The senior management of a large Midwestern nursing home gathered data on its quality of
patient care and patient safety. They found that the quality of patient care and safety in the
nursing home was deficient. To solve the problem, the managers, with the help of a total
quality management expert, implemented a sophisticated continuous quality improvement
(CQI) process with structured monthly meetings to review relevant data.
Except for the senior nurse manager, other clinical employees did not participate or receive
information on the deliberations of the meetings. While the top managers were very
satisfied that the CQI addressed the problem in a systematic and formal manner, the
clinical staff employees were very frustrated in their efforts to report medical errors. This
was because, for every medication error, staff members were assigned one point and
disciplined after three points. They could even be terminated as the disciplinary process
progressed. The points accumulated over the year were also used to determine the annual
salary increases and promotions of the nurses.
Based on the above performance appraisal system, the nursing home reported an
improvement in the reduction of medication errors. However, adverse clinical outcomes for
patients remained unchanged. To investigate this problem, the top management team hired
a new HR consultant. After promising that all information would be strictly confidential, the
consultant was able to convince the clinical staff to talk freely about the problem of patients
with adverse outcomes. In fact, the clinical staff admitted not filling out incident reports
because of the punitive reporting system and expressed concern about the disconnection
between the nursing home’s goal of improving medication safety practices and the nursing
home’s approach to error.
1. What would you do when implementing a CQI process to reduce medical errors?
2. How would you change the incident reporting and performance appraisal systems?
Present your ideas in a 2-3 page APA-formatted paper with a minimum of three references
plus the textbook. Additional references must be reliable sources retrieved from the
library, Internet, or elsewhere.
• Understand the important role that performance appraisal plays in managing
human resources (HR) in health care organizations.
• See the connection of performance management function with other key HR
functions of recruitment/selection, training/development, and compensation and
• Have an appreciation of the legal implications of performance appraisal.
• Paper utilizes materials presented in the textbook and a minimum of three outside
sources in a 2-3 page document.
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