AGENCY NAME

PERFORMANCE MANAGEMENT PROCESS

Associate Number:Dept. Number:

Job Title: Social WorkerJob Code:

Appraisal Period: Review Due Date:

Type of Appraisal:  AnnualOther

General Instructions

This assessment form must be completed and processed in accordance with the following instructions and Human Resources Policy to ensure that an accurate record of the evaluation is maintained; the Associate is informed of the quality of his/her performance; the Associate and Manager identify areas of strength and development needs and set goals for accomplishing defined tasks.

This tool consists of four sections: three with a quantitative value (Essential Job Functions, Compliance, and Goals/Business Plan Accountability) and a section for compliance with Hospital Standards.

This assessment is intended to be a performance management process that begins at the introductory period and requires Managers to continually evaluate Associate performance by observing and documenting behaviors and competencies and by coaching Associates, intermittently, to allow them to perform and actively participate in a dynamic workforce. When an Associate transfers to another department, the manager should complete this form and forward a copy to the new manager.

Annually, both Manager and Associate, should complete the attached form and arrange for a meeting to discuss the results of the appraisal. During the appraisal meeting, discuss both the Manager and Associate performance ratings and determine an agreed upon final performance rating. Ratings of Exceptional and/or Less than Acceptable need appropriate documentation justifying the rating and Senior Management (A.V.P, V.P. or Sr. V.P.’s) must approve all overall ratings of Exceptional. Goals and identification of major strengths and development needs should be developed during this meeting for the next review period. Sign and date the Assessment form at the conclusion of the meeting and return the original form to Human Resources for placement in the Associate’s file. Retain a copy for your file and give a copy to the Associate.

Rating Definitions

Exceptional (3): Associate who consistently exceeds expectations, exceeds the overall requirements of the essential job functions and achieves excellent results. Demonstrates exemplary behavioral competencies.

Competent (2): Associate who satisfactorily performs the essential job functions, consistently meets and occasionally exceeds expectations. Demonstrates satisfactory behavioral competencies.

Less Than Acceptable (1): Job Performance and/or learning progress is unacceptable; has failed to achieve the minimum results required. Behavioral competencies are inadequate.

Job Description/Performance Management Tool

Job Title: Social WorkerJob Code:

Department: Hospice/Home Care Support ServicesFLSA: Non-Exempt

Goal Level: B

General Summary:Ensures that all services are delivered in accordance with the Mission Statement and Values of AGENCY NAME. Provides professional, comprehensive, family-oriented services to individuals in the home setting. Assesses patients’ and families’ psychosocial, environmental, and financial needs. Formulates, implements, and evaluates a plan of care in collaboration with patient, family, and other caregivers, and provides case management as appropriate. Offers counseling services to provide information and support during all facets of the dying and grieving process to help the hospice patient/family cope with terminal illness.

Minimum Knowledge, Skills, & Abilities Required: Graduation from an accredited school of social work, with a Master’s Degree in Social Work, plus current licensure in the State as a licensed clinical social worker (LCSW). Requires minimum of three (3) years of clinical experience, one year in a community health setting preferred.

Working Conditions: Please refer to the Physical Requirements and Working Conditions form.

Reporting Relationship: Director of Social Work and Support Services

I. Essential Job Functions

Associate
Rating / Manager
Rating / Essential Job Functions / Performance Measure / Weight / Final
Rating / Weight
X
Final
Rating
SOCIAL WORK PROCESS
A. Assessment / 1. Assesses patient/family psychosocial needs; monitors and intervenes as appropriate to meet those identified needs. / 5
2. Documents assessment according to approved agency standards. / 4
3. Assesses patient’s environment and financial needs and makes appropriate referrals to identified community resources. / 5
4. Maintains strict confidentiality of all hospital, agency, or healthcare system matters, including patient, family, physician, Associate, and financial information. / 4
B. Planning / 1. Develops a plan of care in collaboration with physicians, team, patient, and family in order to meet identified needs. / 3
2. Establishes short- and long-term goals and completes according to established data. / 1
3. Actively participates in multi-disciplinary team conferences and documents outcomes as needed. / 2
4. Maintains documentation in patient’s record per internal, regulatory, and professional standards. / 2
5. Documentation is timely, accurate, concise, legible, and appropriate. / 1
6. Administers care within the agency’s established financial guidelines and explores alternate reimbursement sources necessitated by changing levels of care and reimbursement limitations. / 2
C. Evaluation / 1. Monitors, observes, and evaluates changes and progress in patient’s condition and environment and reports changes, progress, or lack of progress to physician and/or nurse case manager. / 3
2. Evaluates patient/family understanding of care and provides appropriate education as needed. / 3
3. Involves patient and family/significant other in plan of care. / 2
4. Revises strategies/interventions based on evaluation. / 2
D. Leadership / 1. Demonstrates team-building skills. Serves as a role model/resource for other team members. / 2

I. Essential Job Functions

Associate
Rating / Manager
Rating / Essential Job Functions / Performance Measure / Weight / Final
Rating / Weight
X
Final
Rating
3. Assumes responsibility and accountability for individual social work judgments and actions. / 2
4. Identifies strengths/weaknesses in clinical practice and make necessary adjustments. / 1
5. Assumes role of MSW per agency standard. / 1
6. Demonstrates the ability to function independently in the absence of a supervisor by solving routine problems. / 2
E. Communication / 1. Appropriately and effectively communicates with colleagues, physicians, patients, families, etc. / 3
2. Utilizes proper channels of communication to resolve departmental issues on an ongoing basis. / 2
3. Appropriately represents the Agency at meetings, both inside and outside the facility. / 1
F. Safety / 1. Maintains a neat, clean, and safe work environment according to departmental standards. / 1
2. Complies with safety and emergency procedures consistent with hospital regulatory agencies and Carroll Hospice/Home Care specific standards. / 2
G. Education / 1. Assumes responsibility for professional growth through keeping abreast of changing hospice/home care standards and changing trends in the social work profession. / 2
2. Assumes responsibility for continuing education and licensure requirements through participation in educational programs, current literature, inservice meetings, and workshops, etc. / 1
3. Attends and participates in staff meetings and inservices according to departmental standards. / 1
Totals / 60
II. SPIRIT Compliance / Rating Definitions
Associate Rating / Manager Rating / Exceptional
(3) / Competent
(2) / Less than Acceptable
(1) / Final Rating
Service / Demonstrates concern for exceeding internal and external customers’ expectations. Uses customer feedback and complaints to make changes that improve service. Consistently anticipates customer concerns and tells them what to expect. Is recognized by customers as consistently providing exceptional customer service. / Demonstrates concern for meeting internal and external customers’ expectations. Shows enthusiasm in providing services. Asks questions and accurately interprets customer’s needs or expectations of the service or work output. Responds to customers with an appropriate level of urgency. Keeps own emotions from interfering with responding effectively to customer’s needs. / Frequently ignores customers’ requests, questions and concerns. Creates a negative impression by using inappropriate body language, voice tone, talks in a condescending manner or inappropriately uses technical jargon. Discusses personal matters or confidential business in the presence of customers.
Performance / Promotes improvement; is one step ahead; consistently evaluates the total situation and thinks of creative new ways to improve the situation; selects most effective approach using all available resources. / Constantly works to deliver efficient, high quality services and make improvement in services, work processes and results to ensure excellence in performance. Offers constructive suggestions to improve own work; listens non-defensively and with an open mind to suggestions and complaints; recognizes situations that need special attention. / Consistently complains with infrequent or no problem solving effort; willfully blames other for poor service rather than taking responsibility for turning a negative situation into a positive one.
Innovation / Acts as the hospital cheerleader, seeking ideas and suggestions for improvement. Wins over others effectively as supporters of new ideas or changes. Displays a high level of curiosity and translates it into new approaches to solutions. Gets involved with other departments and Associates to brainstorm and problem-solve. / Demonstrates the ability to generate creative and valuable ideas and to use the ideas to develop new or improved processes, methods, systems, products or services hospital-wide as well as in one’s own department. Tries new methods for completing required tasks, challenging the status quo. Takes action to call attention to a problem or heighten the awareness of a need to change. / Is resistant to change: actively tries to convince others to resist change or passively does nothing to implement change. Habits and approaches are stale; has a narrow perspective - Does not see the Big Picture. Identifies problems but does not identify resolutions
Respect / Consistently demonstrates creativity and respect when interacting with others and shows concern and openness for others’ ideas and feelings even in difficult and complex situations. Looks at issues and opportunities from other’s viewpoint before making decisions. / Creates an atmosphere of valuing, accepting and honoring the dignity of others. Interacts with others in a respectful manner. Listens and responds with concern and openness for others’ ideas and feelings. Acts to protect and does not violate or compromise the privacy or confidentiality of information or patient issues. / Frequently demonstrates mistrust of others’ ideas and feelings; is antagonistic toward others (chip on shoulder)
Integrity / Recognizes when situations are directly or indirectly in conflict with professional ethics or with the hospital’s stated values and takes appropriate action; does not hide or overlook it. / Acts in an ethical and honest manner based on personal accountability and a conviction to do the right thing. Demonstrates concern about own creditability; builds trust by taking commitments seriously and follows through to meet them. / Fails to recognize unethical situations - overlooks or hides from situations. Does not follow through on commitments
Teamwork / Consistently demonstrates high degree of mutual trust and confidence within the team; utilizes collaborative ways which promote a win/win situation; consistently contributes to and participates in team decisions; anticipates team needs and promotes creativity (new ideas) and flexibility within the team. Identifies and pushes for solutions in which all parties can benefit. / Willingly cooperates and works collaboratively toward solutions which generally benefit all involved parties; works cooperatively to accomplish hospital objectives. Seeks the input of group members and encourages participation. Functions with mutual trust and confidence. Participates collaboratively and supports team decisions. Reacts positively to creativity (new ideas). Recognizes and responds to need for help from other team members. / Undermines trust and confidence among team members; Demonstrates opposition to collaboration with the team. Fails to participate in team decisions. Exhibits inflexibility in response to team needs. Reacts negatively to creativity (new ideas).
Total of SPIRIT Scores
Divided by 6 =
Average SPIRIT Score
Multiply by Weight of 25 / x 25
Weighted Score
(Transfer to Section II of the
Summary Page)

III. Goals/Business Plan Accountability Narrative

(Current Year)

FROM: TO .

Associate
Rating / Manager
Rating / Goals (Hospital, Departmental, Individual) / Actual Results / Final
Rating
Idea to improve Hospital or healthcare system services:
Total of Goals
divided by number of goals =
Average Score
Multiply by Weight of ?? / x
Weighted Score
(Transfer to Section III of the Summary Page)

Minimum of 3 Goals

Maximum of 6 Goals

Goals/Business Plan Accountability for Upcoming Year

FROM: TO .

Goals (Hospital, Departmental, Individual)
Idea to improve Hospital or healthcare system services:
Summary of Major Strengths and Development Needs
Major Strengths
(Justification for Exceptional Ratings) / Development Needs
(Justification for Less than Acceptable Ratings)

Summary of Sections I, II & III

Section / Total
Weight / Total
Weighted Rating
I. / Essential Job Functions / 60
II. / S.P.I.R.I.T. Compliance / 25
III. / Goals/Business Plan Accountability / . / 15
Totals / 100

Compared to the standards that have been established for this job, this Associate’s overall performance competency is rated as:

Overall Score =

Exceptional / Competent / Less than Acceptable
300-270 / 269-245 / 244-215 / 214-195 / 194-0
IV. Hospital Standards
Complies with Environment of Care competency assessments: / Date of Completion / Complies with Departmental competency assessments: / Date of Completion
Internal Disaster
External Disaster
Snow Emergency
Infection Control
Safety
Fire
Bio-Hazardous Precautions
C.P.R. (If applicable)
  • Increases will not be processed unless the above environment of care or departmental standards have been met. Once the E.O.C. or departmental standards have been met, increases will be processed effective the date of completion.

Evaluator’s Signature: Date:

COMMENTS:

Associate’s Signature:Date:

COMMENTS:

Senior Management Initials:

(Required for Overall Score of Exceptional Only)

Salary Action:

$ / % / $ / $
Current Base Rate / Merit Increase % / Merit Increase Amount / (Current Base Rate + Merit Increase Amount) =
New Base Rate

This document is intended to describe the general content of and requirements for the performance of this job. It is not construed as an exhaustive statement of duties, responsibilities or requirements.

Developed:Reviewed By:

Revised:Human Resources Staff Member

V. COACHING LOG:

______

Meeting Date Manager’s Signature Associate’s Signature

Comments:

______

Meeting Date Manager’s Signature Associate’s Signature

Comments:

______

Meeting Date Manager’s Signature Associate’s Signature

Comments: