Rehab Concerns: Working Off the Clock, Split Shifts and Curtailment

Over the last month several members of the Rehabilitation Services Department raised concerns about having to work off the clock, being asked to clock out during their shift if not seeing a patient and feeling pressured to clock out during their shifts in order to keep their productivity ratios high. Additionally, legal and ethical concerns were raised over management suggested billing practices in order to improve productivity metrics.

We interviewed members over a period of about two weeks.

  “We are asked to clock out if patients cancel, but patients don’t get charged if they don’t cancel in a timely manner. The assumption is that if a patient cancels we should clock out. But we have work to do other than give treatments to patients. We are left with the choice of working off the clock or clocking out; otherwise our productivity stats suffer.”

“They don’t do shift curtailment per contract, they just curtail based on whether or not individual patients cancel.”

“Employees do charting on lunch, about 90% chart on lunch breaks to get our charts done. If a patient calls in the night before we get told to come in late. I get here early to do chart reviews before my shift starts [without pay]. It’s the only way to keep productivity up.”

“If you don’t keep your productivity numbers up you get denied the opportunity for continuing education, you get emails and phones calls.”

“It’s easier to work off the clock than deal with all that.”

One former member spoke with us shortly after she left OHSU to work at a competing health care facility. They state that:

“75% of therapists chart through their break and lunch.”

“You can go into the break room and see people eating and charting at the same time. Managers see it and they know it’s going on but they don’t say anything to discourage it.”

“If you mention working off the clock in an email they will tell you not to because they know it’s wrong, but they set up conditions so that the only way you can meet productivity is to work off the clock for many people.”

“Productivity is impacted by things therapists have absolutely no control over. They feel that they have to make their units this week so they have to work through lunch to make units.”

Members told us if therapists take paid time to chart, they will not have enough units billed in relation to hours worked to make their productivity standards. Several members also said that consideration is not given that some patient cases require more charting than others, especially evaluations. There is pressure to make productivity even if it means working off the clock.

“Employees are denied the right to get time to do continuing education if they don’t maintain productivity for three months in a row, which creates more pressure to work off the clock.”

“My patient had arrived late but had been told they would get a full treatment. The patient eventually arrived but I didn’t know it so some time had passed. I had told the patient that I would see him for the full treatment and therefore I ran late. [My manager] said I should have been going out to check every five minutes to see if the patient was already there. This discounts the fact that I have lots of other work to do – not just charting, but for complex patients there are other resources and staff that must be engaged in a treatment plan, all that takes time, but it’s time that many therapists put in before their shift starts or after it ends, off the clock.”

This member once asked coworkers how they get their charting done and many of them said that they get here an hour early and open all their charts.

“I definitely stayed late working off the clock frequently.” “They would send emails saying you aren’t supposed to work off the clock, but managers would see people on computers charting well before shift, but would never question whether they were on the clock when they obviously weren’t but, if I mentioned in an email that I was working off the clock, they would tell me I should be on the clock for that. They only seemed to care if there was documentation.”

“Some people were billing three units when they should have been billing one, maybe two. I would only bill them one unit. If I only saw them for fifteen minutes I’m not going to bill for three units.”

Other examples:

“I can’t chart while I am in the room because the patient can’t move, I can’t chart and move them at the same time – [Supervisor] said “maybe you should be billing more units if you are taking more time to document.”

“[Supervisor] is the one who encouraged me to bill more units than I felt comfortable with in the ALS clinic. When she took on this job she knew she was going to do ALS clinic, she shadowed a couple of days, and there were times when I wasn’t making productivity because I stayed clocked in to chart.”

[Supervisor] told the member they could bill units for doing charting but the member contacted the licensing board. The board told the member to contact coding compliance and the member found out that type of billing would have been illegal. The member advised the supervisor but the supervisor never advised the rest of the staff that the practice of billing for charting was inappropriate.

One member was told their time was valuable and that they should bill for it. The member’s response was “if my time is valuable you should pay me for it.” The member would work off the clock at the beginning or end or end of shift but refused to clock out for no shows during the day. “I told [Supervisor] I was not going to clock out in the middle of the shift. The supervisor would make a lot of suggestions about things I could do when I was clocked out like go for a run or do errands.”

“I once billed 45 minutes of OT [the manager] told me to “correct this” or give him an explanation.”

A few days after our initial interview we had an opportunity for a follow up interview with our former member.

“Multiple times when I got messages from supervisors, I’ve been told you should clock out because you have two no shows. You should come in late in the morning if patient cancels”

“It’s not fair to make us clock out to keep our per hour productivity up.”

“The only way therapists have control over productivity is if they clock out when they are not seeing a patient. The effect is that they can’t meet standards unless they are willing to clock out every minute they are not seeing a patient and charting. They have no control over scheduling yet they lose money and opportunity due to scheduling.”

When one member finally got her full time FTE her supervisor told her to develop hand therapy skills. The member said “Sure, when are you going to block time for me to learn?” The manager said “you can come in and shadow on your time off, that’s what previous staff did, they came in early and on their day off to shadow and learn” This member was able to give us the name of at least one other therapist who trained during her time off.

Several other members also had information to share:

“I’ve been told by my supervisors that you need to tell therapists to clock out if they are waiting for a patient.”

“They gave me 45 minutes to prepare for a one hour academic presentation.” When this member said you can’t prepare a one hour presentation in 45 minutes, she was told that she “could do it on her own time.”

They told me that they “need to be billing for all the time you spend in clinic whether you are seeing someone or not.”

“If I work overtime they cancel patients the next day so as not to go over 40 hours per week. Which means some patients aren’t getting seen.”

Fear of Retaliation

We asked one member about working off the clock, clocking out for missed appointments, why people do that, and why more don’t express their concerns over these issues.

She felt that many employees were afraid of retaliation. We asked her what forms perceived retaliation would look like. Her answer:

“Some other examples of why individuals worry about speaking up:

  • Concerned they will not be allowed to change their schedule to desired shift
  • Concerned they will be paged or asked into a meeting where they are confronted
  • Opportunities for continuing education, program development, leadership roles will not be offered to them
  • Removal from leadership and differential paying roles such as Team Lead
  • Concerned they will be assigned to work that is not their preferred work area
  • Concerned they will not be granted exceptions for vacation or schedule conflicts or needs.”
  • Concerned they will be more closely scrutinized for missteps, errors, productivity and then put on a work plan”

OHSU management should:

  • Endorse legal and ethical billing practices
  • Follow labor law and contract provisions for scheduling of work and curtailment
  • Stop perpetuating a culture of fear and retaliation
  • Value all of an employee’s contribution and work by creating systems and environments that pay employees for all of the time to complete the job, not just the billable time.
  • Institute productivity measures that encourage the production of completed staff work and which do not pressure employees to work off the clock to meet standards.

Next article: Staffing and Quality of Care.

15 thoughts on “Rehab Concerns: Working Off the Clock, Split Shifts and Curtailment”

  1. This practice isn’t uncommon. “We need to cut labor”, not because it’s not affordable, it’s due to the “spiffs” management gets for keeping cost down.
    OHSU has effectively traded in quality of care, for profit. Forcing staff to operate below capacity, off the clock, and on their lunch, does nothing to increase patient care. These therapists came into this field to help people, OHSU is effectively cutting them off at the knees.

    More therapists = better care, faster discharge, and less return rate. If this is truly about the patients, OHSU needs to set aside the greed and step up.

  2. Asking people to act unethically, work off the clock , (OHSU should ask Legacy how that worked out for them), etc. Yet management is shocked when the employee engagement survey comes in so terrible.

    Is it in the best interest of the patients for management to treat our members as if they are making widgets instead of working to improve people’s health and well-being?

  3. Keep fighting! I love the work you’re doing right now in organizing and getting the word out. I know the process is slow, but progress will come.

    Have you considered doing any actions such as everyone ONLY working contract hours and nothing more? Period. It would be interesting to see the administration’s reaction.

    Solidarity!!

    1. Thanks for your support! The problem with only working our contracted hours is retaliation. Productivity and finishing paperwork is an easy way to determine if you are meeting job requirements. In the past when some therapists only worked contracted hours they didn’t make productivity requirements or finish documentation on time. Management then targeted those employees by creating “personal improvement plans” which documents that you are currently not meeting work expectations. So if the problem continues, you could be at risk for getting fired.

      The other problem is employees who are hired as part time or less employees but work full time rely on the income. A 0.15 fte contract is only 6 hours of work per week! The department is already short staffed which results in patients not being seen in the acute care setting, so if that 0.15 employee decreases her hours worked from 40 hours to 6 hours theres an even bigger detriment to patient care and work load added to already over-worked co workers.

      However, if EVERYONE in the department did this, I doubt the administration would write personal improvement plans for the entire staff. And the administration could then be the ones answering to doctors and nurses about why patients aren’t getting treatment by rehab staff.

      1. Thank you for this comment, people who work with patients every day can clarify the issues so much better than those of us who are only told of these problems.

      2. NP makes some great points about working only our FTE. This issues has been brought up in other departments as well and, unfortunately, many therapists rely on the extra income if they are working over their FTE. Cutting down hours may not be financially possible, which is what management banks on when hiring staff at a 0.15 FTE.

  4. OHSU should be ashamed of themselves for letting these things happen. This is not new information to them and am glad it is going more public. Fear of retaliation has been strong for many years and my hope is that everyone can come together and stay strong. I support OHSU rehab staff.

  5. As a former employee of the OHSU rehab department I understand what all of the therapists are going through. I LOVED my job. But the culture of negativity created by management made the daily stress no longer sustainable, so I left a job and coworkers that I loved. I am proud of what the rehab department is doing now in collaboration with AFSCME, and I truly hope real change is created. Keep fighting!

  6. It is so refreshing to see the rehab employees uniting and standing up for fair and ethical treatment. As a former member, I can attest that this bullying behavior by management has gone on for over a decade.

  7. If this isn’t a top-down problem, then OHSU needs to replace this management team with ethical and supportive leaders. It sounds like this negative culture is pervasive and long-standing. I am hopeful for the future of this rehab team and applaud their courage and fortitude.

  8. Time and time again, during staff meeting after staff meeting and employee engagement survey after survey, therapists consistently report patient care as the single most rewarding aspect of their profession and the primary contributor to job satisfaction. This has worked out supremely well for the organization so far, as many of us continue to work under these demoralizing conditions because we simply love what we do and want to provide the best patient care possible, and therefore put up with this state of affairs . OHSU should TAKE NOTICE and right years of wrong, starting first and foremost by replacing management that has fostered this culture of bullying, fear, and unethical behavior with leaders that truly understand our mission to provide excellent care.

  9. I left OHSU/Doernbecher because of the culture of retaliation and the pervasively hostile work environment perpetrated by the director of rehab, Connie Amos. with over ten year of pediatric experience, including managerial experience, I found her demands around shift-curtailment, split shifts and working off the clock to be unethical and appalling. I made multiple attempts to address my concerns with HR and with Ms. Amos’ immediate supervisor, Joe Ness. Nothing happened. Mr. Ness even had a round table discussion with pediatric staff and made verbal assurances that there would be positive change. He did not live up to his word. Instead, he was complicit in perpetuating the culture of retaliation by allowing Ms. Amos to target those of us that did not follow her unethical directives, providing little to no oversight.

    Working off the clock, shift curtailment and split shifts set up a cyclical negative environment for my staff. It provided false data about the true workload of the pediatric therapists, thereby supporting her erroneous belief that staff could bill a certain number of units in a day as a norm. Documentation, which is not billable (and therefore does not bring money for the department) is a necessary part of providing care. It has value-added by providing vital medical information that the team uses to determine a safe plan of care and a safe discharge plan. Yet Ms. Amos perpetuated an environment that expected staff to document off the clock. If, as a supervisor, I did not enforce the policy, it was made clear that it would reflect negatively on my individual performance review. At the same time, when staff would start to talk with the union about documenting off the clock, she would send a department-wide email stating that the department and the hospital did not want staff to work off the clock. Yet billable units, which translated into productivity, was the basis with which she approved continuing education time for staff, putting the staff in a catch-22.

    She wanted the rehab department to start documenting at point of care, for ALL patients. This was unreasonable and unsafe and I shared my concerns with her. Peer-reviewed articles show that patients do not provide a full medical history if they feel their practitioner is not fully engaged (tapping away on a keyboard during the session). For those of us who have worked with the pediatric population, we know that establishing trust is vital to fostering positive outcomes. Tapping away on a keyboard while engaging with a child will not accomplish this goal.

    Ms. Amos and Mr. Ness have had multiple opportunities to remediate this situation. But it was not fiscally advantageous for them to do so. I believe some of the values that OHSU touts are integrity, compassion and transparency. Ms. Amos and Mr. Ness are in direct conflict with these values, and have been for quite some time.

    I fully support the compassionate and skilled providers in the rehab department at OHSU and Doernbecher. They deserve better.

  10. Jackie, thank you for so intelligently and eloquently explaining why productivity standards based on billable time are unreasonable and unethical. I’m so proud to work with you.

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