2021-22 Appraisal Form V4Rose

UCLH Appraisal 2021 / 22 – all staff (except doctors / dentists)
For more information on appraisal, please visit our appraisal pages on myUCLH. Continue on separate pages, as required.
Appraisee Name Job title / Band Division / Board

3 Cancer
Lilieth Douglas
Step 1 Step 2 Step 3 Step 4 Step 5

Preparation / review of Appraisal Agree 2021/22 Support, Confirmation and sign-off
overall performance in Meeting objectives and Health, Safety
past year 2020/21 Discussion PDP & Wellbeing
Step 1. Preparation / review:

To be completed by appraisee and submitted to appraiser prior to appraisal meeting
Reflect on appraisee overall performance during the 2020/21 appraisal year. Consider: achievement of objectives,
service provision successes / challenges, responses to change, personal strengths, development needs, improvement
opportunities, future career development / aspirations
I would describe my overall performance as very good in terms of consistently performing to a high standard when
carrying out my duties, ensuring that I always adhere to the trust values at all times. The challenges that I am facing
would be:
1. understaff, which does have an impact on my health and wellbeing.
2. Communication, over worked, lack of motivation and undervalue
3. Lack of skill development
I am very open minded which enables me to adapt to changes when they arises in a positive way.
I am a personably individual who always try to go above and beyond in helping and assisting patients, colleagues and
visitors.
I am learning how to communicate in how to manage conflict, although a more improvement is needed. My future
aspirations is to pursue the Registered Nursing Associate or continue developing myself in my current role.
Step 2: Appraisal Meeting Discussion:
To be completed by appraiser
Review performance with appraisee against last year’s objectives. Discuss demonstration of Trust values.
Coaching-style question examples, and guidelines for rating the values, can be found here
Appraiser to consider:
- how well the appraisee has supported and managed their team to achieve objectives?
- how well the appraisee has dealt with conflict and poor performance in their team?
- how well the appraisee has performed as a leader against UCLH Leader Model (drawing on 360 degree feedback if
applicable)
Notes:
Mandatory Training – I confirm that today the appraisee is fully compliant with mandatory training, and/or has booked
onto the required classroom mandatory training (check the Mandatory Training pages of myUCLH to confirm
current availability of topics)
Ratings:
Please use the 5-point rating guidelines in the annex to rate appraisee against the objectives and values.
A. Overall performance against the performance objectives
1 2 3 4 5
B. Overall demonstration of the Trust Values

1 2 3 4 5
Notes:
Step 3. Agree 2021/22 Objectives:

To be completed following discussion between the appraiser and appraisee
Include at least one objective that is related to Improvement, and if you are a manager of staff at least one objective
needs to be related to people management, for example: developing your team, or improving health and wellbeing.
Please also see the Objective-Setting template on myUCLH.
(a) Performance Objectives - What will I achieve and how will I achieve it?
Objective UCLH’s Priority UCLH’s Values Expected outcome/ Timescale
What are your Which UCLH What Trust value will measure of When will this be
priorities for the year objective is your own this objective achievement completed/
ahead? objective connected demonstrate? What will success achieved?
to? look like?
Continue on separate pages, as required
(b) Personal Development Objectives

To be completed following discussion between the appraiser and appraisee
Please outline agreed actions in relation to personal development over the coming year. Refer to the PDP template,
courses available on the UCLH Learning Portal, details of our Apprenticeship programmes, and our Staff Development
Opportunities brochure.
Step 4: Appraisee Support, Health, Safety & Wellbeing

Appraiser to lead discussion with appraisee for this section, to ensure that all bullet points are covered.
 Please explore whether the appraisee has felt adequately supported over the past year (e.g. via regular 1:1s,
having adequate resources etc). If not, what else needs to be put in place?
 Please have a short discussion with the appraisee regarding their Health and Wellbeing and clarify any support
and/or access to further resources they may need (refer to our Avenues of Support document)
 Please explore the appraisee’s work-home balance and whether they wish to explore flexible or remote
working options if not already in place (please refer to our Flexible Working and Remote Working policies)
 If the appraisee regularly works from home as part of their role, please confirm that you have carried a risk
assessment in line with the guidance contained within the Health and Safety at UCLH Handbook and agreed
solutions to any identified problems: Yes / No
Step 5: Appraisal confirmation and sign-off:

To be completed by appraiser and appraisee
- confirm mandatory training compliance with all learning that is available
- confirm NMC revalidation progress (if applicable)
- set progress meeting dates
- agree process for writing-up and storing (electronic or hard-copy) appraisal record (for use in future progress
meetings)
Sign-off:
Appraiser signature: Print name:
Appraisee signature: Print name: Lilieth Douglas
Date of appraisal completion:
Appraisal reporting:
To report appraisal completion, access ESR ‘Manager Self-Service’, go to ‘My Team Career Information’ and click on
‘Appraisal and Reviews’. For full and detailed reporting guidelines, please see Appraisal webpage on myUCLH
Progress meetings (please refer to our 1:1 supervision template for suggested format for these):
1st date: 2nd date: 3rd date:
Notes: Notes: Notes:
Performance and Values Ratings
RATING DESCRIPTOR - PERFORMANCE DESCRIPTOR - VALUES AND

AGAINST OBJECTIVES BEHAVIOURS
5 – Outstanding Has met or exceeded all objectives. Acts as a role model for the Trust values and
Consistently performs at a high level. Goes behaviours, and holds others to account for
the extra mile to meet expectations. meeting them.
4 – Good Has met all objectives that are within their Acts as a role model for the Trust values and
control. Consistently delivers to agreed behaviours at all times
standards and meets the requirements of
their role.
3 – Acceptable Has met the majority of their objectives. Demonstrates the Trust values and
Regularly delivers to agreed standards and behaviours the majority of the time.
meets most of the requirements of their
role. Committed to further development.
2 – Improving Has not met all of their objectives, despite Demonstrates some, but not all, of the
having the opportunity and/or the support Trust values and behaviours, or does not
to do so. Does not meet all the requirements consistently demonstrate the Trust values
of their role. and behaviours.
Manager needs to have an informal Manager needs to have an informal
improvement plan in place to help the improvement plan in place to help the
employee achieve a 3 rating. employee achieve a 3 rating.
1 - Unsatisfactory Is currently in a formal employee relations Is currently in a formal employee relations

process regarding their performance. Pay process regarding their conduct. Pay
progression will be delayed if there is a progression will be delayed if there is a
formal sanction in place on a pay step date. formal sanction in place on a pay step date.

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UCLH Appraisal 2021 / 22 – all staff (except doctors / dentists)

Appraisee Name Job title / Band Division / Board

Step 1 Step 2 Step 3 Step 4 Step 5

Step 1. Preparation / review:

Step 2: Appraisal Meeting Discussion:

A. Overall performance against the performance objectives

B. Overall demonstration of the Trust Values

Step 3. Agree 2021/22 Objectives:

Continue on separate pages, as required

(b) Personal Development Objectives

Step 4: Appraisee Support, Health, Safety & Wellbeing

Step 5: Appraisal confirmation and sign-off:

Performance and Values Ratings

RATING DESCRIPTOR - PERFORMANCE DESCRIPTOR - VALUES AND

1 - Unsatisfactory Is currently in a formal employee relations Is currently in a formal employee relations

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