/ HEFT APPRAISAL DOCUMENT
Appraisee Name:
Appraiser’s Name:
Appraisal Date:

Trust’s Objectives

Performance Area / Performance Criteria / Performance Area / Performance Criteria
Safe & Caring / Top 10% in England for safety metrics / Locally Engaged / Distinct identity for each hospital
80% net recommender index / Elderly service redesign
75% staff engagement / Good corporate citizen
Recognised for staff involvement / Health and wellbeing
Efficient / 15% cost reduction / Innovative / Institute of healthcare research
Emergency length of stay 6 days or less / Faculty of education developed
50% cost reduction in absence / Leading open organization
Consistent delivery of targets / National recognition HEFT nurse brand

NHS Values:

  • Respect & dignity
  • Commitment to quality of care
  • Compassion
  • Improving lives
  • Working together for patients
  • Everyone counts
  • Other Points:
  • Appraisal Guidance notes can be found on the intranet under A
  • This is a generic document and can be amended.
  • Prescriber, please ensure you discuss non-medical prescribing during the appraisal as a base format to be amended / adapted to user’s requirements.
  • In-house courses can be found via the following link:
  • If the Appraisee is unhappy with any part of their appraisal, then it should be raised with the Appraiser’s line manager.

APPRAISEE SELF REFLECTION FORM

Guidance: It is best practice that the Appraisee completes this prior to the appraisal and return to their Appraiser 1 week before the appraisal date. The Appraiser should review and make comments where necessary. This form must be taken to the appraisal meeting.

COMMENTS / COMMENTS
What have you achieved in the past 12 months that you are proud of? / Have you undertaken all necessary training and development identified in your PDP in your last appraisal?
What gives you the greatest job satisfaction and least satisfaction?
Please state why. / What specific objectives were you set in your last appraisal that contributed to your service / department plans and Trust Objectives and have they been met /achieved?
(Trust Objectives can be found on page 1)
What do you need to maintain health & wellbeing and your motivation at work?
What skills or abilities do you have that your manager is not aware of? How can they support you to unlock your potential? / Are you fully competent / up to date with:
a) Role specific competencies
b) Mandatory Training
c) Medical devices
d) Mentor of Nursing & Midwifery Students requirements
Supplementary documentation for c) and d) can be found on
If you have completed a 360 feedback questionnaire, what areas require reflection?
CPD (Continuous Professional Development) – What evidence and reflective pieces do you have in your Personal Folder to support CPD?
Have all your clinical / professional / technical competencies been assessed and are up to date?
Have you achieved all necessary KPI indicators as set by your manager/Trust?
Are there any issues regarding your competencies?
What do you feel are your key development needs for the next 12 months and what individual objectives may be appropriate to enable you to support the team/Trust objectives?
Any other comments to discuss:
REFLECTION OF BEHAVIOURS

Guidance: This should be used by the Appraisee to reflect on their strengths, limitations and development needs around key behaviours. Use the “Appraisee Evidence” column to document examples around each of the listed categories. You may want to use additional evidence or data to assist with this process, i.e. absence data.

GENERIC BEHAVIOURAL QUESTIONS FOR ALL STAFF TO COMPLETE / MANAGEMENT / LEADERSHIP SPECIFIC QUESTIONS
QUESTION / RATING & COMMENTS / QUESTION / RATING & COMMENTS
Q1) Do you understand the impact of your behaviours on others? / Q1) Do you ensure that your service plans fit within the wider internal strategy and, where appropriate, wider healthcare system?
Q2) Do you change your behaviour in light of feedback and reflection? / Q2) Do you accurately identify the appropriate type and level of resources required to deliver safe and effective services?
Q3) Do you communicate effectively with others, adjusting style as necessary (i.e. taking into consideration social, cultural backgrounds, age, gender and ability)? / Q3) Do you regularly and consistently review the performance of teams and team members to ensure that planned services outcomes are met?
Q4) Do you actively seek views from others? / Q4) Do you take responsibility for tackling difficult situations?
Q5) Do you listen to others and recognise different perspectives? / Q5) Do you seek and act upon patient, carer, user and staff feedback and experiences?
Q6) Do you have a clear sense of your role, responsibilities and purpose within the team? / Q6) Do you act as a positive role model for innovation and improvement?
Q7) Do you actively raise concerns around risk, potential malpractice or wrong doing? / Q7) Do you clearly articulate the need for change and its impact on people and services?
Q8) Are you open with patients and their families?
Q9) Do you always strive to maintain the highest possible standards of care

RATING:YES / NO / SOMETIMES

When you have completed the appraisal: please email appraise name, appraiser name and the date of the appraisal to:

PERSONAL DEVELOPMENT PLAN &

INDIVIDUAL PERFORMANCE TARGETS / OBJECTIVES

Identify development needs to support the individual in achieving career goals and personal development, address any areas of improvement and support the service needs and the 4 Trust priorities.

Target / Objective Identified
Objectives set should clearly link to the team objectives and overall Trust objectives. / How will this be addressed?
E.g. course / coaching / Date to be achieved by / Date to be Reviewed / Expected Outcome / Comments / Objective Review
Has the target been met? Please tick
E.g. to represent the team in a staff forum / Internal minute taking course / July 2013 / May 2014 / To improve communication and staff engagement for own area and across directorate
Development Need Identified / How will this be addressed?
E.g. course / coaching / Date to be achieved by / Date to be Reviewed / Expected Outcome / Comments / Objective Review
Has the target been met? Please tick
E.g. Aspiration to undertake Office Manager position / Shadowing
Mentoring / November 2013 / May 2014 / To have knowledge and experience of role in order to further career
Has the job description been recently reviewed?

DOCUMENTATION SIGN OFF FORM

COMMENTS OF APPRAISER

Signature of Appraiser ………………………………………………………………………….Date………………………………………………………

COMMENTS OF APPRAISEE

Signature of Appraisee ……………………………………………………………………………Date …………………………………………………………

INCREMENTAL PAY REVIEW

I confirm that this appraisal meeting established that is performing to the appropriate level. Therefore, incremental pay progress should take place.

Signature of Line Manager ……………………………………………………………………… Date …………………………………………………

PLEASE NOTE – In order for the increment to be actioned, your mandatory training record will be checked and must show full completion.

When you have completed the appraisal: please email appraise name, appraiser name and the date of the appraisal to: