Keeping Staff Accountable

How to keep employees on task—without being big brother.

By Carl Mattiola

Physical therapists in private practice measure objectives when it comes to our patients. However, when we step away from patients and focus on running our practices, we do not often know what to measure or how to measure it. One critical measure that elicits a great deal of discussion, emotion, and controversy is employee performance.

Why the controversy? I have heard myriad excuses from colleagues:

“It will take too long to set up.”

“Collecting data is too Big Brother-y.”

“Staff will be resentful if we evaluate them by the numbers.”

“It’s micro-managing.”

“It’s messy.”

“Our system works fine the way it is.”

However, that is not necessarily the case. Accurately tracking performance is one of the best ways to improve your physical therapists’ productivity and increase their job satisfaction.¹ As Jason Richardson, vice president of clinical operations at Results Physiotherapy says, “If you cannot measure it, you cannot influence it.”

Measuring performance can help in the following ways:

1. Practice owners can get an objective view of their clinicians’ areas for improvement and overall potential. In addition, access to accurate statistics makes it easier to start crucial conversations about performance.
2. Physical therapists will have a clearer picture of their job—what is expected of them and how they can meet those expectations. Employees who understand how they are being assessed are more satisfied than those who feel their role is ambiguous.² With a clear path to follow, clinicians are in control of their destiny.
3. Patients will benefit from an efficient practice, staffed by satisfied employees.
4. Your practice’s productivity will increase, and so will the bottom line.

How should you measure performance in your practice?

They key lies in your company culture. In fact, it is the single most important factor in implementing any new system. Start by explaining your goals in a way that shows the benefit to everyone, and take time to listen to employees’ concerns. Sturdy McKee, chief executive officer of San Francisco Sport and Spine Physical Therapy, has had great success with implementing employee accountability. His advice? “Keep the lines of communication open and you will manage change more effectively. Change implementation will take longer than you expect and will remain a work in progress for a long time.” Reinforce that this is a positive tool to help everyone improve.

Once your team is on board, establish key performance indicators (KPIs) for each physical therapy. “Each therapist in our company shares these metrics at our weekly staff meeting: visits, attendance rate, new patients, discharges, percentage of discharges, and how they look for the upcoming week,” says Chad Madden, Founder of Madden Physical Therapy. “If there is an area that needs attention, the physical therapists reveal to the group how they plan to improve over the next week. This makes it easier on our management team because each physical therapist is accountable to the entire group. If they have a percentage of patients falling off on plans of care, the physical therapist can see how it affects the group. With good staff in place, it becomes self-regulating and a win-win for everyone.” (Learn more about establishing KPIs here (http://www.ppsimpact.org/setting-goals)

Next, discuss each individualized plan with your physical therapists. Explain what you will track and how often you will check on their progress. Use this conversation to motivate and energize employees by letting them know you anticipate great things from them. According to Dr. Eric Bull, chief executive officer and co-founder of Spine and Sport, “When people know what they are there to do and then you measure it with a statistic, it actually gives them a good feeling of job security. People tend to like it when it is done well.”

One this reporting is in place, track your KPIs. If you have a practice management system in place, you already have a plethora of information available. Make the effort to consistently pull, review, and share the data. When you do this regularly, metrics become a normal part of work life, not something to fear. Even if there is initial trepidation, McKeever says, “There are a lot of emotions that come into all of this as we learn and grow and change, and that is okay. We all have room to grow and learn.”

Practices across the country have found this process to be helpful. There are also few unexpected benefits:

1. You will notice immediate opportunities for change. “The first thing we found was that about 50 percent of our total patient referrals came from two positions. If something happened to one of those people, that could be a significant change to our business and might affect our survivability,” says McKeever. They immediately began broadening their marketing initiatives to widen their referral base.
2. Staff will rise to the occasion, with performance improving across the board.³ This unique phenomenon is called “Metric Motivation,” and it occurs when public recognition from employers ignites extrinsic motivation among employees.
3. Your best employees will excel further and be happier. Even though they are already high performers, bringing hard numbers into the mix often inspires additional achievement.
4. Your lowest performing employees may turn over. Or, they may finally have the role clarity they need to improve.
5. When your physical therapists are happier, your patients will be happier; you may even see an increase in those who come for their full plan of care. You might worry that increased productivity will reduce quality of care, but it should not. Maximizing your clinicians’ performance is about positive motivation, not about cutting corners.

It has been proven that in almost any business, happier employees and happier patients add up to a happier bottom line.⁴ So it is no surprise that practices that value productivity outperform those that do not. Start measuring clinician performance today, and you will be measuring increased revenue tomorrow.

Carl Mattiola is founder and chief executive officer of ClinicMetrics. He can be reached at carl@clinicmetrics.com.

References:

1. Bohannon RW. Productivity among physical therapists: an evaluation of one department. Phys Ther. 1984; 64: 1242-1244. Available from: www.physicaltherapyjournal.com/content/64/8/1242.full.pdf Accessed June 16, 2014.

2. Hurrell, Jr., Joseph J, Levi, et al. Encyclopedia of Occupational Health and Safety. Jeanne Mager Stellman, Editor-in-Chief., Geneva: International Labor Organization; 2011. Available at: www.ilo.org/oshenc/part-v/psychosocial-and-organizational-factors/factors-intrinsic-to-the-job/item/21-role-clarity-and-role-overload. Accessibility verified June 16, 2014.

3. Human Capital Institute. The value and ROI of employee recognition: linking recognition to improved job performance and increased business value—the current state and future needs. Available at: www.marketing.org/files/Value_and_ROI.pdf. Accessed June 16, 2014.

4. Harter JK, Schmidt FL, Hayes TL. Business-Unit-Level Relationship Between Employee Satisfaction, Employee Engagement, and Business Outcomes: A Meta-Analysis. Journal of Applied Psychology. 2002; 268-279.