Appraisal and Performance Review of Staff Bands 8a, 8b, 8c, 8d, 9 and Executive
Appraisal and Performance Review
Staff Bands 8a, 8b, 8c, 8d, 9 and Executive
Name:
Role:
Date of Performance Review:
Name of Manager:
Introduction
This Performance Review (Appraisal) Form contains two sections:
Section 1 will need to be completed before the performance review by the Manager and Employee.
Section 2 will need to be completed during and after the performance review by the Manager and
Employee.
Section 1 - Complete this section before the performance review meeting.
Review of the past 12 months
a. Personal Reflection.
b. Objectives – Contribution and Success to objectives.
c. Values and Behaviours – Consider behaviours and adherence to Trust values over the past 12 months.
d. Completion of Statutory and Mandatory training (Evidence and/or certificates to be brought to meeting).
e. Completion of training and Clinical and Professional Requirements and Competencies.
Section 2 – Complete this section during and after the performance review meeting.
Planning for the future
a. Overall Performance Assessment Grading.
b. Objectives for year ahead.
c. Personal Development Plan for year ahead.
Portsmouth Hospitals NHS Trust, Appraisal and Performance Review Policy – Band 8a - Executive
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Appraisal and Performance Review of Staff Bands 8a, 8b, 8c, 8d, 9 and Executive
Section 1 - Review of the past 12 months (Before Performance Review – Manager and
Employee)
a. Reflection on past 12 months (Before Performance Review – Manager and Employee)
Consider - Achievements, the low points, the most satisfying aspects of role/performance, the least
satisfying aspects of role/performance, what has been learnt? What has been done well?
b. Objectives – Contribution and success towards these over the past 12 months (Before
Performance Review – Manager and Employee).
Objectives (Write down objectives Contribution and Success (Outcome to date, evidence of
agreed last year):
success, progress so far):
Manager To Assess Employee On Completion Of Objectives (Tick appropriate box):
Met and/or Exceeded All
Met No Objectives
Met Some Objectives
Objectives
Portsmouth Hospitals NHS Trust, Appraisal and Performance Review Policy – Band 8a - Executive
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Appraisal and Performance Review of Staff Bands 8a, 8b, 8c, 8d, 9 and Executive
c. Values and Behaviours (Before Performance Review – Manager and Employee).
Employee indicate where they see themselves on each line with an X / Manager indicate where they see employee on each line with an 0.
Effective Behaviours
Ineffective Behaviours
1) Strategic Approach – clarity on objectives, clear on expectations
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3
1
2
Click and drag the cross/circle to the appropriate position on the scale
Effective Behaviours
Ineffective Behaviours
Plans and takes initiative in the best interests of the patient/customer
Makes decisions based on organisations strategic direction
Makes success criteria clear to others and focuses them on what matters most
Avoids major problems through anticipation and contingency planning
Reactive with no initiative and little consideration
Makes little or no reference to the organisational strategy
Unable to articulate the objective leading to confusion and inconsistent messages
Plans are overly rigid with little ability to adjust to unforeseen changes
Following Discussion Between Employee And Manager – Total Score
Examples for discussion (List and provide supplementary
evidence):
Examples for discussion (List and provide supplementary
evidence):
1)
Portsmouth Hospitals NHS Trust, Appraisal and Performance Review Policy – Band 8a - Executive
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Appraisal and Performance Review of Staff Bands 8a, 8b, 8c, 8d, 9 and Executive
2) Relationship Building – communicate effectively, be open and willing to help, courtesy, nurtures partnerships
4
2
3
1
Click and drag the cross/circle to the appropriate position on the scale
Effective Behaviours
Ineffective Behaviours
Consistently seeks to understand and meet the needs and interests of customers/patients
Asks open questions and listens to other ideas to develop joint solutions
Involves key stakeholder and staff in planning organisational change
Focuses on own needs and does not listen to others
Makes little effort to ask, listen or consider the needs and interest of others
Ignores key stakeholders in planning change, imposes own agenda
Following Discussion Between Employee And Manager – Total Score
Examples for discussion (List and provide supplementary
evidence):
Examples for discussion (List and provide supplementary
evidence):
Portsmouth Hospitals NHS Trust, Appraisal and Performance Review Policy – Band 8a - Executive
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Appraisal and Performance Review of Staff Bands 8a, 8b, 8c, 8d, 9 and Executive
3) Personal Credibility – visibility, approachable, back bone, courage, resilience, confidence, role model, challenge bad behaviour,
manage poor performance, act with honesty and integrity
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2
3
1
Click and drag the cross/circle to the appropriate position on the scale
Effective Behaviours
Ineffective Behaviours
Articulates a compelling vision of how things could be and might
Consistently delivers on promises
Consistently acts in accordance with, and champions PHTs values
Displays sensitivity to the needs and feelings of others
Has a zero tolerance to, and challenges bad behaviour
Actively manages poor performance
Energy is unfocused, tries to do everything with little sense of priority
Regularly over promises and under delivers
Takes an expedient route that compromises PHTs values
Presents a one-sized case, blames others for mistakes
Ignores bad behaviour allowing others to replicate
Accepts poor performance and the impact it has on productivity
Following Discussion Between Employee And Manager – Total Score
Examples for discussion (List and provide supplementary
evidence):
Examples for discussion (List and provide supplementary
evidence):
Portsmouth Hospitals NHS Trust, Appraisal and Performance Review Policy – Band 8a - Executive
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Appraisal and Performance Review of Staff Bands 8a, 8b, 8c, 8d, 9 and Executive
4) Passion to Succeed – patient centred, positive attitude, take action, take pride, take responsibility, aspire for excellence
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3
1
2
Click and drag the cross/circle to the appropriate position on the scale
Effective Behaviours
Ineffective Behaviours
Motivates others through infectious enthusiasm and ‘can do’ attitude
Maintains optimism and professionalism in stressful situations
Emphasises the positive side of difficulties, portraying them as opportunities
Finds ways around seemingly insurmountable obstacles, not easily defeated
Infuse pride and joy at work
Lead by example by taking responsibility, being compassionate and aspiring for excellence
Emphasises what is going wrong rather than what is going well
Loses patience and professionalism in stressful situations
Quick to take a defeatist attitude when faced with unforeseen obstacles
Loses energy and enthusiasm when faced with challenges, becomes negative
Create fearfulness amongst colleagues and staff
Sits in the background and displays a lack of ownership
Following Discussion Between Employee And Manager - Total Score
Examples for discussion (List and provide supplementary
evidence):
Examples for discussion (List and provide supplementary
evidence):
Portsmouth Hospitals NHS Trust, Appraisal and Performance Review Policy – Band 8a - Executive
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Appraisal and Performance Review of Staff Bands 8a, 8b, 8c, 8d, 9 and Executive
5) Harness Performance Through Teams – champion positive change, develop staff, create a culture without fear of retribution,
actively listen and value contribution, feedback and empower staff, respect diversity
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3
1
2
Click and drag the cross/circle to the appropriate position on the scale
Effective Behaviours
Ineffective Behaviours
Takes proactive steps to develop team members using a variety of approaches
Involves team members in planning and delivering change
Stimulates and communicates cross disciplinary communication
Recognises and rewards effort, not just achievement
Matches the needs of activity to available resource
Seeks out and listens to team members and stakeholders, welcoming warnings or problems
Invests little or no effort in developing team members
Excludes team members from planning and keeps them in the dark
Engenders a competitive and non-cooperative atmosphere
Makes little or no effort to engage team members
Fails to match available resource to demand priorities
Fails to listen, ignores concerns and makes bad news unwelcome
Following Discussion Between Employee And Manager - Total Score
Examples for discussion (List and provide supplementary
evidence):
Examples for discussion (List and provide supplementary
evidence):
Portsmouth Hospitals NHS Trust, Appraisal and Performance Review Policy – Band 8a - Executive
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Appraisal and Performance Review of Staff Bands 8a, 8b, 8c, 8d, 9 and Executive
d) Statutory and Mandatory Training (Essential Skills) (Before Performance Review – Manager and
Employee).
(Refer to Individual Essential Skills Matrix (ESR), Manager to be assessed against their team being
Essential Skills compliant)
Statutory and Mandatory
Is it up to date?
Your comments:
Training required to undertake
(or refer to Individual Essential
Skills Matrix on ESR):
e) Training, Clinical and Professional Requirements completed (Before Performance Review –
Manager and Employee).
Clinical and Professional
Training undertaken this
Your comments:
Requirements and
year:
Competencies needed for your
role (i.e. proof of up to date
PIN/registration or CPD):
Manager To Assess Employee On Completion Of Essential Skills
Did Employee Complete Essential Skills? Yes / No (please circle)
Portsmouth Hospitals NHS Trust, Appraisal and Performance Review Policy – Band 8a - Executive
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Appraisal and Performance Review of Staff Bands 8a, 8b, 8c, 8d, 9 and Executive
Section 2 - Planning for the future (During and After Performance Review – Employee and
Manager)
a. Overall Performance Assessment Score - Manager complete the following assessment:
Objectives – Has the employee completed their objectives? (Tick appropriate box):
None Completed
Some Completed
All Completed/Exceeded
Behaviours – What overall score has the employee achieved in their values and behaviours
evaluation? (Add individual scores together and complete below)
Behaviours
Score
1) Strategic Approach
2) Relationship Building
3) Personal Credibility
4) Passion to Succeed
5) Harness Performance Through Teams
Overall Numerical Score
Convert Score To Performance Assessment Grade
19.1 - 20.0
16.0 – 19.0
9.6 – 15.9
6.0 – 9.5
Equates to A:
Equates to B:
Equates to C:
Equates to D:
5.0 – 5.9
Equates to E: Poor – Failed to achieve any key behaviours (Performance Management Required –
Exceptional – Continually meeting and exceeding all required behaviours
Very Good – Meets required standard of behaviours and often exceeding in some
Good – Meets most but not all required behaviours
Needs Improvement/Development – Meeting few required key behaviours
(Consideration for Performance Management – see Policy guidance)
see Policy guidance)
Overall Behavioural Grade (A-E)
Essential Skills – Has the employee completed their required Statutory and Mandatory Training
(Essential Skills)? (Tick appropriate box):
Yes – Has completed all Essential Skills
No – Has not completed Essential Skills
Overall Performance Grade - Manager to give employee overall performance assessment grade.
IMPORTANT NOTE – If employee has not completed Essential Skills, they are automatically graded at
D/E and remedial action must take place (see Policy Guidelines for more details)
A – Exceptional – Continually meeting and exceeding all objectives and behaviours
B – Very Good – Meets objectives & required standard of behaviours/often exceeding in some
C – Good – Meets most but not all objectives and behaviours
D – Needs Improvement/Development – Achieving few key objectives and behaviours (Consideration
for Performance Management)
E – Poor (Performance Management Required) – Failed to achieve any key objectives and behaviours
and requirements of the role.
Employee Overall Performance Grade =
*If Bands 8c, 8d & 9 graded at D/E see Policy Guidance reference pay progression
Portsmouth Hospitals NHS Trust, Appraisal and Performance Review Policy – Band 8a - Executive
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Appraisal and Performance Review of Staff Bands 8a, 8b, 8c, 8d, 9 and Executive
b. Objectives for year ahead
Specialty/Team Objectives:
Employees Objectives - Consider Section
10 in the Appraisal and Performance
Review Policy, when setting objectives:
Portsmouth Hospitals NHS Trust, Appraisal and Performance Review Policy – Band 8a - Executive
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When do I need to do this by and the
success criteria (how will I know the
objective has been met)?
Appraisal and Performance Review of Staff Bands 8a, 8b, 8c, 8d, 9 and Executive
c. Personal Development Plan (PDP). The PDP underpins and supports delivery of objectives, values and behaviours.
Consider - Skills, knowledge and behaviours needed to develop, specific details of how objectives will be achieved, timescales, success criteria
and key dates. Consider Management and Leadership Skills Programme and Talent Management Section (Main Page – Performance
Management Framework)
Personal Development Plan:
Career Aspirations (Consider Talent Management and Management and Leadership Development Programme – main page Performance
Management Framework):
Employee Signature:
Manager Signature:
Date:
Date:
Senior Manager Signature if Employee Graded D or E in Overall Performance Grade
Portsmouth Hospitals NHS Trust, Appraisal and Performance Review Policy – Band 8a - Executive
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