1. Annual Performance Evaluation
Peri-Operative Coordinator
Position Code: 324-37957-74200
Require Patient Population tab: No
Employee Name: JESSICA VASQUEZ-ABAUNZA
Employee Number: xxx217530
Department: 324-74200-SURGERY
I have received and reviewed this Annual Performance Evaluation at a meeting dated 08/03/2016.
Manager Comments:
Jessica you have been an excellent addition to Peri-Operative Services. You have maintained high accuracy under tight deadlines.
You are trusted to do tasks demanding high accuracy and you do them well. You always are willing to help others in the department. You
continuously are willing to learn new task. You have improved many departmental procedures including payroll, communication via a
newsletter and Tissue Management. You have set your priorities very well while you continues to grow. We are glad to have you onboard
Thanks for your continuous support
Todd
Employee Reviewed: JESSICA VASQUEZ-ABAUNZA Reviewer: TODD HENDERSON Document Date: 08/03/2016
Annual Performance Evaluation Process
My acknowledgement only confirms that I have had the opportunity to review this performance review and does not confirm that I agree or disagree with
my assigned level of performance within each performance expectation. If I do not agree with this appraisal, I have the opportunity to make comments
expressing my concern and/or disagreement on this form.
JOB STANDARD
Job Standard Weight
1. Department Coordination 35.00%
Performance Expectation Score Comments
1.1 Prepares reports, statistical data, and graphs as
requested by departmental director and manager.
Exceeds Job
Requirements
Jessica prepares monthly reports which involve statistical data and graphs
such as the IUSS Report, Block Utilization Summaries & Letters for
Surgeons, PIMS, and creates reports for CPD. In addition, prepares power
point presentation that includes stats & graphs, for committees such as the
SSEC, CPD Workgroup, Laser Safety, etc.
1.2 Assists with service line certification and
accreditation survey preparation as directed.
Maintains current and ongoing action plans
including contacting department managers for
plans.
Exceeds Job
Requirements
Jessica has been invovled, present, and taken on the lead of action plans as a
result of survey findings, survey readiness, and sentinel events. In addition,
she updates policies, monitors compliance, and re-orients staff on policies.
1.3 Coordinates follow-up of action plan items to
ensure documentation of completion as assigned by
the department Director.
Exceeds Job
Requirements
Jessica coordinates follow-up action plan items to ensure documentation of
completion as assigned and exceeds in those tasks. A few examples would
be coordinating the staffing schedules for Peri-Operative Services, the
training and transition of our timekeeping system, and has gone above and
byeond to take on the Position Control.
1.4 Coordinates the scheduling and planning of
departmental meetings. Prepare meeting packets.
Fully Competent Jessica coordinates the scheduling and planning of departmental meetings,
prepares meeting minutes and packets, and follows up.
1

2. Maintain and distribute meeting minutes. Follows
up with members as needed.
1.5 Coordinates medical record chart pulls as
necessary. Fully Competent
Jessica has been able to access MediTech appropriately and accessed
medical record charts to pull information related to implants and staffing; to
generate reports or do investigative research for information.
1.6 Develops audits and survey reports as directed for
department initiatives and distributes data as
directed.
Fully Competent Jessica has audited timesheets, staffing levels, and policies and processes.
1.7 Supports and assists the Department Director in
scheduling, project completion and program
activities and events; supports coordinators within
the department that report to the department
Director, as assigned.
Exceeds Job
Requirements
Jessica has played a critical role in supporting me as the Director in
scheduling meetings, project completions, and program activities. She
collaborates with other departments and supports the Charge RN & Interim
Educator in the department.
Total Points Divided By
Number of
Performance Expectation
=
Score
(Rounded to nearest hundredth)
25 / 7 = 3.57
Additional Department Job Standard
(please describe)
Achieved
(Yes/No)
*Written comments:
JOB STANDARD
Job Standard Weight
2. General Office 35.00%
Performance Expectation Score Comments
2.1 Responsible for maintaining files, records, and databases in accordance with
internal procedures.
Fully Competent
2.2 Performs support functions such as copying, ordering supplies, processing
invoices and reimbursement requests, sending faxes, opening and distributing
mail as requested.
Fully Competent
2.3 Interacts with physicians and physician offices as directed including meeting
scheduling, minutes and follow up as needed.
Fully Competent
2.4 Prepares confidential documents and maintains associated files.
Exceeds Job
Requirements
Jessica prepares employee confidiential
documents, departmental confidential
documents, and more,
2.5 Completes other duties as assigned. Fully Competent
2.6 Represents the department in a pleasant, respectful, and courteous and
professional manner. Maintains confidentiality at all times.
Exceeds Job
Requirements
Total Points Divided By
Number of
Performance Expectation
=
Score
(Rounded to nearest hundredth)
20 / 6 = 3.33
Additional Department Job Standard
(please describe)
Achieved
(Yes/No)
*Written comments:
JOB STANDARD
2

3. Job Standard Weight
3. P.I., Performance Metric and standards support 0.00%
Performance Expectation Score Comments
3.1 Enters patient care records accurately and timely into national quality improvement data registry. N/A
Total Points Divided By
Number of
Performance Expectation
=
Score
(Rounded to nearest hundredth)
N/A / 0 = N/A
Additional Department Job Standard
(please describe)
Achieved
(Yes/No)
*Written comments:
ORG. STANDARD Total Weight 30%
ORG. STANDARD Weight
1. Dignity Health Core Values 8.90%
Performance Expectation
N/A
Not
Applicable
Unsatisfactory
Below Job
Requirements
Fully
Competent
Exceeds Job
Requirements
Outstanding
Comments
1.1 Collaboration
Personal Characteristics - Acts with
integrity and strives for fairness in
decisions and treatment of people.
Deals with people in an open
straightforward way. Builds
relationships on trust and respect.
Holds self and others accountable;
admits mistakes and learns from them.
Teamwork - Uses appropriate methods
and a flexible interpersonal style to
help build a cohesive team. Actively
participates as a team member to move
team forward toward completion of
goals. Regularly acknowledges
contributions of others. Open to others'
ideas and opinions, supports the
department's efforts, and maintains
confidentiality.
Accountability Adapts quickly to
changing conditions and needs, adds
value to the organization by going
beyond boundaries of own job to
improve organizational performance.
X
1.2 Dignity
Effective verbal and legible written
communications and interpersonal
skills with associates, community and
other customers.
Provides accurate and helpful
information and instructions to
departmental and hospital customers.
Accurate listening skills while
checking understanding, with
appropriate follow through on requests
X
3

4. for information and/or services.
Communicates and interacts
appropriately with all personnel.
1.3 Excellence
Customer / Patient Focus - Makes
customers/patients and their needs a
primary focus. Is dedicated to meeting
the expectations of internal and
external customers/patients. Represents
organization in a positive and
professional manner. Solicits
customer/patient feedback and uses it
for improvements in service
Maximizing Service to Customers
(Excellence) - Identifies and responds
to needs and expectations of all
customers, both internal and external,
delivers quality service and care in a
timely and efficient manner, is seen as
a true ambassador of customer service.
Innovation/Continuous
Improvement of Operations
(Excellence) - Delivers high quality
results on time, contributes to
departmental/organizational quality
and/or process improvement efforts,
actively promotes innovation, speed
and change in improving processes,
programs or services.
X
1.4 Justice
Mission and Commitment -
Demonstrates commitment to
organization's mission and values. Is
respectful of all levels of the
organization. Inclusive of diverse ideas,
backgrounds, cultures. Seeks out
opportunities to represent the
workplace.
Accountability - Makes effective
decisions, accepts responsibility for
decision.
X
1.5 Stewardship
Continuous Improvement -
Participates effectively in process
improvement changes. Originates
action to improve existing conditions
and processes.
Financial Responsibilities
Stewardship - Works efficiently,
utilizes all resources in a cost-effective
manner, adheres to organization's
policies and procedures, actively seeks
ways to reduce cost and conserve
resources to improve results.
X
Total Points Divided By
Number of
Performance Expectation
=
Score
(Rounded to nearest hundredth)
18 / 5 = 3.60
ORG. STANDARD Total Weight 30%
ORG. STANDARD Weight
4

5. 2. Standards of Behavior 8.80%
Performance Expectation
N/A
Not
Applicable
Unsatisfactory
Below Job
Requirements
Fully
Competent
Exceeds Job
Requirements
Outstanding
Comments
2.1 Attitude and Sense of
Ownership. Treat our customers'
with respect and courtesy. Keeping
their information confidential.
Work as a Team. Demonstrates a
behavior which is always willing to
assist and would Never uses terms
such as "It's not my job".
Be part of the solution. Promotes
communications which supports an
agreeable solution.
Standards of Conduct. Must
comply with Hospitals Standards of
Conduct
X
2.2 Communication.
Use AIDET, Acknowledge,
Introduce, Duration, Explain, and
Thank you.
Proper use of Ceridian to record
time.
Use proper etiquette when speaking
on the phone or drafting emails.
Assist others by giving direction.
Provide communications that is
clear and effective. Uses positive
verbal/non verbal communications.
X
2.3 Appearance and Safety. Good
personal hygiene is expected.
Adhere to the hospitals dress code
policy including wearing ID badge.
Keep working environment
well-maintained, clean and
uncluttered.
Know the policies and procedures,
both hospital-wide and
departmental.
X
Total Points Divided By
Number of
Performance Expectation
=
Score
(Rounded to nearest hundredth)
10 / 3 = 3.33
ORG. STANDARD Total Weight 30%
ORG. STANDARD Weight
3. General Competencies: 8.80%
Performance Expectation
N/A
Not
Applicable
Unsatisfactory
Below Job
Requirements
Fully
Competent
Exceeds Job
Requirements
Outstanding
Comments
3.1 Job Standards - Maintains current
and appropriate licensure and
certification to meet job requirements.
Annual safety, health, education,
X
5

6. compliance and HIPAA requirements
are met on time.
3.2 Health and Safety Plan - Wears
proper clothes/shoes per dress code,
takes appropriate safety precautions,
demonstrates good body mechanics,
plans lifting projects, gets help when
appropriate.
X
3.3 Security Management Plan - Wears
ID badge, knows hospital code
identifications, reports all unsafe
conditions or work hazards, is aware
of environment, uses common sense,
adheres to patient/visitor
identification policies.
X
3.4 Hazardous Materials Plan - Handles
hazardous materials appropriately,
knows chemicals used in job, knows
proper use/mix of chemicals used in
job, demonstrates proper medical
waste management practices, can
locate and understand MSDS
(Material Safety Data Sheets).
X
3.5 Emergency Preparedness Plan -
Participates appropriately in
disaster drills, understands role in
emergency situations.
X
3.6 Infection Control - Demonstrates
proper hand washing, uses personal
protective equipment per policy,
follows isolation techniques where
indicated, adheres to universal
precautions.
X
3.7 Medical Equipment Management
Plan - Complies with Safe Medical
Device Act. Checks patient use of
electrical equipment for up to date
tag, makes sure personal electrical
equipment has been checked by
Engineering, checks conditions of
electrical equipment.
X
3.8 Attendance - Demonstrates concern
for patients, co-workers by being
prepared to work in the work area on
time. Number of Occurrences during
the rating period
X
3.9 Patient Privacy - Demonstrates work
practices that maintain patient privacy
and confidentiality. Consistently
follows regulatory, The Joint
Commission, and hospital policy
requirements relating to the release or
access of protected health
information.
X
3.10 Ability to demonstrate respect -
Ability to demonstrate respect for
people in ethical and courteous
behavior to patients, patient relatives,
visitors and fellow employees. Ability
to accept supervision and guidance
and work cooperatively with others.
Ability to follow regulations of the
X
6

7. Hospital pertaining to job
performance, behavior and patient
care. Ability to be flexible in meeting
the need of varying situations. Ability
to maintain continuing education
requirements for licensure. Must have
the ability to read, write and speak
English.
3.11 Cultural Diversity Exhibits
behaviors that are culturally sensitive,
taking into account the individual
needs of each customer. Identify
ethical issues and refer to appropriate
resources.
X
Total Points Divided By
Number of
Performance Expectation
=
Score
(Rounded to nearest hundredth)
31 / 10 = 3.10
ORG. STANDARD Total Weight 30%
ORG. STANDARD Weight
4. Incumbents in this position shall comply with all applicable laws and rules including the Dignity Health Standards of Conduct and Dignity
Health policies and procedures that apply to his/her job responsibilities, seek guidance when in doubt, promptly report any potential or
suspected violation of Dignity Health Standards of Conduct, Dignity Health policy or procedure or applicable laws/regulations and when
requested, assist Dignity Health personnel in investigating all allegations of violation. When called upon, the incumbent shall assist in risk
evaluation and work collaboratively with facility/entity leaders to implement, monitor and mitigate risk corrective plans outlined by the
Compliance program.
3.50%
Performance Expectation
N/A
Not
Applicable
Unsatisfactory
Below Job
Requirements
Fully
Competent
Exceeds Job
Requirements
Outstanding
Comments
4.1 1) Take responsibility for his/her own
actions
2) Know and comply with applicable
laws and rules, including applicable
Federal health care program
requirements, the Dignity Health
Standards of Conduct and Dignity
Health policies and procedures as
they apply to his/her particular job
responsibilities
3) Seek guidance as provided in the
Dignity Health Standards of Conduct
and/or policies when in doubt about
his/her responsibilities
4) Refrain from involvement in
illegal, unethical or otherwise
improper acts
5) Promptly report any potential or
suspected violation of Dignity Health
Standards of Conduct, Dignity Health
policy or applicable laws or
regulations
6) As requested, assist Dignity Health
personnel and authorized outside
personnel in investigating all
allegations of violations
7) Meet training requirements within
designated timelines assigned
X
7

8. 8) Understand and accept
consequences for failure to comply
with Dignity Health Standards of
Conduct
Total Points Divided By
Number of
Performance Expectation
=
Score
(Rounded to nearest hundredth)
3 / 1 = 3.00
SUMMARY
Job Standard Score X Weight =
Rating
(Round to the
nearest thousandth)
1 Department Coordination 3.57 X 0.3500 = 1.250
2 General Office 3.33 X 0.3500 = 1.167
3 P.I., Performance Metric and standards support N/A X 0.0000 = 0.000
Total Weight for all Job Standard must equal 70% Subtotal = 2.417
Org. Standard Score X Weight =
Rating
(Round to the
nearest
thousandth)
1 Dignity Health Core Values 3.60 X 0.0890 = 0.320
2 Standards of Behavior 3.33 X 0.0880 = 0.293
3 General Competencies: 3.10 X 0.0880 = 0.273
4 Incumbents in this position shall comply with all applicable laws and rules including the Dignity Health
Standards of Conduct and Dignity Health policies and procedures that apply to his/her job responsibilities, seek
guidance when in doubt, promptly report any potential or suspected violation of Dignity Health Standards of
Conduct, Dignity Health policy or procedure or applicable laws/regulations and when requested, assist Dignity
Health personnel in investigating all allegations of violation. When called upon, the incumbent shall assist in risk
evaluation and work collaboratively with facility/entity leaders to implement, monitor and mitigate risk
corrective plans outlined by the Compliance program.
3.00 X 0.0350 = 0.105
Subtotal = 0.992
Job Standard Rating
Subtotal
+
Org. Standard Rating
Subtotal
=
Overall Rating
2.417 + 0.992 = 3.408
JESSICA VASQUEZ-ABAUNZA
GOALS
Employee Goals Supporting Activities Time Frame
END Annual Performance Evaluation END
8