Rehab: Productivity, Timekeeping and Patient Care

Over the last month we’ve published a series of articles outlining our concerns that management’s scheduling and productivity demands have had negative economic, personal, and professional impacts on our members who work in rehab services. It is our opinion that the productivity matrix used by OHSU forces employees to work off the clock in order not to be penalized by management for productivity concerns and to provide the best care possible for our patients.

Not all time spent working off the clock is before or after their shift. Much of this off the clock work occurs during lunch and breaks which are times employees normally do not clock out.

Further, we went to our members and asked them how they would respond to concerns that their problems with the productivity matrix are that they are simply not managing their time well.

In response, Rehab members asked us to share specifics about how the productivity matrix used by OHSU forces them to work off the clock to complete their work, and how it impacts patient care.

As you will read, the issue is not about more efficient use of time but rather about inadequate time scheduled and budgeted by management.

Members tell us that adult outpatient appointments are booked back to back. Documentation time for each patient takes at least 10-15 minutes, if not more. An employee working a ten hour day is expected to treat 12 patients a day. That employee would need at least 120 minutes minimum to complete documentation. However, the amount of time blocked on the schedule for documentation is only 30 minutes.

Members working in pediatrics share similar time needs for documentation. “If we are supposed to see between 7 and 9 patients a day to meet productivity, then we need at least 70 minutes to complete outpatient notes”. Pediatric evaluation appointments are even more complex, requiring at least 50 minutes to score the necessary assessments.

This time is not provided in their schedules.

Also, Inpatient therapists have similar time needs for documentation. They tell us that management claims the non-productive time of their day is for this documentation time, and also for the time they spend on patient care rounds and care conferences.

Members state that this is simply not true.

The non-productive time of their day is the time required to do their work to safely care for medically fragile patients – including necessary chart reviews and coordinating with nursing, respiratory therapists and physicians, in addition to completing documentation.

None of these tasks counts as billable time toward productivity.

The following OHSU rehab management suggestions to improve efficiency and productivity raise ethical and patient care concerns for our members. Each suggestions is followed by the members’ concern in italics.

  • Document in the room or while with a patient to increase billable time. Documentation is not billable time, this is fraud.
  • Limit chart review and clarification of precautions and restrictions with providers. This could lead to unsafe patient care
  • Use students to increase number of patients seen per day and therefore productivity. In some cases this is fraud, potentially unsafe for patients and a disservice to student learning.
  • Save parts of an assessment or evaluation for another day and charge separately for that time. “We’ve been told by management that we don’t have to do a formal assessment on the first day, but the issue is that the assessment needs to get done, and for the most part we need to know where the child is at baseline…assessing the child…is essential, especially when determining numbers of visits and appropriateness of services” This suggestion is unethical and could be considered “un-bundling” of services, which is fraud.
  • Prioritize evaluations over treatments to increase productivity, making the budget more profitable/favorable. This is a disservice to those patients in need of intervention and follow-up care.

Previous articles have addressed the harm to our members’ well-being from OHSU rehab management’s productivity requirements and accounting system. Now, members are sharing the impact this system can have on patient care and services.

OHSU needs to prioritize employee and patient well-being over profit. Members and patients deserve better.

8 thoughts on “Rehab: Productivity, Timekeeping and Patient Care”

  1. “Not unto ourselves alone are we born”. That is the motto of my alma mater. It is a message that resonates with me. I believe in service. My profession and work afford me so many opportunities for service to patients, case managers, nurses, families, physicians, students and my co-workers. But it is increasingly difficult to work for an organization that puts me in conflict with my core belief in service. I stand with my colleagues in rehab and across OHSU that want better service for patients and better treatment for themselves. Non nobis solum nati sumus!

    1. As therapists , we are drawn to this work, out of a deep sense of service. In fact it is professionally expected and cultivated; as it should also be throughout all levels of management and leadership in health care organizations.
      The underlying profits before quality patient care approach is too often the un realistic exploitive reality.
      These grievances with OHSU rehab are revealing common ethical discrepancies often found between boastful glitzy marketing and what you get above and below the surface.
      It takes courageous authentic leadership and advocacy to stand against exploitive health care delivery models.
      OHSU is perched to see and lead the way. Isn’t it?
      It requires a servant heart and leadership style to care, to push for change and align the walk with the words, for the sake of all stakeholders.
      Hopefully these advocacy efforts will result in equitable changes

  2. Ethically dubious at best. Fraud and substandard patient care at worst. This from the “most trusted”health care provider in the state?

  3. Hey OSHU. I see that you’re “here to do what can’t be done”.
    By reading these blog posts, it’s clear that what couldn’t be done for more than a decade is to hold accountable those that have created and enabled a hostile, fraudulent and unethical work environment in the rehab department. Protect your patients and support your care givers. Fire Connie Amos and Joe Ness. Don’t tell us it can’t be done. Respectfully, Your Patients.

  4. There are 5 behaviors of a healthy organization:
    1. Trust (this is the foundation)
    2. Healthy Conflict
    3. Commitment
    4. Accountability
    5. Results
    This isn’t rocket science. We learned this at the very start of our Master’s in Healthcare Administration program.
    Notice how results are the last thing and without the other 4, it is impossible to acquire? Can we say with honesty that Connie Amos and Joe Ness have built trust, allowed for healthy conflict, shown commitment to the team, and have been accountable for their actions? I think not. The adult and pediatric rehab staff at OHSU/DCH have had to suffer under Connie Amos for years and years and years. Joe Ness entered the scene, met with staff, and promised a change for the better. He failed the staff by turning a blind eye to Connie’s ongoing hostile managerial style. He did not keep his word because it was not fiscally advantageous. Take a look at the turnover in Connie’s departments. It’s telling (and public knowledge). It’s time for new leadership; leadership that is not steeped in hostility, back-stabbing, and retaliation. OHSU also needs to realize that in order to deliver safe and effective care, they MUST increase their FTE. Yes, it cuts into their bottom line. But last I checked, OHSU cuts to the front of the line for grants from the state, receives millions from wealthy donors and advertises itself as the premiere healthcare organization in Oregon. It’s time they earn the reputation.

  5. The more I learn about the ongoings that our union brothers and sisters have to endure in the department the more my mind is drawn back to the climbing over dead bodies comment, and that I once went through PT at OHSU, and to be viewed as just a body, a step to someones bonus is hurtful but it is expected to a degree in the system where the profit is the end game and body count is key. John D. Rockefeller, Cornelius Vanderbilt, Andrew Carnegie, Henry Ford and J.P. Morgan would be proud of this business model.

  6. As an acute care therapist, I can say that it’s just not possible to hit the productivity standard everyday. When I hit my 3rd patient who I’ve prepared to work with and is unavailable (too painful, too sick, at a procedure, etc), I think “well, there goes my lunch break”. This should not be!

  7. Senior Leadership and HR representatives at OHSU should be ashamed of themselves. Either they condone and support this unethical and abusive management or they are asleep on the job and not diligent in providing appropriate patient care and a professional work environment. Patients deserve better. Oregonians deserve better.

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