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Effective job descriptions are specific, detailed
Recognize interdependence between jobs in agency
Every home health manager understands the importance of clearly written job descriptions and competency assessments, but how effective are your job descriptions and do they really help you evaluate your employees' performance?
"The real challenge for home health agencies is the time and effort it takes to develop job descriptions that are specific to the agency's services and the employee's actual job," says Sherry Taylor, CHCE, director of home care operations for Quorum Health Resources in Brentwood, TN. "If the agency is affiliated with, or owned by a hospital, it is even tougher because the job descriptions may come from a template used throughout the hospital," she adds.
It is important to make sure your agency's job descriptions accurately reflect the employee's responsibilities as well as your expectations so that everyone knows what standards have been set for the evaluation, says Taylor. "Unfortunately, I see job descriptions that don't vary much from nurse to clerk," she says.
"Obviously, these two employees have very different jobs, so they should have different job descriptions with different competencies identified," she says.
Job descriptions and the accompanying competency assessments that are used in the employee performance evaluation should be based on specific criteria. If your job descriptions are too general, it will be hard to accurately evaluate the employee, says Taylor. "If the job description says that the employee must arrive on time to work, you need to define 'on time,'" she says. For example, a business office employee should be required to be "on time for regular office hours that are 8:30 to 5:00 p.m., Monday through Friday," while a field clinician might have "on time" defined as "arrive at patient's home at the scheduled time" or "no instances of patient complaints about not knowing what time the nurse will arrive."
When setting specific standards, include a time frame, suggests Taylor. "If you conduct annual performance evaluations, say 'for a 12-month period' in the competency assessment or job description," she says. "You also can't say that documentation should be completed in a timely manner without defining timely," she says. "Say that documentation must be complete within 24 hours or 48 hours of the visit to make sure that you can measure compliance," she adds.
Another issue that many home health agencies overlook when developing job descriptions is the impact that one person's job has on the ability of another person to do his or her job, points out Taylor. "The accounting manager may be held accountable for keeping accounts receivable days below 60, but if you are not requiring nurses to submit documentation within a specific time frame, you are asking the accounting manager to meet a standard without any control over when the documentation comes to her," she says.
When dealing with financial issues, the most successful agencies make all employees responsible for financial performance, says Taylor. "These agencies educate all employees to show how portions of their job responsibility flow to other departments that are filing claims and collecting payments," she says. Once your entire staff understand how they all interact, some of the requirements of their jobs make more sense, she adds.
Ask for employee input
At CareSouth in Winchester, TN, staff members also participate in updating job descriptions and competency assessments when needed. "I make site visits with employees as part of their evaluations [see story at end of article for more on conducting effective performance evaluations] so if I notice any areas that may need improvement among the staff, we put together a focus group of staff members to discuss the problems and come up with ideas on how to address them," says Darlene Stewart, RN, director of the agency. In addition to identifying additional inservice education, the group also develops additional competencies that should be added to make sure that expectations are clearly defined, she adds. "Working within the group enables all staff members to see how other clinicians are handling different situations and we are able to share ideas," she says.
"The most difficult competencies relate to wound care and medication compliance," says Stewart. "Our wound care competencies specify that nurses will measure the wound one time per week and will describe the wound in the documentation at each visit," she says. By including this level of specificity, job performance evaluations are much easier, she adds.
Ensuring the patient's compliance with medication administration is a little tougher, admits Stewart. "So many patients forget to tell nurses if their doctor has changed their prescription medication, added an over-the-counter medication, or asked them to start taking vitamins," she says. "Even if the nurse asks if there have been any changes, patients may say no because they've forgotten about the change or they assume the nurse already knows," she adds.
Stewart's nurses are expected to ask about a change in medication, vitamins, or over-the-counter medications at every visit. "We also expect nurses to look at the medications once every week to see if there are any bottles that weren't in the house the week before," she says. If there is a new medication, the patient is asked about it, and the nurse makes sure that the patient understands what it is prescribed for and how it should be taken, she adds.
"We also check for proficiency in the use of glucose monitors, pulse oximeters, and lab draws," says Stewart. If the nurse performs any of these tasks on the patient visit that Stewart attends, the skills are checked off at that time. Otherwise, nurses can demonstrate their skills at the office, she adds.
Although her agency doesn't care for pediatric patients, nurses do have to distinguish the different needs of younger adults as compared to elderly patients, says Stewart. "The most obvious difference is in the patient's ability to understand the educational information and comply with care instructions," she says. She adds, "Even with younger adults, nurses can't assume that they understand and they do have to demonstrate that they understand what they've been told."
For more information about developing effective competency assessments, contact:
Motivate employees with meaningful evaluations
Recognize outstanding effort with praise
You know that your job descriptions and competency assessments are thorough, specific to employee's job, and clearly define performance expectations, but how do you make sure that your performance evaluation is conducted in such as way that it provides good feedback to the employee and reflects the employee's contribution to the agency?
For a clinicians' performance evaluation, accompanying them on actual visits to patients is essential, says Darlene Stewart, RN, director of CareSouth in Winchester, TN.
"I choose one visit for each employee," she says. She never chooses a new admission; instead, she focuses on a patient that the nurse has visited before. "I can better judge what the nurse's normal practice is by watching to see if the patient acts as if the nurse has never checked the patient's ability to grasp or performed other physical assessments that might be appropriate for the patient," she says. Because a nurse will conduct a patient visit "by the book" when a supervisor is there, the patient's reaction is the best indicator of any surprises, she explains. "If they act like or say that they've never had this checked before, I know that the nurse doesn't always follow protocol," she adds.
In addition to Stewart's site visit and review of personnel documentation to evaluate the employee's performance, the employee's self-evaluation is included in the performance review. "I have employees go through the evaluation form, which is based on competencies and criteria established in the job description, and rate themselves as being able to perform the skill, not sure about performing the skill, or not able to perform the skill," says Stewart. Nurses know that there is no punitive action if they admit to not knowing how to perform a skill so they are willing to mark this category so that they can discuss with Stewart how to get the needed training.
"We encourage our clinicians to always ask for help if they are performing a service or using equipment that they've not used before," says Stewart. "Even if a nurse becomes proficient with a Wound VAC because she has a number of patients with wounds requiring this treatment at one time. If she goes months without using the equipment, she may want assistance the first time she uses it again," she explains. Clinicians know that asking for help is not a negative in her agency, so they help each other maintain a high level of skills, she adds.
Once you've completed the performance evaluation, look carefully at how you administer salary increases, suggests Sherry Taylor, CHCE, director of home care operations for Quorum Health Resources in Brentwood, TN. "Too many agencies still have the 'across the board' mentality when it comes to raises," she says. By giving all employees a 3% raise, regardless of the performance evaluation, you send a message that everyone is valued at the same level, she explains.
"I like the idea of telling a manager that he or she has a certain amount of money or a certain total percentage to grant to employees, then let the manager divide it up as appropriate," says Taylor. "While money is not a major reason for job satisfaction for home health nurses, recognition of their effort to do a good job is a contributor to job satisfaction," she says. "If a nurse knows that she will receive a higher raise if she exceeds the minimum requirements for the job than the nurse who meets minimum requirements, then she'll be motivated to strive to be a better employee."