Performance Assessment - Hygienist updated 6-15-23.xlsx

	A	B	C	D	E	H	I	J	K
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2	Team Member Performance Assessment
3	Dental Hygienist
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5	Team Member Name:						Date of Hire:
6	Date of review:
7	Date of last review:
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9	Performance Rating	Explanation							Points Earned
10	Exceeds Expectations	This rating indicates that you consistently exceed in your job performance. You go above & beyond the basic expectations in a given area.							3
11	Meets Expectations	This rating indicates that you perform your job task at the basic level that is expected of you. You understand your job requirements & you meet all aspects of it with minimal supervision.							2
12	Additional Development Needed	This rating indicates that you are not completely performing your job tasks at an acceptable level. This may be due to your actual time in the position, whereby more training is indicated, or it may be due to a greater commitment level needed on your part to develop within a particular job area.							1
13	Below Expectations	This rating indicates that you require ongoing supervision in the performance of your duties. You fail to meet the basic job expectations, despite having been provided adequate training & feedback.							0
14	Weight Factor	Not all things are created equal. While it is important to master all aspects of your job position, there are certain aspects of your position on the team which are more critical to mastering & implementing than others. Each job characteristic &/or task has been given a weight factor, from 1-3, reflecting its importance in the overall evaluation of your contributions to the team. Your points earned in each category will be multiplied by each weight factor to help determine your overall Performance Rating.							1-3
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16		Below Expectations	Additional Development Needed	Meets Expectations	Exceeds Expectations	Comments
17	PERSONAL CHARACTERISTIC / JOB TASK	0	1	2	3
18	Dependability & Flexibility - The team can depend on you to be where you need to be; your personal days are well planned for; you seek to provide coverage for your position so as not to burden the rest of your team; you arrive to work on time & take allotted & necessary breaks; you recognize when you are needed the most & you make accommodations; you are able to accommodate & accept office & patient scheduling changes with ease. You only take allotted time off per handbook.
19	Professional Appearance - You are professional in your dress at all times; your hair is clean & always put back; your nails are neatly manicured & professional in length; your make-up is applied with good taste & appropriate; your jewelry is not excessive & is consistent with the guidelines provided in the team member handbook.
20	Productivity & Quality of Work – You accomplish your work assignments in a timely manner; you complete your job tasks with accuracy & dependability; you pay attention to detail & have a strong sense of quality & how to achieve it in everything that you do; you are committed to & take pride in providing an excellent final product; you seek out ways to improve what you do as well as expanding your own capabilities when time permits.
21	Organization & Neatness – Your work area is organized & neat at all times; your space is free of clutter; you are considerate of & respect your team member’s space as well as community office space.
22	Ownership & Commitment – You take ownership in your position; you are accountable first to yourself & then to the rest of your team; you take responsibility for what is yours & you are not defensive when short comings are pointed out to you; you take responsibility for your mistakes; you seek ways to improve & excel in your area; you demonstrate a desire for team success; you are willing to sacrifice personal desires for overall needs; you make a positive, recognizable contribution to the office.
23	Promoter of Teamwork – You are a source of encouragement & appreciation to your team members; you are willing to pitch in no matter what the task to get the job done; you display good listening skills; you show sensitivity & empathy to the needs of others; you display integrity in your commitments; the team can depend on you to follow through with what you say you will do; you do not participate in gossip at any level; you speak honesty & truth at all times; you display confidentiality at all times.
24	Proactive & Resourceful – You are proactive in doing what most needs to be done without being asked; you feel empowered when necessary & you can make decisions that are best for the patients & for the office overall; you use good judgment at all times; you can discern what is important & what is not; you appropriately gather all facts before making a decision; you are resourceful & able to identify & resolve problems that are presented to you with realistic solutions; you know how much you can handle & you ask for help when necessary; you offer solutions when presenting problems that need solving.
25	Independent - You are able to work independently; you are self-motivated & do not need someone to tell you what needs to be done; you can evaluate a situation & jump in without being asked; you can re-establish priorities using your own judgment & an understanding of what is best for the patients & the group as a whole; your time does not need to be "managed".
26	Personal Demeanor & Attitude - You have a positive attitude when at work; you smile often; you look to the positive side of things & you encourage others to do the same; you leave personal issues out of the office; when you are not 100%, you own your situation & you communicate your needs to your team members; you do not participate in negative talk that goes on between other team members; you take opportunities to turn negative situations into positive ones; you embrace change & recognize that it is a means to growth & improvement.
27	Team Meetings – You participate enthusiastically in both morning & monthly team meetings; you provide open & honest communication; you communicate your thoughts clearly & professionally & always with respect to others in the group; you arrive on time & you are prepared to participate.
28	Referrals Reviews - You ask patients to refer their family & friends; you ask patients to give us an online review.
29	Patient Relations - Patients are greeted with enthusiasm & warmth; personal touch is used appropriately; you offer patient amenities consistently to all patients; you always make patients feel special regardless of the busyness of the schedule; patients never feel rushed in your care; patient handoff is always done correctly.
30	Patient Education & Co-Diagnosing - You spend time in the treatment room educating patients on periodontal conditions as well as general & cosmetic dental procedures; you talk to the patient in the absence of the Dr. about available treatment options; you spend time discerning what a patient's chief complaint is as well as their long term dental health goals; you communicate your information to the Dr.; you inform the patient of all the various procedures the practice offers to our patients; you note in the progress notes discussions you have with the patient; you always communicate pre- & postoperative instructions to patients with confidence & credibility.
31	Flexibility & Timeliness of Appointments - You are flexible with daily changes to your schedule; you are able to stay on schedule throughout the day; you are able to recognize when you are getting behind schedule & you ask for help accordingly; you request & allow yourself a reasonable amount of time for various procedures.
32	Overall Understanding of Dental Procedures & Proper Use of CDT Codes - You have a good understanding of all dental procedures; you can explain the process of all procedures to patients with confidence & credibility; you can answer patient questions regarding pre- & post operative expectations based on your knowledge of the procedures; you record & treatment plan what was actually done on the patient regardless of insurance benefits; understands all (hygiene) procedure codes and their proper use.
33	Radiographs & Intraoral Camera – You take radiographs & photos that are of diagnostic quality; you are proactive in taking necessary films & photos based on patient's chief complaints & without waiting for the Dr. to direct you; you utilize the x-ray equipment & the intraoral camera equipment properly & with care; you keep the patient current with their FMXs; you do not let insurance dictate to you the frequency of taking x-rays & use proper verbiage to convince patient to take films; you understand the benefits of taking photos to educate & motivate patients to accept their treatment plans & you use the camera frequently; you have the camera ready for the Dr. to use frequently & quickly.
34	Patient Charting & Record Keeping - You utilize all patient forms appropriately & make sure they are uploaded to the patient's Doc Center; you are thorough in your documentation; you follow & use all appropriate abbreviations when writing notes; you check for spelling errors; your charting is completed before leaving for the day; you utilize all aspects of the computer correctly relative to patient charting; you always have patients sign proper consent forms prior to starting any treatment; treatment plans are entered & prioritized properly.
35	In-Office & Take Home Whitening Procedures - You recognize patients who are good candidates for whitening & you discuss the procedure frequently with patients; you perform the In-Office whitening procedure efficiently & with absolute patient comfort & always according to equipment directions; you take proper impressions for take home whitening trays; you pour up models & fabricate trays quickly & accurately; you deliver post treatment instructions with accuracy & clarity; you follow through with patient treatment from beginning to end; you have patients sign all necessary consent forms prior to beginning treatment; patients are provided realistic expectations for results prior to treatment; you always invite patients to be part of the practice when they come for whitening procedures only. To be rated at 2, must have sold at least 3 per month. To be at a 3, must have sold 5+ per month.					Goal 3 sets per month Current YTD _______ Previous Year _________
36	Periodontal Disease Diagnosing, Case Typing & Treatment - You do full mouth perio charting on all new patients; you Case Type all periodontally compromised patients according to the office's Periodontal Program & without consideration to insurance benefits; you always have the patient sign necessary consent forms; you explain their condition with confidence & credibility; you thoroughly explain what they can expect throughout their treatment; you are thorough in your treatment of scaling & root planing, always with the patient's comfort in mind; you use chemotherapeutic agents when indicated. To be rated at 2, perio % of production should be at goal. To be rated at 3, perio % of production should be above goal. Goal is 50% of Perio Pts seen.					Goal 50% Current YTD _______ Previous Year _________
37	Arestin - You recognize patients who would benefit from Arestin & you are able to help patients understand why they are candidates. To be rated at 2, Arestin % should be at goal. To be rated at 3, Arestin % should be above goal. Goal is 50% of perio pts seen.					Goal 50% Current YTD _______ Previous Year _________
38	Fluoride - You recognize patients who are good candidates for fluoride & you discuss the benefits at every visit with patients. To be rated at 2, fluoride % should be at goal. To be rated at 3, fluoride % should be above goal. Goal is 50% of pts seen.					Goal 50% Current YTD _______ Previous Year _________
39	Technical Skills - You are gentle yet thorough in your prophylaxis technique on both adults & children alike; you administer anesthetic appropriately & painlessly; patients feel comfortable & confident in your care; you use good judgment at all times & establish appropriate continuing care cycles based on each patient's needs; you are effective in scheduling next visit appointments from your treatment room.
40	Diagnosing & Placement of Sealants – You are efficient & effective in the placement of sealants; you diagnose the need for placement & discuss their benefits with both patients & parents of children; you are flexible to place sealants on same day as cleanings when situation deems appropriate & for the convenience of the patient.					Goal 25 per month Current YTD _______ Previous Year _________
41	Laser Treatment - You use the laser on every quad that has bleeding and with patients that are not showing improvement. Goal is 50% of perio pts seen. To be rated at 2, Laser % should be at goal. To be rated at 3, Laser % should be above goal.					Goal 50% Current YTD _______ Previous Year _________
42	Demonstration & Sales of Retail Items - You take time to educate your patient about various retail products that are promoted in the office; you recognize that the sale of retail is a service to our patients; you incorporate discussions of retail products into your patient education & you make notes of your discussions in your progress notes for future reference.
43	OSHA & HIPAA Compliance – You understands & follow all OSHA & HIPAA requirements & recommendations at all times; the sterilization area is clean & organized & always within OSHA guidelines ; treatment rooms are kept clean & clutter-free & always within OSHA guidelines; patient information is always held confidential & caution is made with regards to discussing protected information within the office.
44	Instrument & Equipment Maintenance/Repair- You handle all instruments & dental equipment with care; you follow all maintenance recommendations timely & according to directions; you attend to faulty equipment immediately; you attempt to fix equipment within the office before contacting an outside repair company.
45	Office Production - Every team member contributes to the office's ability to produce and be profitable by the way they interact with patients and team members, their attention to detail, and their willingness to maintain a win/win mentality. If the office is more profitable, it can afford to pay team members more. Monthly Net Production (Production - Adjustments) Goal vs Actual. Office must be at goal to score a 2 and above goal to score a 3.					Goal $________ Current YTD $_______ Previous Year $_________
46	Office Collections - Collections is an intregal part of any business. All team members contribute to how much the office collects in different ways. The assistant contributes by ensuring that clinical notes are complete & accurate, handoffs are done every time, and that patient balances are checked at every visit. Monthly Net Collections (Collections - Refunds & NSFs) Goal vs Actual. Office must be at goal to score a 2 and above goal to score a 3.					Goal $________ Current YTD $_______ Previous Year $_________
47	Daily Preparation - You review route slips with detail & scrutiny; you follow up on notes that are indicated; you look for opportunities throughout your day to provide extra services to patients; you are aware & prepared for "red lights" in the schedule every day; you are familiar with the daily goal & what is needed to reach/exceed that goal; you strategize with your team throughout the day on ways to obtain daily bonus'.
49	AVERAGE PERFORMANCE RATING	0.00
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51	0 - 0.99	Below Expectations				1.76 - 2.5		Meets Expectations
52	1.0 - 1.75	Add'l Development Needed				2.6 - 3.0		Exceeds Expectations
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54	Pay increases are based upon the following:
55	The Practice's ability to support the increase. This is determined by analyzing the current labor percentages in the practice & overall practice profitability.
56	Individual job performance & overall contributions to the team. This is determined by the results of the team member's performance assessment.
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59	Pay Raise Indicated?
60	Increase %:				From:		To:	$ -
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62	PLAN OF ACTION FOR PERFORMANCE IMPROVEMENT
63	Below is an Action Plan provided for you to improve in all areas that currently do not Meet Expectations of your job position. Failure to show a commitment to improvement may prompt a more serious discussion of your desire to keep your current position.
64	Follow Up Meeting scheduled for:
65	Action Plan for Improvement on any area scored less than 2:
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68	Dr. and/or Manager Comments:
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71	Employee Comments:
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74	Employee's Signature:	____________________________________
75	Dr. and/or Manager's Signature:	____________________________________
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