Sample Chief Executive Officer Performance Appraisal Process And Assessment Form Page 3
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22Assessment of Essential CEO Accountabilities
Please evaluate the CEO’s performance for each accountability area using the scale outlined below. Consider all criteria
together when forming an impression about the CEO’s performance. Add comments you believe provide context to your
rating, or that would be helpful to the CEO in improving his or her performance.
5 – Exceeds Expectations: The CEO performs above and beyond these accountabilities as a part of his or her leadership.
The CEO’s performance in this area is outstanding and exceeds my expectations.
4 – Meets All Expectations: The CEO always practices these accountabilities as a part of his or her leadership. The
CEO’s performance in this area meets all of my expectations.
3 – Meets Most Expectations: The CEO often practices these accountabilities as a part of his or her leadership, but not
always. The CEO’s performance in this area generally meets my expectations.
2 – Meets Some Expectations: The CEO inconsistently practices these accountabilities as a part of his or her leadership.
The CEO’s performance in this area only meets some of my expectations.
1 – Does Not Meet Expectations: The CEO rarely or never practices these accountabilities as a part of his or her
leadership. The CEO does not perform well in this area.
N/A – Not Applicable: Not applicable or has not been observed.
In the event that you rate the CEO’s performance 2 or below, please provide specific suggestions for needed
performance improvement.
Please Circle the Applicable Performance
Rating and Include Your Comments
Quality and Patient Safety
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2
3
4
5
N/A
•
Comments:
Ensures that quality and patient safety is a top priority at
every level in the organization
•
Establishes and nurtures a culture built on quality, service and
continuous improvement
•
Prioritizes delivering patient-centered care that meets the
highest patient satisfaction and customer service standards
•
Advances the organization’s culture to ensure the patient
experience is exemplary in every aspect of care
•
Ensures appropriate resources are allocated throughout the
organization to deliver high quality, patient-centered care
•
Uses quality outcomes and data to drive actionable
decision-making
•
Ensures that patients receive the right care, at the right place
and at the right time
CEO Self-Rating: [Insert CEO rating from self-evaluation here before giving to Board members]
CEO Comments: [Insert CEO comments from self-evaluation here before giving to Board members]
AHA 2017 Sample CEO Performance Appraisal Process and Assessment Form
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Parent category: Business