**Short Case 6: Annual Performance Evaluation: Can You Coach Kindness?**

*Ann Scheck McAlearney*

Bob Carter, RN, has been working at New Hope Hospital for six years, ever since he finished nursing school. He has always planned to become a manager at some point in his career, and it seems that the opportunity might soon be available. As a floor nurse, Carter has earned the respect of his peers, never taking no for an answer and, in many cases, saving patients’ lives because of his solid clinical instincts.

At this point, Carter has been working for two years as a case manager in the clinical case management department, participating in case management and discharge planning within the hospital. Carter is considering applying for a promotion to manager of discharge planning to fill a newly vacated position in the clinical case management department, and he is looking forward to his upcoming performance review with the director of clinical case management as an opportunity to discuss this possible promotion.

Sally Valen is the vice president of clinical operations, and the clinical case management department is one of her areas of responsibility. She is particularly concerned about the role of this department in ensuring appropriate discharge planning for all patients, especially in light of the new attention focused on discharge planning through the Centers for Medicare & Medicaid Services (CMS) Core Measures Program.

You are the director of clinical case management, and eager to fill the vacant manager of discharge planning position. You know that any manager in the department will require a strong clinical background, but you are also aware that this individual must have the ability to work well with others in process improvement activities needed to strengthen discharge planning and clinical case management services throughout the hospital.

In reviewing Carter’s file before his performance evaluation, you are reminded of several issues that might affect your decision about his promotion. First, you are aware that Carter’s attitude toward social workers within the department has been less than collegial. Your observations of his work style indicate that he feels superior to the social workers, but you have not discussed this directly with him. Second, you are somewhat concerned about Carter’s potential management style. While he has yet to be tested as a manager, you have seen him verbally reprimand other nurses in front of other employees, which has frustrated some of his coworkers.

On the positive side, though, you know that Carter has excellent clinical instincts. Further, while he may seem to have a superior attitude in interactions with some of his coworkers, his interactions with patients have been consistently outstanding. His ability to help patients manage challenging health issues and take responsibility for their care post-discharge has been noted several times in his file.

Your reflections about Carter’s possible promotion have left you confused. You have several considerations.

**Case Questions**
1. What is the relative importance of clinical competence and patient focus over one’s ability to work as a member of a clinical team in this department?
2. Do you want Carter to be a manager in your department?
3. What should you tell Carter to help him improve and develop his managerial skills regardless of your recommendation for him to apply for the manager position?
4. Based on your recommendation about Carter’s possible promotion, what do you do now to help him succeed in a managerial role, or how do you encourage his professional development within New Hope so that he does not leave for a different job?