By Jackie Lombard
Let’s be clear. No one is saying employees should not be accountable or productive in the OHSU rehab department,
Accountability/productivity is measured by billing CPT codes or “units”. Units can only be billed for direct patient care. They are a volume measurement and do not account for value or quality of service or work.
A problem with the OHSU rehab productivity standard and the system for measuring productivity is that it does not accurately account for the value of the work that cannot be captured by a unit but is none the less required of therapists and desired by the organization. This type of work includes things like documentation, program development, provider conferences, multi-disciplinary rounds, patient care conferences, professional development, teaching, research, publication, administrative tasks and mentoring. The time allocated or allowed for this work is insufficient under the current productivity standard and budget.
Another problem is that the OHSU rehab productivity system in no way accounts for quality as measured by patient functional outcomes or kindness or patience or compassion.
These problems, and attempts to fix them with management, have real negative consequences. First, meeting the productivity standard is a requirement for precepting students and for approval for some types of paid continuing education. The inaccurate productivity system limits professional development of therapists and limits opportunities for education of the next generation of therapy providers. It denies rehab therapists participation in activities essential to and at the core of professionalism.
Second, therapists have been put on work plans or performance improvement plans because they didn’t meet the productivity standard. These therapists are not lazy, or fraudulent, or incompetent in patient care delivery. In fact, they are some of the most skilled, devoted, ethical and hardworking therapists in the department. They are those often tasked with program development or administrative roles essential to OHSU. But they simply don’t bill enough units. And they can’t account for the value of their work any other way. The result of a work plan or even the threat of a work plan is the creation of a chronic ethical dilemma; meet productivity by focusing on billing units above all else or face termination and the inability to support yourself and your family.
A third problem is that questions about the productivity system and barriers to meeting productivity put forth to management go either unacknowledged or disregarded. For example; one manager failed to acknowledge 3 separate emails listing barriers to meeting productivity provided over a 6 week period. The barriers were offered in response to the manager’s request and the emails included solutions to the barriers. The manager finally responded to the last email with “Wow, a lot of ideas”. Another example is that several requests to substantiate the source of the productivity benchmark have simply been ignored. Trying to improve the system is then perceived as futile.
What’s more, expressing concern or opinion about the productivity standard or system of measurement is labeled as “not positive”, “disappointing” and “not team oriented” by management. These labels are discouraging and demoralizing to say the least.
Persistent feelings of futility, discouragement, ethical distress, job insecurity and professional ineffectiveness result in physical, emotional and psychological injury. This harm leads to provider burnout and illness. Is it any wonder that some are tempted to work off the clock to increase productivity and avoid this pain?
OHSU should care about and protect the health and well being of its employees. It is not enough for OSHU rehab management to send email reminders to not skip breaks or lunch or work off the clock while maintaining an inaccurate and unsubstantiated productivity standard and system.
Please, OHSU leadership, make a system that fairly accounts for value and quality, not just volume.