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 Always
The 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
61 – 80
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
21 – 40
percent of
the time
41 - 60
percent of
the time
61 – 80
percent of
the time
>81 percent
of the time
Adaptive Nursing Performance
Statement Unacceptable Needs
Improvement
Satisfactory Good Excellent
Please rate
employee’s
performance
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 Performance
Statement Unacceptable Needs
Improvement
Satisfactory 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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