Medical Performance Appraisal Tool

This tool is designed to facilitate a discussion on current performance and planned development activities for all Senior
Medical Staff.

For the purpose of this document the Senior Medical Staff member undergoing the performance review is referred to as “employee” and the
Medical Leader conducting the review is referred to as “manager”.

Instructions on how to use this form:

1. Complete every section of this form prior to attending the Performance Appraisal Meeting with your Manager
2. Provide a copy to the Manager prior to the Performance Appraisal Meeting to prepare for the meeting
3. At the Performance Appraisal Meeting, both parties are to use the completed form as the basis for two-way discussion
4. Unit Heads and Service Directors are also required to complete Appendix 1 that is specific to the performance of a Unit Head/Service Director
5. At the end of the meeting, both parties to sign the form.
6. Manager and Employee to keep a copy of completed performance appraisal. This copy would be referred to at the subsequent year’s appraisal to monitor completion of
performance plans.
7. To ensure that completion of performance appraisals are captured on the organisational systems for the purposes of reporting, Unit Heads are required to complete the
following spreadsheet: Performance Review Record and then email it to: performancereviews@monashhealth.org.
8. Employees to enter the performance review date on ESS as a record of completion.

For further information or assistance, contact Director of Medical Services on

9594 2547
 Employee Profile Declaration
First name I declare that the Manager and I have had an opportunity to provide each other with two-way feedback
about my performance appraisal. I agree to the specific responsibilities, accountabilities and target dates
detailed in this form.
Last name
Employee Number Employee signature
Unit Manager Signature
Manager name
& designation
Date

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Section One – My Individual Performance Review
This section provides an opportunity to reflect on and discuss actions and behaviours related to professional competencies and provide feedback on performance against
expected behaviours and activities.
• Review individual performance over the last 12 months.
• Provide feedback on performance. Discuss discrepancies if any in rating of performance with a view to understanding why ratings differ and come to a shared
understanding of the issue.
• The Tool uses a Competency Framework familiar to medical staff to rate behaviours and actions that are expected of all employees of Monash Health.
Oil Clinic .
Alignment To
Monash Health
Oil Clinic
Professional Competency Rating Values
value

Medical Expert
Rarely Sometimes Most of the time Consistently N/A
Provides safe and high-quality care within agreed scope of Employee     
practice 1 2 3 4
Excellence
Rarely Sometimes Most of the time Consistently N/A
Manager     
1 2 3 4

Rarely Sometimes Most of the time Consistently N/A

Contributes meaningfully to quality improvement activities Employee     
including peer review, mortality and morbidity meetings 1 2 3 4

and clinical audit Rarely Sometimes Most of the time Consistently N/A
Manager     
1 2 3 4

Communicator
Rarely Sometimes Most of the time Consistently N/A
Engages patients and their families in decisions about their Employee     
care that reflect the patient’s values and preferences 1 2 3 4

Rarely Sometimes Most of the time Consistently N/A

Manager     
1 2 3 4

Communicates effectively with multidisciplinary team

Rarely Sometimes Most of the time Consistently N/A Respect
Employee     
members 1 2 3 4

Rarely Sometimes Most of the time Consistently N/A

Manager     
1 2 3 4

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Collaborator
Rarely Sometimes Most of the time Consistently N/A
Works with interdisciplinary and inter-professional teams to Employee     
achieve best outcomes for patients 1 2 3 4
Respect
Rarely Sometimes Most of the time Consistently N/A
Manager     
1 2 3 4

Health Advocate
Rarely Sometimes Most of the time Consistently N/A
Promotes health equity so all individuals and populations Employee     
can reach their full potential 1 2 3 4

Rarely Sometimes Most of the time Consistently N/A

Manager     
1 2 3 4

Leader

Leads with humility, kindness, respect and compassion Employee

Rarely

Sometimes

Most of the time

Consistently

N/A

Humility,
1 2 3 4 Kindness,
Rarely Sometimes Most of the time Consistently N/A Respect,
Manager     
1 2 3 4 Compassion
Rarely Sometimes Most of the time Consistently N/A
Takes ownership and accountability for outcomes and Employee     
performance of the team 1 2 3 4
Accountability
Rarely Sometimes Most of the time Consistently N/A
Manager     
1 2 3 4

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Scholar
Rarely Sometimes Most of the time Consistently N/A
Engages in continuing professional development activities Employee     
to maintain competence or develop clinical skills and 1 2 3 4

knowledge Rarely Sometimes Most of the time Consistently N/A

Manager     
1 2 3 4
Excellence
Rarely Sometimes Most of the time Consistently N/A
Actively contributes to teaching, training or supervision of Employee     
junior medical staff and other clinical staff 1 2 3 4

Rarely Sometimes Most of the time Consistently N/A

Manager     
1 2 3 4

Professional
Rarely Sometimes Most of the time Consistently N/A
Relentlessly pursues excellence in professional practice Employee     
1 2 3 4
Excellence
Rarely Sometimes Most of the time Consistently N/A
Manager     
1 2 3 4

Rarely Sometimes Most of the time Consistently N/A

Demonstrate a commitment to own health and well-being Employee     
to foster optimal patient care 1 2 3 4
Accountability
Rarely Sometimes Most of the time Consistently N/A
Manager     
1 2 3 4

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Section Two – My Achievements and Challenges
This section enables a positive discussion about the achievements and positive aspects of the Senior Medical Staff’s work that they enjoy. It provides an opportunity to
recognise good performance and express thanks for hard work and support provided.
It also provides an opportunities to discuss challenges faced and strategies to overcome those challenges together.
What have been your most valuable achievements in the last 12 months? What have you enjoyed most within you role/ unit in the last 12 months?

1. 1.

2. 2.

3. 3.

4. 4.

What have been the challenges? What did you/ will do to overcome these challenges? What help do you need?

1. 1.

2. 2.

3. 3.

4. 4.

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October 2020
Section Three – My Performance Plan
This sections enables a discussion and documentation of individual goals and actions for the coming year.
Discuss individual performance and/or professional development goals. Consider how the goals will also support Monash Health to achieve its strategic objectives.
Role Related Goals Actions By When? Criteria
Goals that I am personally responsible for achieving The tasks I need to undertake Month / year What measure can demonstrate that these actions
that support the organisation in meeting its strategic to achieve my goals have been successfully completed?
objectives
E.g. Actively contribute to a patient centred culture in line E.g. Become a member of the E.g. 80% attendance as demonstrated by attendance log
with Monash Health strategic priority.
Oil clinic Program level quality committee.

Professional Development Goals Actions By When? Criteria

Developmental goals for my performance as a doctor The tasks I need to undertake Month / year What measure can demonstrate that these actions
and a leader to achieve my goals have been successfully completed?

E.g. Undertake supervision and feedback training E.g. Enrol in Supervision and feedback course provided by my E.g. Course completion certificate, Self-rated improvement in
College performance appraisal conversations with Junior Medical Staff

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October 2020
Section Four – Credentialling and Scope of Practice
This section provides an opportunity for reviewing current credentials, scope of practice. It enables a discussion on new skills or training that has been acquired and
possible change in scope of practice to incorporate those skills.
It also enables a discussion for reduction of scope of practice, transition to retirement if applicable, discuss any conflicts of interest and any other issues that impact on the
capacity or capability of the doctor to carry out your duties safely and effectively. This is an opportunity for the leader to support the doctor through the issues that may
come up.
It provides an opportunity to review current job plan and make any changes by mutual agreement.

Variation/change to Scope of Clinical Practice Complete Change in scope of practice form

Any desire or need to increase scope of practice at
MonashOil Health,
clinic or decrease scope due to change in
clinical practice profile?

Variation to Job plans/New Job Plan Amend Job Plan/Develop job plan
Any desire or need to change the allocation of clinical
and non-clinical duties?

Plans to introduce any new technology / clinical Discuss process of application to introduce new technology
practice

Declarations of conflict of interest Complete Conflict of Interest form

Any new or existing professional or personal interest
which could make it difficult for you to impartially carry
out your duties?

Leave plans Apply for leave on KRONOS for manager to approve

Annual Leave (6:4:2)
CME leave
Other: Long Service, Sabbatical

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Section Five – My Mandatory Training
Complete / discuss mandatory training
Items Who? Frequency Completed? Completion date
(Yes / No) (Month / year)

Mandatory
Fire training All Monash Doctors Annually

iBelong All Monash Doctors Annually

Introduction to Health and Safety All Monash Doctors Annually

Using Social Media All Monash Doctors Annually

Managing Challenging Behaviour (OVA) All Monash Doctors Annually

Unconscious Bias All Monash Doctors Once-Off

Aboriginal & Torres Strait Islander Cultural
All Monash Doctors Once-Off
Awareness

Required
BLS Training (online ) All Monash Doctors 3-yearly
As per College
ALS All Monash Doctors practicing in Critical Care
standards
Hand Hygiene All Monash Doctors 3-yearly

Aseptic Technique All Monash Doctors with a clinical role 3-yearly

Open Discussion (Disclosure)
All Monash Doctors Once-off
Quality, Safety & Managing Risk for SMS
All Monash Doctors Once-Off
Unit Heads, Service Directors, Deputy Program Directors and
Partnering with Consumers Once-Off
Program Directors

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