Accredited HME companies have several human resource tasks that
they are required to perform throughout the year, such as
documenting orientation, having job descriptions and evaluating
staff competency. Another item that is required is conducting an
annual performance evaluation for staff members who have been
employed for more than one year. (Depending on the accreditor, some
allow small providers to conduct these evaluations every two years
rather than each year. )
Providers can choose to perform this process either once
annually during a fixed period for all staff, regardless of their
hire date; or at each employee's individual anniversary date.
Many providers prefer to conduct evaluations once a year during
a fixed period of time. While some stress that it's a burden to get
the evaluations accomplished within a few weeks, they are happy to
have that task completed and off of their to-do list for the
remainder of the year.
It's common for providers to conduct these annual evaluations at
the beginning of the year. January and February work well for this
process as these months are generally not popular vacation months
and, thus, all staff are available. In the spring and summer with
vacations and in the fall with back-to-school and the holidays,
performing evaluations can feel much more cumbersome.
The burden is to pick a month or timeframe and stick to it. If
you let this slip, it can be impossible to catch up quickly.
One of the first questions asked by providers who perform
once-a-year evaluations for all is “How do I handle employees
who have not been employed for at least year?” My best advice
is to go ahead and conduct the evaluations of those staff members,
but only for those who have been employed for more than three
months. You should identify that the evaluation is not actually an
annual evaluation but only for the particular timeframe applicable
to that staff member. This way, the evaluation is completed and the
staff member will be “caught up” next year when it is
time to perform the evaluations again.
Other providers prefer to conduct annual evaluations at the
anniversary date of the employee. If you have a large number of
employees, this method may be impossible, since you could be
conducting evaluations every month unless you have dedicated human
resources staff. This method is much better suited for smaller
providers who prefer to conduct these evaluations once the employee
has been on staff for a full year and who do not have large numbers
of employees.
Regardless of the method, you need to ensure that you are
meeting your accreditor's requirements. Your accreditor's standards
may state that you evaluate employees based on the requirements of
their job duties and tasks. This is best accomplished by using
standardized evaluation tools that “match” tasks
itemized on the employee's job description. The best tools also
offer an opportunity for the employee to provide a self-evaluation
with the review of the supervisor.
For example, if the employee's job description lists the
requirement to participate in the provider's on-call program, this
is what the matching item might look like:
Assume on-call responsibilities during non-business hours in
accordance with company policy
| Employee | 5 | 4 | 3 | 2 | 1 |
| Supervisor | 5 | 4 | 3 | 2 | 1 |
This meets the requirement to evaluate the staff member by task
and offers both the employee and the supervisor the opportunity to
rate performance of this task on a scale of 1-5.
Many accreditors also require that your evaluation tool offer a
place for the employee to sign and date the review in order to
document that he or she has seen it and that it was performed at
the appropriate date. The best tools also have a place to document
any disagreement with findings and, in the event of poor
performance, to describe a plan for continued progress. This is yet
another reason to have a good policy and procedure manual so that
you have access to quality forms and tools that meet both CMS' and
your accreditor's requirements.
Read more Accreditation Now
columns.
Mary Ellen Conway, RN, BSN, is president of Capital
Healthcare Group, LLC, Bethesda, Md., which provides health
care management expertise in accreditation preparation and survey
follow-up, operations assistance, design of quality improvement
programs and outcome measures. She can be contacted by phone at
301/896-0193 or through www.capitalhealthcaregroup.com.
