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Raising the Bar in Rehab

What Should We Measure?

Published February 28, 2013 5:00 PM by Lisa Mueller
I'm slowly becoming more interested in the idea of performance reviews for physical therapists. The first few years as a physical therapist I didn't really think much about the process, because I was new and enjoying my career and that was overwhelming enough! Now that I've had time to reflect on my previous reviews and prepare for this year's, I wonder what the best way is to accurately summarize a year of providing quality care to patients.

There are a few different perspectives to consider when thinking about physical therapy data -- what would you want to know if you were a patient? What would you want to know if you were a business owner? And finally, what would you want to know as a therapist? I've thought about all the possible measurement tools over the past few weeks and have come up with this list:

1. Measure therapists on their efficiency, or the number of visits per evaluation for a patient to be discharged from care. This seems simple enough -- a skilled or talented therapist will be able to help patients in a shorter amount of time. This measurement doesn't account for the number of patients who self-discharge from care, or the number of patients who are seen for an evaluation only.

2. Measure how many patients reach their goals. Our primary role is to help our patients reach goals that they have deemed most important, but part of this measurement tool depends on writing appropriate and achievable goals.

3. Measure patient satisfaction. I've read a few articles on how higher patient satisfaction is linked to higher-quality care, as engaged patients are more likely to listen and participate in their care. (I wrote about this recently).

4. Measure improvements based on outcome measure surveys. As a therapist, I think this is where our profession is moving toward, but this is also the most difficult to capture. Clinics need to have the right software in order to track outcome measures.

5. Measure productivity. This is probably the most common measurement tool in the physical therapy world, partly because it's an easy calculation to determine. Like I've mentioned before, I think this is a little bit of a dangerous tool because therapists measured by productivity alone can be driven to improper billing in order to improve their productivity data.

6. Measure number of referrals received. This is an important piece of data for understanding which therapists drive volume and business through the clinic. The truth is that talented therapists with good outcomes will attract more business by word-of-mouth referrals, and that's something all business owners will want to measure.

As many of these measurements include (to some extent) the patients (their outcomes, their length of stay), it's important to remember aspects of each patient that may influence the measurements. For example, if a patient isn't motivated or especially participatory in his care, it may reflect poorly on the therapist even though it's a factor that can't be entirely controlled.

What do you think about this? What do you want to be measured on? If you were a patient, what measurements would you consider before choosing a physical therapist?

2 comments

Toni,

Great perspective.  I think that's why this topic interests me so much- because there isn't a clear answer.  But when you say "We all know who the good therapists are where we work"- how are you forming those opinions?  We must be measuring ourselves and our colleagues on some aspects of patient care.  

I was an ICU therapist, and when it came to goal-writing I was very conservative to ensure that even the smallest improvements were attainable.  If our "product" as a profession is patient care, and our patients participate in therapy to reach their goals, we must be at least partially accountable to the achievement of those goals. (And monitoring/adjusting goals when appropriate).  

Thanks for sharing your thoughts!

Lisa Mueller March 1, 2013 1:03 PM

Those are all good ideas but the majority are subjective or can be affected by an outside variable.  Percentage of goals achieved is good except many pts don't achieve their goals for reasons beyond the control of their therapist. I would hate to be an ICU therapist if my raise was based on goal achievement.

There is no good way to assess PTs.  Timeliness of documentation is often used.  Another might be contribution to staff learning via inservices and journal club.  There is also peer reviews of documentation and of skills.    We all know who the good therapists are where we work.

Eventually it falls to productivity which again is somewhat beyond control.  If I work in a neuro ICU I "waste" a lot of time preparing my pts for treatment, etc, but may never sit down.  If I work on a rehab unit I'm forced to be productive.

I don't think there is an answer.

Toni February 28, 2013 6:26 PM

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