Productivity and the SLP

One of the top concerns of Speech Language Pathologists in the healthcare world is the topic of productivity.

A Google search of the word productivity:

  1. the state or quality of producing something, especially crops.
  2. “the long-term productivity of land”
    • the effectiveness of productive effort, especially in industry, as measured in terms of the rate of output per unit of input.
    • “workers have boosted productivity by 30 percent”
    • the rate of production of new biomass by an individual, population, or community; the fertility or capacity of a given habitat or area.
    • “nutrient-rich waters with high productivity”
  3. Productivity in a facility such as a hospital or Skilled Nursing Facility (SNF) is measured by the amount of time spent working directly (or billed) for patients divided by total time in the facility.

  4. Many SLPs are reporting productivity expectations of 90% or higher.  

  5. A productivity of 90% would be 432 minutes of your work day spent in therapy with patients out of your 480 minute (8 hour) work day.  This leaves 48 minutes of your work day for paperwork, conferences, meetings, bathroom breaks, consultation with other disciplines, etc.

  6. Why is productivity difficult to achieve?

  7. The person you are looking for is never where you go to find them.  There are times that you may have to search the entire facility.  There are at least 270 places to hide and to search to find the last person you need to see on your list.  The person that has to be seen on THAT day and for xxx number of minutes.  You may spend 20 minutes of your day just finding someone who knows where the person for whom you are looking is hiding!

  8. Documentation

  9. Point of care documentation (documenting as you are treating) is a great idea, but sometimes it is very difficult to actually complete.  You may have every intention of giving your patient/client some work to complete as you document but in our field, that can be difficult.  We may be working on cognition where the person requires your undivided attention to complete anything.  You may be working on swallowing and need to cue your patient through every therapeutic trial or swallow.

  10. Documentation is so important as it is a written account of your session.  This is not only what gets your facility reimbursed by insurance, but it also highlights outcomes and progress and is your protection should you ever have to defend your therapy in court.  Documentation is also where another SLP can determine what you have been doing so that they can step in and take over should you go on vacation or get sick.

  11. Why do we need time for consultation with other disciplines?

  12. Outcome based therapy is a direction in which our field has been moving for years.  Our reimbursement is becoming bundled and will very much depend on the effectiveness of our treatments and a decrease in the rate of re-hospitalization.  When we are talking about patients with swallowing difficulties, being able to consult with others that help to care for the patient is crucial.  The SLP needs to be able to talk to nursing and let them know the patient needs to have nectar thick liquids and use a chin tuck with their pills crushed and given in applesauce.  The nurse may not see a note if you leave it.  The Physical Therapist may get the patient, not realize they are on thickened liquids and give the person water during their therapy.

  13. Consultation between facility SLPs is equally as important.  We all know that documentation from the Modified Barium Swallow (MBSS) does not necessarily make it from the acute care hospital to the Skilled Nursing Facility.  What if the SNF SLP then makes incorrect recommendations.

  14. By having time for consultation, we can provide the patient with the best care possible.

  15. How do we fix this productivity issue?

  16. First, I would like to recognize that this is not an issue for every SLP or every facility.  I have been fortunate to have jobs with very reasonable productivity expectations.  I am currently expected to have 27 visit points for home health, which has been more than obtainable on a regular, full week.

  17. This topic is a hot one on Facebook.  How do we fix this problem?  As long as there are people “achieving” this productivity standard, it won’t change.  SLPs are often faced with clocking out for documentation, consultation or even bathroom breaks.  Showing the ones that expect such a high level of productivity that it can be achieved, will never make this issue go away.

  18. What is your take on productivity?  What is your productivity expectation?


14 thoughts on “Productivity and the SLP

  1. Excellent blog, Tiffani. As you mentioned, Productivity is increasingly defined as “Billable Time.” I have experienced 90% to 100% productivity expectations and find anything above 75% to be inhumane to downright torturous. This may work well in an industrial setting, but SNFs, hospitals, and other healthcare facilities are not factories. Clinicians are not machines. Patients are not widgets.

    1. I agree! I have found 80-85% manageable in small buildings, but on some days 80% can’t even be met due reasons mentioned in the blog. When I interview for positions that mention 90% or higher, I know to walk away. I’m not a machine.

  2. Thanks for this thoughtful post. I agree that the responsibility to reject unreasonable productivity standards and not compromise regardless of compensation. It is also paramount to report billable and non billable times accurately. When no one accepts the job the requirements will have to change.

  3. Expecting the clinicians to clock out to document is unfair, and probably unethical if we want to open up that can of worms. This is the main reason I don’t care for working in a SNF. It is important to manage your time, and yes documenting while treating is ideal, but when do we really ever have an ideal day? I feel fortunate that I am in an outpatient setting, and that my clients are there waiting for me, and I don’t have to search them down all over the hospital. There are times I cannot document while treating, but I do have some time each day when I can document (while on the clock). I think it is important for SLPs to consider their time as valuable, and quit selling themselves short. Paperwork is required, so time to complete it needs to be paid time. My thoughts.

    1. I agree. I think we get so many new clinicians or CFs that are told to document off the clock and just don’t know or are afraid to stand up for themselves! I’m also fortunate that there is no expectation or even a thought that I’ll document off the clock because that is just not happening.

    2. For the reasons you’ve mentioned, I’ve strongly considered leaving SNF. It’s unfortunate because I absolutely love what I do in rehab/SNF.

  4. Interesting post! It is true that we are in part responsible for the standard in place. Unfortunately, for-profit companies want the most labor while paying the least amount. As speech pathologists, we went into the profession because we had an innate desire to do good and help. Sadly, we often have to do good and maintain our integrity at the expense of our own time in order to meet high standards. If there therapists as a whole refused to meet the standard, the companies would be less inclined to demand it. Some therapists; however, meet this standard which enables these companies to continue to require the impossible.

  5. My first job had unrealistic productivity standards. Many therapist were coming in off the clock to finish paperwork. I refused. Id rather be penalized by my employer for being late on paperwork then spend my personal time doing work. I also believe that by working off the clock we do nothing to improve the situation and empoyers needs to see that its not just one person struggling but five and maybe they will change their standard. We often perpetuate the problem by letting our employers get away with increasing productivity and encouraging employees to work off the clock (which is illegal if you are hourly, which I was). I tell all my students to not accept a job that has a productivity rate higher than 80%. Needless to say I finally quite and NEVER looked back and now have a job that I love rather than dread.

  6. One comment I am not hearing is what I consider a huge problem with productivity requirements… Getting sent home when we can’t meet productivity! Getting hired for a “full time” job and then being told that you have to leave early with no pay or take PTO time and risk loosing your healthy insurance is what forces do many to “meet” those productivity demands in “creative” ways! It’s easy to say “just quit”, but when you are the sole provider of your family for income and health insurance it’s not that easy to actually do… No matter how dedicated you are to the profession:( These companies cannot provide theses services without us… Why can’t we just be hired to provide our services and all that incompases those services (evaluation, treatment, education, etc)???

    1. I feel that productivity has hurt our profession as a whole. Demands of productivity make it difficult to complete continuing education, especially live courses and we don’t have the time to do what we need to do. At some point, we do have to stand up for our profession. We can’t just quit our job. As much as I would love to some days, I can’t quit either!

      1. Have you guys/gals ever thought about unionizing? I know SLP’s are supposedly highly paid, but when you really think about the extra time you put in to meet these unrealistically high “productivity” requirements (such malarkey), you actually make much less per hour. These extremely poorly defined only to cater to the organizations’ greed, and need to be fought.

        A fellow SLP

      2. I don’t know that unionizing is the answer. I would love to say I’m high paid! Haha! By the time we pay ASHA dues, CEUs and state license……union dues would further decrease our pay.

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