Has anyone else felt like this in the health care industry lately? If so, I am right there with you.

These words may resonate with you, or could sound a bit harsh, especially when taken out of context.

But gosh darn it, this is how I have felt on several occasions while trying to do my job well and serve my client population. Therefore, I would like to shed some light on “conveyer belt health care” and the negative implications this unfortunate style of health care delivery is having on everyone in its path. 

Last week I listened to the Seniors Flourish podcast with host and creator, Mandy Chamberlain MOTR/L, discussing a hot topic with Debora Davidson PhD, OTR/L episode dated April 25th regarding, DUN DUN DUN, that dreaded word…….. productivity

Now for those just starting out, or possibly working in a magical land without fun-sucking productivity standards, what I am talking about is that arbitrary number that some higher-up, non-therapy-giving, bureaucrats decided upon to make our lives twice as hard and often the care half as good.

Unfortunately, even the best therapy companies are forced to comply with, and implement, these standards to keep up with our ever-changing health care system. And for those of you asking “why?”, it can be attributed to the phenomenon our nation has inadvertently created: a system where the very essence of health care has now become THE biggest business in America.

Insurance companies are profiting, health care professionals are drowning, and clients are receiving conveyer belt care.

I understand. I do. Everything is a business and we cannot be naive to that. But what really irks me is when insurance companies are greedily demanding more in exchange for less.

Your current reality may feel as though you are buried in a sea of paperwork, ultimatums, and standards, dictating how to do your “dream job.” Therefore, today’s topic focuses on what YOU can do as a hard-working therapist to comply and still thrive.

1. Give More Than the Watered Down Version 

According to Debora Davidson PhD OTR/L, as a result of today’s challenging productivity standards and stringent health care guidelines, what many therapists are delivering is a watered down version of what occupational therapy can truly accomplish.

“Due to trying to juggle all of these crazy demands, I guess this session we will do arm exercises…again,” you think while implementing a therapy intervention treatment.

Do not get me wrong – upper extremity exercises are incredibly important and necessary when incorporated appropriately. However, rote exercises often replace functional, occupation-based, treatment sessions due to time constraints and unattainable standards. It pains me to see this, and I am even guilty of this on occasion, because it is most definitely not what I went to school for, it is not going to bring the greatest benefit and outcomes to our clients, and it is responsible for causing higher levels of burnout and job dissatisfaction.

Something I began doing recently is to make a conscious effort not to get sucked into a vortex of monotony, but rather implement functional, occupation-based, interventions no matter how much time I have, and regardless of the context in which I am working with my client (therapy room, client’s home, in the community, etc.).

Even if you are unable to complete all of the activity demands required for an occupation, completing components of it is necessary in maintaining the root of occupational therapy.

Use your activity analysis skills during interventions – the ones you read about with passion and intrigue during graduate school – whether you have two minutes or fifty.

Surprise your clients with what you are able to provide to them by accessing a strong brew of OT coffee instead of the watered down version.

Occupational therapy is SO powerful when practiced as intended!

2.  “Let Me Help You Look Good” 

Who doesn’t want to look good? I can assure you that your employer and facility definitely want to. With looking good comes clients followed by reimbursement. In order to gain your employer’s trust, help them look good. Let them know that you are the therapy authority, and explain what it is you need to do in order to do your job to the best of your ability.

Create buy-in with your health care team of nurses, administrators, etc., by explaining to them, “Let me help you look good. Let me identify this problem, assess the situation, extrapolate what needs to happen, and then implement a formidable intervention plan that will knock the socks off of you, your client and caregivers. Let me do what needs to be done, because I know how.”

“Give me the freedom to do this.”

Having this backing from your interdisciplinary team and all levels of administration can support your efforts to create flexibility in order to implement therapy in an ethical and effective way.

Seek to create a framework in your facility or clinic that is sustainable. A framework that not only allows you to help your employer look good and creates team camaraderie, but one that brings you job satisfaction, and ultimately generates positive outcomes for our clients.

3.  Dig Deeper into the System 

Learn how the health care system works. Become overly familiar with the expectations and rules so that we can play the game better.  If we continue practicing OT by implementing poorly thought out, melancholy, interventions, those are exactly the outcomes we will see, and our beloved profession will inevitably become obsolete. 

As distractible humans, bringing your A-game every day is TOUGH. The goal is to avoid becoming bogged down in all of the superfluous minutia of the day-to-day and stand true to what you know.  

Ultimately, it is up to all therapists to advocate for our clients and be their voice, as the voice of those needing our services is often lost in today’s health care system. We are all aware that our services are not truly making a difference, and money is essentially being wasted, when we are forced to half-heartedly complete treatment sessions.

Once you learn the rules to play the game, do not be afraid to blow the whistle if you need to.

4. Blow the Whistle

Blow the whistle on unethical treatments and abuse of our Code of Ethics – it is ultimately your license at stake, your integrity, and your ability to sleep at night. Call your boss, the insurance companies, the administrator, heck, even get in touch with AOTA – let them know what you are up against.

In order to adequately compensate for declining reimbursement rates, health care professionals are required to see more clients per hour, resulting in poorer outcomes, medical mistakes, and, ultimately, the client suffering devastating consequences.

We have all been there: battling between maintaining productivity standards, following Medicare guidelines, doing what the patient needs, all while following occupational therapy’s scope of practice.  Unfortunately, something has to give, and our demands do not fit neatly into a pretty package with a sparkly bow.

Find a mentor. Join an OT community. Join Thrive Alive’s OT community! And find reasons to persevere.

5. Dust Off That OT Practice Framework

No matter what stage of the game you are in, it is time to find your OT Practice Framework that is collecting dust amidst all of your grad school books, take it to the clinic with you, and implement what it says.

{If you do not have one already printed and available, you can easily find yours here by logging into your AOTA account, downloading the PDF, and printing all 52 pages of exactly how to be a rockstar OT.}

AOTA has done the heavy lifting. When I brought the practice framework back into my practice and interventions, I was amazed after a few weeks of how my documentation really shifted from sounding like a generic discipline-less therapy note, to one completed by a well-versed, and easily identifiable, occupational therapist.

6. “Refresh, Regroup, Recenter”

Overcoming the aforementioned ethical dilemmas with some advice from Debora Davidson: Refresh, Regroup and Recenter.  

Pull out your OT practice framework and fill up your OT cup of creativity and authenticity again. Use AOTA website and handouts to educate others on what occupational therapy can do, and why you need their backing.

Here you will find a resource page from AOTA to supply to caregivers and clients in order to address OT intervention plans. Said resources include what occupational therapy services typically include, such as:

•   Customized treatment programs to improve one’s ability to perform daily activities

•   Comprehensive home and job site evaluations with adaptation recommendations

•   Performance skills assessments and treatment

•   Adaptive equipment recommendations and usage training

•   Guidance to family members and caregivers. 

Just like we set our clients up to be successful, set YOURSELF up to be successful each month. Re-fall in love with occupational therapy.

Similar to setting up a date night with your partner, if you want to keep the spark alive, find time to re-invest yourself in the occupational therapy profession. Be an authentic occupational therapy practitioner (and for continued guidance on this, join the authentic OT Facebook page).

You do not have to do rote exercises all day just because that is what other deflated therapists are doing.

I will leave you with two challenges:

  • “Practice to the tip of your license.” – AOTA
  • “Practice OT, not faux-T” – Debora Davidson PhD OTR/L

Until next time, Thrive Alive.