Productivity in Therapy

Productivity in Therapy: An Open Discussion

While productivity is a common word, anyone in the therapy world knows exactly what we’re talking about when we mention it. Whether you’re practicing in OT, PT or SLP, you know we’re not talking about ways to make ourselves more effective in managing our time, we’re talking about that percentage that looms over our heads while we head to work.

We’re talking about the reason you have to wait until *just* the right moment to use the bathroom or get a drink. We’re talking about the reason something as simple as helping a patient with a non-clinical task could throw off your entire day.

Within some circles, productivity seems like a dirty word. It’s not often discussed, but it is something that we all deal with. Even if we work in a treatment setting that doesn’t monitor our every working minute, productivity is something we have all become too familiar with. You may find yourself asking, “How can I improve my productivity? Am I the only person struggling with productivity?”

You are not the only one! So, we will be sharing some thoughts and ideas about productivity in occupational therapy in this article as well as in our companion article, Low Stress Tips and Tricks for Achieving Productivity. These productivity articles are applicable to all therapy disciplines. 

First, How NOT to Stay Productive

Unfortunately, this article won’t have the magic fix that will keep your productivity sky-high without adding any stress to your day. It will, though, have some tips and tricks from experienced practitioners who have worked in high-productivity environments for years. We will also review what not to do to keep that number where it should be.

To start, let’s talk about what you should not do to keep your productivity high. Under no circumstances should you violate your morals and lie. Even if it feels like your coworkers are doing this to get by, it is not worth the risk to your license, reputation, and career. It is also not fair to your patients. 

True story: I worked with a PTA who kept his productivity at exactly 90% (our facility’s requirement for assistants). His secret? He would come in at 4:00 AM every morning, clock in, pick up his schedule, then head back home and go back to bed. Around noon, he would stroll back in, write some notes, and then clock out at precisely the right time to be at 90. Obviously, no one had any clue that this was happening. In fact, he was able to keep this up for almost a month. Once someone noticed some odd clocking in times, he was swiftly fired and had his license revoked.

It takes a lot of guts to get to the point that you’re doing absolutely no patient care. But that kind of traumatic change doesn’t happen overnight. I am sure that before he ended up at that extreme, he was spending 45 minutes with a patient and billing 55, then spending 30, then 20, then 10. Fudging numbers is a slippery slope that can lead you to a place you never thought you would go.

If you find yourself working at a job that requires therapists to fudge numbers, even by a few minutes here and there to maintain their standards, it is probably a good idea to look for other job options that will allow you to practice ethically and not burn yourself out by constantly working to maintain ultra-high, unrealistic productivity percentages. 

occupational therapy productivity ethics

How to Stay Productive 

Clearly, committing insurance fraud is not the answer to achieving the productivity level that you need. What are you supposed to do to keep your productivity high? Here are some helpful tips that have been gathered from a number of practitioners with decades of experience working in high-productivity environments.

Plan ahead. If your goal is to stay on top of your productivity numbers all day, you need to have a game plan to make that happen. People do this in different ways. One OT recommends looking through your patient list and seeing who you recognize. We all have those patients that we know will do anything with us at any time. Others might have scheduled appointments or may just be better in the morning or afternoon.

Even if you don’t know all the patients on your schedule, another good trick is to go around and introduce yourself to each of your patients. During this time, educate them on the purpose of occupational therapy (use your OT elevator pitch!) and what they can expect to see during their treatment. Sometimes, you’ll even be able to catch some ADLs and get some more substantial minutes chipped away!

Once you are more familiar with who is on your schedule, you can develop a game plan for what you will do with each person. While doing this, be sure to look for things that will be easy to break into chunks and work throughout the day. For example, if you know you have a feeding goal to work with someone on, you can pop in for a few minutes to help them set up their breakfast, then catch the person down the hall for some therapeutic exercise. After that, you might be able to work further down that same hallway and do some transfer training. Having treatments planned out in a route makes it easier to eliminate the unbillable time for walking from room to room.

Another helpful tip is making wise use of hands-off treatments. Even though we all want to be as hands-on and functional with our treatments, nothing works to improve functional activity tolerance quite like an arm bike or a NuStep. If you’re going to have someone using one of these devices, that would be a great time to catch up on treatment notes or ask another therapist to keep an eye on them while you take a quick bathroom break.

Possibly the biggest game-changer for productivity, though, is point-of-service documentation. Point-of-service can be challenging and isn’t always an option, but once you’ve gotten the hang of it, you’ll be able to work on notes while treating a patient. Even if you can’t write your full note during the treatment, jotting down a few aspects about the session as you go will make a difference. That way, you don’t have to waste time trying to remember what you did 6 hours ago and how well they performed. Instead, you’ll have some personal notes that will make writing your actual notes a no-brainer. You can also review their progress with them while you’re documenting their treatment so that you’re still providing skilled care as well.

point of service documentation

A Final Thought on Productivity

All of this sounds great in theory, but any therapist who has spent time practicing under a productivity requirement knows that it is rarely as easy as it sounds to stay productive. And any practitioner who has spent years in the field has seen the productivity expectations of management slowly creep up to the almost unimaginable numbers we see today.

Add to that the addition of concurrent and group treatment expectations, and now some therapists are expected to regularly hit a productivity percentage higher than 100%!

How did this happen?

The sad truth is that we as a practice have slowly brought it upon ourselves. How so? As therapy management companies have pushed the boundaries that we as practitioners are comfortable with maintaining, we have continually allowed these expectations that previously seemed impossible to become the norm. Even if we personally have spoken up, we may have been reminded that if we are not willing to meet company expectations, there are plenty of other practitioners who are willing to. Each time we give an inch of leeway to the powers that be, we slowly take away some of our own rights for the future.

That seems pretty grim, so what can we do about it?

The first step that each and every one of us can take is to stand our ground when it comes to what we know to be the best practice for our clients. Never sacrifice your integrity or the quality of the care you provide just to meet a productivity requirement.

On a bigger scale though, no one practitioner is able to make a sweeping change across the board on their own. Instead, associations like AOTA, APTA and ASHA, as well as state and local therapy associations regularly advocate for a better understanding of productivity expectations and the effect that they have on practitioners and treatment. Supporting these organizations in whatever way we can will help make a better future for the field that we love so much.

What other thoughts do you have about therapy productivity? Do you have any other suggestions about how we can help practitioners keep realistic and ethical standards? Let us know in the comments below! We would like for this to be an open and thought provoking discussion.  

Additional Readings and Resources

Essay: High Productivity Demands Negatively Impact Patient Quality of Care

APTA Productivity Library 

Our Picks for the Best Therapy Productivity Calculators (My OT Spot)

8 Excellent SNF Productivity Tips For OT Practitioners (OT Flourish)

This article was cowritten by Michel Moniger, COTA/L and Sarah Stromsdorfer, OTR/L.

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