Grady final paper

Running head: MANAGEMENT SYSTEM AT GRADY 1

Implementation of a Performance Management System at Grady Memorial

La’Keiya Benefield & Samuel Dunham

Valdosta State University

November 17, 2014

MANAGEMENT SYSTEM AT GRADY 2

The Organizational Context

Grady Memorial Hospital is located in Atlanta, Georgia and is one of the largest health

systems in the United States. Grady Health System is involved in the health care industry, which

has over 18 million workers nationally and is the fastest growing sector of the U.S. economy

(Centers for Disease Control and Prevention, n.d.). According to U.S. News & World Report,

Grady Hospital currently employs five thousand employees, provides general/surgical care and is

a teaching hospital. The organization has six neighborhood health centers that provide primary

care services. Grady also has over 900 beds available for patient care.

Grady’s purpose is to provide health services to those who need them. Because they are a

not-for-profit organization, individuals are able to seek care, regardless of their financial status.

Their mission statement is quite large and describes in great detail who they are, where they are

going, and how their objectives and goals will be achieved. They strive to provide patients with

services and access that other organizations in the Atlanta area are not able to provide,

particularly individuals of low social-economic status who may not be able to the receive

necessary care in private institutions such as Piedmont Hospital (Grady Memorial Center, n.d.).

An objective in their mission statement is to educate the public about the importance of health

and healthy living. Their goal is to train the best health care workers to help promote and inform

the public about health and provide primary care to those in need. They also noted that they look

to invest in quality care such as technology in order to achieve their mission of providing quality

that rivals the services offered at other Atlanta health institutions.

A challenge that some hospitals are currently dealing with is Medicare and Medicaid. A

provision of the Affordable Care Act (ACA) requires every state to expand Medicaid and include

financial assistance that makes expansion less costly to states. According to the Washington


Post, that provision was stuck down by the Supreme Court after several states sued the federal

government. Georgia decided not to expand and formulate measures to increase access to

Medicaid. Grady Hospital admits a large portion of low income and uninsured patients. Most of

their care is uncompensated, which places a heavy financial burden on Grady. Almost all public

health institutions rely on Disproportionate Share Hospital (DSH) funding that eases the burden

of treating uninsured patients. Under the ACA, there will be a reduction in payments within five

years. With the expansion, Grady would have received millions in funds from Medicaid,

accruing over 60 million dollars in revenue and covering approximately thirty thousand patients

(Blau, 2013). Grady Hospital is looking to reduce operations and downsize staff as 90 million

dollars in DSH funding will be reduced to only 45 million dollars in 2018.

Emergency rooms are typically overcrowded and understaffed. Approximately 75 percent

of Grady patients are among the poorest patients in the area (Karkaria, 2013). Grady is required

to absorb the costs of care because emergency room (ER) patients cannot afford the services. As

a safety-net institution, Grady has an obligation to care for these patients, regardless of their

inability to pay. Grady has anticipated the percentage of ER visits to surge by 15 percent, or over

120,000 dollars annually over the next five years (Karkaria, 2013). Providing uncompensated

care may prove to be difficult for a hospital such as Grady, who is already lacking monetary

resources.

Recently, Grady has invested 74 million dollars in ER expansion. Their agenda is to

increase patient flow by caring for the sickest of patients and transferring low-risk patients to

primary care facilities. With this expansion, Grady will be able to admit more patients because of

the expansion and hire more workers. In response to reimbursement challenges, Grady hopes that

the new facility will attract insured patients to make a return of investment.


The Job/Functional area

Registered nurses are needed in the healthcare setting because they deal with the

immediate needs of healthcare patients and visit those patients much more frequently than

doctors are able to. Nurses are the individuals who keep the patient’s health maintained while the

doctors are determining the problem. They also keep patient records, which gives the doctor

more time to spend trying to solve the issue rather than to figure out what the issue is. Registered

nurses are vital because it is their care that keeps the patient from facing health declines, which

allows the doctor to focus on the main problem of the patient. This holds true because the

maintenance of the nurses keep the main problem from creating more problems for the doctor to

focus on, which makes everyone’s job much more efficient.

Nurses have an important role in healthcare and they accomplish their purpose through

many key job tasks. One important job task for registered nurses is to maintain accurate, detailed

reports and records. By doing this, doctors can spend more time problem-solving for the patient

instead of troubleshooting the problem. Another important primary task is to administer

medications to patients. Along those lines it is also vital for nurses to monitor patients for

reactions or side effects. As the first line of defense for patients in healthcare settings, the actions

of the nurses can literally save lives or lose them. Nurses also prepare rooms, sterile instruments,

equipment, etc. and ensure that the stock of supplies is maintained. In an industry where the

difference between success and failure can be as small as a few seconds, having things prepared

in advance is important in successfully treating patient health problems. Another important task

for registered nurses is for them to direct or coordinate infection control programs, advising or

consulting with specified personnel about necessary precautions. Related to the aforementioned

job tasks, nurses also consult and coordinate with healthcare team members to assess, plan,


implement, or evaluate patient care plans. In some cases, they have the most information about

the patient and because of that; they have a unique perspective that aids in patient care (National

Center for O*NET Development, 2013).

Nursing is a high stress and indispensable job in healthcare settings and as a result, there

are many occupational challenges faced by nurses. A major challenge for nurses involves the

generational issues that can arise from having people from different generations with different

motivations working in the same place towards a common goal. Clarke (2006) describes four

generations that are currently working in the nursing profession. In the article, it is also noted

that these generational differences can be sources of internal conflict between the nurses working

in a particular healthcare organization. These internal conflicts can be sources of stress,

counterproductive work behaviors (CWBs), and eventually turnover. Along those lines, another

challenge faced by nurses are the major technological changes that occur often. As Pineau,

Montemerlo, Pollack, Roy, & Thrun (2003) mention, there are many new technological methods

and procedures being introduced into the profession and it requires nurses to be highly adaptive.

Some of these changes can be so drastic that the nurse cannot use any advanced organizers to

learn the new technology. These changes tend to be more difficult for more experienced nurses,

so it can become a source of stress.

Another challenge for nurses is the ethical challenges that present themselves on the job.

Ethically, one of the major challenges is for nurses to control their own actions and behavior

when they experience a difficult ethical decision. That includes factors like job responsibilities

and their workplace environments (Sørlie, Kihlgren, & Kihlgren, 2005). An example would be a

nurse who sees that there is a drug that could help two of her patients, but only one is offered the

drug due to insurance coverage and cost. Nurses also have the added pressure of making sure


that what they tell the patient is best for their total well-being. Should a nurse tell a patient who

has a bleak diagnosis that they have that diagnosis if they ask? An often forgotten challenge for

nurses involve the legal issues that can arise. The actions that nurses take can lead to legal

problems for the hospitals they work in (Huston, 2013). This leads to more job pressure because

they are only one mistake from inviting a legal dispute in the hospital, which can lead to the

nurse’s dismissal. These two challenges tend to relate closely to each other, because actions that

are done on an ethical basis may bring legal problems.

Turnover is also a major challenge in the nursing profession. Between the high levels of

stress and other factors, nurses tend to leave the profession at alarming rates (Hayes et al., 2006).

The turnover leads to a more difficult job for the nurses who remain. Among the increased

difficulties is an increased workload, which tends to lead to an extraordinary amount of nurses

working mandatory overtime shifts. Jackson, Mannix, & Daly (2001) suggest that the overtime is

negatively impacting nurses in terms of stress and leaves them constantly drained, which leads to

increased turnover. Nurses face many challenges that the performance management system must

consider.

Implementing the Performance Management System

This performance management system (PMS) will be used for the following evaluative

purposes: employee development, administrative decision-making and training needs analysis.

One of the best predictors of future performance is past performance (Bradshaw & Su, 2013) and

in a field that has serious consequences for poor performance such as nursing, it is imperative

that the right employees are placed in the right situations. The performance management system

will allow an employee to have a maximum of two poor performance appraisals during any two

year period before any negative administrative consequences are used. The performance system


will also allow Grady to see what areas of performance are below standards or may even be up to

standards, but could be better for the sake of the patients. Through this performance system,

Grady Hospital will be able to see whether there are any particular training needs that should be

addressed. As a result of the training needs analysis, the performance system will also be used to

help employee development, which will likely come through training, but it could come from

other sources as well, such as conferences, seminars, and independent learning.

Job performance will be defined as “the nurse’s frequency in engaging in behaviors

supported by nursing best practices, their ability to adapt in high-stress situations, and in their

ability to work in teams.” There will be three aspects of job performance that will be examined

through the performance system. The first aspect that will be measured is the frequency of the

how often nurses perform particular behaviors during their work time. These would include the

behaviors associated with tasks such as (but not limited to) administering medications to patients

and administering anesthetics. The daily behaviors of nurses in patient care situations are being

included in the system because these behaviors make up most of the decisions that nurses make

in a typical day. To not include this in the performance system would likely lead to a large

criterion deficiency for the job performance construct. The second aspect that will be included is

the nurse’s ability to adapt their behavior in high-stress situations. This would include factors

such as nurse composure and perception of supervisory support (O’ Connell, McNeely, & Hall,

2008). This may be the most consequential factor of job performance for the nurse because high

performance in this factor will likely lead to better health outcomes for the patients. The third

component of job performance that will be measured is the nurse’s ability to work in a team

setting. Nurses are asked to work in teams often, and as such it is important for this performance

system to determine how well nurses can cooperate in teams. These three components of job


performance are all vital and measurable, which is why they are being included in the

performance system. One thing to note is that this system will be unable to cover every

factor/behavior associated with job performance because there are many extraneous factors that

will impact the performance of the nurses.

There are many factors that could affect a nurse’s performance in the system, but there

are a few situations that are more probable than others. One factor that is out of the nurse’s

control that could affect their performance in the system is receiving incorrect prescriptions from

doctors or incorrect instructions from doctor (e.g., incorrect dosage). Regardless of how well the

nurse can administer any medication, if the instructions are wrong, then the nurse will also give

the wrong medication or dosage. This would show in their performance as an error, but it is one

that the nurse would not be able to control. Another extraneous factor that could affect

performance is the interpersonal differences in medication side effects throughout patients. The

nurse is charged with monitoring for any side effects or reactions, but different people

experience different side effects/reactions for the same problem. Though the nurse should be able

to recognize as many side effects for a medication as possible, it is not feasible for every nurse to

know every side effect that can occur. Another factor that can affect nurse performance involves

the nature of certain side effects. Some side effects take longer to appear than others, meaning

that the situation could already be serious by the time the nurse notices any symptoms. The nurse

can only respond to what they physically see and some side effects have already begun before

any reaction can be seen. The final factor that will be mentioned is the patient’s ability to handle

stressful situations. Some patients handle stress well and others do not. Over-arousal of a patient

could make it difficult for the nurse to administer any shots. For example, a nurse may appear to

have difficulty in administering shots, but in reality, the patient is moving around and yelling


constantly. Good performance would be difficult for any nurse of any skill level to obtain in this

example.

The field of medicine comes with risks as there are no guarantees that a particular

procedure or medication will yield positive outcomes. There is always the possibility that work

situations will change. Nurses generally have to be prepared for the unexpected because their

jobs are unpredictable. It is important that nurses are able to perform in situations that call for

adaptability. According to Shoss, Witt, & Vera (2012), adaptive performance is a form of

performance in which employees modify their work behaviors in response to change. In general,

nurses must be able to perform regardless of the situations that occur on the job.

Adaptive performance is multi- dimensional and ties in well with job performance.

Dorsey, Cortina and Luchman (2012) suggested that adaptive performance enables the employee

to be aware of the environment and recognize when changes to behaviors are needed. For

example, monitoring patients for reactions or side effects is a vital task that ensures patient safety

and recovery. Nurses must be aware of any changes in the patient’s behaviors or any signs of

symptoms. If, after surgery, the patient starts to vomit while in recovery, a reactive approach

would be to administer anti-nausea drug to reduce vomiting. Whereas, if the patient is nauseated,

a proactive approach would be to administer anti-nausea medication to ease the symptom.

Another aspect of adaptive performance is dealing with stress. Most patients willingly take

medications without incident, but there are those who become combative to remedies, or refuse

medications because of their side effects. In stressful situations such as uncooperative patients,

nurses have to remain professional and mollify patients or administer alterative medications to

complete the task. A nurse anesthetist (CRNA) is required to administer local, inhalation,

intravenous, or other anesthetics. CRNAs have to be aware of any changes in the patient’s


condition during and after surgical procedures. A dimension of adaptive performance that ties in

with this task is handling emergencies and crisis situations. For example, if a patient suddenly

stops breathing after receiving an inhalation anesthetic, then the situation becomes a matter of

life and death. In this situation, a nurse must sustain their composure and administer a reversal

drug to allow for the physician to stabilize breathing.

In considering the extraneous factors that can impact job performance, the proposed

performance system will be measured using a behaviors approach. This approach will used for

two reasons. One, although the nurses should already have the skills and abilities needed to do

the work successfully, there are many other extraneous factors that can impact the nurse’s

performance that cannot be controlled. If a patient has a reaction to a medication because they

did not disclose their allergies to the nurse, then the nurse can administer the medication

correctly, but the result would be poor. Along those lines, the behaviors of the nurses and the

results that come from them are not always clearly related. The nurse can administer everything

correctly, but the patient may still have a serious reaction, just because medications tend to have

a plethora of side-effects. Between on-the-job training and higher education opportunities, it is

fair to expect nurses to be able to successfully complete their expected tasks at a high level of

performance, but there are too many factors that are outside of the nurse’s control which can

affect the their performance evaluations in a system where a results approach was used.

In order to measure job performance, there will be four sources used to gather

performance information: a supervisor appraisal form, a nurse self-report form, the

documentation of critical incidents, and patient surveys. An electronic appraisal form will be

given for the supervisors and the individual nurses to fill out for each appraisal period. The forms

will be virtually identical with a few words being changed to be applicable to the status of the


person filling out the form (supervisor vs. nurse self-report). For example, one item may read

“The nurse leads effectively in team situations” for supervisors, while the same item would read

“I lead effectively in team situations.” The use of the electronic form allows the hospital to save

money on the administrative costs of a paper form over the long term. The electronic form also

allows the supervisors and nurses to easily access the form and the results can be gathered much

quicker than the paper forms would. There will be three sections on the appraisal form: Daily

Behaviors, Adaptive Nursing Performance, and Team Performance. Items in the “Daily

Behaviors” section will measure how often the nurses exhibit the behaviors that are associated

with positive health outcomes. The items in the “Adaptive Nursing Performance” section will

measure how well the nurse reacts in situations that require fast action and quick thinking. Items

in the “Team Performance” section will measure how well the nurse works with their supervisor

and other nurses during team tasks.

The supervisor and nurse self-report forms will consist of a list of behaviors that nurses

should perform when serving their patients. The scoring anchors for the “Daily Behaviors” items

will created using a 5 point scale, with a score of “1” meaning that the nurse almost never does

the behavior when checking on patients (less than 20 percent of the time), a score of “2” meaning

that the nurse rarely does the behavior (21 – 40 percent of the time), a score of “3” indicating that

the nurse sometimes does the behavior when checking on patients (41 - 60 percent of the time), a

score of “4” meaning that the nurse does the behavior often (61 – 80 percent of the time), and a

score of “5” meaning that the nurse almost always does the behavior (over 81 percent of the

time). The following statement is an example of a “Daily Behaviors” item: “The nurse checks to

make sure that the medication dosage is correct.” Another example item for this section would be

“The nurse checks patient files to make sure that the correct patient is being treated.”


The scoring anchors for both “Adaptive Nursing Performance” and “Team Performance”

will consist of a 5 point scale. Scale anchors for each section are: “1” representing an

“Unacceptable” rating, meaning that work performance fails to meet standards for the required

task; “2” representing “Needs Improvement” which means work performance is inconsistent to

standards for the required task; “3” representing a “Satisfactory” rating which means work

performance meets standards for the required task; “4” representing a “Good” rating which

means work performance is above standards for the required task and “5” representing an

“Excellent” rating which means work performance consistently exceeds standards for the

required task. For Adaptive performance an example performance item would be “Please rate

employee’s performance during crisis situations.” An example of a Team Performance item

would be “Please rate how well the nurse works in teams.” For examples of the scoring anchor

descriptions for these items, see Appendix A. The forms will also have a comments section after

each item (in each section) and at the end of the form so that justifications can be made for the

given ratings.

The critical incident form will be a paper form so that those filling them out can quickly

access and write down the important details. Many research articles have found that memory

recall tends to decrease as the time between an event and having to remember the event increase

(e.g., Flin, Boon, Knox, & Bull, 1992). This is especially problematic for recalling critical

incidents after they occur and an electronic form would likely lead to longer delays between the

event and the reporting of the event. The form can be found in Appendix B. The patient feedback

survey will also be a paper form given to the patient before their discharge from the hospital.

Any type of customer feedback survey is difficult to get people to fill out, and it becomes even

less likely the longer they wait to fill it out. An electronic form would likely lead to only a few


responses. It is also important to remember that Grady tends to cater to lower-income patients

with less educational background. Internet surveys tend to be best when the form is more

complex (Taylor-Powell & Hermann, 2000). The survey will include a five point Likert scale

and contain statements that they can agree with concerning the care they received from their

nurse. A score of “1” equals strongly disagree, “2” equals disagree, “3” equals neutral, “4”

equals agree, and “5” equals strongly agree. An example item would be “My nurse was friendly

towards me.”

The use of supervisor ratings is suggested because supervisors tend to see how nurse

performance impacts the hospital on an organizational level. They are also made aware of any

and all incidents that occur in the hospital, so they would have files of important performance

records for the nurses. The use of supervisory ratings will require supervisors to watch the

behaviors of the nurses and their performance in adaptive and teamwork situations, but that is a

small sacrifice needed to ensure that the nurses are exhibiting good job performance. Without

this sacrifice, these ratings will be nothing more than speculation at best. Nurse self-reports will

also be utilized because even though the supervisors should be aware of most of the situations

occurring in the hospital, they cannot always be around. It follows that because the supervisors

cannot be everywhere, they are not able to see all aspects of nursing performance. By having the

nursing input in the system, the nurses are more likely to feel that not only do their opinions

matter, but that the system is fair and inclusive. The reason for having both measures is so that

any performance gaps can be found. This will help in determining whether any additional

training is necessary and also help to determine whether there are other factors that are impacting

any rater discrepancies. The use of critical incident tracking will also be utilized in the

performance system because they will provide adequate source of documentation of both


exceptional and poor performance. The critical incidents will be a major factor used by Human

Resources to determine whether an appeal has any merit. The documentation of critical incidents

will mostly be used as a source of data for any needs analyses and also for employee

development. Finally, patient survey feedback will also be considered in the system. However,

these will only be used for the purpose of employee development; no administrative decisions

will be made based on patient feedback. This allows Grady to get a perspective of how nurses are

viewed by the people who they serve. Most patients do not have the expertise in nursing to

accurately evaluate nurse performance, but they are the reason for having nurses in the hospital.

As such, their feedback is important so that Grady can help nurses become more helpful to the

patients.

However, it should be acknowledged that there are advantages and disadvantages

associated for each method of information gathering. One advantage of having the supervisor

ratings is that they are aware of the employee’s work in relation to organizational goals which

allows for a more meaningful evaluation. One disadvantage of the supervisor ratings is that there

is the possibility of personal biases against some of the nurses that could impact the feedback

given. The nurse self-report has an advantage in that the nurses tend to keep track of their good

performance so their good work is not likely to be lost in the appraisal process. One disadvantage

of the inclusion of self-report is that the nurses are likely to be more lenient in their ratings; some

purposely, some by ignorance, and some by incidental overestimation. For critical incident

tracking, one major advantage is that it will provide documentation that can be used in evaluating

nursing performance. However, the disadvantage of using critical incidents is that most of the

performance tracked will probably be examples of poor performance. Good performance may

get lost in critical incident tracking, but that possibility is the reason other forms of evaluation


are being included in the performance system. Patient survey feedback has the advantage of

giving the “customer” a voice that allows their opinions to be heard and addressed. Since the

patients are the focus of Grady Hospital, it is imperative that they be able to state their opinions

and help in the nurse development mission. One disadvantage of patient surveys is that they do

not expertise in nursing practices and so their perceptions of how well something is done and the

actual performance could differ. It is for this reason that patient feedback is being used solely for

the purpose of employee development.

In the system, Frame of Reference (FOR) training will be used to minimize potential

rating distortions for the supervisors in their ratings and the nurses in their self-reporting

(Gorman & Rentsch, 2009). The FOR training will be done with practice dummies because using

real people could result in legal problems. The training would occur before the performance

system is implemented and would occur annually afterwards. FOR training allows the

supervisors and the nurses to see what different levels of performance look like for each task.

This should minimize the rating distortions because both the nurses and the supervisors will be

taught how to accurately assess performance. They will both also see what the expectations of

Grady Hospital are. The supervisors would attend training and the nurses would attend a separate

training covering the exact same performance topics to allow openness in the training sessions

for both parties. In order to minimize rating distortions for the critical incidents, supervisors will

be strongly encouraged to document examples of excellent performance by each nurse. By

giving this strong suggestion, it gives the supervisors the idea that Grady is looking for instances

of both positive and negative incidents in the documentation. The feedback that comes from the

patient surveys will be hard for Grady to minimize rating distortions. It is for that reason that the

best way to minimize the consequences of any possible distortions is to limit what decisions are


made with the information. The survey feedback will only be used for developmental purposes

because employees may not give accurate ratings.

The appraisal periods in the performance system would be every six months due to

importance of job and consequences of having poor performers working in their setting. This

allows the supervisor to avoid filling out a lot of forms at the same time. The two appraisal

periods allow the supervisor to break up the workload during both periods. This also would be

helpful for the nurses because if a nurse has one “off-period,” then it would not be the only

performance evaluation on their record for the year. However, it should be noted that having

more frequent periods would give supervisors less time to perform their own responsibilities,

which will require sacrifices from Grady.

Performance evaluation meetings will be conducted by the supervisors within one week

after each six month period ends. One supervisor will conduct the meeting with one nurse. The

reason for this is that having multiple individuals in the meeting could be threatening for the

employee, or may even give the nurses motivation go into the meeting with a defensive mindset,

which would likely hurt the effectiveness of the meeting. All supervisors will conduct evaluation

meetings with the nurses they directly manage. In the meeting, the supervisor will go over the

data that comes from each of the four information sources being considered in the appraisal with

the nurse (supervisor rating, nurse self-report, critical incident documentation, and patient

feedback).

There are a few considerations that will be strongly encouraged by Grady for the

supervisors when they are conducting the performance evaluation meetings. The first

consideration that will be taken is that nurses will be given a chance to express any concerns they

have with their ratings. This will allow the meeting to be interactive, so that the nurses not only


feel like a part of the process, but actually become a part of the process. Mutual goal setting will

also be strongly encouraged so that the needs of Grady Hospital and the nurses are met

simultaneously. The supervisor will explicitly ask the nurse what their personal work goals are

because this shows concern for the staff and helps in employee development. For instance, a

nurse’s poor rating on a particular factor of performance could be the result of a lack of

stimulation in their current work. The third consideration is that the nurse and supervisor will

sign a paper indicating that the meeting occurred and that the goals were mutually created by

both meeting participants. The fourth consideration that will be taken is that the supervisor will

give both positive and negative feedback in combination. A meeting with only one type of

feedback is not beneficial to the nurse or to the hospital. Steps for improvement will also be

given by the supervisor to the nurse regardless of how well the nurse is doing. If the nurse has

excellent performance on all of the aspects of job performance measured, then the focus of the

feedback will turn to employee development.

Nurses will have the opportunity to appeal their ratings if they so choose. The first step in

the appeals process is for Human Resources to review the complaint to determine whether it has

merit, which will be determined by a majority vote by 7 members of the human resources

department. If the nurse’s complaint does not have any verifiable merit, then the nurse will be

told that the appeal will not go forward. From there, the nurse will be allowed to appeal this

decision, but the responsibility of proving that the appeal has merit will shift from Human

Resources to the nurse. The standing of the initial decision will be solely based on the Director of

Human Resources during the second appeal. If the appeal is still determined to not have merit

then no more appeals will be allowed for the particular situation. If the complaint is determined

to have merit (whether during the initial or second appeal), then Human Resources will attempt


to resolve the issue by gathering both, the supervisor and the nurse together while gathering all

of the relevant information (e.g., past performance appraisals, customer satisfaction trends and

possibly other supervisors, etc.). The goal of the meeting will be to create a mutual agreement

from both sides. If it is, then the solution that is agreed upon will be implemented. If a resolution

is not possible, then the appeal will be taken to unbiased arbitrators. The arbitrators would form

an independent panel that does not directly impact the day to day job of either the nurse or the

supervisor. The decision that is reached by the independent panel will be the final word in the

process.

A successful performance management system is extremely important to evaluate how

well the nurses are performing. In order for the performance system to run smoothly, Grady has

to ensure that the factors are being measured correctly, with the objectives and goals being met.

For this PMS, the appropriateness will be evaluated by several indicators. The first indicator is

whether employees have been trained before PMS implementation because employees should

not be measured on a task they have not been trained to do. The goal is to eliminate any instances

of criterion contamination beforehand. The next indicator is whether all of the performance

management activities have been completed. The performance system will evaluate whether all

supervisors have completed the performance management forms for all of nurses they supervise.

The HR department should have these forms on file for evaluation. If the departmental heads

(supervisors) are not completing performance reviews, this could indicate a deficiency in the

performance system in terms of content. The PMS will also be evaluated on the improvement of

nurse behaviors and whether the nurse has achieved their necessary performance objectives and

goals. Grady’s PMS will have to comply with all legal statues and regulations. The PMS will

evaluate the depth of such compliance in terms of updated information and the rights of the


nurses to make changes against performance appraisal results, as well as to protect the hospital

from such charges.


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Appendix A

Daily Behaviors Statement Never Rarely Sometimes Often AlwaysThe nurse checks to make sure

that the medication dosage is correct

<20 percent of the time

21 – 40 percent of the time

41 - 60 percent of the time


>81 percent of the time

The nurse checks

patient files to make

sure that the correct

patient is being treated

<20 percent of the time


41 - 60 percent of the time


>81 percent of the time

Adaptive Nursing PerformanceStatement Unacceptable Needs

ImprovementSatisfactory Good Excellent

Please rate employee’s performanc

e during crisis

situations

Nurse is completely unable to

control their emotions. Nurse’s presence creates

situational chaos. Nurse

causes disturbances

for all relevant parties

involved in the situation.

Nurse has difficulty remaining calm and

taking control of the

situation. Nurse adds

to the situational

chaos. Nurse causes

disturbances for most of the relevant

parties involved in

the situation.

Nurse composure is barely

more calm than

stressful. Nurse does not reduce

the situational stress, but does not add to it either.

Nurse is able to calm some of the

relevant parties

involved in the

situation.

Nurse exhibits

good composure

and situational

control. Nurse creates

order in the situation. Nurse can

mostly calm most relevant parties

involved in the

situation.

Nurse exhibits complete

composure and

situational control.

Nurse is in complete control of

the situation. Nurse can completely

calm all relevant parties

involved in the

situation.


Team PerformanceStatement Unacceptable Needs

ImprovementSatisfactory Good Excellent

Please rate how well the

nurse works in teams.

Nurse is unable to work with any other nurses and

the supervisor.

Nurse refuses to hear

different views/ideas.

Nurse refuses to resolve conflict.

Nurse is unable to work with

most nurses and/or the supervisor.

Nurse grudgingly listens to different

ideas/views. Nurse must be highly

encouraged to resolve conflict.

Nurse can manage to be cordial with other team

members and the

supervisor. Nurse listens to different ideas/views. Nurse can

reach a resolution to

conflict.

Nurse is able to work in harmony with most nurses and

the supervisor.

Nurse openly listens to different

ideas/views. Nurse

resolves conflict

effectively.

Nurse works in harmony

with all nurses and

the supervisor.

Nurse openly listens to and encourages

different views/ideas.

Nurse resolves conflict

quickly and effectively.


Appendix B

Grady Memorial Hospital Nurse Critical Incident Report

Date of Incident: __________________ Time of Incident: _________________

Name of Nurse Involved: __________________________________________

Type of incident (Circle one):

Exemplary Performance Behavioral Error Procedural Error Other:___________________

Describe the incident as specifically as possible:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Name of Person Reporting: ______________________ Position: ______________________

Signature: ____________________________________ Date: _________________________

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