Employee Name: Employee #: Job Title: Date of Hire: Department Name: Reports to: Appraisal Period FROM: TO: The Cedars-Sinai Health System Performance Appraisal System is meant to promote individual and organizational effectiveness and to encourage ongoing, constructive communication between employee and manager. The objectives of the system are to: (1) Assess performance using specified standards (2) Assist in identifying performance objectives for future accomplishment (3) Promote employee development (4) Provide information for human resource decisions, including promotion, transfer, and separation (5) Provide a basis for awarding merit pay increases. RATINGS DEFINITIONS: Exceeds Performance Requirements (E) Meets Performance Requirements (M) Improvement Needed (I) Does Not Meet Performance Requirements (N) Overall performance consistently exceeds requirements: Performance is characterized by exceptional skill and initiative, as well as superior job knowledge. Performance exceeds most others in the same or similar position. Performance is exceptional in that it exceeds performance standards on a regular basis. Overall performance consistently meets and may occasionally exceed standards. Performance represents a significant contribution to the organization. Performance consistently meets and occasionally exceeds performance expectations, standards and goals for the position. This level of performance reflects what is expected of employees who are fully competent and solid performers. Overall performance does not consistently meet standards in several key areas. Improvement is required to get to a meets expectations level. Must improve performance to a meets expectations level. Action plan and follow up are required to address performance deficiencies and maintain current position. Overall performance does not meet standards. Performance is inadequate (below minimum acceptable standards and expectations). Performance is causing problems/disruption/hardships to the department and/or co-workers and is having a negative impact on departmental effectiveness and/or productivity. Section I Primary Day-to-Day Job Responsibilities Note: This section focuses on primary ongoing day-to-day responsibilities that are part of your routine work; special projects get addressed in the Goals Section. Primary Day-To-Day Responsibilities - List top 3-5 work tasks which best reflect essential elements of your role within the appraisal period: Section I - Manager Comments & : SELECT RATING EIS Staff Performance Appraisal Training Handout Page 1 of 6 September 2011
Section II - Compliance Mandatory Requirements Requirement Date Completed Requirement Date Completed Annual Medical Clearance Annual Safety Certification Fire Safety Card (4 years) Expiration Date: Job Hazard Analysis Corporate Compliance Section III Values for EIS Staff Note: This section addresses Values for EIS Staff. While the definitions may appear new, they capture the spirit of the legacy forms. VALUES Supports to the vision, mission and values of the organization. Demonstrates professionalism in behavior and appearance. Acts ethically, values diversity and delivers quality work. Holds self and others accountable to the Cedars-Sinai values and supporting the vision and mission of the organization. - Meets Demonstrates personal commitment to CSHS vision/mission/value s. Takes initiative and responsibility for professional conduct/ethics, quality of work, customer service and valuing diversity. - Exceeds Models and exemplifies CSHS values in thoughts and actions. Expands own and other s understanding of professional conduct/ethics, quality of work, customer service and valuing diversity Manager Comments & Values : TEAMWORK Contributes to the achievement of a high performing team. Shares information, resources and ideas. Helps to integrate new team members through mentoring and coaching. Volunteers for assignments. Finds common ground and solves problems for the good of all; represents own interests while being fair to others. Is seen as a cooperative team player who works well with diverse team members and groups. - Meets example: Shows commitment to team objectives, willingly shares information with others and contributes fair share of effort. Supports team members by encouraging participation and listening to other s ideas. Works towards best solution, not necessarily own solution. Shares credit with others. - Exceeds example: Inspires and models cooperation and teamwork. Promotes team accountability and cross-functional collaboration. Strengthens group problem-solving capabilities; demonstrates understanding of other s perspective(s) and proactively negotiates/resolves team conflict. Manager Comments & Teamwork : INTERPERSONAL SKILLS & CUSTOMER RELATIONS Establishes rapport and builds constructive, effective relationships. Fosters trust with others though own authenticity and follow-though on commitments. Listens and relates well to others in-person, in writing, electronically and with body language. Uses diplomacy and tact; sees conflicts as opportunities to strengthen relations. Exercises good judgment re: timing/circumstance/place/person. - Meets example: Develops effective and respectful working relationships with internal and external customers, vendors, stakeholders, departments, etc. Maintains open lines of communication by listening and engaging in constructive dialogue. - Exceeds example: Demonstrates ability to turn-around troubled relationships with others. Brings out the best in others and is considered a peer resource for ideas, mentoring and guidance when relationship strain or break downs occur. Manager Comments & Interpersonal Skills & Customer Relations : PERFORMANCE AND QUALITY ASSURANCE IMPROVEMENT Understands CSHS performance improvement methodology of Plan, Do, Study and Act; challenges the status quo; demonstrates commitment to providing the highest quality products and services to customers; Has a continuous improvement mindset and is adaptable to change. - Meets example: Double checks own work to ensure quality. Contributes ideas, suggestions and concerns on a regular basis. Corrects flaws in work processes; looks for ways to improve quality/service. - Exceeds example: Understands how EIS systems impact hospital operations and patient care 24/7. Expands thinking to look at situations from different points of view and help others see things from customer perspective(s). Identifies and/or initiates and implements actions to improve product/service delivery and workflow effectiveness. Manager Comments & Performance and Quality Assurance Improvement : EIS Staff Performance Appraisal Training Handout Page 2 of 6 September 2011
SAFETY Demonstrates a genuine concern for safety and reliability of systems at all times; is mindful of the impacts of EIS managed systems on patient safety; appropriately manages risks and keeps stakeholders informed. Implements fixes and changes to keep small problems from becoming big problems. - Meets example: Monitors own work to identify both expected and unexpected risk. Takes actions to minimize risk and negative impact. Produces excellent results despite time restraints. - Exceeds example: Proactively and consistently identifies risks associated with EIS activities and drives or supports actions to ensure continuous operation of systems. Ensures that risk/safety discussions are given appropriate time and attention and that primary and back-up support is available to resolve issues that could have Severity One disruption. Manager Comments & Safety : RESOURCE MANAGEMENT Accurately scopes out the duration and difficulty of tasks and projects as well as the technical specifications; sets objectives and goals that include time and effort and financial considerations; optimizes the use of all resources (information/capital/items/people) to promote productivity and cost efficiency. - Meets example: Demonstrates ability to work within timelines, company structures and budgets for successful completion of tasks and projects. Understands and monitors critical path for projects; spends time on what s important and keeps initiatives/projects on track. - Exceeds example: Consistently assesses project scope, complexity, timeline and resource needs accurately and plans for contingencies. Anticipates shifts in resource demands; contributes ideas/plans to optimize, maximize or decrease resource requirements. Manager Comments & Resource Management : REASONING ABILITY Makes good decisions based upon a mixture of analysis, wisdom, experience and judgment; asks good questions and probes for answers; can see underlying or hidden problems and patterns; demonstrates flexibility in examining new approaches; effectively prioritizes activities based on unit demands; identifies opportunities proactively to solve problems. - Meets example: Gathers and organizes information to solve problems, analyze/monitor work process. Applies critical thinking skills and generates workable solutions or consults with secondary resources to devise effective solutions. - Exceeds example: Sets example for decision making and problem solving. Narrows or broadens focus, as needed. Consistently uncovers root causes and applies both creative and sensible problem solving. Manager Comments & Reasoning Ability : TECHNICAL COMPETENCE Possesses the functional/technical knowledge and skills to perform job tasks at a high level of accomplishment. Understands and appropriately applies existing, new or emerging technology. Is respected by EIS peers and customers as a knowledgeable, skilled technical resource. - Meets example: Stays current professionally - technical skillset matches capabilities required to deliver services and resolve problems; demonstrates ability to leverage experience and skills to support emerging needs. - Exceeds example: Perceived as the go to person by peers because of breadth or depth of knowledge, skills and experience. Discovers and champions new and innovative approaches, methods, products, services that will make a significant impact to the business. Manager Comments & Technical Competence : DEVELOPMENT/EDUCATION Assumes responsibility for own career growth and development. Seeks feedback on own performance and accepts it non-defensively. Looks for ways to grow professional skills to meet immediate demands and prepare for future challenges. Enjoys challenge of unfamiliar tasks and exhibits openness to change. - Meets example: Has sincere interest in growth and learning. Participates in relevant training programs; obtains and maintains certifications; follows through on development agreements and commitments. - Exceeds example: Takes an active role in advancing professional skills; routinely identifies/requests stretch assignments. Provides opportunities to strengthen team capabilities and advance knowledge of self and others. Manager Comments & Development/Education : EIS Staff Performance Appraisal Training Handout Page 3 of 6 September 2011
REGULATORY Complies with Cedars-Sinai policies and procedures; completes all required training/competency assessments on schedule; maintains confidentiality of patient care and business matters; meets organizational Standards of Conduct outlined in the CSHS Corporate Compliance Program; understands/follows/demonstrates CSHS policies (e.g., fire, safety, hazard communication, disaster, physical/information security, medical equipment, audits, and Significant Adverse Events. ) - Meets example: Demonstrates understanding of the regulatory requirements associated with role, applicable professional/technical standards and CSHS employment. Gives compliance appropriate priority in relation to other work and completes training and activities on time. - Exceeds example: Demonstrates extraordinary commitment to regulatory compliance and standards; Volunteers for projects to ensure compliance and/or drives efforts to enhance regulatory adherence. Manager Comments & Regulatory : TIME MANAGEMENT AND ATTENDANCE Maintains a consistently reliable work schedule and demonstrates solid personal time management skills and behaviors. Demonstrates a solid understanding of the 24/7 requirements of the job. Pitches in to address spikes in work volume or staffing shortages; provides quality work during these times. Meets CSHS attendance standards. - Meets example: Employs solid time management practices and allocates own time efficiently; handles multiple demands and competing priorities; adjusts plans to respond to changing business priorities. - Exceeds example: Provides leadership in accommodating the 24/7 nature of the business. Willingly adapts to multiple demands, shifting priorities, rapid change & ambiguity. Leads or participates in more than fair share of off-hours efforts and maintains a positive attitude. Manager Comments & Time Management and Attendance : Section III Summary - Manager Comments & : SELECT RATING Section IV Goals for THIS Performance Appraisal Period Write up to 4 goals that reflect the special projects, stretch assignments or operational goals that you worked on during this performance appraisal period. If these goals were previously documented, the ratings from this section will impact your Overall Performance ; If NOT, the ratings will be for discussion purposes and written goals will be expected next performance appraisal period. Goal #1 (description) Goal #2 Goal #3 Goal #4 Additional Goals (optional): Section IV Summary - Manager Comments & : Please check the relevant box below and add comments: Goals were previously documented [actual rating] Goals were NOT previously documented [rating is for discussion purposes] SELECT RATING EIS Staff Performance Appraisal Training Handout Page 4 of 6 September 2011
Section V Goals for NEXT Performance Appraisal Period Note: This section focuses on special projects, operational goals &/or stretch assignments that contribute to position/department/organizational effectiveness. Employee: Write Goals and suggest % weights. Manager: Confirm/edit Goals and ADD Meets & Exceeds Target criteria and goal % weights, if applicable Goal #1 (description) Meets Target (criteria) Exceeds Target (criteria) %Weight Goal #2 Meets Target Exceeds Target %Weight Goal #3 Meets Target Exceeds Target %Weight Goal #4 Meets Target Exceeds Target %Weight Key Strengths in Current Role - List up to 3 1. 2. 3. Section VI Strengths, Opportunities and Career Interests Opportunities for Development in Current Role (within the next appraisal period, 12 months) - Use SMART goals, if applicable. 1. 2. 3. Career Interests (beyond the next appraisal period, 2-5 years) Years in current role Career development interests Section VII - Overall Performance Appraisal Summary Manager Comments and Overall Performance Summary : Section VIII Acknowledgement Signatures I have reviewed this document, discussed the contents with my manager and had the opportunity to make written comments. My signature indicates that I have been advised of my performance status and does not necessarily imply that I agree with this appraisal. Employee Name: Employee Signature: Date: Manager/Appraiser Name: Manager/Appraiser Signature: Date: 2 nd Level Manager Name: 2 nd Level Manager Signature: Date: Employee Final Comments (optional): EIS Staff Performance Appraisal Training Handout Page 5 of 6 September 2011
EIS Staff Performance Appraisal Training Handout Page 6 of 6 September 2011