Monday, January 30, 2017

Therapy in a Skilled Nursing Facility: Customer Service Required

By: Kristy Hill

Therapy provided in a skilled nursing facility (SNF) is a little different than therapy provided in an outpatient setting, the hospital, and even home health. We have more rules to follow, more insurance guidelines related to treatment, and productivity requirements. Our freedom with clinical judgement, and our ability to provide the best customer service to our patients can be challenging. That comes with the territory. But it is most certainly NOT an excuse.

Let’s start with productivity requirements. Every SNF setting will have their own productivity standards. This is set by the rehab company working under the SNF, and each facility is different. In our SNF setting, Physical therapists (PT’s), Occupational Therapists (OT’s), and Speech Language Pathologists (ST’s) are required to be 80% productive over their eight hour day. Physical Therapist Assistants (PTA’s), and Occupational Therapist Assistants (COTA’s) are required to be 90% productive over their eight hour day. This means that a PT, OT, and ST need a minimum of 385 treatment minutes out of a total of 480 minutes in their day, and PTA’s, and COTA’s need a minimum of 435 treatment minutes out of 480 minutes in their day. Treatment minutes is time spent one on one, hands on with a patient. Any time spent doing paperwork, chart review, communicating with other departments, calling physicians, etc., does not count as treatment time and therefore, negatively impacts productivity. Our days as therapists must be carefully planned around meal schedules, doctor appointments, family visits, and so on, to meet our productivity requirements. Any wrench thrown into the works can throw off our entire day. 

You can see how this might impact our ability to provide the best customer service. If we’re working with Mary for a scheduled 50 minute treatment, we know as soon as that 50 minutes is up, we’re going to go get Harold, who is leaving for a doctor appointment in half an hour. But, when we take Mary back to her room after 50 minutes, she decides she wants to lay down, and you end up spending 15 extra minutes with Mary to make sure she is comfortable. Now, you don’t have enough time to see Harold before he leaves for his appointment. We had two options in this instance. Do exactly what we did, spending an extra few minutes with Mary, who was desperate to lie back down, or tell Mary we don’t have time. She’ll need to press her call light and wait for assistance from a nursing assistant (CNA) because Harold has a doctor appointment. Neither one is the wrong choice. But, I believe that if the patient is truly being put first, the choice is clear. Helping Mary back to bed should take priority. Being able to provide great customer service amidst the productivity requirements, paper work, care plan meetings, team meetings, etc., is what sets the good therapists and the GREAT therapists apart. Productivity requirements are important, but they should never be number one. Being a great therapist is making the patient number one, every time, in every situation, and using teamwork to ensure the business side of the department doesn’t suffer. Communicating, getting creative, and making sacrifices, make great customer service possible. We just need to remember why we’re there in the first place. If you find yourself struggling, here is what five years working in a SNF has taught me about customer service.

Take the phrase “That’s not my job”, and lose it. Never say it again. Because the truth is, you cannot possibly have great customer service without great teamwork. Nothing should be out of your job description, within reason. If you see trash on the floor, pick it up. If the toilet paper roll needs to be changed in the public restroom, change it. If you see a patient’s bathroom is in need of some attention and you have 5 minutes left with that patient, wipe down the sink and toilet. This is your patient’s home, and family members will be pleased to see a clean restroom when visiting. If you go to get a patient and they’re still in bed, not dressed, but they need to use the restroom, don’t make them wait for a CNA. At the very least, help them to the restroom, and go to your next patient. If you see a family member standing at the nurse’s station, with no nurse in sight, acknowledge them. Ask them if you can help them. We are all busy. But nothing is more frustrating to see than someone pushing off responsibility when they’re perfectly capable of doing it themselves. From great teamwork, comes great customer service. Always be empathetic. Even when it’s hard.

Remember that in this setting, the therapy we provide will vary depending on the patient. And just like we ask the patient to be flexible, we have to be flexible too. If you have a difficult patient, maybe a personality conflict, challenge yourself to be more compassionate than you thought possible. Sometimes what your patient really needs is a listening ear. Sure, it may not be the most therapeutic session physically, and it may slow down your paperwork for that day, but it will strengthen the trust with that patient. You’ll have a better understanding of their thought process and therefore a better understanding of their needs, and how to achieve them. It may be the most important session you have with them, even though they didn’t lift a single weight.

Another important thing to remember is that your attitude will introduce you long before you say a word. You may be having the worst week of your life, but your patient shouldn’t know that. You should always approach them with a smile, and set the tone for a positive treatment session. A bad attitude in the workplace is best described as a cancer. The more you feed it, the more it spreads. I understand that everyone needs to vent, everyone has bad days, but you shouldn’t be venting to every coworker you come across. Especially not out on the floor where family members, and patients may overhear you. Every time you complain, you plant a seed of negativity in the workplace. The more is grows, the more it affects the whole team’s morale. If you need to vent, it should be to your manager behind closed doors, or outside of work. Focus on doing your job, being the best therapist you can be for your patients, and you’ll be surprised how quickly the negativity will fade.

Stop thinking of patients as patients, and start thinking of them as what they truly are: customers. They chose your facility. They came to receive services you have to offer. They are paying for those services. Don’t fall in the habit of thinking you’re doing them a favor by doing your job. These are people with lives outside of your facility. They have families, some have pets, and I can assure you, very few if any want to be there. Remind yourself that some of these patients may be terrified. We may not understand it, but we don’t have to. Some of these patients may be very sad, and very lonely. We may be the only person they talk to on a regular basis at this point in their lives. Regardless of the kind of day we are having, we, as therapists, should be the bright spot in their day. And always remember, sometimes the most difficult person to deal with, is the one that needs you the most. You can’t be a great therapist if you’re not willing to go the extra mile for your patients, and that is the very definition of customer service.

Kristy is a Physical Therapist Assistant/Rehab Manager in Nashville, TN. Prior to her current position, she spent several years in retail, and retail management.

She has spent her entire career working with the public, and thus has gained extensive experience in the field of customer service. She currently works with the geriatric population, where she has developed a passion for elder care. She loves her family, her husband, and her dog, Jack. Follow Kristy on LinkedIn.

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