Health care organization such as Skilled Nursing Facilities, and Rehab Facilities often establish productivity measurements for their professional services staff. Performance objectives are at a high level, simply the product of minutes billed divided by minutes worked; but what happens when the math is wrong?
One facility I just reviewed showed the following example in their Policy Manual for Productivity Calculations for determining minutes worked, i.e. the denominator:
Example: “Therapist works 8:00 A.M to 12:00 P.M. in Facility A = 240 minutes (4 hours)”
Do you see the error already? Think about it a minute, what’s missing?
Where is the accounting for ten minute break required by law? This facility makes no adjustment for required breaks, there by overstating the denominator and lowering percent productivity in their performance equation. Double this error for a standard 8 hour day, and you’re off by 20 minutes, and that’s just the beginning. Failing to remove breaks alone from hours work will result in understating productivity by approximately 4.3%.
Still there is another thing that is missing, (though stated in this institutions policy, it was never reflected in the productivity calculation) that being Administrative Duties. Administrative duties are actions that need to be done, that can not be attached to any specific patient or care of patients. To test for Administrative Duties, as yourself: “is my license required to perform this duty?”, if the answer is no, it’s very like an administrative task and should not be reflected in the calculation of one’s productivity.
Removing breaks and administrative duties from hours worked can easily result in understating productivity by over 10%.
Each work day, for example, begins with some process around assignments, establishing what needs to be done and perhaps in what optimal order. Though establishing treatment plans for the day may require a license to do well, printing out the list of assignments or having it immediately available every morning, is not a task requiring a license.
Administrative duties come up all throughout the day and included but not limited to: photocopying, filing, fetching results, verifying orders, as well as appropriate facility specific process documentations, and many more. Having visited hundreds of facilities in my career, the most efficient had approximately 27 minutes of daily administrative duties. If there are organizations with less than 27 minutes of daily administrative activities per therapeutic role, I would be delighted to know.
So what do you need to know.
That which is referred to as “Productivity” is actually “Revenue Productivity”, this is because the numerator is minutes billed. If, for an example for the Speech Therapist, a clinical productivity number might be the number of aspiration pneumonia patients per 100 patients treated. In this case the most productive would be the SLP with the smallest percent of patients with right lower lobe aspiration pneumonia. Of course, one would have to consider the possible over-ordering of swallowing studies, but that is beyond the purpose of this piece.
Each facility needs to agree upon a proper number of minutes to attach to Administrative Duties, by clinical discipline, and then include that in the calculations. The best way to do this is to engage a consultant to perform an Activity Based Costing methodology to discovering the true number of minutes attached to administrative tasks. Because of the “ask a fish to describe his environment, the last thing he’ll tell you about is the water” effect, processes tend to disappear because of the “that’s the way we’ve always done it” phoneme. People too familiar with the internal processes of an organization cease to see all that is truly going on.
Finally, do your own math. For your convenience, I built a simple little spreadsheet (Excel 2007 version, back rev’d to 2003) for you to check out.
