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Raising the Bar in Rehab

How Do You Measure Quality?

Published December 5, 2012 12:46 PM by Lisa Mueller

I'm stuck. As 2012 comes to an end and I start writing goals for 2013, I don't know the best way to measure quality-driven initiatives within our rehab department without relying on quantitative data. How can I prove that our team is the best? How do you measure quality?

Patient satisfaction is a popular way for businesses to gauge their success, which makes sense on some level. If the customers are pleased with their experience and results, they will (theoretically) return again, indicating the quality was sufficient (or no harm was done) to engage the clients. What if a patient is happy even though he received poor quality physical therapy? What if none of the patient's goals were met, the therapist used ineffective methods for treatment, but the patient had a good time at his appointments and rated his satisfaction high? That's why patient satisfaction and quality of care are independent variables and can't be exclusively linked.

If you ask me for a suggestion for a surgeon, or even for another therapist, I can give you the name of someone I'd trust. I base my recommendation on a few factors -- that person's skills, outcomes and the number of bad experiences she has. I don't think about her bedside manner, response time by email, adaptability to change or any number of things you may see in a performance review. That's how I measure the quality of another provider -- but how can that be measured in a tractable format? How do you measure someone's skills? By watching that person practice? By having annual competencies to complete?

Measuring outcomes is becoming more common in the physical therapy profession. Does your facility integrate forms such as the DASH or the Berg Balance Test, and the data from those surveys as a measurement of your quality as a therapist? Is that a fair tool to measure your quality as a therapist?

This becomes more complicated to me when I think about measuring the quality of therapists who have completely different treatment styles, patient populations and diagnoses. Apples and oranges, really. One of my old job sites was overwhelmingly obsessed with productivity. It was discussed at nearly every meeting and was certainly part of performance reviews. It drove me crazy. I didn't understand why a great therapist would be measured on something that appeared completely unrelated to my skills as a therapist. It makes sense to me now -- productivity is easy to calculate. Productivity can be used to compare therapists regardless of their differing skills.

My thoughts are kind of scattered across this blog, but I think that's because there are so many factors that drive quality, and none of them can be individually measured. A patient's experience and success in physical therapy relies as much on his own beliefs and expectations as it does on the skills of the therapist.

What do you think? How is quality measured at your physical therapy practice?


When I worked in the UK, I was frustrated by the fact that there was an abundance of qualitative measures and too few quantitative. On that note, I recall one highly skilled Pulmonary Specialist who had the worst bedside manner in the world, no really, in 22 years I've never seen worse. He was always clinically right, but often the patient's couldn't or wouldn't take in what he said or his instructions because they were either shocked or offended by his manner. Qualitative measures do have value and implications for quantitative outcomes. Asking patients if they felt like they were treated with respect and dignity; if they felt the clinician really listened to what they had to say; if they felt there was value for money in receiving treatment, all might help improve patient satisfaction and improving business thereby allowing you more opportunity to collect quantitative outcomes. Good luck!

Dean Metz December 5, 2012 6:48 PM

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