Staff make the grade on 'report cards'
Staff make the grade on report cards’
Performance reports encourage staff to excel
It’s happened to almost everyone: After a year of work, your manager calls you in for an annual performance review. You are presented with a piece of paper with vague headings, such as "attitude." Each of these has a scale of one to five, and your boss has circled a number for each heading.
"That kind of performance evaluation tells you nothing," says Beth Henn, MS, RN, director of quality management at SNI Companies, a health management company in Flourtown, PA, which provides hospital staffing and home health services out of three offices in Pennsylvania. "It is very subjective, and doesn’t tell you what your staff is doing or if they are doing it well."
In 1993, Henn piloted a report card system to be used for both clinical and nonclinical staff that she hoped would give managers and employees a better sense of strengths and weaknesses, give employees an impetus to improve their performance, and cut orientation time for staff. It met all her expectations and more.
Start from the start
One key element of the report card system, says Henn, is to know an employee’s capabilities from the very start of employment. She begins before the first day of work, giving new hires multiple-choice tests in a variety of subjects that are usually covered during orientation. Initially, a 75 was needed to pass each test. The passing score has since been raised to 85.
Orientation was changed to a modular format corresponding to the various tests, which cover medical topics such as wound care or patient safety. If a new employee passes a test in a certain module, and if there is corresponding work experience in that area, then that person can opt out of that orientation module, says Henn.
An employee who scores well in all the modules could have a two-day orientation, rather than one lasting five days. Such an orientation will focus on corporate information and how SNI prefers paperwork to be completed. "We just can’t have people in an orientation for six weeks," says Henn. "This gets them out into the field faster."
Once in the field, the new employee is put under the auspices of a preceptor for six weeks. That person monitors the new hire’s work. At three weeks, a baseline competency test is done on a visit. "That gives us our first report card," she says. At six weeks, the test is repeated.
The preceptor and manager sit down to discuss the employee’s performance. Then, the person is either allowed to work on his or her own, is kept under the auspices of a preceptor, or terminated.
Taking a test vs. applying the knowledge
If a weak area is spotted in one of the modules the employee was exempted from upon employment, the employee is required to take that orientation module, says Henn. "Some people test well and aren’t as good at applying knowledge," she explains. "Others don’t test well but are great at the application."
After a year of employment, the employee is taken through a thorough review process that includes these four items:
1. Standardized tests.
SNI tests employees in four key functions that are determined by chart reviews, as well as items the Joint Commission on Accreditation of Health Care Organizations is focusing on during the current round of surveys. For example, if a chart audit shows a problem with falls, then patient safety might be one of the four tests. Each module has 25 questions.
2. Field assessments.
Senior nurses score employees on their visits. Those nurses all go on joint observation visits where they each score a single caregiver. Their scores are compared to ensure there is a level of objectivity in the scoring.
3. Chart audit.
"Most requirements say you have to do chart audits on 10% of the patient population per quarter," Henn says. "We felt this was not enough to determine how every staff member was doing." Instead, SNI does audits on all the patients that are visited during the field assessment, ensuring every caregiver is audited. The employee is scored on both clinical and clerical aspects of the chart.
4. Credentials.
Staff credentials and any continuing education requirements are checked.
"This is a multidisciplinary scoring process that gives us a good view of the person’s performance in an objective fashion," Henn says.
The evaluation doesn’t just provide information on performance, but also a plan of action to correct low scores. Any area in which an employee scores 75 or below also requires a return to preceptor status. Failure to improve can lead to termination. Last year, Henn says four people on the staff of 500 were terminated.
The report cards on individuals can be compared to other individuals throughout the company, or to individuals in a particular team, such as pediatrics. Teams can also be compared against other. Henn takes data on how staff performed in a particular module and checks for weaknesses. "If everyone scores low in the safety module, then we can see where people are having trouble," she says. "Maybe we need to change something in the questions, or maybe our educational program has to change."
Know where you stand
The staff members are only given raises if they score 95% in each of the tested areas. "They know our expectations, and every year they sign a document that says they understand this," she says.
The 95% rule is hard and fast. One manager came to Henn this year wanting to give a nurse a raise. She had scored the required 95 or above in all areas but one: the chart audit. Henn looked at the woman’s work and found she was not documenting the safety checklist on recertifications. "But this is what the Joint Commission will note," she says. "That is where they will zing you."
After discussing the situation, Henn says the manager felt better about not giving this nurse a raise.
The first year, there was a lot of complaining about the program, Henn recalls. "The second year, there was less complaint, and by the third year, there were people who realized that they weren’t going to get a raise without performance."
While acknowledging that some agencies have a hard time finding and keeping staff and might find such a program a detriment to recruiting efforts, Henn says SNI has no trouble finding and keeping staff. "And we don’t want to keep people who can’t meet these goals," she says.
The result has been a real effort among staff to improve their scores, she says, and even some competition between teams. "I think they like having us in the field paying attention to what they are doing. You can keep renegades under control, help the people who need it, and provide those who feel they are alone with an audience."
Average score increased 8 points
Scores are increasing, she says. In 1993, the pilot year, scores averaged 85. "We set that goal because initially, it seemed that not knowing 15% was acceptable," Henn explains. "And we were still in the process of getting material together." In 1994, the goal was increased to 90%, and the following year, it was again increased to 95%. That year, the staff averaged a score of about 93. "We just decided that this has to be the standard of practice. You have to know these things to pass the survey, and not knowing 5% is acceptable. Not knowing more than that is not."
The 95% goal for staff, she adds, is the same as the goal she has set for a Joint Commission survey next year.
Another benefit of the report cards is an ability to target remedial help to those who need it, she says. "Before, if there was a low score on a test, everyone was brought in for help in that area, rather than just the people who needed it. This keeps more people in the field making money."
[Editor’s note: SNI is selling its report card program. Henn says the program’s cost depends on how many disciplines you want to purchase the report card system for.
For that investment, a buyer gets a database, educational and testing materials, and a "train the trainer" session. As the program is updated, purchasers will also receive those updates.
The only computer equipment needed is a PC system that can run Microsoft Access.
More information is available by faxing Henn at (215) 836-9011.]
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.