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ACUTE CARE THERAPISTS CAN SURVIVE AND THRIVE IN UNCERTAIN TIMES Combined Sections Meeting 2015 February 6 th, 2015 Indianapolis, IN.

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Presentation on theme: "ACUTE CARE THERAPISTS CAN SURVIVE AND THRIVE IN UNCERTAIN TIMES Combined Sections Meeting 2015 February 6 th, 2015 Indianapolis, IN."— Presentation transcript:

1 ACUTE CARE THERAPISTS CAN SURVIVE AND THRIVE IN UNCERTAIN TIMES Combined Sections Meeting 2015 February 6 th, 2015 Indianapolis, IN

2 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

3 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.

4 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.

5 What Problems are we Facing Today?

6 The Harsh Reality

7 International Comparison of Spending on Health

8 2012 The Organisation for Economic Co-operation and Development (OECD)

9 USA Health Care Outcomes

10 Uninsured Rates for Adults Ages The Baker Institute 2014 Health Reform Monitoring Survey

11 Texas % Uninsured by Federal Poverty Level The Baker Institute 2014 Health Reform Monitoring Survey

12 Disproportionate Share Hospital Allotments Kaiser Family Foundation 2014

13 More People and Better Service and Higher Quality and Better Outcomes with Less Money to Pay for it all??? More People and Better Service and Higher Quality and Better Outcomes with Less Money to Pay for it all???

14 This Is Too Much!

15

16 How much of this $ is from PT?

17 Where does all the money go?

18

19 Money in my Wallet How much raise do you expect each year? 2% 3% 5% 7%

20 The Universal Equation Total Value Added ______________________________ Total Cost of Services

21 The Universal PT Equation Uncertainty of Total Value Added ______________________________ $92,000 per Acute PT *Source: APTA.

22 The Universal Acute PT Equation Uncertainty of Total Value Added ______________________________ $1,988,764,000

23 The Universal Acute Care Equation Uncertainty of Total Value Added ______________________________ $3,380,908,000

24 2012 The Organisation for Economic Co-operation and Development (OECD)

25 The Universal PT Equation Uncertainty of Total Value Added ______________________________ $92,000 per Acute PT *Source: APTA.

26 Productivity!

27 Pop Quiz! When was the theory behind productivity first developed?

28 The Impressive History of Productivity Measurement

29 Does This Encourage Quality Outcomes?

30 Level 1 Doing What We Do Level 2 True Best Practice Level 3 Ideal Hospital Stay Level 4 Population Manage- ment

31 Level 1 Doing What We Do Level 2Level 3 Level 4

32 Level 1 Level 2 True Best Practice Level 3 Level 4

33 Level 1Level 2 Level 3 Ideal Hospital Stay Level 4

34 Level 1Level 2Level 3 Level 4 Population Manage- ment

35 Level 1 Doing What We Do Level 2 True Best Practice Level 3 Ideal Hospital Stay Level 4 Population Manage- ment Value added

36 What Do Other People Say About You? What Are You Going to do About It?

37 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?

38 How are you branded?

39 SBAR S ituation B ackground A ssessment R ecommendation

40 Low Potential Referrals

41 The Universal PT Equation Uncertainty of Total Value Added ______________________________ $92,000 per Acute PT

42 Level 1 Doing What We Do Level 2 True Best Practice Level 3 Ideal Hospital Stay Level 4 Population Manage- ment Value added

43 Changing Practice Patterns Clinical Practice Guidelines? Best Practice? Evidence Based Practice?

44 May 2013 June – Oct 2013 Dec 2013

45

46 Revisions to Guidelines Clearer Directions Leaders as Champions Staff Engagement

47

48 Have we achieved Value – Added Therapy?

49 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 Porter, 2010 The Outcome Measure Hierarchy

50 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

51 Comparison of Pre & Post Data: Falls October & November 2013 January & February 2014 January thru February 1-17, 2014 February 18-28, 2014 Education PT: 0/80 (0.00%) OT: 1/59 (1.69%) Education PT: 33/77 (42.86%) OT: 12/71 (16.90%) Education PT: 27/67 (40.30%) OT: 7/63 (11.11%) Education PT: 6/10 (60.00%) OT: 5/8 (62.50%) Special Test PT: 0/80 (0.00%) OT: 0/59 (0.00%) Special Test PT: 39/77 (50.65%) OT: 28/71 (39.44%) Special Test PT: 31/67 (46.27%) OT: 21/63 (33.33%) Special Test PT: 8/10 (80.00%) OT: 7/8 (87.50%)

52 Pre & Post-Data Results for Falls: Graph

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

54

55

56 Every minute = value

57 It’s all about me

58 It’s only me….It’s only me….

59 Strategy vs Culture “Culture eats strategy for lunch” ~Peter Drucker

60 “Culture Eats Strategy for Breakfast, Lunch, Dinner and a Midnight Snack” ~Sharon Cheng

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

62 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

63 Polynesian Culture

64 White Star Lines

65 Best Practice Guidelines Why were we more successful than literature suggests?

66 Group leaders didn’t understand the goal Team members new to reading research Team members were assigned articles to read per week Roadblocks

67 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

68 Shifting Culture Partner therapists strategically Select your groups purposefully Keep groups small, 6 to 8 people

69 Shifting Culture Members should be skilled in critical thinking and group dynamics The leader should be skilled in keeping the group on task

70 Delancey Street Foundation Started in 1971 No government funding Average resident: – convicted felon – high school dropout – substance abuser – illiterate

71 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

72 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

73 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?

74 The best way to learn is to teach Let your staff do the teaching You may need to train your staff to teach

75 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

76 The Blame Game

77 It’s All Healthcare Reform’s Fault

78 US healthcare is not the best We cannot sustain the current percentage of GNP for substandard results Reality Check

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

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

81 I can’t do any more than what I’m doing now

82 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

83 This Change is All About YOU “If you do not change direction, you may end up where you are heading.” ~ Lao Tzu

84 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

85 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

86 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

87 What if You are a Team of One?

88 What if You are a Team of Many?

89 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

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

91 Contact Info

92 References Abrahams J, Zucker D., Zucker J., Airplane [DVD]. United States: Paramount Pictures: By the Numbers. (2014, July). PT in Motion, 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.Org Francke, 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 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.

93 References Grol, R., & Wensing, M. (2004). What drives change? Barriers to and incentives for achieving evidence-based practice. The Medical Journal of Australia, 180(6 Suppl), S 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: Jette, A. M. (2012). Face into the storm. Physical therapy, 92(9), 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), Kocher, R. P., & Adashi, E. Y. (2011). Hospital readmissions and the Affordable Care Act: paying for coordinated quality care. JAMA, 306(16), Kotter, John P., and James L. Heskett. Corporate Culture and Performance. New York: Free, Print. Orszag, P. R., & Emanuel, E. J. (2010). Health care reform and cost control. New England Journal of Medicine, 363(7),

94 References Our Accomplishments. Delancey Street Foundation Web site. Published Accessed November 3, 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), Polynesia’s Genius Navigators. PBS.org Web site. navigators.html. Published February 15, Accessed November 4, Porter, M. E. (2010). What is value in health care?. New England Journal of Medicine, 363(26), 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),

95 References Porter, 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), 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), 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), RMS Titanic. Titanic Pages: Titanic History Web site. Published Updated Accessed October 3, Rothstein JM. Thirty-Second Mary McMillan Lecture: Journeys beyond the horizon. Phys Ther. 2001;81:1817–1829

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


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