OBJECTIVES• After 30 minutes of discussion, the NEA 606a class will be

able to:1. Discuss controlling and performance appraisal.2. Discuss the reasons and principles for evaluation.3. Enumerate and explain the basic components of the

control process.4. Identify methods of measuring performance.5. Differentiate quality assurance from quality

improvement.6. Discuss the different levels of disciplinary action.

• Also known as evaluation• It is an ongoing function of management

which occurs during planning, organizing, and directing activities.

1. Evaluation ensures that quality nursing care is provided.

2. It allows for the setting of sensible objectives and ensures compliance with them.

3. It provides standards for establishing comparisons.

4. It promotes visibility and a means for employees to monitor their own performance.

5. It highlights problems related to quality care and determines the areas that require priority attention.

6. It provides an indication of the costs of poor quality.

7. It justifies the use of resources.8. It provides feedback for improvement.

1. Evaluation must be based on the behavioral standards of performance which the position requires.

2. There should be enough time to observe employee’s behavior.

3. The employee should be given a copy of the job description, performance standards, & evaluation form before the scheduled evaluation conference.

4. The employee’s performance appraisal should include both satisfactory and unsatisfactory results with specific behavioural instances to exemplify these evaluative comments.

5. Areas needing improvement must be prioritized to help the worker upgrade his/her performance.

6. The evaluation conference should be scheduled and conducted at a convenient time for the rater and the employee under evaluation, in a pleasant surrounding and with ample time for discussion.7. The evaluation report and conference should be structured in such a way that it is perceived and accepted positively as a means of improving job performance.

• OBJECTIVITY – Free from bias

• RELIABILITY– Accuracy or precision of the tool

• VALIDITY– Relevance of the measurement to the

performance of the employee• SENSITIVITY

– Can measure fine lines of differences among the criteria being measured

a. Establishment of standards, objectives, and methods for measuring performance.

b. Measurement of actual performancec. Comparison of actual performance to

standardsd. Action to reinforce strengths or successese. Implementation of corrective action as

necessary.

• STRUCTURE Focus on structure or management system

• PROCESS Decisions and actions of the nurse

relative to the nursing process

• OUTCOME Results of the care provided

Structure Process Outcome

o The Agency Setting Vision Mission Philosophy Objectiveso Human Resources Staffing Qualificationso Material Resources Equipment Supplies Facilities

o The Nursing Processo Assessment of Client’s need, problemso Nursing Diagnosiso Prioritized Plan of Careo Nursing Interventions/ Implementation of Care Plan

o Positive change in patient’s conditiono Increased knowledge and understanding of his ailmento Satisfaction of patients with their careo Personnel satisfactiono Positive image of agency

• A control process in which employee’s performance is evaluated against standards.

• It is the most valuable tool in controlling human resources and productivity.

• It reflects how well the nursing personnel have performed during a specific period of time.

• Determine salary standards and merit increases;• Select qualified individuals for promotion or

transfer;• Identify unsatisfactory employees for demotion

or termination;• Make inventories of talents within the institution;• Determine training and developmental needs of

employees;• Improve the performance of work groups by

examining, improving, correcting interrelationships between members;

• Improve communication between supervisors and employees and reach an understanding on the objectives of the job;

• Establish standards of supervisory performance;• Discover the aspirations of employees and

reconcile these with the goals of the institution;• Provide “employee recognition” for

accomplishments; and• Inform employees “where they stand”.

• Halo effect– The result of allowing one trait to influence the

evaluation of other traits or of rating all traits on the basis of a general impression.

• Horns effect– The opposite of halo effect. The evaluator is

hypercritical.

• Contrast effect– tendency of the evaluator to rate the employee

opposite from the way the evaluator perceives oneself

• Central tendency effect– A narrow range of scores are produced.

• Proximity effect– The rating on a preceding characteristic influences

the rating on the following trait.

• INFORMAL– Consists of incidental observation or performance

while the worker is performing nursing care or by responses made by the worker during conferences.

• FORMAL– Accomplished regularly and methodically by

collecting objective facts that can demonstrate the difference between what is expected and what was done.

ESSAY

• The appraiser writes a paragraph or more about the worker’s strengths, weaknesses and potentials.

CHECKLISTS

• A compilation of all nursing performances expected of a worker. The appraiser’s task is to mark the appropriate column whether the worker does or does not show the desired behavior.

– Advantages: it can categorically assess presence or absence of behaviors, determine behaviour to be observed in advance and consistent use of criteria

– Disadvantage: behaviour observed may not be representative

• Simple checklist – Uses words or phrases to describe behaviours. They

may be categorized by concepts such as assertiveness skills.

• Forced checklist – requires the evaluator to select a desirable and

undesirable behaviour for each person. The behaviours may be given a quantitative value that results in a score that may be used for employment decisions.

• Weighted checklist – gives weighted scores for each behaviour.

RANKING– In simple ranking, the evaluator ranks the

employees according to how he or she fared with co-workers with respect to certain aspects of performance or qualifications.

– Disadvantage: it may lead to competition rather than cooperation and it doesn’t lend itself to large numbers.

Formula: N(N-1)/2 Where: N is the total number of employees

Example: 4(4-1)/2 = 4(3)/2 = 12/2 = 6 pairs

Nurses Possible Pairs

Anita Anderson AA with SJ SJ with PP

Sue Jones AA with PP SJ with SS

Pam Peterson AA with SS PP with SS

Sara Smith

AA SJ SJ PP

AA PP SJ SS

SS PPSSAA

VS.

VS.

VS.

VS.VS.

VS.

RATING SCALES

• A rating scale includes a series of items representing the different tasks or activities in the nurse’s job description or the absence or presence of desired behaviours and the extent to which these are possessed.

• Numerical rating scale – Includes numbers against which a list of behaviours

are evaluated.

Observation of working hours 1 2 3 4 5 Ability to get along with others 1 2 3 4 5

Rate the staff member on the items belowResponses have the following values:1 = never2 = Sometimes3 = About half the time4 = Usually5 = Always

Observation of working hours 1 2 3 4 5 Ability to get along with others 1 2 3 4 5

NURSE

OBSERVATION OF WORKING HOURS

Lowest (1)

Below Average

(2)

Average (3)

Above Average

(4)

Highest (5)

Betty Green x

Sara Smith x

Pam Peterson x

Sue Jones x

Anita Anderson x

Graphic rating scale Words rather than numbers are used. Usually,

list extremely broad and general personal characteristics that are to be rated from poor to excellent or from low to high.

Descriptive rating scale Similar to the graphic rating scale except it

presents a more elaborate description of the behaviour being rated.

• Behaviourally Anchored Rating Scales (BARS)–BARS evaluate behaviour relevant to the specific

demands of the job and provide examples of specific job behaviours corresponding to good, average and poor performances.

–Time consuming, expensive to use, you need a separate BARS for each job and it is applicable to physically observable behaviors rather than conceptual skills.

Administers oral medication properly

• Check each medication order against original physician’s order. Always Sometimes Never

• Identify the patient carefully. Always Sometimes Never

• Assist patient to an upright or lateral position.Always Sometimes Never

• Behavioral Observation Scales–The evaluator lists a number of critical events for

each performance dimension and rates the extent to which the behaviour has been observed on a five-point scale ranging from almost never to almost always.

–Time consuming and expensive to develop.

• Circle the number that most closely approximates your assessment of the staff member on the following qualities:

PunctualAlmost never 12345 Almost always

Gets along well with co-workersAlmost never 12345 Almost always

• Percentage rating scale - Provides a quantitative choice. The employee may rank the employee’s behaviour on any given criterion as among the bottom 10% of a specific category of personnel, next 20%, middle 40%, or top 10% of that category of personnel.

OBSERVATION OF WORKING

HOURS

10% Bottom 20% 40% 20% 10%

Top

PEER REVIEW

• Process whereby a group of practicing registered nurses evaluates the quality of another registered nurse’s professional performance.

• It provides a feedback for sharing ideas, comparing the consistency of the staff member’s performance with standards, recognizing outstanding performance, and identifying areas in which further development is required.

ANECDOTAL RECORDS

– Describes the nurse’s experience with a group or a person, or in validating technical skills and interpersonal relationships.

–Advantages: it is an objective description of behaviour, no rigid structure and systematic means of recording observations

–Disadvantages: it doesn’t guarantee relevant observations

• It is a process of evaluation that is applied to the health care system and the provision of health care services by health workers.

• Ongoing, systematic process designed to evaluate and promote excellence in health care given to groups of clients.

• It is a problem solving process that systematically assesses the quality of care and corrects any observable defects.

• Continuous, ongoing measurement and evaluation process that includes structure, process, and outcome.

• A systematic process to improve outcomes based on customers’ needs.

• A proactive approach that emphasizes “doing the right thing” for the customer.

Quality Assurance Quality Improvement

- Doing it right Doing the right thing

- Assess or measure performance Meet the customer’s needs

- Determine whether performance meets standards

Build quality performance into the work process

Improves performance when it does not meet standards

Improve performance continuously as an ongoing management strategy, not just when standards are not met (Mclaughlin & Houston, 2003)

• A way to ensure customer satisfaction by involving all employees in the improvement of every product or service.

• All systems are evaluated and improved. • It aims to reduce waste and cost of poor

quality. • It is a structured system for involving an

entire organization in a continuous quality improvement process targeted to meet and exceed customer expectations.

• A process of continuously improving a system by gathering data or performance and using multi-disciplinary team to analyze the system, collect measurements, and propose changes.

• 4 main principles:Customer focusThe identification of key processes to improve qualityThe use of quality toolsThe involvement of all people in problem solving

It begins with 3 questions:a.What are we trying to accomplish?b.How will we know that a change is an improvement?c. What changes can we make that will result in improvement?

PLAN ACTDO CHECK

a.Focus on an improvement ideab.Organize a team that knows the processc. Clarify what is happening in the current processd.Understand the degree of change needede.Solve the problem

• Measuring and comparing the results of key work processes with those of “best performers” in a field or industry.

• Is a collaborative and ongoing measurement process.

• Will identify gaps in performance and provide options for improvement.

• Focuses on key services or processes.

An unexpected occurrence causing death or serious physical or psychological injury to a patient.

• All health professionals should collaborate in the effort to measure and improve care.

• Coordination is essential in planning a comprehensive quality assurance program.

• Resource expenditure for quality assurance activities is appropriate.

• There should be focus on critical factors such as function and activities that yield the greatest health and financial benefit to reveal significant findings.

• Quality patient care is accurately evaluated through adequate documentation.

• The ability to achieve nursing objectives depends upon the optimal functioning of the entire nursing process and its effective monitoring.

• Feedback to practitioners is essential to improve practice.

• Peer pressure provides the impetus to effect prescribed changes based on the results of assessment and needed improvements on the quality of care.

• Reorganization in the formal organizational structure may be required if assessment reveals the need for a different pattern of health care.

• Collection and analysis of data should be utilized to motivate remedial action.

• Performance evaluation focuses on the worker.

• Quality Assurance focuses on the care and service the patient receives.

• Patient Care Audits– Concurrent– Retrospective

• Peer Review• Quality Circles

• Periodic review of materials and supplies in the various nursing units.

• Consumption of supplies should be proportionate to the number of patients served.

• Requisitions of and /or stocking a large number of supplies and materials should be avoided to prevent pilferage, misuse or spoilage.

• A high turnover inventory is desired. A low turnover is a result of poor purchasing policies, overstocking or a decreased demand for the item.

• An equipment utilization report should be made including the frequency of breakdown.

• Preventive maintenance requires the regular inspection of equipment to prevent breakdown and/or detect needed repairs.

• End-users of supplies, materials and equipment should be given opportunity to evaluate their quality.

• Absences due to leaves, whether scheduled or not should be analyzed as these may be implications for staffing.

• Constructive and effective means by which employees take personal responsibility for their own behavior and performance (self-discipline).

• A strong commitment to the vision, philosophy, goals and objectives of the institution.

• Laws that govern the practice of all professionals and their respective Codes of Conduct.

• Understanding the rules and regulations of the agency.

• An atmosphere of mutual trust and confidence.• Pressure from peers and organization.

• Counseling & Oral Warning• Written Warning• Suspension• Dismissal