meaningful rehabilitation productivity: metrics and practices october 9,2014 presented by: marc...
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Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
Presented By:Marc Womeldorf, FACHE, MBA/HA, MS-PT, Cert. MDT
Director, Rehabilitation Services, University of Maryland, Baltimore Washington Medical Center
At the:
Rehabilitation Community Providers Association ConferenceSeven Lakes Mountain Resort
Thursday October 9, 2014
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
Acknowledgement In 1992, at the NCPTA Spring Conference, I attended a productivity seminar. The presenter, Peter Kovacek, used a simple format – Two slide projectors. On one screen, he posted slides under the heading “Productivity as a Weapon”, and on the other “Productivity as a Tool.” Peter’s course provided me with a foundation for which I will be forever grateful. Twenty two years later, The University of Maryland Rehabilitation Network (UMRN) engaged Mr. Kovacek to help us to develop a common language & understanding around productivity. Mr. Kovacek’ s teachings are throughout this presentation. He offers them free of charge at;• http://www.ptmanager.com/• http://www.ptmanager.com/downloads/:
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
Objectives • Provide an understanding of the issues involved in managing,
measuring and improving productivity in Rehabilitation.
• Review UM-BWMC & UMRN experiences and lessons learned and how they may apply to your settings & goals.
• Through audience participation, gain additional insight & ideas on the above topics.
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
Agenda• Typical challenges of productivity management.
– Discussion.• Respectfully managing staff through productivity enhancement.
– Techniques.• Challenges of productivity measurement.
– Experiences.• Productivity metrics.
– Examples.• Metrics and change management.
– Realistic expectations based upon our experience.
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
Concepts
• Acknowledging the challenges.
• Modeling values.
• Introducing techniques.
• Acknowledging individualism.
• How adults learn.
• Leadership style & management role.
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
Acknowledging challenges.• Staff goals may be different than organization goals.
• Patient goals may be different than therapist goals.
How does the leader, manager or staff member know how she/he is meeting his/her personal or stakeholder(s) goals?
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
Acknowledging challenges.
How does the leader, manager or staff member know how she/he is meeting his/her personal or stakeholder(s) goals?
• Listen.
• Using stakeholder input, align their goals to organizational values.
• Collaborate and agree upon key metrics to measure progress & to provide feedback.
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
Modeling values.
What role does each of the following groups play in defining & modeling values?
• Administrative support staff.
• Supervisor?
• Manager?
• Director?
• Senior manager?
How can each of these groups work together to model values in a way that also improves productivity?
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
Modeling values.
How can each of these groups work together to model values in a way that also improves productivity?
• Collaborate around values.
• Measure the processes that allow for and the outcomes that define success.
• Link productivity measurements to valued outcomes.
– Potentially avoidable utilization.
– Potentially avoidable complications.
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
Introducing Techniques.
• What does it take for an individual or group to be successful?– Know what to accomplish.
– Know how to accomplish it.
– Have access to the tools to accomplish it.
– Be motivated to succeed.
– Take responsibility for their own success.
– Recognize when it occurs.
How can each of the aforementioned groups help the other to be successful?
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
Introducing Techniques.
How can each of the aforementioned groups help the other to be successful?
• Everyone can trace their roles to organizational values & strategies.
– Know what to accomplish.
• Standardized processes that add value to the patient experience.
– Know how to accomplish it.
• Productivity training, process descriptions, & collaborative improvement efforts.
– Have access to the tools to accomplish it.
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
Introducing Techniques.
How can each of the aforementioned groups help the other to be successful?
• Employees that fit team values.
– Be motivated to succeed.
• Productivity, process & outcome metrics.
– Take responsibility for their own success.
– Recognize when it occurs.
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
Acknowledging Individualism.
• Standardization is vital to productivity. So is creative prioritization & problem-solving.
• Is individualism at odds with standardization in the following?
– Operational processes.
– Clinical protocols.
– Communication scripting.
When can individualism enhance standardization?
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
Acknowledging Individualism.
When can individualism enhance standardization?
• Applying standard processes to meet the unique set of patient goals.
• Performing “disciplined experiments” to improve;
– Staff utilization (productivity),
– Communication, protocols & processes to enhance the patient experience (value & “values” based productivity)
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
How adults learn.
• They need a “safe” place to;
– Play.
– Experiment.
– Practice.
What are the critical elements that create a “safe” work environment for innovation?
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
How adults learn.
What are the critical elements that create a “safe” work environment for innovation?
• Transparency & security to result in staff feelings of accomplishment & accountability.
• Structures for consistent results.
• Leaders who expose barriers and work to eliminate them.
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
Leadership competencies & management roles.
What leadership competencies promote employee accountability?• Ability to clearly communicate;
– A vision.
– Values.
– Priorities.
• Transparency.• Security.• Structure.
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
Leadership competencies & management roles.
With respect to productivity, what are the primary roles of the manager?
• To clarify the personal role of the employee
• To reduce the variability of the many small trade-off decisions that the staff member must make every day.
How does the manager help the staff member with prioritizing trade-offs?
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
Leadership competencies & management roles.
How does the manager help the staff member with prioritizing trade-offs?
• Communicate the following priorities of each staff member – Their individual;– Objectives,
– Quality & productivity outcomes (And why they are NOT mutually exclusive).
– Why these outcomes are important.
– How to accomplish them.
– When a certain outcome is a priority.
– Who is critical accomplishing the outcome.
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
Break
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
Productivity Tools & Metrics UM-BWMC.
• Encounter Form – The Foundation– IP & OP– Evaluations– Encounters– Contact Units– Carved Out Units– Documentation Units– Worked Hours
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
Productivity Tools & Metrics UM-BWMC.
• Daily Schedule & Encounter Form Workbook – The 1st Point of Data Entry– Separate spreadsheet for each discipline.– Encounter Form & Schedule completion data for each clinician.– Performs important percentage and ratio calculations.– Daily averages and totals column.
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
Productivity Tools & Metrics UM-BWMC.
• Pay Period Ending Worksheet – Aggregates daily totals by pay period.– Populated from Daily Schedule & Encounter Form Workbook.– Totals & averages of key data elements.– Scheduled vs. seen percentages & analysis.– Performs important percentage and ratio calculations.
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
Productivity Tools & Metrics UM-BWMC.
• Monthly Data Worksheet – Aggregates daily totals by month.– Populated from Pay Period Ending Worksheet.– Same totals and averages as PPE Worksheet.– With the addition of Monthly, M-F & Weekend comparisons.
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
Productivity Tools & Metrics UM-BWMC.
• Monthly Graphs– Current & Previous Fiscal Year comparison.– All totals, averages & ratios.
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
Productivity Tools & Metrics UM-BWMC.
• Individual Therapist Productivity Data & Results– All totals, averages & ratios.– Harvested from clinician’s results in Daily Schedule & Encounter
Form Worksheet.– Pasted to monthly spreadsheets under individual clinician’s tab.– Aggregated by month.– Graphed by month and FY.
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
Productivity Tools & Metrics UM-BWMC.
• Individual Therapist Productivity Data & Results– Comparative performance on key productivity results harvested from
individual tabs.– Aggregated by month.– Peer comparison of key ratios graphed by month.
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
Productivity Tools & Metrics UM-BWMC.
• Therapist Productivity Training & Development Materials– “The Productivity Quiz” from “The Productive Therapist”.– Personalized Encounter Form.– Comprehensive Encounter Form Instructions including objective,
goals & completion steps.– Encounter Form Competency Exam.– Individual Staff Member Productivity Review & Planning Sheet – For
individual productivity meetings with supervisor.– Ongoing assistance from both clinical supervisor and practice
coordinator (administrative support staff member).
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
Break
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
Challenges of Productivity Measurement – The UM-BWMC Experience.
1. Fall 2010: Explain philosophy of productivity as a tool instead of a weapon & calm initial concerns.
2. Winter 2010-11: With staff, collaboratively develop Encounter Form with essential productivity data elements.
3. Spring 2011: Use initial productivity results to justify staffing needs.
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
Challenges of Productivity Measurement – The UM-BWMC Experience.
4. Spring 2011: Successfully argue poor validity of external benchmark as a senior management tool for FTE decision-making.
5. Fall 2011: Demonstrated how standard against external benchmark needed to be changed to be valid.
6. Winter 2011-2012: Draconian productivity benchmarking enacted unilaterally by BWMC.
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
Challenges of Productivity Measurement – The UM-BWMC Experience.
7. Spring 2012: Began using individual productivity results as part of staff performance appraisals.
8. Summer-Fall 2012: Regular individual productivity meetings between supervisors & managers and employees using adapted Kovacek form.
9. Winter 2012-13: Refined productivity targets and encounter forms with staff. Continued use of productivity as a tool instead of as a weapon.
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
Challenges of Productivity Measurement – The UM-BWMC Experience.
10. Spring 2013-Spring 2014: Used productivity results to justify staff and to expand services to meet requirements of BWMC-employed surgeons. Intense battle over utility of external benchmarking results.
11. Spring-Summer 2014: Celebrate one year without using a contract employee to fill a therapist vacancy.
12. Summer 2014: Performance standard compared to external benchmark brought closer to internal productivity targets.
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
Challenges of Productivity Measurement – The UMRN Experience.
1. Fall 2011: UMRN Leadership expresses universal frustration with the lack of validity & reliability of external benchmark results to predict staffing needs or to assist with performance improvement. Agrees to embark on UMRN “system-wide” productivity measurement.
2. Fall 2012: Engaged Peter Kovacek a 3-part productivity workshop series designed for UMRN. 1st workshop entitled “Concepts of Rehabilitation Productivity” for UMRN Leadership.
3. Fall 2012: 2nd of Kovacek workshop series “The Productive Therapist” with AM session for clinicians and PM session for clinical management & UMRN leadership.
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
Challenges of Productivity Measurement – The UMRN Experience.
4. Winter 2013: 3rd workshop (Peter Kovacek unable to attend for personal reasons): UMRN leadership;
A. Agrees upon common metrics and taxonomy,
B. identifies venue sub-groups for creation of productivity targets and best practices.
5. Spring 2013: UMRN Leadership tables project due to advent of EPIC rollout. Agrees to re-visit with emphasis on sharing best practices at a later date.
6. Summer 2014: UMRN used UM-BWMC productivity results and associated LEAN project results to politic for changing the EPIC outpatient build from a Document Flow Sheet driven system to a Smart-Text note template as the tool.
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014
How will you use productivity in your organization?
Thank you.
Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014