Problems with Pliable Policies

person pulling yellow putty apart

Accommodate for the greater good without weakening foundations

By Nathan Risley

When considering the idea of flexible policies, there are two, many times contradictory, lines of thought that run through my mind. The first thought is wanting to be flexible with a policy to help someone better achieve a goal with less hurdles and resistance in the way. It is in the spirit of empathy or support that I want to make the road to success as smooth as possible. This tends to conflict with the second thought; what is the purpose of intentionally constructed policies if they need to have an asterisk next to them with a list of exceptions?

There are many areas where the letter of the law, sometimes quite literally, must be followed exactly and without exception. These include but are not limited to compliance with state and federal regulation, contractual obligations, licensing and credentialing, protected health information, and much more. These are non-negotiables and should be clear to all staff and clients alike through clear explanation and consistent application.


Policies are so vitally important in physical therapy for reasons of compliance, client relations, staff coordination, consistency in outcomes, financial success, and many other considerations. Before we can look at the potential areas of flexibility, we first need to know why we have the policy in the first place.

Policies should be clear, tested, replicable, and reviewed in some frequency to update them as needed or eliminate them altogether if they are not serving their intended purpose. In this process, we should be able to remove the need for “flexibility” if the policy is comprehensive and considers its purpose with the benefit of practice and review. Good policies give us a road map; great policies can anticipate detours and still get us to our destination on time.


With that said, there will be occasions that will not have been predicted and need to be addressed uniquely within a vacuum.

It seems that many situations where we consider bending an established policy is in an attempt to accommodate a client in one way or another. An undoubtedly common instance for many practices would be the application or waiving of cancellation fees. When we want to satisfy every client in our care, it can feel aggressive and customer unfriendly to charge cancellation fees that can arise from a wide variety of circumstances. Any of us can relate to the crunch of coordinating a number of schedules and inevitably overcommitting our time.


Before the consideration of a policy’s flexibility, first review the purpose of the policy and why it was originally conceived. Cancellation fees are a tool to protect the valuable time of our administrative staff and therapists and to ensure that appointment slots are not going to waste with so many clients that would have benefited from therapy in that lost appointment. It is also an investment incentive for the client to stick to their plan of care and to commit to the schedule that they agreed to uphold as a part of their therapy.

Still, there may be occasions where more leniency is afforded to someone who had to cancel within that cancellation fee window. Be it illness, family emergency, automotive issues; so many occurrences can draw us toward an empathetic waiving of the fee in opposition to an established policy. First, we need to involve anyone that would make the ultimate decision on ignoring a policy as an accommodation. Cancellation fee policies depend so heavily on their consistent application. It would be untenable to let anyone decide the legitimacy of a policy from occurrence to occurrence and expect it to be an effective tool. Next, we will need to determine if it is truly appropriate to ignore or modify a policy in this one-off situation. Are the circumstances so unreasonable that this is truly a unique episode? Would this lead to a less clear function of the original policy? If this is not a unique episode, does the policy need to be addended, or does better training need to be offered to the staff to more effectively observe the policy in a consistent manner?

Another perspective to evaluate when bending a policy is at what cost does this exception arrive. Using the cancelation fee example, if we are waiving a fee for a patient to accommodate them in some way. What is the cost of that decision? Clearly, there is the lost revenue of the visit or the fee to subsidize the loss. In some instances, this may be justified by you and your team in light of the unique circumstances. There is, however, the added cost of investment and value on the part of the client. The client enters an agreement with the scheduling of their plan of care. Even under noble circumstances to waive that fee, if the importance of the policy is not reminded to the client, then any consideration of canceling in the future will be with some assurance of accommodation based on precedent. Think of the downstream implications of that flexibility. A policy is far harder to uphold the longer communication of its importance is delayed. It will be hard to apply that cancellation fee if you waived it four times before attempting to enforce it.


I encourage you to look at a process you may take for granted as rote, something you may have assigned to autopilot in your mind. If that policy has a written instruction, follow it to the T and imagine it as a new hire may view the policy. If it is clear to you, have another team member repeat the process to make sure it is clear to others as well. Not only will this review allow you to evaluate the effectiveness of the policy, it will also offer the opportunity to imagine the anomalies and how to get ahead of them. Only when we fully understand and appreciate our policies and how they benefit our practices will we acknowledge that being flexible can sometimes lead to our demise. 

Nathan Risley

Nathan Risley is an APTA Private Practice member, the Office Manager for Action Potential Physical Therapy in South Eastern PA. Collaborating and learning from others is our best education, so please reach out if you have any questions or comments at

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