I wrote a post in February 2015 about what 90% productivity looks like. I received a comment that my math was wrong. I put the amount of billable minutes (432) for an 8-hour day (480 minutes) into a 9-hour day (540 minutes). It looked pretty challenging to achieve, but that was actually 80% productive!
While preparing for a talk I am delivering to graduate students, I sat down and I crunched the numbers again. I checked and rechecked the numbers.
This is what 90% productivity looks like
This is freakin’ impossible. There are tears in my eyes. This is not what patient-centered care looks like. This is now what a healthy work environment looks like.
90% Productivity for an 8-hour day looks like this:
8 hours = 480 minutes
90% billable time = 432 treatment minutes
10 patients a day means an average of 43 minutes per patient
This example* assumes a therapist only spends 3 minutes in between patients (to transport patients, switch out materials, and walk to next patient), which would be record speed since most buildings I have worked in have had 4 wings or floors with 100+ beds to traverse. This example also assumes all patients would benefit from the exact same number of treatment minutes.
8:00-8:05 Drop personal things off, pick up today’s schedule, gather materials for first patient, walk to patient
8:05-8:48 Patient number 1
8:51-9:34 Patient number 2
9:37-10:20 Patient number 3
10:23-11:06 Patient number 4
11:09-11:52 Patient number 5
11:55-12:25 Clock out for lunch and bathroom break.
12:25-12:28 Obtain materials for next patient, walk to patient
12:28-1:11 Patient number 6
1:14-1:57 Patient number 7
2:00-2:43 Patient number 8
2:46-3:29 Patient number 9
3:32-4:17 Patient number 10 (this one is 45 minutes to add the extra 2 minutes needed to have 432 treatment minutes a day)
4:20-4:30 Document session notes and time to complete non-billable necessary tasks
I have talked to some therapists (or seen comments on forums) who say 90% is a challenge, but it is achievable. If that’s you, please educate me. How do you achieve 90% productivity? If my math isn’t accurate, please correct me (I almost hope it isn’t accurate). This is impossible, right?
Non-billable tasks include:
- Calling families to update on status and recommendations for discharge planning.
- Attend care plan meetings with families, nursing staff, social worker, doctor, etc to discuss status and discharge planning.
- Complete screenings of patients who have been admitted to the building recently, annual screenings, or nursing concerns.
- Complete evaluations and obtain standardized scores.
- Write up evaluations, discharge summaries, weekly progress notes, 30 day recertifications, etc.
- Attend therapy team meetings to discuss status, collaborate to improve patients outcomes, etc.
- Consult with other professionals (SLPs, social workers, psychiatrists, psychologists, etc) regarding complex patient cases.
- Write orders updating treatment frequency and duration.
- Write orders and educate nurses and CNAs regarding diet texture and consistency changes.
- Obtain patient records from modified barium swallow studies, prior speech therapy, gastrointestinal specialists, otolaryngologists, etc. to update plan of care.
- Problem solve behavior and communication challenges and train nurses and CNAs to provide appropriate level of cueing and assistance to maximize independence and while maintaining safety.
- Complete inservice trainings with new staff or current staff at regular intervals to ensure that appropriate referrals are being made and staff is equipped with skills to manage dysphagia and cognitive-communication disorders.
- Troubleshoot computer and documentation software issues. I have never worked with software that was so buggy as the documentation software used by therapists in SNFs.
- Copy and prepare materials for therapy, such as patient education handouts and obtaining food for trials from the kitchen.
- Supervise graduate student interns or clinical fellows.
- File paper copies of progress notes, evaluations, recertifications, and discharge summaries in paper charts.
- Complete company required continuing education.
- Reading email and written notes from managers (often about failure to meet productivity expectations) or having meetings with managers about failure to meet productivity requirements.
- Performance reviews and other human resources related activities.
These non-billable tasks are important and make a difference in patient outcomes.
**This schedule does not account for the 10-15 minute paid breaks that many states grant workers for every 4 hour period work. Google “paid rest break” + your state to learn more about your state’s laws.
***Very seldom does a schedule go as smoothly as this schedule. Often a therapist will go to see a patient and they will be in the shower, out for a doctor’s appointment, working with another healthcare professional, visiting with family, refuse, etc. Which means therapists are walking to the patient’s room. Finding they are not there. Then they have to consult with CNAs and nurses to locate the patient. The therapist is unable to see the patient, but spent 10 minutes trying to locate the patient. Then the therapist goes to the next patient. Rarely does a SNF have a schedule for therapy. Therapists are given names and required minutes for the day, and it’s essentially a free for all.
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