Evaluating employee performance, particularly documenting changes based on those evaluations, has always been a challenge. The emphasis on evidence-based practice has focused clinicians providing treatment to achieve outcomes based on clinical research. An outcome-based performance evaluation focuses supervisors on evaluating performance by providing employees with measurable goals that are tied to compensation.

The Board of Directors of The Treatment and Learning Centers (TLC), a private nonprofit agency, directed the management team to develop a merit pay system for all employees. This initiative came from board members in the for-profit business sector whose business practices included accountability in measurable terms. This was a challenge for the entire agency, given the diversity of programs, including outpatient services, school programs, child care program, and administrative support staff. This was a unique problem for clinical positions, including audiology and speech-language pathology, since the nature of the therapeutic process included many variables the clinicians felt were beyond their control. The performance system was established in 1998 and has evolved over time. It continues to be the method for employee compensation and yearly raises.