Saturday, August 3, 2013

Soapbox Saturday: Knowing when to walk away

I'm a problem solver.  Giving up is generally not in my vocabulary.  Unless we are playing Monopoly-a game of monopoly seems to go on forever.  I'm fine with surrendering during Monopoly.  

Sometimes giving up, referring on, recognizing that you don't have the knowledge or skills to help is the best and most courageous action that you can take.

My first job was working with adults in a day treatment work program.  They only added 2-3 new patients per year.  I stayed for just over a year.  I loved working there but I couldn't figure out how I would continue to treat these patients each year and bill medical assistance.

I stayed at my next job for 13 years.  I worked as a speech language pathologist and about 2-3 years in was promoted to manager.  The clinic where I worked was the only pediatric facility owned by a national rehab company.  We were sold several times.  Each time I would start the process of attempting to educate the new owners on what pediatric habilitative care looked like.  I made up a 30 page business plan to explain it.  I spent hours at home (on my own time) creating programs, educational inservices for my staff, paperwork templates etc.  I loved parts of my job and I loved the employees that I worked with and managed.

I felt like my job was to try to act as a buffer between my staff and upper management.  For instance, completing all of your paperwork at time of service became a big issue for the company.  We were pediatrics.  You can't do a checklist for an evaluation, you can't sit at your computer and type up an evaluation or a treatment plan when you have a 6 year old with Autism in your room.  Plus, it is unethical.  Paperwork is not-no matter what you supervisor is telling you-a skilled service that is billable.  Even if the patient is present.  I've heard stories of therapists who have gone into treatment rooms and done their paperwork while a patient was taking a nap.  

I fell into a routine of getting new directives from Corporate and spending hours explaining why that wouldn't work.  Double book patients at an outpatient clinic?  Customer Service nightmare.  Complete all testing and evaluation write up within a 60 minute period?  Have they given the CELF?  They told me lies about their friends who owned pediatric clinics where the therapists were able to meet 90% + productivity requirements.  I asked for the phone numbers to collaborate.

More questions came up for me.  Do we need to meet productivity requirements if we are exceeding our profit margin?  Why do we need to meet a 30% profit margin when the only person who was tracking anything pediatric related was me?  How much profit is enough?

I had therapists who would cut their hours-come in right when their first patient came in, leave in the middle of the day and leave immediately after their last treatment.  They cut hours by 10 or more hours per week and still we had difficulty meeting the productivity expectations of the company.

I still felt like if I just presented the information in the right way, I could change corporate thinking.  One day I started looking more closely at scheduling and productivity and some financial information.  I found two things that excited me.  First, I realized that they were miscalculating part of our finances based on an error in the excel speadsheet.  Second, I found that the productivity numbers that we were required were mathematically impossible to achieve.  Even if we scheduled one patient for every minute we were there, we wouldn't have met the standard due to cancellations and how they were calculating the productivity.

This was the information that I had been waiting 12 years to find.  I brought it up to my supervisor and received the following response: "It's not my job to tell you how to do it.  It's just my job to set the expectation."  That's when I finally gave up.

 I now work at a clinic with more reasonable expectations with an open minded owner who has made some decisions to put the quality of patient care before productivity and profit.

I can't believe the amount of time and resources I put into trying to just justify myself and pediatrics over a ten year period.  In the last two years, I've had time to come up with new therapy activities, learn more about treatment, collaborate with my peers, start a blog, open a TPT store and have more time for my family.

Sometimes it's best to just walk away.  I wish I'd realized that sooner.


Twin Sisters Speech and Language Therapy said...

Loved your thoughts expressed in this post. Productivity expectations in the rehab world can be almost impossible to meet and the sad truth is that the focus is put on those numbers more than patient care at times. Thank you again for this thoughtful post.

Kim Marie said...

Spot on! Thanks so much for sharing this story, so similar to the many experiences I have had. Still, the privilege of being an SLP is having the best job on earth! :)
Kim Marie

Laura Dee said...

Thanks for being so honest and sharing life lessons. Good point.

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