Efficiency and overly high expectations hurt residents and therapists
As in any area of work where you are taking care of people, burnout can exist both physically and emotionally. As employers in the healthcare field, we have to think proactively to try to provide the best working environment we can. We need good systems to allow staff to get work done and thrive in an atmosphere of reasonable expectations.
As dollars get tighter and tighter in our field, however, we see less attention paid to important factors that lead to staff satisfaction. In my opinion, lack of concentration on these areas leads to an organization's demise because without our staff, we are nothing.
Specifically, some companies in the therapy field, especially in long-term care, do not provide good working conditions, good systems and most importantly, reasonable expectations for staff. These companies demand such high efficiency levels, they do not allow time for adequate documentation, let alone the time needed to talk with the interdisciplinary team. This can result not only in burnout; it also increases the chance of missing key information — and, more detrimentally, potential faults when caring for individuals. If any member of the interdisciplinary team is not in constant communication with the team, care will most likely not be as successful as it should be.
When therapists get out of school, we find that no matter where we work, we get to help people. Yet, we also have to realize we work within a business. We need to make sure the company where we work asks for appropriate actions. When billing efficiency expectations are too high and seem difficult to reach, it puts therapists in compromising situations that may result in poor choices.
The higher expectations are for billing efficiency, the greater the chance will be for inappropriate ethical and moral decision making. If a therapist is required to achieve a certain level of efficiency in billing—and knows that if this doesn't happen, he or she will be reprimanded by a supervisor—a wrong decision can easily be made. More specifically, therapists may feel pushed to make poor choices and allow billing to occur when care hasn't happened.
Medicare wants to see distinctive, individualized care delivered to all patients. Every single evaluation and treatment should be specific for each individual. Again, if therapists work for a company with high efficiency expectations, the ability to individualize and differentially diagnose and treat could diminish significantly.
We hire therapists for their clinical knowledge and ability to apply it. Companies are doing a huge disservice to therapists by asking them to meet overly high expectations. Doing so leads to huge frustration for therapists by not giving them time to dedicate to each patient and promoting burnout by asking them to perform at an overly high level.
When my company took over the contract at a skilled nursing facility that was previously using a large therapy company as a provider, I was startled by responses we received from therapists about our expectations. When I said my expectations were at 80% for efficiency, they started talking among themselves and I asked what their concerns were. One therapist replied, “We don't know what we are going to do with all our extra time.”
After further discussion, I learned their former employer had set the expectation at 94%. What this meant was that only thirty minutes of their eight-hour day was allowed for any down time. That means they had no time to update physicians, no time to finish documentation and no time to talk with the staff/family member who cares for a patient. This demand on therapists is not right from so many angles—and may even touch on legal rights in some states, where therapists are entitled to take 15-minute breaks in the morning and afternoon.
Therapists need to stand up to organizations that demand so much they diminish the quality of care that is being delivered to the patients who are entitled to it. Just as we were taught in school how to be advocates for patients, we also need to be advocates for ourselves and our licenses/certifications—and stand up for what is appropriate and what is not appropriate. In my opinion, that's the best way to ensure the highest quality care for those we serve.
Centrex Rehab CEO and President Kristy Brown is a speech language pathologist, and previously was the executive director of therapy services at Augustana Therapy Services from 1999-2012.