I frequently get emails from readers asking how to improve productivity. So this week, Gray Matter Therapy is focusing on productivity. On Tuesday, I wrote about my approach to productivity. Today’s guest blog post is from Jennifer Kleber, an SLP in Indiana. She shares tips for improving productivity. What do you do to help improve productivity?
One of the biggest issues that was discussed in grad school and blogs was productivity and how high and difficult the demands were. I recently looked back at my grad school notes from a “Getting Ready for the Real World” lecture in which I wrote in the margins “80% productivity is difficult.” This is what we were told, this was pounded in our brains. With the help of my Director of Rehab, I was able to navigate my SNF and find ways to streamline my practice without sacrificing my ethics.
A bit about me: I work in a 45+ room SNF that is basically shaped as a big figure 8 and have 80-85% productivity requirements. Most days I range from 83-87% but definitely have those 76% or 91% days. This is with 2-3 bathroom breaks “on the clock,” and screeners that I can’t bill for. Yes, sometimes I may finish up a note here or there over lunch on a particularly busy day in which a patient was more intense than normal. But overall, I feel I do everything on the clock, ethically and professionally.
Tips to improve productivity
In this blog post, I hope to share some tips that will help eek out another percentage or two to your daily routine or help a new SLP in a SNF find his/her flow. I know many SNFs are larger and moving from patient to patient takes more time. When family, other disciplines, etc. have already taken the patient you were hoping to see, it can get very frustrating. At first I was getting 75% every day at best, but I knew the expectations and that others were doing it; I just needed to put my planning, problem solving, and executive functions to work. Here are some things that have worked for me.
1) When to start the clock
I start the clock the second I walk in the door. You know how you are constantly assessing people on the street? You are doing the same thing with your patient. As I approach my patient, I am assessing his/her current disposition; “how are you” is more than a colloquialism, the patients’ responses can be very informative including what they say and how they say it. If I am taking a patient down a hallway to go to another room (I don’t have an office, but I have a couple choice places where I like to work), we will talk along the way about what we are going to do in therapy, or find a calendar and do some orientation/visual scanning/reading comprehension work and then discuss the listed activities for the day.
2) Know your tools and economize
Every morning I choose around 3 activities that are appropriate for my caseload (task 1 for patients a, b, and c, task 2 for patients x, y, and z modified to____ support for patient Y and so on). If I do have activities that require photo copies, I probably already have many already printed out and in my accordion file or I make enough to last a while with not only today’s patients but for others in the future, especially if it is one of my go-to activities.
It took me a while at first to plan, copy, get everything together but now that I know my materials fairly well, I go through my planning in about 15 minutes.
I also take some time in my car driving to work to assess myself and my mood to decide what I feel like working on, which helps focus that “on the clock” planning time. Is today a memory day? Fantastic, everyone’s working on memory (if that’s a goal, which it almost always is)! Do I just want to play today? Great, card games for all! Now, I can decide (in planning) what we will do with the cards to target that patient’s specific goals.
3) Documentation online and mental templates
I write the majority of my notes and evaluations while the patient is working or I have a system which I will need to do a quick tally at the end. Personally, I use dots if incorrect (when I know how many this will be out of or can easily figure it out), a + and -, or a scale of 0-4 (4 being independent) so I can write as I go. A lot of iPad apps do the percentages for you as well.
On days I need to do weekly notes, I don’t do a daily note, likewise for evaluations/recertifications.
While this is not true for every patient, there are almost always certain tasks which patients just needs time to think through the material. I use that time to do my write ups, while monitoring the patient to make sure he/she isn’t sleeping or checked out. I also try to make sure I use the activities on weekly note/evaluation days. While I am a big believer in errorless learning, I also believe, especially with our higher level patients, there is a time and a place to sit back and be quiet.
I also have a general mental template for my reports so writing them goes pretty fast and I don’t need to attend to my reports rioting as much. This way, I can continue to interact and provide therapy with my patient such as playing Odd Man Out (working memory, problem solving, word finding) while writing my report. Long story short, don’t reinvent the wheel.
4) Tetrising time and patients
I loved playing Tetris as a kid, and I was good at it. I am also pretty good filling in every nook and cranny in a car before moving or going on a road trip. I looked at my schedule the same way.
If one patient is next door to the other, I will see them next, so I am wandering around the building in less circles. It doesn’t always work out, but it helps to keep my plan focused. I don’t wait for a patient, either. If he/she is with a nurse or another therapy, I say I will try later and move on, even if it’s “just 5 mins” (which is usually double whatever you are quoted). If I can’t find someone else in that time, I may wait or do some filing or billing, but I am rarely waiting for anything or anyone.
Basically I looked for the best way to economize as many patients before 12 and because I want to go to lunch and I wanted to do my personal hobby classes after work as early as possible. I love my job and the people I work with. There are times I will still stay after I clock out and chit chat with my boss or coworkers, or share a horror story with the interns (they love it). But on most days, I don’t want to be at work any longer than I have to.
I truly hope this helps some new or struggling therapists in the SNF setting. As I wrote earlier, this is an amazing setting, albeit a bit challenging at first (but what isn’t?). Maybe productivity requirements aren’t the best way to go (I personally like the idea of pay per client) but it is the reality we have right now, and together we can help each other to figure it out. I would love to hear other tips and tricks you have learned in your experiences!
Guest blogger bio
Jennifer Kleber, MA, CCC-SLP is an Indiana University graduate. She has worked in inpatient and outpatient settings for the IU Health Hospital system and currently works full time in Bloomington, Indiana for a Five-Star Rehabilitation SNF. Outside of work, Jennifer is an avid aerialist and is planning a wedding and a relocation later this year.
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