Question: Scenario: Care in this type of setting is delivered by physicians, physician assistants, nurse practitioners, and advanced practice professionals. This area of health care is the most widely used, and it is a major focus of the Affordable Care Act of 2010, focusing on primary care providers and decreasing the focus on the utilization of specialty providers.

This primary care organization has a high focus on creating an environment for their most valuable asset-their employees. Last year, as a result of gaining more feedback from the employees, the facility contracted the services of a third-party organization to conduct an employee survey. The result was some surprising comments from employees regarding missed opportunities for promotions, special assignments, and skills certification/licensure.

The Director of Human Resources, meeting with the executive staff to review the survey results, places an emphasis on some ongoing problems and create some action plans for resolving and rectifying the employee concerns. He states that the organization has a very good performance management system that includes good rating instruments and clearly stated policy and procedures for ensuring each employee receives fair and constructive feedback for the review period.

Under initial scrutiny, the performance management system seems to indicate that the Director of Human Resources is correct: The system is almost perfect. However, upon closer examination and further analysis, it appears that some managers use the system as designed, but others use a more preferred approach that fits their "team."

When considering that noncompliance with the current system could result in wrongful terminations and failure to gain a promotion or new assignment, how would you address the following:

Question 1: Are performance evaluations required by law? Why or why not?

Question 2: How should managers receive special training in the use of the appraisal system?

Question 3: How would you hold the managers accountable for the proper use of performance appraisal systems?

Question 4: How do you determine if a performance appraisal system is effective or ineffective?

Question 5: How do you determine the factors used in the evaluation of employee performance?

Question 6: If the policy and rating instruments are "almost perfect," what could be the primary cause of the problems with the employees?

Question 7: Given the feedback from the survey, what are the potential repercussions of the workplace culture?