RS MGMT Chapter 9 Performance Management in Health Information Management

Performance appraisals are an important component of the entire performance management ecosystem within a healthcare organization.

-These appraisals provide confirmation of an employee's performance by providing standardized documentation that allows for individual performance comparisons from year to year and allows for comparisons between individuals with similar jobs. -They provide a common basis for evaluating an employee's promotion readiness by reflecting on competency and job task mastery for particular jobs. -Performance appraisals provide standardized documentation on an employee's soft skill ratings, their ability to work in teams, and their ability to meet or exceed competency standards throughout the evaluation period. -Open the communication lines between an employee and manager by allowing the employee to provide a self-appraisal and develop individualized goals for the next evaluation time period. -Reflect individual training and development needs particularly if an individual does not accomplish select job tasks efficiently or effectively. -Help the employee develop goals that will allow him or her to achieve success at a higher level or be promoted when training and development needs are identified specific to the goals. In turn, a performance appraisal can reflect the outcomes of training and development programs when an employee demonstrates improved completion of particular job tasks that were the focus of the training programs.

Pay for Performance: Pay for performance impacts performance in two ways: incentive effect and sorting effect.

1. The incentive effect relates to how pay influences the level or intensity of individual motivation toward job performance. 2. The sorting effect relates to the effect of pay for performance on the composition of the actual workforce. Different pay systems may attract different job applicants, and it may be more difficult to maintain employees within a strictly pay for performance work environment

The sources of performance data for HIM job tasks are typically work sampling and benchmarks.

1. Work sampling is a statistical method that reviews a select portion of tasks performed and provides baseline data for further job performance assessment. ex: the average time for completion of coding an inpatient record, Work sampling then takes into account the quantity of activities that can be completed within a certain time frame. This aggregation of work sampling provides the framework for a performance standard for the particular activity. 2. Benchmarking is a measurement that takes into account the quality aspect of completing a job task from start to finish. Benchmarks can be developed internally within an HIM department or can be solicited externally from professional organizations or other similar healthcare organizations. The measurements are based on aggregated data and provide an average job standard against which all employee performance is measured for the particular job tasks. Standard performance measures may need to be recalculated when new processes are integrated into a job or when there is a significant shift in the amount of work to be completed. These standards are shared with new employees upon hire and are incorporated into the annual performance appraisal. page 184 for Table examples

Employee Performance Improvement Plans

An employee performance improvement plan (PIP) is initiated whenever an individual's job performance is substandard or the employee violates a departmental or healthcare organizational policy. The PIP—a strategic roadmap for the employee to utilize to achieve more positive results within his or her job—begins whenever a manager identifies that an employee is performing below the expectations for a particular job standard(s). The focus of improving employee performance can reflect two methods of thought or a combination of both-either by altering an employee's weaknesses or reinforcing performance by focusing on the employee's strengths. Focusing on employees' strengths can result in a positive work climate and can result in motivated employees who perform above and beyond average. -Developing strength-based performance improvement goals can result in motivated employees who strive to meet performance standards. -Employees should receive regular communication on how job standards are being met or not being met. -An example of this in the HIM department is that coders are expected to maintain a level of coding productivity (quantity) and quality. --Whenever a coder falls below the required standard for coding productivity or quality, the coding manager should identify whether this is a trend or a single event. If substandard performance in either productivity or quality becomes a trend for the coder, the coding manager should initiate a PIP.

Job Complexity

Another aspect that affects job performance is job complexity. Complexity is the quality or condition of being difficult to understand or lacking simplicity. The greater the level of job complexity, the more difficult is it is for an employee to acquire the skills necessary to perform the job. Additionally, the more complex the job tasks, the more time it takes for employees to adequately perform these tasks. There are two distinct stages of job performance development: the transition stage and the maintenance stage. -The transition stage occurs when an employee starts a new position or when tasks and responsibilities are changed. The more complex a job, the longer the employee may remain in the transition stage, which in turn affects individual and overall workgroup performance. -The maintenance stage occurs when an employee is sufficiently trained and the individual is using well-learned and developed processes but needs to learn a new technique in an established process or should receive a refresher course about these processes. When evaluating job performance, it is important to take into account the employee's stage of development and ensure that performance goals are aligned with the employee's skills and abilities The HIM role that is most highly impacted by job complexity is that of an HIM coder, who is required to learn multiple new classification and nomenclature systems as well as multiple electronic health information systems and applications.

Completion of the Performance Appraisal Document: Measuring Performance with Qualitative and Quantitative Data

At the completion of the performance appraisal, qualitative and quantitative data will be analyzed for each job task (as appropriate) and employee performance will be aggregated for the year. Qualitative performance data describes the qualities or characteristics of an employee's job tasks, such as accuracy of ICD-10-CM/PCS code assignment or inclusion of the appropriate forms within an ROI request. Quantitative performance data describes the actual number of tasks completed within certain timeframes, such as the number of inpatient charts coded per hour or the number of ROI requests processed per day. Each job performance standard that has quantitative or qualitative scores attached will be aggregated and an overall score for job performance standards and goals will be given to the employee. see image Performance appraisals will also include other items for evaluation, and many of these items are standardized by the healthcare organization. One section may delineate specific employee values that match the mission and vision of the organization such as is the employee respectful, honest, or reliable, works as a team player or not. It is important that the HIM manager understands how these values can be objectively exhibited by employees and how the manager can assess these values during the performance appraisal process.

Working from Home

Best practice guidelines for at-home (remote) office setup should be developed by the HIM manager. When the employee first sets up the home office, the HIM manager should perform a site visit in-person or virtually to ensure the office is set up appropriately. Distractions in a remote work environment are not as easy to quantify and their bearing on employee performance is not as evident as when the HIM employee works within the HIM department or other departments within the healthcare organization.

The contingent reward leadership style has been found to be an excellent deployment method for ensuring that managers and employees are on board with the outcomes of annual performance appraisal.

Contingent reward leadership is "an active and positive exchange between employees and managers whereby employees are rewarded or recognized for accomplishing agreed-upon performance objectives" (Reb and Greguras 2010). This type of leadership can contribute to employees' belief in performance rewards that are provided by annual merit pay raises as it engages employees directly in the performance appraisal process.

Performance Appraisal Methods: Forced Ranking

Forced ranking or forced distribution is starting to appear more frequently in healthcare organizations when in the past it was often utilized inside larger corporations such as major energy and car companies. Forced ranking ranks employees in terms of forced allocations, meaning that only 10 to 20 percent of the employees' performance will fall into the higher levels of job performance, 70 to 80 percent will fall into the middle ranges of job performance, and the rest will fall into the lowest levels of job performance. The high, middle, or low levels of performance ratings are based on the aggregate performance standard scores calculated within annual performance appraisals. For example, based on the job standard scoring outlined in figure 9.2, a high level of job performance would be an aggregate score of 3.5 to 4; a middle-range job performance would be an aggregate score of 2.5 to 3.49; and the low range of job performance would be an aggregate score below 2.5. Employee increases for the next year would be based on the forced ranking allocation—high-, middle-, or low-range job performance. In addition, the department or workgroup will only be allowed to have so many employees fall within each range of job performance regardless of how well each individual performs. Advantage: -it forces management to really assess personnel performance and categorize the employees who are the highest performers versus those who are the lowest performers. -creates and sustains a high-performance culture in which the employees continuously strive to improve performance. Disadvantages: -it can harm morale, discourage collaboration and teamwork, and it can create a more competitive or cutthroat workforce. -The forced ranking system results in a heightened focus on individual performance rather than on the importance of teamwork. - This methodology can be a detriment to employee morale because it forces managers to rank employees on a scale and against one another rather than just on objective performance. This could result in negative work outcomes because the forced ranking requires the manager to rank employees higher than others even when the overall team is performing at a high level

Performance Appraisal Methods: Graphic Rating Scales

Graphic rating scales are the most common methodology employed in HIM departments. Checks or monitoring are conducted on an employee's performance throughout the performance cycle. The content of the performance monitoring includes quantity of work, quality of work, dependability, judgment and critical thinking, cooperation, and initiative or motivation. Rating scales are assigned to each key performance indicator and a typical scale Advantage: -Graphic rating scales take less time to develop than other more subjective evaluation types. -Quantitative comparison of job performance can be performed within each segment of the performance cycle or against the previous year's job performance for individual employees. Disadvantage: -scoring can vary between managers, or managers can vary how they use the scoring for each individual employee -Common rater errors often appear when using graphic rating scales and the most common rater errors are: • Halo effect: The rater subjectively assesses all performance for an employee as either positive or negative based on one specific aspect rather than the performance overall. • Central tendency: The rater feels that the performance of all employees should be rated as average rather than objectively assessing each employee individually. • Leniency or strictness: The rater subjectively leans toward being more tolerant or rigorous when evaluating employee performance. • Bias or similar-to-me: The rater judges the employee's performance on how similar the performance is to the rater's own performance..

Improving employee performance is an important component of an HIM manager's job role.

HIM managers should consistently review employee performance against job performance standards on a regular basis (daily, weekly, or monthly) and communicate these results to all employees via a standardized communication method such as a confidential email or weekly individual meetings. HIM managers and employees should work together to develop strategies for improving job performance both individually and as a workgroup.

Based on periodic reviews throughout the performance appraisal period, an employee should understand what to expect in the outcome of the year's performance appraisal.

If he or she has had a variable performance year, he or she will then understand the appraisal may not result in the optimal pay increase or desired promotion. Often employee performance improvement plans are required if the employee's job performance is suboptimal. If an individual's performance necessitates improvement at any time during the appraisal cycle, an employee improvement plan should be initiated.

Task or Workflow Interdependence in the Workplace

If the necessary resources are not located centrally to all employees completing the job tasks, job performance can be hindered. With the advent of electronic health records, the physical interdependence of job tasks is not nearly as important to completion of HIM jobs as in the past. It still is optimal for those individuals who complete similar tasks within the HIM department to be physically located near one another, but if this is not possible, electronic tools such as email and instant messaging can eliminate communication gaps between individuals who are not physically next to one another.

Completion of the Performance Appraisal Document

In healthcare organizations, the HR department is responsible for maintaining standardized performance appraisal documents that are utilized by everyone throughout the organization. One of the performance objectives for most managers is that all employee performance appraisals are completed in a timely manner according to the healthcare organization's policy. Managers must follow the standardized processes to ensure that fair and consistent appraisals are performed on a regular basis. Most healthcare organizations utilize systems that impact an employee's pay so it is imperative the manager can provide evidence that supports the increase or denial of increase in pay based on the annual performance appraisal.

Self-evaluation of Performance

In order to engage employees during the performance appraisal life cycle, employees should be involved in assessing their own performance on a regular basis. A good performance appraisal allows employees to regularly provide feedback and input on their performance. The feedback should be related to the goals set by the employee and management at the beginning of each annual performance appraisal cycle. It is important that each employee takes the initiative to write an accurate and reflective self-assessment of job performances as this is a way to improve the relationship with his or her manager. This process opens and improves communication between the manager and the employee and provides the manager with valuable insight regarding the employee's initiative. Standardized forms should be used for collecting self-assessments, and the employee's self-assessment should be a component of the formal performance appraisal.

Performance Appraisal Methods

It is the responsibility of the HR department along with senior leadership to develop the performance appraisal methodology most appropriate for that healthcare organization. The six most common methods: 1. Critical Incident Method 2.Graphic Rating Scales 3. Essay Evaluation Method 4. 360 Performance Appraisal 5. Forced Ranking 6. Management by Objectives

In evaluating employee performance, it is important to understand the impact of different factors that may enhance or hamper employee performance.

Job engagement in terms of physical, emotional, and cognitive components influences job performance. Engagement relates closely to predicting job performance in terms of job involvement, job satisfaction, and intrinsic motivation (the employee's inner drive to perform). In terms of job performance, one aspect that can engage employees from the start of employment is developing goals and standards that are congruent with the employee's motivations. If an employee relates to the goals, the individual will more likely perform the tasks adequately or exceeding what is expected

Performance Assessment

Job performance has a dynamic component in which employees can experience either short-term or long-term variances in job performance. While employees may experience variances in job performance over the years, their perception may be tainted in that they feel their performance remains stable over time. It is important to assess individual job performance regularly, as required by the job, so variances in productivity or quality of tasks are caught early on. Examples: An HIM coder's productivity and quality should be assessed on a weekly basis to monitor varying trends as they occur, while a coding manager's performance would be assessed on a monthly basis as she reports the coding areas productivity and quality to her manager. An example of a job variance in the HIM department would be when a document imaging specialist's quality decreases for a month or two (short-term variance) or when his or her productivity for the year does not match the previous year's overall document imaging productivity (long-term variance).

Job Experience

Job performance is also impacted by the relationships between job experience, organizational tenure, and age. Job experience is the accumulation of job knowledge from action and practice and is linked to the tasks and duties associated with a particular job. Job experience leads to the amassing of relevant knowledge, skills, and abilities that should positively impact job performance. HIM managers need to develop different management skills to address the changing HIM workforce, such as managing remote workers and a diverse workforce of individuals who have varying levels of HIM technological skills. Job experience was often a relatively stable factor for HIM professionals but now job performance variability is occurring for HIM professionals at all stages of their career.

Performance Appraisal Methods: Management by Objectives

Management by objectives (MBO) addresses the assessment of performance at the management level. MBO is a management approach that defines target objectives for organization work and compares performance against those objectives. MBO is a participative approach to performance and requires goals and objectives to be defined by management-level employees to provide a framework for managing performance outcomes for a given time period. Often management teams within particular departments will have goals and objectives for performance that are interrelated and outlined in each manager's performance appraisal. Advantage: -Collaboration and teamwork within the management group is essential in order to meet the performance objectives. Disadvantage: If one of the team members within the particular management group fails to achieve a component of the goal, all of the team's performance objectives will be impacted and may result in a negative outcome for everyone

Noise in the Workplace

Noise in an office environment can aggravate the perception of the loss of privacy and can cause overstimulation for many individuals. Noise is any sound that is undesired or interferes with one's hearing of something or concentration. Critical thinking skills required for HIM jobs can be hindered by too much noise in the office.

Job Experience cont'd

Organizational tenure is an accumulation of work-related information from job experience and the information gathered is only relevant to the current organization climate or culture. With the multitude of mergers and acquisitions between healthcare organizations, organizational tenure is also a fluctuating factor that influences job performance as long-term employees strive to adjust to changing cultures and climate. Age is another aspect that can impact job performance. Aging impacts how all individuals function in the workplace, ranging from deterioration in motor coordination and strength, memory, reasoning, and cognition to the motivation for developing new job skills. Learning new skills or systems at any age can be challenging, so a multigenerational workforce offers many advantages in terms of sharing wisdom and skills for developing a career of lifelong learning.

Performance Standards

Performance standards measure work performance and the stated expectations for acceptable quality and productivity associated with a job or job function. Job descriptions are the basis for the development of performance standards as performance is measured against the job tasks outlined in job descriptions. Four dimensions of performance that should be measured in a performance management system and evaluated on the annual performance appraisal: - productivity - quality - timeliness - fiscal responsibility It is important for the HIM manager to develop processes for collecting performance data on a regular basis and sharing this information with individual employees on a regular basis.

Privacy in the Workplace

Personal space in terms of privacy and noise are environmental factors that can affect an employee's job performance. Privacy is the quality or state of being hidden from, or undisturbed by, the observation or activities of other persons; or freedom from unauthorized intrusion An employee needs to feel that there is some control over the amount of privacy that is experienced on a day-to-day basis.

Personalization and Identity in the Workplace

Personalization and identity are important particularly for employees who associate their workplace as not only the place to work but also a home-away-from-home. Personalization allows individuals to decorate or mark their workstation with items of interest (within reason) such as favorite quotes, family pictures, and sports team memorabilia. The personalization of a workspace allows employees to feel more at home and to work in a comfortable environment. -provides an outward identity for an employee. There is a connotation between the size of offices and the status of the individual who uses the office. -For example, the CEO of a large healthcare organization will most likely have a nicely decorated large office with windows; this provides an identity of authority for this individual.

Early intervention of variances in job performance allows management to intercede quickly and provide additional training, support, or resources as necessary to negate the variances.

Short-term fluctuations of job performance are often related to situational cues such as increased job complexity and issues related to resource allocation. Personal issues such as illness or loss of a loved one may also cause a variance in job performance.

There is a direct relationship between job satisfaction and job performance.

Situational strength, the cues employees experience in their workplace that allow particular job performance behaviors to occur, provides a link between job satisfaction and job performance as well. The climate of an organization can fluctuate from very strong to weak. In strong situations, there are uniform expectations and adequate incentives for job performance. Employees have a common framework and know what is expected of them. In weak situations, there are no uniform expectations and the organization does not offer sufficient incentives for performance. The situation is not construed the same by all employees and there is not a common framework for performance in place. Unconstrained (weak) environments do not offer the same amount of job satisfaction because employees do not feel the work performance parameters are outlined. The management style exhibited by a workgroup leader also impacts employees' perception of the situational strength

Spatial Density in the Workplace

Spatial density refers to the number of items within a specific area or space and for this discussion it refers to the square footage available to employees in a given work area. Negative side The more individuals there are working in a small area can result in the perception of overcrowding. Allowing no personal space for employees can result in overstimulation and provoke conflict and emotional reactions between employees, cultivating a negative work environment, and affect an employee's overall work performance. The positive side of having individuals performing similar jobs within a small area can result in improved communication and cooperation among workgroup members.

Performance Appraisal Methods: 360 Performance Appraisal

The 360 performance appraisal is a methodology most often used in conjunction with other more traditional methods such as graphic rating scales and critical incident methods. It measures the manner and capacity of work performance and concentrates on the more subjective areas of work such as teamwork, character, and leadership. The 360 performance appraisal method requires that employees obtain confidential and anonymous assessments from their colleagues. "360" implies that the entire picture of an employee's job performance can be assessed with this type of performance methodology. Advantage: -it provides a more comprehensive and accurate assessment of an individual's performance. -Employees tend to feel part of the entire performance appraisal process when they have the ability to provide feedback to both peers and management Disadvantages: -It is a time-consuming process and requires training both for administrators of the process and for those who are completing the evaluations. -An employee may select individuals to perform the 360 evaluations that will only provide positive feedback and avoid those peers and managers who may provide a more negative evaluation of the employee's performance. - It is very difficult for a manager to quantify the results, particularly if there is a great variance between the 360 evaluators in terms of the employee's performance.

Pay for Performance: Performance appraisal programs should be designed to account for the nature of job performance and build in dynamic performance ratings that take into account variable work performance

The HR department typically designs and implements pay for performance, but individual managers are responsible for the actual delivery of the program to their employees. Managers are the individuals in the organization who evaluate employee job performance and communicate the actual outcomes of the performance appraisal process. Ensuring all managers are trained on the use of the performance appraisal system upon hire and are updated when any changes occur to the system are key factors to the successful outcome of any pay for performance initiative.

Human Resources and Performance Management

The HR department within healthcare organizations typically utilizes a standardized performance management plan to handle employee performance on a regular basis. The HR department along with executive management develops the performance management process for the entire healthcare organization. Healthcare organizations are required to monitor employee performance and productivity as many of the accrediting bodies (such as the Joint Commission or the Commission on Accreditation for Rehabilitation Facilities) require that employee performance appraisals be provided as evidence to meet accreditation standards in regard to employee performance. In order for performance management systems to be successful in healthcare organizations, performance needs to be linked to employees' daily job tasks and the outcomes of these tasks.

Performance Appraisal Methods: Critical Incident Method

The critical incident method involves maintaining a log or documentation of critical incidences, both positive and negative, throughout each employee's performance cycle. Each incident will be described in detail at the time the incidence occurs. This can be very time-consuming documentation for the manager as each incident needs to be specifically documented and then shared with the employee at the time of occurrence. Advantages: -detailed incident documentation can be maintained and shared with the employee on both positive and negative occurrences. -no surprises during the evaluation process as incidences were shared with the employee throughout the year. Disadvantages: -Detailed documentation is very time consuming and frequently only negative incidences are tracked by managers rather than also including positive incidences. -Difficult to quantify the impact of the incidences on performance in the overall scheme of job performance for the year

Performance Appraisal Methods: Essay Evaluation Method

The essay evaluation method is mostly applied in combination with another methodology, such as the graphic rating scale. This method requires that the manager develop an employee appraisal by qualitatively identifying the strong and weak points of each employee's behavior and documenting each of these items in a written essay. -The information the manager may use when assessing the employee's behavior includes job knowledge, application of the organization's policies and procedures, working relationships with peers and management, attitude, and organizational abilities. -Each of these items will be included in the performance appraisal and the manager will be required to write an essay regarding the strengths and weaknesses exhibited by the employee. Advantage: It requires the manager to perform research on each individual and really get to know the employee's job performance. Disadvantage: The manager may not take time to objectively assess the employee's behavior and the performance appraisal may be very subjective in nature

Performance Appraisal Process

The performance appraisal process is the third component of an overall performance management system in a healthcare organization (as reflected in the performance appraisal life cycle). Often there are negative connotations associated with actual performance appraisals; if not managed appropriately, they can be painful and emotionally charged. Many employees feel that performance appraisals are very subjective even when the evaluations contain objective criteria for evaluation. If the department or organization does not provide adequate development or training opportunities for employees to perform their jobs adequately, the performance appraisal process is negated. If a standardized performance management system is in place, positive outcomes should be the result of the performance appraisal process. A standardized performance management process keeps all employees in the loop so they know the process and expectations required to meet job performance standards. Performance appraisals become more relevant to employees and employees connect learning and development to growth in performance

The Physical Working Environment

The physical working environment can be a connection between employee behavior and outcomes that impacts job performance overall. The four broad issues that are associated with an employee's work environment are: • Personal space • Spatial density or crowding • Workplace personalization and identity • Task or workflow interdependence

Performance Appraisal Life Cycle

The plan encompasses a performance appraisal life cycle that begins upon an employee's hire and continues throughout his or her tenure at the organization. Some synonyms for the performance appraisal process are employee annual evaluations, professional development planning, and merit rating. Figure 9.1. Performance appraisal life cycle see image 1. Planning The cycle includes planning—setting performance goals based on an employee's job description—which sets the stage for the employee's expected performance for the following year. 2. Periodic Review The next phase of the performance appraisal life cycle is a periodic review that requires managers to collect performance data on a regular basis and review progress toward expected goals throughout the year, as established in the planning phase. 3. Annual Review The performance appraisal annual review between the employee and his or her manager completes the cycle. It starts over with setting performance goals for the following year at the time of the annual performance appraisal review.

Completion of the Performance Appraisal Document: Evaluating Job-specific Responsibilities

The second section of the performance appraisal document includes the major job responsibilities and the specific performance standards that were developed for each particular job task. The HIM manager will compare standardized performance measures for all employees performing similar tasks. The job performance standards are set upon hire and initial job performance standards are reviewed during the probationary performance review cycle. The HR department should provide training to managers on all aspects of the job performance appraisal in regard to providing ongoing evaluation of job performance and how to communicate evaluation results to employees.

Pay for Performance

The term pay for performance as related to job performance refers to remuneration for job tasks completed throughout a certain time frame. The major component that makes pay for performance programs successful is the way in which it defines and measures performance. Method of Pay for Performance 1. Merit Pay - Used in roughly 90 percent of all US companies, including healthcare organizations. -Merit pay is an increase to base salary (often annually) that is based on performance appraisal ratings by an employee's manager. -This concept can also be referred to as meritocracy, where employees are evaluated by positions and rewarded based on individual merits and contributions. The final ratings from these evaluations are linked to the employee's pay, thus the term pay for performance. Performance ratings are usually statistically related to the amount of merit raises (Gerhart et al. 2009). The overall performance rating or score (aggregated within the performance appraisal) for an individual employee will be directly related to the percentage of merit increase that he or she may receive for the next year.

Completion of the Performance Appraisal Document: Individual Goals

The third section of the performance appraisal document includes individual employee goals that are developed in collaboration with the manager. These goals may also include development or training needs for the next performance year. The goals should include specific measurable outcomes written in the SMART format and be agreed upon by both the employee and the manager.

Angela's annual performance appraisal is scheduled for next month. She has been asked by her supervisor to provide the names of two peers and one person in another department with whom she regularly interacts. These individuals will contribute to Angela's evaluation. This is an example of what type of performance appraisal method? a. 360 performance appraisal b. Critical incident method c. Essay evaluation d. Graphic rating scale

a. 360 performance appraisal

Charles is a supervisor of the imaging section of the HIM department. In trying to update scanning productivity standards, Charles calls around to other area hospitals to ask what their scanning standards are. This is an example of what source of performance data? a. Benchmarking b. Job appraisal c. Observation d. Work sampling

a. Benchmarking

Cynthia is an inpatient coder who has been employed by University Hospital for several years. Normally Cynthia is a conscientious employee who clocks in on time and exceeds her daily coding productivity and quality requirements Over the last two months, Cynthia's coding productivity and quality has been slipping and she has been consistently tardy. Cynthia's manager, the HIM coding manager, has been verbally counseling her on her performance issues with no improvements. The HIM coding manager's next step is to initiate a _________________. a. Performance improvement plan b. 360 performance appraisal c. Self-evaluation of performance d. Pay-for-performance plan

a. Performance improvement plan

A sense of privacy in the work environment positively affects job performance by improving: a. Personal space b. Spatial density c. Workflow interdependence d. Workplace personalization

a. Personal space

Performance appraisals

are an evaluation of an employee's performance during a designated period of time and can also be referred to as performance evaluations or performance reviews.

As an HIM manager, Chelsea documents both positive and negative examples of her employees' work throughout the year. She refers back to these examples during annual evaluations. This is an example of what type of performance appraisal method? a. Forced ranking b. Critical incident method c. Graphic rating scale d. Management by objectives

b. Critical incident method

Eleanor is a release of information clerk in the HIM department. Once a quarter she meets with her supervisor to review her productivity and progress toward her annual goals. This represents which phase in the performance appraisal life cycle? a. Annual review b. Periodic review c. Planning d. Training

b. Periodic review

The job performance standard "Inpatient records will be coded at 100 percent accuracy within one day of discharge" exhibits which of the SMART method attributes? a. Attainable and realistic b. Attainable and measurable c. Specific and measurable d. Realistic and measurable

c. Specific and measurable

Which of the following is an advantage to the graphic rating scale performance appraisal method? a. Involves peers and other colleagues in the appraisal process b. Scoring can be subjective and vary greatly from one supervisor to another c. Takes less time to complete than other method d. Training must be done for supervisors to use this method correctly

c. Takes less time to complete than other method

In addition to calling other area hospitals, Charles also asked the current scanners to track their tasks on an activity log. Each scanner logs in the time it takes to scan a specific amount of records. This is an example of what source of performance data? a. Benchmarking b. Job appraisal c. Observation d. Work sampling

d. Work sampling

Elizabeth is single and has quite a few photos of her dog and two cats hung up where everyone can see them. Elizabeth's work environment influences her job performance by creating: a. Personal space b. Spatial density c. Workflow interdependence d. Workplace personalization

d. Workplace personalization

Performance management

is a set of tools and practices for setting performance goals and designing sustainable job improvement strategies with employees, monitoring employee progress toward job performance goals with feedback, and coaching by managers and measuring individual or group performance. Performance management assesses job performance based on job descriptions and job performance standards set in conjunction with annual performance appraisals.

A probationary performance review cycle

is a set period of time that allows an organization to ascertain whether the new employee will be able to handle the job tasks and challenges associated with the new job. This period allows employers to evaluate an employee before making the hire permanent (USLegal 2015). Depending on the skill development required for the job, the employee has a limited amount of time (usually 90 days to 6 months) to develop skills appropriately, and if the individual successfully meets the mutually agreed upon goals and expectations for job performance, he or she is then considered a permanent employee. If the new employee does not meet the mutually agreed upon job goals and expectations, the individual is either rendered an extended probationary period or the individual's employment is severed. After the new employee successfully completes the probationary period, the individual is then entered into the annual performance appraisal program. The employee's manager should meet with the individual to set up goals and expectations for the next phase of employment. The actual job performance standards should be discussed with the employee and the manager should outline how feedback will occur periodically in regard to job performance outcomes.

Job performance

is the "work-related activities expected of an employee and how well the activities were executed" during a set time frame

Job performance standards

measure work performance and the stated expectations for acceptable quality and productivity associated within a job or job function. These standards form the basis for annual performance reviews. The communication includes whether or not the individual meets established job performance standards, and the process includes outlining job expectations, setting job performance objectives, identifying performance goals, and providing regular feedback on actual job performance against expected performance.

Communicating Performance Appraisal Results

upon hire, all employees should receive an explanation of the purpose of the performance appraisal process and this information should outline the employees' role in the entire process. Upon hire, managers should be trained not only on how to complete the required documents for employees but also on the soft skills required to communicate performance appraisal results. Monitoring and evaluating employee job performance is a key role for HIM managers, and HIM managers should be trained on the use of the healthcare organization's performance management plan. Performance management training should incorporate methods for conducting the performance evaluation. - The overall performance appraisal should be a positive experience for both the manager and employee, even if the employee's performance was below the standard for the year. - There should never be any surprises in the actual performance appraisal document or during the actual performance appraisal meeting. -The setting should also be neutral, where the manager is sitting to the side of the desk or at a table with the employee so that there are no perceived barriers between the manager and the employee. Employees are the greatest asset for any organization, and they deserve to receive adequate time and appropriate feedback face-to-face regarding performance. Constructive feedback should be provided in the performance appraisal regarding both negative and positive job performance. The manager should start out with positive comments on the employee's performance, then move to areas in need of improvement before ending the appraisal with positive thoughts on next year's planned performance.

Some tips for writing a self-assessment are:

• Be proud. Do not hesitate to highlight the tasks and projects that provide examples of commendable work. • Be concise. Clearly articulate insight to performance in terms of both strengths and weaknesses. • Be honest. Indicate areas that require improvement and be open to training and development to enhance performance. • Be professional. Provide reflection on why goals were not met and what resources are needed to attain these particular goals

Performance Management Tools

• Job descriptions: Job descriptions outline all the responsibilities and tasks for a particular position. Job performance is measured based on the tasks outlined in the job description. • Probationary performance reviews: This evaluation is performed within a set time period after an individual has been hired. This evaluation sets initial performance goals and provides an overall assessment of the employee's initial job performance. • Multisource feedback (360 forms): The feedback provided in a 360 form allows employees to provide a confidential and possibly anonymous assessment of their peers. • Performance appraisal forms: The performance appraisal forms contain the job responsibilities and tasks as outlined in an employee's job description and the job standards against which the employee will be measured. This is a standardized form that is used for all individuals in the healthcare organization but modifications are made during the performance appraisal process for each employee. • Performance improvement plans: These are standardized plans initiated based on negative performance outcomes. Job performance standards that must be met and improved in order for the employee to continue in his or her job role are outlined Each of these tools plays a part in appraising job performance throughout the review time frame (usually annually). All managers who have a role in evaluating employee job performance should be trained on the use of these tools upon hire and retrained on the use of them whenever necessary..

The major components involved in developing a performance management plan are:

• Maintaining updated job descriptions with current major tasks or functions outlined for each job. • Determining performance standards for each major task or function. • Evaluating performance based on the process and components outlined by the performance appraisal. Items included in the appraisal process are: ○ Length of the evaluation period (usually annually) ○ Timing of the evaluation cycle ○ Interim contact points for assessing performance, providing ongoing coaching, and feedback ○ Inclusion of annual performance goals (employee and management driven) ○ Standardized evaluation ratings ○ Documentation required to substantiate performance and ongoing certification maintenance. (Performance Appraisal Methods 2010)

During the appraisal process, the following should be done by the manager:

• Provide feedback to the employee on the self-assessment completed prior to the meeting. • Solicit suggestions on how the manager can assist the employee in reaching his or her performance goals. • Develop new performance goals for the next performance appraisal cycle. • Solicit feedback on the manager's performance. • Wrap-up the performance appraisal by thanking the employee for his or her contributions to the workgroup, department, and the healthcare organization

Another key component of creating job performance standards is that they should be written employing the SMART technique.

• Specific: Job standards should be written so that they specifically represent the job tasks being performed • Measurable: Each of the job performance standards should be written so that it can measured in an objective manner • Attainable: All job performance standards should be written so that they are attainable by the employees performing them • Realistic: All job performance standards should be written with a realistic expectation that the employee can meet the standard • Timely: The job performance standard should be written so it is bound by time in some manner If performance standards and goals are written appropriately, utilizing the SMART goal format, assessment of performance can take place in an objective manner.

The following steps should be followed when initiating an employee PIP:

• Step 1: Document performance issues. The manager should have objective documentation reflecting the dates and the results of the suboptimal employee job performance. For example, if the coding quality standard is to code all patient discharges with 95 percent accuracy and a coder's quality measures for the past two months are 92 percent and 88 percent accuracy rate, these employee performance standards should be documented. The coding manager should also have specific examples of coding errors or trends in the type of coding errors being made by the coder. • Step 2: Develop an action plan incorporating SMART goals for improving an employee's job performance (Wayne State University 2015). Building on the example in Step 1, the coding manager should outline several performance goals in order to improve the employee's coding accuracy. These goals should include additional training and resources to assist the employee in achieving these performance improvement goals. • Step 3: Review the performance plan with HR and the department director. After creating the PIP, the manager should review the actual plan with the department director and the HR department. The HR department will provide guidance on the duration of the PIP and the next steps if the employee's performance does not improve. • Step 4: Meet with the employee to review the PIP. A confidential meeting should be arranged with the employee to go over the job performance standards that are not being met and that resulted in the creation of the PIP. The manager should explain the suboptimal or deficient job performance and outline the specific performance improvement expectations. The manager should clearly and concisely delineate the time frame in which the employee has to meet these expectations. The employee should give feedback on the performance goals outlined within the PIP and add additional goals. The manager should provide training methods and tools that will assist the employee in improving job performance, define the communication process for the time frame of the PIP, and explain the next steps if the employee does not demonstrate improvement in job performance. • Step 5: Follow-up with the employee. The manager should set up regular meeting times with the employee to ensure the employee is working toward the performance improvement goals. The manager should provide documentation of progress toward the performance improvement goals. For the example provided in Steps 1 and 2, the coder should have regular reports (daily or weekly) on coding accuracy rates and coding errors should be shared with the employee immediately. • Step 6: PIP conclusion. The PIP will have a specific termination date and the job performance goals will need to be met at this time. If the employee successfully meets all the performance improvement goals, the manager and employee will sign off on the PIP and the results will be forwarded to the HR department to be stored in the employee's file. This process may be done manually or electronically depending on the HR performance management system used within the organization (How to Establish a Performance Improvement Plan 2015).