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Why and how to establish criteria-based performance standards.

In our increasingly litigious society, it was only a matter of time before employer-employee issues stormed the courtroom. Work related cases now clog the docket. One result has been accelerated intervention by the Federal government and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in promulgating personnel guidelines and requirements.

The courts recognize that it would be impossible to devise a completely objective instrument by which to evaluate work-related legal disputes. They have nevertheless made it clear that subjective work evaluations do not provide sufficient grounds for discharge, demotion, transfer, or failure to promote. Quality assurance and the extent to which quality of work can be measured are growing concerns in all areas of health care, certainly including the laboratory.

These issues bring performance appraisal to the forefront of managerial concern. Few aspects of supervisory responsibility are more critical than the duty to evaluate employee performance accurately. Performance appraisals directly affect training, compensation, and productivity.

With all these issues in mind, the authors have worked independently and together with various organizations to develop criteria based performance standards that would assist managers in performing legally defensible employee appraisals. 9 Overview. To assess the viability of a performance appraisal instrument, we must examine the entire process, summarized in Figure I. Criteria-based performance standards form an integral part of employee evaluation and must meet certain objectives. The standards must be congruent with the organization's objectives and must support them in every way. They must clearly define departmental goals and objectives in terms of work performance. Writing performance standards is only one part of a process. According to Section 14.C.2 of the Federal Uniform Guidelines of 1978, a performance appraisal instrument must be derived from analysis of the job itself. This should include "an analysis of the important work behaviors required for successful performance and their relative importance" focusing on the "work behaviors" themselves and the tasks associated with them. A job analysis for each laboratory position must specify the behavior necessary to perform the job at the time and in the organization under consideration. The analysis should not be written to reflect ideal conditions that the manager would like to see or the way in which the job was previously done elsewhere. The job analysis should consist of a list of basic tasks necessary to perform the job.

The job analysis provides a starting point for the job description, which serves two major purposes. First, it offers a broadbrush description of the knowledge, skills, and abilities needed to perform the job outlined in the job analysis. Second, it is an effective instrument for comparing the position with others.

Working from these two documents, the manager determines the major areas of performance (MAPs) associated with each position. MAPs are umbrella statements that define areas for which the employee is responsible and accountable. MAPs are written to support the work behavior needed to complete a particular job. They are never to be contrived to fit the person occupying the position. When drafted properly, criteria based performance standards permit satisfactory ratings to be developed for entry-level employees as well as for seasoned staff members.

Using performance standards as an instrument of measurement, the manager evaluates an employee's work against a predetermined standard defining conditions that exist as the result of a job well done. As the final step in performance appraisal, the conclusions of the evaluation are discussed with the employee.

It is difficult to assess an employee's performance and developmental needs accurately. Critical goals include objectivity, uniformity, and equity. Criteria based performance standards provide an approach for determining how well employees are fulfilling their responsibilities. 9 Definition. What is a performance standard? It is a criterion, a gauge, a yardstick. Standards play a prominent role in all aspects of laboratory operations. The lab manager must have a model-a reference point-for determining relative value. We often make informal assessments implying that an employee has or has not met the expected level of performance. In calling someone "the most efficient technologist I have ever met" or "a top-flight manager," or in categorizing a report as poor," we are making subjective judgments. They mean something to us, but others can only guess at our rationale because the standards applied are not evident. Problems arise when, as a result, the employee doesn't know what constitutes a good job. Vague comments as contrasted with a formal evaluation make it hard for that person to alter behavior to achieve a more acceptable performance. Without adequate guidelines, there is no guarantee that the excellent employee will continue to produce fine work or that the staff member who has been found wanting will improve.

* Characteristics. Writing criteria-based performance standards requires the drafting of measurable criteria that can be used to validate the accuracy of subsequent evaluations. A proper standard:

1. Enables the laboratory manager to differentiate between acceptable and unacceptable results.

2. Challenges the employee.

3. Is attainable by any qualified, competent, and thoroughly trained employee.

4. Sets a time frame for accomplishment. 5. Offers a method of observation by which to measure performance against requirements of the standard. 6. Describes conditions that exist when the job is done well. 7. Measures a job element performed well and expressed in terms of quality, quantity, time, cost, effect obtained, and manner of performance demonstrated.

8. Does not purport to measure traits or constructs, such as intelligence, aptitude, personality, common sense, judgment, leader ship, or spatial ability (as de scribed in the Uniform Guideline of 1978, Section 14.C. 1).

9. Must not deal with subjective measurement criteria as ex pressed in such terms as "timely," "good ... .. adequate," or

satisfactory. o Dimensions of measurement. Because laboratory positions are many and varied, the lab manager must use different dimensions of measurement in establishing performance standards. Standards must be prepared for each position rather than for a general job title, such as laboratory technician or medical technologist.

Some elements of certain positions lend themselves to more precise measurement than others. The dimension of the laboratory position in question must allow measurement that is as accurate and as able to be observed an documented as possible. A discussion of nine types of performance standards follows.

Quality of work. A performance standard that measures th dimension of quality describes how well the job is done or how thorough the results have to be. This standard can refer to accuracy, appearance, usefulness, or effectiveness. It can be expressed as an error rate or as the percentage of errors allowed for every unit of work.

If a numerical rating is not feasible, the standard may be expressed in terms of expected results.

"All assigned test procedures must be performed in accordance with laboratory protocols an must be completed within established deadlines 95% of the time.

Time requirements. Standards that establish time requirements address when, how soon, and within what time frame the job must be performed. It may be necessary to set time limits when quantity cannot be easily determined. A laboratory's workload tends to fluctuate, and there are seasonal trends. In such cases a time requirement provides a practical means for developing a standard measurement.

"All CAP workload counts will be forwarded to the appropriate individual within one working day after the reporting period has ended. "

"All proficiency test specimens will be analyzed and reported within five days of receipt. "

Cost-effectiveness. This approach works when performance can be assessed in terms of the amount of money saved, earned, or expended.

"Travel costs for specimen pickup and delivery of test results this year will not exceed last year's expenses by more than 5%. "

Results desired. This dimension becomes a measurement tool when performance is expressed in terms of the ultimate effect to be obtained. Such standards include the following cause-and-effect phrases.: "so that," "in order that," "in order to," and "as shown by. " This approach is useful when results are not easily quantifiable.

"Supply decisions will be made with sufficient accuracy so that no reagents run out or remain beyond their expiration dates. "

"Blood shipments will be coordinated so that the outdate rate systemwide does not exceed 2%. "

Manner of performance. This widely used category of assessment is helpful in developing standards for positions for which personal contact is an integral part of the job or when a laboratorian's behavior directly affects the performance of others. Standards using this dimension of measurement address issues regarding in what manner and resulting in what "Conducts orientation sessions for new employees on their first day of employment to enable them to understand all laboratory policies and procedures. "

Method of performance. This measurement is used when there is a standard procedure for performing a task.

"CAP workload reporting forms will be completed in compliance with CAP instructions. Deviations will not exceed 3 %. "

Historical standards. These set a current standard as a specified maximum higher or lower percentage of previous results.

"The capital equipment budget this year will be no more than 3% greater, than it was last year."

Historical standards are adequate only if the data on which they are based are valid and realistic. If equipment costs increase by 10% annually, the example offered above may not be appropriate. Historical standards won't help a laboratory facing major expenditures to replace outdated instruments or about to purchase equipment to facilitate adding a new laboratory service.

The historical standard above would work, however, for a laboratory in which a 3% increase in the budgeted amount will support efficient and effective management in the coming year.

Comparative standards. This type of standard is based on the known performance or goals of other employees or other laboratories. It is particularly appropriate when industrywide standards are available as gauges. For example, JCAHO stipulates:

"In keeping with JCAHO standards (NM 2.2.10), the hospital will maintain a record in which radionuclides and radiopharmaceuticals are tracked from the time these substances enter the building until they have been administered and disposed of. "

Knowing the JCAHO standard, the laboratory manager can develop his or her own:

". . . the technologist will track radionuclides and radiopharmaceuticals from the time of receipt in the laboratory until the time of administration and-or disposal. "

Engineered standards. Stated as an absolute requirement, this standard allows no deviation. With engineered standards, there is no basis for comparison.

"Cytotechnologists will review no more than 100 slides per day, as defined by state statute. "

"Every technologist will be responsible for submitting workload data by the last workday of each month. "

Developing standards. Performance standards must be established for all laboratory positions. While it is easier to identify quantitative standards for routine, repetitive jobs, standards must also be established for technical, professional, supervisory, and managerial positions. Although some areas do not lend themselves to quantification, managers must find a way to establish measurable standards that help them meet the criteria outlined in this article.

Simplifying this task is lab managers' predisposition to measure outcomes. In most cases, anticipated results have already been identified. To write standards, ask the following questions for each MAP:

What are the indicators of success?

How well or accurately must this task be performed?

How soon or by what date or time must this task be completed?

What cost is acceptable for performing this task?

What conditions will indicate that the task has been done well?

The answers to such questions make it possible to focus on measurable aspects of the MAP and dimensions by which it can be measured. Criteria-based performance standards for management positions, which are harder to quantify, can be delineated by answering the five questions listed above. A standard for lab managers would incorporate personnel responsibilities such as administering all personnel functions, conducting performance evaluations within a specified period, performing disciplinary actions, overseeing the budget, and formulating work schedules.

Performance standards must be established for all MAPS. The number of standards needed depends on how many it will take to define performance expectations.

In the above discussion of the characteristics of performance standards, it was noted that they must be realistic and attainable while presenting the employee with a challenge. Unreasonably high standards frustrate employees who cannot meet them, whereas unnecessarily low standards offer no challenge and can be a serious demotivator. Either way, productivity suffers.

Standards must describe the fully acceptable level of performance. This means not average or mediocre performance but performance at a level that fully satisfies the manager's expectations. The employee should be doing the job he or she was hired to do.

As you formulate acceptable levels of performance, consider setting a range. Specifying that a technologist must process five to nine Stat tests per hour, for example, is more constructive and more realistic than stating that laboratorians should complete seven Stats per hour. Building a range of acceptable performance creates flexibility on two levels. First, it accommodates workload fluctuations that resist strict control. Second, it enables new employees to perform within the same range as their more experienced colleagues.

Standards must measure performance in as many dimensions as are necessary and appropriate to describe acceptable accomplishment adequately. Performance will be considered acceptable when downtime due to operator error is no more than 15 minutes within any six consecutive working hours" (or "when the laboratory section is within its budget allocation at the end of each fiscal quarter" or "when routine SMAC maintenance is performed each morning according to the five minute procedure").

it is critical to establish standards that make it possible to measure and document the required level of accomplishment. Careful phrasing is paramount. Words such as rarely," "seldom," timely," and "reasonable" leave too much to interpretation. As a rater, you may define rarely" and "seldom" as once or twice a year, yet employees may consider those words to mean once or twice a month.

When establishing any standards, think about how you plan to use them to measure performance. Will the standard make it easy or difficult to track and record employees' performance? Is the behavior described observable, or will it be necessary to measure results quantitatively? Figure 11 provides questions managers should ask themselves in evaluating performance standards they have drafted.

The same standard cannot cover all laboratorians. One may handle phlebotomy, urinalysis, and hematology, for example, while another oversees specimen shipping and receiving, microbiology, and chemistry. A single set of standards may be used, however, for positions involving identical duties and working conditions. Do not designate a group average performance as the acceptable level. Current performance may vary substantially from average levels. A time study analysis may help determine appropriate performance of certain tasks.

Keep in mind throughout the process that criteria-based performance standards are meant to serve two purposes: to give the manager or supervisor an objective instrument for the equitable evaluation of all employees and to spell out the criteria by which employees will be evaluated. Having objective measurements in use is necessary to meet Federal guidelines that require advance notification of job expectations. Employees can thus know exactly what is expected of them. While performance standards are not carved in stone, they should be made as complete as possible from the outset to avoid revisions during the employee appraisal period. Changes should be established quickly so that the employee will have as much time as possible to operate under the new standard before undergoing an evaluation.

Performance standards that are realistic, measurable, communicated, and understood reap benefits for all concerned. Well-delineated standards enhance productivity, assisting the laboratory in accomplishing its stated mission. n

General references:

Albrecht, K. successful management by Objectives." Englewood Cliffs, N.J., Prentice-Hall, 1978.

Beaulieu, R. An easier look at performance appraisal, Training Dev. J. 34:56-58, October 1980. Equal Employment opportunity commission. Adoption of questions and answers to clarity and provide a common interpretation of the Uniform Guidelines on Employee Selection Procedures. Federal Register 44(43): 11996-12009, 1979. Equal Employment opportunity coordinating council. Employee selection procedures: Uniform Guidelines. Federal Register 41(136): 29016-29022,1976.

Holland, M.G. Can managerial performance be predicted? J. Nurs. Admin. 11: 17 38, June 1981.

Johnson, R.G. "The Appraisal Interview Guide." New York, AMACOM, 1979,

Markowitz, J Four methods of job analysis Training Dev. J. 35: 112-118, September 1981.

McLagan, P.A. Competency based models. Training Dev. J. 34: 22-26, December 1980.

Odem, V.J. Performance Appraisal: Legal Aspect." Technical Report No. 3, La Mirada, Calif., Center for Creative Leadership, May 1977 Shear, L.E. Ability to measure performance should be an integral part of management information systems Hospitals 55: 123-130, October 1981. Springer, J., ed. "Job Performance Standards and Measures." Madison, Wis., American Society of Training and Development, 1979

Thompson, D.E., and Moskowitz, D. A legal look at performance appraisal. Wharton Magazine 61: 66-70, winter 1981-82.
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Author:Hudson, Charlotte Greene; Boe, Gerard Patrick
Publication:Medical Laboratory Observer
Date:Jan 1, 1991
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