Staff Member: Supervisor: Program/Dept: Topics Discussed (Check all that apply) Accuracy of Assessment & Referral Documentation issues PTO/Annual Leave Attitude DSR/Progress Note Compliance Reports Audit/Corrective Action Plan Ethical Issues Strategic Plan Updates Barriers to Accomplish Work Holidays Supervision of Staff Behavior Legal Aspects Tardiness/ Attendance Billable Hour Standards No Show Rate Time Management Updates Clinical Outcomes Payor Mix Treatment Plans/ Assessment Clinical Supervision Performance Treatment/Service Information Cooperation/Participation Professional Standards Utilization Management Consumer Satisfaction Project Management Updates Workload/Caseload Cultural Competency Issues Provider/ Stakeholder Issues Other: Topic(s) Summary (Provide a brief summary of the issues/needs in the topic(s) indicated above): Notes: Customer Service Expectations: All contacts (e-mail or phone) will be responded to within You CAN help. Respond positively. Utilize experts within 1 business day. the system. Be available as the expert of your function. Put the customer first Seek first to understand, then to be Jabber – understood. Communicate effectively, share background, assessment, and recommendation. Notes: KPIs (Key Performance Indicators from Job Description): Notes: 4. Accomplishments/Strengths/Progress Since Last Supervision Session: Notes: 5. Solution Plan (Complete if change needs identified require employee action beyond this supervision session): a. Specific Change/Performance Requirements Needed: Notes: b. Performance Improvement Indicators Required: Notes: c. Date Action Plan to be Completed: d. Progress Review Date: you see any opportunities for LifeWays to improve operations at the team or agency level? ►Do Notes: Clinical Supervision Comments/Instruction (complete this section only if clinical supervision is provided): ► Notes: Competencies: No data reviewed Documentation reviewed/see QMHP review Clinical case supervision ► Employee/Contract Provider Comments: Notes: Team Member Signature Date Supervisor Signature Date
Staff Member: Supervisor: Program/Dept: Topics Discussed (Check all that apply) Accuracy of Assessment & Referral Attitude Audit/Corrective Action Plan Barriers to Accomplish Work Behavior Billable Hour Standards Clinical Outcomes Clinical Supervision Cooperation/Participation Consumer Satisfaction Cultural Competency Issues Documentation issues DSR/Progress Note Compliance Ethical Issues Holidays Legal Aspects No Show Rate Payor Mix Performance Professional Standards Project Management Updates Provider/ Stakeholder Issues PTO/Annual Leave Reports Strategic Plan Updates Supervision of Staff Tardiness/ Attendance Time Management Updates Treatment Plans/ Assessment Treatment/Service Information Utilization Management Workload/Caseload Other: Topic(s) Summary (Provide a brief summary of the issues/needs in the topic(s) indicated above): Notes: Customer Service Expectations: All contacts (e-mail or phone) will be responded to within 1 business day. Put the customer first – Seek first to understand, then to be understood. Communicate effectively, share background, assessment, and recommendation. You CAN help. Respond positively. Utilize experts within the system. Be available as the expert of your function. Jabber Notes: KPIs (Key Performance Indicators from Job Description): Notes: 4. Accomplishments/Strengths/Progress Since Last Supervision Session: Notes: 5. Solution Plan (Complete if change needs identified require employee action beyond this supervision session): a. Specific Change/Performance Requirements Needed: Notes: b. Performance Improvement Indicators Required: Notes: c. Date Action Plan to be Completed: d. Progress Review Date: ►Do you see any opportunities for LifeWays to improve operations at the team or agency level? Notes: ► Clinical Supervision Comments/Instruction (complete this section only if clinical supervision is provided): Notes: ► Competencies: No data reviewed Documentation reviewed/see QMHP review Clinical case supervision Employee/Contract Provider Comments: Notes: Team Member Signature Date Supervisor Signature Date