If You Want My Respect, Earn It
Currently I'm working in a SNF. Every Monday we have our weekly meeting to go over proposed discharged dates. Our census generally runs 125-135 which is a lot of patients to keep track of. Since we're all together in one place we frequently have a department meeting first. We had one today. Once again I sat there and shook my head. My problem isn't the meetings. It's the manager. I don't respect her. I don't think she's doing a good job or really has a clue about what needs to be done. She knows the Medicare regs and ins and outs of how a SNF works. Her people skills are great. She might be an excellent therapist. I don't know. I've only known her as a manager. Her managerial skills need some work.
It's hard to work for someone you don't respect. A level of respect comes with a managerial position. Respect is a funny thing. A job title only goes so far. To have respect you have to earn it. Now no one can know everything. If you're a manager I have an expectation of knowledge and skill that go with the job. I expect a certain ability to recognize problems and implement solutions. I'm not sure she sees the problems. I think she misses the procedures in search of the outcomes. If you don't know the steps you can't fix the problem.
For example we have a problem with lost minutes. If minutes aren't documented they never happened. All SNF reimbursement is based on the amount of time a patient receives skilled services so every minute counts. Her solution is to change the location where we record our minutes. Instead of alphabetical listings, it will be based on assessment periods. Now if I'm forgetting to record minutes I'm going to forget to record them no matter where you want me to write them. This is a great solution if you want to keep track of assessment minutes. But it's not going to help someone remember to write them down in the first place.
Another problem is one way communication. All communication goes through her to the weekly care plan meetings. That's efficient and prevents the therapists from wasting time. The problem is the communication only goes one way. Unless I make a point to ask about a specific patient I never know is said. Telling me someone is going home with family just isn't helpful. It doesn't tell me what I want to know. Will there be adequate supervision? Is the family aware of the patient's limitations? Will the caregiver be able to adequately care for the patient? What kind of environment is home? My patients are frequently confused. They can't tell me these things. Unless I meet a family member or caregiver I don't know. There needs to be a way for the treating therapists to get this information. As far as I can tell our manager doesn't even recognize this as a problem. Our Social Workers aren't much for documentation so there's not much help there.
However today we were told not to discharge a patient for refusals until we try a different therapist. We were also told to put patient who's missed a treatment during the week on the weekend schedule. These things are already happening. I had to sit there and wonder. If your staff is good and knows what to do without being told, does that automatically make you a good manager or just lucky? No one told us what to do. We just do it.
Now I'm not saying I would do any better. Nor do I think I have all the answers. I would certainly address things differently but that's no guarantee of a different outcome. There are lots of great managers out there who work hard. Sometimes a mistake is made. I can think of a few classics from the past I've seen. I think a good manager is someone who knows her department, knows what needs to be done and knows when to ask for help.