University of the Philippines UP SPMS Form 1

S.2014
PHILIPPINE GENERAL HOSPITAL

a.
INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR)

I, Camille Joy C. Topacio, Nurse II at 6RCB1 of the PGH Department of Pay Patient Services, commit to deliver and agree to be rated on the attainment of the following targets in accordance with the indicated measures
for the period Jan 01, 2017 to June 30 2017.

QET Rating Scale Camille Joy C. Topacio

Poor (50% and below) 1 Ratee
Date:____________________________
Unsatisfactory (51%-99%) 2
__
Satisfactory (100%-114%) 3
Very Satisfactory (115%-129%) 4
Outstanding (130% and above) 5

b. Reviewed by: Date c. Approved By: Date

Alona F. Sacayanan 06/09/17 Clarita P. Paragas 06/09/17

Immediate Supervisor Supervisor

Function Name Success Indicator Actual Accomplishments % Distribution Rating Ave Remarks
Targets (T) + Measures (M) Score
(b) (f) (g)

(c) Q 1

E
2
T
3
A
4
(l=g x k)
(m)

(h) (i) (j ) (k = ave of h,i,j)

Strategic Functions:
Integration of public service and Hospital services Performed hospital services of 90% of the 5 5 5 0.25
communication program T: 90% clients who rated the hospital services as
M: Percentage of clients who rate the satisfactory or better
hospital services as satisfactory or
better
Core Functions:

Integration of Public Service and Quality Nursing care services Performed the implementation/ provision 20 4 4 4 4 0.8
Communication Program T: 100% of quality nursing care of 90% of admitted
M: Percentage of compliance to patients
implementation of quality nursing care
of admitted patients, focusing on
assessment, planning,
implementation and evaluation
Quality assurance Competency enhancement Participated in 80% of teaching/ learning 5 5 5 0.25
T: 100% activities within the rating period
M: Percentage of nursing personnel
who had undertaken activities to
develop and enhance their
competency
Linkage with government regulatory Compliance with other requirements Implemented 100% compliance to 5 5 5 0.25
agencies and regulations regulatory requirements
T: 100%
M: Percentage of regulatory
requirements complied with
Integration of Public Service and Quality Nursing care services Performed implementation of hospital 10 5 5 5 0.5
Communication Program T: 100% infection control measures/ guidelines to
M: Percentage compliance to 100% of all patients
monitoring and implementation of
hospital infection control
measures/guidelines of all patients

Legend:1 - Quality 2 - Efficiency 3 - Timeliness 4 – Average

 University of the Philippines UP SPMS Form 1
S.2014
PHILIPPINE GENERAL HOSPITAL

Streamlining of university processes
Integration of public service and
communication program
Integration of Public Service and
Communication Program
Support Functions:
Linkage with government regulatory
agencies
Linkage with government regulatory
agencies
o. Final Average Rating: 4.35
p. Comments and Recommendations for Development Purposes (please use UP SPMS Form No. 5 for Staff Development Plans)
Improvement and intervention in HR Implemented <80% compliance in 15 2 2 2 2 0.3
processes monitoring of provision of rational nursing
T: 100% staffing compliment for 24 hours in the
M: Percentage of compliance in unit
monitoring provision of rational
nursing staffing compliment for 24
hours in all clinical areas
Quality nursing care services Performed the facilitation of the peri- 15 5 5 0.75
T: 100% operative needs for 100% of patients for
M: Percentage of compliance to emergency/ elective surgeries within the
facilitating/ assisting peri-operative prescribed time
needs of patients for emergency /
elective surgeries
Quality nursing care services Performed the documentation of quality 15 5 5 5 0.75
T: 100% nursing care rendered to 100% of
M: Percentage compliance to admitted patients
monitoring of documentation of quality
nursing care rendered to admitted
patients
Compliance with other requirements Implemented100%compliancetoselfassessmentQMS 5 5 5 0.25
and regulations certification/sorAgency’sOperationsManualcovering
T: 100% selectedcoreprocessesorareaofoperations
M: Self assessment QMS
certification/s or Agency's Operations
Manual covering selected core
processes or area of operations
Compliance with other requirements Implemented 100% compliance to good 5 5 5 0.25
and regulations governance conditions of EO No. 80 S.
T: 100% 2012
M: Percentage of compliance to good
governance conditions of EO No. 80
S. 2012 (e.g. transparency seal
requirements maintained/updated)
Adjectival Rating: Very Satisfactory

q. Discussed with Date r. Assessed by: Date s. Final Rating by: Date
I certify that I discussed my assessment of the performance with the employee

Donabel G. Burre 07/26.17 Alona F. Sacayanan 07/27/17 Clarita P. Paragas 07/27/17

Immediate
Name and Signature of Employee Supervisor Head of Office

Overall Rating Scale

2.5
1-
3.5
NUM 4.51-5.00 3.51-4.50 0 1.51-2.50 .51-1.50
ADJ O VS S U P

Legend: 1 - Quality 2 - Efficiency 3 - Timeliness 4 - Average