ACUTE CARE THERAPISTS CAN SURVIVE AND THRIVE IN UNCERTAIN TIMES Combined Sections Meeting 2015...

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ACUTE CARE THERAPISTS CAN SURVIVE AND THRIVE

IN UNCERTAIN TIMES

Combined Sections Meeting 2015

February 6th, 2015 Indianapolis, IN

Speakers

Baylor Institute for Rehabilitation System Directors of Acute Care Therapy Services:

• Brian Hull, PT, MBA• Cathy Thut, PT, DPT, MBA• Donna Fitch Kaufhold, OTR• Sharon Cheng, PT, MBA, MSPT

Course description

The current environment of health care reform and cost cutting require hospital therapists take significant steps to manage their culture and actual practice patterns. The physical therapy profession consistently promotes advancement, but are hospital therapy programs consistently following through with true best practice top to bottom? Are hospital therapists aware of health care system politics? Do hospital therapists have strategies to successfully navigate politics and influence change? How is a therapy department viewed by executive leadership in a hospital? How can hospital therapy programs ensure they are seen in a positive light? This course will discuss the urgent need to manage culture to help lead health care reform change in today’s hospitals to avoid becoming irrelevant.

Objectives

Upon completion of this course, you will be able to:

1. Recognize the impact of health care reform on acute care therapy practice.2. Determine the correlation between hospital finances and therapy productivity.3. Evaluate perceptions and its implications to the future of therapy programs. 4. Create strategies to advance professionalism within hospital practice.

What Problems are we Facing Today?

The Harsh Reality

International Comparison of

Spending on Health

France

Germany

Denmark

Canada

Switzerland

Norway

United States

Health Care Expen-diture as % of GDP

2012 The Organisation for Economic Co-operation and Development (OECD)

USA Health Care Outcomes

Uninsured Rates for Adults Ages 18-64

The Baker Institute 2014 Health Reform Monitoring Survey

Texas % Uninsured by Federal Poverty Level

The Baker Institute 2014 Health Reform Monitoring Survey

Disproportionate Share Hospital Allotments

Kaiser Family Foundation 2014

More Peopleand

Better Serviceand

Higher Qualityand

Better Outcomeswith

Less Money to Pay for it all???

This Is Too Much!

How much of this

$is from PT?

Where does all the money go?

Hospital Expense Breakdown0.0

4.5%Margin

Non-Medical Supplies

Leases, Utilities, Operations

Depreciation/Interest

Medical Services

Other Expenses

Physician Expenses

Medical Supplies

Purchased Services

Salaries/Benefits

Where does all the money go?

$ Per Discharge$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

$16,000

$18,000

$816Margin

Non-Medical Supplies

Leases, Utilities, Operations

Depreciation/Interest

Medical Services

Other Expenses

Physician Expenses

Medical Supplies

Purchased Services

Salaries/Benefits

Money in my Wallet

How much raise do you expect each year?

2%3%5%7%

The Universal Equation

Total Value Added______________________________

Total Cost of Services

The Universal PT Equation

Uncertainty of Total Value Added______________________________

$92,000 per Acute PT*Source: APTA. http://www.apta.org/WorkforceData/

The Universal Acute PT Equation

$1,988,764,000

The Universal Acute Care Equation

$3,380,908,000

France

Germany

Denmark

Canada

Switzerland

Norway

United States

Health Care Expen-diture as % of GDP

2012 The Organisation for Economic Co-operation and Development (OECD)

$92,000 per Acute PT*Source: APTA. http://www.apta.org/WorkforceData/

Productivity!

Pop Quiz!

When was the theory behind productivity first developed?

1881190919341953

The Impressive History of

Productivity Measurement

Does This Encourage Quality Outcomes?

Level 1Doing What

Level 2True Best

Practice

Level 3Ideal

Hospital Stay

Level 4Populatio

n Manage-

Level 1Doing What

Level 2 Level 3 Level 4

Level 1Level 2

True Best

Practice

Level 3 Level 4

Level 1 Level 2Level 3Ideal

Hospital Stay

Level 4

Level 1 Level 2 Level 3Level 4

Population

Manage-ment

Level 1Doing What

Level 2True Best

Practice

Level 3Ideal

Hospital Stay

Level 4Populatio

n Manage-

Productivity Value added

What Do Other People Say About You?

What Are You Going to do About It?

How other professions see you

How do doctors and nurses ask about how patients are doing?

How do many PTs answer these simple questions someone asks about the pt?

How are you

branded?

Situation

Background

Assessment

Recommendation

Low Potential Referrals

$92,000 per Acute PT

Level 1Doing What

Level 2True Best

Practice

Level 3Ideal

Hospital Stay

Level 4Populatio

n Manage-

Productivity Value added

Changing Practice Patterns

Clinical Practice

Guidelines?

Best Practice?

Evidence Based

Practice?

May 2013

June – Oct 2013

Dec 2013

Our Journey

Problems

Time to Refocus

Revisions to

GuidelinesClearer Directions

Leaders as

ChampionsStaff

Engagement

Best Practice

Guidelines

Have we achieved Value –Added Therapy?

Porter, 2010

Tier 1 •Survival•Degree of Health/Recovery

Tier 2 •Time to recovery and return to normal activities•Disutility of care or treatment

Tier 3 •Sustainability of health/recovery•Long term consequences of therapy

Care induced illness

Recurrences

Health status achieved

Process of Recovery

Sustainability of health

The Outcome Measure Hierarchy

TiTer 1 •Survival•Degree of Health/Recovery

Tier 2 •Time to recovery and return to normal activities•Disutility of care or treatment

Tier 3 •Sustainability of health/recovery•Long term consequences of therapy

An Example from our BPG on Falls• Mortality• Functional level achieved• Pain level achieved• Return to Prior level of Function• Time to treatment• Time to return to PLOF• Pain, LOS, PE, DVT, delirium• Maintain functional level• Ability to live independently• Loss of mobility due to recurrent

falls• Risk of fracture• Reduced mobility

Tier 1

Tier 2

Tier 3

Comparison of Pre & Post Data: FallsOctober & November 2013

January & February 2014

January thru February 1-17, 2014

February 18-28, 2014

EducationPT: 0/80 (0.00%)OT: 1/59 (1.69%)

EducationPT: 33/77 (42.86%)OT: 12/71 (16.90%)

EducationPT: 27/67 (40.30%)OT: 7/63 (11.11%)

EducationPT: 6/10 (60.00%)OT: 5/8 (62.50%)

Special TestPT: 0/80 (0.00%)OT: 0/59 (0.00%)

Pre & Post-Data Results for Falls: Graph

Oct & Nov 2013

Jan & Feb 2014

Feb 18 - 28, 2014

Falls Education

Oct & Nov 2013

Jan & Feb 2014

Feb 18 - 28, 2014

Falls Special Testing

National Stats on CPGs

• 1/3 are aware of CPGs• 13% know how to access• 9% have “easy” access• < 50% use them frequently

Culture Changes

Lessons Learned

Every minute = value

Non-Negotiables

It’s all about me

It’s only me….

Strategy vs Culture

“Culture eats strategy for lunch” ~Peter

Drucker

“Culture Eats Strategy for Breakfast, Lunch, Dinner

and a Midnight Snack” ~Sharon Cheng

“In reality, culture does not trump strategy, rather they work together to enhance the success of one another.”

~Mike Myatt

Definition of Culture

“Culture is the deeper level of basic assumptions and beliefs that are shared by members of an organization, that operate unconsciously and define in a basic ‘taken for granted’ fashion an organization's view of its self and its environment.”

~Edgar Schein

Polynesian Culture

White Star Lines

Best Practice Guidelines

Why were we more successful than literature suggests?

• Group leaders didn’t understand the goal• Team members new to reading research• Team members were assigned 40-50

articles to read per week

Roadblocks

• Staff didn’t use existing clinical practice guidelines and systematic reviews

• Staff didn’t implement guidelines because too busy and didn’t see the need for them

Roadblocks

Shifting Culture

• Partner therapists strategically• Select your groups purposefully • Keep groups small, 6 to 8 people

Shifting Culture

• Members should be skilled in critical thinking and group dynamics• The leader should be skilled in keeping the

group on task

Delancey Street Foundation

• Started in 1971• No government funding• Average resident: – convicted felon– high school dropout– substance abuser– illiterate

Delancey Street Foundation Results

• Over 10,000 people have received high school equivalency degrees• Over 1000 graduates from their state

accredited vocational three-year program

How Was It Done?

• Teach people to find and develop their strengths

• The best way to learn is to teach

• Function as an extended family, a community in which every member helps the others

Teach people to find and develop their strengths

• Who is good at reading research?• Who is clinically experienced?• Who can help these two groups communicate

with each other?

The best way to learn is to teach

• Let your staff do the teaching • You may need to train your staff to teach

Function as an extended family, a community in which every member

helps the others

• The each-one-teach-one process• Use a diverse group of trainers by discipline

and generation

The Blame Game

It’s All Healthcare Reform’s Fault

• US healthcare is not the best• We cannot sustain the current percentage of

GNP for substandard results

Reality Check

It’s management’s job to tell us what we need to do

Therapists have the most knowledge about how to best prioritize patient care

Reality Check

I can’t do any more than

what I’m doing now

• You probably can’t do more if you continue to do things the way you have always done them

• Are you still focusing on units/visits?• Are you consistently using evidence-based

practice?

Reality Check

This Change is All About YOU

“If you do not change direction, you may end up where you are heading.”

~ Lao Tzu

No More Blame Game

• Successful people focus on their strengths• The best way to learn is to teach• Function as an extended family, a community

in which every member helps the others

Therapists Can Add Value• Active participation in decreasing Average Length of Stay (ALOS)• Active leadership in fall reduction• Minimize low potential referrals and treatments• Intervene purposefully using our strengths

How YOU Can Survive and Thrive

• Define your passion• Share with your manager• Share with your work support system • Share with your home support system

What if You are a Team of One?

What if You are a Team of Many?

How YOU Can Survive and Thrive

• Find out if you are a team of one or many• Pick your first project• Figure out what support you need• Ask for support

“The greatest danger in times of turbulence is not the turbulence – it is to act with yesterday’s logic.”

~Peter Drucker

Contact Info

• Brian.Hull@BaylorHealth.edu• CathyT@BaylorHealth.edu• DonnaFi@BaylorHealth.edu• Scheng@bir-rehab.com

ReferencesAbrahams J, Zucker D., Zucker J., Airplane [DVD]. United States: Paramount Pictures:

1980.By the Numbers. (2014, July). PT in Motion, 64-64.Dunleavy J, Steffes, L. Managing the Transition from Volume to value: Productivity

Standards. APTA Webinar Series: April 17, 2014 Federal Medicaid Disproportionate Share Hospital (DSH) Allotments. (n.d.). Retrieved

May 5, 2014, from KFF.OrgFrancke, A. L., Smit, M. C., de Veer, A. J., & Mistiaen, P. (2008). Factors influencing the

implementation of clinical guidelines for health care professionals: a systematic meta-review. BMC medical informatics and decision making, 8(1), 38.

Frederick Winslow Taylor. (n.d.). Retrieved November 4, 2014, from http://www.ibiblio.org/eldritch/fwt/taylor.html

Grimshaw, J., Thomas, R., MacLennan, G., Fraser, C., Ramsay, C. R., Vale, L., ... & Donaldson, C. (2004). Effectiveness and efficiency of guideline dissemination and implementation strategies.

ReferencesGrol, R., & Wensing, M. (2004). What drives change? Barriers to and incentives for

achieving evidence-based practice. The Medical Journal of Australia, 180(6 Suppl), S57-60.

Ho, V., Marks, E., and Bray, P.G. James A. Baker III Institute for Public Policy, Rice University, The Episcopal Health Foundation, Health Reform Monitoring Survey – Texas, Issue Brief #3. Houston, Texas: 2014.

Jette, A. M. (2012). Face into the storm. Physical therapy, 92(9), 1221-1229.K. Davis, K. Stremikis, C. Schoen, and D. Squires, Mirror, Mirror on the Wall, 2014 Update:

How the U.S. Health Care System Compares Internationally, The Commonwealth Fund, June 2014

Kaplan, R. S., & Porter, M. E. (2011). How to solve the cost crisis in health care. Harv Bus Rev, 89(9), 46-52.

Kocher, R. P., & Adashi, E. Y. (2011). Hospital readmissions and the Affordable Care Act: paying for coordinated quality care. JAMA, 306(16), 1794-1795.

Kotter, John P., and James L. Heskett. Corporate Culture and Performance. New York: Free, 2011. Print.

Orszag, P. R., & Emanuel, E. J. (2010). Health care reform and cost control. New England Journal of Medicine, 363(7), 601-603.

ReferencesOur Accomplishments. Delancey Street Foundation Web site.

http://www.delanceystreetfoundation.org/accomplish.php. Published 2007. Accessed November 3, 2014.

Ploeg, J., Davies, B., Edwards, N., Gifford, W., & Miller, P. E. (2007). Factors Influencing Best Practice Guideline Implementation: Lessons Learned from ‐Administrators, Nursing Staff, and Project Leaders. Worldviews on Evidence‐Based Nursing, 4(4), 210-219.

Polynesia’s Genius Navigators. PBS.org Web site. http://www.pbs.org/wgbh/nova/ancient/polynesia-genius-navigators.html. Published February 15, 2000. Accessed November 4, 2014.

Porter, M. E. (2010). What is value in health care?. New England Journal of Medicine, 363(26), 2477-2481.

Porter, M. E. This framework paper is Supplementary Appendix 1 to Porter ME. What is value in health care? New England Journal of Medicine, 363(26), 2477-2481.

ReferencesPorter, M. E. This framework paper is Supplementary Appendix 2 to Porter ME.

What is value in health care? New England Journal of Medicine, 363(26), 2477-2481.

Pravikoff, D. S., Tanner, A. B., & Pierce, S. T. (2005). Readiness of US nurses for evidence-based practice: many don’t understand or value research and have had little or no training to help them find evidence on which to base their practice. AJN The American Journal of Nursing, 105(9), 40-51.

Prior, M., Guerin, M., & Grimmer Somers, K. (2008). The effectiveness of clinical ‐guideline implementation strategies–a synthesis of systematic review findings. Journal of evaluation in clinical practice, 14(5), 888-897.

RMS Titanic. Titanic Pages: Titanic History Web site. http://www.titanicpages.com/ Published 2007. Updated 2014. Accessed October 3, 2014.

Rothstein JM. Thirty-Second Mary McMillan Lecture: Journeys beyond the horizon. Phys Ther. 2001;81:1817–1829

ReferencesShore, S., & Griggs, G. K. (2010). Health Care Reform. NC Med J, 71(5).Sood, N., Huckfeldt, P. J., Escarce, J. J., Grabowski, D. C., & Newhouse, J. P.

(2011). Medicare’s bundled payment pilot for acute and postacute care: analysis and recommendations on where to begin. Health Affairs, 30(9), 1708-1717.

Thurber RM, Terry Tate, Office Linebacker [TV]. Canton, MA: Reebok; 2002

ACUTE CARE THERAPISTS CAN SURVIVE AND THRIVE IN UNCERTAIN TIMES Combined Sections Meeting 2015...

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