Monthly Archives: July 2014

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You might have to let the rubber ball bounce.

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Highly successful people, especially entrepreneurs like private practice owners, often take their work life to extremes. They push well beyond a typical work day or work week at the expense of family and relationships. For these people (I might as well say my people), Gary Keller, author of The ONE Thing recommends counterbalancing. In other words - taking the same approach with leisure time that you take with your work life.

If you are going to work extreme hours… you need to spend some extreme time in rest and recuperation mode as well. If you don’t push your life out of balance, you might get away with a typical work week and relaxing on the weekend… taking the 60-70% of your allotted paid time off each year as many Americans do. For those of us that push hard for long periods of time, failing to counterbalance can lead to big health, relationship and even professional problems.

While our personal rhythm of push and counterbalance might work for us, we often expect the people in their lives to accept the same sort of rhythm. The challenge is that most relationships don’t do well with extremes. If you check out emotionally and don’t focus on your family for a month or two while you are pushing on a work goal, you should not expect everything to be great after a little counterbalancing with a family vacation. Relationships – and particularly spouses and children, require counterbalancing with much greater frequency.

A frequently cited metaphor in the literature around work/life balance comes to us from Bryan Dyson, then CEO of Coca-cola in his mid ‘90s commencement speech at Georgia Tech. He says:

6613406_mImagine life as a game in which you are juggling some five balls in the air. You name them - work, family, health, friends and spirit - and you’re keeping all of these in the air. You will soon understand that work is a rubber ball. If you drop it, it will bounce back. But the other four balls - family, health, friends and spirit - are made of glass. If you drop one of these, they will be irrevocably scuffed, marked, nicked, damaged or even shattered. They will never be the same. You must understand that and strive for balance in your life.

Similarly, counterbalancing with diet and exercise just plain doesn’t work. Ever tried pigging out and avoiding exercise for a few months and then trying to get back in shape with a few weeks of eating healthy and exercising? Health requires daily attention… going to extremes doesn’t work.

Failing to counterbalance the stress and fatigue from pushing toward our career goals leads us to begin to pull attention away from the daily and weekly rhythm of relationships and the habits that lead to health, energy and longevity.

Keeping the habits and rhythms of diet and exercise, family and relationships, church and spiritual life (the glass balls) provides us with the resilience we need to launch our professional rubber ball as hard and as fast as we can.

Which ‘ball’ do you tend to have trouble keeping track of?

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Top 7 Lessons From My First Year in Practice

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Before I left for physical therapy school, I had one great fear: no matter how hard I tried, I was going to be a bad PT. I confided this fear to a mentor of mine, a well-respected PT himself. His response is one I’ve thought about regularly since that day- that with a solid foundation in school and good mentorship afterwards, there was no doubt I would be a great PT.

Having now completed my education and practiced for a year, I realized that my mentor’s comments ring true for not just me, but for anyone entering the profession.With a new cohort of freshly licensed PT’s and PTA’s coming in to the profession, I took some time to reflect upon the major lessons I have learned over my first year in practice. The below points have resonated with me most, but please feel free to add your own in the comments section below!

1. Mentorship is made by you, not provided by someone else. When interviewing for jobs, we all hear promises of weekly mentorship time and guided learning. Yet, if you do not prioritize this time, it’s likely to get lost in the pressures of the day. It’s our responsibility to make sure our mentorship time actually happens and is effectively used. Here are a few practices I have found helpful: a) block off your mentor time on your schedule- it’s simple, but makes the time more official; b) make sure your mentor is someone who you want to learn from; c) plan it out- set individual goals for yourself each time you meet with your mentor.

2. Don’t compromise your values. Coming out of school, the lines between right and wrong seem pretty clear. However, those lines may quickly blur by pressures to bill more units, see more patients, or take on a practice outside of your ethical comfort zone. Remember that these decisions are ultimately in your hands- it’s your license and happiness that’
s on the line by being in a job that challenges your morals, ethics, and ability to take quality care of your patients.

3. Develop self-management strategies and remember your role. Patient care is hard. And a lot of responsibility. While we may see 60 patients per week, our patients only see us once or twice. Many times, we are the only health professional caring for their well-being. Because of the time we spend with our patients and trusting relationships we develop, many patients often end up airing all of their concerns to us. We may not be trained as social workers or psychologists, but the nature of our job demands we play a role as a quasi director of their care. There’s no doubt about it- doing this for patient after patient is mentally, physically, and emotionally draining. In response to this fatigue, I’ve developed a couple strategies to make my day more manageable. First and foremost, I always try to remember my role- we don’t have the time or training to be everything to everyone, so I make sure to refer to other professionals when appropriate, even when it means embarking on a difficult conversation. Second, I try to take 2-3 minutes between patients to decompress. Just a few minutes allows me to refresh, knock out a bit of documentation, and ensure I approach the next patient as a clean slate. I find I can bring more to the treatment session with those couple minutes to myself, even if it means I’m slightly late to the next treatment session.

12080051_m4. Attitude is truly infectious. It’s easy to fall down the wormhole of complaining about patients or co-workers, but finding ways to stay positive, smile, and bring joy to the clinic is much more rewarding. We all have difficult days, but bringing a positive attitude to work can change the entire culture within a clinic. I challenge you to be that compassionate and empathetic person that brings positivity to a clinic. Once you do, your colleagues will start to look at you as a leader and your patients will notice.

5. Recognize your needs. Then verbalize and fight for them. Everyone has an idea of what it means to be successful, but only you know what you need to be successful. Too often, I see new employees try to conform to a system and environment that does not work for them. Whether you feel you need more mentorship, want to attend a continuing education course, or even would like something as simple as a slightly longer lunch, do not let a resentful feeling brew- approach your employer in a respectful fashion. Chances are that your employer is looking to support you, but does not see your needs. If your employer is not willing to acknowledge or support your needs, it might be time to consider a change.

6. Reflection really is important. Be a conscious practitioner. In PT school, our class reflected on everything. In fact, I’m pretty sure we reflected on our reflections. We reflected so much that reflection became a dirty word. However, I have come to find great power held within reflection. Make sure to periodically ask yourself, “what could I have done better during my last treatment session,” or “what could I improve upon from last week?” It’s easy to go through the motions, but approaching your treatment session consciously, by analyzing what you are doing, why you are doing it, and how you can improve will lead to greater growth and fulfillment.

7. It’s worth it. Patient care is challenging. Most days are exhausting. Yet, if you give it your all and fully engage with your patients, it can be extremely rewarding. The feeing you get when someone looks you in the eye, shakes your hand, and says a genuine ‘thank you for your help,’ is a feeling I have never reproduced elsewhere in the world. We play a special role in our patients’ lives, giving them our time, touch, and knowledge. Cherish your relationships with your patients and never forget what it feels like to help someone achieve their goals.

Any big lessons I missed? Please consider adding your own lessons to the list in the comments section below!

About the Guest Blogger: Josh D’Angelo, PT, DPT served as APTA Student Assembly President in 2013 and is now active with APTA’s DC Chapter and Private Practice Section. He graduated from George Washington University’s Doctorate of Physical Therapy program in 2013, where he was the University’s sole student to win the George Washington Award. Josh is also a former APTA Mary McMillan Scholarship awardee and is currently practicing in the outpatient orthopedic setting in Washington, D.C. He is a regular contributor at PTHaven.

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What is Quality in Physical Therapy?

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I have had some interesting interactions in social media over the past few weeks that have had me thinking about the definition of quality in physical therapy. Therapists are paid for our time and the procedures we perform. Because of this (or at least I blame this system) we tend to define quality around ‘actions taken’ and method of work. For example:

  • Quality providers are able to manipulate an acute low back
  • Quality providers avoid modalities
  • Quality providers provide good home exercise programs
  • Quality providers set and track goals
  • Quality providers use evidence based interventions
  • Quality providers spend (however long) with each patient
  • Quality providers do not use PT Assistants or Aides
  • Quality providers have this or that certification
  • Quality providers have/avoid the latest gadgets
  • Quality providers use/have/do whatever is important to you…

We do this in large part because these are the most visible parts of a practice we might judge it by. However, I would argue that while there are a host of factors that the best practices have in common, quality is not defined by actions or our broken reimbursement system. Quality is defined by patient outcome and by patient experience. In this post, I’d like to provide a window into how we measure quality at Texas Physical Therapy Specialists.

In our practice, we measure outcome using a national database called Focus on Therapeutic Outcomes (FOTO). This system uses adaptive surveys to determine a risk adjusted baseline when a patient starts physical therapy, and then tracks their progress. The results can then be used to provide feedback to individual therapists (i.e.”Dr.____, your outcomes with ankle patients aren’t as good as Dr.___’s, lets see what they are doing that you are not) and more importantly can be used to compare outcomes with other participating practices across the nation.

The other component of quality in physical therapy practice is patient experience. We break this into two components: customer service (all staff interactions) and providing quality connection between the therapist and the patient.

We measure customer service with a survey that has multiple components but centers around the ‘net promoter score‘. Often called ‘the most important question in business’ it is simple and captures the desired customer service outcome for most practices.11268773_m

“How likely is it that you would recommend us to a friend or colleague?”

Much harder to measure but equally important to patient experience is the quality of connection between patient and therapist. This is how well a therapist listens and how much empathy they show. These things have a powerful impact on clinical outcome so we measure them separately using a survey specifically for these items (Consultation and Relational Empathy instrument or CARE) at the completion of the first visit. Interestingly, our therapists scored significantly better in this area after receiving training specific to compassion and empathy.

The confluence of these three things is the product our practice produces.

The amount we charge a cash-paying patient, the contract we sign with an insurer or the assignment we accept from the federal government is simply how we receive payment for that product. Our current payment system bases this on time spent and a host of other items that have no direct relationship to quality. Paying for time without accounting for outcome is like paying a mechanic for the time spent on your car without accounting for whether the problem is solved. Regulating work methods is like mandating that a mechanic can’t use helpers and again not accounting for whether the problem is solved. We have to comply with these external definitions (which vary wildly by state and payer) but we do not have to let them define what Quality is. In my opinion, quality in physical therapy is a simple equation:

Quality = Outcome + Patient Experience.

There are many ways to get there, and undoubtedly some are better than others. Having the ability to measure quality gives us the opportunity to find bright spots and emulate best practices. How do you measure the quality of your service?