This document discusses performance appraisal and quality assurance in healthcare. It begins by outlining the objectives of discussing these topics, including controlling performance, evaluation principles, the control process, measuring performance, and disciplinary action. Several reasons for evaluation are provided, such as ensuring quality care and establishing standards. The basic components of the control process and different methods of measuring performance like checklists, scales, and peer review are described. The document distinguishes quality assurance from quality improvement and discusses their key aspects. It also outlines different levels of disciplinary action for employees.

2. OBJECTIVES
• After 30 minutes of discussion, the NEA 606a class
will be able to:
1. Discuss controlling and performance appraisal.
2. Discuss the reasons and principles for
evaluation.
3. Enumerate and explain the basic components of
the control process.
4. Identify methods of measuring performance.
5. Differentiate quality assurance from quality
improvement.
6. Discuss the different levels of disciplinary action.

3. • Also known as evaluation
• It is an ongoing function of management
which occurs during planning, organizing,
and directing activities.

4. 1. Evaluation ensures that quality nursing care
is provided.
2. It allows for the setting of sensible
objectives and ensures compliance with
them.
3. It provides standards for establishing
comparisons.
4. It promotes visibility and a means for
employees to monitor their own
performance.

5. 5. It highlights problems related to quality
care and determines the areas that
require priority attention.
6. It provides an indication of the costs of
poor quality.
7. It justifies the use of resources.
8. It provides feedback for improvement.

6. 1. Evaluation must be based on the behavioral
standards of performance which the position
requires.
2. There should be enough time to observe employee’s
behavior.
3. The employee should be given a copy of the job
description, performance standards, & evaluation
form before the scheduled evaluation conference.
4. The employee’s performance appraisal should include
both satisfactory and unsatisfactory results with
specific behavioural instances to exemplify these
evaluative comments.

7. 5. Areas needing improvement must be prioritized to
help the worker upgrade his/her performance.
6. The evaluation conference should be scheduled
and conducted at a convenient time for the rater
and the employee under evaluation, in a pleasant
surrounding and with ample time for discussion.
7. The evaluation report and conference should be
structured in such a way that it is perceived and
accepted positively as a means of improving job
performance.

8. • OBJECTIVITY
– Free from bias
• RELIABILITY
– Accuracy or precision of the tool
• VALIDITY
– Relevance of the measurement to the
performance of the employee
• SENSITIVITY
– Can measure fine lines of differences among
the criteria being measured

9. a. Establishment of standards, objectives, and
methods for measuring performance.
b. Measurement of actual performance
c. Comparison of actual performance to
standards
d. Action to reinforce strengths or successes
e. Implementation of corrective action as
necessary.

10. • STRUCTURE
 Focus on structure or management system
• PROCESS
 Decisions and actions of the nurse relative to
the nursing process
• OUTCOME
 Results of the care provided

11. Structure Process Outcome
o The Agency
Setting
 Vision
 Mission
 Philosophy
 Objectives
o Human Resources
 Staffing
 Qualifications
o Material
Resources
 Equipment
 Supplies
 Facilities
o The Nursing
Process
o Assessment of
Client’s need,
problems
o Nursing Diagnosis
o Prioritized Plan of
Care
o Nursing
Interventions/
Implementation of
Care Plan
o Positive change in
patient’s condition
o Increased
knowledge and
understanding of his
ailment
o Satisfaction of
patients with their
care
o Personnel
satisfaction
o Positive image of
agency

12. • A control process in which employee’s performance
is evaluated against standards.
• It is the most valuable tool in controlling human
resources and productivity.
• It reflects how well the nursing personnel have
performed during a specific period of time.

13. • Determine salary standards and merit increases;
• Select qualified individuals for promotion or transfer;
• Identify unsatisfactory employees for demotion or
termination;
• Make inventories of talents within the institution;
• Determine training and developmental needs of
employees;
• Improve the performance of work groups by
examining, improving, correcting interrelationships
between members;

14. • Improve communication between supervisors and
employees and reach an understanding on the
objectives of the job;
• Establish standards of supervisory performance;
• Discover the aspirations of employees and
reconcile these with the goals of the institution;
• Provide “employee recognition” for
accomplishments; and
• Inform employees “where they stand”.

15. • Halo effect
– The result of allowing one trait to influence the
evaluation of other traits or of rating all traits on
the basis of a general impression.
• Horns effect
– The opposite of halo effect. The evaluator is
hypercritical.

16. • Contrast effect
– tendency of the evaluator to rate the employee
opposite from the way the evaluator perceives
oneself
• Central tendency effect
– A narrow range of scores are produced.
• Proximity effect
– The rating on a preceding characteristic influences
the rating on the following trait.

17. • INFORMAL
– Consists of incidental observation or performance
while the worker is performing nursing care or by
responses made by the worker during
conferences.
• FORMAL
– Accomplished regularly and methodically by
collecting objective facts that can demonstrate the
difference between what is expected and what
was done.

18. ESSAY
• The appraiser writes a paragraph or more
about the worker’s strengths, weaknesses
and potentials.

19. CHECKLISTS
• A compilation of all nursing performances
expected of a worker. The appraiser’s task is to
mark the appropriate column whether the worker
does or does not show the desired behavior.
– Advantages: it can categorically assess presence or
absence of behaviors, determine behaviour to be
observed in advance and consistent use of criteria
– Disadvantage: behaviour observed may not be
representative

20. • Simple checklist
– Uses words or phrases to describe behaviours. They
may be categorized by concepts such as assertiveness
skills.
• Forced checklist
– requires the evaluator to select a desirable and
undesirable behaviour for each person. The
behaviours may be given a quantitative value that
results in a score that may be used for employment
decisions.
• Weighted checklist
– gives weighted scores for each behaviour.

21. RANKING
– In simple ranking, the evaluator ranks the
employees according to how he or she fared with
co-workers with respect to certain aspects of
performance or qualifications.
– Disadvantage: it may lead to competition rather
than cooperation and it doesn’t lend itself to large
numbers.
Formula: N(N-1)/2
Where: N is the total number of employees
Example: 4(4-1)/2 = 4(3)/2 = 12/2 = 6 pairs

22. Nurses Possible Pairs
Anita Anderson AA with SJ SJ with PP
Sue Jones AA with PP SJ with SS
Pam Peterson AA with SS PP with SS
Sara Smith
AA SJ SJ PP
AA PP SJ SS
SSPPSSAA
VS.
VS.
VS.
VS.VS.
VS.

23. RATING SCALES
• A rating scale includes a series of items representing
the different tasks or activities in the nurse’s job
description or the absence or presence of desired
behaviours and the extent to which these are
possessed.

24. • Numerical rating scale
–Includes numbers against which a list of behaviours
are evaluated.
Observation of working hours 1 2 3 4 5
Ability to get along with others 1 2 3 4 5

25. Rate the staff member on the items below
Responses have the following values:
1 = never
2 = Sometimes
3 = About half the time
4 = Usually
5 = Always
Observation of working hours 1 2 3 4 5
Ability to get along with others 1 2 3 4 5

26. NURSE
OBSERVATION OF WORKING HOURS
Lowest
(1)
Below
Average
(2)
Average
(3)
Above
Average
(4)
Highest
(5)
Betty
Green x
Sara
Smith x
Pam
Peterson x
Sue Jones x
Anita
Anderson x

27. Graphic rating scale
Words rather than numbers are used. Usually,
list extremely broad and general personal
characteristics that are to be rated from poor
to excellent or from low to high.

28. Descriptive rating scale
Similar to the graphic rating scale except it
presents a more elaborate description of
the behaviour being rated.

29. • Behaviourally Anchored Rating Scales
(BARS)
–BARS evaluate behaviour relevant to the specific
demands of the job and provide examples of
specific job behaviours corresponding to good,
average and poor performances.
–Time consuming, expensive to use, you need a
separate BARS for each job and it is applicable to
physically observable behaviors rather than
conceptual skills.

30. Administers oral medication properly
• Check each medication order against original
physician’s order.
Always Sometimes Never
• Identify the patient carefully.
Always Sometimes Never
• Assist patient to an upright or lateral position.
Always Sometimes Never

31. • Behavioral Observation Scales
–The evaluator lists a number of critical events for
each performance dimension and rates the
extent to which the behaviour has been observed
on a five-point scale ranging from almost never to
almost always.
–Time consuming and expensive to develop.

32. • Circle the number that most closely
approximates your assessment of the staff
member on the following qualities:
Punctual
Almost never 12345 Almost always
Gets along well with co-workers
Almost never 12345 Almost always

33. • Percentage rating scale
- Provides a quantitative choice.
The employee may rank the employee’s behaviour
on any given criterion as among the bottom 10%
of a specific category of personnel, next 20%,
middle 40%, or top 10% of that category of
personnel.
OBSERVATION
OF WORKING
HOURS
10%
Bottom
20% 40% 20%
10%
Top

34. PEER REVIEW
• Process whereby a group of practicing registered
nurses evaluates the quality of another registered
nurse’s professional performance.
• It provides a feedback for sharing ideas,
comparing the consistency of the staff member’s
performance with standards, recognizing
outstanding performance, and identifying areas in
which further development is required.

35. ANECDOTAL RECORDS
– Describes the nurse’s experience with a group
or a person, or in validating technical skills and
interpersonal relationships.
–Advantages: it is an objective description
of behaviour, no rigid structure and
systematic means of recording
observations
–Disadvantages: it doesn’t guarantee
relevant observations

36. • It is a process of evaluation that is applied to
the health care system and the provision of
health care services by health workers.
• Ongoing, systematic process designed to
evaluate and promote excellence in health
care given to groups of clients.
• It is a problem solving process that
systematically assesses the quality of care and
corrects any observable defects.

37. • Continuous, ongoing measurement and
evaluation process that includes structure,
process, and outcome.
• A systematic process to improve outcomes
based on customers’ needs.
• A proactive approach that emphasizes “doing
the right thing” for the customer.

38. Quality Assurance Quality Improvement
- Doing it right Doing the right thing
- Assess or measure performance Meet the customer’s needs
- Determine whether performance
meets standards
Build quality performance into the
work process
Improves performance when it does
not meet standards
Improve performance continuously
as an ongoing management
strategy, not just when standards
are not met (Mclaughlin & Houston,
2003)

39. • A way to ensure customer satisfaction by involving
all employees in the improvement of every product
or service.
• All systems are evaluated and improved.
• It aims to reduce waste and cost of poor quality.
• It is a structured system for involving an entire
organization in a continuous quality improvement
process targeted to meet and exceed customer
expectations.

40. • A process of continuously improving a system by
gathering data or performance and using multi-
disciplinary team to analyze the system, collect
measurements, and propose changes.
• 4 main principles:
Customer focus
The identification of key processes to improve quality
The use of quality tools
The involvement of all people in problem solving

42. It begins with 3 questions:
a.What are we trying to accomplish?
b.How will we know that a change is an
improvement?
c. What changes can we make that will result
in improvement?
PLAN ACTDO CHECK

43. a.Focus on an improvement idea
b.Organize a team that knows the process
c. Clarify what is happening in the current process
d.Understand the degree of change needed
e.Solve the problem

44. • Measuring and comparing the results of key
work processes with those of “best performers”
in a field or industry.
• Is a collaborative and ongoing measurement
process.
• Will identify gaps in performance and provide
options for improvement.
• Focuses on key services or processes.

45.  An unexpected occurrence causing death or
serious physical or psychological injury to a
patient.

46. • All health professionals should collaborate in the
effort to measure and improve care.
• Coordination is essential in planning a
comprehensive quality assurance program.
• Resource expenditure for quality assurance
activities is appropriate.
• There should be focus on critical factors such as
function and activities that yield the greatest
health and financial benefit to reveal significant
findings.

47. • Quality patient care is accurately evaluated
through adequate documentation.
• The ability to achieve nursing objectives depends
upon the optimal functioning of the entire nursing
process and its effective monitoring.
• Feedback to practitioners is essential to improve
practice.
• Peer pressure provides the impetus to effect
prescribed changes based on the results of
assessment and needed improvements on the
quality of care.

48. • Reorganization in the formal
organizational structure may be required if
assessment reveals the need for a
different pattern of health care.
• Collection and analysis of data should be
utilized to motivate remedial action.

49. • Performance evaluation focuses on the
worker.
• Quality Assurance focuses on the care and
service the patient receives.

50. • Patient Care Audits
–Concurrent
–Retrospective
• Peer Review
• Quality Circles

51. • Periodic review of materials and supplies in the
various nursing units.
• Consumption of supplies should be proportionate
to the number of patients served.
• Requisitions of and /or stocking a large number
of supplies and materials should be avoided to
prevent pilferage, misuse or spoilage.
• A high turnover inventory is desired. A low
turnover is a result of poor purchasing policies,
overstocking or a decreased demand for the
item.

52. • An equipment utilization report should be made
including the frequency of breakdown.
• Preventive maintenance requires the regular
inspection of equipment to prevent breakdown
and/or detect needed repairs.
• End-users of supplies, materials and equipment
should be given opportunity to evaluate their
quality.
• Absences due to leaves, whether scheduled or
not should be analyzed as these may be
implications for staffing.

53. • Constructive and effective means by which
employees take personal responsibility for
their own behavior and performance (self-
discipline).

54. • A strong commitment to the vision, philosophy, goals
and objectives of the institution.
• Laws that govern the practice of all professionals and
their respective Codes of Conduct.
• Understanding the rules and regulations of the
agency.
• An atmosphere of mutual trust and confidence.
• Pressure from peers and organization.

55. • Counseling & Oral Warning
• Written Warning
• Suspension
• Dismissal