meaningful rehabilitation productivity: metrics and practices october 9,2014 presented by: marc...

Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014

Presented By:Marc Womeldorf, FACHE, MBA/HA, MS-PT, Cert. MDT

Director, Rehabilitation Services, University of Maryland, Baltimore Washington Medical Center

At the:

Rehabilitation Community Providers Association ConferenceSeven Lakes Mountain Resort

Thursday October 9, 2014


Acknowledgement In 1992, at the NCPTA Spring Conference, I attended a productivity seminar. The presenter, Peter Kovacek, used a simple format – Two slide projectors. On one screen, he posted slides under the heading “Productivity as a Weapon”, and on the other “Productivity as a Tool.” Peter’s course provided me with a foundation for which I will be forever grateful. Twenty two years later, The University of Maryland Rehabilitation Network (UMRN) engaged Mr. Kovacek to help us to develop a common language & understanding around productivity. Mr. Kovacek’ s teachings are throughout this presentation. He offers them free of charge at;• http://www.ptmanager.com/• http://www.ptmanager.com/downloads/:


Objectives • Provide an understanding of the issues involved in managing,

measuring and improving productivity in Rehabilitation.

• Review UM-BWMC & UMRN experiences and lessons learned and how they may apply to your settings & goals.

• Through audience participation, gain additional insight & ideas on the above topics.


Agenda• Typical challenges of productivity management.

– Discussion.• Respectfully managing staff through productivity enhancement.

– Techniques.• Challenges of productivity measurement.

– Experiences.• Productivity metrics.

– Examples.• Metrics and change management.

– Realistic expectations based upon our experience.


Concepts

• Acknowledging the challenges.

• Modeling values.

• Introducing techniques.

• Acknowledging individualism.

• How adults learn.

• Leadership style & management role.


Acknowledging challenges.• Staff goals may be different than organization goals.

• Patient goals may be different than therapist goals.

How does the leader, manager or staff member know how she/he is meeting his/her personal or stakeholder(s) goals?


Acknowledging challenges.

How does the leader, manager or staff member know how she/he is meeting his/her personal or stakeholder(s) goals?

• Listen.

• Using stakeholder input, align their goals to organizational values.

• Collaborate and agree upon key metrics to measure progress & to provide feedback.


Modeling values.

What role does each of the following groups play in defining & modeling values?

• Administrative support staff.

• Supervisor?

• Manager?

• Director?

• Senior manager?

How can each of these groups work together to model values in a way that also improves productivity?


Modeling values.

How can each of these groups work together to model values in a way that also improves productivity?

• Collaborate around values.

• Measure the processes that allow for and the outcomes that define success.

• Link productivity measurements to valued outcomes.

– Potentially avoidable utilization.

– Potentially avoidable complications.


Introducing Techniques.

• What does it take for an individual or group to be successful?– Know what to accomplish.

– Know how to accomplish it.

– Have access to the tools to accomplish it.

– Be motivated to succeed.

– Take responsibility for their own success.

– Recognize when it occurs.

How can each of the aforementioned groups help the other to be successful?




• Everyone can trace their roles to organizational values & strategies.

– Know what to accomplish.

• Standardized processes that add value to the patient experience.

– Know how to accomplish it.

• Productivity training, process descriptions, & collaborative improvement efforts.

– Have access to the tools to accomplish it.




• Employees that fit team values.

– Be motivated to succeed.

• Productivity, process & outcome metrics.

– Take responsibility for their own success.

– Recognize when it occurs.


Acknowledging Individualism.

• Standardization is vital to productivity. So is creative prioritization & problem-solving.

• Is individualism at odds with standardization in the following?

– Operational processes.

– Clinical protocols.

– Communication scripting.

When can individualism enhance standardization?


Acknowledging Individualism.

When can individualism enhance standardization?

• Applying standard processes to meet the unique set of patient goals.

• Performing “disciplined experiments” to improve;

– Staff utilization (productivity),

– Communication, protocols & processes to enhance the patient experience (value & “values” based productivity)


How adults learn.

• They need a “safe” place to;

– Play.

– Experiment.

– Practice.

What are the critical elements that create a “safe” work environment for innovation?


How adults learn.

What are the critical elements that create a “safe” work environment for innovation?

• Transparency & security to result in staff feelings of accomplishment & accountability.

• Structures for consistent results.

• Leaders who expose barriers and work to eliminate them.


Leadership competencies & management roles.

What leadership competencies promote employee accountability?• Ability to clearly communicate;

– A vision.

– Values.

– Priorities.

• Transparency.• Security.• Structure.



With respect to productivity, what are the primary roles of the manager?

• To clarify the personal role of the employee

• To reduce the variability of the many small trade-off decisions that the staff member must make every day.

How does the manager help the staff member with prioritizing trade-offs?



How does the manager help the staff member with prioritizing trade-offs?

• Communicate the following priorities of each staff member – Their individual;– Objectives,

– Quality & productivity outcomes (And why they are NOT mutually exclusive).

– Why these outcomes are important.

– How to accomplish them.

– When a certain outcome is a priority.

– Who is critical accomplishing the outcome.


Break


Productivity Tools & Metrics UM-BWMC.

• Encounter Form – The Foundation– IP & OP– Evaluations– Encounters– Contact Units– Carved Out Units– Documentation Units– Worked Hours



• Daily Schedule & Encounter Form Workbook – The 1st Point of Data Entry– Separate spreadsheet for each discipline.– Encounter Form & Schedule completion data for each clinician.– Performs important percentage and ratio calculations.– Daily averages and totals column.



• Pay Period Ending Worksheet – Aggregates daily totals by pay period.– Populated from Daily Schedule & Encounter Form Workbook.– Totals & averages of key data elements.– Scheduled vs. seen percentages & analysis.– Performs important percentage and ratio calculations.



• Monthly Data Worksheet – Aggregates daily totals by month.– Populated from Pay Period Ending Worksheet.– Same totals and averages as PPE Worksheet.– With the addition of Monthly, M-F & Weekend comparisons.



• Monthly Graphs– Current & Previous Fiscal Year comparison.– All totals, averages & ratios.



• Individual Therapist Productivity Data & Results– All totals, averages & ratios.– Harvested from clinician’s results in Daily Schedule & Encounter

Form Worksheet.– Pasted to monthly spreadsheets under individual clinician’s tab.– Aggregated by month.– Graphed by month and FY.



• Individual Therapist Productivity Data & Results– Comparative performance on key productivity results harvested from

individual tabs.– Aggregated by month.– Peer comparison of key ratios graphed by month.



• Therapist Productivity Training & Development Materials– “The Productivity Quiz” from “The Productive Therapist”.– Personalized Encounter Form.– Comprehensive Encounter Form Instructions including objective,

goals & completion steps.– Encounter Form Competency Exam.– Individual Staff Member Productivity Review & Planning Sheet – For

individual productivity meetings with supervisor.– Ongoing assistance from both clinical supervisor and practice

coordinator (administrative support staff member).


Break


Challenges of Productivity Measurement – The UM-BWMC Experience.

1. Fall 2010: Explain philosophy of productivity as a tool instead of a weapon & calm initial concerns.

2. Winter 2010-11: With staff, collaboratively develop Encounter Form with essential productivity data elements.

3. Spring 2011: Use initial productivity results to justify staffing needs.



4. Spring 2011: Successfully argue poor validity of external benchmark as a senior management tool for FTE decision-making.

5. Fall 2011: Demonstrated how standard against external benchmark needed to be changed to be valid.

6. Winter 2011-2012: Draconian productivity benchmarking enacted unilaterally by BWMC.



7. Spring 2012: Began using individual productivity results as part of staff performance appraisals.

8. Summer-Fall 2012: Regular individual productivity meetings between supervisors & managers and employees using adapted Kovacek form.

9. Winter 2012-13: Refined productivity targets and encounter forms with staff. Continued use of productivity as a tool instead of as a weapon.



10. Spring 2013-Spring 2014: Used productivity results to justify staff and to expand services to meet requirements of BWMC-employed surgeons. Intense battle over utility of external benchmarking results.

11. Spring-Summer 2014: Celebrate one year without using a contract employee to fill a therapist vacancy.

12. Summer 2014: Performance standard compared to external benchmark brought closer to internal productivity targets.


Challenges of Productivity Measurement – The UMRN Experience.

1. Fall 2011: UMRN Leadership expresses universal frustration with the lack of validity & reliability of external benchmark results to predict staffing needs or to assist with performance improvement. Agrees to embark on UMRN “system-wide” productivity measurement.

2. Fall 2012: Engaged Peter Kovacek a 3-part productivity workshop series designed for UMRN. 1st workshop entitled “Concepts of Rehabilitation Productivity” for UMRN Leadership.

3. Fall 2012: 2nd of Kovacek workshop series “The Productive Therapist” with AM session for clinicians and PM session for clinical management & UMRN leadership.


Challenges of Productivity Measurement – The UMRN Experience.

4. Winter 2013: 3rd workshop (Peter Kovacek unable to attend for personal reasons): UMRN leadership;

A. Agrees upon common metrics and taxonomy,

B. identifies venue sub-groups for creation of productivity targets and best practices.

5. Spring 2013: UMRN Leadership tables project due to advent of EPIC rollout. Agrees to re-visit with emphasis on sharing best practices at a later date.

6. Summer 2014: UMRN used UM-BWMC productivity results and associated LEAN project results to politic for changing the EPIC outpatient build from a Document Flow Sheet driven system to a Smart-Text note template as the tool.


How will you use productivity in your organization?

Thank you.


meaningful rehabilitation productivity: metrics and practices october 9,2014 presented by: marc...

Documents

productivity metrics

productivity enhancement

heading productivity

productivity seminar

rehabilitation services

staff goals

key metrics

practices octobe