For the last two months we have been describing how the staffing model regarding use of part-time FTE and the productivity system in use by OHSU’s Rehabilitation Services Department affect the rehabilitation therapists.
We believe this model and system has resulted in the loss of wages and benefits to rehab employees as well as producing possible wage and hour law violations by creating conditions which lead to employees working off the clock. Other impacts include the inability of employees to avail themselves of continuing professional education and increased staff turnover rates due to low morale and provider burnout.
Now let’s talk about patient care
Rehab members tell us that OHSU chronically and systematically understaffs the department. Simply, there are not enough therapists to provide services to the patients. When members raise concerns and ask for more staff, they are told the budget does not support it because the department does not meet the productivity numbers. Previous articles (Timekeeping and Patient Care) have shared the errors in OHSU’s productivity system. Here are some examples from members about the lack of patient services:
- The NICU (babies in intensive care) is staffed with one therapist per, on average, about 40 patients.
- Acute Pediatrics has no Occupational Therapy coverage in the hospital on Sundays or holidays. There is often no Physical Therapy coverage in the hospital for Sundays.
- Adult Acute Occupational Therapy is not available on Sundays, holidays or in the medical, trauma/surgical or cardiovascular ICUs.
- Adult Acute Physical and Occupational Therapists are so understaffed that most therapists are routinely assigned 2-3 times the number of patients they can see in a day.
- Adult Acute Speech Language Pathology had chronic and severe staffing shortages the past year and only recently achieved staffing at a level appropriate for patient care needs.
- Often patients in Inpatient and Outpatient care are able to receive an evaluation, but have delay in follow-up treatment services. In some cases in acute care, a patient may go several days without services because there is not enough staff.
- Adult Acute Rehab has only one rehab aide to provide assistance to the entire department, a position essential to providing assistance to therapists for patient care.
The ultimate result of OHSU management’s staffing plan is the daily certainty that many patients who need to be seen by rehab therapists will not receive rehab services. No amount of efficiency, productivity or working off the clock will change that. Patients not getting seen is directly related to OHSU management’s staffing and budget plan. Members would like to share more specific data in support of these claims, but are fearful of retaliation by the organization.
What happens when patients who need rehab therapy services don’t receive them, or receive them late or at sub optimal frequency?
Our members raise concerns that several undesirable outcomes are possible:
- Patients may suffer loss of function or sub-optimal functional recovery
- Patients may suffer longer length of stay
- Sub-optimal discharge planning
- Lower patient satisfaction
- Moral distress/burnout for rehab providers
All of this can combine to result in increased costs to OHSU related to longer patient length of stay, less available beds for new admissions due to delayed and sub-optimal discharge, return of patients to the hospital due inability to succeed at discharge, and poor recruitment and retention of rehab staff.
Members have and continue to raise staffing concerns directly with their manager(s) and director. Members have and continue to raise staffing concerns through the employee engagement survey process. Our union has repeatedly raised these concerns to OHSU leadership. The staffing issues continue. The patient care concerns continue. The stress on therapists trying to accomplish what is literally impossible, continues. Fear of retaliation for speaking up about these issues continues.
OHSU leadership needs to address these concerns, with our members and our union, in an atmosphere that can be guaranteed to be free of retaliation.