Management of Physical Therapy Services

1. Management of Physical Therapy Services PO 006.04

2. Learning Objectives • The Physical Therapy Technician will perform service management by: • Completing PT stats • Defining workload stats • Complete statistics log books appropriately • Explaining and promoting continuous quality improvement activities • Self and peer evaluations • Chart audits

3. Learning Objectives Continued . . . • Explaining and promoting risk management strategies • Define standard of practice • Define standard operating procedures (SOP) • Create basic SOP for PT departments • Implementing a plan for patient complaints • Investigate valid patient complaints regarding PT services • Help devise recommendations to address valid complaints

4. Statistics • The collection, organization, analysis, interpretation and presentation of data • A statistic refers to a quantity (such as an average) which is calculated from a set of data • Collecting stats allows for the, analysis, interpretation or explanation, and presentation of data

5. Statistics Example • 12 PTT students take a test • The grades are as follows: • 100 • 90 • 89 • 86 • 75 • 70 • 78 • 85 • 78 • 92 • 95 • 88 • What is the average of the class? • To calculate average, add all the grades together then divide the answer by the total number of grades: • Add all 12 grades = 1026 • Divide by 12 = 85.5% • Therefore, the average grade in the class is 85.5%

6. Workload Stats • Stats collected on data pertaining to a particular employee and the services provided by that person, to evaluate an outcome • Entered daily and collected during all hours classified as work • Data is broken down into several categories which can be used to evaluate the overall effectiveness of that employee

7. Workload Stats Data • Examples of information that can be collected as workload stats: • Number of hours worked • Number of patients seen • Number of new patients • Number of follow-up patients • Number of visits per patient • Number of discharges • Number and types of treatments provided

8. PT Workload Stats • It is important to record workload stats in the PT department for several reasons: • To evaluate each employee’s performance • To justify PT services and profession • To evaluate departmental success • To identify areas needing improvement for individuals and the department as a whole • To create historical trend reports

9. PT Workload Stats Continued . . . • Each PTT should be required to keep a daily record of workload stats • This is best done electronically in spreadsheets, using a program such as Excel • PTTs should be required to turn in their stats on a monthly basis to the senior PTT, who can then tabulate the data to generate monthly department reports

10. PT Log Books • Currently at the Polyclinic, there are two log books for tracking stats: • Admission log book • Daily treatment log book • A similar policy should be implemented in the hospital setting • At the moment, nothing is done with the data, but this is something that can be addressed in the future

11. Admission Log Book

12. Daily Treatment Log Book

13. Statistical Reports • On a yearly basis, all the workload reports should be combined to create a historical PT department report • Used to show the chain of command the quantity, quality and trends in PT services • Should be presented to the chain of command to help justify changes on the Tashkiel that would improve patient care

14. Statistical Reports Continued . . . • Historical reports should include: • Number of staff • Total number of days worked • Total number of patients who received PT services • Total number of patient referrals • Number of referrals per condition or body area • Average number of visits per patient • Average numbers of each treatment modality used

15. Quality Assurance • A system of recognized procedures for establishing standards, including a plan for achieving these standards • PT services should have a written plan for continuous improvement of quality of care and performance of services • PTTs shall demonstrate commitment to quality assurance by peer review and self-assessment

16. Quality Improvement Plans • Provide evidence of ongoing review and evaluation of the physical therapy service • Provide a mechanism for documenting improvement in quality of services and performance • Are consistent with requirements of external agencies, as applicable

17. Quality Enhancement • Taking deliberate steps to bring about continuous improvement • This term may be applied to PT educational programs and practice • Need for quality enhancement is usually identified through the analysis of statistical reports

18. Evaluation • Evaluationis designed to answer the question “what standard does this service achieve?” • It is carried out to define or judge current care, measuring current service without reference to a standard • It usually involves analysis of data, but it may include administration of a simple interview or questionnaire

19. Evaluation Continued . . . • Two main forms of evaluation should be performed by PTTs: • Peer reviews: • The process of professionally evaluating the work of a colleague • Self reviews: • The process of examining oneself in order to assess aspects that are important in one’s profession • Can be done formally (i.e. accreditation) or less formally through questionnaires

21. Employee Self-Evaluation Answer the following questions by checking the appropriate box to the right. After you have finished answering each question, total the number of checked boxes in each column. Multiply the total of each column by the severity factor for that category. Add together the total of each column. This is your evaluation score. The higher the score, the better your understanding is of your company, its structure and your role in it.

22. Standard Operating Procedure (SOP) • A set of written procedures for a routine or repetitive activity carried out by an organization • The development and use of SOPs are an integral part of a successful quality system as they provides individuals with the information to perform a job properly, and facilitate consistency in the quality and integrity of a product or end-result

23. SOPs Continued . . . • Purpose: • detail the regularly recurring work processes that are to be conducted within an organization • Benefits: • minimize variation and promote quality through consistent implementation of a process or procedure within the organization, even if there are temporary or permanent personnel changes

24. How to Write SOPs • Should be written in a concise, step-by-step, easy-to-read format • Keep it simple and short • Information should be conveyed clearly and explicitly to remove any doubt as to what is required • If appropriate, use flow charts to illustrate the process being described

25. SOP Guidelines • Should be written by individuals with knowledge of the activity and the structure of the organization • Need to be reviewed and re-enforced by the chain of command • Current copies of SOPs need to be readily accessible for reference in the work areas of those individuals actually performing the activity

26. SOP Guidance • More detailed information on the specifics of writing SOPs can be found at: • http://www.epa.gov/QUALITY/qs-docs/g6-final.pdf

27. Standard of Practice • An acceptable level of performance or an expectation for professional intervention, formulated by professional organizations based upon current scientific knowledge and clinical expertise

28. Standards of Practice • A collection of documents describing the professional consensus on the practice of physical therapy for physical therapist technicians working in any occupational setting • Standards reflect the collective judgment of the profession at a given point in time

29. Service Standards • Outline aspects of the physical therapy service, for which the organization is responsible in order to maintain the safety and quality of services for staff and patients

30. Clinical Practice Guidelines • Statements developed through systemic processes to assist practitioners and individuals in making decisions about appropriate forms of health care in particular clinical areas, taking account of individual circumstances and need • Defined by the governing organization (i.e. The World Confederation of Physical Therapy)

31. Scope of Practice • A statement describing physical therapy within the context of the regulatory environment and evidence base for practice within a jurisdiction • Scopes of practice are dynamic, evolving with changes in the evidence base, policy and needs of service users • WCPT sets out the internationally agreed scope of practice and member organizations set out the scope of practice agreed in their countries

32. SOPs and Scope of Practice • Local SOPs should be generated to reflect the international scope of practice for PT, standards of practice and clinical guidelines • SOPs are commonly used in the military setting to outline routine procedures • Currently, there are no existing SOPs in the PT departments

33. Quality of Care • It is often difficult to accurately assess the quality of care that is being provided • One way to gather feedback is through the use of patient feedback forms • It is also important to have a system to allow patients to provide feedback about services that they are not happy with

34. Patient Feedback Forms • These forms are usually provided to patients at discharge • Completion of these forms is voluntary • Forms are filled out anonymously to ensure patients feel comfortable providing accurate feedback • Forms are collected and reviewed by department staff

35. Patient Complaints • PT departments should have a system to collect patient complaints • Usually in the format of a form and a collection box • Patients can report complaints anonymously • Complaints should be reviewed and investigated by the chain of command

36. Patient Feedback Form

37. Dealing With Complaints • Quality assurance activities focus on service user satisfaction by ensuring that: • A system is in place for monitoring satisfaction of users • Users are invited to make suggestions about services provided • A complaints procedure exists including a system for response

38. Dealing With Complaints Continued . . . • When complaints are filed, they should first be address with the staff member involved to gather all information pertaining to the specific event or care provided • The Chain of Command should also be informed about all complaints • If the complaint is deemed valid, corrective measures should be taken to address the shortcomings of the staff or department

39. Continued . . . • Once measures have been enforced to address the complaint, the person who filed the complaint should be informed of the corrective action • Remember, physical therapy is a patient centered service • The welfare of the patient is the most important factor to consider when providing care

40. Summary • Workload stats provide important information to evaluate PT services • Quality assurance programs ensure that PT services are effective and to a particular standard • SOPs need to be generated to outline routine practices in local PT departments • It is important to have a system in place to collect and review patient feedback

41. Questions?

42. Comprehension Check • What can workload stats collected in the PT department be used for? • How often should PTTs turn in their workload stats? • What are the two main methods of evaluation that should be performed by PTTs? • What are standards of practice? • How should complaints from patients be dealt with

43. Answers • They can be used: • To evaluate each employee’s performance • To justify PT services and profession • To evaluate departmental success • To identify areas needing improvement for individuals and the department as a whole • To create historical trend reports

44. Answers… • Monthly • Peer-review and self-review • An acceptable level of performance or an expectation for professional intervention, formulated by professional organizations based upon current scientific knowledge and clinical expertise

45. Answers • they should first be address with the staff member involved to gather all information pertaining to the specific event or care provided - If the complaint is deemed valid, corrective measures should be taken to address the shortcomings of the staff or department - Once measures have been enforced to address the complaint, the person who filed the complaint should be informed of the corrective action