96
ACUTE CARE THERAPISTS CAN SURVIVE AND THRIVE IN UNCERTAIN TIMES Combined Sections Meeting 2015 February 6 th , 2015 Indianapolis, IN
| Date post: | 16-Dec-2015 |
| Category: |
Documents |
| Upload: | silvester-horn |
| View: | 213 times |
| Download: | 0 times |
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
11.8
11.6
11.5
11.3
11.6
11.6
17.7
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
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
4.5%Margin
Non-Medical Supplies
Leases, Utilities, Operations
Depreciation/Interest
Medical Services
Drugs
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
Drugs
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
Uncertainty of Total Value Added______________________________
$1,988,764,000
The Universal Acute Care Equation
Uncertainty of Total Value Added______________________________
$3,380,908,000
France
Germany
Denmark
Canada
Switzerland
Norway
United States
11.8
11.6
11.5
11.3
11.6
11.6
17.7
Health Care Expen-diture as % of GDP
2012 The Organisation for Economic Co-operation and Development (OECD)
The Universal PT Equation
Uncertainty of Total Value Added______________________________
$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
We Do
Level 2True Best
Practice
Level 3Ideal
Hospital Stay
Level 4Populatio
n Manage-
ment
Level 1Doing What
We Do
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
We Do
Level 2True Best
Practice
Level 3Ideal
Hospital Stay
Level 4Populatio
n Manage-
ment
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?
SBAR
Situation
Background
Assessment
Recommendation
Low Potential Referrals
The Universal PT Equation
Uncertainty of Total Value Added______________________________
$92,000 per Acute PT
Level 1Doing What
We Do
Level 2True Best
Practice
Level 3Ideal
Hospital Stay
Level 4Populatio
n Manage-
ment
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%)
Special TestPT: 39/77 (50.65%)OT: 28/71 (39.44%)
Special TestPT: 31/67 (46.27%)OT: 21/63 (33.33%)
Special TestPT: 8/10 (80.00%)OT: 7/8 (87.50%)
Pre & Post-Data Results for Falls: Graph
Oct & Nov 2013
Jan & Feb 2014
Feb 18 - 28, 2014
0%
10%
20%
30%
40%
50%
60%
70%
Falls Education
PTOT
Oct & Nov 2013
Jan & Feb 2014
Feb 18 - 28, 2014
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Falls Special Testing
PTOT
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
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
![The Indianapolis times. (Indianapolis [Ind.]) 1930-09-03 ...](https://static.documents.pub/doc/80x56/622b5b88f37f047da24ceb91/the-indianapolis-times-indianapolis-ind-1930-09-03-.jpg)
![The Indianapolis Star - Indianapolis, IN - Publisher ... · The Indianapolis Star - Indianapolis, IN - Publisher, Broadcasting & Media Production | Facebook 1/10/2013 4:09:30 PM]](https://static.documents.pub/doc/80x56/5b84ed5a7f8b9a317e8cea29/the-indianapolis-star-indianapolis-in-publisher-the-indianapolis-star.jpg)
![The Indianapolis times. (Indianapolis [Ind.]) 1932-11-05 ...](https://static.documents.pub/doc/80x56/6190c3bd602f303e2d37f096/the-indianapolis-times-indianapolis-ind-1932-11-05-.jpg)
