A Cog in the Machine: Is productivity a bad word?
All aboard! Welcome to the SLP work engine. Watch your step as you get on and make room because there is a train-load of us trying to squeeze into this machine. If we are on the train long enough, or simply aren't paying enough attention, we might even forget that we ARE the machine. Each of us is essentially a cog seeing patient after patient in an attempt to reach that 80% productivity mark. Once you prove you can do that (and are willing to), it will go up to 85%. Then 90%. The game we are playing here is a race to the bottom. A race that we are all running, but nobody is winning.
Productivity is not a bad word
Productivity in itself can be great. Healthcare spending is out of control and important changes need to be made. But these changes shouldn't dictate exactly how much time we should spend with a patient and they shouldn't be telling us which referrals and recommendations we can make (in fact the time and energy spent advocating for services is in itself unproductive). Instead of finding ways to see more patients, we should be finding ways to do more for those patients.
It’s all about inputs and outputs
Productivity is a simple formula. It increases when output increases and input stays the same. Or when input decreases and output stays the same. For SLPs, an input might include our time, the expense of our equipment, and the time/expense of our referrals and recommendations. It’s everything we put into the machine to get the intended output (positive patient outcomes).
You get what you give
The Pareto Principle says that 20% of our actions yield 80% of results. Was there ever a time you thought to yourself, “What am I really doing for the patient right now?” Yes? Good- because everybody goes through unproductive time periods throughout the day where our input is doing very little (or nothing) towards achieving our intended output. But many don’t recognize it, or worse, they refuse to acknowledge it. In many cases, we can shift our time away from the 80% of ineffective or counterproductive actions to the 20% of actions that actually make a difference.
For example, instrumental studies will give you more clinical information more efficiently than, say, staring at somebody eat in the dining room. And instead of traditional cueing, we can use biofeedback to more efficiently modify a patient’s behavior. Although the expense of these inputs may be higher per unit of time, the time will be much less and the gains we make towards our intended outcome can far outweigh the cost (sort of like driving to the store instead of walking).
Starting at the top
So if we change the way we think about productivity you can see that it can, and should create a ton of value for our patients. This kind of productivity is called practicing at the top of our license. We are doing high-level skills that only we can do (e.g. chart review, diagnostics, education, training, managing care plans, utilizing technology, analyzing imaging, making referrals, etc.). It’s not only more engaging and interesting for the professional but is more efficient and effective for the patient (and the healthcare system as a whole).
Giving more and giving better
We might be just another cog in the machine, but we can still impact the output of that engine by changing the input. Productivity should not be defined simply by our physical presence with a patient (there’s a lot we can (and should) do outside the room) or the number of patients we’ve seen in a day (quality beats quantity every time). Being more productive means doing the things that matter. It means using valuable skills that require deep work to build. And these skills are productive by definition because they make a difference in our patients’ lives. And they are simultaneously the things we actually enjoy doing. So if we are stuck on this train, let’s advocate from the inside to make sure we are putting into the engine what we want to get out of it.
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