Sample Chief Executive Officer Performance Appraisal Process And Assessment Form


Sample Chief Executive Officer Performance
Appraisal Process and Assessment Form
Note: The following is intended to be an example that boards may adapt to meet their individual
chief executive officer (CEO) evaluation needs.
The Board of Trustees is responsible for conducting the CEO evaluation and regularly reviewing the
policy and process to ensure it contributes to the achievement of the organization’s mission, vision and
goals. The purpose of the CEO evaluation is to provide timely, clear and focused input to the CEO
about how well he or she is performing in the key performance areas identified as most critical by the
Board of Trustees in achieving the hospital’s or health system’s strategic objectives.
The CEO should be evaluated using criteria specified in a CEO compensation policy established by the
Board, and agreed to by the CEO. The criteria used to evaluate the CEO and determine incentive
payment should be based on a variety of factors that support the organization’s mission, vision and
goals. When mutually agreed-upon, the CEO evaluation may include a “360-degree” approach that
seeks feedback on performance from the Board, medical staff leaders, senior management and the
The following assessment form provides an opportunity to evaluate the CEO’s performance across
three dimensions: essential CEO accountabilities, personal attributes and leadership qualities, and CEO
goals and objectives. The next section describes how to use this form to create and conduct a CEO
assessment process for your organization.
Creating a Customized CEO Evaluation
1. Modify the Assessment Form. The Board or an assigned Board committee should review the
sample CEO assessment form included in this document and make modifications to adapt the
assessment questions and criteria to the organization’s unique needs.
2. CEO Self-Evaluation. The Chairman of the Board should initiate the CEO performance appraisal
process by asking the CEO to complete a self-assessment. The CEO self-evaluation should
ideally include a summary of achievements relative to the goals and objectives defined at the
beginning of the planning year, and a self-appraisal of performance based on the CEO’s key
accountabilities in each of the areas also rated by the Board. The CEO’s self-ratings and


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