Ethics VS Productivity
As I've always said, productivity standards can jeopardize our ethical obligation. Trying to maintain productivity on a consistent basis is a tough task, especially with most employers requiring 85% or better. However, faced with the threat of losing your job can easily tempt us to alter the minutes we report.
There are other things besides productivity that tempt us to alter minutes. Some of the toughest patients to work with are usually placed in a high or ultra-high RUG group. It's very challenging to do a treatment for 60+ minutes with a patient who can barely respond, is verbally abusive or highly dependent with most ADLs.
Not long ago I had a patient who was not happy with having to do therapy, being confined in the nursing home, being sick, etc. and took all of their frustrations out on anyone around them. Fifteen minutes felt like an hour with the continual complaints and verbal abuse from the patient.
Another patient I remember was very lethargic and suffered with Alzheimer's. Addressing the set goals required maximum assist and maximum verbal cues for everything, even simple tasks. Not that this is a bad situation for therapy, but after the person has been on caseload for months with little change it got frustrating.
These are just a couple of situations that I've found myself facing in the past. Sometimes I admit the little voice in my head said "Get me out of here, ten minutes early won't hurt." Then all the other things run through my head, like what if I get caught or the person says something? My license is not worth cheating the clock out of ten minutes.
Of course employers get part of the blame for tempting us to be unethical with minute reporting. Since they have no worries of losing their license to practice they can demand increased productivity. But the license at stake is yours, and violations can have penalties ranging from fines, suspensions or jail.
Again, we are dealing with a system that has high expectations for the work we do. Being unethical will only make OT seem less of a viable profession to outsiders who do not understand the system. We must work by the rules, but my main thought is healthcare shouldn't be about minutes, it should be about what the patient needs.
Until next time, hope all your thoughts are good-