Rolling Out a Performance Management System

Chapter 7
Rolling Out the Performance Management System
7-1
Copyright © 2019 Chicago Business Press

Overview
Preparation
Communication Plan
Appeals Process
Rater Training Programs
Pilot Testing
Ongoing Monitoring and Evaluation
7-2

Preparation
Rolling out refers not only to launching a new system from
scratch, but also, to revising and improving an existing one
7-3

Communication Plan Components
7-4

Communication Plan
Answers the Questions:
What is Performance Management (PM)?
How does PM fit into our strategy?
What’s in it for me?
How does it work?
What are my responsibilities?
How does PM relate to other initiatives?
7-5

Communications Effectiveness
Selective Exposure
Selective Perception
Selective Retention
7-6

Recommended Appeals Process
7-7

Minimizing Unintentional Rating Errors
Rater Error Training (RET):
Make raters aware of types of rating errors they are likely to
make
Help raters minimize errors
Increase rating accuracy
7-8

Rater Error Training (RET)
7-9

Frame of Reference Training (FOR)
Goal of FOR*
Raters develop common frame of reference
Observing performance
Evaluating performance
Expected results of FOR
Raters provide consistent, more accurate ratings
Raters help employees design effective development plans
*Most appropriate when PM appraisal system focuses on
behaviors
7-10

Frame of Reference (FOR) Training

How does FOR training help counter biases in performance
ratings?
What are some obstacles to implementing FOR training within
organizations?
7-11
Frame of Reference Training (FOR)

Behavioral Observation Training (BO)
Goals of BO
Minimize unintentional rating errors
Improve rater skills by focusing on how raters:
Observe performance
Store information about performance
Recall information about performance
Use information about performance
7-12

Pilot Testing
Pilot testing is done before the system is implemented.
Provides ability to:
Discover potential problems
Fix them
7-13

Pilot Testing—Benefits
Gain information from potential participants
Learn about difficulties/obstacles
Collect recommendations on how to improve system
Understand personal reactions
Get early buy-in from some participants
Get higher rate of acceptance
7-14

Roll out test version with sample group
Staff and jobs generalizable to the organization
Fully implement planned system
All participants keep records of issues encountered
Do not record appraisal scores
Collect input from all participants
7-15

When system is implemented, decide:
How to evaluate system effectiveness
How to measure implementation
How to measure results
Evaluation data to collect:
Reactions to the system
Assessments of operational and technical requirements
Effectiveness of performance ratings
7-16

Company Spotlight
BT Global Services used a three-step approach to rolling out a
new PM system
Workshops that helped executives articulate why a new system
was needed, what roles employees would play, and how those
roles would contribute to the success of the company
Training line managers
Ongoing monitoring of the program using data from employee
surveys, face-to-face meetings with line managers, and team
meetings
7-17

Indicators to Consider
Number of individuals evaluated
Quality of qualitative performance data

Quality of follow-up actions
Quality of performance discussion meetings
System satisfaction
Cost-benefit ratio or return on investment (ROI)
Unit-level and organization-level performance
7-18

Quick Review
Preparation
Communication Plan
Appeals Process
Rater Training Programs
Pilot Testing
7-19

All rights reserved. No part of this publication may be
reproduced, stored in a retrieval system, or transmitted, in any
form or by any means, electronic, mechanical, photocopying,
recording, or otherwise, without the prior written permission of
the publisher. Printed in the United States of America.
1-20

20
The grading guidelines are as follow:
Ethics Final Paper--Evaluation Rubric
Possible Score
Your Score
Introduction: Summary of what is known about the ethical issue
Well summarized (20) Adequately summarized (15),
Superficially summarized (10) Poorly summarized (5)

20
Ethical Dimensions of the Issue Identified and Discussed (why
is this an ethical issue)
Ethical Dimensions Clearly Identified (5), Superficially
identified (2), Not identified (0)
Ethical Dimensions Clearly Discussed (5), Superficially
discussed (2), Not discussed (0)
10
Relevance of the Ethical Issue to Health Professions/Nursing
Relevance of the Ethical Issue to Nursing well described (10),
Adequately described (7), Poorly summarized (3)
10
Relevant Ethical Analysis (Principles, Ethical Theories, Laws,
and Standards of Practice)
Complete Analysis of Principles, Ethical Theories, Laws, and
SOP (30)
Adequate Analysis (15), Superficial Analysis (10), Poorly
Analyzed (5)
30
Personal Professional Response to the Issue
Thorough discussion (10), Adequate Discussion (7), Superficial
Discussion (5)
10
Conclusion: Reflection of What you Learned
Reflection clearly articulated (8), adequately articulated (6),
superficially articulated (4), poorly articulated (2)
8
Spelling, Punctuation and Grammar—pdf. version of paper

WILL NOT be accepted and will result in a grade of zero points
for the assignment without discussion
No errors (10), 1-2 errors (8), 3-4 errors (6), 5 or more errors
(4), errors obscure meaning or the instructions for the
assignment were disregarded (2)
10
Clarity and Organization – Rubric Headings utilized
Headings utilized, paper clear/concise/organized (10)
Headings not utilized, paper clear/concise/organized (7),
No Headings, paper unclear/ not concise/disorganized (5),
Lack of organization obscures meaning or you have not
corrected feedback given in prior assignments (2)
10
Correct APA Style (6th or 7th)
No errors (5), 1-2 errors (4), 3-4 errors (3), 5-6 errors (2),6-7
errors (1), 8 or more errors (0)
5
Correct Length 7 pages of text, PLUS title page and references
YES or NO
2
Minimum of 3 professional nursing references, 5 years old or
less
YES or NO
5
Total Points
120

9
The Ethical Principle of Providing Healthcare for Deaf Patients
College of Nursing, Resurrection University
NUR 4242: Ethics in Nursing

The Ethical Principle of Providing Healthcare for Deaf Patients
The deaf community is a vulnerable population with a language
barrier when accessing healthcare (Laur, 2017). Due to their
condition, deaf patients cannot hear, preventing them from
effectively communicating with providers and nurses about their
health. According to the American with Disabilities Act,
hospitals and clinics must have communication methods for
patients and family members who are deaf or hard of hearing
(United States Department of Justice, 2005). A sign-language
interpreter is trained to effectively communicate with the
patient using American Sign Language (ASL). The interpreter is
an advocate for the patient and helps communicate with
healthcare professionals throughout their hospital stay. This
communication includes the patient’s chief complaints,
signs/symptoms, tests, medications, procedures, and treatment.
When a health care professional overlooks the patient’s
condition and does not address the patient’s communication
needs, miscommunication occurs, leading to misdiagnosis from
the physician or delayed medical treatment. This is a significant
issue to investigate because they do not provide a level of
standard of care for the patient. There is a breach of ethical and
professional duty leading to negligence and lawsuit against the
hospital. This paper investigates theprinciple of treating deaf
patients, the impact of a language barrier when accessing
healthcare and the moral responsibility in providing care to the
deaf community.
Ethical Dimensions of Limited Access to Healthcare
Limited access to health care for the deaf community is an
ethical problem. There are 6 million deaf patients in the United
States of America and 38 million people with hearing problems
(Laur, 2017). They are not receiving equal access to health care

and services as abled individuals. According to the ADA, all
locations must have accessibility and proper communication for
an individual with a disability (U.S. Department of Justice,
2005). This lack of accessibility leads to health disparities for
individuals in the vulnerable population, such as the deaf
community for resources, transportation, nutrition, education,
advocacy, and health promotion. Furthermore, deaf patients are
at a disadvantage because they need additional help and undergo
ethnocentrism due their disability. Deaf community has negative
connotations and has experienced victimization and
discrimination with terms such as, “deaf-dumb”, “deaf-mute” or
hearing impaired meaning they do not have a voice and nor have
to ability to learn or have reasonable thinking (National
Association of Deaf, 2020).
Another ethical issue in the deaf community is communication
barriers and whether hospitals should provide accommodation
due to additional employer costs. Without additional assistance,
deaf patients cannot receive critical health information and
qualified health care. Research shows deaf patients make fewer
appointments with their general practitioner and fewer
prescription follow-ups compared to hearing patients (Laur,
2017). The lack of health information and communication
access in ASL often results in deaf people, including those who
are educated, scoring lower in health literacy and health
knowledge.
Relevance of the Ethical Issue involving Language Barrier and
Maltreatment
Deaf patients are at a disadvantage with limited access to health
care because there is inequality in the treatment of deaf patients
because of the language barrier. Research has shown a lack of
training for health care to recognize and provide appropriately
for the deaf patient (Laur, 2017). Furthermore, healthcare
professionals do not know how to act around deaf community
and do not provide compassion nor understanding for the
patient. Providers and nurses that assume deaf patients can read
their lips and write down notes without additional assistance,

such as a sign language interpreter. Without providing
additional assistance, deaf patients and families are frustrated
because there no intentions in providing benevolence and
patient-centered care.
Role of the Nurse
Part of the role as nurses is to provide patient-centered to every
individual no matter the race, sex, gender, orientation, religion,
culture, and disability. For a vulnerable population such as the
deaf community, nurses must provide comprehension,
compassion, sensitivity along with additional resources for the
patient to understand the care and treatment during their visit
(American Nurses Association, 2016). Furthermore, healthcare
staff should focus on the diagnosis of the deaf patient versus
their condition, to provide autonomy and advocacy for the
patient. Ethnocentrism and lack of sensitivity contributes to
victimization and lack of providing a rapport for a good patient
care relationship. It is vital to educate nurse about promoting
the patient’s health and wellness while providing patient-
centered care to avoid any mistakes and eliminate barriers to
healthcare.
Relevant Ethical Analysis: Moral Principles
Limited accessibility for the deaf community involves the lack
of health care professionals providing four moral principles that
affect cohesive and ethical decision making: justice, autonomy,
beneficence and nonmalifience. Justice involves providing
equal, and appropriate treatment due to their condition
(Burkhardt & Nathaniel, 2020). When there is a lack of
resources or effective needs of communication, there is lack of
distributive justice to provide medical services and assistance to
the deaf patients. Autonomy is the principle of allowing a
patient to make their own decisions about their medical
condition and self-determination (Burkhardt et.al, 2020) A
patient that is deaf has limited autonomy due their language
barrier and being able to express their decisions. Beneficence
requires healthcare professionals to provide care that benefits
the patients by preventing harm, promoting patient’s health and

nonmalifience by removing harm based on a patient’s human
rights (American Nurses Association, 2016). Nurses are
required to provide beneficence, by having virtue ethics that
involve compassion, trustworthiness with the patient, and
integrity. When these moral principles are not applied during
care, healthcare professionals not providing a standard of care
towards their patient.
Standard of Care and Nursing Practice Act
A standard of care/practice is the minimal set of guidelines to
healthcare staff must provide to provide competent care as their
ethical obligation. For health care professionals, maintaining a
standard of care involves patient advocacy and sensitivity no
matter the patient’s cultural, social, and ethnic differences or
disabilities (Laur, 2017). When healthcare professionals fail to
provide a standard of care, the form of breach in their duty to
care causing mistakes such as misdiagnosis and mistreatment
leading to negligence. For example, healthcare professionals
must be able to provide informed consent for deaf patients when
providing interventions and treatments. Informed consent
involves comprehension of care, risk/benefits and document the
patient’s signature. In the deaf community, without providing
effective means communication, there no intent of receiving
informed consent, the patient is not able to understand their
health condition and there is a breach in their duty to act (Laur,
2017).
Violation of Health Insurance Portability and Accountability
Act
Along with standards of care, an ethical violation of patient’s
privacy can occur often in the deaf community due limited
communication alternatives. Health Insurance Portability and
Accountability Act of 1996 (HIPPA) is a federal law that
protects patient sensitive information from being released with
the patient’s knowledge (Center of Disease Control and
Prevention, 2020). For example, the healthcare facility may
depend on untrained interpreter such as family or friend to
communicate medical information to the patient. The untrained

interpreter can break the patient’s confidentiality by sharing the
patient’s personal information with others and without the
permission of the patient. This is a violation of the patient’s
privacy and confidentiality between medical personnel and the
patient (CDC, 2020). This is a violation that can lead to loss of
medical license and jail time. Another part of the HIPPA
violation is the patient may not be comfortable sharing the
information with family or friends causing a moral dilemma
whether the nurse should rely on another individual besides the
interpreter to relay information to the patient. Also, the
untrained interpreter may not have education in medical
terminology to leading to difficulties to comprehend and
misinformation (Laur, 2017). Also, the patient may not be
comfortable sharing the information with family or friends
causing a moral dilemma whether the nurse should rely on
another individual besides the interpreter to relay information to
the patient Overall, the hospital is responsible in protecting
patient privacy, providing resources to limit the accessibility of
medical care, decrease barriers to care, train their employees to
provide effective care to help deaf patients receive the care they
need (U.S. Department of Justice, 2005).
Personal Professional Response
The limited access of health in the deaf community involves the
lack of education and how to properly take care of patients with
an intellectual or developmental disability. For example, my
boyfriends’ grandmother was born deaf and knows ASL. She
was diagnosed with lupus during the last stages of her life.
When I would go to the doctor with his family, it would be
always difficult to accommodate for his grandmother. The
nurses would be awkward during the initial patient assessment
say words other their breath and assume the patient cannot hear
due to her disability. At times, additional resources would be
denied such as sign language interpreter and my boyfriend’s
mother, would need to be at clinic or there would not be an
interpreter due to lack of resources. My boyfriend’s family was
always there for her to advocate for proper care from the

healthcare staff which should be given without a problem I was
shocked by how unethically a healthcare professional would
treat an individual with a disability, especially in comparison to
how they treat an abled individual. Deaf patients should be
provided additional community resources for the patients, their
family, and caregivers to benefit the patient’s hospital or clinic
visit.
I believe that the healthcare professionals should be able to de -
stigmatize patients with a disability. If I had a patient that was
deaf or hard of hearing, I would approach the situation by first
providing a sign language interpreter, communicating with the
family about the patient’s chief complaint, signs, and
symptoms. I would not want to make any assumptions, or the
patient feel awkward in any way. Furthermore, I would
communicate with the interpreter to provide a step by step
patient assessment, interventions, treatment, that the patient and
family can understand. By taking these steps, I would allow for
the patient and family to trust me to provide beneficence,
autonomy, and mind-body-spirit care. As a current emergency
medical technician (EMT) and a future nurse I will provide
more time for a patient with a disability and more patience
during my care. I will communicate with the family directly to
understand the patient’s condition and provide comfort.
Furthermore, I will limit any ethnocentrism or negative
judgement towards the patient. I can learn more about my
patient their behavior, emotion and lifestyle while working on a
nursing care plan to deliver appropriate care. As nurses, being
aware of our own actions, how we act, think, can helps improve
and become better nurses.
Conclusion: Reflection
The research behind the topic about limited access of medical
care for deaf patients has opened my eyes when learning how to
act and provide care to deaf patients. As a child that was never
around the deaf community or people with disabilities, I never
knew how vulnerable the deaf population is and limited
resources available to them. In addition, I never knew about

important sign language interpreters are when conveying in
medical information to the deaf patient and their family. I was
able to learn about ethical and moral principles involved in
nursing and how to learn appropriate methods of communication
for deaf patients. Deaf patients have developed National
Association of Deaf (NAD) and the World Federation of Deaf
(WFD) as organizations to benefit the deaf community and
provide representation (NAD, 2020).
As a current medical employee and future nurse, we must
consider the amount of diversity training and sensitivity
involved when providing care to deaf patients. Furthermore, we
must have compassion and empathy when working with
someone that has a disability. I cannot imagine it being easy to
ask for additional help. Therefore, it is important to advocate
for vulnerable populations and provide beneficence for the
patient. Questions to discuss are: Is there enough training?
Should we allow family members to interpret patient
information versus a social worker? How we can help advocate
for a deaf community? As we think about these questions, we
communicate with the community about issued faced in the
healthcare setting to provide equality in healthcare.
References
ADA Business BRIEF: Communicating with People Who Are
Deaf or Hard of Hearing in Hospital Settings. (2005, August
11). https://www.ada.gov/hospcombr.htm.
ANA Center for Ethics and Human Rights. (2016, February).
The Nurse's Role in Ethics and Human Rights - ANA Position

Statement. https://www.nursingworld.org/practice-
policy/nursing-excellence/official-position-statements/id/the-
nurses-role-in-ethics-and-human-rights/.
Burkhardt, M. A., & Nathaniel, A. K. (2020). Ethical Theory. In
Ethics and issues in contemporary nursing: nursing ethics for
the 21st century (1), (pp. 20–38). Elsevier.
Center of Disease Control and Prevention. (2018, September
14). Health Insurance Portability and Accountability Act of
1996 (HIPAA).
https://www.cdc.gov/phlp/publications/topic/hipaa.html.
Community and Culture – Frequently Asked Questions. (2020).
https://www.nad.org/resources/american-sign-
language/community-and-culture-frequently-asked-questions/.
Laur, A. (2017). Healthcare access for deaf patients – The legal
and ethical perspectives. Medico-Legal Journal, 86(1), 36–41.
https://doi.org/10.1177/0025817217743416

Rolling Out a Performance Management System

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