Innovation at Work - Alexian Brothers Medical Center Builds a Values-Based Performance Evaluation

September-October 2007


Ms. Prunty is chief workforce development officer, Alexian Brothers Medical Center, Elk Grove Village, IL.

One of the most anxiety-producing conversations conceivable — for both supervisors and employees — is the job performance appraisal. For the supervisor, adding to the dread is the task of preparing an evaluation that is meaningful, instructive, and constructive; clearly identifies both strengths and areas for improvement; and provides ideas for achieving that improvement.

In the autumn of 2005, the leaders of Alexian Brothers Medical Center, Elk Grove Village, IL, decided to replace their existing performance evaluation process, which they found insufficient, with a new one.

Supervisors expressed frustration with the evaluation tool itself, which contained 121 separate areas to appraise and used between 65 and 291 standards. In addition, supervisors thought that the performance appraisal process placed too much emphasis on technical expertise and left obvious behavioral issues unaddressed, resulting in unrealistically high ratings. They felt that the performance appraisal tool did not strengthen accountability and minimized effective feedback, so they set out to create a new and better evaluation process, one that would set a minimum expectation of excellence.

Core Values as the Base
The resolution to make a change was arrived at relatively easily. Much more challenging was deciding how to structure the new performance evaluations. The facility's human resources (HR) executives began by making a decision that would influence all aspects of the development of the new evaluations: They determined that the evaluations should be based on the Alexian Brothers' five core values — dignity of the person, care of the poor, holism, partnership, and compassion. Because they form the basis for the medical center's mission, these values guide its strategies and decisions as an institution. In making the core values the basis of employee evaluation, the facility center also reinforced, in a very concrete way, the values' importance to its mission and staff.

Dean Grant, president of Alexian Brothers Hospital Network (based in Arlington Heights, IL), said, "The Alexian Brothers' emphasis on excellence combined with compassion makes the development of a values-based performance appraisal process important and unique."

Having established the basis for the change, the facility's leaders took only 12 weeks to complete the development of a new evaluation process. They began by creating an interdisciplinary focus group composed of medical center executives to consider the question "What should be included in a great performance appraisal?" After considering their experiences with the old process, they developed several objectives:

  • Get to the point, be concise, emphasize a dialogue first and a paper report second
  • Make it a constructive process — meaningful, not redundant
  • Create standards for performance that are very clear and reflect the organization's goals and expectations
  • Provide training in all aspects of the evaluation process
  • Include three basic components: behavioral standards, job standards, and goals
  • The focus group had four basic expectations. It intended to:
  • Build an appraisal from the ground up, using the Alexian Brothers' values as the core criteria
  • Create an updated appraisal process
  • Involve key stakeholders in the new performance appraisal system, clearing the way for commitment
  • Simplify both the evaluation process itself and the tool used to provide feedback to employees

Developing a New Process
After a kickoff meeting that included a "vision exercise," the focus group broke up into smaller groups, each of which represented one of the core values. In a series of meetings, each smaller group identified work behaviors consistent with its value and later presented those behaviors to the larger group for additional discussion and refinement. Based on these discussions, the focus group created a new employee appraisal tool.

Besides creating the new appraisal tool, the group linked employee behaviors to comments from patient satisfaction surveys, simplified the entire evaluation process, and streamlined communications with employees concerning the process.

In the meantime, a review team had been formed to review the focus group's new appraisal tool. The review team validated the focus group's efforts and edited its work to ensure that there were no duplicate or similar questions appearing on the new performance appraisal.

Focus group members then tested the new appraisal tool among staff members of their departments. When this piloting proved to be successful, the focus group showed the tool to the facility's executive team. Once the executive team had given its approval, the focus group drew up a plan for communicating the new process to employees and educating them in its use.

Education and Training
Employees involved in developing the new process took enthusiastic ownership of it. "Going through this process and producing this evaluation tool is a vivid example of empowerment — because we did it ourselves," said Mary Kane, the facility's nurse director and a member of the focus group. "I'm proud of what we did."

This approach not only made personnel more vested in the evaluation, it also saved the medical center a great deal of money. Before deciding to go with the internally driven approach, the HR department had explored using outside consultants to manage the process. They considered either hiring a computer consultant to develop an online evaluation or purchasing off-the-shelf software and customizing it. But these options would have cost between $100,000 and $200,000.

Having developed the new evaluation tool, the facility's next step was to train both leaders and employees to use it. The education process, which took four months, involved separate training sessions for leaders and employees. The training had three parts:

  • Using the new performance appraisal tool
  • Conducting performance appraisal interviews
  • Encouraging accountability for staff performance

For example, performance evaluations based on the Alexian Brothers' value of compassion considered both competent care in specific cases and the overall attitudinal approach to caring for the patient. The performance standard concerning attitude says:

The employee chooses a positive attitude that reflects the values of the Alexian Brothers on a daily basis. Those expected behaviors include: displays understanding of the power to choose one's own attitude and maintains professionalism; respects all viewpoints including cultural differences of all people; conveys sincerity, empathy and understanding through one's body language; positively accepts and supports decisions made and shares concerns in the appropriate forum; demonstrates a willingness to learn and change; follows chain of command in a positive manner; demonstrates a sense of urgency when meeting needs.

The behavioral standards count for 50 percent of an employee's ranking. The other 50 percent comprises such elements as competencies met during the year, a discussion of technical proficiency vis-à-vis job description, results and goals for employee performance, and an employee development plan to ensure an employee's growth at the facility. Ratings for performance are made on a five-point scale.

The values-based performance evaluation tool is used not only with current employees but with prospective employees as well. Its use during the interview process helps prospective employees understand how the Alexian Brothers' values are expected to be integrated into an employee's day-to-day work. The performance appraisal document is also used during new-employee orientation to further reinforce the values and their role in guiding the work that is done at the medical center.

"The behavioral expectations on how we treat each other and our patients are as important as the skills required for the role," said Linda Baker, vice president of HR at the facility.

Making Values Clear
Basing the performance appraisal on the sponsoring congregation's core values ensures that the management style and employee performance reflect those ideals. It establishes excellence as the ultimate measure of performance and eliminates incongruence between what is said, on one hand, and actual behavior, on the other. It makes very clear what is expected of employees. Perhaps even more important, the process explains why those expectations have been set and enables all involved to recognize when those expectations have been met.

"If we do the right thing for the right reason at the right time, we will be speaking to all five core values of the Alexian Brothers," explained Br. Richard Dube, CFA, provincial of the Immaculate Conception Province of the Alexian Brothers. "A true leader is not one who controls, but one who empowers others according to their skills and talents. Our performance evaluation tool helps to reinforce that concept."

For more information on how to build a values-based performance evaluation, contact Kathleen Prunty at (847) 981-6557, or [email protected].


Copyright © 2007 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.

Innovation at Work - Alexian Brothers Medical Center Builds a Values-Based Performance Evaluation

Copyright © 2007 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.