Examine the ethical and legal issues in performance appraisal and challenges of

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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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