Jan 29, 2015
Watchful Eyes

Staff evaluations may be one of the most overlooked opportunities for athletic training departments to improve their services. The key is making evaluations a learning tool, not a critique of past mistakes.

By Jon Almquist

Jon Almquist, ATC, is the Athletic Training Program Administrator for Fairfax County (Va.) Public Schools. He serves as Chair of the Athletic Training Advisory Board with Virginia’s Board of Medicine and is a member of the Sports Medicine Advisory Committee for the Virginia High School League. He has received a Most Distinguished Athletic Trainer Award from the NATA and can be reached at: [email protected].

Several years ago, while doing workshops across the nation on transferring spine injured athletes and the removal of facemasks, I had the opportunity to present to both certified athletic trainers and emergency medical technicians. Consistently, the groups of athletic trainers would listen and watch the demonstration intently, and then shy away from the opportunity to practice with their peers. The EMTs, on the other hand, would be jumping out of their seats during the demonstration and trample each other for the opportunity to practice.

There is probably more than one reason why the two groups reacted so differently. But one thought stayed with me: The certified athletic trainer may not always look at someone scrutinizing their practice as a positive experience. As a group, we seem to not embrace the process of being evaluated.

However, as any administrator in any field will tell us, evaluations of one’s work are critical for improvement and moving forward professionally. Without feedback, how can we know if we are doing a poor, good, or fantastic job? How do we know what our strengths and weaknesses are?

Athletes are continually being evaluated and offered suggestions for improvement. Teachers and professors in most educational institutions are evaluated on a regular basis, as are coaches. Yet, in many settings, few certified athletic trainers are offered constructive feedback or formal evaluations in a timely manner.

I have the good fortune to work with over 50 certified athletic trainers on a daily basis, and part of my job is to conduct ongoing evaluations of the athletic training programs at each of their schools. I have found this practice to be a critical aspect of both improving the athletic training services we provide and helping individuals grow in their jobs. Work evaluations can be an immensely useful tool, as long as they are structured correctly and have a clear end-goal in mind.

GETTING STARTED

When instituting an evaluation process, the first thing to consider is how to ensure you will have buy-in from your staff. The evaluations should not be seen as a way to criticize or call out others on something they’ve done wrong. Instead, they should be presented to staff as something to help them grow and improve the entire athletic training department.

When we hire new athletic trainers, we try to identify individuals who are willing to make efforts toward continuous growth as they work in our organization. The ugly reality is that there are certified athletic trainers who are very set in their ways and resistant to any improvement strategies because it takes effort, energy, or simply a change from their routine. We definitely shy away from hiring this type of person.

Once the staff is on board, I explain our evaluation process and how it can help them become better in their jobs. We talk about how everyone has areas of weakness and how evaluations can help individuals understand what they need to do differently for their professional growth. I try to emphasize taking the opportunity to learn from their peers, addressing those awkward areas head on, and not falling prey to avoiding areas of discomfort. The idea is to not just maintain status quo in one’s comfort zone, but to expand it.

As a staff, we talk about how evaluations can ultimately improve the overall athletic healthcare we are providing student-athletes. If everyone improves in just one aspect every year, our staff can reach great heights! This explanation can lessen the perception of individual scrutiny by focusing on the level of athletic healthcare being provided. We focus more on “What level of care is the athletic training program delivering?” and less on “What kind of job is the athletic trainer doing?”

One great way to get staff buy-in with evaluations is to have them include a self-assessment. This relays the fact that you want your staff member’s opinion on his or her strengths and weaknesses, and that this is a process to help them. It helps them become more conscious of constantly evaluating their own work, which can often be the best way for employees to improve. And it gives you an indication of where they need support and mentoring.

Another important element is to structure the evaluations as an ongoing process and not a one-time occurrence. If you only talk about performance once a year, it can be easy to disregard the suggestions and ideas. Instead, the outcomes of the evaluations should be continuously monitored.

For example, if one of my staff members needs to work on communication skills, I’ll occasionally listen in on some of his of her interactions with others. Then, I’ll provide feedback once the athletes have left the area. It can be as simple as, “Remember to pause when giving instructions to a student-athlete and ask them if they understand.” And if I see this staff member doing something positive in terms of communication, I want to be sure to point out what a great job he or she did–even if it’s something very small.

Knowing the staff members’ personalities and adapting your approach may also prove helpful. It seems the norm has been for employees to recognize the unique personalities of their supervisors and just learn to deal with any negative aspect of them in order to keep their jobs. In keeping up with social changes, as leaders, perhaps we need to make more adaptations to address our staff members in ways that work for them.

There are also times where feedback can come in the form of a global announcement or discussion as opposed to individual interaction. We have the good fortune to meet every other week as a group of head athletic trainers. As one can imagine, with the number of helicopter parents representing the more than 9,000 student-athletes each season, we are occasionally confronted with issues. More often than not, the underlying reason for any problem with parents or coaches has to do with communication. The meetings provide an opportunity to address, understand, and learn about the issue while leaving the details of the individuals involved anonymous.

You also need systems in place to gather criteria on what you want to evaluate–you can’t personally oversee what staff members are doing at all times. The solution is to think about ways to obtain this feedback on their work through several different avenues. This can include asking coaches (or even student-athletes or parents) to fill out evaluation forms, taking the time to review their record keeping, and assessing outcomes of their rehab.

When asking others for their feedback, I recommend reviewing these responses in the aggregate and not getting hung up on any one poor performance indicator. When a coach, athlete, or parent fills out a survey soon after an athletic trainer indicated less than full participation for the athlete, there is a good chance there will be a bias in the survey. Look for disturbing trends as opposed to individual criticisms. An athletic trainer’s clinical evaluation skills should only be assessed by a medical professional, and this can be done by a team physician or a veteran certified athletic trainer. Exactly what to evaluate in this area will vary greatly based on the individual’s job responsibilities.

Gathering input for an evaluation also requires constantly assessing the job a staff member is doing whenever you work side by side with them. If you notice anything positive or negative the staff member is doing, take a moment to write down your observations. You can even do this in a hand-held electronic device, then transfer it to a text file when you get back to your computer. It is critical to maintain quality written documentation over time. This may be essential should your employee’s position be in jeopardy of something like a budget cut, or should you need to terminate their employment.

It’s also important to have a formal procedure for the evaluations planned ahead of time. Figure out when you will conduct the sit-down evaluations and where. Do you want to structure the meeting as a discussion or a rundown of your thoughts? Will you give employees something in writing, and if so, during or after your discussion? Is there any procedure to follow according to your institution’s human resources policies?

In our school division, our head athletic trainers work full time with no teaching responsibilities. They fall under the “support employee” evaluation system with our human resources department. There is a formal self evaluation, mid-year evaluation, and final evaluation that must be completed by their school based administrator. To accompany these formal evaluations, as the athletic training program administrator, I provide the clinical competency information to the overall evaluation process.

Finally, your evaluation needs to have the right criteria. This will vary depending on your particular situation. I’ll explain some areas to consider in the next sections.

BASICS

What exactly should you be reviewing in an evaluation? The first step is to take a look at the staff member’s job description. A good job description should outline the scope of practice that the employee will be providing. The evaluation can then assess how the employee is performing these specific functions.

Another document that should be used is the Appropriate Medical Care for Secondary School Age Athletes. With minor modifications, this document may also be appropriate for the college setting as well, since it provides the areas and levels of healthcare that should be provided to athletes.

However, the evaluation should also be specific to your school, situation, and the employee. For example, some athletic trainers may be responsible for overseeing the AED program, including the CPR training of institutional staff, while others are not. Some schools may want the athletic trainer to oversee an emergency medical plan, while others will want a team physician or risk manager to take the lead in this area. Regardless of the specifics, it would be in the best interest of the athletic training profession to have the certified athletic trainer involved in all aspects of their job that fall under the scope of practice of an athletic trainer based on the NATA domains, CAATE curriculum, and/or the state practice act.

Another area I evaluate is the athletic training facility. It’s important that each of our athletic trainers maintains an efficient and effective facility. I assess the facility for its cleanliness, physical organization, and equipment. Included is how the equipment is used, not simply that it is there and clean. A whirlpool filled with old pads, boxes of tape, and crutches represents poor utilization of resources and space. I also assess whether the facility is providing equal access to both males and females.

Finally, I critique the staff on maintaining professional responsibilities. Since our profession is constantly evolving and growing, it’s critical for athletic trainers to keep up professionally. Along with making sure they are maintaining CEUs and state licensure requirements (when appropriate), I assess if they are involved with professional development opportunities. If they are not, I might encourage them to start small, getting involved in something locally. It is amazing the transformation of work ethic and productivity that can be achieved simply by empowering someone to get involved with a project involving the institution or professional organization.

IN THE RECORDS

Along with the above basic areas, a key area to critique is the athletic trainer’s record keeping. This may be the most important area to review in an evaluation, since excellent record-keeping is important for reducing liability risks and making sure the athlete is given the best possible care.

First, I assess records for the completeness. Do the records tell a story from initial evaluation through discharge? Do they include all the details necessary?

Simply having a written record of an athlete incurring a lateral ankle sprain on a particular date and having ice applied is not a complete record. The records should provide a story of what was found during the initial evaluation, how the injury occurred, and what immediate treatment was provided, as well as a plan for the near future. Each visit the patient makes with the athletic training staff should identify and record any changes to the case and all care that was provided during that visit such as any exercises, modalities, etc. All changes to the injury and all treatments that were provided as the athlete recovered must be included.

A high quality, well maintained record keeping system provides a chronological story from injury to full recovery and return to full participation that makes sense during a review a year or two later. Picture yourself in a court of law defending a staff’s actions regarding a year-old case. Would the records be able to validate enough information regarding what was done and why within the scope of practice of athletic training?

I have found that record keeping can be an accurate indicator of performance. Certified athletic trainers are medical professionals, licensed to practice in many states. They must take their responsibilities seriously, and you can often assess this in how well they keep records. A good record keeping protocol should provide a snapshot of every interaction and activity regarding each patient, even those who simply need to have a blister covered with a bandage and donut.

Record keeping can also provide support for needed changes or additions to the athletic training facility or program. For example, records can provide useful data that can be used to prove the need for additional support, justify the maintenance of funding during tough budget times, and validate the individual needs of the athletic training program.

COMMUNICATION

One area that is not always in a typical athletic trainer’s job description, but is important to evaluate, is communication skills. I have found that the most common concerns about our athletic training staff can be traced back to a problem with communication.

Rarely, if ever, is there an issue with clinical competence. It is not “what was done,” but instead “how it was done” or “how it was perceived” that causes issues. This should not be surprising when we think about all the different people an athletic trainer must communicate with in any day, from athletes to coaches to parents to each other.

What constitutes good communication? It runs the gamut from being well prepared for a parents or coaches meeting with a concise, efficient, clearly scripted presentation, to making the effort to contact a parent (in high school settings) when their son or daughter has consulted with you about a problem. Here are some areas to possibly include in an evaluation:

• Does the staff member provide consistent and timely communication with all coaches? • Is the staff member “approachable” in the eyes of students? • Does the staff member listen well? • Does the staff member provide clear and accurate direction to others? • Does the staff member process information before offering an opinion? • Is the staff member aware of when to not share information with others, due to privacy concerns? • Does the staff member support the overall athletic program through his or her communication? • Is the staff member consistently positive in their communication skills with others?

GOALS

Along with evaluating an athletic trainer based on the criteria you’ve developed, it can work well to ask staff members to develop goals every year based on their review. A few times a year I ask our group to come up with ideas on how we can improve our athletic healthcare. It’s also great when athletic trainers come up with their own individual goals.

Then, provide the tools and resources necessary to assist the athletic trainer’s improvement. If a staff member needs to improve their record-keeping skills, show them examples of great records and come up with a schedule for you to review their records periodically. Give them specific feedback on what is lacking in their records and how to make them complete.

With goals in place and buy-in from staff members, the concept of an evaluation can be a positive experience for all involved. It can help all of us move our profession forward on a daily basis and support each other in our work.

Sidebar: CHEAT SHEET

When conducting an evaluation, it can be helpful to have a reminder of which specific areas you’re evaluating the athletic trainer on. The author’s evaluation sheet includes the following criteria.

Goals: Has the ATC met their goals? What are their new goals?

Athletic training facility: Is the athletic training room clean and organized? Is equipment properly maintained? Are the handwashing facilities appropriate?

Record keeping: Is the ATC’s ITTS status satisfactory? Do they have easy computer access? Do they keep proper injury reports and update them as necessary? What sort of shape is the physician’s report file in?

Athlete interaction: Does the ATC welcome athletes with an “I can help” attitude? Do they have good listening skills, take complete histories, and make appropriate recommendations?

Coach Interaction: Does the ATC address coaches in a positive manner, with a professional attitude and approach?

Co-worker interaction: Does the ATC have professional dialogue with their co-workers? Do they communicate with their co-workers at an appropriate frequency? Do they share the specifics of cases professionally?

Parent interaction: Is the ATC professional and polite in their interactions with parents?




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