Professional Development: Part 5 – Performance Evaluation

     As a supervisor, you most likely complete regular performance evaluations for your subordinates. This is usually an organizational requirement, and sometimes linked to raises and promotions. The first time I was promoted to shift supervisor, doing annual performance evaluations was one of my functions. It was one of the responsibilities I liked least about being a supervisor. Initially I had no idea what I was expected to do or how best to evaluate those I worked with. Supervisors and subordinates alike often dread this annual event. What can you do to make the process less painful and more valuable, and to become comfortable evaluating your subordinates? There are some concepts and methods that can make your job easier and your subordinates more accepting of the process. Performance evaluation is really just one component of a performance improvement cycle. Let's begin at the beginning.

Clear Expectations

     The performance evaluation process begins with the job description. All basic organizational performance expectations should be included in this. Your organization should have written job descriptions for every position. If it doesn't, you have some work to do.

     All new employees should be clear about what the organization expects of them. Communicate clearly and ensure your subordinates understand what you want. The job description articulates this for the record, and so is the yardstick for your evaluation. Compare your subordinate's performance to their job description. How well has the employee met expectations?

     One of your responsibilities as a leader is to communicate with the people you lead. Part of your regular dialogue should include performance expectations. Ask your subordinates what they think the organization expects of them. Also discuss what they expect of the organization and what their personal goals and objectives are. Finally, relate their goals and objectives to the organization's strategic plan and vision for the future. What role can your subordinates play in meeting organizational goals and objectives? How can they participate in moving the organization toward realizing its vision? How can they meet their personal goals? All of these dimensions support an agreed-upon set of expectations you can use for evaluating performance.

     One of the most difficult aspects of the evaluation process is listening. You have to practice active listening skills to ensure you are actually communicating with your subordinates. You have to be able to pay absolute attention to what they're saying. How often do you find yourself formulating a response in your head before someone finishes speaking? Do you start to reply with your inner voice? Part of the skill of active listening is silencing that inner voice, so you listen only to the person speaking to you.

Objective Standards

     Objective standards are not subject to opinions. If the standard is "Complete 15 successful IV attempts with at least a 90% success rate," a person either meets it or doesn't. Your organization should have identified and communicated specific and objective performance standards based upon the job description, strategic plan, rules and regulations, and operating procedures. Performance standards should be based upon observable behaviors. Evaluation is then also based upon observed behavior. Observable behaviors that are the basis for performance standards are also specific descriptions of performance expectations. They are the two sides of the evaluation coin. You make observations (or review patient care reports) and evaluate behaviors versus objective standards and clear expectations. Always evaluate behaviors, not people.

Physicians Working Together

     The Physician Consortium for Performance Improvement, convened by the AMA, works to enhance quality of care and patient safety through the development, testing and maintenance of evidence-based clinical performance measures and measurement resources for physicians.

     More than 100 national medical specialty and state medical societies participate in the PCPI, including ACEP, the CDC, the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS). A 23-member executive committee is supported by advisory committees on implementation and evaluation, development of new measures, and planning.

     Membership is open to any person or group committed to healthcare quality improvement and/or patient safety, and who participates in the development, review, dissemination or implementation of performance measures and measurement resources. For more, see www.ama-assn.org.

Performance Improvement Planning

     For an evaluation to be meaningful, it must be more than an isolated annual event. It must be one component of an ongoing process. You and your subordinates should collaborate to develop and agree upon a set of individual performance standards, based upon the dimensions listed above as well as the subordinate's personal goals and objectives. These will provide a road map forward and a means to measure progress and success.

     We previously mentioned SMART objectives in our discussion of strategic planning (Part 2 of the Professional Development series, which appeared in March). They apply here too. SMART objectives are specific, measurable, achievable, realistic and time-limited. Performance improvement planning should be based upon SMART objectives. You can then evaluate performance based upon how well the person achieved what you agreed upon.

     It's important to understand that the performance improvement process you apply for individuals is similar to the process organizations use. The performance improvement process begins with looking at current levels of performance related to expectations and standards. For example, in what percentage of incidents of patients complaining of chest pain would you expect an EMT to administer oxygen? Ideally, it would be 100%. The next step is to assess the actual rate in your system. Say you review PCRs for all cases with chief complaints of chest pain for a period of 30 days. What was the percentage? If it was 100%, you move on to some other issue. But what if it was 75%? What do you do? You analyze the system to identify the reasons why your EMTs aren't administering oxygen. You are looking for system issues rather than individual issues. Is there a lack of training? Have you been running out of oxygen or delivery supplies? Is it a problem of administering O2 but not documenting it? What other reasons can you think of? Once you identify the most likely cause, implement appropriate changes to address it, and reevaluate.

     You can use this same process to improve yourself and help subordinates improve. Say one of your goals is to get promoted, and the promotional process includes a written exam, an oral exam, two role-play scenarios and an interview. How can you apply the performance improvement process to help you achieve your goal? There should be at least four sets of objectives in your plan related to the four components of this promotional process. Set your standards and time frames and get to work. We'll look more at personal professional development in a later article, but I hope you can see how the processes are similar.

     There are also similarities to the delegation process described in April. You can incorporate evaluation of how well your subordinates met your expectations for the tasks you delegated into the performance evaluation.

Performance Evaluation Resources

• Archer North's Performance Appraisal: The Complete Online Guide—www.performance-appraisal.com/home.htm
• Performance Management and Appraisal Help Center—https://performance-appraisals.org
• Performance Management, Evaluation, Review, Improvement—https://humanresources.about.com/od/performancemanagement/Performance_Management_Evaluation_Review_Improvement.htm
• International Society for Performance Improvement—www.ispi.org
• Performance Improvement Stages, Steps and Tools—www.prime2.org/sst

When Employees Fall Short

     What if an employee does not meet expectations? First you must communicate the facts to your subordinate. Clearly explain to the individual the performance areas where they are falling short of expectations. What specific goals have they not met? You have a responsibility to help people identify the reasons they're not meeting expectations. Once you've determined the causes, together you make a plan to implement changes; an improvement plan that includes SMART objectives. You must also clearly communicate the consequences of continuing to not meet expectations, and ensure they're understood. This could involve remedial training or education, probation, or initiating a disciplinary process. We will look more closely at methods you can use to change behavior in the future.

Conclusion

     Effective performance evaluation is part of an ongoing cyclical process. It is based upon clearly communicated expectations and objective performance standards. Standards are directly linked to organizational rules and regulations, operational guidelines and strategic plans. Personal goals and objectives are the basis for additional standards. As with strategic planning, you can use performance evaluation at any level. You can also use the delegation process as the foundation for further evaluation.

     Communicate with your subordinates to ensure they understand your organization's expectations and your expectations as their supervisor. You are responsible for observing their work throughout the year, not just on their anniversary date. You can help your subordinates participate in the success of the organization. You can help them grow and succeed in their careers. You can help yourself grow and improve too. Effective evaluation is a leadership skill that incorporates other skills, such as active listening. If you think about it as an ongoing collaborative activity with your bosses and your subordinates, you'll begin to feel less anxiety when it's time for that dreaded annual review.

     Michael Touchstone, BS, EMT-P, is chief of EMS training for the Philadelphia Fire Department. He has been involved in EMS since 1980 as an EMT, paramedic and instructor. He has participated in EMS leadership, management and educational development initiatives at the local, state and national levels. Contact him at m-touch@comcast.net.