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:
the state or quality of producing something, especially crops.“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”
ECOLOGYthe 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”
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.
Many SLPs are reporting productivity expectations of 90% or higher.
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.
Why is productivity difficult to achieve?
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!
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.
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.
Why do we need time for consultation with other disciplines?
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.
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.
By having time for consultation, we can provide the patient with the best care possible.
How do we fix this productivity issue?
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.
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.
What is your take on productivity? What is your productivity expectation?