mandatory. Although there are many possible uses of perfnrm:mce evaluation, the most pron1inent are termination of 0000-performing assets", promotion of competent employees and giving of rewards (scholarships or salary increases). The performance appraisal of PHNs should focus on their duties and responsibilities (including additiona l assignments given to them). The rating given to them should be based on the extent to which they meet performance stanchu-ds. It is the responsibility of nurse n1anagers to define the standards of performa nce for the different nursing personnel. This sbou Jd be done in consultation,vith those cont:erned. In RHUs, PHNs evaluate the perforn1ance of midwives. Guide in conducting pe,:formance evaluation 1. Performance appraisal should be done jointly by the supervisor/rater and su pervisee/ ratee. 2. The. appraisal interview should be conducted in non-threa tening Wa)' at the office of the supervisor. The supervisor should ensure the confidentiality of what transpired during the interview. 3. The supervisor should use available records and reports to support bis/ her rating of the supervisee. 4. The result of the evaluation should be thoroughly discussed and the goals for the next evaluation period should be identified. 5. Both the rater and the ratee should sign the accomplished evaluation form.. 6. Ratees who do not agree ·with their supervisor's final rating should be informed of their right to appeal to a grievance committee within the LGU. Quality assurance Quality assurance ( QA) is animportantmanagement activity to honor the health facility's commitment to provide quality care to its clients. It is defined as a process that aims to guarantee quality or a level of excellence in client. care by comparing what is actually delivered to established standards. These standards are established by professional organizations, regulatory agencies (such as the DOH), accreditation bodies, and health organizatio ns (such as the WHO). Quality is present if clients receive care/service that is consistent,'lfith generally recognized contemporary standards. A standard is the desired level of performance against which actual practice is compared. It is "what should be" in terms of structure, process and outcome. Structure stando:,-ds define the rules under which service must be delivered. These cover the hea Jth care facility, human resources, equipment, supplies and manuals of policies. For example, RA 108:. 1 provides that a municipality with a population of 20,000-50,0 00, should have two PHNs while o·ne with a popufation greater than 50,000 should have four PHNs. The different public health programs have structure standards that a. i:-e critical to their success. For example, cold chain in EPI. essential drugs in MCH program and microscopes in the TB Control Program. 111e Standards of Public Health Nursing (NLPGN) define the qualifications of public health nurses. Process standards on the other hand, define bow nursing care is provided, ho,v services are to be carried out, and how programs are to be managed. Nursing standards are defined by the PNA and the NLPGN while the health program standards are contained in the DOH program manuals. 427 