Self-Evaluation - Michigan Medicine



UNIVERSITY OF MICHIGAN HEALTH SYSTEMPerformance Evaluation Process-Self-evaluation with Peer InputThe process of annual evaluation is a professional and contractual obligation. All parties are accountable for following this process and ensuring timely review. The evaluation process is supportive of professional growth and development of all parties to ensure quality patient care and optimal outcomes.5540375220345Target Audience: Nursing at Michigan | Author/Contact: Mark Kempton | Last reviewed: August 201700Target Audience: Nursing at Michigan | Author/Contact: Mark Kempton | Last reviewed: August 2017Upon receiving notification of the annual evaluation, the employee has three weeks to complete the self-evaluation (including peer feedback) process. The self-evaluation is to be submitted electronically to the manager/designee after including a summary of the peer feedback received. If materials are not submitted within two weeks of the due date, the manager may proceed with completing the evaluation process. Peer Review ProcessThe nurse will select and request a minimum of 3 peers to perform peer review.Those selected must be educated in the peer review process. At least one peer must be an RN. Each nurse will be asked to evaluate the person on 2-3 selected domains, so that all Role Specific domains are reviewed by peers.The RN will send the peers the feedback tool electronically, identifying the specific domain(s) for completion.The Clinical Thinking and Judgement domain must be completed by an RN.The peers selected will use the current Peer Input tool for the RN requesting their feedback. They will complete the feedback tool:Peers should indicate the appropriate behavioral level. Peer reviewers would be encouraged to support their views with concrete examples on the right hand side of the page.Peers should return the completed feedback electronically to the nurse being evaluated and to the manager/designee within 7 days Self-Evaluation ProcessThe nurse will complete the level (A, C, D, E, RSAM) appropriate self-evaluation and submit electronically to the manager or designee. The nurse will consider the input provided by the peer evaluation(s) when completing their self-evaluation and will summarize the peer feedback on the performance review form in the Required Feedback Section. Supportive responses for behaviors will be included in the summary section(s). Manager ProcessThe manager will review the peer review form, peer summary and self-evaluation and then complete the manager section of the evaluation form within the anniversary month of the nurse.The manager will utilize peer and self-evaluations as well as own knowledge of employee performance in determining ratings on the Performance Planning and Evaluation form.Supportive responses for behaviors will be included in the summary section(s) including rational for other than “meets expectations”. Arrange an appointment to meet with the nurse.Sending the completed evaluation to the nurse electronically for review prior to the meeting will allow conversation to be focused on goals. Note: Any area of the evaluation the employee or manager would like to discuss more in-depth will also occur during the meeting.The Peer Review forms will be returned to the nurse as well as kept with the completed evaluation paperwork following the performance evaluation process and a copy of the completed Performance Plan/Evaluation will be given to the nurse.RN Case Manager CompetentScale: N = Behavioral Expectations Not Met or N/A A = Approaching Behavioral Expectations M = Meets Behavioral Expectations E = Exceeds Behavioral ExpectationsSelf-EvaluationManager’s EvaluationUMHHC Performance Expectations For All Employees (Click for Framework Domain Behavior Descriptions)Customer Focus: Relates work and job purpose to UMHHC mission and commitment to putting patients and families first. FORMTEXT ????? FORMTEXT ?????Teamwork: Interacts effectively and builds respectful relationships within and between units and among individuals. FORMTEXT ????? FORMTEXT ?????Communication: Communicates effectively in ways that enhance productivity and build respectful relationships. Demonstrates active listening, written, verbal, and information technology skills. Shares relevant information. FORMTEXT ????? FORMTEXT ?????Conflict Resolution: Seeks constructive approaches to resolving workplace issues. FORMTEXT ????? FORMTEXT ?????Integrity: Adheres to high standards of personal and professional conduct. FORMTEXT ????? FORMTEXT ?????Adapting to Change: Responds positively to change, showing willingness to learn new ways to accomplish work. FORMTEXT ????? FORMTEXT ?????Respect for Individuals: Fosters mutual respect and supports UMHS commitment to diversity. Promotes community building and diversity initiatives that help employees learn and respect each other’s’ differences. FORMTEXT ????? FORMTEXT ?????Safety: Contributes to a safe and secure environment for patients, visitors, faculty, and staff by following established procedures and protocols as appropriate by job function. FORMTEXT ????? FORMTEXT ?????Quality: Adopts practices to improve work processes, enhance customer satisfaction and ensure excellence in daily work. FORMTEXT ????? FORMTEXT ?????Efficiency: Accomplishes work in ways that maximize productivity and available resources while minimizing waste. FORMTEXT ????? FORMTEXT ?????Attendance. FORMTEXT ????? FORMTEXT ?????Summary of UMHHC Performance Behaviors (Includes supporting comments and areas requiring further development.Self:Manager:CLINICAL THINKING AND JUDGEMENT Ratings → FORMTEXT ????? FORMTEXT ?????Practice is guided by policies, procedures, and standards and is driven by theory and experience.Within department guidelines, assesses multi-dimensional factors (physiological, psychological, social, economic, and spiritual) of the patient/family for anticipated needs post point of service.Identifies and recognizes actual and potential needs for care transitions.Identifies and assures that the patient meets criteria for current patient classification.Identifies expected outcomes and interventions needed to meet identified discharge needs maintain standards of practice.Demonstrates basic recognition of barriers to effective and timely discharge.Develops, coordinates, and evaluates a safe and effective plan of care with resources available.Utilizes interprofessional rounds to facilitate discharge plan.SYSTEM THINKINGRatings → FORMTEXT ????? FORMTEXT ?????Has current knowledge of utilization management: Patient classification, level of care, length of stay, insurance, regulatory bodies, and CMS Guidelines.Recognizes and collects data related to avoidable days/delays.Learns patient/family story, goals, resources, and the meaning of illness/health care episode in the life of the patient.Collaboratively develops and implements transition plan with patient/family and interprofessional team.***Identifies, addresses, communicates, and documents actual and potential safety issues during and post transition of care, including patient referrals.***Knowledgeable about cost, payer sources, and system resources.Identifies patients who are at risk for readmission.***ADVOCACYRatings → FORMTEXT ????? FORMTEXT ?????Recognizes, respects, and supports, and supports patient/family rights and maintains confidentiality.Aware of UMHS patient rights and responsibilities.Knows, understands, and honors patient’s goals for discharge plan.Develops a plan for the day and plan for the stay that is based on patient goals.Assures that patient receives information on benefits and costs related to current stay and post-discharge care and services.***THERAPEUTIC RELATIONSHIPS/ENGAGEMENTRatings → FORMTEXT ????? FORMTEXT ?????Individualizes communication based on assessment of patients and families.Possesses clarity on one’s own values and how they affect interactions, relationships and boundary setting, incorporating that understanding into patient/family interactions. Demonstrates empathy in interactions with patients and families.Invites patients and families to actively participate in plan of care to foster growth, competence, and self-efficacy.***COLLABERATION/COMMUNICTION AND PROFESSIONAL RELATIONSHIPSRatings → FORMTEXT ????? FORMTEXT ?????Engaged, active team member and leader.Recognizes role of each member of the interprofessional team.Demonstrates empathy and compassion in interactions with team members.Approaches conflict situations in a constructive manner.FACILITATOR OF LEARNING AND PROFESSIONAL DEVELOPMENTRatings → FORMTEXT ????? FORMTEXT ?????Identifies patient/family level of understanding of their disease process, and care needs.Identifies patient and family ability and willingness to learn and considers preferred way to learn.Assures individualized educational plan is in place.Ensures that education regarding disease process and care needs has been provided by the appropriate members of the health care team.***Provides basic information regarding level of care, resources, insurance, and community resources.Identifies gaps in knowledge of team members that affects their ability to provide effective care to the patient/family.Maintains current knowledge of case management, utilization management, and discharge planning, as specified by federal, state, and private insurance companies.Identifies own learning needs and sets goals for knowledge/skill enhancement within the practice setting.Attends in-services, department continuing education, and staff meetings.Participates in department continuing education pletes all mandatory programs.RESPONSE TO DIVERSITYRatings → FORMTEXT ????? FORMTEXT ?????Aware of and values the diversity in patients and families, incorporating diversity considerations in patient care.Seeks to learn about and optimize the unique contribution inherent in the diversity and culture of each individual.Assures all communication is non-judgmental and sensitive to cultural differences within the environment.Aware of and values diversity in all members of the health care team. Recognizes own biases and demonstrates empathy as a member of the health care team.ADVANCING PRACTICERatings → FORMTEXT ????? FORMTEXT ?????Demonstrates an awareness of current literature in care management.Collects data to support quality initiatives and concerns.COORDINATIONRatings → FORMTEXT ????? FORMTEXT ?????Designated within domains with *** asterisksOverall Summary of UMHHC Performance Expectations and Individual Framework DomainsIdentify the individual areas of strengths and opportunities for improvement within the domains (Includes supporting comments and areas requiring further development) Self: Manager:Previous Year’s Learning and Self-Development Plan Assessment. Sources: M-Learning system transcript and other sources for specific courses and activities completed towards goal achievement and or professional growth and development. , List supporting comments and areas requiring further development below. Include last year’s evaluation petency / Mandatory Requirement Summary – See M-Learning link to obtain transcript. Required mandatories include: Fire/Safety, Corporate Compliance, Unit Critical Incident Plan, and Patient Safety. Refer to blue folder competency tab for competencies not included in M-Learning.Annual Plan; The Learning, Self-Development and Improvement Plan is used to set personal and professional goals which contribute to the staff member’s growth and development. Time frames should be stated with all staff development goals.1. Growth Area:Time FrameOutcome:Action:Evaluation:Comments:2. Growth Area:Outcome:Action:Evaluation:Comments:3. Growth Area:Outcome:Action:Evaluation:Comments:REQUIRED FEEDBACKUMHS Peer Feedback tool – all 5 domains (Clinical Skills and Knowledge domain must be completed by RN), a minimum of 3 – Refer to instructions Additional sources of peer/customer feedback may include:Patient satisfaction survey results360 Feedback resultsEmployee Recognition received e.g. Making a DifferenceWritten feedback (i.e. emails) regarding the individuals performanceEmployee’s Summary of Peer feedback received:Additional Feedback:Employee Comments: (Optional)Overall Evaluation Summary Statement-ManagerGuidelines for the overall performance ratings go to (form must be unlocked to use links) Overall Performance RatingNAMEScale: N = Behavioral Expectations Not Met or N/A A = Approaching Behavioral Expectations; M = Meets Behavioral Expectations; E = Exceeds Behavioral Expectations FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX If “N” or “A” used in the overall rating, check problem area(s) listed below. Identify any action plans for UMHHC performance expectations, job specific, or self development areas not listed above. FORMCHECKBOX Job Specific FORMCHECKBOX Customer Service FORMCHECKBOX Communication FORMCHECKBOX Effective team / group work FORMCHECKBOX Other: FORMTEXT ?????Action Plan: DateEmployee’s SignatureDateSupervisor/Manager NameSupervisor/Manager SignatureDepartment Code of Conduct Attestation located in M-Learning ................
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