Thursday, May 6, 2010

Non-Patient Activity

My current attention has move towards addressing workload and optimal staffing models. Currently I'm developing a framework for determining the optimal staffing levels for Allied Health (okay,... my bias in on PT). My approach is novel (based on my literature review). One issue I would like to bring up now is "non patient care" activity. For Canadian PTs in acute care... particularly those familiar with the Workload Measurement System developed by CIHI and our respective national associations some 30+ years ago... you probably are familiar with what non-patient care activities (NPCA) pertain to.

In general, NPCAs are those tasks that support service delivery but cannot be linked to a specific patient or group of patients. This might include developing policies, procedures, and guidelines. In some cases it will continuing professional development (education) activities such as attending Grand Rounds, inservices,etc. It also includes time becoming oriented to ones role, addressing team issues, etc.

Over the past decade due to the lack of investment in rehabilitation, particularly in light of the growing body of evidence of the effectiveness of rehabilitation interventions, many organization have adjusted to having more patients and fewer therapists by increasing the expectation on clinicians to spend a greater portion of their workday in patient care activities, particularly direct patient care. In some case, organizations are no longer tracking non-patient care activities at all. I have heard managers voice an expectation that clinicians should be spending 100% of their time in direct and indirect patient care. But, I have yet to see or hear a report that these decisions have been beneficial to patient care. At a minimum, the effect on clinicians has been clearly negative. And, from an organizational perspective, the resulting longer patient lengths of stay and higher other health care costs have been overlooked.

It is ESSENTIAL that clinicians have time for activities such as continuing professional development, professional socialization, mentorship and coaching, and reflection on practice... and NO, these are NOT activities that should be pursued on the staff member's own time. These activities clearly impact the ability of the organization to deliver on its promises to patients and the community and it is unacceptable for the organization to not take responsibility for them.

My personal experience is that clinical effectiveness and staff member satisfaction are closely associated with the organization's ability to support non-patient care activities. When well supported, the bottom line ($) of health care is improved.

If organizations want to get a little more "work" out of their staff members, they should focus on reducing the waste associated with service delivery. Some sources of this waste of time are waiting for patients, wasting time moving between patient that could be avoided, waiting for information (such a the physician that neglects to write an order), or waiting for assistance when patient care requires multiple staff member to provide it safely.

Any focus on non-patient care activities... particularly when I work with an organization that does not have a single therapist not spending 80+% of their time in patient care activities... is misguided, and in my view, foolish.

PT Wonk

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