflated because managers didn’t like giving workers a bad score that would hurt their paychecks, Jewell recalls.
"And the staff, whether or not they were happy with their score on the final rating, didn’t understand how the manager arrived at that number because the process was not uniform," she adds.
Worse, the old system did little to nip bad habits in the bud. "Some managers would not confront employees about problems until their annual review," Jewell notes. By that time, managers wouldn’t remember what the problem had been, and they wouldn’t be able to address it.
The staff made some good points, and the facility’s management decided to revamp the entire performance evaluation and competency assessment programs.
After two years of researching, experimenting, tweaking, and finally rolling out a new system, the hospital developed an evaluation process that pleases the staff, makes the managers’ system of evaluating easier to understand, and offers incentives to top-performing employees.
Plus the new system gives employees a chance to voice their ideas and concerns to managers and to discuss their career goals. "Employees like that very much," Jewell says. "They don’t feel like they’re being judged; they feel like they’re being encouraged to grow."
Also, the hospital since has completed successful accreditation surveys by both CARF... The Rehabilitation Accreditation Commission in Tucson, AZ, and the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL.
Here are the steps Sheltering Arms took to build its new performance evaluation system:
1. Form a team and research existing performance guidelines. The facility formed a 15-person work team that included the highest-level administrators and hourly workers. The work group had subcommittees, and members were given specific assignments regarding gathering information to present to the larger group.
Team members researched competency assessment guidelines by the Joint Commission because the hospital is Joint Commission-accredited. "As the Joint Commission’s guidelines became more and more specific about what they expected hospitals and medical facilities to do, we needed to follow that to maintain our accreditation," Jewell says.
Then the team reviewed human resources literature and researched articles in professional journals that related to human resources. Team members reviewed this information as it related to specific disciplines, such as nursing, physical therapy, occupational therapy, speech pathology, dietary, psychology, social work, and audiology.
Members even talked to managers at other hospitals to see what types of performance evaluation process and competency programs they used. "We also surveyed all the licensing requirements in Virginia and those of various organizations, and we cross-referenced these to see what was the same for every discipline and what would be specific for certain disciplines," Jewell adds.
2. Standardize the evaluation process. The team’s goal was to create a system for all employees, although clinical staff would have some specific standards built into their performance guidelines and competency requirements.
With that in mind, the team came up with an initial revision of the performance evaluation process, which had a mandatory feedback component in which all managers had to request feedback from a set number of co-workers.
Also, the evaluation form had standard evalu ation pieces that related to the facility’s mission and policies, infection control, and safety.
Everyone is graded on generic skills
"We made sure everyone was graded on the same generic skills, in addition to their own job-specific skills," Jewell says.
Generic skills included safety issues, infection control, and knowing the facility’s policies and procedures.
The team also developed the forms managers would use to assess how well employees meet their skill requirements. "Our old system was one set of papers, stapled together, that had all the duties that a person might have in no particular order," Jewell explains. "Our goal was to make it easier to use."
They printed the criteria for different skills on color-coded paper. That way, managers could pull out one color form for physical therapists, other colors for nurses and other disciplines, still others for managers, and white forms for the generic assessment criteria by which every employee is judged.
Finally, the team included feedback forms in each assessment packet for co-workers to return to managers. Feedback remains anonymous to the employee being assessed, although the employee gets a general idea of who was asked to complete a feedback form.
"The way it works is, my boss and I would sit down and talk about who would be on a list of people to give me feedback," Jewell explains. "I give the manager a list of five to seven people, and from that list my boss chooses at least three people."
The feedback portion of the assessment process also might include any feedback the manager had received over the course of the year from other employees.
3. Define performance goals and competency for each discipline. First, the team had to figure out how to define the words "competency" and "performance."
"We all use a lot of the same words, but we use them in different ways, and that was especially true for competency," she says. "For some people in our group, being competent meant you had to be an expert, while for others it meant you could be a new graduate without any work experience."
They wrestled with this and finally came up with this definition for competency: An employee has to demonstrate that he or she has the knowledge and ability to carry out all duties of his or her particular job. "You’re asking whether employees know what’s expected of them and whether they know at a minimum level what to do for that job duty, and if the answer is yes,’ then they’re considered competent for that duty," Jewell says.
Performance means that an employee is doing what that employee knows how to do. "I’m a physical therapist by training, so if I’m deemed competent to do range of motion on a client, and this is part of my job, then my boss has to verify that I am doing this," she says.
Diversity of duties
The team also identified which duties posed a high risk to patients and which duties required a high level of sophistication. All duties falling in those categories would require direct observation by a manager or clinical coordinator conducting the competency assessment.
In other cases, there might be a written test. "Direct observation takes a lot of time, and it takes people away from their day-to-day routine, so we didn’t want every single competency to be directly observed," Jewell adds.
The competency assessment process has a separate package of forms, including the direct observation verification forms. If an employee has a problem with a particular competency task, the manager documents the failure, the remedial plan, and its timetable for completion.
Competencies relating to mandatory items for everyone, such as knowing hazardous waste and safety procedures, are included in each annual performance assessment process. Other competencies are conducted according to licensing or accred itation guidelines. New employees or workers who are new to a particular job are placed in a three-month probationary period in which they must complete their competency requirements.
The human resources department keeps track of which competencies need to be completed on an employee’s hiring anniversary date. As competency deadlines arise, human resources officials will send a packet to the employee’s manager.
The facility used the new performance and competency assessment program for one trial year, and then made changes to improve it.
4. Decide how to tie competency/assessment to pay/incentives. First, the team eliminated the old rating system and its link to salary increases. Then, after incorporating research on how other rehabilitation facilities handle pay increases and incentives, the team developed a two-tiered system that works this way:
• If an employee has completed all competencies for that year and has not had any probation or disciplinary actions, the employee is eligible for a minimum increase. The increase is determined by the hospital’s administration, and the same percentage increase is issued to all qualifying employees.
• Employees who have exceeded expectations beyond their job duties are eligible for a bonus or incentive. For example, if an employee creates a way for the facility to save money, she may receive a bonus. Or if an employee brings a new product line to the hospital, he may receive an incentive. "But it has to be a stretch above or beyond the routine," Jewell stresses.
The incentive program is still being adjusted and revised. "We’ve looked at different reward systems, such as some companies offer gift catalogues, where employees receive a certain number of points for doing something above and beyond," she says.
These gifts might include frequent-flier miles. Jewell says administrators still have to decide whether to use cash bonuses or gift equivalents. They already have decided not to give bonuses that involve a percentage-point increase in salary.
While employees have applauded the elimination of the rating system, they have expressed some dissatisfaction with the bonus process. "Some people feel the current payment method related to across-the-board pay increases and bonuses is not adequately rewarding those people who are doing a job that is a cut above," Jewell explains.
"There are some who believe that by having a minimum pay increase across-the-board, you’re encouraging stagnation or are not encouraging the staff to reach beyond their current abilities," she adds. "So we’re looking to define more clearly what a cut above’ means and define it with examples."
However, most human resource literature states that money is not the main factor in retaining productive employees. Employees need job satisfaction, including having control over their daily work and being able to participate in decision making. Employees want to be paid what they’re worth, but they also want to work in an environment that is positive and gives them some autonomy. If they are unhappy with their jobs because of management conflicts or other nonfinancial issues, throwing money at them is not the answer, Jewell explains.
"For instance, if I identify a problem in my day-to-day routine, how much authority do I have as a staff-level clinician to make a change?" she says. "The degree to which a company can bring problem-solving down to the staff level is a large motivator for employees."
As part of the new performance and competency process, the team requires managers to empower employees by seeking their input and involving them in developmental or action plans particular to each worker. That doesn’t mean managers ask for employees’ opinions only once a year. Managers and employees set specific dates to meet and discuss performance goals and the action plans.
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