Accountability Agreement Tool Kit - Custom Learning · Accountability Agreement Tool Kit 0 P: ... (Provider & Employer of Choice) # 6 Mos (baseline - if ... I accept full responsibility

Accountability Agreement Tool Kit

0 P:\Smart Tools\Tools\2_Current\Accountability_Agreement_Tool_Kit.doc 10/05/2013



Organization-Wide

Leadership Accountability Agreement

Effective Date:

I. HCAHPS Goals (Provider of Choice)

# 12 Mos

High

12 Mos

Low

Year 1

(Date)

Year 2

(Date)

Year 3

(Date)

1. Communication with nurses

2. Communication with doctors

3. Responsiveness of hospital staff

4. Pain Management

5. Communications about Medications

6. Cleanliness of hospital environment

7. Quietness of hospital environment

8. Discharge Information

9. Overall

10. Willingness to Recommend

II. Patient Satisfaction Mean Score Goals (Provider of Choice)

# Overall Scores 12 Mos

High

12 Mos

Low

Year 1

(Date)

Year 2

(Date)

Year 3

(Date)

1. Inpatient

2. Outpatient

3. Ambulatory Services

4. ER

5. Clinics

6. Long Term Care

III. Internal Support Services Scorecard Goals (Provider & Employer of Choice)

# Hospital Overall 6 Mos (baseline - if applicable)

(Date)

12 Mos

(Date

1. Timeliness of Service

2. Telephone Etiquette

3. Quality of Service

4. Professionalism & Attitude

5. Overall

IV. Employee Satisfaction (Employer of Choice)

# Hospital Overall Current (baseline)

(Date)

6 Mos (if applicable)

(Date)

12 Mos

(Date)

1. Hospital Overall

V. Employee Turnover (Employer of Choice)

# By Position, Department or Overall Turnover Staff Turnover

Current

Turnover Goal

Year 1(Date)

Year 2

(Date)

Year 3

(Date)

Total # # % # % % %

1. Clinical

2. Non-Clinical

VI. Service Excellence Goals (Provider & Employer of Choice)

# 6 Mos (baseline - if applicable)

(Date)

12 Mos

(Date)

1. Service Huddles

2. DO IT Meetings



Department-Specific


Department/Unit:

Leader Name:

Position:

Reports to:


# Domain 12 Months High 12 Months Low Year 1 Goal (Date)




4. Pain Management





9. Overall



# Specific survey vendor questions as they pertain

to your department.

12 Months High 12 Months Low Year 1 Goal (Date)

1.

2.


# Criteria 6 Months (baseline - if

applicable)

(Date)

12 Months

(Date)





5. Overall


# Domain (if applicable) Current (baseline)

(Date)

6 Months (if

applicable)

(Date)

12 Months

(Date)

1.

2.


# May be by Position Staff Turnover

Current

Turnover Goal

Year 1 (Date)

Total # # % # %

1. RNs

2.

VI. Service Excellence Goals (Provider / Employer of Choice)

# Responsibilities 6 Months (baseline - if

applicable)

(Date)

12 Months

(Date)

1. Service Huddles

2. DO IT Meetings

Agreement: Effective today’s date, I accept full responsibility and accountability for the above noted goals, including gaining buy-in

and support from my staff. I further acknowledge that __________% of my performance review will be linked to the outcome of these

goals.

Signature: Date:



Individual

Leadership Accountability Agreement Department/Unit:

Leader Name:

Position:

Reports to:

I. Semi-Annual Leadership Empowerment Survey

# Survey Questions 6 Months (baseline)

(Date)

12 Months Goal

(Date)

1. Visionary & Change Agent: This Leader helps me understand change

and to see the “Big Picture”.

2. Builder of Trust & Personal Effectiveness: This Leader practices what

he/she preaches, is a good role model, and treats me with courtesy and

respect.

3. Communicator: This Leader keeps me informed so that I truly feel like

a knowledgeable “insider”.

4. Customer Service & Survey Literate: This Leader does a good job of

inspiring patient-centered service in my department and is always

aware of feedback from our satisfaction surveys.

5. Team Leader: This Leader promotes teamwork within our department

and with other departments/units.

6. Meeting Leader: This Leader runs meetings/huddles that inspire me

and encourage me to speak up.

7. Project & Time Management: This Leader ensures that I have the tools

and training to do my job in a timely and effective way.

8. Creative Problem Involver: This Leader encourages open and creative

problem-solving in my department.

9. Empowerer/Delegator: This Leader gives me clear assignments and

empowers me to do my best.

10. Employee Developer & Coach: This Leader is effective at coaching

me, developing my skills and keeping me on track.

11. Performance & Conflict Manager: This Leader is timely and

appropriate with both positive feedback and corrective action.

12. Hardwirer: This Leader is actively engaged in the Service Excellence

Initiative™ Process. (Year II and beyond)

13. Overall I rate my working relationship with this Leader as:

II. Service Excellence Goals


applicable) (Date)

12 Months

(Date)

1. Attendance at Training Sessions

2. Participation on OASIS Teams

3. Patient Rounding (if applicable)

4. Staff Rounding

Agreement: Effective today’s date, I accept full responsibility and accountability for the above noted goals. I further

acknowledge that __________% of my performance review will be linked to the outcome of these goals.

Signature: Date:



Department-Specific


Department/Unit:

Leader Name:

Position:

Reports to:


# Domain 12 Months High 12 Months Low Year 1 Goal (Date)




4. Pain Management





9. Overall



# Specific survey vendor questions as they pertain

to your department.

12 Months High 12 Months Low Year 1 Goal (Date)

1.

2.


# Criteria 6 Months (baseline - if

applicable)

(Date)

12 Months

(Date)





5. Overall


# Domain (if applicable) Current (baseline)

(Date)

6 Months (if

applicable)

(Date)

12 Months

(Date)

1.

2.


# May be by Position Staff Turnover

Current

Turnover Goal

Year 1 (Date)

Total # # % # %

1. RNs

2.

VI. Service Excellence Goals (Provider / Employer of Choice)


applicable)

(Date)

12 Months

(Date)

1. Service Huddles

2. DO IT Meetings

Agreement: Effective today’s date, I accept full responsibility and accountability for the above noted goals, including gaining buy-in

and support from my staff. I further acknowledge that __________% of my performance review will be linked to the outcome of these

goals.

Signature: Date:



LEADERSHIP ACCOUNTABILITY AGREEMENT ANNUAL HCAHPS SCORES

Position:

Department/Unit:

NURSING

Leader Name:

Reports to:

# I Leader Owned Goal % Goal % by Year

Survey Question Last ¼ Next 12

Months

Y2 Y3

“How often did nurses communicate well with patients?”

1. During this hospital stay, how often did nurses treat you with

courtesy and respect?

2. During this hospital stay, how often did nurses listen carefully to

you?

3. During this hospital stay, how often did nurses explain things in a

way you could understand?

“How often did patients receive help quickly from hospital staff?”

4. During this hospital stay, after you pressed the call button, how

often did you get help as soon as you wanted it?

5. How often did you get help in getting to the bathroom or in using a

bedpan as soon as you wanted?

“How often was patients’ pain well controlled?”

6. During this hospital stay, how often was your pain well controlled?

7. During this hospital stay, how often did the hospital staff do

everything they could to help you with your pain?

“How often did staff explain medicines before giving them to

patients”

8. Before giving you any new medicine, how often did hospital staff

tell you what the medicine was for??

9. Before giving you any new medicine, how often did hospital staff

describe possible side effects in a way you could understand?

“How often was the area around patients’ room kept quiet at night?”

10. During this hospital stay, how often was the area around your room

quiet at night?

“Were patients given information about what to do during their

recovery at home?”

11.

During this hospital stay, did doctors, nurses or other hospital staff

talk with you about whether you would have the help you needed

when you left the hospital?

12.

During this hospital stay, did you get information in writing about

what symptoms or health problems to look out for after you left the

hospital?

II Organization Wide Goal

How do patients rate the hospital overall?

Would patients recommend the hospital to friends and family?

Agreement: Effective today’s date, I accept full responsibility and accountability for the above noted

“Leader Owned Goals”, including gaining buy-in and support from my staff to achieve these. I further

acknowledge that ____% of my performance review will be linked to these goal’s outcomes.

Signature: Date:



LEADERSHIP ACCOUNTABILITY AGREEMENT

ANNUAL PATIENT SATISFACTION SCORES

Position:

Department/Unit:

CASE MANAGEMENT

Leader Name:

Reports to:

# I Leader Owned Goal %tile Range Goal %tile

Survey Question 12

Month

High

12

Month

Low

Last

¼

Next 12

Months

Year

2

Year

3

1. Discharge

2. Extent felt ready discharge

3. Speed of discharge process

4. Help arranging homecare services


Inpatient

Outpatient

Emergency Department

Ambulatory

Physician Clinics

Long Term Care

Home Health

Agreement: Effective today’s date, I accept full responsibility and accountability for the above

noted “Leader Owned Goals”, including gaining buy-in and support from my staff to achieve

these. I further acknowledge that ____% of my performance review will be linked to these goal’s

outcomes.

Signature: Date:





Position:

Department/Unit:

DIETARY

Leader Name:

Reports to:


Survey Question 12

Month

High

12

Month

Low

Last

¼

Next 12

Months

Year

2

Year

3

1. Meals

2. Special/restricted diet explained

3. Temperature of food

4. Quality of the food


Inpatient

Outpatient


Ambulatory

Physician Clinics

Long Term Care

Home Health




outcomes.

Signature: Date:





Position:

Department/Unit:

ENVIRONMENTAL SERVICES

Leader Name:

Reports to:


Survey Question 12

Month

High

12

Month

Low

Last

¼

Next 12

Months

Year

2

Year

3

1. Room temperature

2. TV, call button, etc. worked

3. Helpfulness People Info desk


Inpatient

Outpatient


Ambulatory

Physician Clinics

Long Term Care

Home Health




outcomes.

Signature: Date:




ANNUAL HCAHPS SCORES Position:

Department/Unit:

ENVIRONMENTAL SERVICES

Leader Name:

Reports to:

# I Leader Owned Goal % Goal % by Year

Survey Question Last

¼

Next 12

Months

Year

2

Year

3

“How often were the patients’ rooms and bathrooms kept clean?”

1. During this hospital stay, how often were your room and

bathroom kept clean?

How do patients rate the hospital overall?

Would patients recommend the hospital to friends and

family?

Agreement: Effective today’s date, I accept full responsibility and accountability for the above noted

“Leader Owned Goals”, including gaining buy-in and support from my staff to achieve these. I further

acknowledge that ____% of my performance review will be linked to these goal’s outcomes.

Signature: Date:





Position:

Department/Unit:

HOUSEKEEPING

Leader Name:

Reports to:


Survey Question 12

Month

High

12

Month

Low

Last

¼

Next 12

Months

Year

2

Year

3

1. Room

2. Pleasantness of room décor

3. Room cleanliness

4. Courtesy of person cleaning room


Inpatient

Outpatient


Ambulatory

Physician Clinics

Long Term Care

Home Health




outcomes.

Signature: Date:





Position:

Department/Unit:

PHYSICIANS

Leader Name:

Reports to:


Survey Question 12

Month

High

12

Month

Low

Last

¼

Next 12

Months

Year

2

Year

3

1. Physician

2. Time physician spent with you

3. Physician concern question/worries

4. Physician kept you informed

5. Friendliness/courtesy of physician

6. Skill of physician

7. Staff include decisions restatement


Inpatient

Outpatient


Ambulatory

Physician Clinics

Long Term Care

Home Health




outcomes.

Signature: Date:





Position:

Department/Unit:

LAB

Leader Name:

Reports to:


Survey Question 12

Month

High

12

Month

Low

Last

¼

Next 12

Months

Year

2

Year

3

1. Test & Treatments

2. Wait time for test & treatments

3. Concern/comfort during T&T

4. Skill of person took blood

5. Courtesy of person started IV

6. Courtesy of X-ray Staff


Inpatient

Outpatient


Ambulatory

Physician Clinics

Long Term Care

Home Health




outcomes.

Signature: Date:





Position:

Department/Unit:

OCCUPATIONAL THERAPY

Leader Name:

Reports to:


Survey Question 12

Month

High

12

Month

Low

Last

¼

Next 12

Months

Year

2

Year

3








Inpatient

Outpatient


Ambulatory

Physician Clinics

Long Term Care

Home Health




outcomes.

Signature: Date:





Position:

Department/Unit:

PHYSICAL THERAPY

Leader Name:

Reports to:


Survey Question 12

Month

High

12

Month

Low

Last

¼

Next 12

Months

Year

2

Year

3








Inpatient

Outpatient


Ambulatory

Physician Clinics

Long Term Care

Home Health




outcomes.

Signature: Date:





Position:

Department/Unit:

RADIOLOGY

Leader Name:

Reports to:


Survey Question 12

Month

High

12

Month

Low

Last

¼

Next 12

Months

Year

2

Year

3








Inpatient

Outpatient


Ambulatory

Physician Clinics

Long Term Care

Home Health




outcomes.

Signature: Date:





Position:

Department/Unit:

RESPIRATORY THERAPY

Leader Name:

Reports to:


Survey Question 12

Month

High

12

Month

Low

Last

¼

Next 12

Months

Year

2

Year

3








Inpatient

Outpatient


Ambulatory

Physician Clinics

Long Term Care

Home Health




outcomes.

Signature: Date:





Position:

Department/Unit:

OVERALL

Leader Name:

Reports to:


Survey Question 12

Month

High

12

Month

Low

Last

¼

Next 12

Months

Year

2

Year

3

1. Staff sensitivity to inconvenience

2. Extent staff wore ID badges

3. Info. family re-condition/treatment


Inpatient

Outpatient


Ambulatory

Physician Clinics

Long Term Care

Home Health




outcomes.

Signature: Date:

Documents

Accountability Agreement Tool Kit - Custom Learning · Accountability Agreement Tool Kit 0 P: ... (Provider & Employer of Choice) # 6 Mos (baseline - if ... I accept full responsibility