Staff Performance Competency

Please assess Strong Commitment Competence against the performance factors as follows:
Exceeds (E) - consistently performs in an exceptional manner that far exceeds performance standards.
Meets (M) - consistently performs in a manner that fully meets expected performance standards.
Needs Improvement (NI) - performs in a manner that needs improvementidentified area of growth.
Self Evaluator
Integrity I will conduct myself in a fair and trustworthy manner. (Type E ! or "#$
%emonstrates meeting customer needs &y providing the highest 'uality service with utmost care
and courtesy( recogni)es his*her wor+ as a reflection of him*herself.

Ensures patients, right to privacy &y creating a secure and trusting environment. Treats all patient
information confidentially.

-ses good .udgment in all situations ensuring ethical standards are met.

Comments:
ompassion ! I will act with empathy and understanding toward others.
Commits to understanding patient and family mem&ers, uni'ue individual needs.

-ses good .udgment in all situations ensuring ethical standards are met.

/esponds to patients in a timely manner &y giving status reports( uses care and courtesy when
responding.

Comments:
"ccounta#ility ! I have an o#ligation to ta$e responsi#ility for my actions and to %oin with my colleagues in
reali&ing the hospital's vision.
0ollows through on all assigned duties*responsi&ilities to ensure they are completed correctly and
in a timely manner.

Solves pro&lems rather than &laming others or offering excuses.

1alues and supports co-wor+ers and actively participates in team,s success.

Comments:
(espect ! I will treat patients) families and colleagues with dignity and sensitivity) valuing their differences.
#ntroduces self greeting others warmly offering assistance.
Strives to &etter understand the diverse cultures and customs of patients and their families.
-ses words and tones appropriate to a health care setting.
Comments:
Excellence ! I will rise a#ove the ordinary through my personal efforts and those of my team.
Treats co-wor+ers with courtesy consideration respect and trust. /ecogni)es that he*she is part
of a team.

Engages in continuous learning to promote personal and professional growth.

2or+s to create team success as well as individual success.

3elps to maintain our facility &y +eeping it clean and uncluttered.

Comments:
__________________________________________ _____________________________________
Employee Signature Evaluator Signature
__________________________________________ _____________________________________
Employee ID # Date
#n +eeping with the !ission 1ision and 1alues of Strong !emorial 3ospital all employees
are responsi&le for the delivery of care and services that reflect the Strong Commitment and
are consistent with the following values and expected &ehaviors.
" *E(S+N", +MMI-MEN- -+ +.( /",.ES
Integrity ! # will conduct myself in a fair responsi&le and trustworthy
manner.
ompassion ! # will act with empathy and understanding towards others.
"ccounta#ility ! # have an o&ligation to ta+e responsi&ility for my actions
and to .oin with my colleagues in reaching the hospital4s vision.
(espect ! # will treat patients families and colleagues with dignity and
sensitivity valuing their differences.
Excellence ! # will rise a&ove the ordinary through my personal efforts and
those of my team.
0E1"/I+(S -1"- S.**+(- +.( +MMI-MEN-
5. 2ear neat proper dress including a visi&le #% &adge.
6. 7reet others warmly offer assistance and escort them to their destination
if needed.
8. #ntroduce yourself and explain your role.
9. -se words and tones appropriate to the healthcare setting.
:. /espect every person4s privacy (+noc+ &efore entering a room pull
privacy curtains where possi&le$.
;. <lways give patients and families priority (in elevators lines par+ing
lots$.
=. Solve pro&lems rather than &lame others or offer excuses. <pologi)e for
any inconveniences.
>. ?e flexi&le and willing to listen to ideas that are different from your own.
@. 1alue and support your co-wor+ers and actively participate in team
success.
5A. Beep our hospital clean (report spills pic+ up trash and reduce clutter$.
I have read and understand that I am responsible to adhere to the above Strong Commitment
Standards and Strong Commitment Performance Behaviors. I acknowledge that my failure to do so
will result in disciplinary action up to and including termination.
__________________________________________ _____________________________
Signature Date
__________________________________________ _____________________________
Print Name Employee ID #