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Go to: Job Performance Core Values What Matters to You Final Rating
Self-Review
________________________________________________________
___________________________________________________________________
WHAT TO EXPECT THIS YEAR:
• Reflection and conversation prompts
• Simplified, high-level ratings for: 1. Job Performance, 2. Service Values, and 3. Final Rating using the scale of
Exceeds, Meets Plus, Meets, Meets Minus, Does Not Meet
• Additional, unrated questions that promote reflection and conversation on engagement, well-being, and
development
Learn more about the why behind question prompts, get suggestions, and see examples…
Education, background, and support materials are available throughout this form. Look for clickable icons for
additional guidance, or scan QR Codes with your mobile phone if you printed the form.
Manager’s and Self-Evaluator’s guides are on Pulse to help with making the most of your review conversations and
identifying development opportunities: Pulse > Training (Green Top Pages Icon) > Talent & Performance Management
>Performance Management.
Instructions:
1. Save this form to your computer with your initials added to the end of the file name (e.g., Jane Ann Doe would save
as 2021-2022_Performance_Review-JAD).
2. Reflect on your past year’s performance and add your comments on the following pages. Be concise; the reflection
questions are to prompt conversation. If you need additional space, you can use the “Additional Comments”
section on the last page or add comments to a Word document.
3. Save and send the form and any additional comments to your manager. Your manager will review it, add their
thoughts, and then arrange a time for discussion with you.
4. After your performance discussion, you and your manager will sign the form. Your manager will provide you a copy
of the completed form and add a copy into your personnel file. If you do not have easy access to a computer, you
may print the form and write in your responses to give to your manager.
http://pulse/EMPResources/HumanResources/LearningDevelopment/Pages/PerfMgmt.aspx
http://pulse/EMPResources/HumanResources/LearningDevelopment/Pages/PerfMgmt.aspx
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Team Member: Consider your current key job responsibilities. Please provide a summary for each of the prompts.
Manager: Provide comments on the following page. If helpful, you and your team member may reference job
descriptions. Job Descriptions are available on the Shared drive (Shared Drive>Doc-Dist>NorthShore Documents>Human
Resources>Job Descriptions).
Note: The italicized prompts are things to consider if you need help completing those sections.
1. Describe your overall job performance. Highlight specific accomplishments and outcomes.
Click the link or scan the code for guidance on what makes a self-evaluation effective and
how to write one. How have you contributed to achieving departmental goals, such as quality
improvement, financial, or patient experience goals? Have you received recognition for your work
including Service Values or Loyalty Leader awards?
2. Share an issue or challenge that you faced in your role during the past year and what you did to try to reduce or
resolve the issue. Were your attempts successful? If not, what could you have done differently? What did you learn from this
experience that you can use in the future?
3. Describe how effectively you worked with teammates or with other teams. How did you contribute to the success of the
team? What are opportunities to do better when working with others?
TEAM MEMBER COMMENTS
(REQUIRED)
TEAM MEMBER COMMENTS (REQUIRED)
TEAM MEMBER COMMENTS (REQUIRED)
http://learningtechnologyteam.com/PerformanceReview/Neutral-Better-Best
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JOB PERFORMANCE
Click the link icon or scan the QR code to view how NorthShore leaders apply ratings to job
performance for several sample job roles.
Considering your answers on the previous page, how would you rate your overall job performance?
Note: Descriptions below provide guidance but in no way reflect all performance or behaviors.
Exceeds: Consistently exceeds role expectations. Performs all of the behaviors from Meets Plus AND significantly contributes
towards the achievement of department goals and innovation; if clinical, may also lead efforts to improve patient care. To
achieve this rating, performance impact should be objectively measurable, such as through outcomes of documented goals.
Meets Plus: Often exceeds role expectations and behaviors from Meets AND takes on additional responsibilities without being
asked. Proactively seeks ways to improve performance, processes, and support team and department goals.
Meets: Consistently does a great job and meets all role expectations; may occasionally exceed role expectations. Performance
contributes to excellent patient care and/or supports department, unit, or team goals.
Meets Minus: May meet some role expectations, though still needs to develop and significantly improve in some areas. Shows
willingness to improve.
Does Not Meet role expectations and may be resistant to feedback or efforts to improve. Has documented behavioral or
performance issues such as a Corrective Action or Performance Improvement Plan (PIP).
Select a rating from the dropdown list in your corresponding field below:
JOB PERFORMANCE VALUES RATING
TEAM MEMBER SELF RATING MANAGER RATING OF TEAM MEMBER
ADDITIONAL TEAM MEMBER COMMENTS (IF NEEDED) MANAGER COMMENTS (REQUIRED)
http://learningtechnologyteam.com/PerformanceReview/SamplePerformanceReviewRankingExpectations2021
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NorthShore’s Service Values and Always Behaviors are foundational elements of how we treat
one another and the patients, families, and visitors that we serve. These core values are
expected of every team member. If you are not in a patient facing role, consider the Always
Behaviors in the context of your immediate team members, other departments, and external
customers.
Click the link icon or scan the QR code to view sample descriptions of Service Values by Performance Ratings.
Service Values
• Exceptional Customer Service: Focus on Empathy, Communication, and Compassion
• Supportive Workplace Interactions: Focus on Teamwork and Positive Outlook
• Professional Work Ethic: Focus on Integrity, Initiative, and Results
Always Behaviors
• Welcome each patient by initiating a greeting, calling them by proper name, acknowledging friends/family, stating your
name and role
• Explain what you are going to do, how long it will take, and the impact on the patient; explain reason for delays
• Connect by initiating conversation that is sensitive to the patient’s demeanor; seek to learn something about the patient as
a person
• Anticipate patient needs, concerns, questions; ask what you can do to further assist
• Reassure – provide reassurance; respond promptly and courteously to requests and questions
• Exit with a warm closing statement, and transition to the next member of the care team with information of what will come
next
Consider your interactions with your team members, members of other teams, patients, families, and visitors. How
would you rate yourself?
Note: Descriptions below provide guidance, but in no way reflect all performance or behaviors.
Exceeds: Fulfills all qualifications of Meets Plus AND goes out of their way to put others at ease. Proactively looks for ways to
assist others and leads efforts to improve processes. Demonstrates outstanding integrity and empathy. Overwhelmingly
positive feedback from team members, patients, families, and/or visitors.
Meets Plus: Fulfills all qualifications of Meets AND takes on additional responsibilities without being asked to assist team
members, patients, families, and/or visitors. Consistently anticipates customer needs and proactively seeks to help.
Meets: Consistently does a great job and exhibits all Service Values with team members, patients, families, and/or visitors,
and may occasionally exceed expectations. Performance contributes to excellent patient care and/or supports department,
unit, or team goals. Receives positive feedback from team members, patients, families, and/or visitors.
Meets Minus: May do well in some Service Values behaviors, though still needs to develop and significantly improve in some
areas. May have received negative feedback regarding Service Values.
Does Not Meet Service Values expectations and may be resistant to feedback or efforts to improve. Consistently receives
negative feedback for behaving unprofessionally or refusing to follow policy or procedure. Has documented behavioral or
performance issues (e.g., Corrective Action, PIP).
Select a rating from the dropdown list in your corresponding field below:
CORE VALUES RATING
TEAM MEMBER SELF RATING MANAGER RATING OF TEAM MEMBER
TEAM MEMBER COMMENTS MANAGER COMMENTS (REQUIRED)
http://learningtechnologyteam.com/PerformanceReview/ServiceValuesBehaviorsRubric
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What matters to you also matters to NorthShore. By understanding what matters to you, we can identify opportunities
where your personal goals and values align with the organization’s mission, vision, and goals.
Note: Questions on this page do not affect your rating. Click the video
icon, scan the QR code, or visit your user guide to learn more about why
we included this section. There is additional information for each
question in your user guide.
Before you begin, how would you describe where you are today in your role?
New/still learning my role Satisfied in current role/developing in place Looking for stretch opportunities
INSTRUCTIONS: Pick 1 of the following topics to discuss based on what matters to you and how this could positively
impact your work experience and engagement. You may also choose to discuss something else that is important to you,
which isn’t listed.
• What do you find most exciting, rewarding, or are most proud of in your work at NorthShore that you would like
to do more often?
• Would you like help understanding how your role contributes to the organization’s mission, vision, and goals?
• What support do you need? Share concerns and/or ideas you have for your wellbeing at work.
• Are there work goals you would like to accomplish in the coming year for which you need support?
• What development opportunities would you like to receive to help you progress in your role or career?
• Are there areas within your department where you would like to take on more responsibility or try new tasks,
and what assistance do you need to do so?
• Are there ideas you have for improving processes that you would like to share and possibly try to implement?
TEAM MEMBER COMMENTS
https://jwp.io/s/JAu0yj43
http://learningtechnologyteam.com/PerformanceReview/ServiceValuesBehaviorsRubric
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RATINGS SCALE DEFINITIONS
Does Not Meet
Highly inconsistent or
doesn’t display desired
qualifications
Meets Minus
Needs improvement or
additional skills to meet
role expectations
Meets Expectations
Consistently well-done,
expected performance
Meets Plus
Strong performance,
often “above & beyond”
Exceeds Expectations
Role model with exceptional
performance
(Must be rated Exceeds in
both Job Performance and
Core Values, and AVP
signature required)
• Ability to meet role
expectations or
documented goals
varies widely
• Inconsistently
demonstrates Core
Values
• May show
unwillingness or
inability to improve
• Has documented
performance or
behavioral issues
(e.g., Corrective
Action, PIP)
• Meets some, but not
all documented goals
or role expectations
• Demonstrates Core
Values most of the
time
• Shows some
willingness to improve
performance
• Successfully meets all
documented goals and
role expectations and
may on occasion
exceed expectation
• Consistently
demonstrates Core
Values
• Contributes to success
of the unit,
department, or team
• Fulfills all
expectations of
Meets rating, and
• Regularly contributes
to department goals;
improves and
innovates work
practices
• Takes on additional
work without being
asked and shares
knowledge
• Fulfills all expectations of
Meets Plus rating, and
• Consistently exceeds all
documented goals and
role expectations
• Considered expert and
role model by others;
always contributes to
department goals;
improves and innovates
work practices
• Solves big problems and
finds new opportunities
without needing
direction
You can also use the chart below to help determine Final Rating based on Core Values and Job Performance ratings.
EXAMPLE: to receive an Exceeds
as a Final Rating, both Job
Performance and
Core Values
ratings must be Exceeds.
Job Performance Rating (from page 3)
Does Not Meet
(DNM)
Meets Minus
(MM)
Meets
(M)
Meets Plus
(MP)
Exceeds
(E)
Co
re
V
al
ue
s
Ra
tin
g
(f
ro
m
p
a
g
e
4
) Does Not Meet (DNM) DNM DNM or MM* MM MM MM
Meets Minus (MM) DNM or MM* MM MM OR M* M M
Meets (M) MM MM or M* M M or MP* MP
Meets Plus (MP) MM M M or MP* MP MP
Exceeds (E) MM M MP MP E
* Manager discretion can be used.
Self Manager
Job Performance
Core Values
FINAL RATING:
I ACKNOWLEDGE THAT I HAVE READ THIS PERFORMANCE EVALUATION IN ITS ENTIRETY AND HAVE BEEN PROVIDED THE
OPPORTUNITY TO DISCUSS IT WITH MY MANAGER. MY SIGNATURE ACKNOWLEDGES THAT I HAVE RECEIVED A COPY OF THIS
PERFORMANCE EVALUATION BUT DOES NOT NECESSARILY REPRESENT MY AGREEMENT WITH THE CONTENT CONTAINED WITHIN.
TEAM MEMBER SIGNATURE:______________________________________________________________DATE:_______________
MANAGER SIGNATURE:__________________________________________________________________DATE:________________
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ADDITIONAL COMMENTS
ADDITIONAL TEAM MEMBER COMMENTS (IF NEEDED)
ADDITIONAL MANAGER COMMENTS (IF NEEDED)
-
ANNUAL PERFORMANCE REVIEW
JOB PERFORMANCE
JOB PERFORMANCE
CORE VALUES
WHAT MATTERS TO YOU?
FINAL PERFORMANCE RATING
-
TEAM MEMBER NAME:
- TEAM MEMBER COMMENTS REQUIRED:
- TEAM MEMBER COMMENTS REQUIRED_2:
- TEAM MEMBER COMMENTS REQUIRED_3:
- ADDITIONAL TEAM MEMBER COMMENTS IF NEEDED:
- MANAGER COMMENTS REQUIRED:
- TEAM MEMBER COMMENTS:
- MANAGER COMMENTS REQUIRED_2:
- TEAM MEMBER COMMENTS_2:
- DATE:
- DATE_2:
- ADDITIONAL TEAM MEMBER COMMENTS IF NEEDED_2:
- ADDITIONAL MANAGER COMMENTS IF NEEDED:
- Check Box1: Off
- Check Box2: Off
- Check Box3: Off
- TM-name:
- Mgr-name:
- JP-MGR: [ ]
- JP-TM: [ ]
- CV-MGR: [ ]
- CV-TM: [ ]
- FR-TM: [ ]
- FR-JP-TM: [ ]
- FR-CV-TM: [ ]
- FR-MGR: [ ]
- FR-JP-MGR: [ ]
- FR-CV-MGR: [ ]
JOB ROLE:
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