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PT and the Greater Good

Is My New York showing?

Published December 2, 2009 11:50 AM by Dean Metz
I was attending a committee meeting this week about the new screening form being created for all the teams and disciplines in my county. This is a project that has been in the works for a while and the form is nearly in pilot ready condition. Well, that's what I was told and what the group believed.

The polite guest in the foreign country disappeared for a little bit and the cantankerous old geezer showed up instead. Now I know that forms and documentation are a necessary part of health care and when properly designed and utilized they can actually assist in our work. This was supposed to be a screening tool. Each discipline would still do their own thorough evaluation. It is eight pages long. HUH?!?! No.

In an era when health professionals the world over are being told to become more efficient and effective at the same time, the old idea of throwing another form at a problem is as outdated as a Brontosaurus. I've been on a lot of form committees and groups to design forms. I've even designed a field evaluation tool for nurses (yes, nurses) which was implemented by my old employer just this month. These are my thoughts on new forms:

1. Is it Essential? Is there a real problem that needs to be fixed, is there a staff training issue that could satisfy the same need, or could information be gathered in some other way? If it is not essential, then don't create another piece of paper to be completed.

2. Is it Effective? Are you really going to get the information you need or identify areas previously missed or improve practice or reduce errors? Will everyone be filling it out the same way or will it be the Tower of Babel? Do you have clear means to evaluate the form once it is piloted? Staff liking it or hating it is nice, but rarely what one is looking for when a new form is designed.

3. Is it Efficient? Are you gathering too much information, rewriting information available in some other part of the record, or creating a monster that clinicians will not comply with due to the burden placed upon them? Edit, Edit, Edit!

So, I spoke up. Surprisingly, the nurses seemed to agree with me and the rehab staff gave me the biggest challenge. I came up with some ideas on how to decrease the amount of narrative documentation. That wasn't received well. In the end, I was heard and my point of view was validated, but not adopted. The form will go to pilot. I will press to be part of the evaluation committee! Yes, I will kick and scream against extraneous documentation!

Being a new member of any staff is never easy. I have told many people that if things were going smoothly at your new employer's place, they wouldn't have needed to hire you in the first place. Being a new member of staff and a foreigner (from New York yet) makes the boundaries between assertive and aggressive even more difficult to negotiate.


When I was in a position to create and implement new forms, my rule was:  Don't implement a new piece of paperwork unless it allows you to dispose of at least two pieces of existing paperwork.  Of course, that can't always be done, but it is a good measure to shoot for - and keeps you focused on the three Es you mentioned.  Unless you are with a new program that doesn't have all paperwork created yet, if a new form is truly all three of those Es, then chances are it will replace at least two existing forms.

Janey Goude December 3, 2009 3:45 PM

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About this Blog

    Dean Metz
    Occupation: Staff Development Specialist
    Setting: New York, NY – Newcastle Upon Tyne, Great Britain
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