MANAGEMENT PRACTICES SURVEY FOR CHILDRENS HOSPITALS

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MANAGEMENT PRACTICES SURVEY FOR CHILDRENS
HOSPITALS

• ASHA Convention, November 2008
• Terry Wiegel M.S. CCC-SLP
• Director, Rehabilitative Services Department
• The Childrens Medical Center
• One Childrens Plaza
• Dayton, Ohio 45404
• [phone]
• wiegelt_at_childrensdayton.org
• 
  

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Survey

• 14 Childrens Hospitals were contacted in the
  fall of 2006 for the survey. Managers and/or
  directors were interviewed.
• The majority of hospitals had large outpatient
  therapy departments similar to our hospital.
• Our goal was to determine how other hospitals
  handled issues such as productivity, continuing
  education, patient attendance/scheduling and to
  use that information to change our practices

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Speech Therapy Productivity

• 13 hospitals had a minimum productivity
  requirement
• Productivity was usually equal to billable time
  with the patient (most hospitals give additional
  unit(s) for evaluation report writing time)
• Productivity requirements ranged from 48 - 85
• The hospital requiring 85 was in a state where
  therapists are hourly employees
• The hospital with 75 had many group sessions
• 7 hospitals were in the 60 - 65 range
• The majority of staff were reported to meet
  productivity standards at 10/13 hospitals

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Audiology Productivity

• 6 hospitals had a minimum productivity level for
  audiology
• Many hospitals reported difficulty measuring
  productivity for audiology as the time to perform
  specific tests often varied
• Most who did track productivity have assigned
  procedure counts to each test based on the
  average time it takes to complete it
• Productivity levels ranged from 50 to 100
• The hospital with 100 productivity was in a
  state where audiologists are hourly employees

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Productivity Adjustments

• 7 hospitals deduct time spent in certain
  activities from a therapists available units
  when they calculate productivity. These
  activities included
• Short term projects
• New program development
• Student supervision
• New employee orientation/training
• CFY supervision
• Continuing education
• Learning new skills/procedures

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Productivity Bonus Systems

• 3 hospitals offered monetary rewards to staff who
  exceeded the minimum productivity standard and 1
  hospital was in the process of developing a bonus
  system
• Several hospitals incorporated productivity into
  the yearly performance appraisal system

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Continuing Education Hours

• 8 hospitals had no set amount - hours were given
  at the managers discretion
• 1 hospital required staff to use vacation time to
  attend continuing education courses
• 1 hospital gave 2 days per year
• 2 hospitals gave 3 days per year
• 2 hospitals gave 5 days per year

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Continuing Education Money

• 2 hospitals gave no money for education and
  offered their own courses
• 6 hospitals had no set amount money was given
  at the discretion of the manager
• 5 hospitals gave 500 per year
• 1 hospital gave 1000 per year
• 1 hospital gave 1,500 per year

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Patient Attendance Policy

• 1 hospital had no patient attendance policy
• 1 hospital required 50 attendance
• 2 hospitals required 70 attendance
• 3 hospitals required 75 attendance
• 2 hospitals required 80 attendance
• Most hospitals also discharged patients after 2
  consecutive no shows

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Attendance Policies for Medically Fragile Patients

• Most hospitals attempted to assist their
  medically fragile patients by
• Offering to reschedule their session later in the
  week
• Allowing therapists to make an exception to the
  policy for these patients
• Filling their spot with a temporary or short term
  patient until they were able to return
• Offering to schedule them week by week using
  cancellation times
• Putting them back on the waiting list, but giving
  them priority scheduling when they were healthy

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Length of therapy sessions

• 8 hospitals offered 45-60 minutes sessions
• 7 hospitals offered 30 minute sessions
• Most hospitals offering 30 minute sessions
  attributed the shorter sessions to reimbursement
  issues and the high demand for services

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Average wait for a Speech/Language Evaluation

• 5 hospitals 1 week or less
• 1 hospital 2 weeks
• 1 hospital 3-4 weeks
• 1 hospital 6 weeks
• 1 hospital 1-2 months
• 1 hospital 3-6 months
• 1 hospital 12 months

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Changes Productivity

• Our minimum productivity level for speech therapy
  was raised from 57 - 65 due to survey feedback
  and budgetary constraints
• We maintained our productivity bonus system, but
  raised the minimum level needed for a bonus to
  67 (we provide bonus for 67 up through 75)
• CFY supervision time and training time for
  learning some new skills (i.e. MBS) is not
  included in the productivity calculation
• After one year on the new system, most of our
  staff were meeting the 65 level and many
  obtained the productivity bonus

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Changes Continuing Education

• We now offer 2 days of continuing education each
  year and those hours are deducted from their
  available units when calculating productivity
• Staff can take additional continuing education
  days provided they still meet the minimum
  productivity requirement (any time over 2 days is
  not deducted from their available units)
• Staff are given up to 900 a year for
  education/travel (pro-rated for part time staff)

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Changes Patient Attendance

• We raised our patient attendance standard from
  75 to 80 and communicated this change to our
  customers
• New patients are given the attendance policy when
  scheduled and reminded that they must come to 80
  of their visits (i.e. at least 8 out of every 10
  visits)
• We send out no show and attendance warning
  letters as needed (these come addressed from our
  office manager)
• Families can request to go back on the waiting
  list after being discharged due to attendance,
  but they have a long wait to resume therapy. If
  they are discharged a second time for attendance,
  we do reschedule them again.

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Benefits of the Survey

• Staff were better able to accept the changes in
  productivity and patient attendance after the
  survey results had been reviewed with them
• Staff were happy to know that there were still
  hospitals out there with higher productivity
  standards than our hospital
• Staff appreciate our continuing education
  benefits knowing many hospitals are not as
  generous in this area

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Our Productivity System

• Productivity is calculated every two weeks when
  we do payroll
• Staff are given an spreadsheet at the end of each
  pay period reporting their productivity for the
  pay period and a year to date percentage
• They are given feedback as to where their year to
  date productivity level places them in our
  performance appraisal rating system (i.e. Needs
  Improvement, Strong Performer, Role Model or
  Bonus Level)
• Productivity makes up about 18 of their final
  performance appraisal score each year

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Sample Productivity Chart