2021-2022_Self_Performance_Evaluation_Form.pdf

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ANNUAL PERFORMANCE REVIEW Self-Review

TEAM MEMBER NAME: ________________________________________________________

JOB ROLE: ___________________________________________________________________

WHAT TO EXPECT THIS YEAR:

• Reflection and conversation prompts

• Simplified, high-level ratings for: 1. Job Performance, 2. Service Values, and 3. Final Rating using the scale of Exceeds, Meets Plus, Meets, Meets Minus, Does Not Meet

• Additional, unrated questions that promote reflection and conversation on engagement, well-being, and development

Learn more about the why behind question prompts, get suggestions, and see examples… Education, background, and support materials are available throughout this form. Look for clickable icons for additional guidance, or scan QR Codes with your mobile phone if you printed the form.

Manager’s and Self-Evaluator’s guides are on Pulse to help with making the most of your review conversations and identifying development opportunities: Pulse > Training (Green Top Pages Icon) > Talent & Performance Management >Performance Management.

Instructions: 1. Save this form to your computer with your initials added to the end of the file name (e.g., Jane Ann Doe would save

as 2021-2022_Performance_Review-JAD).

2. Reflect on your past year’s performance and add your comments on the following pages. Be concise; the reflection questions are to prompt conversation. If you need additional space, you can use the “Additional Comments” section on the last page or add comments to a Word document.

3. Save and send the form and any additional comments to your manager. Your manager will review it, add their thoughts, and then arrange a time for discussion with you.

4. After your performance discussion, you and your manager will sign the form. Your manager will provide you a copy of the completed form and add a copy into your personnel file. If you do not have easy access to a computer, you may print the form and write in your responses to give to your manager.

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JOB PERFORMANCE Team Member: Consider your current key job responsibilities. Please provide a summary for each of the prompts.

Manager: Provide comments on the following page. If helpful, you and your team member may reference job descriptions. Job Descriptions are available on the Shared drive (Shared Drive>Doc-Dist>NorthShore Documents>Human Resources>Job Descriptions).

Note: The italicized prompts are things to consider if you need help completing those sections.

1. Describe your overall job performance. Highlight specific accomplishments and outcomes. Click the link or scan the code for guidance on what makes a self-evaluation effective and how to write one. How have you contributed to achieving departmental goals, such as quality improvement, financial, or patient experience goals? Have you received recognition for your work including Service Values or Loyalty Leader awards?

2. Share an issue or challenge that you faced in your role during the past year and what you did to try to reduce or resolve the issue. Were your attempts successful? If not, what could you have done differently? What did you learn from this experience that you can use in the future?

3. Describe how effectively you worked with teammates or with other teams. How did you contribute to the success of the team? What are opportunities to do better when working with others?

TEAM MEMBER COMMENTS (REQUIRED)

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JOB PERFORMANCE Click the link icon or scan the QR code to view how NorthShore leaders apply ratings to job performance for several sample job roles.

Considering your answers on the previous page, how would you rate your overall job performance?

Note: Descriptions below provide guidance but in no way reflect all performance or behaviors.

Exceeds: Consistently exceeds role expectations. Performs all of the behaviors from Meets Plus AND significantly contributes towards the achievement of department goals and innovation; if clinical, may also lead efforts to improve patient care. To achieve this rating, performance impact should be objectively measurable, such as through outcomes of documented goals.

Meets Plus: Often exceeds role expectations and behaviors from Meets AND takes on additional responsibilities without being asked. Proactively seeks ways to improve performance, processes, and support team and department goals.

Meets: Consistently does a great job and meets all role expectations; may occasionally exceed role expectations. Performance contributes to excellent patient care and/or supports department, unit, or team goals.

Meets Minus: May meet some role expectations, though still needs to develop and significantly improve in some areas. Shows willingness to improve.

Does Not Meet role expectations and may be resistant to feedback or efforts to improve. Has documented behavioral or performance issues such as a Corrective Action or Performance Improvement Plan (PIP).

Select a rating from the dropdown list in your corresponding field below:

JOB PERFORMANCE VALUES RATING TEAM MEMBER SELF RATING MANAGER RATING OF TEAM MEMBER

ADDITIONAL TEAM MEMBER COMMENTS (IF NEEDED) MANAGER COMMENTS (REQUIRED)

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CORE VALUES NorthShore’s Service Values and Always Behaviors are foundational elements of how we treat one another and the patients, families, and visitors that we serve. These core values are expected of every team member. If you are not in a patient facing role, consider the Always Behaviors in the context of your immediate team members, other departments, and external customers.

Click the link icon or scan the QR code to view sample descriptions of Service Values by Performance Ratings.

Service Values • Exceptional Customer Service: Focus on Empathy, Communication, and Compassion• Supportive Workplace Interactions: Focus on Teamwork and Positive Outlook• Professional Work Ethic: Focus on Integrity, Initiative, and Results

Always Behaviors • Welcome each patient by initiating a greeting, calling them by proper name, acknowledging friends/family, stating your

name and role• Explain what you are going to do, how long it will take, and the impact on the patient; explain reason for delays• Connect by initiating conversation that is sensitive to the patient’s demeanor; seek to learn something about the patient as

a person• Anticipate patient needs, concerns, questions; ask what you can do to further assist• Reassure – provide reassurance; respond promptly and courteously to requests and questions• Exit with a warm closing statement, and transition to the next member of the care team with information of what will come

Consider your interactions with your team members, members of other teams, patients, families, and visitors. How would you rate yourself? Note: Descriptions below provide guidance, but in no way reflect all performance or behaviors.

Exceeds: Fulfills all qualifications of Meets Plus AND goes out of their way to put others at ease. Proactively looks for ways to assist others and leads efforts to improve processes. Demonstrates outstanding integrity and empathy. Overwhelmingly positive feedback from team members, patients, families, and/or visitors. Meets Plus: Fulfills all qualifications of Meets AND takes on additional responsibilities without being asked to assist team members, patients, families, and/or visitors. Consistently anticipates customer needs and proactively seeks to help.

Meets: Consistently does a great job and exhibits all Service Values with team members, patients, families, and/or visitors, and may occasionally exceed expectations. Performance contributes to excellent patient care and/or supports department, unit, or team goals. Receives positive feedback from team members, patients, families, and/or visitors. Meets Minus: May do well in some Service Values behaviors, though still needs to develop and significantly improve in some areas. May have received negative feedback regarding Service Values. Does Not Meet Service Values expectations and may be resistant to feedback or efforts to improve. Consistently receives negative feedback for behaving unprofessionally or refusing to follow policy or procedure. Has documented behavioral or performance issues (e.g., Corrective Action, PIP).

Select a rating from the dropdown list in your corresponding field below:

CORE VALUES RATING TEAM MEMBER SELF RATING MANAGER RATING OF TEAM MEMBER

TEAM MEMBER COMMENTS MANAGER COMMENTS (REQUIRED)

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WHAT MATTERS TO YOU? What matters to you also matters to NorthShore. By understanding what matters to you, we can identify opportunities where your personal goals and values align with the organization’s mission, vision, and goals.

Note: Questions on this page do not affect your rating. Click the video icon, scan the QR code, or visit your user guide to learn more about why we included this section. There is additional information for each question in your user guide.

Before you begin, how would you describe where you are today in your role?

New/still learning my role Satisfied in current role/developing in place Looking for stretch opportunities

INSTRUCTIONS: Pick 1 of the following topics to discuss based on what matters to you and how this could positively impact your work experience and engagement. You may also choose to discuss something else that is important to you, which isn’t listed.

• What do you find most exciting, rewarding, or are most proud of in your work at NorthShore that you would liketo do more often?

• Would you like help understanding how your role contributes to the organization’s mission, vision, and goals?• What support do you need? Share concerns and/or ideas you have for your wellbeing at work.• Are there work goals you would like to accomplish in the coming year for which you need support?• What development opportunities would you like to receive to help you progress in your role or career?• Are there areas within your department where you would like to take on more responsibility or try new tasks,

and what assistance do you need to do so?• Are there ideas you have for improving processes that you would like to share and possibly try to implement?

TEAM MEMBER COMMENTS

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FINAL PERFORMANCE RATING RATINGS SCALE DEFINITIONS

Does Not Meet Highly inconsistent or

doesn’t display desired qualifications

Meets Minus Needs improvement or additional skills to meet

role expectations

Meets Expectations Consistently well-done, expected performance

Meets Plus Strong performance,

often “above & beyond”

Exceeds Expectations Role model with exceptional

performance (Must be rated Exceeds in both Job Performance and

Core Values, and AVP signature required)

• Ability to meet roleexpectations ordocumented goalsvaries widely

• Inconsistentlydemonstrates CoreValues

• May showunwillingness orinability to improve

• Has documentedperformance orbehavioral issues(e.g., CorrectiveAction, PIP)

• Meets some, but notall documented goalsor role expectations

• Demonstrates CoreValues most of thetime

• Shows somewillingness to improveperformance

• Successfully meets alldocumented goals androle expectations andmay on occasionexceed expectation

• Consistentlydemonstrates CoreValues

• Contributes to successof the unit,department, or team

• Fulfills allexpectations ofMeets rating, and

• Regularly contributesto department goals;improves andinnovates workpractices

• Takes on additionalwork without beingasked and sharesknowledge

• Fulfills all expectations ofMeets Plus rating, and

• Consistently exceeds alldocumented goals androle expectations

• Considered expert androle model by others;always contributes todepartment goals;improves and innovateswork practices

• Solves big problems andfinds new opportunitieswithout needingdirection

You can also use the chart below to help determine Final Rating based on Core Values and Job Performance ratings.

EXAMPLE: to receive an Exceeds as a Final Rating, both Job Performance and Core Values ratings must be Exceeds.

Job Performance Rating (from page 3)

Does Not Meet (DNM)

Meets Minus (MM)

Meets (M)

Meets Plus (MP)

Exceeds (E)

Core

Val

ues

Ratin

g (f

rom

4) Does Not Meet (DNM) DNM DNM or MM* MM MM MM

Meets Minus (MM) DNM or MM* MM MM OR M* M M

Meets (M) MM MM or M* M M or MP* MP

Meets Plus (MP) MM M M or MP* MP MP

Exceeds (E) MM M MP MP E

* Manager discretion can be used.

Self Manager

Job Performance

Core Values

FINAL RATING:

I ACKNOWLEDGE THAT I HAVE READ THIS PERFORMANCE EVALUATION IN ITS ENTIRETY AND HAVE BEEN PROVIDED THE OPPORTUNITY TO DISCUSS IT WITH MY MANAGER. MY SIGNATURE ACKNOWLEDGES THAT I HAVE RECEIVED A COPY OF THIS PERFORMANCE EVALUATION BUT DOES NOT NECESSARILY REPRESENT MY AGREEMENT WITH THE CONTENT CONTAINED WITHIN.

TEAM MEMBER SIGNATURE:______________________________________________________________DATE:_______________

MANAGER SIGNATURE:__________________________________________________________________DATE:________________

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ADDITIONAL COMMENTS

ADDITIONAL TEAM MEMBER COMMENTS (IF NEEDED)

ADDITIONAL MANAGER COMMENTS (IF NEEDED)