This entry was posted on Thursday, January 21st, 2010 at 11:58 am and is filed under Increasing Productivity. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.
Increasing Productivity: Click here for the results of the CEO survey on productivity.
Here are the results of the CEO Survey on Productivity:
80% of CEOs said that productivity is either the top priority or very important.
Only 33% said that staff would say productivity is top priority or very important.
Answers to the question: What has been your experience improving productivity in your organization?
Two steps forward, one step back.
Lots of resistance.
Turnover increases when we increase expectation.
Hard to get rest of organization to support workers in their productivity (ie prioritizing Electronic Clinical Record, geographical case assignment etc).
Very difficult to impact. But we’ve made great strides over time.
As we are currently defining it (% of direct time), it has improved over the past two years, but has much room for continued improvement.
There is significant resistance to tying wages to productivity.
Staff defensive and indicate they are overburdened by paperwork requirements.
It has declined with the launch of a new EMR system. After 9 months it is beginning to return to prior levels.
When we focus on it, it improves. When we get distracted, it subsides.
Staff feel expectations are too high, paperwork gets in the way of them providing service to our consumers. Some staff have been able to meet or exceed the standards.
A large % of our staff are represented by collective barganing. Standards have been set for clinical productivity and failing to meet standards has resulted in progressive dicipline. We have not been successful however in tying productivity to compensation.
Here are the questions that CEOs have posed for their fellow CEOs.
Have you hit peak productivity, in your opinion, and, if so, what is it (in terms of % of total hours).
How have you retained employees as you’ve raised expectations?
Do you expect higher productivity from longer-term, more highly paid staff or is it one standard marker?
How has it been rolled out to staff for buy in?
What are specific productivity standards and how are they enforced?
What incentive compensation arrangements have proven most effective in improving productivity and retaining your best clinicians while continuing to meet corporate compliance and other external mandates for ethical billing practices?
How do you account for non billable time?
What tools and techniques have they used that brought about the biggest change in productivity?
What have they tried that they would not recommend and why?
How do we balance the notion of productivity with compliance on data entry? Too many folks focus on one over the other to the detriment of each.
How do organizations improve productivity for clinicians working in partial hospital and intensive outpatient programs?
(What is the) Process used to tie compensation to productivity among union represented staff.
And the question on everyones list:
What has worked in your organization to improve productivity?
Close supervision using real-time data, linking compensation incentives to high productivity.
Supporting workers in removing barriers.
Holding people accountable and terminating those who can’t meet expectations.
Remote access to do paperwork anywhere. Increased issuing of laptops, concurrent service delivery and paperwork for session.
Increasing staff awareness of actual productivity levels. One aspect is the percentage of their work hours spent in face to face contact. The other aspect is the number of hours of CSM or SC service per year a consumer with SMI or DD is actually receiving.
Set stretch goals, give staff access to a productivity calculator that allows them to see in real time the effect of holidays, sick leave, vacations, short months, etc. on their own productivity so they can adjust performance accordingly.
Additional training and holding staff accountable for performance results in greater productivity. The more integrated the expected productivity is into data collected, performance measures, etc. the greater the improvement in productivity.
Linking them to performance goals and salary increases. Discussing with staff what they perceive the barriers are that prohibits them from meeting those goals and working to remove them. Providing note templates and prompts for documentation to streamline the time it takes to compelte it.
Producing data-driven productivity reports for individual clinicians; focusing on process improvements.
Constant vigilence clear standards focusing on systems and proceedures weekly reporting and tracking when necessary making it a priority for first and second line supervisors to monitor.
It is more effective to focus on improving low performers’ productivity and to set and monitor team goals than it is to simply raise the overall productivity goals (which tends to selectively punish the existing better performers).
Mentoring. We are currently working on a bonus/incentive system which may help as well.
Measurement indicators that are reliable, valid and timely.
Creating reports that staff can use to monitor productivity and posting the results within units.
Over time I have come to believe that using the term “productivity” gives a conflicting message. We place many requirements on staff in addition to face to face service, do we consider staff to be “non-productive” when completing those tasks which we require? We have tried to shift our focus to providing the services defined in the consumer’s person centered plan. We have a goal of our EMR being able to accurately project out time commitments based on authorizations tied to PCP’s. The data system is not quite there yet, but having focused our conversation with staff in this way has resulted in reduced encounter rates over the last several years, which is a good proxy measure for “productivity”.
As a funder of organizations that provide services and supports what are the best contract mechanisms that optimize service activity and outcomes?
Success is contingent upon helping the clinician understand and buy into that this is a key performance issue and expectation of the job, training them on how to bill effectively for the work they do, and providing regular, consistent feedback and data around the issue.
Training on concurrent documentation has been hugely helpful, with supervisor feedback and support in assisting clinicians in becoming proficient with this.
Virtually all of the suggestions here address either 1) How to track staff productivity 2) How to incent staff with pay to improve productivity or 3) Training to help staff be more productive.
While these are important and valuable suggestions, there is a fundamental issue that, in my opinion, is being overlooked. If you look at the data in the chart at the top of the page (from the survey many of you completed) you will see that 80% of the CEOs said that productivity is either the top priority or very important, while only 33% said that staff see it that way. This gap in perception is a root cause issue to the struggle with productivity. If staff don’t see productivity as important, or worse yet (as with many of the clients we have worked with) they see it as an annoyance or an impossible target to attain, you can give them all the data and training in the world and many of them won’t use either.
Closing this gap in perception, having them see productivity as the lifeblood that allows them to serve consumers is vital to making substantive improvement. What do you think?
I agree with Brad. The task of management is to close the perception gap about the importance of productivity. We have taken a step in that direction by providing each clinician with their own bi-weekly productivity report. They can see, graphically by CPT code, how much of their time is billable and what their no show/cancellation rate is. Their first reaction generally was to question the data. Once we got past that, they started focusing on what they can do to improve the numbers. We have formed several process improvement teams to remove barriers and solve problems that have resulted in lower no shows/cancellations. Things are looking up, but we have a ways to go still.
My View: Maximizing Productivity and effectiveness is one of my top organizational priorities. It is also one of the top priority for the people we serve. Directly attacking this apparent gap in perception is a key priority in our strategic plan. To bridge the gap our first step is to make sure we understand the definition of increased productivity from the service provider point of view as well as from the point of view of those we serve and lastly from the “management perspective. The definitions contain different elements and have different metrics. The outcome of productivity “increased consumer life outcomes” is commonly held by each perspective. The important piece in bridging the gap is the barrier identification and barrier busting from each perspective. We must initiate, encourage and support this activity that frees people up tp do more important things…
bridge the gap one commonly held improvement at a time
Productivity has been an on-going issue for many years at CCS. Staff have complained about management’s focus on finances to the exclusion of client services. The past 6 or 8 months have really served to “bring home” the importance of productivity to our staff. We have gone through two staff lay-offs and a huge change in funding from sub-capitated to “fee for service”. Our survival now depends on the maximization of billable services. Our staff have responded well. Some of our out-patient units have been averaging over 70%.
When I respond to the survey question of line staff priorities I was thinking from their perspective that I would hope that productivity is an important priority for them but perhaps not the “top” priority.
As Jeff suggested. management should be doing all that it can to help staff do their jobs as effectively and efficiently as possible. The Electronic record system we started last March has been an immense help to staff
As an agency, we were faced with a year where our productivity was low, turnover high, and the state cut our reimbursement rate resulting in a significant deficit. Utilizing the principles learned through our collaboration with PMP, our senior management team approached the many challenges facing the center in a novel way. One of the keys was not just raising our standards, but doing so in a supportive culture that promoted staff leadership and commitment to our mission. Our net result was a 19.6% increase in productivity and a decrease in turnover. This positioned us well to face further economic challenges posed by federal and state cutbacks