PERFORMANCE DEVELOPMENT PLAN

(Individual Contributor)
Employee's Name XXXX Employee ID

Title Dokter Umum Company/ Unit

Appraiser's Name dr. Ristanti Karina Department

Performance Review Period 2023 Performance Rating

A. KPI : 80%

RATING SCORE 3 - Meet KPI Target

1 - Far less than KPI Target 4 - Above KPI Target
2 - Less than KPI Target 5 - Outstanding Above KPI Target

KPI TARGET WEIGHT

1. Dokter Umum mengikuti Modul CME

2. Dokter Umum mencapai kompetensi minimal dari

Learning and Growth modul CME 20%

3. Dokter Umum ikut dalam Mockdrill pasien penyakit

menular

1. Konversi pasien IGD to IPD > 20%

Operasional IGD 20%

2. Pasien dari IGD dirujuk ke RS lain < 10%

Operasional IGD Assesmen Awal dilengkapi 1x24 jam 15%

Operasional IPD Pelaksanaan Whats Matters To You 10%

Operasional IPD Code Blue < 10 Pasien / Tahun 10%

 Patient Experience 1
(Based on Customer Experience)
Average of Customer Satisfaction Index (CSI)

3,90 – 4,00 : 5
3,40– 3,59 : 2 3,80 – 3,89 : 4
0 – 3,39 : 1 3,60 – 3,79 : 3
Patient Experience 12.5%
Patient Experience 2
(Based on Patient Journey)
% KPI achieved divided with number of KPI in each service function

90% - 100% : 5
60% - 69,9% : 2
80% - 89,9% : 4
0% - 59,9% : 1 70% - 79,9% : 3

% of Risk Indicators achieved divided by the number of indicators

under their responsibility
Quality and Risk Management 12.5%
95 % - 100 % : 5
70 % - 79,9 % : 2 90 % - 94,9 % : 4
0 - 69,9 % :1
80 % - 89,9 % : 3

100%
B. CORE COMPETENCIES : 5%
RATING SCORE 3 - Regularly display this competency
1 - Has never demonstrated this competency 4 - Always display this competency
2 - Has displayed this competency ocassionally 5 - Significantly consistent display this competency

CORE COMPETENCIES BEHAVIOR INDICATORS

Demonstrate to carry out work with impactful result

Committed to deliver Service Excellence to all of our customers
Commitment
Prioritizing tasks/ time in order to meet committed deadlines
Desire for Personal Learning & Self Development
Ability to take responsibility in accordance with ethics ( including conflict of interest )
Being honest and truthful including admitting mistakes
Integrity
Doing the Right thing even if it is unpopular or even if nobody is looking
Discipline in terms of being punctual when attending work and starting work.
Ability to carry out work in a systematic, complete, with on time result.
Ability to work as a team
Professionalism
Implementation of 5 S (Sort, Straighten, Sweep, Standardize & Sustain) in daily activities.
Ability to innovate and to perform continuous improvement.
Having good communication and listening skills.
Be able to manage customer complaint and/or request as per required standard
Compassion
Helping customers or patients/coworkers even after working hours.
Be able to manage customer complaint and/or request as per required standard
Ability to be open, listen and respect different opinion.
Maintaining Confidentiality
Trust
Open to receive constructive feedback
Being reliable for task that being delegated
Total Score Core Competencies

C. TECHNICAL COMPETENCIES : 15%

RATING SCORE 3 - Meets Expectation
1 - Significantly Below Expectation 4 - Exceeds Expectation
2 - Below Expectation 5 - Significantly Exceeds Expectation
 TECHNICAL COMPETENCIES - Max 5

1. Kemampuan melakukan intubasi pasien dalam kondisi kegawatdaruratan

2. Kemampuan mengkomunikasikan keterampilan terapeutik dan komunikasi yang efektif dalam memberikan pelayanan
kepada pasien

3. Mampu memberikan terapi rutin sesuai program pengobatan dari DPJP

4. Get ACLS and ATLS Certification

5. Tidak melakukan kesalahan penulisan resep (Medication Error)

Total Score Technical Competencies

KPI Total Score (x 80%) 0.00 80%

Core Competencies Total Score (x 5%) 0.00 5%
Technical Competencies Total Score (x 15%) 0.00 15%
Final Rating
RATING
D : 0 - 2,5 C : 2,51 - 2,99 B : 3 - 3,49 A : 3,5 - 4,5 A+ : 4,51 - 5
SCALE

PERSONAL DEVELOPMENT PLAN

My Career Aspiration

What are your aspired target roles for the next 12 months? [e.g. Remain in
Current Role with same or expanded responsibilities, or other specific roles that What is your long term career aspiration e.g. 2 - 3 y
you believe you are now ready or almost ready]

My Strengths
1. What skills, competencies and knowledge do I possess and can I leverage to achieve my career aspiration?

2. What types of activities do I usually receive positive feedback on from others? Please list examples to illustrate.

3. What do I want others to value about me the most?

My Potential Challenges
1. What skills, competencies and knowledge do I need to be successful in a job that I don’t have yet?
2. What skills, competencies and knowledge that I have for areas of improvement?

3. What would really keep me from succeeding in my career?

My Development Action Plan

Target Completion
Development Area Development Action Plan Objectives Date Success Measure

My Mobility Options

Year-end Review Comments

Appraiser

Employee
ENT PLAN
or)
XXXX

Mayapada Hospital Bogor

Medical Services

ng D

KPI Target

RESULT RATING TOTAL

XXXXX 0 0.00

XXXXX 0 0.00

XXXXX 0 0.00

XXXXX 0 0.00

XXXXX 0 0.00
 XXXXX

0.0 0.00

XXXXX

XXXXX 0 0.00

Total Score KPI 0.00

is competency
competency
ent display this competency

WEIGHT RATING TOTAL

20% 0 0.00

nterest )

20% 0 0.00

20% 0 0.00
y activities.

ard
20% 0 0.00

ard

20% 0 0.00

e Competencies 100% 0.00

n
s Expectation
 WEIGHT RATING TOTAL

20% 0 0.00

erikan pelayanan 20% 0 0.00

20% 0 0.00

20% 0 0.00

20% 0 0.00

ical Competencies 100% 0.00

80% 0
5% 0.00
15% 0.00
Final Rating 0.00

A+ : 4,51 - 5 D

rm career aspiration e.g. 2 - 3 years? [List functions, roles, level, etc]

tion?

o illustrate.
Success Measure Completion Status
 dr. Okky dr. Okky

KPI Learning and Growth

1. Dokter
Umum 2. Dokter Umum mencapai
kompetensi minimal dari
NAMA DOKTER mengikuti
modul CME
Modul CME

1 dr. Anggita Dewati Putri

2 dr. Denisa Prahajna
3 dr. Muhammad Aprianto Ramadhan
4 dr. Okky Putri
5 dr. Septyne Rahayuni Putri
6 dr. Tenny Nalita Kanti
7 dr. Daisha Vika Audina
8 dr. Ahmed Haykal Hilman
9 dr. Melisa Ramadhani
10 dr. Ryantino Irdan
11 dr. Clayrino Emiro Nerviadi
12 dr. Fadhil Wiryawan
13 dr. Solehudin Widya Putra
14 dr. Luthfi Suharyo
15 dr. Istiadi Mukharam
16 dr. Raesya Dwi Ananta
 Hikmah RM The Tami RM

ning and Growth Operasional IGD Operasional IGD Operasional IPD

3. Dokter Umum ikut dalam Pelaksanaan

Mockdrill pasien penyakit 1. Konversi pasien IGD 2. Pasien dari IGD Assesmen Awal Whats Matters
menular to IPD > 20% dirujuk ke RS lain < 10% dilengkapi 1x24 jam To You

75% 0 77.61%
25% 19% 0 77.61%
75% 17% 0 77.61%
100% 0 77.61%
100% 19% 0 77.61%
75% 16% 0 77.61%
75% 19% 0 77.61%
75% 16% 0 77.61%
50% 18% 0 77.61%
100% 17% 0 77.61%
75% 17% 0 77.61%
100% 19% 0 77.61%
100% 17% 0 77.61%
100% 17% 0 77.61%
75% 18% 0 77.61%
75% 24% 0 77.61%
Operasional IPD

Code Blue < 10

Pasien / Tahun
 PERFORMANCE DEVELOPMENT PLAN
(Individual Contributor)
Employee's Name XXXX Employee ID

Title Dokter Umum Company/ Unit

Appraiser's Name dr. Ristanti Karina Department

Performance Review Period 2023 Performance Rating

A. KPI : 80%

RATING SCORE 3 - Meet KPI Target

1 - Far less than KPI Target 4 - Above KPI Target
2 - Less than KPI Target 5 - Outstanding Above KPI Target

KPI TARGET WEIGHT

1. Dokter Umum mengikuti Modul CME

2. Dokter Umum mencapai kompetensi minimal dari

Learning and Growth modul CME 20%

3. Dokter Umum ikut dalam Mockdrill pasien penyakit

menular

1. Konversi pasien IGD to IPD > 20%

Operasional IGD 20%

2. Pasien dari IGD dirujuk ke RS lain < 10%

Operasional IGD Assesmen Awal dilengkapi 1x24 jam 15%

Operasional IPD Pelaksanaan Whats Matters To You 10%

Operasional IPD Code Blue < 10 Pasien / Tahun 10%

 Patient Experience 1
(Based on Customer Experience)
Average of Customer Satisfaction Index (CSI)

3,90 – 4,00 : 5
3,40– 3,59 : 2 3,80 – 3,89 : 4
0 – 3,39 : 1 3,60 – 3,79 : 3
Patient Experience 12.5%
Patient Experience 2
(Based on Patient Journey)
% KPI achieved divided with number of KPI in each service function

90% - 100% : 5
60% - 69,9% : 2
80% - 89,9% : 4
0% - 59,9% : 1 70% - 79,9% : 3

% of Risk Indicators achieved divided by the number of indicators

under their responsibility
Quality and Risk Management 12.5%
95 % - 100 % : 5
70 % - 79,9 % : 2 90 % - 94,9 % : 4
0 - 69,9 % :1
80 % - 89,9 % : 3

100%
B. CORE COMPETENCIES : 5%
RATING SCORE 3 - Regularly display this competency
1 - Has never demonstrated this competency 4 - Always display this competency
2 - Has displayed this competency ocassionally 5 - Significantly consistent display this competency

CORE COMPETENCIES BEHAVIOR INDICATORS

Demonstrate to carry out work with impactful result

Committed to deliver Service Excellence to all of our customers
Commitment
Prioritizing tasks/ time in order to meet committed deadlines
Desire for Personal Learning & Self Development
Ability to take responsibility in accordance with ethics ( including conflict of interest )
Being honest and truthful including admitting mistakes
Integrity
Doing the Right thing even if it is unpopular or even if nobody is looking
Discipline in terms of being punctual when attending work and starting work.
Ability to carry out work in a systematic, complete, with on time result.
Ability to work as a team
Professionalism
Implementation of 5 S (Sort, Straighten, Sweep, Standardize & Sustain) in daily activities.
Ability to innovate and to perform continuous improvement.
Having good communication and listening skills.
Be able to manage customer complaint and/or request as per required standard
Compassion
Helping customers or patients/coworkers even after working hours.
Be able to manage customer complaint and/or request as per required standard
Ability to be open, listen and respect different opinion.
Maintaining Confidentiality
Trust
Open to receive constructive feedback
Being reliable for task that being delegated
Total Score Core Competencies

C. TECHNICAL COMPETENCIES : 15%

RATING SCORE 3 - Meets Expectation
1 - Significantly Below Expectation 4 - Exceeds Expectation
2 - Below Expectation 5 - Significantly Exceeds Expectation
 TECHNICAL COMPETENCIES - Max 5

1. Kemampuan melakukan intubasi pasien dalam kondisi kegawatdaruratan

2. Kemampuan mengkomunikasikan keterampilan terapeutik dan komunikasi yang efektif dalam memberikan pelayanan
kepada pasien

3. Mampu memberikan terapi rutin sesuai program pengobatan dari DPJP

4. Get ACLS and ATLS Certification

5. Tidak melakukan kesalahan penulisan resep (Medication Error)

Total Score Technical Competencies

KPI Total Score (x 80%) 2.75 80%

Core Competencies Total Score (x 5%) 4.00 5%
Technical Competencies Total Score (x 15%) 4.00 15%
Final Rating
RATING
D : 0 - 2,5 C : 2,51 - 2,99 B : 3 - 3,49 A : 3,5 - 4,5 A+ : 4,51 - 5
SCALE

PERSONAL DEVELOPMENT PLAN

My Career Aspiration

What are your aspired target roles for the next 12 months? [e.g. Remain in
Current Role with same or expanded responsibilities, or other specific roles that What is your long term career aspiration e.g. 2 - 3 y
you believe you are now ready or almost ready]

Memperdalam ilmu psikiatri, mengikuti berbagai seminar psikiatri ppds psikia

My Strengths
1. What skills, competencies and knowledge do I possess and can I leverage to achieve my career aspiration?

meningkatkan ilmu psikiatri, mengikuti seminar, komunikasi yang baik, meningkatkan empati terhadap pasien
2. What types of activities do I usually receive positive feedback on from others? Please list examples to illustrate.

dapat diandalkan, komunikasi baik, jujur, kerja sama yang baik

3. What do I want others to value about me the most?

kerja sama yang baik, dapat diandalkan, membantu bila dibutuhkan

My Potential Challenges
1. What skills, competencies and knowledge do I need to be successful in a job that I don’t have yet?
manajemen waktu, leadership
2. What skills, competencies and knowledge that I have for areas of improvement?

kegawatdaruratan, komunikasi, empati, leadership

3. What would really keep me from succeeding in my career?

kurang percaya diri

My Development Action Plan

Target Completion
Development Area Development Action Plan Objectives Date Success Measure

peningkatan pelayana
bidang kegawatdaruratan, ilmu bidang kegawat darurata
psikiatri mengikuti berbagai seminar 2024 psikiatri

My Mobility Options

Year-end Review Comments

Appraiser

Employee
ENT PLAN
or)
XXXX

Mayapada Hospital Bogor

Medical Services

ng B

KPI Target

RESULT RATING TOTAL

XXXXX 4 0.80

XXXXX 3 0.60

XXXXX 5 0.75

XXXXX 3 0.30

XXXXX 3 0.30
 XXXXX

0.0 0.00

XXXXX

XXXXX 0 0.00

Total Score KPI 2.75

is competency
competency
ent display this competency

WEIGHT RATING TOTAL

20% 4 0.80

nterest )

20% 4 0.80

20% 4 0.80
y activities.

ard
20% 4 0.80

ard

20% 4 0.80

e Competencies 100% 4.00

n
s Expectation
 WEIGHT RATING TOTAL

20% 3 0.60

erikan pelayanan 20% 4 0.80

20% 5 1.00

20% 5 1.00

20% 3 0.60

ical Competencies 100% 4.00

80% 2.2
5% 0.20
15% 0.60
Final Rating 3.00

A+ : 4,51 - 5 B

rm career aspiration e.g. 2 - 3 years? [List functions, roles, level, etc]

ppds psikiatri

tion?

terhadap pasien
o illustrate.
 Success Measure Completion Status

peningkatan pelayanan di
bidang kegawat daruratan dan
psikiatri on proses
 PERFORMANCE DEVELOPMENT PLAN
(Individual Contributor)
Employee's Name XXXX Employee ID

Title Dokter Umum Company/ Unit

Appraiser's Name dr. Ristanti Karina Department

Performance Review Period 2023 Performance Rating

A. KPI : 80%

RATING SCORE 3 - Meet KPI Target

1 - Far less than KPI Target 4 - Above KPI Target
2 - Less than KPI Target 5 - Outstanding Above KPI Target

KPI TARGET WEIGHT

1. Dokter Umum mengikuti Modul CME

2. Dokter Umum mencapai kompetensi minimal dari

Learning and Growth modul CME 20%

3. Dokter Umum ikut dalam Mockdrill pasien penyakit

menular

1. Konversi pasien IGD to IPD > 20%

Operasional IGD 20%

2. Pasien dari IGD dirujuk ke RS lain < 10%

Operasional IGD Assesmen Awal dilengkapi 1x24 jam 15%

Operasional IPD Pelaksanaan Whats Matters To You 10%

Operasional IPD Code Blue < 10 Pasien / Tahun 10%

 Patient Experience 1
(Based on Customer Experience)
Average of Customer Satisfaction Index (CSI)

3,90 – 4,00 : 5
3,40– 3,59 : 2 3,80 – 3,89 : 4
0 – 3,39 : 1 3,60 – 3,79 : 3
Patient Experience 12.5%
Patient Experience 2
(Based on Patient Journey)
% KPI achieved divided with number of KPI in each service function

90% - 100% : 5
60% - 69,9% : 2
80% - 89,9% : 4
0% - 59,9% : 1 70% - 79,9% : 3

% of Risk Indicators achieved divided by the number of indicators

under their responsibility
Quality and Risk Management 12.5%
95 % - 100 % : 5
70 % - 79,9 % : 2 90 % - 94,9 % : 4
0 - 69,9 % :1
80 % - 89,9 % : 3

100%
B. CORE COMPETENCIES : 5%
RATING SCORE 3 - Regularly display this competency
1 - Has never demonstrated this competency 4 - Always display this competency
2 - Has displayed this competency ocassionally 5 - Significantly consistent display this competency

CORE COMPETENCIES BEHAVIOR INDICATORS

Demonstrate to carry out work with impactful result

Committed to deliver Service Excellence to all of our customers
Commitment
Prioritizing tasks/ time in order to meet committed deadlines
Desire for Personal Learning & Self Development
Ability to take responsibility in accordance with ethics ( including conflict of interest )
Being honest and truthful including admitting mistakes
Integrity
Doing the Right thing even if it is unpopular or even if nobody is looking
Discipline in terms of being punctual when attending work and starting work.
Ability to carry out work in a systematic, complete, with on time result.
Ability to work as a team
Professionalism
Implementation of 5 S (Sort, Straighten, Sweep, Standardize & Sustain) in daily activities.
Ability to innovate and to perform continuous improvement.
Having good communication and listening skills.
Be able to manage customer complaint and/or request as per required standard
Compassion
Helping customers or patients/coworkers even after working hours.
Be able to manage customer complaint and/or request as per required standard
Ability to be open, listen and respect different opinion.
Maintaining Confidentiality
Trust
Open to receive constructive feedback
Being reliable for task that being delegated
Total Score Core Competencies

C. TECHNICAL COMPETENCIES : 15%

RATING SCORE 3 - Meets Expectation
1 - Significantly Below Expectation 4 - Exceeds Expectation
2 - Below Expectation 5 - Significantly Exceeds Expectation
 TECHNICAL COMPETENCIES - Max 5

1. Kemampuan melakukan intubasi pasien dalam kondisi kegawatdaruratan

2. Kemampuan mengkomunikasikan keterampilan terapeutik dan komunikasi yang efektif dalam memberikan pelayanan
kepada pasien

3. Mampu memberikan terapi rutin sesuai program pengobatan dari DPJP

4. Get ACLS and ATLS Certification

5. Tidak melakukan kesalahan penulisan resep (Medication Error)

Total Score Technical Competencies

KPI Total Score (x 80%) 3.05 80%

Core Competencies Total Score (x 5%) 4.00 5%
Technical Competencies Total Score (x 15%) 4.60 15%
Final Rating
RATING
D : 0 - 2,5 C : 2,51 - 2,99 B : 3 - 3,49 A : 3,5 - 4,5 A+ : 4,51 - 5
SCALE

PERSONAL DEVELOPMENT PLAN

My Career Aspiration

What are your aspired target roles for the next 12 months? [e.g. Remain in
Current Role with same or expanded responsibilities, or other specific roles that What is your long term career aspiration e.g. 2 - 3 y
you believe you are now ready or almost ready]

meningkatkan skill dan potensi PPDS

My Strengths
1. What skills, competencies and knowledge do I possess and can I leverage to achieve my career aspiration?

Meningkatkan keterampilan komunikasi efektif, kemampuan menjadi leader yg baik.

2. What types of activities do I usually receive positive feedback on from others? Please list examples to illustrate.

komunikasi baik kepada pasien, keluarga dan teman kerja

3. What do I want others to value about me the most?

bertanggung jawab, dapat dipercaya dan diandalkan

My Potential Challenges
1. What skills, competencies and knowledge do I need to be successful in a job that I don’t have yet?
manajemen waktu
2. What skills, competencies and knowledge that I have for areas of improvement?

manajemen waktu
3. What would really keep me from succeeding in my career?

scheduling, jujur dan berkomunikasi baik

My Development Action Plan

Target Completion
Development Area Development Action Plan Objectives Date Success Measure

Meningkatkan keterampilan
komunikasi efektif, kemampuan
menjadi leader yg baik. Scheduling.
mengikuti pelatihan, simposium,
manajemen waktu. Peningkatan mengikuti program pendidikan dokter
skill emergency spesialis secepatnya tepat waktu, skill menin

My Mobility Options

Year-end Review Comments

Appraiser

Employee
ENT PLAN
or)
XXXX

Mayapada Hospital Bogor

Medical Services

ng B

KPI Target

RESULT RATING TOTAL

1. 100%
2. 94 5 1.00
3. 75%

1. 17.45% 2 0.40
2. 0

1. 98.82% 5 0.75

1. 77.61% 4 0.40

1. 100% 5 0.50
 XXXXX

0.0 0.00

XXXXX

XXXXX 0 0.00

Total Score KPI 3.05

is competency
competency
ent display this competency

WEIGHT RATING TOTAL

20% 4 0.80

nterest )

20% 4 0.80

20% 4 0.80
y activities.

ard
20% 4 0.80

ard

20% 4 0.80

e Competencies 100% 4.00

n
s Expectation
 WEIGHT RATING TOTAL

20% 4 0.80

erikan pelayanan 20% 5 1.00

20% 5 1.00

20% 4 0.80

20% 5 1.00

ical Competencies 100% 4.60

80% 2.44
5% 0.20
15% 0.69
Final Rating 3.33

A+ : 4,51 - 5 B

rm career aspiration e.g. 2 - 3 years? [List functions, roles, level, etc]

PPDS

tion?

o illustrate.
 Success Measure Completion Status

tepat waktu, skill meningkat dalam proses

 PERFORMANCE DEVELOPMENT PLAN
(Individual Contributor)
Employee's Name XXXX Employee ID

Title Dokter Umum Company/ Unit

Appraiser's Name dr. Ristanti Karina Department

Performance Review Period 2023 Performance Rating

A. KPI : 80%

RATING SCORE 3 - Meet KPI Target

1 - Far less than KPI Target 4 - Above KPI Target
2 - Less than KPI Target 5 - Outstanding Above KPI Target

KPI TARGET WEIGHT

1. Dokter Umum mengikuti Modul CME

2. Dokter Umum mencapai kompetensi minimal dari

Learning and Growth modul CME 20%

3. Dokter Umum ikut dalam Mockdrill pasien penyakit

menular

1. Konversi pasien IGD to IPD > 20%

Operasional IGD 20%

2. Pasien dari IGD dirujuk ke RS lain < 10%

Operasional IGD Assesmen Awal dilengkapi 1x24 jam 15%

Operasional IPD Pelaksanaan Whats Matters To You 10%

Operasional IPD Code Blue < 10 Pasien / Tahun 10%

 Patient Experience 1
(Based on Customer Experience)
Average of Customer Satisfaction Index (CSI)

3,90 – 4,00 : 5
3,40– 3,59 : 2 3,80 – 3,89 : 4
0 – 3,39 : 1 3,60 – 3,79 : 3
Patient Experience 12.5%
Patient Experience 2
(Based on Patient Journey)
% KPI achieved divided with number of KPI in each service function

90% - 100% : 5
60% - 69,9% : 2
80% - 89,9% : 4
0% - 59,9% : 1 70% - 79,9% : 3

% of Risk Indicators achieved divided by the number of indicators

under their responsibility
Quality and Risk Management 12.5%
95 % - 100 % : 5
70 % - 79,9 % : 2 90 % - 94,9 % : 4
0 - 69,9 % :1
80 % - 89,9 % : 3

100%
B. CORE COMPETENCIES : 5%
RATING SCORE 3 - Regularly display this competency
1 - Has never demonstrated this competency 4 - Always display this competency
2 - Has displayed this competency ocassionally 5 - Significantly consistent display this competency

CORE COMPETENCIES BEHAVIOR INDICATORS

Demonstrate to carry out work with impactful result

Committed to deliver Service Excellence to all of our customers
Commitment
Prioritizing tasks/ time in order to meet committed deadlines
Desire for Personal Learning & Self Development
Ability to take responsibility in accordance with ethics ( including conflict of interest )
Being honest and truthful including admitting mistakes
Integrity
Doing the Right thing even if it is unpopular or even if nobody is looking
Discipline in terms of being punctual when attending work and starting work.
Ability to carry out work in a systematic, complete, with on time result.
Ability to work as a team
Professionalism
Implementation of 5 S (Sort, Straighten, Sweep, Standardize & Sustain) in daily activities.
Ability to innovate and to perform continuous improvement.
Having good communication and listening skills.
Be able to manage customer complaint and/or request as per required standard
Compassion
Helping customers or patients/coworkers even after working hours.
Be able to manage customer complaint and/or request as per required standard
Ability to be open, listen and respect different opinion.
Maintaining Confidentiality
Trust
Open to receive constructive feedback
Being reliable for task that being delegated
Total Score Core Competencies

C. TECHNICAL COMPETENCIES : 15%

RATING SCORE 3 - Meets Expectation
1 - Significantly Below Expectation 4 - Exceeds Expectation
2 - Below Expectation 5 - Significantly Exceeds Expectation
 TECHNICAL COMPETENCIES - Max 5

1. Kemampuan melakukan intubasi pasien dalam kondisi kegawatdaruratan

2. Kemampuan mengkomunikasikan keterampilan terapeutik dan komunikasi yang efektif dalam memberikan pelayanan
kepada pasien

3. Mampu memberikan terapi rutin sesuai program pengobatan dari DPJP

4. Get ACLS and ATLS Certification

5. Tidak melakukan kesalahan penulisan resep (Medication Error)

Total Score Technical Competencies

KPI Total Score (x 80%) 2.55 80%

Core Competencies Total Score (x 5%) 4.80 5%
Technical Competencies Total Score (x 15%) 4.20 15%
Final Rating
RATING
D : 0 - 2,5 C : 2,51 - 2,99 B : 3 - 3,49 A : 3,5 - 4,5 A+ : 4,51 - 5
SCALE

PERSONAL DEVELOPMENT PLAN

My Career Aspiration

What are your aspired target roles for the next 12 months? [e.g. Remain in
Current Role with same or expanded responsibilities, or other specific roles that What is your long term career aspiration e.g. 2 - 3 y
you believe you are now ready or almost ready]

mendaftar ppds mata residen ma

My Strengths
1. What skills, competencies and knowledge do I possess and can I leverage to achieve my career aspiration?

komunikasi baik, bekerja sesuai SOP

2. What types of activities do I usually receive positive feedback on from others? Please list examples to illustrate.

tepat waktu dalam pengisian rekam medis

3. What do I want others to value about me the most?

komunikasi baik, teratur dalam bekerja

My Potential Challenges
1. What skills, competencies and knowledge do I need to be successful in a job that I don’t have yet?
skill kegawatdaruratan
2. What skills, competencies and knowledge that I have for areas of improvement?

peningkatan manajemen waktu dan pasien

3. What would really keep me from succeeding in my career?

sense of emergency kadang masih kurang

My Development Action Plan

Target Completion
Development Area Development Action Plan Objectives Date Success Measure

kemampuan gawat darurat, ilmu kemampuan gawat dar

penyakit mata inhouse training, seminar mata 2024 meningkat, diterima ppd

My Mobility Options

Year-end Review Comments

Appraiser

Employee dr. Clayrino Emiro Nerviadi

ENT PLAN
or)
XXXX

Mayapada Hospital Bogor

Medical Services

ng C

KPI Target

RESULT RATING TOTAL

1. 100%, 2. 100%, 3. 75% 3 0.60

1. 17%, 2. 0% 2 0.40

100% 5 0.75

77,6% 3 0.30

100% 5 0.50
 XXXXX

0.0 0.00

XXXXX

XXXXX 0 0.00

Total Score KPI 2.55

is competency
competency
ent display this competency

WEIGHT RATING TOTAL

20% 5 1.00

nterest )

20% 5 1.00

20% 4 0.80
y activities.

ard
20% 5 1.00

ard

20% 5 1.00

e Competencies 100% 4.80

n
s Expectation
 WEIGHT RATING TOTAL

20% 2 0.40

erikan pelayanan 20% 4 0.80

20% 5 1.00

20% 5 1.00

20% 5 1.00

ical Competencies 100% 4.20

80% 2.04
5% 0.24
15% 0.63
Final Rating 2.91

A+ : 4,51 - 5 C

rm career aspiration e.g. 2 - 3 years? [List functions, roles, level, etc]

residen mata

tion?

o illustrate.
 Success Measure Completion Status

kemampuan gawat darurat

meningkat, diterima ppds mata dalam proses

no Emiro Nerviadi
 PERFORMANCE DEVELOPMENT PLAN
(Individual Contributor)
Employee's Name Daisha Vika Audina Employee ID

Title Dokter Umum Company/ Unit

Appraiser's Name dr. Ristanti Karina Department

Performance Review Period 2023 Performance Rating

A. KPI : 80%

RATING SCORE 3 - Meet KPI Target

1 - Far less than KPI Target 4 - Above KPI Target
2 - Less than KPI Target 5 - Outstanding Above KPI Target

KPI TARGET WEIGHT

1. Dokter Umum mengikuti Modul CME

2. Dokter Umum mencapai kompetensi minimal dari

Learning and Growth modul CME 20%

3. Dokter Umum ikut dalam Mockdrill pasien penyakit

menular

1. Konversi pasien IGD to IPD > 20%

Operasional IGD 20%

2. Pasien dari IGD dirujuk ke RS lain < 10%

Operasional IGD Assesmen Awal dilengkapi 1x24 jam 15%

Operasional IPD Pelaksanaan Whats Matters To You 10%

Operasional IPD Code Blue < 10 Pasien / Tahun 10%

 Patient Experience 1
(Based on Customer Experience)
Average of Customer Satisfaction Index (CSI)

3,90 – 4,00 : 5
3,40– 3,59 : 2 3,80 – 3,89 : 4
0 – 3,39 : 1 3,60 – 3,79 : 3
Patient Experience 12.5%
Patient Experience 2
(Based on Patient Journey)
% KPI achieved divided with number of KPI in each service function

90% - 100% : 5
60% - 69,9% : 2
80% - 89,9% : 4
0% - 59,9% : 1 70% - 79,9% : 3

% of Risk Indicators achieved divided by the number of indicators

under their responsibility
Quality and Risk Management 12.5%
95 % - 100 % : 5
70 % - 79,9 % : 2 90 % - 94,9 % : 4
0 - 69,9 % :1
80 % - 89,9 % : 3

100%
B. CORE COMPETENCIES : 5%
RATING SCORE 3 - Regularly display this competency
1 - Has never demonstrated this competency 4 - Always display this competency
2 - Has displayed this competency ocassionally 5 - Significantly consistent display this competency

CORE COMPETENCIES BEHAVIOR INDICATORS

Demonstrate to carry out work with impactful result

Committed to deliver Service Excellence to all of our customers
Commitment
Prioritizing tasks/ time in order to meet committed deadlines
Desire for Personal Learning & Self Development
Ability to take responsibility in accordance with ethics ( including conflict of interest )
Being honest and truthful including admitting mistakes
Integrity
Doing the Right thing even if it is unpopular or even if nobody is looking
Discipline in terms of being punctual when attending work and starting work.
Ability to carry out work in a systematic, complete, with on time result.
Ability to work as a team
Professionalism
Implementation of 5 S (Sort, Straighten, Sweep, Standardize & Sustain) in daily activities.
Ability to innovate and to perform continuous improvement.
Having good communication and listening skills.
Be able to manage customer complaint and/or request as per required standard
Compassion
Helping customers or patients/coworkers even after working hours.
Be able to manage customer complaint and/or request as per required standard
Ability to be open, listen and respect different opinion.
Maintaining Confidentiality
Trust
Open to receive constructive feedback
Being reliable for task that being delegated
Total Score Core Competencies

C. TECHNICAL COMPETENCIES : 15%

RATING SCORE 3 - Meets Expectation
1 - Significantly Below Expectation 4 - Exceeds Expectation
2 - Below Expectation 5 - Significantly Exceeds Expectation
 TECHNICAL COMPETENCIES - Max 5

1. Kemampuan melakukan intubasi pasien dalam kondisi kegawatdaruratan

2. Kemampuan mengkomunikasikan keterampilan terapeutik dan komunikasi yang efektif dalam memberikan pelayanan
kepada pasien

3. Mampu memberikan terapi rutin sesuai program pengobatan dari DPJP

4. Get ACLS and ATLS Certification

5. Tidak melakukan kesalahan penulisan resep (Medication Error)

Total Score Technical Competencies

KPI Total Score (x 80%) 0.00 80%

Core Competencies Total Score (x 5%) 0.00 5%
Technical Competencies Total Score (x 15%) 0.00 15%
Final Rating
RATING
D : 0 - 2,5 C : 2,51 - 2,99 B : 3 - 3,49 A : 3,5 - 4,5 A+ : 4,51 - 5
SCALE

PERSONAL DEVELOPMENT PLAN

My Career Aspiration

What are your aspired target roles for the next 12 months? [e.g. Remain in
Current Role with same or expanded responsibilities, or other specific roles that What is your long term career aspiration e.g. 2 - 3 y
you believe you are now ready or almost ready]

Memiliki dan menambah skill yang dimil

Meningkatkan skill dan mengupdate ilmu dan potensi sehingga dapat
memuaskan dan berkesan bagi pasien, me
memberikan pelayanan lebih baik lagi
spesialis

My Strengths
1. What skills, competencies and knowledge do I possess and can I leverage to achieve my career aspiration?

Komunikasi, rasa empati dan simpati yang baik, pendengar yang baik
2. What types of activities do I usually receive positive feedback on from others? Please list examples to illustrate.

Bekerja dengan ikhlas, sabar dan sepenuh hati

3. What do I want others to value about me the most?

Pekerjaan, profesionalitas
My Potential Challenges
1. What skills, competencies and knowledge do I need to be successful in a job that I don’t have yet?
Kurang percaya diri dengan skill/kemampuan yang dimiliki
2. What skills, competencies and knowledge that I have for areas of improvement?

Lebih percaya diri dalam mengambil tindakan dan keputusan

3. What would really keep me from succeeding in my career?

Belajar lebnih banyak, mengasah skill sehingga lebih percaya diri

My Development Action Plan

Target Completion
Development Area Development Action Plan Objectives Date Success Measure

Lebih percaya diri dan

Mengikuti, pelatihan, seminar dan dalam menangani
Emergency Skill workshop Okt-24 kegawatdaruratan

My Mobility Options

Year-end Review Comments

Appraiser

Employee
ENT PLAN
or)
1080

Mayapada Hospital Bogor

Medical Services

ng D

KPI Target

RESULT RATING TOTAL

XXXXX 0 0.00

XXXXX 0 0.00

XXXXX 0 0.00

XXXXX 0 0.00

XXXXX 0 0.00
 XXXXX

0.0 0.00

XXXXX

XXXXX 0 0.00

Total Score KPI 0.00

is competency
competency
ent display this competency

WEIGHT RATING TOTAL

20% 0 0.00

nterest )

20% 0 0.00

20% 0 0.00
y activities.

ard
20% 0 0.00

ard

20% 0 0.00

e Competencies 100% 0.00

n
s Expectation
 WEIGHT RATING TOTAL

20% 0 0.00

erikan pelayanan 20% 0 0.00

20% 0 0.00

20% 0 0.00

20% 0 0.00

ical Competencies 100% 0.00

80% 0
5% 0.00
15% 0.00
Final Rating 0.00

A+ : 4,51 - 5 D

rm career aspiration e.g. 2 - 3 years? [List functions, roles, level, etc]

n menambah skill yang dimiliki, memberikan pelayanan yang

an berkesan bagi pasien, menjalani program pendidikan dokter
spesialis

tion?

o illustrate.
 Success Measure Completion Status

Lebih percaya diri dan teliti

dalam menangani
kegawatdaruratan
 PERFORMANCE DEVELOPMENT PLAN
(Individual Contributor)
Employee's Name dr.Denisa Prahajna Employee ID

Title Dokter Umum Company/ Unit

Appraiser's Name dr. Ristanti Karina Department

Performance Review Period 2023 Performance Rating

A. KPI : 80%

RATING SCORE 3 - Meet KPI Target

1 - Far less than KPI Target 4 - Above KPI Target
2 - Less than KPI Target 5 - Outstanding Above KPI Target

KPI TARGET WEIGHT

1. Dokter Umum mengikuti Modul CME

2. Dokter Umum mencapai kompetensi minimal dari

Learning and Growth modul CME 20%

3. Dokter Umum ikut dalam Mockdrill pasien penyakit

menular

1. Konversi pasien IGD to IPD > 20%

Operasional IGD 20%

2. Pasien dari IGD dirujuk ke RS lain < 10%

Operasional IGD Assesmen Awal dilengkapi 1x24 jam 15%

Operasional IPD Pelaksanaan Whats Matters To You 10%

Operasional IPD Code Blue < 10 Pasien / Tahun 10%

 Patient Experience 1
(Based on Customer Experience)
Average of Customer Satisfaction Index (CSI)

3,90 – 4,00 : 5
3,40– 3,59 : 2 3,80 – 3,89 : 4
0 – 3,39 : 1 3,60 – 3,79 : 3
Patient Experience 12.5%
Patient Experience 2
(Based on Patient Journey)
% KPI achieved divided with number of KPI in each service function

90% - 100% : 5
60% - 69,9% : 2
80% - 89,9% : 4
0% - 59,9% : 1 70% - 79,9% : 3

% of Risk Indicators achieved divided by the number of indicators

under their responsibility
Quality and Risk Management 12.5%
95 % - 100 % : 5
70 % - 79,9 % : 2 90 % - 94,9 % : 4
0 - 69,9 % :1
80 % - 89,9 % : 3

100%
B. CORE COMPETENCIES : 5%
RATING SCORE 3 - Regularly display this competency
1 - Has never demonstrated this competency 4 - Always display this competency
2 - Has displayed this competency ocassionally 5 - Significantly consistent display this competency

CORE COMPETENCIES BEHAVIOR INDICATORS

Demonstrate to carry out work with impactful result

Committed to deliver Service Excellence to all of our customers
Commitment
Prioritizing tasks/ time in order to meet committed deadlines
Desire for Personal Learning & Self Development
Ability to take responsibility in accordance with ethics ( including conflict of interest )
Being honest and truthful including admitting mistakes
Integrity
Doing the Right thing even if it is unpopular or even if nobody is looking
Discipline in terms of being punctual when attending work and starting work.
Ability to carry out work in a systematic, complete, with on time result.
Ability to work as a team
Professionalism
Implementation of 5 S (Sort, Straighten, Sweep, Standardize & Sustain) in daily activities.
Ability to innovate and to perform continuous improvement.
Having good communication and listening skills.
Be able to manage customer complaint and/or request as per required standard
Compassion
Helping customers or patients/coworkers even after working hours.
Be able to manage customer complaint and/or request as per required standard
Ability to be open, listen and respect different opinion.
Maintaining Confidentiality
Trust
Open to receive constructive feedback
Being reliable for task that being delegated
Total Score Core Competencies

C. TECHNICAL COMPETENCIES : 15%

RATING SCORE 3 - Meets Expectation
1 - Significantly Below Expectation 4 - Exceeds Expectation
2 - Below Expectation 5 - Significantly Exceeds Expectation
 TECHNICAL COMPETENCIES - Max 5

1. Kemampuan melakukan intubasi pasien dalam kondisi kegawatdaruratan

2. Kemampuan mengkomunikasikan keterampilan terapeutik dan komunikasi yang efektif dalam memberikan pelayanan
kepada pasien

3. Mampu memberikan terapi rutin sesuai program pengobatan dari DPJP

4. Get ACLS and ATLS Certification

5. Tidak melakukan kesalahan penulisan resep (Medication Error)

Total Score Technical Competencies

KPI Total Score (x 80%) 2.60 80%

Core Competencies Total Score (x 5%) 4.60 5%
Technical Competencies Total Score (x 15%) 4.60 15%
Final Rating
RATING
D : 0 - 2,5 C : 2,51 - 2,99 B : 3 - 3,49 A : 3,5 - 4,5 A+ : 4,51 - 5
SCALE

PERSONAL DEVELOPMENT PLAN

My Career Aspiration

What are your aspired target roles for the next 12 months? [e.g. Remain in
Current Role with same or expanded responsibilities, or other specific roles that What is your long term career aspiration e.g. 2 - 3 y
you believe you are now ready or almost ready]

menjadi dokter yang memiliki ilmu dan kompetensi yang mumpuni supaya
Melanjutkan sekolah
dapat menangani pasien dengan baik, menjadi TKHI

My Strengths
1. What skills, competencies and knowledge do I possess and can I leverage to achieve my career aspiration?

ACLS, ATLS, Hiperkes, Vaksinasi, resusitasi neonatus,

2. What types of activities do I usually receive positive feedback on from others? Please list examples to illustrate.

komunikasi yang baik dengan pasien dan kolega, multitasking, sabar/tidak mudah temperamen jika ada masalah di lapang
3. What do I want others to value about me the most?

kecepatan dan ketepatan dalam menangani pasien di IGD

My Potential Challenges
1. What skills, competencies and knowledge do I need to be successful in a job that I don’t have yet?
PALS (pediatric advanced life support), ponek
2. What skills, competencies and knowledge that I have for areas of improvement?

vaksinasi
3. What would really keep me from succeeding in my career?

kepercayaan diri dan kegigihan dalam mencapai impian

My Development Action Plan

Target Completion
Development Area Development Action Plan Objectives Date Success Measure

mengikuti seminar, workshop secara

meningkatkan emergency skill berkala 1 tahun

My Mobility Options

Year-end Review Comments

Appraiser

Employee
ENT PLAN
or)
30886

Mayapada Hospital Bogor

Medical Services

ng B

KPI Target

RESULT RATING TOTAL

1. 100%
2. 91 3 0.60
3. 50%

1. 17.45% 3 0.60
2. 0

98.82% 4 0.60

77.61 3 0.30

7 5 0.50
 XXXXX

0.0 0.00

XXXXX

XXXXX 0 0.00

Total Score KPI 2.60

is competency
competency
ent display this competency

WEIGHT RATING TOTAL

20% 5 1.00

nterest )

20% 4 0.80

20% 5 1.00
y activities.

ard
20% 4 0.80

ard

20% 5 1.00

e Competencies 100% 4.60

n
s Expectation
 WEIGHT RATING TOTAL

20% 3 0.60

erikan pelayanan 20% 5 1.00

20% 5 1.00

20% 5 1.00

20% 5 1.00

ical Competencies 100% 4.60

80% 2.08
5% 0.23
15% 0.69
Final Rating 3.00

A+ : 4,51 - 5 B

rm career aspiration e.g. 2 - 3 years? [List functions, roles, level, etc]

Melanjutkan sekolah spesialis/S2

tion?

o illustrate.

n jika ada masalah di lapangan, mampu bekerja sama dengan tim

Success Measure Completion Status

tersertifikasi
 PERFORMANCE DEVELOPMENT PLAN
(Individual Contributor)
Employee's Name Fadhil Wiryawan Employee ID

Title Dokter Umum Company/ Unit

Appraiser's Name dr. Ristanti Karina Department

Performance Review Period 2023 Performance Rating

A. KPI : 80%

RATING SCORE 3 - Meet KPI Target

1 - Far less than KPI Target 4 - Above KPI Target
2 - Less than KPI Target 5 - Outstanding Above KPI Target

KPI TARGET WEIGHT

1. Dokter Umum mengikuti Modul CME

2. Dokter Umum mencapai kompetensi minimal dari

Learning and Growth modul CME 20%

3. Dokter Umum ikut dalam Mockdrill pasien penyakit

menular

1. Konversi pasien IGD to IPD > 20%

Operasional IGD 20%

2. Pasien dari IGD dirujuk ke RS lain < 10%

Operasional IGD Assesmen Awal dilengkapi 1x24 jam 15%

Operasional IPD Pelaksanaan Whats Matters To You 10%

Operasional IPD Code Blue < 10 Pasien / Tahun 10%

 Patient Experience 1
(Based on Customer Experience)
Average of Customer Satisfaction Index (CSI)

3,90 – 4,00 : 5
3,40– 3,59 : 2 3,80 – 3,89 : 4
0 – 3,39 : 1 3,60 – 3,79 : 3
Patient Experience 12.5%
Patient Experience 2
(Based on Patient Journey)
% KPI achieved divided with number of KPI in each service function

90% - 100% : 5
60% - 69,9% : 2
80% - 89,9% : 4
0% - 59,9% : 1 70% - 79,9% : 3

% of Risk Indicators achieved divided by the number of indicators

under their responsibility
Quality and Risk Management 12.5%
95 % - 100 % : 5
70 % - 79,9 % : 2 90 % - 94,9 % : 4
0 - 69,9 % :1
80 % - 89,9 % : 3

100%
B. CORE COMPETENCIES : 5%
RATING SCORE 3 - Regularly display this competency
1 - Has never demonstrated this competency 4 - Always display this competency
2 - Has displayed this competency ocassionally 5 - Significantly consistent display this competency

CORE COMPETENCIES BEHAVIOR INDICATORS

Demonstrate to carry out work with impactful result

Committed to deliver Service Excellence to all of our customers
Commitment
Prioritizing tasks/ time in order to meet committed deadlines
Desire for Personal Learning & Self Development
Ability to take responsibility in accordance with ethics ( including conflict of interest )
Being honest and truthful including admitting mistakes
Integrity
Doing the Right thing even if it is unpopular or even if nobody is looking
Discipline in terms of being punctual when attending work and starting work.
Ability to carry out work in a systematic, complete, with on time result.
Ability to work as a team
Professionalism
Implementation of 5 S (Sort, Straighten, Sweep, Standardize & Sustain) in daily activities.
Ability to innovate and to perform continuous improvement.
Having good communication and listening skills.
Be able to manage customer complaint and/or request as per required standard
Compassion
Helping customers or patients/coworkers even after working hours.
Be able to manage customer complaint and/or request as per required standard
Ability to be open, listen and respect different opinion.
Maintaining Confidentiality
Trust
Open to receive constructive feedback
Being reliable for task that being delegated
Total Score Core Competencies

C. TECHNICAL COMPETENCIES : 15%

RATING SCORE 3 - Meets Expectation
1 - Significantly Below Expectation 4 - Exceeds Expectation
2 - Below Expectation 5 - Significantly Exceeds Expectation
 TECHNICAL COMPETENCIES - Max 5

1. Kemampuan melakukan intubasi pasien dalam kondisi kegawatdaruratan

2. Kemampuan mengkomunikasikan keterampilan terapeutik dan komunikasi yang efektif dalam memberikan pelayanan
kepada pasien

3. Mampu memberikan terapi rutin sesuai program pengobatan dari DPJP

4. Get ACLS and ATLS Certification

5. Tidak melakukan kesalahan penulisan resep (Medication Error)

Total Score Technical Competencies

KPI Total Score (x 80%) 2.25 80%

Core Competencies Total Score (x 5%) 3.00 5%
Technical Competencies Total Score (x 15%) 3.80 15%
Final Rating
RATING
D : 0 - 2,5 C : 2,51 - 2,99 B : 3 - 3,49 A : 3,5 - 4,5 A+ : 4,51 - 5
SCALE

PERSONAL DEVELOPMENT PLAN

My Career Aspiration

What are your aspired target roles for the next 12 months? [e.g. Remain in
Current Role with same or expanded responsibilities, or other specific roles that What is your long term career aspiration e.g. 2 - 3 y
you believe you are now ready or almost ready]

Bisa menangani semua kasus kegawat daruratan jadi spesialis ra

My Strengths
1. What skills, competencies and knowledge do I possess and can I leverage to achieve my career aspiration?

Radiologi,
2. What types of activities do I usually receive positive feedback on from others? Please list examples to illustrate.

Komunikasi
3. What do I want others to value about me the most?

Skill
My Potential Challenges
1. What skills, competencies and knowledge do I need to be successful in a job that I don’t have yet?
Radiologi,
2. What skills, competencies and knowledge that I have for areas of improvement?

ACLS, ATLS,EKG
3. What would really keep me from succeeding in my career?

cuek

My Development Action Plan

Target Completion
Development Area Development Action Plan Objectives Date Success Measure

Kegawatan, Radiologi Seminar 2025 PPDS

My Mobility Options

Year-end Review Comments

Appraiser

Employee
ENT PLAN
or)
31149

Mayapada Hospital Bogor

Medical Services

ng C

KPI Target

RESULT RATING TOTAL

XXXXX 3 0.60

XXXXX 3 0.60

XXXXX 3 0.45

XXXXX 3 0.30

XXXXX 3 0.30
 XXXXX

0.0 0.00

XXXXX

XXXXX 0 0.00

Total Score KPI 2.25

is competency
competency
ent display this competency

WEIGHT RATING TOTAL

20% 3 0.60

nterest )

20% 3 0.60

20% 3 0.60
y activities.

ard
20% 3 0.60

ard

20% 3 0.60

e Competencies 100% 3.00

n
s Expectation
 WEIGHT RATING TOTAL

20% 4 0.80

erikan pelayanan 20% 4 0.80

20% 3 0.60

20% 4 0.80

20% 4 0.80

ical Competencies 100% 3.80

80% 1.8
5% 0.15
15% 0.57
Final Rating 2.52

A+ : 4,51 - 5 C

rm career aspiration e.g. 2 - 3 years? [List functions, roles, level, etc]

jadi spesialis radiologi

tion?

o illustrate.
Success Measure Completion Status

PPDS on going
 PERFORMANCE DEVELOPMENT PLAN
(Individual Contributor)
Employee's Name XXXX Employee ID

Title Dokter Umum Company/ Unit

Appraiser's Name dr. Ristanti Karina Department

Performance Review Period 2023 Performance Rating

A. KPI : 80%

RATING SCORE 3 - Meet KPI Target

1 - Far less than KPI Target 4 - Above KPI Target
2 - Less than KPI Target 5 - Outstanding Above KPI Target

KPI TARGET WEIGHT

1. Dokter Umum mengikuti Modul CME

2. Dokter Umum mencapai kompetensi minimal dari

Learning and Growth modul CME 20%

3. Dokter Umum ikut dalam Mockdrill pasien penyakit

menular

1. Konversi pasien IGD to IPD > 20%

Operasional IGD 20%

2. Pasien dari IGD dirujuk ke RS lain < 10%

Operasional IGD Assesmen Awal dilengkapi 1x24 jam 15%

Operasional IPD Pelaksanaan Whats Matters To You 10%

Operasional IPD Code Blue < 10 Pasien / Tahun 10%

 Patient Experience 1
(Based on Customer Experience)
Average of Customer Satisfaction Index (CSI)

3,90 – 4,00 : 5
3,40– 3,59 : 2 3,80 – 3,89 : 4
0 – 3,39 : 1 3,60 – 3,79 : 3
Patient Experience 12.5%
Patient Experience 2
(Based on Patient Journey)
% KPI achieved divided with number of KPI in each service function

90% - 100% : 5
60% - 69,9% : 2
80% - 89,9% : 4
0% - 59,9% : 1 70% - 79,9% : 3

% of Risk Indicators achieved divided by the number of indicators

under their responsibility
Quality and Risk Management 12.5%
95 % - 100 % : 5
70 % - 79,9 % : 2 90 % - 94,9 % : 4
0 - 69,9 % :1
80 % - 89,9 % : 3

100%
B. CORE COMPETENCIES : 5%
RATING SCORE 3 - Regularly display this competency
1 - Has never demonstrated this competency 4 - Always display this competency
2 - Has displayed this competency ocassionally 5 - Significantly consistent display this competency

CORE COMPETENCIES BEHAVIOR INDICATORS

Demonstrate to carry out work with impactful result

Committed to deliver Service Excellence to all of our customers
Commitment
Prioritizing tasks/ time in order to meet committed deadlines
Desire for Personal Learning & Self Development
Ability to take responsibility in accordance with ethics ( including conflict of interest )
Being honest and truthful including admitting mistakes
Integrity
Doing the Right thing even if it is unpopular or even if nobody is looking
Discipline in terms of being punctual when attending work and starting work.
Ability to carry out work in a systematic, complete, with on time result.
Ability to work as a team
Professionalism
Implementation of 5 S (Sort, Straighten, Sweep, Standardize & Sustain) in daily activities.
Ability to innovate and to perform continuous improvement.
Having good communication and listening skills.
Be able to manage customer complaint and/or request as per required standard
Compassion
Helping customers or patients/coworkers even after working hours.
Be able to manage customer complaint and/or request as per required standard
Ability to be open, listen and respect different opinion.
Maintaining Confidentiality
Trust
Open to receive constructive feedback
Being reliable for task that being delegated
Total Score Core Competencies

C. TECHNICAL COMPETENCIES : 15%

RATING SCORE 3 - Meets Expectation
1 - Significantly Below Expectation 4 - Exceeds Expectation
2 - Below Expectation 5 - Significantly Exceeds Expectation
 TECHNICAL COMPETENCIES - Max 5

1. Kemampuan melakukan intubasi pasien dalam kondisi kegawatdaruratan

2. Kemampuan mengkomunikasikan keterampilan terapeutik dan komunikasi yang efektif dalam memberikan pelayanan
kepada pasien

3. Mampu memberikan terapi rutin sesuai program pengobatan dari DPJP

4. Get ACLS and ATLS Certification

5. Tidak melakukan kesalahan penulisan resep (Medication Error)

Total Score Technical Competencies

KPI Total Score (x 80%) 2.55 80%

Core Competencies Total Score (x 5%) 4.60 5%
Technical Competencies Total Score (x 15%) 4.00 15%
Final Rating
RATING
D : 0 - 2,5 C : 2,51 - 2,99 B : 3 - 3,49 A : 3,5 - 4,5 A+ : 4,51 - 5
SCALE

PERSONAL DEVELOPMENT PLAN

My Career Aspiration

What are your aspired target roles for the next 12 months? [e.g. Remain in
Current Role with same or expanded responsibilities, or other specific roles that What is your long term career aspiration e.g. 2 - 3 y
you believe you are now ready or almost ready]

mendaftar ppds residen

My Strengths
1. What skills, competencies and knowledge do I possess and can I leverage to achieve my career aspiration?

bekerja sesuai sop

2. What types of activities do I usually receive positive feedback on from others? Please list examples to illustrate.

komunikasi yang baik antar rekan dan pasien. kerja sampai diluar jam kerja
3. What do I want others to value about me the most?

kerja sama yang baik

My Potential Challenges
1. What skills, competencies and knowledge do I need to be successful in a job that I don’t have yet?

manajemen waktu, skill kegawatdaruratan

2. What skills, competencies and knowledge that I have for areas of improvement?

skill kegawatdaruratan
3. What would really keep me from succeeding in my career?

dapat diandalkan, bertanggung jawab

My Development Action Plan

Target Completion
Development Area Development Action Plan Objectives Date Success Measure

skill kegawatdaruratan, meningkatkan skill manajemen waktu

komunikasi efektif, manajemen dan komunikasi efektif, mengikuti skill kegawat darurat
waktu pelatihan, simposium, 2024 meningkat

My Mobility Options

Year-end Review Comments

Appraiser

Employee
ENT PLAN
or)
XXXX

Mayapada Hospital Bogor

Medical Services

ng C

KPI Target

RESULT RATING TOTAL

1. 100%, 2. 94%, 3. 75% 3 0.60

1. 17,45%, 2. 0% 2 0.40

98,82% 5 0.75

77,6% 3 0.30

100% 5 0.50
 XXXXX

0.0 0.00

XXXXX

XXXXX 0 0.00

Total Score KPI 2.55

is competency
competency
ent display this competency

WEIGHT RATING TOTAL

20% 5 1.00

nterest )

20% 5 1.00

20% 4 0.80
y activities.

ard
20% 4 0.80

ard

20% 5 1.00

e Competencies 100% 4.60

n
s Expectation
 WEIGHT RATING TOTAL

20% 2 0.40

erikan pelayanan 20% 4 0.80

20% 5 1.00

20% 5 1.00

20% 4 0.80

ical Competencies 100% 4.00

80% 2.04
5% 0.23
15% 0.60
Final Rating 2.87

A+ : 4,51 - 5 C

rm career aspiration e.g. 2 - 3 years? [List functions, roles, level, etc]

residen

tion?

o illustrate.
 Success Measure Completion Status

skill kegawat daruratan

meningkat on process
 PERFORMANCE DEVELOPMENT PLAN
(Individual Contributor)
Employee's Name Luthfi Suharyo Employee ID

Title Dokter Umum Company/ Unit

Appraiser's Name dr. Ristanti Karina Department

Performance Review Period 2023 Performance Rating

A. KPI : 80%

RATING SCORE 3 - Meet KPI Target

1 - Far less than KPI Target 4 - Above KPI Target
2 - Less than KPI Target 5 - Outstanding Above KPI Target

KPI TARGET WEIGHT

1. Dokter Umum mengikuti Modul CME

2. Dokter Umum mencapai kompetensi minimal dari

Learning and Growth modul CME 20%

3. Dokter Umum ikut dalam Mockdrill pasien penyakit

menular

1. Konversi pasien IGD to IPD > 20%

Operasional IGD 20%

2. Pasien dari IGD dirujuk ke RS lain < 10%

Operasional IGD Assesmen Awal dilengkapi 1x24 jam 15%

Operasional IPD Pelaksanaan Whats Matters To You 10%

Operasional IPD Code Blue < 10 Pasien / Tahun 10%

 Patient Experience 1
(Based on Customer Experience)
Average of Customer Satisfaction Index (CSI)

3,90 – 4,00 : 5
3,40– 3,59 : 2 3,80 – 3,89 : 4
0 – 3,39 : 1 3,60 – 3,79 : 3
Patient Experience 12.5%
Patient Experience 2
(Based on Patient Journey)
% KPI achieved divided with number of KPI in each service function

90% - 100% : 5
60% - 69,9% : 2
80% - 89,9% : 4
0% - 59,9% : 1 70% - 79,9% : 3

% of Risk Indicators achieved divided by the number of indicators

under their responsibility
Quality and Risk Management 12.5%
95 % - 100 % : 5
70 % - 79,9 % : 2 90 % - 94,9 % : 4
0 - 69,9 % :1
80 % - 89,9 % : 3

100%
B. CORE COMPETENCIES : 5%
RATING SCORE 3 - Regularly display this competency
1 - Has never demonstrated this competency 4 - Always display this competency
2 - Has displayed this competency ocassionally 5 - Significantly consistent display this competency

CORE COMPETENCIES BEHAVIOR INDICATORS

Demonstrate to carry out work with impactful result

Committed to deliver Service Excellence to all of our customers
Commitment
Prioritizing tasks/ time in order to meet committed deadlines
Desire for Personal Learning & Self Development
Ability to take responsibility in accordance with ethics ( including conflict of interest )
Being honest and truthful including admitting mistakes
Integrity
Doing the Right thing even if it is unpopular or even if nobody is looking
Discipline in terms of being punctual when attending work and starting work.
Ability to carry out work in a systematic, complete, with on time result.
Ability to work as a team
Professionalism
Implementation of 5 S (Sort, Straighten, Sweep, Standardize & Sustain) in daily activities.
Ability to innovate and to perform continuous improvement.
Having good communication and listening skills.
Be able to manage customer complaint and/or request as per required standard
Compassion
Helping customers or patients/coworkers even after working hours.
Be able to manage customer complaint and/or request as per required standard
Ability to be open, listen and respect different opinion.
Maintaining Confidentiality
Trust
Open to receive constructive feedback
Being reliable for task that being delegated
Total Score Core Competencies

C. TECHNICAL COMPETENCIES : 15%

RATING SCORE 3 - Meets Expectation
1 - Significantly Below Expectation 4 - Exceeds Expectation
2 - Below Expectation 5 - Significantly Exceeds Expectation
 TECHNICAL COMPETENCIES - Max 5

1. Kemampuan melakukan intubasi pasien dalam kondisi kegawatdaruratan

2. Kemampuan mengkomunikasikan keterampilan terapeutik dan komunikasi yang efektif dalam memberikan pelayanan
kepada pasien

3. Mampu memberikan terapi rutin sesuai program pengobatan dari DPJP

4. Get ACLS and ATLS Certification

5. Tidak melakukan kesalahan penulisan resep (Medication Error)

Total Score Technical Competencies

KPI Total Score (x 80%) 3.05 80%

Core Competencies Total Score (x 5%) 3.00 5%
Technical Competencies Total Score (x 15%) 3.80 15%
Final Rating
RATING
D : 0 - 2,5 C : 2,51 - 2,99 B : 3 - 3,49 A : 3,5 - 4,5 A+ : 4,51 - 5
SCALE

PERSONAL DEVELOPMENT PLAN

My Career Aspiration

What are your aspired target roles for the next 12 months? [e.g. Remain in
Current Role with same or expanded responsibilities, or other specific roles that What is your long term career aspiration e.g. 2 - 3 y
you believe you are now ready or almost ready]

My Strengths
1. What skills, competencies and knowledge do I possess and can I leverage to achieve my career aspiration?

Memiliki rasa untuk terus belajar dan kepedulian untuk menolong pasien
2. What types of activities do I usually receive positive feedback on from others? Please list examples to illustrate.

Komunikasi baik dan kerjasama

3. What do I want others to value about me the most?

Profesionalitas dalam bekerja

My Potential Challenges
1. What skills, competencies and knowledge do I need to be successful in a job that I don’t have yet?
Kurang percaya terhadap kemampuan sendiri
2. What skills, competencies and knowledge that I have for areas of improvement?

Lebih percaya diri dalam mengambil keputusan

3. What would really keep me from succeeding in my career?

Belajar lebih banyak lagi dan mengambil pelatihan

My Development Action Plan

Target Completion
Development Area Development Action Plan Objectives Date Success Measure

mengikuti pelatihan, simposium,

Meningkatkan skill dalam mengikuti program pendidikan dokter
kegawatdaruratan spesialis 1 tahun

My Mobility Options

Year-end Review Comments

Appraiser

Employee
ENT PLAN
or)
31171

Mayapada Hospital Bogor

Medical Services

ng B

KPI Target

RESULT RATING TOTAL

1. 100%
2. 91 5 1.00
3. 100%

1. 17,45% 2 0.40
2. 0%

1. 98.82% 5 0.75

1. 77.61% 4 0.40

1. 100% 5 0.50
 XXXXX

0.0 0.00

XXXXX

XXXXX 0 0.00

Total Score KPI 3.05

is competency
competency
ent display this competency

WEIGHT RATING TOTAL

20% 3 0.60

nterest )

20% 3 0.60

20% 3 0.60
y activities.

ard
20% 3 0.60

ard

20% 3 0.60

e Competencies 100% 3.00

n
s Expectation
 WEIGHT RATING TOTAL

20% 3 0.60

erikan pelayanan 20% 4 0.80

20% 4 0.80

20% 4 0.80

20% 4 0.80

ical Competencies 100% 3.80

80% 2.44
5% 0.15
15% 0.57
Final Rating 3.16

A+ : 4,51 - 5 B

rm career aspiration e.g. 2 - 3 years? [List functions, roles, level, etc]

tion?

o illustrate.
Success Measure Completion Status
 PERFORMANCE DEVELOPMENT PLAN
(Individual Contributor)
Employee's Name dr. Muhammad Aprianto Rama Employee ID

Title Dokter Umum Company/ Unit

Appraiser's Name dr. Ristanti Karina Department

Performance Review Period 2023 Performance Rating

A. KPI : 80%

RATING SCORE 3 - Meet KPI Target

1 - Far less than KPI Target 4 - Above KPI Target
2 - Less than KPI Target 5 - Outstanding Above KPI Target

KPI TARGET WEIGHT

1. Dokter Umum mengikuti Modul CME

2. Dokter Umum mencapai kompetensi minimal dari

Learning and Growth modul CME 20%

3. Dokter Umum ikut dalam Mockdrill pasien penyakit

menular

1. Konversi pasien IGD to IPD > 20%

Operasional IGD 20%

2. Pasien dari IGD dirujuk ke RS lain < 10%

Operasional IGD Assesmen Awal dilengkapi 1x24 jam 15%

Operasional IPD Pelaksanaan Whats Matters To You 10%

Operasional IPD Code Blue < 10 Pasien / Tahun 10%

 Patient Experience 1
(Based on Customer Experience)
Average of Customer Satisfaction Index (CSI)

3,90 – 4,00 : 5
3,40– 3,59 : 2 3,80 – 3,89 : 4
0 – 3,39 : 1 3,60 – 3,79 : 3
Patient Experience 12.5%
Patient Experience 2
(Based on Patient Journey)
% KPI achieved divided with number of KPI in each service function

90% - 100% : 5
60% - 69,9% : 2
80% - 89,9% : 4
0% - 59,9% : 1 70% - 79,9% : 3

% of Risk Indicators achieved divided by the number of indicators

under their responsibility
Quality and Risk Management 12.5%
95 % - 100 % : 5
70 % - 79,9 % : 2 90 % - 94,9 % : 4
0 - 69,9 % :1
80 % - 89,9 % : 3

100%
B. CORE COMPETENCIES : 5%
RATING SCORE 3 - Regularly display this competency
1 - Has never demonstrated this competency 4 - Always display this competency
2 - Has displayed this competency ocassionally 5 - Significantly consistent display this competency

CORE COMPETENCIES BEHAVIOR INDICATORS

Demonstrate to carry out work with impactful result

Committed to deliver Service Excellence to all of our customers
Commitment
Prioritizing tasks/ time in order to meet committed deadlines
Desire for Personal Learning & Self Development
Ability to take responsibility in accordance with ethics ( including conflict of interest )
Being honest and truthful including admitting mistakes
Integrity
Doing the Right thing even if it is unpopular or even if nobody is looking
Discipline in terms of being punctual when attending work and starting work.
Ability to carry out work in a systematic, complete, with on time result.
Ability to work as a team
Professionalism
Implementation of 5 S (Sort, Straighten, Sweep, Standardize & Sustain) in daily activities.
Ability to innovate and to perform continuous improvement.
Having good communication and listening skills.
Be able to manage customer complaint and/or request as per required standard
Compassion
Helping customers or patients/coworkers even after working hours.
Be able to manage customer complaint and/or request as per required standard
Ability to be open, listen and respect different opinion.
Maintaining Confidentiality
Trust
Open to receive constructive feedback
Being reliable for task that being delegated
Total Score Core Competencies

C. TECHNICAL COMPETENCIES : 15%

RATING SCORE 3 - Meets Expectation
1 - Significantly Below Expectation 4 - Exceeds Expectation
2 - Below Expectation 5 - Significantly Exceeds Expectation
 TECHNICAL COMPETENCIES - Max 5

1. Kemampuan melakukan intubasi pasien dalam kondisi kegawatdaruratan

2. Kemampuan mengkomunikasikan keterampilan terapeutik dan komunikasi yang efektif dalam memberikan pelayanan
kepada pasien

3. Mampu memberikan terapi rutin sesuai program pengobatan dari DPJP

4. Get ACLS and ATLS Certification

5. Tidak melakukan kesalahan penulisan resep (Medication Error)

Total Score Technical Competencies

KPI Total Score (x 80%) 2.15 80%

Core Competencies Total Score (x 5%) 4.00 5%
Technical Competencies Total Score (x 15%) 4.00 15%
Final Rating
RATING
D : 0 - 2,5 C : 2,51 - 2,99 B : 3 - 3,49 A : 3,5 - 4,5 A+ : 4,51 - 5
SCALE

PERSONAL DEVELOPMENT PLAN

My Career Aspiration

What are your aspired target roles for the next 12 months? [e.g. Remain in
Current Role with same or expanded responsibilities, or other specific roles that What is your long term career aspiration e.g. 2 - 3 y
you believe you are now ready or almost ready]

PPDS Kardio PPDS Kard

My Strengths
1. What skills, competencies and knowledge do I possess and can I leverage to achieve my career aspiration?

Skill dalam kegawatan jantung dan kardiologi klinis

2. What types of activities do I usually receive positive feedback on from others? Please list examples to illustrate.

Kondisi pasien kegawatan dan critical, terutama pasien penyakit kardiovaskular

3. What do I want others to value about me the most?

Skill yang baik,

My Potential Challenges
1. What skills, competencies and knowledge do I need to be successful in a job that I don’t have yet?
Penulisan karya ilmiah
2. What skills, competencies and knowledge that I have for areas of improvement?

Skill resusitasi dalam tim

3. What would really keep me from succeeding in my career?

Kurang disiplin

My Development Action Plan

Target Completion
Development Area Development Action Plan Objectives Date Success Measure

My Mobility Options

Year-end Review Comments

Appraiser

Employee
ENT PLAN
or)
30960

Mayapada Hospital Bogor

Medical Services

ng C

KPI Target

RESULT RATING TOTAL

Modul CME 100%, skor

84, partisipasi mockdrill 3 0.60
75% (izin tidak hadir saat
sedang ujian PPDS)

Konversi IGD to IPD

17.45%, rujuk ke RS lain 3 0.50
tercapai <10%

99% 3 0.45

77% 3 0.30

7 pasien/tahun 3 0.30
 XXXXX

0.0 0.00

XXXXX

XXXXX 0 0.00

Total Score KPI 2.15

is competency
competency
ent display this competency

WEIGHT RATING TOTAL

20% 4 0.80

nterest )

20% 4 0.80

20% 4 0.80
y activities.

ard
20% 4 0.80

ard

20% 4 0.80

e Competencies 100% 4.00

n
s Expectation
 WEIGHT RATING TOTAL

20% 4 0.80

erikan pelayanan 20% 4 0.80

20% 4 0.80

20% 4 0.80

20% 4 0.80

ical Competencies 100% 4.00

80% 1.72
5% 0.20
15% 0.60
Final Rating 2.52

A+ : 4,51 - 5 C

rm career aspiration e.g. 2 - 3 years? [List functions, roles, level, etc]

PPDS Kardio

tion?

o illustrate.
Success Measure Completion Status
 PERFORMANCE DEVELOPMENT PLAN
(Individual Contributor)
Employee's Name dr. Raesya Dwi Ananta Employee ID

Title Dokter Umum Company/ Unit

Appraiser's Name dr. Ristanti Karina Department

Performance Review Period 2023 Performance Rating

A. KPI : 80%

RATING SCORE 3 - Meet KPI Target

1 - Far less than KPI Target 4 - Above KPI Target
2 - Less than KPI Target 5 - Outstanding Above KPI Target

KPI TARGET WEIGHT

1. Dokter Umum mengikuti Modul CME

2. Dokter Umum mencapai kompetensi minimal dari

Learning and Growth modul CME 20%

3. Dokter Umum ikut dalam Mockdrill pasien penyakit

menular

1. Konversi pasien IGD to IPD > 20%

Operasional IGD 20%

2. Pasien dari IGD dirujuk ke RS lain < 10%

Operasional IGD Assesmen Awal dilengkapi 1x24 jam 15%

Operasional IPD Pelaksanaan Whats Matters To You 10%

Operasional IPD Code Blue < 10 Pasien / Tahun 10%

 Patient Experience 1
(Based on Customer Experience)
Average of Customer Satisfaction Index (CSI)

3,90 – 4,00 : 5
3,40– 3,59 : 2 3,80 – 3,89 : 4
0 – 3,39 : 1 3,60 – 3,79 : 3
Patient Experience 12.5%
Patient Experience 2
(Based on Patient Journey)
% KPI achieved divided with number of KPI in each service function

90% - 100% : 5
60% - 69,9% : 2
80% - 89,9% : 4
0% - 59,9% : 1 70% - 79,9% : 3

% of Risk Indicators achieved divided by the number of indicators

under their responsibility
Quality and Risk Management 12.5%
95 % - 100 % : 5
70 % - 79,9 % : 2 90 % - 94,9 % : 4
0 - 69,9 % :1
80 % - 89,9 % : 3

100%
B. CORE COMPETENCIES : 5%
RATING SCORE 3 - Regularly display this competency
1 - Has never demonstrated this competency 4 - Always display this competency
2 - Has displayed this competency ocassionally 5 - Significantly consistent display this competency

CORE COMPETENCIES BEHAVIOR INDICATORS

Demonstrate to carry out work with impactful result

Committed to deliver Service Excellence to all of our customers
Commitment
Prioritizing tasks/ time in order to meet committed deadlines
Desire for Personal Learning & Self Development
Ability to take responsibility in accordance with ethics ( including conflict of interest )
Being honest and truthful including admitting mistakes
Integrity
Doing the Right thing even if it is unpopular or even if nobody is looking
Discipline in terms of being punctual when attending work and starting work.
Ability to carry out work in a systematic, complete, with on time result.
Ability to work as a team
Professionalism
Implementation of 5 S (Sort, Straighten, Sweep, Standardize & Sustain) in daily activities.
Ability to innovate and to perform continuous improvement.
Having good communication and listening skills.
Be able to manage customer complaint and/or request as per required standard
Compassion
Helping customers or patients/coworkers even after working hours.
Be able to manage customer complaint and/or request as per required standard
Ability to be open, listen and respect different opinion.
Maintaining Confidentiality
Trust
Open to receive constructive feedback
Being reliable for task that being delegated
Total Score Core Competencies

C. TECHNICAL COMPETENCIES : 15%

RATING SCORE 3 - Meets Expectation
1 - Significantly Below Expectation 4 - Exceeds Expectation
2 - Below Expectation 5 - Significantly Exceeds Expectation
 TECHNICAL COMPETENCIES - Max 5

1. Kemampuan melakukan intubasi pasien dalam kondisi kegawatdaruratan

2. Kemampuan mengkomunikasikan keterampilan terapeutik dan komunikasi yang efektif dalam memberikan pelayanan
kepada pasien

3. Mampu memberikan terapi rutin sesuai program pengobatan dari DPJP

4. Get ACLS and ATLS Certification

5. Tidak melakukan kesalahan penulisan resep (Medication Error)

Total Score Technical Competencies

KPI Total Score (x 80%) 3.48 80%

Core Competencies Total Score (x 5%) 3.40 5%
Technical Competencies Total Score (x 15%) 3.00 15%
Final Rating
RATING
D : 0 - 2,5 C : 2,51 - 2,99 B : 3 - 3,49 A : 3,5 - 4,5 A+ : 4,51 - 5
SCALE

PERSONAL DEVELOPMENT PLAN

My Career Aspiration

What are your aspired target roles for the next 12 months? [e.g. Remain in
Current Role with same or expanded responsibilities, or other specific roles that What is your long term career aspiration e.g. 2 - 3 y
you believe you are now ready or almost ready]

Mengembangkan kemampuan klinis dibidang kedokteran dengan selalu

mengupdate ilmu salah satunya dengan cara mengikuti sertifikasi, training,
melanjutkan PPDS prodi Ilm
maupun pertemuan medis yang bertujuan untuk agar mampu menangani
pasien dengan baik dan komprehensif

My Strengths
1. What skills, competencies and knowledge do I possess and can I leverage to achieve my career aspiration?

memiliki kemampuan berkomunikasi yang baik, baik kepada pasien dan civitas dilingkungan kerja serta bersungguh-sungg
2. What types of activities do I usually receive positive feedback on from others? Please list examples to illustrate.

Dapat diandalkan dan memiliki relasi yang baik dengan rekan kerja
3. What do I want others to value about me the most?

Profesionalitas dalam bekerja

My Potential Challenges
1. What skills, competencies and knowledge do I need to be successful in a job that I don’t have yet?
kemampuan dalam membagi waktu dalam bekerja
2. What skills, competencies and knowledge that I have for areas of improvement?

time management
3. What would really keep me from succeeding in my career?

meningkatkan kompetensi medis, menjalani komunikasi efektif, dapat beradaptasi dengan baik, dan kemauan untuk terus

My Development Action Plan

Target Completion
Development Area Development Action Plan Objectives Date Success Measure

lebih tepat, akurat, dan

meningkatkan kompetensi medis EBM dalam menanga
terutama dibidang mengikuti kegiatan pelatihan, mendiagnosa, dan men
kegawatdaruratan workshop, maupun seminar medis 1 tahun pasien

My Mobility Options

Year-end Review Comments

Appraiser

Employee
ENT PLAN
or)
31174

Mayapada Hospital Bogor

Medical Services

ng B

KPI Target

RESULT RATING TOTAL

XXXXX 4 0.80

XXXXX 2 0.40

XXXXX 3 0.45

XXXXX 3 0.30

XXXXX 4 0.40
 XXXXX

4.0 0.50

XXXXX

XXXXX 5 0.63

Total Score KPI 3.48

is competency
competency
ent display this competency

WEIGHT RATING TOTAL

20% 3 0.60

nterest )

20% 3 0.60

20% 3 0.60
y activities.

ard
20% 4 0.80

ard

20% 4 0.80

e Competencies 100% 3.40

n
s Expectation
 WEIGHT RATING TOTAL

20% 3 0.60

erikan pelayanan 20% 3 0.60

20% 3 0.60

20% 3 0.60

20% 3 0.60

ical Competencies 100% 3.00

80% 2.78
5% 0.17
15% 0.45
Final Rating 3.40

A+ : 4,51 - 5 B

rm career aspiration e.g. 2 - 3 years? [List functions, roles, level, etc]

melanjutkan PPDS prodi Ilmu Penyakit Dalam

tion?

erja serta bersungguh-sungguh dalam bekerja.

o illustrate.
k, dan kemauan untuk terus belajar

Success Measure Completion Status

lebih tepat, akurat, dan sesuai

EBM dalam menangani,
mendiagnosa, dan menterapi
pasien tersertivikasi
 PERFORMANCE DEVELOPMENT PLAN
(Individual Contributor)
Employee's Name XXXX Employee ID

Title Dokter Umum Company/ Unit

Appraiser's Name dr. Ristanti Karina Department

Performance Review Period 2023 Performance Rating

A. KPI : 80%

RATING SCORE 3 - Meet KPI Target

1 - Far less than KPI Target 4 - Above KPI Target
2 - Less than KPI Target 5 - Outstanding Above KPI Target

KPI TARGET WEIGHT

1. Dokter Umum mengikuti Modul CME

2. Dokter Umum mencapai kompetensi minimal dari

Learning and Growth modul CME 20%

3. Dokter Umum ikut dalam Mockdrill pasien penyakit

menular

1. Konversi pasien IGD to IPD > 20%

Operasional IGD 20%

2. Pasien dari IGD dirujuk ke RS lain < 10%

Operasional IGD Assesmen Awal dilengkapi 1x24 jam 15%

Operasional IPD Pelaksanaan Whats Matters To You 10%

Operasional IPD Code Blue < 10 Pasien / Tahun 10%

 Patient Experience 1
(Based on Customer Experience)
Average of Customer Satisfaction Index (CSI)

3,90 – 4,00 : 5
3,40– 3,59 : 2 3,80 – 3,89 : 4
0 – 3,39 : 1 3,60 – 3,79 : 3
Patient Experience 12.5%
Patient Experience 2
(Based on Patient Journey)
% KPI achieved divided with number of KPI in each service function

90% - 100% : 5
60% - 69,9% : 2
80% - 89,9% : 4
0% - 59,9% : 1 70% - 79,9% : 3

% of Risk Indicators achieved divided by the number of indicators

under their responsibility
Quality and Risk Management 12.5%
95 % - 100 % : 5
70 % - 79,9 % : 2 90 % - 94,9 % : 4
0 - 69,9 % :1
80 % - 89,9 % : 3

100%
B. CORE COMPETENCIES : 5%
RATING SCORE 3 - Regularly display this competency
1 - Has never demonstrated this competency 4 - Always display this competency
2 - Has displayed this competency ocassionally 5 - Significantly consistent display this competency

CORE COMPETENCIES BEHAVIOR INDICATORS

Demonstrate to carry out work with impactful result

Committed to deliver Service Excellence to all of our customers
Commitment
Prioritizing tasks/ time in order to meet committed deadlines
Desire for Personal Learning & Self Development
Ability to take responsibility in accordance with ethics ( including conflict of interest )
Being honest and truthful including admitting mistakes
Integrity
Doing the Right thing even if it is unpopular or even if nobody is looking
Discipline in terms of being punctual when attending work and starting work.
Ability to carry out work in a systematic, complete, with on time result.
Ability to work as a team
Professionalism
Implementation of 5 S (Sort, Straighten, Sweep, Standardize & Sustain) in daily activities.
Ability to innovate and to perform continuous improvement.
Having good communication and listening skills.
Be able to manage customer complaint and/or request as per required standard
Compassion
Helping customers or patients/coworkers even after working hours.
Be able to manage customer complaint and/or request as per required standard
Ability to be open, listen and respect different opinion.
Maintaining Confidentiality
Trust
Open to receive constructive feedback
Being reliable for task that being delegated
Total Score Core Competencies

C. TECHNICAL COMPETENCIES : 15%

RATING SCORE 3 - Meets Expectation
1 - Significantly Below Expectation 4 - Exceeds Expectation
2 - Below Expectation 5 - Significantly Exceeds Expectation
 TECHNICAL COMPETENCIES - Max 5

1. Kemampuan melakukan intubasi pasien dalam kondisi kegawatdaruratan

2. Kemampuan mengkomunikasikan keterampilan terapeutik dan komunikasi yang efektif dalam memberikan pelayanan
kepada pasien

3. Mampu memberikan terapi rutin sesuai program pengobatan dari DPJP

4. Get ACLS and ATLS Certification

5. Tidak melakukan kesalahan penulisan resep (Medication Error)

Total Score Technical Competencies

KPI Total Score (x 80%) 0.00 80%

Core Competencies Total Score (x 5%) 0.00 5%
Technical Competencies Total Score (x 15%) 0.00 15%
Final Rating
RATING
D : 0 - 2,5 C : 2,51 - 2,99 B : 3 - 3,49 A : 3,5 - 4,5 A+ : 4,51 - 5
SCALE

PERSONAL DEVELOPMENT PLAN

My Career Aspiration

What are your aspired target roles for the next 12 months? [e.g. Remain in
Current Role with same or expanded responsibilities, or other specific roles that What is your long term career aspiration e.g. 2 - 3 y
you believe you are now ready or almost ready]

My Strengths
1. What skills, competencies and knowledge do I possess and can I leverage to achieve my career aspiration?

2. What types of activities do I usually receive positive feedback on from others? Please list examples to illustrate.

3. What do I want others to value about me the most?

My Potential Challenges
1. What skills, competencies and knowledge do I need to be successful in a job that I don’t have yet?
2. What skills, competencies and knowledge that I have for areas of improvement?

3. What would really keep me from succeeding in my career?

My Development Action Plan

Target Completion
Development Area Development Action Plan Objectives Date Success Measure

My Mobility Options

Year-end Review Comments

Appraiser

Employee
ENT PLAN
or)
XXXX

Mayapada Hospital Bogor

Medical Services

ng D

KPI Target

RESULT RATING TOTAL

XXXXX 0 0.00

XXXXX 0 0.00

XXXXX 0 0.00

XXXXX 0 0.00

XXXXX 0 0.00
 XXXXX

0.0 0.00

XXXXX

XXXXX 0 0.00

Total Score KPI 0.00

is competency
competency
ent display this competency

WEIGHT RATING TOTAL

20% 0 0.00

nterest )

20% 0 0.00

20% 0 0.00
y activities.

ard
20% 0 0.00

ard

20% 0 0.00

e Competencies 100% 0.00

n
s Expectation
 WEIGHT RATING TOTAL

20% 0 0.00

erikan pelayanan 20% 0 0.00

20% 0 0.00

20% 0 0.00

20% 0 0.00

ical Competencies 100% 0.00

80% 0
5% 0.00
15% 0.00
Final Rating 0.00

A+ : 4,51 - 5 D

rm career aspiration e.g. 2 - 3 years? [List functions, roles, level, etc]

tion?

o illustrate.
Success Measure Completion Status
 PERFORMANCE DEVELOPMENT PLAN
(Individual Contributor)
Employee's Name XXXX Employee ID

Title Dokter Umum Company/ Unit

Appraiser's Name dr. Ristanti Karina Department

Performance Review Period 2023 Performance Rating

A. KPI : 80%

RATING SCORE 3 - Meet KPI Target

1 - Far less than KPI Target 4 - Above KPI Target
2 - Less than KPI Target 5 - Outstanding Above KPI Target

KPI TARGET WEIGHT

1. Dokter Umum mengikuti Modul CME

2. Dokter Umum mencapai kompetensi minimal dari

Learning and Growth modul CME 20%

3. Dokter Umum ikut dalam Mockdrill pasien penyakit

menular

1. Konversi pasien IGD to IPD > 20%

Operasional IGD 20%

2. Pasien dari IGD dirujuk ke RS lain < 10%

Operasional IGD Assesmen Awal dilengkapi 1x24 jam 15%

Operasional IPD Pelaksanaan Whats Matters To You 10%

Operasional IPD Code Blue < 10 Pasien / Tahun 10%

 Patient Experience 1
(Based on Customer Experience)
Average of Customer Satisfaction Index (CSI)

3,90 – 4,00 : 5
3,40– 3,59 : 2 3,80 – 3,89 : 4
0 – 3,39 : 1 3,60 – 3,79 : 3
Patient Experience 12.5%
Patient Experience 2
(Based on Patient Journey)
% KPI achieved divided with number of KPI in each service function

90% - 100% : 5
60% - 69,9% : 2
80% - 89,9% : 4
0% - 59,9% : 1 70% - 79,9% : 3

% of Risk Indicators achieved divided by the number of indicators

under their responsibility
Quality and Risk Management 12.5%
95 % - 100 % : 5
70 % - 79,9 % : 2 90 % - 94,9 % : 4
0 - 69,9 % :1
80 % - 89,9 % : 3

100%
B. CORE COMPETENCIES : 5%
RATING SCORE 3 - Regularly display this competency
1 - Has never demonstrated this competency 4 - Always display this competency
2 - Has displayed this competency ocassionally 5 - Significantly consistent display this competency

CORE COMPETENCIES BEHAVIOR INDICATORS

Demonstrate to carry out work with impactful result

Committed to deliver Service Excellence to all of our customers
Commitment
Prioritizing tasks/ time in order to meet committed deadlines
Desire for Personal Learning & Self Development
Ability to take responsibility in accordance with ethics ( including conflict of interest )
Being honest and truthful including admitting mistakes
Integrity
Doing the Right thing even if it is unpopular or even if nobody is looking
Discipline in terms of being punctual when attending work and starting work.
Ability to carry out work in a systematic, complete, with on time result.
Ability to work as a team
Professionalism
Implementation of 5 S (Sort, Straighten, Sweep, Standardize & Sustain) in daily activities.
Ability to innovate and to perform continuous improvement.
Having good communication and listening skills.
Be able to manage customer complaint and/or request as per required standard
Compassion
Helping customers or patients/coworkers even after working hours.
Be able to manage customer complaint and/or request as per required standard
Ability to be open, listen and respect different opinion.
Maintaining Confidentiality
Trust
Open to receive constructive feedback
Being reliable for task that being delegated
Total Score Core Competencies

C. TECHNICAL COMPETENCIES : 15%

RATING SCORE 3 - Meets Expectation
1 - Significantly Below Expectation 4 - Exceeds Expectation
2 - Below Expectation 5 - Significantly Exceeds Expectation
 TECHNICAL COMPETENCIES - Max 5

1. Kemampuan melakukan intubasi pasien dalam kondisi kegawatdaruratan

2. Kemampuan mengkomunikasikan keterampilan terapeutik dan komunikasi yang efektif dalam memberikan pelayanan
kepada pasien

3. Mampu memberikan terapi rutin sesuai program pengobatan dari DPJP

4. Get ACLS and ATLS Certification

5. Tidak melakukan kesalahan penulisan resep (Medication Error)

Total Score Technical Competencies

KPI Total Score (x 80%) 3.25 80%

Core Competencies Total Score (x 5%) 4.00 5%
Technical Competencies Total Score (x 15%) 4.00 15%
Final Rating
RATING
D : 0 - 2,5 C : 2,51 - 2,99 B : 3 - 3,49 A : 3,5 - 4,5 A+ : 4,51 - 5
SCALE

PERSONAL DEVELOPMENT PLAN

My Career Aspiration

What are your aspired target roles for the next 12 months? [e.g. Remain in
Current Role with same or expanded responsibilities, or other specific roles that What is your long term career aspiration e.g. 2 - 3 y
you believe you are now ready or almost ready]

Meningkatkan skill dan mengupdate ilmu dan potensi sehingga dapat Memiliki dan menambah skill yang dimiliki, m
memberikan pelayanan lebih baik lagi spesialis

My Strengths
1. What skills, competencies and knowledge do I possess and can I leverage to achieve my career aspiration?

Komunikasi, rasa empati dan simpati yang baik

2. What types of activities do I usually receive positive feedback on from others? Please list examples to illustrate.

Selalu bekerja maksimal dan sepenuh hati

3. What do I want others to value about me the most?

Pekerjaan, profesionalitas
My Potential Challenges
1. What skills, competencies and knowledge do I need to be successful in a job that I don’t have yet?
Kurang percaya diri dengan skill yang dimiliki
2. What skills, competencies and knowledge that I have for areas of improvement?

Lebih percaya diri dalam mengambil tindakan

3. What would really keep me from succeeding in my career?

Belajar lebnih banyak, mengasah skill sehingga lebih percaya diri

My Development Action Plan

Target Completion
Development Area Development Action Plan Objectives Date Success Measure

Lebih percaya diri dal

Emergency Skill Mengikutin pelatihan dan workshop Sep-24 menangani kegawatdaru

My Mobility Options

Year-end Review Comments

Appraiser

Employee
ENT PLAN
or)
XXXX

Mayapada Hospital Bogor

Medical Services

ng B

KPI Target

RESULT RATING TOTAL

XXXXX 5 1.00

XXXXX 3 0.60

XXXXX 5 0.75

XXXXX 4 0.40

XXXXX 5 0.50
 XXXXX

0.0 0.00

XXXXX

XXXXX 0 0.00

Total Score KPI 3.25

is competency
competency
ent display this competency

WEIGHT RATING TOTAL

20% 5 1.00

nterest )

20% 4 0.80

20% 4 0.80
y activities.

ard
20% 3 0.60

ard

20% 4 0.80

e Competencies 100% 4.00

n
s Expectation
 WEIGHT RATING TOTAL

20% 3 0.60

erikan pelayanan 20% 4 0.80

20% 4 0.80

20% 5 1.00

20% 4 0.80

ical Competencies 100% 4.00

80% 2.6
5% 0.20
15% 0.60
Final Rating 3.40

A+ : 4,51 - 5 B

rm career aspiration e.g. 2 - 3 years? [List functions, roles, level, etc]

nambah skill yang dimiliki, menjalani program pendidikan dokter

spesialis

tion?

o illustrate.
 Success Measure Completion Status

Lebih percaya diri dalam

menangani kegawatdaruratan
 PERFORMANCE DEVELOPMENT PLAN
(Individual Contributor)
Employee's Name dr. Solehudin Widya Putra Employee ID

Title Dokter Umum Company/ Unit

Appraiser's Name dr. Ristanti Karina Department

Performance Review Period 2023 Performance Rating

A. KPI : 80%

RATING SCORE 3 - Meet KPI Target

1 - Far less than KPI Target 4 - Above KPI Target
2 - Less than KPI Target 5 - Outstanding Above KPI Target

KPI TARGET WEIGHT

1. Dokter Umum mengikuti Modul CME

2. Dokter Umum mencapai kompetensi minimal dari

Learning and Growth modul CME 20%

3. Dokter Umum ikut dalam Mockdrill pasien penyakit

menular

1. Konversi pasien IGD to IPD > 20%

Operasional IGD 20%

2. Pasien dari IGD dirujuk ke RS lain < 10%

Operasional IGD Assesmen Awal dilengkapi 1x24 jam 15%

Operasional IPD Pelaksanaan Whats Matters To You 10%

Operasional IPD Code Blue < 10 Pasien / Tahun 10%

 Patient Experience 1
(Based on Customer Experience)
Average of Customer Satisfaction Index (CSI)

3,90 – 4,00 : 5
3,40– 3,59 : 2 3,80 – 3,89 : 4
0 – 3,39 : 1 3,60 – 3,79 : 3
Patient Experience 12.5%
Patient Experience 2
(Based on Patient Journey)
% KPI achieved divided with number of KPI in each service function

90% - 100% : 5
60% - 69,9% : 2
80% - 89,9% : 4
0% - 59,9% : 1 70% - 79,9% : 3

% of Risk Indicators achieved divided by the number of indicators

under their responsibility
Quality and Risk Management 12.5%
95 % - 100 % : 5
70 % - 79,9 % : 2 90 % - 94,9 % : 4
0 - 69,9 % :1
80 % - 89,9 % : 3

100%
B. CORE COMPETENCIES : 5%
RATING SCORE 3 - Regularly display this competency
1 - Has never demonstrated this competency 4 - Always display this competency
2 - Has displayed this competency ocassionally 5 - Significantly consistent display this competency

CORE COMPETENCIES BEHAVIOR INDICATORS

Demonstrate to carry out work with impactful result

Committed to deliver Service Excellence to all of our customers
Commitment
Prioritizing tasks/ time in order to meet committed deadlines
Desire for Personal Learning & Self Development
Ability to take responsibility in accordance with ethics ( including conflict of interest )
Being honest and truthful including admitting mistakes
Integrity
Doing the Right thing even if it is unpopular or even if nobody is looking
Discipline in terms of being punctual when attending work and starting work.
Ability to carry out work in a systematic, complete, with on time result.
Ability to work as a team
Professionalism
Implementation of 5 S (Sort, Straighten, Sweep, Standardize & Sustain) in daily activities.
Ability to innovate and to perform continuous improvement.
Having good communication and listening skills.
Be able to manage customer complaint and/or request as per required standard
Compassion
Helping customers or patients/coworkers even after working hours.
Be able to manage customer complaint and/or request as per required standard
Ability to be open, listen and respect different opinion.
Maintaining Confidentiality
Trust
Open to receive constructive feedback
Being reliable for task that being delegated
Total Score Core Competencies

C. TECHNICAL COMPETENCIES : 15%

RATING SCORE 3 - Meets Expectation
1 - Significantly Below Expectation 4 - Exceeds Expectation
2 - Below Expectation 5 - Significantly Exceeds Expectation
 TECHNICAL COMPETENCIES - Max 5

1. Kemampuan melakukan intubasi pasien dalam kondisi kegawatdaruratan

2. Kemampuan mengkomunikasikan keterampilan terapeutik dan komunikasi yang efektif dalam memberikan pelayanan
kepada pasien

3. Mampu memberikan terapi rutin sesuai program pengobatan dari DPJP

4. Get ACLS and ATLS Certification

5. Tidak melakukan kesalahan penulisan resep (Medication Error)

Total Score Technical Competencies

KPI Total Score (x 80%) 2.35 80%

Core Competencies Total Score (x 5%) 3.60 5%
Technical Competencies Total Score (x 15%) 3.80 15%
Final Rating
RATING
D : 0 - 2,5 C : 2,51 - 2,99 B : 3 - 3,49 A : 3,5 - 4,5 A+ : 4,51 - 5
SCALE

PERSONAL DEVELOPMENT PLAN

My Career Aspiration

What are your aspired target roles for the next 12 months? [e.g. Remain in
Current Role with same or expanded responsibilities, or other specific roles that What is your long term career aspiration e.g. 2 - 3 y
you believe you are now ready or almost ready]

Bekerja degan baik, upgrade skill dalam penanganan kegawat daruratan.

PPDS Ophthalm
Mengikuti ujian calon PPDS

My Strengths
1. What skills, competencies and knowledge do I possess and can I leverage to achieve my career aspiration?

ACLS, ATLS, Hiperkes, Vaksinasi

2. What types of activities do I usually receive positive feedback on from others? Please list examples to illustrate.

Komunikasi yang baik dan saling menghormati

3. What do I want others to value about me the most?

Komunikasi yang baik dan tanggung jawab

My Potential Challenges
1. What skills, competencies and knowledge do I need to be successful in a job that I don’t have yet?
Management waktu
2. What skills, competencies and knowledge that I have for areas of improvement?

Management waktu yang baik dengan memilah mana yang sangat penting, penting dan tidak penting
3. What would really keep me from succeeding in my career?

Kesunggguhan, disiplin dan Kepercayaan diri

My Development Action Plan

Target Completion
Development Area Development Action Plan Objectives Date Success Measure

Mengikuti Sminar online / offline ,

workshop, mengasah skill anamnesis
Ilmu Penyakit Mata dan pemeriksaan fisik 2024 PPDS Opthalmolog

My Mobility Options

Year-end Review Comments

Appraiser

Employee
ENT PLAN
or)
31151

Mayapada Hospital Bogor

Medical Services

ng C

KPI Target

RESULT RATING TOTAL

XXXXX 4 0.80

XXXXX 2 0.40

XXXXX 3 0.45

XXXXX 3 0.30

XXXXX 4 0.40
 XXXXX

0.0 0.00

XXXXX

XXXXX 0 0.00

Total Score KPI 2.35

is competency
competency
ent display this competency

WEIGHT RATING TOTAL

20% 4 0.80

nterest )

20% 3 0.60

20% 3 0.60
y activities.

ard
20% 4 0.80

ard

20% 4 0.80

e Competencies 100% 3.60

n
s Expectation
 WEIGHT RATING TOTAL

20% 4 0.80

erikan pelayanan 20% 4 0.80

20% 3 0.60

20% 4 0.80

20% 4 0.80

ical Competencies 100% 3.80

80% 1.88
5% 0.18
15% 0.57
Final Rating 2.63

A+ : 4,51 - 5 C

rm career aspiration e.g. 2 - 3 years? [List functions, roles, level, etc]

PPDS Ophthalmology

tion?

o illustrate.
penting

Success Measure Completion Status

PPDS Opthalmology On going

 PERFORMANCE DEVELOPMENT PLAN
(Individual Contributor)
Employee's Name XXXX Employee ID

Title Dokter Umum Company/ Unit

Appraiser's Name dr. Ristanti Karina Department

Performance Review Period 2023 Performance Rating

A. KPI : 80%

RATING SCORE 3 - Meet KPI Target

1 - Far less than KPI Target 4 - Above KPI Target
2 - Less than KPI Target 5 - Outstanding Above KPI Target

KPI TARGET WEIGHT

1. Dokter Umum mengikuti Modul CME

2. Dokter Umum mencapai kompetensi minimal dari

Learning and Growth modul CME 20%

3. Dokter Umum ikut dalam Mockdrill pasien penyakit

menular

1. Konversi pasien IGD to IPD > 20%

Operasional IGD 20%

2. Pasien dari IGD dirujuk ke RS lain < 10%

Operasional IGD Assesmen Awal dilengkapi 1x24 jam 15%

Operasional IPD Pelaksanaan Whats Matters To You 10%

Operasional IPD Code Blue < 10 Pasien / Tahun 10%

 Patient Experience 1
(Based on Customer Experience)
Average of Customer Satisfaction Index (CSI)

3,90 – 4,00 : 5
3,40– 3,59 : 2 3,80 – 3,89 : 4
0 – 3,39 : 1 3,60 – 3,79 : 3
Patient Experience 12.5%
Patient Experience 2
(Based on Patient Journey)
% KPI achieved divided with number of KPI in each service function

90% - 100% : 5
60% - 69,9% : 2
80% - 89,9% : 4
0% - 59,9% : 1 70% - 79,9% : 3

% of Risk Indicators achieved divided by the number of indicators

under their responsibility
Quality and Risk Management 12.5%
95 % - 100 % : 5
70 % - 79,9 % : 2 90 % - 94,9 % : 4
0 - 69,9 % :1
80 % - 89,9 % : 3

100%
B. CORE COMPETENCIES : 5%
RATING SCORE 3 - Regularly display this competency
1 - Has never demonstrated this competency 4 - Always display this competency
2 - Has displayed this competency ocassionally 5 - Significantly consistent display this competency

CORE COMPETENCIES BEHAVIOR INDICATORS

Demonstrate to carry out work with impactful result

Committed to deliver Service Excellence to all of our customers
Commitment
Prioritizing tasks/ time in order to meet committed deadlines
Desire for Personal Learning & Self Development
Ability to take responsibility in accordance with ethics ( including conflict of interest )
Being honest and truthful including admitting mistakes
Integrity
Doing the Right thing even if it is unpopular or even if nobody is looking
Discipline in terms of being punctual when attending work and starting work.
Ability to carry out work in a systematic, complete, with on time result.
Ability to work as a team
Professionalism
Implementation of 5 S (Sort, Straighten, Sweep, Standardize & Sustain) in daily activities.
Ability to innovate and to perform continuous improvement.
Having good communication and listening skills.
Be able to manage customer complaint and/or request as per required standard
Compassion
Helping customers or patients/coworkers even after working hours.
Be able to manage customer complaint and/or request as per required standard
Ability to be open, listen and respect different opinion.
Maintaining Confidentiality
Trust
Open to receive constructive feedback
Being reliable for task that being delegated
Total Score Core Competencies

C. TECHNICAL COMPETENCIES : 15%

RATING SCORE 3 - Meets Expectation
1 - Significantly Below Expectation 4 - Exceeds Expectation
2 - Below Expectation 5 - Significantly Exceeds Expectation
 TECHNICAL COMPETENCIES - Max 5

1. Kemampuan melakukan intubasi pasien dalam kondisi kegawatdaruratan

2. Kemampuan mengkomunikasikan keterampilan terapeutik dan komunikasi yang efektif dalam memberikan pelayanan
kepada pasien

3. Mampu memberikan terapi rutin sesuai program pengobatan dari DPJP

4. Get ACLS and ATLS Certification

5. Tidak melakukan kesalahan penulisan resep (Medication Error)

Total Score Technical Competencies

KPI Total Score (x 80%) 0.00 80%

Core Competencies Total Score (x 5%) 0.00 5%
Technical Competencies Total Score (x 15%) 0.00 15%
Final Rating
RATING
D : 0 - 2,5 C : 2,51 - 2,99 B : 3 - 3,49 A : 3,5 - 4,5 A+ : 4,51 - 5
SCALE

PERSONAL DEVELOPMENT PLAN

My Career Aspiration

What are your aspired target roles for the next 12 months? [e.g. Remain in
Current Role with same or expanded responsibilities, or other specific roles that What is your long term career aspiration e.g. 2 - 3 y
you believe you are now ready or almost ready]

My Strengths
1. What skills, competencies and knowledge do I possess and can I leverage to achieve my career aspiration?

2. What types of activities do I usually receive positive feedback on from others? Please list examples to illustrate.

3. What do I want others to value about me the most?

My Potential Challenges
1. What skills, competencies and knowledge do I need to be successful in a job that I don’t have yet?
2. What skills, competencies and knowledge that I have for areas of improvement?

3. What would really keep me from succeeding in my career?

My Development Action Plan

Target Completion
Development Area Development Action Plan Objectives Date Success Measure

My Mobility Options

Year-end Review Comments

Appraiser

Employee
ENT PLAN
or)
XXXX

Mayapada Hospital Bogor

Medical Services

ng D

KPI Target

RESULT RATING TOTAL

XXXXX 0 0.00

XXXXX 0 0.00

XXXXX 0 0.00

XXXXX 0 0.00

XXXXX 0 0.00
 XXXXX

0.0 0.00

XXXXX

XXXXX 0 0.00

Total Score KPI 0.00

is competency
competency
ent display this competency

WEIGHT RATING TOTAL

20% 0 0.00

nterest )

20% 0 0.00

20% 0 0.00
y activities.

ard
20% 0 0.00

ard

20% 0 0.00

e Competencies 100% 0.00

n
s Expectation
 WEIGHT RATING TOTAL

20% 0 0.00

erikan pelayanan 20% 0 0.00

20% 0 0.00

20% 0 0.00

20% 0 0.00

ical Competencies 100% 0.00

80% 0
5% 0.00
15% 0.00
Final Rating 0.00

A+ : 4,51 - 5 D

rm career aspiration e.g. 2 - 3 years? [List functions, roles, level, etc]

tion?

o illustrate.
Success Measure Completion Status