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Transition to Rehab Management

Let the Festivities Begin
by Karen Schiff

A new task is being tackled this week as the year comes to an end. I've heard the term over and over again through the years, something called "The Budget." I'm not familiar with this term, although I believe my superiors think I am. This term, quite honestly, scares me. On a daily basis, I'm aware of the volume of patients seen at our center, and the hours worked by therapists. As we complete our transition to computerized documentation, we're gradually decreasing the time needed to complete charting at the end of the day. This will have a positive impact on our productivity and overall, the budget.

The New Year also brings with it plans for a complete renovation of our outpatient facility (scheduled to begin in approximately one month), and we have a budget to adhere to (mostly to buy shiny, new equipment). I'm not a shopper, nor do I care to stick to a budget on a personal level, but I feel that I'll be held to some kind of level of spending for the department. Given a dollar amount to spend, and a list of equipment wanted by physiatrists and therapists, somehow I have to balance the "wants" with the dollars available. This should be interesting over the next few months, since the renovation hasn't even started and I have drawings and dimensions available from the architect.

As I begin an almost two-week vacation, I find that balance will be necessary to maintain some sort of sanity. Balance the budget, balance the projects coming up, and balance a career and family life that has become busy beyond control. It will take two weeks to reflect on what has been done, and yet to be accomplished.

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Workplace Changes Continue
by Karen Schiff

As I approach the one-year mark of becoming the manager of a large outpatient rehabilitation facility, I realize the changes that have taken place in such a short period of time. Not only was I put into this position to assist a department that needed someone to look out for them, but also help assist them with organization from the front desk to the gym. A new director was placed in a position to run three facilities, but needed someone to oversee and run this department on a day-to-day basis.

Little did I realize at the time that I'd be the one to help in transitioning the registration process and get all players on board with training (and using registration from other facilities to train them), as well as be involved in assisting therapists with their productivity, time management and interpersonal relationships with the rest of the department. Additionally during this time, we transitioned from a fully paper-chart department to a work-in-progress paperless department. We are the first in the district to transform, which was quite a challenge. However, between my director, therapists and I, we've collaboratively designed an electronic documenting system and continue to work on the insurance authorization and verification process.

All of this as I change all the pediatric schedules for the New Year. For the past three days the transition has taken place, sometimes painfully as I calculate all the therapists' schedule documentation time (as well as shorten their day; 10 hours a day treating pediatrics at a 30-minute slot each is just too much for any professional to tolerate and document quality notes on a laptop).

The changes continue. I look forward to time off during the next few weeks to get some rest and dedicate time to my family and friends!

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Performance Appraisals
by Karen Schiff

One of the toughest parts of management is coming into a facility where there hasn't been management previously, and evaluating the performance of staff for the previous year. On one hand, there hadn't been supportive leadership until they brought aboard a director from another facility, who singlehandedly took care of the high and medium performers, while giving a chance to the lowest performers due to the fact they hadn't received mentoring previously. On the other hand, they realized they were all accountable for their performance, and had been informed of this before my arrival a year ago.

As this year has progressed, I've painstakingly performed many performance appraisals, and although I consider myself a friendly, supportive and approachable leader, I find that some professionals aren't in agreement with their appraisal, and are quite surprised that they haven't been performing in an exceptional or outstanding manner. Kudos to the director who overtook this department and set the standard, establishing a new frontier with myself and the inpatient manager by putting all standards down on paper.

No longer will staff question what they need to do in order to achieve an outstanding appraisal (well, perhaps some will), since a tool to measure performance has been developed to objectively evaluate the previous year of service. As with everything, there will be evaluations where tears are shed due to being informed they can do better and others who refuse to sign their evaluation because they don't agree with the grade they receive (even with the necessary components spelled out).

It's a true art to be able to share with an employee the truth; however, it shouldn't be a surprise if done correctly (i.e., coaching and counseling employees regarding concerns as they happen, not at the time of the annual appraisal). An open-door policy established from day one certainly assists in this open communication. What I've learned most recently, however, is that episodes of coaching weren't expected to be brought up at the time of evaluation.

To balance the tumultuous life of management, home, and somewhat of a social life, I've taken to becoming a homebody. What better way to approach the holiday season than to reflect on what I've done, what I'm doing, and what is yet to come. Striving to be the best at everything I do, leading the highest and mentoring the medium performers in my professional life is only half of it. What I do at home to improve my skills off the clock is what I continually attempt to improve, even on the most difficult days in the office.

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Comrades in Management
by Karen Schiff

A Friday lunch with managers from rehabilitation has come to surface on a day when it was much needed. As an up-and-coming rehabilitation institute, a "world-class model" of care is needed, along with changes in the way care is delivered and portrayed to our customers and community. Within the past two weeks, there have been many episodes where staff has been made aware of improvements in areas that are necessary in order to meet our goals and vision. Communication is key when it comes to leading staff to improvements in a department that will not tolerate anything other than the best care possible.

What I have learned from my peers is that personnel should not need guidance for their personalities. I thought I knew this already. Instead, guidance comes in the form of reinforcing positive behaviors and discussing negative behaviors (which may include verbal counseling or coaching). My confusion rests in the inability of others to be able to step back and recognize that a particular situation could have been handled differently, or that it may have been wrong altogether. As we board this model of excellence in healthcare, there are changes in the works, including the manner in which we behave around others such as peers and customers, both internal and external.

Since we're approaching the weekend, I'm looking in retrospect at what I've dealt with over the past two weeks. Jumping in to treat a patient who was less than pleased with his session with a peer, conducting a performance appraisal or two on staff who thought they weren't rated fairly, and being on the phone with a supportive human resources staff who gave me options to consider in my interactions with my team are just some of the things I've accomplished. I would have rather had different interactions; however, to bring great change, there must be changes that are great. As a team, we're all accountable for our part of the action and everyone must be reminded from time to time. This week ends with numerous interviews for staff who will bring professionalism, teamwork, communication and a fresh outlook on a brilliant future. Last but not least, may I add: Thank goodness it's Friday!

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Trials of Management
by Karen Schiff

One of the hardest adjustments I've had to make in this transition to management is counseling employees. From clinical to clerical staff, it's never an easy thing to have "that" talk about inappropriate behavior or actions that led to our interaction in a closed office.

There's nothing more rewarding than rewarding an employee for exemplary behavior, and this is in the back of my mind when having a counseling session. As with any professional interaction with an employee, I've learned that it helps to have those situations discussed as well, so as to compare and contrast the negative and the positive. Most of the time, employees are in agreement with what is being discussed. However, most recently, some interactions have not gone as smoothly.

Most distressing to me is the inability of personnel to realize that certain behaviors aren't acceptable. As a healthcare professional, I aim to display the most professional behavior at all times. Yes, I do slip every so often, and I'll be the first to admit it. My frustration lies in others not being able to admit it as well, regardless of age, experience or culture.

Perhaps a good night's sleep for some to "sleep on it, think about it" will assist their ability to absorb a difficult conversation; I certainly hope so. Having been in their position more than once of being "written up" for inappropriate behavior or not adhering to policy, it was appalling to me (and quite honestly, a wakeup call) to be called out on the situation by my leader. At the same time, through the tears, I vowed to change and become the professional my leader saw me as outside of the counseling.

I'm a firm believer that "we all make mistakes" and we can pull our act together and move on. There's nothing more rewarding than seeing a change for the better, no matter how a conversation ends. One thing is for certain. I have accepted the fact that we will all sway in our behaviors and actions at some point, and that needs to be recognized so we provide only the best customer service and patient care possible; nothing else will be tolerated. It's up to each of us to grow from the experience or perhaps move on if we decide not to become part of the team.

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Three Steps Forward, Two Steps Back
by Karen Schiff

In a day and age when physical therapists are able to justify (or not) the necessity of skilled services, I've had less and less experience with turning away patients who don't meet the requirements for our intervention. As we move toward a more autonomous practice, many physicians are aware that hospital-based physical therapy services may require a prescription to get a patient to receive our services. However, this may not guarantee the patient will receive services they used to specifically spell out intervention for.

This week has proven differently, in that several patients from one physician in particular had come in for a physical therapy evaluation with chronic diagnoses and no acute changes. Frustrated staff have voiced their concerns and inability to wrap their minds around the fact that some physicians out there don't understand the depth of our knowledge, experience and ability to decide if a patient requires the intervention spelled out on a prescription. After lengthy discussions with my staff, I've armed them with information to share with these physicians, to communicate our abilities to our referral sources.

There are several ways to do this, the easiest being a phone call to a physician and not just leaving a message that we're unable to see the referred patient. Instead, asking to speak with the physician at his soonest convenience and then educating him about what we can and cannot offer. Surprisingly to staff and myself, the physician contacted this week who had referred two such patients to us, responded along the lines of, "I honestly just didn't know what to offer the patient and the family." This in turn allowed us to discuss what resources are available instead of PT services that are not reimbursable at this time.

Yes, there are physicians out there who still don't know or understand the depth of our knowledge or skills. It's up to all of us to continue to reach out to all and share our abilities. What interesting ways have you shared with other professionals the services we have to offer?

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Clinical Ladder
by Karen Schiff

Creating an environment that is conducive to staff development has always been at the heart of many healthcare systems. What about self-development? From personal experience, I've learned that many systems don't always support clinical staff education.

One of the reasons I've stayed at my current place of employment is due to the support of my leaders, not only for personal issues, but professional advancement as well. This past year I had the honor of having my doctorate of physical therapy bestowed on me. Being encouraged by my peers who worked with me every day, I decided the time was right in my life to further my education and become "re-ignited," especially after becoming a single mother of two teenage girls.

What better way to show daughters what a strong woman can accomplish, and come out way ahead of anything we ever imagined. Another reason was because my healthcare system believes in investing in its own dedicated, long-term employees. As a result, there's a higher quality of care being delivered by those of us invested in our "second family." 

Although there is a limited number of those left without a graduate degree in physical therapy in the healthcare system, we continuously look for other opportunities for our clinical staff to develop themselves, if not in furthering their degrees, then improving their clinical status. The latest development is the clinical ladder for rehabilitative medicine. Across the healthcare system, we've developed a tool for staff to consider applying for, which will bestow on them a rank that demonstrates a higher level of care, as well as identify the leaders in our system.

As part of a system that employs different levels of education, ages and skills, some of us have struggled with the idea of what it will take to become a level II or level III clinician. From obtaining a higher degree, to developing a program, performing research, providing a continuing education course to outside therapists, the transition of climbing a step on the clinical ladder is proving to be quite challenging to some, and not so much to others who continuously invest in themselves. 

As an employee of Memorial Healthcare System, I'm often reminded why many of us (including myself) entered the field of rehabilitative medicine. Having experienced the support, both emotionally and financially, over the years, I strongly believe that showing employees their education is valued highly, will continue to produce loyal employees for years to come. This system surely has my vote!

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Community Relations
by Karen Schiff

What a great week to shine in our community, showing what we have to offer to just about anyone who lives in the South Broward Hospital District. Starting off with a meeting tonight, where some of our patients are introduced to those who voluntarily give to our healthcare system, they share their stories and warm the hearts of everyone.

These patients are the "poster children/adults" of our practice, and not only sharing their positive and negative experiences, but also the impact rehabilitation has had on their lives. The day-in and day-out operations of rehab medicine can sometimes be overwhelming for us as practitioners, but these gentle reminders of the teamwork and skill of all of healthcare keep us coming back to continually make a difference in our community.

Following an amazingly hectic week, this Saturday is the Annual Autism Walk at a local university, where many teams of rehabilitation professionals and families of those affected by autism will walk to raise dollars and "sense" for the cause. As part of a team of rehab professionals, I will attend this event with one of our healthcare system's therapy dogs, Lily, to walk the 5K and show support for one of our most commonly seen diagnoses in outpatient rehabilitation. Our team, the "Autism Avengers" will proudly support our community by raising awareness. 

Additionally, another group of therapists will attend (at the same time and day as the autism event), a walk to support those affected by Alzheimer's disease. This is the time of year in south Florida to (comfortably) hold these public events, as you can imagine, and with Halloween coming up next week, we will be out in full force, in costume at work (including our therapy dog), to do more footwork for such worthwhile causes. We encourage participation, to support those around us, as this comes naturally for rehabilitation professionals.

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Learning Experience
by Karen Schiff

A large department brings together varied personalities and cultures, which can create a work environment that may be less than desirable for some employees to deal with. This has not been the case as yet; however, many distinct variables exist that have the potential to harm teamwork and communication within the system.

Initially, my thoughts were that different disciplines may not always agree with each other regarding certain aspects of patient care. On the contrary, each discipline is able to make recommendations within its scope of practice to enhance the patient experience and positively affect outcomes. What I've noticed is the difference of opinions within each discipline, and this has me somewhat perplexed.

As a physical therapist for the past 23 years, I've developed my own set of skills and preferences for treatment. I would consider myself a seasoned therapist who knows my limitations. On the other hand, I'm not afraid to take on a patient who others don't have experience with, such as a client with a TMJ dysfunction, or another patient with a pelvic pain syndrome. Within my own discipline, I've noticed that PTs with fewer years out of school have their own specialty, such as manual skills, orthopedics, or neurological patient care.

I can respect this, but since we've all been trained in general patient care, we should be able to at least perform a thorough evaluation and examination, as well as create a patient care plan and determine an appropriate therapy diagnosis. When all else fails, and a particular patient comes in for an evaluation, any therapist can do an evaluation and refer to an appropriate therapist to most effectively intervene on the patient's behalf.

What better way to keep our general skills in check than to accept the patient with a not-so-familiar diagnosis on our schedule? This is an area that I feel many of us shy away from. What I'd like to foster is a learning environment, and share our knowledge with each other in a non-threatening way so we can continue to grow as we mature in the field of rehabilitative medicine.

By doing so, we create increased communication and teamwork with other disciplines, but most importantly within our own discipline. Challenging ourselves may even spark an interest in other areas of specialization, as well as open other opportunities for the future. In the long run, our patients may be better off with differing clinical opinions, which possibly create opportunities for them in their recovery.

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Protecting Our Assets
by Karen Schiff

After three weeks of moving toward a paperless documentation system, the quirks are being worked out. Trying to decide if things are working properly in this new environment has challenged our IT team as well as the leadership team. Listening to employees and testing the environment has led us to decide that changes need to occur, again, to make the process as close to perfect as possible. With one more week to go to "go-live" again, we are in the middle of crunch time to address all the issues we've found.

In the middle of the chaos, we've experienced the normal, everyday "wrenches" in the department. Nearing the end of hurricane season in south Florida, we've had more than enough rain to keep us lush and colorful. What we didn't expect was a leak in the ceiling that normally we could easily address; however, with all the new laptops in the area, the thought of damage to our shiny equipment sent shivers up and down my spine. Thankfully, staff was quick to protect our assets and take charge of the situation as leadership dealt with documentation concerns. As they learn to document in an electronic environment and bite the bullet on the amount of time it takes, the staff protects what is quickly becoming their best friend (the laptop).

This has, undoubtedly, become one of the most surreal weeks in our facility as we undergo such a major change. Some of the phrases that come to mind are: "never a dull moment," "every day is an adventure" and "nothing surprises me anymore." These things I mention in a lighthearted way, since the experience is felt by all those I'm surrounded by, and we find the positive in everything. Isn't that what a therapist always does? I believe so, at least the best professionals I've come in contact with over the years. We will embrace the challenges and continue to work under any circumstances we are placed in. The rehabilitation family continues to grow and experience together, developing skills that will only improve what we have.

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Back to Class
by Karen Schiff

There's nothing like attending a Saturday continuing education class after a busy week of changing an entire electronic documentation system (which took about a year to create) as well as pulling outpatient appointments out of nowhere because of some type of virus running through the department. Yes, I really am looking forward to absorbing clinical information from our own professionals in the healthcare system. It will be a refreshing change and energizer for our physical therapy staff.

As therapists and clerical staff give feedback on our new "toy," computerized documentation, we are taking into consideration all their recommendations, where it is feasible, and molding it into something that's going to be world-class for the entire system. Backed by an incredible team of programmers and our own team builders who work in IT, we are supported and nurtured by all and continue to make the workflow extremely easy to use. Long days followed by nights of deep sleep have enlightened my director and I to make today, Friday, a special day.

I have dragged myself into the clinic today with all the fixings for "Taco Friday," including a bucket of virgin margaritas, with an eyebrow or two raised as the question is asked: "What's that for?" The entire staff has been magnificent, and I wish to praise everyone for all their input and effort, even the errors. It's because of the errors that we have found solutions to potential problems in the future for this healthcare system. Additionally, all the blood, sweat and tears produced are going to make the transition all the more smooth for our sister facilities in Pembroke Pines, Miramar, and Coral Springs.

Tomorrow, we'll all gather at our main hospital for a formal continuing education class led by Tony Milian, ATC, director of our U18 Sports Medicine program. He has arranged for the top pediatric orthopedic and sports medicine surgeons, physical therapists and athletic trainers from our very own Joe DiMaggio Children's Hospital department of orthopedic surgery and U18 program to present the latest evidence-based surgical and rehabilitation management techniques used to address hip and knee injuries in the young athlete. As I continue to promote education and modernization of our skills in this ever-changing outpatient department, staff members continue to grow in motivation and excel in their field. More to come on our growth and expansion as we reach out to all professionals across the nation.

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Epic Changes
by Karen Schiff

Being one of several outpatient rehabilitation departments in a large, community-driven healthcare system, we've come to realize there are areas where we can improve the workflow and performance processes that will assist us in running as efficiently as humanly possible. Moving from the west outpatient center to the east outpatient center close to a year ago has opened my eyes about how different the two centers are in the documentation and care plans for physical, occupational and speech therapy patients, as well as the scheduling processes and flags in a computer system that will assist therapists, registration, and insurance verification and authorization staff.

The role I'm in has allowed me to assist in supporting a large staff of PTs, OTs and STs, as well as a dynamic clerical staff and director. Previous to my arrival was the director who single-handedly ran many other departments (and still does), but needed someone onsite to try to organize and manage a well-established outpatient rehabilitation center fed by our adult hospitals and major children's hospital. As a result of planning and building a new documentation system by our own therapists and professional staff of people working with us from the vendor, our center is currently transitioning to computerized clinical documentation for outpatient rehab. We are the "guinea pig" for the outpatient rehab team in the system, and working on fine-tuning what is needed to comply with all regulations, as well as changing what had been developed over the past year in order to streamline the whole process for therapists, insurance companies and physicians.

It has been quite a challenge over the past three weeks as we continue to master the skills needed to navigate the process. I'm very proud of everyone around me, including the staff who were and still are present, to assist us with the launch of this major transition. At this time, many responsibilities the manager bears have taken a seat to the side as we get through the first few weeks of this launch, and I hope that soon I'll see my desk again, uncluttered, as we gain more confidence in our ability to achieve a paperless department.

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Moving Forward
by Karen Schiff

The transition to becoming a doctor of physical therapy has come to an end. The celebration continues as I learn how a busy outpatient department runs in the midst of major clinical changes, including the transition to computerized documentation and renovation of our entire building to accommodate our community's needs. Transition seems to be the theme for the past few years, where I have seen my colleagues graduate, move up the clinical ladder, move away from the area, get married, have babies, have grandchildren... the list goes on and on.

As a long-term employee of a major healthcare system in South Florida, I've had the honor of working with such a diverse population, not to mention the professionals who are the foundation of a strong, community-driven system. For almost a year now, I've been the manager of an outpatient rehabilitation center on the east side of town, and have found this transition to be very exciting and rewarding, as well as challenging at times. This is what I'd like to focus on for the future of this blog: the ins and outs, the ups and downs, the excitement and busy days and moments that bring us together as a family and community. I hope you continue to follow me as I explore the fascinating and entertaining world of rehabilitative medicine, from a DPT's perspective.

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DPT Completed
by Karen Schiff

Career goal completed. I officially received my doctorate of physical therapy on August 16, 2013, from Shenandoah University in Winchester, Va. The week was filled with an amazing vacation with my two daughters, followed by a reunion with one of several brothers and a celebration upon my arrival from vacation.

As I sat in the auditorium listening to several speeches from distinguished professors, I found myself reflecting on the past two years and the amount of knowledge and understanding that I gained from this experience. While many of us graduating have been physical therapists for many years, 28 candidates sitting in front of us were completing a three-year program and were just beginning their careers as DPTs.

What sets us apart from these young, energetic DPTs? The experience and understanding of complex situations certainly gives us an advantage; however, similarities exist in that we can provide a higher level of skill and care to our patients than ever before. We are comfortable with sharing our knowledge of evidence-based care, as well as physical therapy diagnostic patterns and descriptions. Going through my mind is, "What is the next step?" Perhaps looking into my PhD, or becoming certified in an orthopedic specialty. After all, I'll have ample time to spare now that my studies have come to an end.

To top it all off, today I was approached by three of my peers who are going to be applying to return to school for their DPTs. This has absolutely floored me, and I'm very impressed with their dedication to their patients and careers. I've truly been blessed to be surrounded with such amazing people at every facility I've worked at. I will support my newest coworkers in their quest for their DPTs and look forward to mentoring Chris, Estela, and Eileen at Memorial Regional Hospital South. You will not be disappointed, and will gain a wealth of knowledge!

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Pre-Grad Vacation
by Karen Schiff
A few days before graduation in a bustling, hectic city brings excitement and quality time with two great traveling companions. You would think that completing a transitional doctorate of physical therapy program would bring me insight on how to navigate technologically through the city of Washington, D.C. However, if it weren't for these two daughters of mine, I would be lost somewhere between the Lincoln Memorial and Washington Monument. 

Yes, each of us has our own smartphone, and apparently my smartphone is much smarter than I (not to mention my kids' ability to show me what I don't know about my own phone). At the moment when I realize that I'm only steps away from the White House and my hotel, I find my kids talking to protestors and sharing their own thoughts with others about freedom of speech and living in the "Land of the Free." This is truly the trip of a lifetime, where not only do I get to experience my own graduation, but also get to see two highly independent daughters develop into something bigger than I ever expected.

This is just what I had prayed and hoped for, to prepare for receiving my DPT and serving as a role model for two daughters who look up to a strong, educated parent, not to mention sharing what I've learned and the need for further research in our field. In the meantime, we'll enjoy our stay together away from home, and create memories that will finish with a hooding ceremony on Friday afternoon. 

With two traveling companions equipped with GPS technology, we will make it to Winchester, Va., by Wednesday afternoon to prepare for Friday's event, joined by family and friends.

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