Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014

1. 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 Conference Seven Lakes Mountain Resort Thursday October 9, 2014

2. 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/:

3. 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.

4. 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.

5. 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.

6. 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?

7. 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.

8. 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?

9. 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.

10. 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?

11. 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.

12. 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.

13. 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?

14. 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)

15. 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?

16. 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.

17. 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.

18. 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?

19. 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.

20. Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014 Break

21. 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

22. 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.

23. 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.

24. 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.

25. 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.

26. 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.

27. 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.

28. 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).

29. Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014 Break

30. Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014 Challenges of Productivity Measurement – The UM-BWMC Experience. • Fall 2010: Explain philosophy of productivity as a tool instead of a weapon & calm initial concerns. • Winter 2010-11: With staff, collaboratively develop Encounter Form with essential productivity data elements. • Spring 2011: Use initial productivity results to justify staffing needs.

31. Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014 Challenges of Productivity Measurement – The UM-BWMC Experience. • Spring 2011: Successfully argue poor validity of external benchmark as a senior management tool for FTE decision-making. • Fall 2011: Demonstrated how standard against external benchmark needed to be changed to be valid. • Winter 2011-2012: Draconian productivity benchmarking enacted unilaterally by BWMC.

32. Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014 Challenges of Productivity Measurement – The UM-BWMC Experience. • Spring 2012: Began using individual productivity results as part of staff performance appraisals. • Summer-Fall 2012: Regular individual productivity meetings between supervisors & managers and employees using adapted Kovacek form. • Winter 2012-13: Refined productivity targets and encounter forms with staff. Continued use of productivity as a tool instead of as a weapon.

33. Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014 Challenges of Productivity Measurement – The UM-BWMC Experience. • 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. • Spring-Summer 2014: Celebrate one year without using a contract employee to fill a therapist vacancy. • Summer 2014: Performance standard compared to external benchmark brought closer to internal productivity targets.

34. Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014 Challenges of Productivity Measurement – The UMRN Experience. • 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. • Fall 2012: Engaged Peter Kovacek a 3-part productivity workshop series designed for UMRN. 1st workshop entitled “Concepts of Rehabilitation Productivity” for UMRN Leadership. • Fall 2012: 2nd of Kovacek workshop series “The Productive Therapist” with AM session for clinicians and PM session for clinical management & UMRN leadership.

35. Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014 Challenges of Productivity Measurement – The UMRN Experience. • Winter 2013: 3rd workshop (Peter Kovacek unable to attend for personal reasons): UMRN leadership; • Agrees upon common metrics and taxonomy, • identifies venue sub-groups for creation of productivity targets and best practices. • 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. • 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.

36. Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014 How will you use productivity in your organization?

37. Meaningful Rehabilitation Productivity: Metrics and Practices October 9,2014 Thank you.