Medical Speech Pathology

Curiosity, Dialogue, and Knowledge

Productivity Problems


A collage of words about healthcare and productivity

Image by Yann Ropars

There are at least two sides to every argument.  This holds true with the issue of productivity in the medical field.  I’ve recently been reading a running thread from the special interest group on dysphagia that speaks out against companies that require 80%, 90%, or even 95% productivity from their therapy staff.  The term productivity here, to be clear, refers to billable hours (1:1 time spent with the patient or the family member/caregiver).

Yesterday when I worked for 150 minutes, only 13 minutes were spent typing my notes into the computer, and all the rest was patient time.  That made me roughly 91% productive with my time.  Without boiling my notes down to a two sentence, slapdash, cut-and-paste note, I couldn’t have shaved any more time off my schedule.  I’ve seen these type of notes, and I know why clinicians write them, but they help so very little in understanding the patient and what to do with the patient in therapy that they are nearly worthless.  I may have even written a few…

Yesterday was a good day for productivity.  There are worse days.  A couple of weekends ago, I did an evaluation of a new patient, whose information I’ll blur a bit here.  The patient was in their early 80’s, had a recent neck injury that resulted in surgery for fixation, and presented with quite a bit of confusion, lethargy, and a chronic cough with nearly all trials of food or liquid. I worked for close to 150 minutes that day, roughly 30 minutes were spent writing the report and 20 minutes were spent conferring with the patient’s nurse, and filling out all the paperwork needed to make sure the patient had a safer diet.  That made me roughly 67% productive.  I wouldn’t change anything about the way I provided care for this patient.

To be fair, the company that I do part-time work for hasn’t bugged me about productivity as of yet.  I was told in the interview that they expect roughly 85% productivity.

Another article I read the other day tackles this from an M.D. student’s perspective.  To see the post in full, by Abraham Nunes, click here.  I’ll do my best to summarize his sentiments in a few lines:  just because we are doing medical work doesn’t mean that we are entitled to spend our time on anything patient related and call it meaningful, and we are obliged to be productive because we should respect the amount of tax payer dollars that are funding our work.  The best quote from his piece in my opinion is this,

Why the hell wouldn’t we want our physicians to be more productive? EVERYONE needs to be more productive. Doctors are no more entitled than garbage collectors in this respect. If garbage collectors don’t collect more garbage for fewer resources, we are either wasting too much money or possessing an excess of garbage water (like when we read nonsensical arguments).

His point about being productive edges us closer to the business argument.  You start a business and expect to make profit based on the services you provide whether those services are baking cookies or providing medicine.  It’s reasonable for a business to want to make profit.  It’s capitalism.  In a competitive market delivering services at a profit is not just a desirable outcome; without it your business will wither and die.  Obviously if your business goes under, then you don’t provide services to anyone.  Patient’s aren’t served well this way either.  The hard truth here is that poor business decisions can be harmful for patients because there is only so much in the way of resources to go around.  A business that thrives provides charitable outreach to the community in ways that a starving business does not and can not provide.

The general fear of the average worker, myself included, is that the businesses are squeezing more productivity out of us only for the betterment of a select few at the top of the financial food chain.  We fear that despite lip service that touts patient first priorities, the true and driving force behind all of it is money.  There is also a healthy fear that a toxic workplace atmosphere will develop that so cherishes the bottom line that patient care will become secondary to the primary goal of the business:  money.

Productivity conversations with your employer should look at what is being required, and what exceptions to those requirements should be made.  You never should have to sacrifice reasonable patient care or safety to be more productive.  At the same time, you can not unreasonably demand more time to do things when you are not being a wise steward of the time and money you already have been given.  Collaborate with your boss to work at your efficiency.  If it’s still totally unreasonable, then take a walk.  Capitalism provides many competitors in the healthcare marketplace.  I’m sure you’ll find one that balances the books and patient care at the same time.

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8 comments on “Productivity Problems

  1. abrahamjnunes
    May 28, 2012

    That last paragraph is beautifully written. Especially the quote: “look at what is being required, and what exceptions to those requirements should be made. You never should have to sacrifice reasonable patient care or safety to be more productive.”

    Critical to understand is that productivity is not solely defined as time per patient, or patient per unit time. Why cant productivity be defined as some sort of patient benefit per visit? Indeed, productivity could be defined as complication rate per admission, patient-rated quality of life per physician encounter, and so on. The possibilities for definition are endless, so long as they are in line with the goals of the organization.

    What we as healthcare workers need to do is make the sufficient amount of noise required to define these metrics in terms of patient benefit. As administrators, we will need to add elements of practice sustainability to those metrics.

    Great post! Thanks!

    Retweeted.

    AJN

  2. Michael Hoeft
    May 31, 2012

    Medical professionals and therapists alike must get the conversation shifted to terms of profitability and NOT productivity. Profitability is what ultimately drives the healthcare business so that we can afford to provide excellent care to patients. One can be a 100% “productive” working one hour a day and billing for one hour. But doing so will fail both the therapist as well as the business since such “productivity” will fail to cover the “sunk” costs of providing those 60 minutes — salary, wages, benefits, overhead etc… Such efficiency may make the manager feel like their containing cost….and they are…but at the sacrifice of making money. Whether its 80, 90, or 85% “productive”, such arbitrary benchmarks are pulled from someone’s arse and have little to no bearing on whether the company, the hospital, or the organization will make money on our services. Some of the more savvy CFO’s I’ve worked with through the years know this. The focus should be on growing referrals via providing outstanding therapy services…which retains talented therapists…which reduces recruitment costs and lost capacity opportunities due to staff shortages (typical of organizations hell bent on productivity). I currently lead a large team of PT, OT’s, and SLP’s who have NO productivity standards put upon them other than to do great work. It is MY job…and our healthcare organization’s responsibility to do what we can to get them lots of patients to fill their days. It’s their job to do great, outstanding therapy that will invariably produce more referrals…more volume…which is where “profit” awaits.

    • Lisa Marie
      October 3, 2014

      I don’t suppose you have any openings? Glad to know such work places even exist.

  3. Heather Garrabrant
    May 31, 2012

    I don’t think anyone is arguing for inefficiency in the workplace, or not being good stewards of medicare and tax dollars. What this medical student you quote will likely learn as he begins to practice, is that serving the healthcare needs of individual human beings, with their individual medical histories, comorbidities, educational, social, and occupational backgrounds, individual goals, caregiver
    support and courses of illness, is quite different than servicing inanimate objects of standard issue with standard equipment like garbage collection. The point that we all need to try to be as efficient as possible because we must for sustainability is appreciated. However, it is short sited to compare healthcare ‘productivity’ to that of making widgets or garbage collection, due to the complexities that human lives bring to the equation. You make a good point for therapists to work with their managers to try to increase efficiency. At my workplace recently we advocated for more laptops and desktop computers because therapists experience downtime just waiting for a computer to be available for documentation. The key to this issue is finding the balance between efficiency and ‘billable hours’ within the scope of providing the best professional services possible within the parameters of our ethical standards.

    • Sandy Hirsch
      May 31, 2012

      Thank you, Heather. I would respond at length, but you have said it all perfectly. We should all be as productive as possible with the view to the best patient care possible. Being required to see patients for a certain number of minutes to meet productivity standards does not meet the criterion of best practices The requirements usually do not match what our clinical expertise and opinion would tell us to do. The dialogue needs to continue.

  4. Admin
    May 31, 2012

    I want to say thanks to everyone that has commented so far. My aim with this piece was not to close the book on discussion, but to further it by including multiple perspectives on this issue. My own experience strongly shapes my own view, which is probably somewhere in the middle. I hope that was conveyed well enough with the original piece.

    A healthy working environment that has good leadership will never sacrifice patient care for random productivity numbers set myopically low to squeeze out more short term profit. As Michael Hoeft pointed out, quality trumps the treadmill approach to care which pushes people through with little regard to individual differences. The Mayo clinic comes to mind as an exemplar of quality. People seek them out. Their business model is structured around quality and excellence in patient care, and it works. Even still, I believe they have to be mindful of how they spend their time and resources or they won’t stay solvent as a business. In my opinion, as healthcare workers we need to make sure we raise red flags when unreasonable expectations are set for us, but we must also resist the urge to make unreasonable demands.

    I hope everyone that has taken the time to read and comment on this article, thanks again by the way, will also find some other interesting tid-bits on the site. If anyone has something they would like to contribute (e.g.- educational articles, opinion articles, multi-media of any sort that fits under the umbrella of medical speech pathology) I am welcoming submissions for consideration. Send submissions to medicalspeechpathology@gmail.com if you are so inclined.

    Also, please check out the interviews from leading researchers section. I’ve gotten replies from some very interesting folks and more will be posted whenever the final answers to the interview questions come in.

    Thanks,

    Walt Greenslade, CCC-SLP

  5. Leslie Kessler
    April 24, 2017

    I would appreciate some information about productivity requirements for speech Pathologists in an out patient setting. I am simply taking a survey of productivity in the out patient setting for my own knowledge. SO please respond

    • Admin
      April 24, 2017

      I’m not currently doing OP, and haven’t for quite some time. But I’m curious to hear what others report.

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