ࡱ> e objbj ebebIl l 84hf    L!h!<! ggggggg$jYmg"*!*!"""g   {hd&d&d&"^  gd&"gd&d&p]b Pn"F_4gh0h_ n" nhbb nbd&"""gg$"""h"""" n"""""""""l B :  EMPLOYEE NAME: JOB TITLE:POSITION REPORTS TO:DEPARTMENT NAME: *Failure to complete self-assessment results in administrative assessment only with no opportunity to challenge rating.Review Type: 180 Day Review:  FORMCHECKBOX  Annual Review:  FORMCHECKBOX  Self Evaluation:  FORMCHECKBOX  Part I Job Description: Review job description to ascertain that it is accurate and up-to date, make corrections where needed and review with evaluate. Acknowledgement of this evaluation attests agreement to identified tasks and functions as outlined in the job description. (Updated signed job description should be included with review) Responsibilities: Acknowledgement of this evaluation attests agreement to and responsibility for understanding and adherence to the Standards of Behavior, Code of Conduct, Corporate Compliance Plan at St. James Hospital, Confidentiality Statement.  Part II Performance measure must be achieved to receive the point value. Score and Definitions: (1) Needs Improvement: Performance meets some, but not all expectations. Performance must be more consistent to be evaluated as competent. Action plan is required to address performance deficiencies in order to remain in current position. (2) Meets expectation: Performance meets the minimum expectations for the position. (3) Consistently meets expectations: Performance consistently meets the expectations for the position and of the organization. (4) Exceeds expectations: Performance always meets, and often exceeds, the expectations for the position and of the organization. MAJOR TASKS, DUTIES AND RESPONSIBILITIESEmployee Self Rating Evaluator Rating Comments/Action Plan Job Knowledge: Able to demonstrate required technical and or clinical knowledge, administrative policies and organizational practices needed to perform your assigned job responsibilities. (Use job description and score each item using a 4 point scale, then average score)  FORMCHECKBOX  1  FORMCHECKBOX  2  FORMCHECKBOX  3  FORMCHECKBOX  4  FORMCHECKBOX  1  FORMCHECKBOX  2  FORMCHECKBOX  3  FORMCHECKBOX  4 Work Quality: Able to demonstrate an overall level of Quantity and Quality of work required to meet hospital/facility/department/unit productivity objectives. FORMCHECKBOX  1  FORMCHECKBOX  2  FORMCHECKBOX  3  FORMCHECKBOX  4  FORMCHECKBOX  1  FORMCHECKBOX  2  FORMCHECKBOX  3  FORMCHECKBOX  4  FORMTEXT      Team Work: Effective working in groups, balancing candor and sensitivity; to encourage the exchange of productive ideas as part of a group. FORMCHECKBOX  1  FORMCHECKBOX  2  FORMCHECKBOX  3  FORMCHECKBOX  4  FORMCHECKBOX  1  FORMCHECKBOX  2  FORMCHECKBOX  3  FORMCHECKBOX  4  FORMTEXT      Problem Solving: Able to quickly recognize potential problems and take effective steps to deal with them. FORMCHECKBOX  1  FORMCHECKBOX  2  FORMCHECKBOX  3  FORMCHECKBOX  4  FORMCHECKBOX  1  FORMCHECKBOX  2  FORMCHECKBOX  3  FORMCHECKBOX  4  FORMTEXT      Planning: Organizes work and established priorities in order to complete tasks within time constraints imposed by the job. Examples: On time Performance Appraisals On time review of Department Policy updates Project deadlines FORMCHECKBOX  1  FORMCHECKBOX  2  FORMCHECKBOX  3  FORMCHECKBOX  4  FORMCHECKBOX  1  FORMCHECKBOX  2  FORMCHECKBOX  3  FORMCHECKBOX  4  FORMTEXT      Communication: Able to effectively present information to direct reports and leaderships utilizing both written and verbal communication formats.  FORMCHECKBOX  1  FORMCHECKBOX  2  FORMCHECKBOX  3  FORMCHECKBOX  4  FORMCHECKBOX  1  FORMCHECKBOX  2  FORMCHECKBOX  3  FORMCHECKBOX  4  FORMTEXT       Leadership: Able to influence others to cooperate and assist with projects or department responsibilities. Provides regular feedback, if applicable. Complies with management responsibilities. FORMCHECKBOX  1  FORMCHECKBOX  2  FORMCHECKBOX  3  FORMCHECKBOX  4 FORMCHECKBOX  1  FORMCHECKBOX  2  FORMCHECKBOX  3  FORMCHECKBOX  4  FORMTEXT       Patient/Customer and Employee Satisfaction: Made improvements within the realm of the job responsibilities to improve patient, employee, or customer satisfaction. Demonstrates ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence). FORMCHECKBOX  1  FORMCHECKBOX  2  FORMCHECKBOX  3  FORMCHECKBOX  4  FORMCHECKBOX  1  FORMCHECKBOX  2  FORMCHECKBOX  3  FORMCHECKBOX  4  FORMTEXT     Complies Regulatory Compliance: Corporate Compliance and The Joint Commission Standards, Department of Health, etc. Ensures compliance on behalf of staff for adherence to the Corporate Compliance Plan. 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""Bkdb+$$IfTl\,Q M, P?< t0644 laytI/T $IfgdfYt $$Ifa$gdS "" " ""L"N""##$h~hhhhhhhhhhhhhhhhhhhhhhhhhhhhhݺ{ݺmj-hZOghS Ujz-hZOghS Uj-hZOghS Uj,hZOghS Uj,hZOghS U hZOghS jhZOghS UU hZOghD>hZOghp95 hZOgh4U hZOghp9jhZOghp9U jhZOghp9UmHnHu(""#*h~hhhhhhhh ii i!i $IfgdG $$Ifa$gdS & F$Ifgdp' $Ifgdp9andards as it pertains to the department. Ensures Compliance with all regulatory standards relevant to area of responsibility FORMCHECKBOX  1  FORMCHECKBOX  2  FORMCHECKBOX  3  FORMCHECKBOX  4  FORMCHECKBOX  1  FORMCHECKBOX  2  FORMCHECKBOX  3  FORMCHECKBOX  4 Quality Management/Performance Improvement: Responsible for creating specific measurable goals, monitoring progress and outcomes. Responsible for creating action plans, reporting progress resulting in the increase in HCAHPS scores Responsible for creating a Culture of Safety in your area of responsibility. Reviews PressGaney satisfaction scores, and develops action plan that increases satisfaction scores. (PressGaney results must be submitted with review). Responsible for creating and managing performance improvement plan and reporting.  FORMCHECKBOX  1  FORMCHECKBOX  2  FORMCHECKBOX  3  FORMCHECKBOX  4  FORMCHECKBOX  1  FORMCHECKBOX  2  FORMCHECKBOX  3  FORMCHECKBOX  4  Average Total:____________ Part III: Goals (measurement at next evaluation) Individual Goal/Goals   Part IV: Signatures (completed by employee and manager at time of review) Employee signature: _________________________________ Date: ___________________ Supervisor/Managers signature: _____________________ Date: ____________________ Employee comments (optional): if employees wish to do so, comments concerning the appraisal or the content may be written below or attached as a separate sheet. if employees disagree with appraisal, they have to option of contacting the next level manager. if employee still have questions, they have the option of contacting the Director of Human Resources.     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