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Sample Employee Surveys - Excel

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Sample Employee Surveys - Excel Powered By Docstoc
					                                                               Mission: UAMS Medical Center     CARE Values
                                                               provides patient centered,cost   Compassion
                                                               effective CARE through a         Positive Attitude
                                                               healthcare system committed to   Respect
                                                               education and research.          Excellence
UAMS MEDICAL CENTER Clinical Programs
Job Title: Staff Education Educator                            Job Description      Performance Appraisal
Reports to:Clinical Services Manager Staff Education           EMPLOYEE NAME________________________________
                                                                                    (Please Print)
Job Title: Staff Education Educator
Performance areas                                                                               Overview
I. GUEST RELATIONS                                             25%                              The Staff Educator is
II. SAFETY AND EMERGENCY PREPAREDNESS                          10%                              responsible for assessing,
III. INSTITUTIONAL/PROFESSIONAL STANDARDS                      5%                               planning, implementing, and
IV. PROCESS IMPROVEMENT                                        5%                               evaluating educational and
V. PERFORM ROLE OF EDUCATOR                                    50%                              staff development activities that
VI. PROFESSIONAL GROWTH                                        5%                               support staff in providing
Qualifications                                                                                  outstanding patient centered
*Licensed by State of Arkansas as appropriate                                                   care.
                                                                                                Annual Training/Competency
                                                                                                Age Specific Competency
*Baccalaureate degree required
                                                                                                Corporate
*Masters Degree preferred                                                                       Compliance                HIPAA
*Five Years clinical experience preferrably in an academic
medical center                                                                                  Annual Requirements Module

*Experience in staff development or training preferred                                          Job Specific Competencies:
Ages Served:Neonates <30 days ____ Infant >30days<1yr.____                                      1. Peer Review
Pediatrics > 1yr < 13 y/o.____ Adolescent <13y/o -<18y/o____                                    2.
Adult > 18y/o < 65y/o____Older Adult > 65 y/o _____                                             3.
                                                                                                4.
                                                                                                5.
 I HAVE READ AND UNDERSTAND THE DESCRIPTION OF MY POSITION WITH UAMS MEDICAL CENTER

EMPLOYEE'S SIGNATURE                                                                                                      DATE
UAMS MEDICAL CENTER                                                                      CLINICAL PROGRAMS
Job Title Staff Education Educator                                                       PERFORMANCE APPRAISAL


EMPLOYEE'S NAME                                                   TITLE

EMPLOYEE'S
DEPARTMENT                                                        SAP#

EVALUATOR'S
NAME                                                              TITLE                               SAP#


DATE EMPLOYEE                                                                              SCHEDULED
BEGAN PRESENT                                         DATE OF LAST                         APPRAISAL
POSITION                                               APPRAISAL                              DATE



INSTRUCTIONS: A performance appraisal will be completed annual for each employee. Each indicator on the job description will
receive a score of 1 - 5 based on the assessment of the performance.criteria. Each score may be determined by percentage, quantity
or quality, individually or in combination. A score of three (3) is consdered to be an average score. When an employee complies with
the performance criteria, a score of 3 should be given. Any score of 1 or 5 requires a comment by the evaluator.




            SCORES:         -1-            -2-              -3-               -4-               -5-

          QUANTITY:        RarelyOccasionally            Routinely        Consistently         Always
                                    Needs                  Meets            Exceeds
           QUALITY: Unacceptable Improvement            Expectations      Expectations      Outstanding
UAMS MEDICAL CENTER                                                                CLINICAL PROGRAMS
Staff Education Educator                                                           PERFORMANCE APPRAISAL
                                                                                   Key: PT =Posttest V=Verbal PR =Peer Review D= Demonstration CEU =
                                                                                   Continuing Education

I. GUEST RELATIONS
                                                                                                     PostTest    Verbal    Peer Review   Demo      CEU
                                                                            SELF     Evaluator         PT          V           PR          D      CEU
Adheres to UAMS Guest Care Guidelines
http://www.uams.edu/uh/policy/human resources/hr103.htm
Uses appropriate communication (written & verbal)
Availability/Responsiveness
Respectful of others
Takes proactive approach toward customers.
                                                          GUEST RELATIONS    0            0
                                                                  SCORE
Comments:

II. SAFETY AND EMERGENCY PREPAREDNESS
                                                                                                     PostTest    Verbal    Peer Review   Demo      CEU
                                                                            SELF     Evaluator         PT          V           PR          D      CEU
Adheres to UAMS patient safety plan
http://www.uams.edu/uh/policy/administration/a406.htm
Complies with safety instructions
Observes safe work practices
Provides input on safety issues
Promotes a safe work environment
                                                            SAFETY SCORE     0            0
Comments:




      Administrative
UAMS MEDICAL CENTER
Job Title                                                                                 PERFORMANCE APPRAISAL
0
III. INSTITUTIONAL/PROFESSIONAL STANDARDS
                                                                                                       PostTest   Verbal   Peer Review   Demo     CEU
                                                                                   SELF    Evaluator     PT         V         PR          D       CEU
Adheres to UAMS Code of Conduct
http://www.uams.edu/adminguide/win04401.html
Adheres to Clinical Programs and Department policies
http://www.uams.edu/uh/policy/pp-toc.htm

Adheres to Clinical Program and Departmental dress code standards

http://www.uams.edu/uh/policy/human resources/hr204.htm
Works effectively with team/work groups and others to fulfill UAMS Mission
Adopts practices to improve work processes,enhance guest
satisfaction and reduce wastes and costs.
Protects confidential information

                                                              STANDARDS SCORE       0         0                       5
                                                                                                       Max Possible score           0         0
Comments:

IV. PROCESS IMPROVEMENT
                                                                                                       PostTest   Verbal   Peer Review   Demo     CEU
                                                                                   SELF    Evaluator     PT         V         PR          D       CEU

Participates in ongoing hospital performance assessment and process improvement.

http://www.uams.edu/UH/policy/administration/a601.htm

Ensures continuing department performance assessment and process improvement.
Creates work processes to enhance customer satisfaction and reduce waste.
                                             PROCESS IMPROVEMENT SCORE              0         0
Comments:




      Administrative
UAMS MEDICAL CENTER
Job Title                                                                                                     PERFORMANCE APPRAISAL
0
V. PERFORMS ROLE OF STAFF EDUCATION EDUCATOR
                                                                                                                           PostTest   Verbal   Peer Review   Demo   CEU
                                                                                                       SELF    Evaluator     PT         V         PR          D     CEU


Provides documentation of demonstration of UAMS Leadership Competencies.
Acts as a resource to staff regarding safety practice.
Acts as a resource to staff regarding their role in an emergency situation.                     -
Supports BLS as a BLS Instructor
Utilizes flexibility in scheduling hours worked to meet Clinical Programs employee
learning needs.
Participates as a representative or resource on councils, ad hoc groups, or task
forces.
Assists staff in utilizing governance system and approved standards.
Serves as a resource for staff in accessing, interpreting, and utilizing policies and
procedures.
Maintains competencies required to operate specialized equipment.
Serves as a resource for staff for equipment usage.
Collaborates with managers and staff to assess learning needs:
-Developes and/or utilizes a mechanism for ongoing needs assessment for designated
areas/programs         -Meets with staff and management as necessary to validate needs and
assessment of future needs.              -Prioritizes needs based on organizational and departmental
goals.                                                              Comments:


Plans educational activities to meet identified learning needs:
- Plans learning activities based on learning needs.
- Collaborates with selected members of target audience and/or managers in planning program
content.    -Conducts program planning.
Comments:


Implements educational activites to meet identified learning needs:                             -
Utilizes adult education learning principles in conducting programs.
- Uses resources, both material and personnel, to meet learning needs of staff.
- Maintains records of educational offerings as directed by Staff Education.

Evaluates effectiveness of educational activities:
-Develops and/or uses a 5 point evaluation tool for each educational activity .
-Provides feedback regarding program evaluation to individuals (managers, program planning
       Administrative
committees, learners, etc.).
Promotes collaborative relationships among health care professionals:                           -
Assists in the identification of resource personnel.                                 - Promotes
collaboration among health care professionals and/or with Clinical Programs staff.
-Works in conjunction with clinical experts in assessing and meeting needs of staff.
-Serves as a consultant to Clinical Programs staff in areas of expertise and on educational issues
Comments:


Uses constructive feedback to improve practice:                                                      -
Developes written goals and plan of action to enhance practice and submits with annual self
evaluation        -Participates in annual peer review activity.
Comments:


Participates in the research process:
-Completes surveys and data collection forms for research/evaluation projects.
-Facilitates data collection for research/evaluation projects by:
-Educating staff on proper documentation of data and completion of forms
-Serving as a resource for questions on research/evaluation projects.
- Providing ongoing monitoring to assure data is collected and providing follow-up action.
-Notifying project coordinator of questions/variances.
- Incorporates current literature/research findings into educational programs
Comments:

Demonstrates commitment to professional growth as evidenced by membership in
relevant professional organization.
                                                         ROLE PERFORMANCE SCORE                          0   0                 5
                                                                                                                 Max. Score Possible   0   0

Comments:




      Administrative
UAMS MEDICAL CENTER
Job Title                                                                           PERFORMANCE APPRAISAL
0
VI.            PROFESSIONAL GROWTH
                                                                                                 PostTest   Verbal   Peer Review   Demo   CEU
Criteria attached                                                            SELF    Evaluator     PT         V         PR          D     CEU
Participates in continuing education 40 contact hours
Participates in professional/institutional advancement
Comments:
                                                 PROFESSIONAL GROWTH SCORE    0         0
Comments:




Employee Comments:




Evaluator Comments:




     Administrative
Administrative
UAMS MEDICAL CENTER                                                                     CLINICAL PROGRAMS
Staff Education Educator                                                                       PERFORMANCE APPRAISAL


                                                                                      SECTION
                                                                          SECTION      TOTAL
                                                             SECTION        MAX      FROM EACH       VALUE        SECTION
Rate Employee's Overall Performance                           VALUE       POSSIBLE    SECTION        WEIGHT        SCORE
  I. GUEST RELATIONS (25%)                                         125            25          0               5                0
     SAFETY AND EMERGENCY PREPAREDNESS
 II.                                                                50             25            0            2                0
     (10%)
     INSTITUTIONAL/PROFESSIONAL STANDARDS
III.                                                                25             30            0 0.8333333                   0
     (5%)
IV. PROCESS IMPROVEMENT (5%)                                        25             15           0 1.6666667                    0
 V. PERFORMS ROLE OF DIRECTOR (50%)                                250             85           0 2.9411765                    0
VI. PROFESSIONAL GROWTH (5%)                                        25             10           0        2.5                   0
                                                                                             OVERALL SCORE                     0

                                                                                             RECOMMENDED
                                                                                             MERIT INCREASE

    Classified Conversion: 500-423=3 Exceeds Expectations;
    425-300 = 2 Satisfactory; 299-100 = 1 Unsatisfactory


COMMENTS:




                     EMPLOYEE’S SIGNATURE / DATE                         EVALUATOR’S SIGNATURE / DATE

                                                                                                              Administrative
    I acknowledge that this performance appraisal was discussed with me.
    Signature does not necessarily mean agreement.

				
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Description: Sample Employee Surveys document sample