Occup Ther Health Downloaded from informahealthcare.com by Chinese University of Hong Kong on 12/26/14 For personal use only.
Marketing: A Reasonable Administrative Approach to Decision-Making Grace E. Gilkeson, EdD, OTR, FAOTA Judith M. Glenn, OTR Ruth S. Webb, OTR
SUMMARY. A marketing approach, the process of controlling exchanges in order to accomplish objectives, should be a basic skill among those used by an occu ational thera y manager. Departmental management can be great& facilitated using marketmg techniques to identify, analyze, and improve relationships, develo ing them into successful exchanges. By avoiding a marketing attitu e an occupational therapy manager may well be unresponsive to health care realities and chanees. Accounts of two a&al situations e erienced by occupational theraov administrators are described. theraoist is emoloved in a diffe;int setting. Each achieved a successful soiution to & hministrative problem using a well-planned marketing strategy. Each situation and resu t is unlque, yet a similar thread can be traced from needs identification through enabling transactions to problem resolutions.
&
!
ax
"r
A marketing approach should be among the basic management attitudes and skills of an occupational therapy administrator. It is a Grace E. Gilkeson, Professor and Dean. School of Occupational Therapy, Texas Woman's University, Denron, TX. Judith M. Glenn is Director, Department of Occupational Therapy. Presbyterian Healthcare System, Dallas. TX. Ruth S. Webb is an occu~ationaltheraoist in Private Practice. Wichita Falls,
TX. This article appears jointly in The Occupational Theram Manager's Survival Handbook (The Haworth Press, Inc., 1988) and in Occupario~lTherapy in
Health Care. Volume 5 , Number 1 (1988). Q 1988 by The Hawonh Press, Inc. All rights resewed.
107
Occup Ther Health Downloaded from informahealthcare.com by Chinese University of Hong Kong on 12/26/14 For personal use only.
108
The Occuparional Thempy Manager's Survival Handbook
method whereby problems can be solved in a systematic, rewarding manner. It can become an exciting part of professional and personal transactions, a fresh way of conducting daily business. An occupational therapy administrator who has developed a marketing attitude will be better able to continue finding a place in the health care delivery system of this decade. Too often marketing is erroneously considered to be synonymous with selling. Actually, salesmanship is only one component of the marketing process and is less important when other aspects of marketing are properly used. Marketing is the process of controlling exchanges in order to accomplish objectives.' Management of an occupational therapy department can be facilitated by using marketing approaches to identify, analyze, and improve exchanges. By avoiding a marketing attitude an occupational therapy administrator may well be unresponsive to health care realities and changes. ~ c c u ~ a t i o n &rapists al can develop attitudes of marketing by learning the language and techniques, then by applying the information to their occupational therapy practices. A typical health care organization usually lets its services speak for themselves, thus limiting its success in meeting objectives and threatening its future survival. Instead, the successful organization looks at what benefit the client derives from a service. Fundamental to any marketing approach is needs analyses followed by transactions that are satisfying to both parties in the resulting exchanges. Each needs analysis is comprised of a breakdown of constituencies, recognition of exchanges, description of the environment in which exchanges are to occur, and identification of problems and objectives before designing, implementing, controlling, and evaluating a marketing strategy.' Accounts of two actual situations experienced by occupational therapy administrators are described here. Each therapist is employed in a different setting. Each achieved a successful solution to an administrative problem by using a well-planned marketing strategy. Each situation and result is unique, yet a similar thread can be traced from needs identification through enabling- transactions to problem resolutions. The first situation involved a community-based problem: lack of public awareness of occupational therapy in a midsize southwestern community resulting in minimal demand for its use in private prac-
Occup Ther Health Downloaded from informahealthcare.com by Chinese University of Hong Kong on 12/26/14 For personal use only.
Gilkeson, Glenn, and Webb
109
tice as well as in all potential institutional occupational therapy units. In the second, an occupational therapy administrator of a physical dysfunction unit in an urban acute care hospital faced low morale and stress among staff due to increased patient load unmatched by increased staff. Each situation was successfully resolved using basic marketing techniques.
CASE I. INCREASED PUBLIC AWARENESS BUILDS OCCUPATIONAL THERAPY DEMAND Overview
A relatively isolated southwestern city of 100,000 in 1985 was the setting for development of a plan to increase public awareness of occupational therapy. The problem was identified by one private practice occupational therapist as a lack of community awareness of occupational therapy resulting in minimal and diminishing use of services, despite the fact that this community serves the health care needs of 18 surrounding rural counties. Participants To solve this problem, the occupational therapist in private practice was joined by colleagues employed in an acute care facility, an out-patient rehabilitation center, a public school system, and a psychiatric hospital. Using a carefully planned marketing approach, this core of therapists proceeded on the basic conviction that occupational therapy in every practice setting must be responsive to changing community attitudes concerning cost effectiveness and utilization of health care delivery services.
Chnmology o f Events Events took place between April and September. In April, personal visits to mass media contacts were initiated. The first television feature was taped in May, and a series of newspaper interviews emphasizing occupational therapy practice areas began. In June, television features continued, and contacts were made with churches, libraries, and malls regarding visual displays. The newspaper series appeared in July. Speaking engagement dates were fi-
110
The Occupational Therapy Manager's Survival Handbook
nalized with civic clubs for early fall programs. August events included continued television coverage and participation in two health fairs. In September, the civic club presentations began.
Occup Ther Health Downloaded from informahealthcare.com by Chinese University of Hong Kong on 12/26/14 For personal use only.
Context
This plan took place in a small city, proud of its civic progress and responsive to needs, but where unfamiliar ideas are slow to root. Lack of familiarity with the value of occupational therapy directly affected both reimbursement and employment opportunities. It was vital that occupational therapy fit into the larger framework of social and economic change occurring in the city, and that potential consumers understand its role in their welfare. Occupational therapy must prove its quality and accessibility in order to,avoid becoming a market liability. Once the problem had been recognized and a marketing approach chosen, a strategy was outlined. Basic needs, preferences, and behaviors of desired consumers were identified, since the concept of exchange underlies the marketing process. An analysis of exchange relationships was made; that is, environmental factors that would influence the exchange were examined and the current status of exchanges assessed. As an example of exchanges, some literature suggests that the real consumers of occupational therapy services are third party payers. Those market segments promising the most favorable opportunities for increasing demand were selected. Publicity was chosen as the major marketing tool in this instance. Different therapists were featured to illustrate the diversity of service delivery. A protocol for interacting with media was established to assure information accuracy and to avoid overlapping material. Professionalism was stressed. Risks and Constraints
Constraints to this plan included (1) limited OTR and COTA personnel in the area to help, (2) no money to finance the project, and (3) absence of any formal participants' organization. There were risks associated with lack of depth of mass communications used to market a service and with having no means to assess efficacy of the approach.
Gilkeson, Glenn, and Webb
111
Occup Ther Health Downloaded from informahealthcare.com by Chinese University of Hong Kong on 12/26/14 For personal use only.
Outcomes During the ensuing six months occupational therapy referrals from area physicians increased, and several facilities reported an increased number of telephone inquiries concerning occupational therapy services for family and friends. Referrals and calls followed television and newspaper features. Interest generated through personal speaking engagements was especially successful because more depth of learning could occur. Perceptive questions following each talk indicated attentive audiences. Questions
1. Who are the consumers of occupational therapy selvices? What do I know about them? 2. What are occupational therapy's strengths and its weaknesses? What do our consumers consider to be our strengths and our weaknesses? When was the last time I asked a client's opinion of occupational therapy? 3. Who are our competitors? How do our consumers rate our service delivery in comparison to these competitors? 4. Would wider community awareness of occupational therapy help to bring my services to the attention of potential patients/ clients? 5. How aggressive should occupational therapists be in marketing their product? 6. If each occupational therapist assumed responsibility for marketing his or her services, what would be the total impact upon our profession? CASE XI. PRODUCTNITYAND MORALE ARE IMPROVED THROUGH USE OF A lMARKETXNG AlTITUDE
The department of occupational therapy at a large urban hospital experienced a dramatic increase in patient load throughout 1984-85. The hospital administration refused to add sufficient staff numbers to handle the increased load. Consequently, the quality and quantity
112
The Occupational Therapy Manager's Survival Handbwk
of patient treatment did not meet regulatory standards. Staff became stressed, and morale within the department was low. The Participants Occup Ther Health Downloaded from informahealthcare.com by Chinese University of Hong Kong on 12/26/14 For personal use only.
The occupational therapy staff consisted of nine OTRs, one
COTA, and one secretary. In addition, three affiliate students were receiving intern training each quarter. The director of the depart-
ment graduated with a BS degree in 1977 and joined the hospital as a staff therapist. She was promoted to her present position in 1980 and returned to college in 1985 to obtain her master's degree in occupational therapy administration through a university evening program.
The hospital is a 950-bed complex offering comprehensive services which include a 32-bed rehabilitation unit. The occupational therapy department has two physical disabilities clinics. The main clinic offers acute care services while the west clinic offers acute care, rehabilitation and outpatient services. The occupational therapy department was under the direction of an associate administrator who also controlled the physical therapy and speech therapy departments. Chronologv of Events
October 1983-Medicare DRG regulations went into effect. The federal government set strict payment and reduced length of stay standards for acute care patients. The occupational therapy department began to give acute patients three treatments a day in order to match the speeded-up discharge from the hospital. January 1984-The occupational therapy department expanded services to six days a week in a further effort to accommodate the new requirements. June 1984 -The hospital applied for and received a Medicare DRG exemption for a rehabilitation unit of 20 beds. Medicare regulations mandated that the occupational therapy department provide 1-112 hours of treatment per day to each rehabilitation patient. June 1985-The hospital expanded its rehabilitation unit to 32
Gilkeson, Glenn, and Webb
113
beds. The additional rehabilitation patients also required 1-112 hours of treatment per day.
Occup Ther Health Downloaded from informahealthcare.com by Chinese University of Hong Kong on 12/26/14 For personal use only.
context
The changes in Medicare funding created pressures for all services to reduce expenses. Demands were placed on the occupational therapy department to adhere to a strict budget and to increase productivity with no increase in staff. Salaries were also kept low to help control costs. The therapists' work load throughout this period increased from an average of nine one-half-hour treatments per day to 12 treatments per day. The therapists struggled to meet the new demands and maintain quality of care at the same time. Slowly the stress level began to rise and the staff became angry and felt unappreciated. No matter how hard they worked they were unable to meet the new productivity standards. A thorough analysis of environmental factors helped the director identify a number of problems that were contributing to poor productivity. The staff was functioning in extremely crowded office and treatment space. The secretary was located in the middle of the department. Distractions were high, and the telephone constantly interrupted treatment. Insurance companies were demanding increasingly detailed documentation which was time consuming. The director of physical therapy was so preoccupied with staffing problems in his own department that he had little time or interest in working out reallocation of shared treatment space or in attempting to reduce distractions. Next, the director determined what type of exchange she desired to have with each of the constituents involved. She wanted those in administration to receive productive therapy in exchange for fair salaries and a small increase in staff. She desired that the physical therapy and occupational therapy departments would work smoothly together to solve mutual problems. She sought to have her staff accept her marketing plan, which included a system of monitoring productivity, and hoped they would choose to increase productivity by learning techniques of working with patients in groups. A needs analysis was completed. The director determined that
Occup Ther Health Downloaded from informahealthcare.com by Chinese University of Hong Kong on 12/26/14 For personal use only.
114
The Occupational Therapy Mamger's Survival Handbook
her staff needed a system of documentation that could be completed quickly and effectively. They needed to work in a distraction-free environment, and they needed job security. Also, the staff needed to receive recognition from the occupational therapy director, the administration, and physicians for their efforts to increase productivity. The director, in exchange, needed support from the staff to increase productivity and cut costs in an effort to ensure that the occupational therapy department would survive the changes in health care reimbursement. The director established marketing objectives, prioritized the objectives and created an implementation plan. A chart was designed including the proposed implementation dates and identification of the people responsible for the course of action. Following is an outline of the implementation plan:
1. The director and the staff would be educated in methods of monitoring and increasing productivity. 2. The director and staff would together design a productivity system for the department including monitoring daily individual productivity, compiling individual and departmental monthly reports, and analyzing data. The productivity report would be sent to those in administration. 3. A new documentation system would be designed. 4. A list of competing hospitals who are paying higher occupational therapy salaries would be submitted to those in administration and in the personnel department for their annual market survey. 5. Job descriptions would be written for two senior staff positions. A proposal for conversion of two existing staff positions to the new positions would be submitted to those in administration. 6. Justifications for adding one full-time OTR position and one part-time aide would be included in the 1986 budget. 7. Inservice sessions would be conducted on ways to do treatment in groups. 8. Secretarial services for occupational therapy and physical therapy would be combined. A receptionist desk and two secretar-
Occup Ther Health Downloaded from informahealthcare.com by Chinese University of Hong Kong on 12/26/14 For personal use only.
Gilkeson, Glenn, and Webb
115
ial work stations would be purchased and set up in the lobby area rather than in the treatment area where presently located. 9. Telephone systems for the two departments would be combined. 10. Clinic space for occupational therapy would be enlarged by an additional 15 feet by 40 feet.
Risb and Constraints There were two rnaior constraints to the implementation planthe hospital administr&on and the director of physical therapy. The director scheduled a series of meetings with both her administrator and the director of physical therapfand presented her marketing plan. The director of physical therapy became enthusiastic because he saw how combining secretarial services would be advantageous to his department. Both directors then worked together to implement the program. The administrator eventually approved all of the objectives.
Outcomes One year has transpired since the marketing plan was implemented. All ten objectives have been achieved. A productivity monitoring system has been created, from which statistics are fed into the department computer which prints out monthly reports. Productivity goals were set. Individual productivity reports have been given monthly to each therapist. The reports and statistics were used to justify the need for additional staff. Two occupational therapist positions have been added to the department. Two senior staff positions were approved. Salary raises were made for all of the staff. New progress note forms were designed. The staff is currently examining the possibility of using a checklist system and the computer to print out their daily documentation. An occupational therapylphysical therapy secretarial center was created, and a centralized telephone and intercom system was installed. The physical therapy department moved their equipment and created additional clinic space for occupational therapy. They
Occup Ther Health Downloaded from informahealthcare.com by Chinese University of Hong Kong on 12/26/14 For personal use only.
116
The Occupational Therapy Manager's Survival Handbook
also gave up a small room so that additional office space was created for the staff. The results of all of these achievements have been positive for the department. Distractions have been reduced. The new documentation forms are easier and quicker to complete. The combined secretarial setvice is much more efficient. Relationships between the physical therapy department and occupational therapy department are excellent. The secretaries from both departments have combined many of their functions and provide back-up for one another. The staff therapists are freely sharing treatment space. The staff no longer indicates feelings of extreme stress; morale is good; complaints are less. Most important of all, productivity has increased 8%,and most of the rehabilitation patients are receiving 1-l/2 hours of therapy a day.
Questions 1. Who are the constituents that affect you and your department?
2. Who are your supporters, regulators, clients, and colleagues? 3. What are the exchanges that you have with these constituents, and how good are they (current status)? 4. How does your environment affect you and your constituents? 5. Who is your competition and how does it affect your objectives? 6. What are your objectives, and what course of action will you take to achieve them? SUMMARY
In spite of the divergence of the two situations described, the underlying focus on reciprocal needs satisfaction can be detected. Traditional methods of problem solving may no longer be producing the results needed. Marketing techniques applied in unconventional arenas like health care can make tremendous differences, as risk-taking and creativity set programs apart from the others. Occupational therapists should apply marketing approaches to the solution of administrative problems.
Gilkeson, Clem, and Webb
Occup Ther Health Downloaded from informahealthcare.com by Chinese University of Hong Kong on 12/26/14 For personal use only.
REFERENCES 1. MacStravic RE Marketing health cam. Germantown, MD: Aspen Systems Corn. 1977 i.. Gilkeson E Occupational therapy leadership potential can be developed rrmmin Octhroueh marketing techniaues. In Cromwell (Ed). Work-RelatedPto" cupa&nal hem&. ~ew'york:The ~ a w o n hP ~ S ,1985
Marketing: A Reasonable Administrative Approach to Decision-Making Grace E. Gilkeson, EdD, OTR, FAOTA Judith M. Glenn, OTR Ruth S. Webb, OTR
SUMMARY. A marketing approach, the process of controlling exchanges in order to accomplish objectives, should be a basic skill among those used by an occu ational thera y manager. Departmental management can be great& facilitated using marketmg techniques to identify, analyze, and improve relationships, develo ing them into successful exchanges. By avoiding a marketing attitu e an occupational therapy manager may well be unresponsive to health care realities and chanees. Accounts of two a&al situations e erienced by occupational theraov administrators are described. theraoist is emoloved in a diffe;int setting. Each achieved a successful soiution to & hministrative problem using a well-planned marketing strategy. Each situation and resu t is unlque, yet a similar thread can be traced from needs identification through enabling transactions to problem resolutions.
&
!
ax
"r
A marketing approach should be among the basic management attitudes and skills of an occupational therapy administrator. It is a Grace E. Gilkeson, Professor and Dean. School of Occupational Therapy, Texas Woman's University, Denron, TX. Judith M. Glenn is Director, Department of Occupational Therapy. Presbyterian Healthcare System, Dallas. TX. Ruth S. Webb is an occu~ationaltheraoist in Private Practice. Wichita Falls,
TX. This article appears jointly in The Occupational Theram Manager's Survival Handbook (The Haworth Press, Inc., 1988) and in Occupario~lTherapy in
Health Care. Volume 5 , Number 1 (1988). Q 1988 by The Hawonh Press, Inc. All rights resewed.
107
Occup Ther Health Downloaded from informahealthcare.com by Chinese University of Hong Kong on 12/26/14 For personal use only.
108
The Occuparional Thempy Manager's Survival Handbook
method whereby problems can be solved in a systematic, rewarding manner. It can become an exciting part of professional and personal transactions, a fresh way of conducting daily business. An occupational therapy administrator who has developed a marketing attitude will be better able to continue finding a place in the health care delivery system of this decade. Too often marketing is erroneously considered to be synonymous with selling. Actually, salesmanship is only one component of the marketing process and is less important when other aspects of marketing are properly used. Marketing is the process of controlling exchanges in order to accomplish objectives.' Management of an occupational therapy department can be facilitated by using marketing approaches to identify, analyze, and improve exchanges. By avoiding a marketing attitude an occupational therapy administrator may well be unresponsive to health care realities and changes. ~ c c u ~ a t i o n &rapists al can develop attitudes of marketing by learning the language and techniques, then by applying the information to their occupational therapy practices. A typical health care organization usually lets its services speak for themselves, thus limiting its success in meeting objectives and threatening its future survival. Instead, the successful organization looks at what benefit the client derives from a service. Fundamental to any marketing approach is needs analyses followed by transactions that are satisfying to both parties in the resulting exchanges. Each needs analysis is comprised of a breakdown of constituencies, recognition of exchanges, description of the environment in which exchanges are to occur, and identification of problems and objectives before designing, implementing, controlling, and evaluating a marketing strategy.' Accounts of two actual situations experienced by occupational therapy administrators are described here. Each therapist is employed in a different setting. Each achieved a successful solution to an administrative problem by using a well-planned marketing strategy. Each situation and result is unique, yet a similar thread can be traced from needs identification through enabling- transactions to problem resolutions. The first situation involved a community-based problem: lack of public awareness of occupational therapy in a midsize southwestern community resulting in minimal demand for its use in private prac-
Occup Ther Health Downloaded from informahealthcare.com by Chinese University of Hong Kong on 12/26/14 For personal use only.
Gilkeson, Glenn, and Webb
109
tice as well as in all potential institutional occupational therapy units. In the second, an occupational therapy administrator of a physical dysfunction unit in an urban acute care hospital faced low morale and stress among staff due to increased patient load unmatched by increased staff. Each situation was successfully resolved using basic marketing techniques.
CASE I. INCREASED PUBLIC AWARENESS BUILDS OCCUPATIONAL THERAPY DEMAND Overview
A relatively isolated southwestern city of 100,000 in 1985 was the setting for development of a plan to increase public awareness of occupational therapy. The problem was identified by one private practice occupational therapist as a lack of community awareness of occupational therapy resulting in minimal and diminishing use of services, despite the fact that this community serves the health care needs of 18 surrounding rural counties. Participants To solve this problem, the occupational therapist in private practice was joined by colleagues employed in an acute care facility, an out-patient rehabilitation center, a public school system, and a psychiatric hospital. Using a carefully planned marketing approach, this core of therapists proceeded on the basic conviction that occupational therapy in every practice setting must be responsive to changing community attitudes concerning cost effectiveness and utilization of health care delivery services.
Chnmology o f Events Events took place between April and September. In April, personal visits to mass media contacts were initiated. The first television feature was taped in May, and a series of newspaper interviews emphasizing occupational therapy practice areas began. In June, television features continued, and contacts were made with churches, libraries, and malls regarding visual displays. The newspaper series appeared in July. Speaking engagement dates were fi-
110
The Occupational Therapy Manager's Survival Handbook
nalized with civic clubs for early fall programs. August events included continued television coverage and participation in two health fairs. In September, the civic club presentations began.
Occup Ther Health Downloaded from informahealthcare.com by Chinese University of Hong Kong on 12/26/14 For personal use only.
Context
This plan took place in a small city, proud of its civic progress and responsive to needs, but where unfamiliar ideas are slow to root. Lack of familiarity with the value of occupational therapy directly affected both reimbursement and employment opportunities. It was vital that occupational therapy fit into the larger framework of social and economic change occurring in the city, and that potential consumers understand its role in their welfare. Occupational therapy must prove its quality and accessibility in order to,avoid becoming a market liability. Once the problem had been recognized and a marketing approach chosen, a strategy was outlined. Basic needs, preferences, and behaviors of desired consumers were identified, since the concept of exchange underlies the marketing process. An analysis of exchange relationships was made; that is, environmental factors that would influence the exchange were examined and the current status of exchanges assessed. As an example of exchanges, some literature suggests that the real consumers of occupational therapy services are third party payers. Those market segments promising the most favorable opportunities for increasing demand were selected. Publicity was chosen as the major marketing tool in this instance. Different therapists were featured to illustrate the diversity of service delivery. A protocol for interacting with media was established to assure information accuracy and to avoid overlapping material. Professionalism was stressed. Risks and Constraints
Constraints to this plan included (1) limited OTR and COTA personnel in the area to help, (2) no money to finance the project, and (3) absence of any formal participants' organization. There were risks associated with lack of depth of mass communications used to market a service and with having no means to assess efficacy of the approach.
Gilkeson, Glenn, and Webb
111
Occup Ther Health Downloaded from informahealthcare.com by Chinese University of Hong Kong on 12/26/14 For personal use only.
Outcomes During the ensuing six months occupational therapy referrals from area physicians increased, and several facilities reported an increased number of telephone inquiries concerning occupational therapy services for family and friends. Referrals and calls followed television and newspaper features. Interest generated through personal speaking engagements was especially successful because more depth of learning could occur. Perceptive questions following each talk indicated attentive audiences. Questions
1. Who are the consumers of occupational therapy selvices? What do I know about them? 2. What are occupational therapy's strengths and its weaknesses? What do our consumers consider to be our strengths and our weaknesses? When was the last time I asked a client's opinion of occupational therapy? 3. Who are our competitors? How do our consumers rate our service delivery in comparison to these competitors? 4. Would wider community awareness of occupational therapy help to bring my services to the attention of potential patients/ clients? 5. How aggressive should occupational therapists be in marketing their product? 6. If each occupational therapist assumed responsibility for marketing his or her services, what would be the total impact upon our profession? CASE XI. PRODUCTNITYAND MORALE ARE IMPROVED THROUGH USE OF A lMARKETXNG AlTITUDE
The department of occupational therapy at a large urban hospital experienced a dramatic increase in patient load throughout 1984-85. The hospital administration refused to add sufficient staff numbers to handle the increased load. Consequently, the quality and quantity
112
The Occupational Therapy Manager's Survival Handbwk
of patient treatment did not meet regulatory standards. Staff became stressed, and morale within the department was low. The Participants Occup Ther Health Downloaded from informahealthcare.com by Chinese University of Hong Kong on 12/26/14 For personal use only.
The occupational therapy staff consisted of nine OTRs, one
COTA, and one secretary. In addition, three affiliate students were receiving intern training each quarter. The director of the depart-
ment graduated with a BS degree in 1977 and joined the hospital as a staff therapist. She was promoted to her present position in 1980 and returned to college in 1985 to obtain her master's degree in occupational therapy administration through a university evening program.
The hospital is a 950-bed complex offering comprehensive services which include a 32-bed rehabilitation unit. The occupational therapy department has two physical disabilities clinics. The main clinic offers acute care services while the west clinic offers acute care, rehabilitation and outpatient services. The occupational therapy department was under the direction of an associate administrator who also controlled the physical therapy and speech therapy departments. Chronologv of Events
October 1983-Medicare DRG regulations went into effect. The federal government set strict payment and reduced length of stay standards for acute care patients. The occupational therapy department began to give acute patients three treatments a day in order to match the speeded-up discharge from the hospital. January 1984-The occupational therapy department expanded services to six days a week in a further effort to accommodate the new requirements. June 1984 -The hospital applied for and received a Medicare DRG exemption for a rehabilitation unit of 20 beds. Medicare regulations mandated that the occupational therapy department provide 1-112 hours of treatment per day to each rehabilitation patient. June 1985-The hospital expanded its rehabilitation unit to 32
Gilkeson, Glenn, and Webb
113
beds. The additional rehabilitation patients also required 1-112 hours of treatment per day.
Occup Ther Health Downloaded from informahealthcare.com by Chinese University of Hong Kong on 12/26/14 For personal use only.
context
The changes in Medicare funding created pressures for all services to reduce expenses. Demands were placed on the occupational therapy department to adhere to a strict budget and to increase productivity with no increase in staff. Salaries were also kept low to help control costs. The therapists' work load throughout this period increased from an average of nine one-half-hour treatments per day to 12 treatments per day. The therapists struggled to meet the new demands and maintain quality of care at the same time. Slowly the stress level began to rise and the staff became angry and felt unappreciated. No matter how hard they worked they were unable to meet the new productivity standards. A thorough analysis of environmental factors helped the director identify a number of problems that were contributing to poor productivity. The staff was functioning in extremely crowded office and treatment space. The secretary was located in the middle of the department. Distractions were high, and the telephone constantly interrupted treatment. Insurance companies were demanding increasingly detailed documentation which was time consuming. The director of physical therapy was so preoccupied with staffing problems in his own department that he had little time or interest in working out reallocation of shared treatment space or in attempting to reduce distractions. Next, the director determined what type of exchange she desired to have with each of the constituents involved. She wanted those in administration to receive productive therapy in exchange for fair salaries and a small increase in staff. She desired that the physical therapy and occupational therapy departments would work smoothly together to solve mutual problems. She sought to have her staff accept her marketing plan, which included a system of monitoring productivity, and hoped they would choose to increase productivity by learning techniques of working with patients in groups. A needs analysis was completed. The director determined that
Occup Ther Health Downloaded from informahealthcare.com by Chinese University of Hong Kong on 12/26/14 For personal use only.
114
The Occupational Therapy Mamger's Survival Handbook
her staff needed a system of documentation that could be completed quickly and effectively. They needed to work in a distraction-free environment, and they needed job security. Also, the staff needed to receive recognition from the occupational therapy director, the administration, and physicians for their efforts to increase productivity. The director, in exchange, needed support from the staff to increase productivity and cut costs in an effort to ensure that the occupational therapy department would survive the changes in health care reimbursement. The director established marketing objectives, prioritized the objectives and created an implementation plan. A chart was designed including the proposed implementation dates and identification of the people responsible for the course of action. Following is an outline of the implementation plan:
1. The director and the staff would be educated in methods of monitoring and increasing productivity. 2. The director and staff would together design a productivity system for the department including monitoring daily individual productivity, compiling individual and departmental monthly reports, and analyzing data. The productivity report would be sent to those in administration. 3. A new documentation system would be designed. 4. A list of competing hospitals who are paying higher occupational therapy salaries would be submitted to those in administration and in the personnel department for their annual market survey. 5. Job descriptions would be written for two senior staff positions. A proposal for conversion of two existing staff positions to the new positions would be submitted to those in administration. 6. Justifications for adding one full-time OTR position and one part-time aide would be included in the 1986 budget. 7. Inservice sessions would be conducted on ways to do treatment in groups. 8. Secretarial services for occupational therapy and physical therapy would be combined. A receptionist desk and two secretar-
Occup Ther Health Downloaded from informahealthcare.com by Chinese University of Hong Kong on 12/26/14 For personal use only.
Gilkeson, Glenn, and Webb
115
ial work stations would be purchased and set up in the lobby area rather than in the treatment area where presently located. 9. Telephone systems for the two departments would be combined. 10. Clinic space for occupational therapy would be enlarged by an additional 15 feet by 40 feet.
Risb and Constraints There were two rnaior constraints to the implementation planthe hospital administr&on and the director of physical therapy. The director scheduled a series of meetings with both her administrator and the director of physical therapfand presented her marketing plan. The director of physical therapy became enthusiastic because he saw how combining secretarial services would be advantageous to his department. Both directors then worked together to implement the program. The administrator eventually approved all of the objectives.
Outcomes One year has transpired since the marketing plan was implemented. All ten objectives have been achieved. A productivity monitoring system has been created, from which statistics are fed into the department computer which prints out monthly reports. Productivity goals were set. Individual productivity reports have been given monthly to each therapist. The reports and statistics were used to justify the need for additional staff. Two occupational therapist positions have been added to the department. Two senior staff positions were approved. Salary raises were made for all of the staff. New progress note forms were designed. The staff is currently examining the possibility of using a checklist system and the computer to print out their daily documentation. An occupational therapylphysical therapy secretarial center was created, and a centralized telephone and intercom system was installed. The physical therapy department moved their equipment and created additional clinic space for occupational therapy. They
Occup Ther Health Downloaded from informahealthcare.com by Chinese University of Hong Kong on 12/26/14 For personal use only.
116
The Occupational Therapy Manager's Survival Handbook
also gave up a small room so that additional office space was created for the staff. The results of all of these achievements have been positive for the department. Distractions have been reduced. The new documentation forms are easier and quicker to complete. The combined secretarial setvice is much more efficient. Relationships between the physical therapy department and occupational therapy department are excellent. The secretaries from both departments have combined many of their functions and provide back-up for one another. The staff therapists are freely sharing treatment space. The staff no longer indicates feelings of extreme stress; morale is good; complaints are less. Most important of all, productivity has increased 8%,and most of the rehabilitation patients are receiving 1-l/2 hours of therapy a day.
Questions 1. Who are the constituents that affect you and your department?
2. Who are your supporters, regulators, clients, and colleagues? 3. What are the exchanges that you have with these constituents, and how good are they (current status)? 4. How does your environment affect you and your constituents? 5. Who is your competition and how does it affect your objectives? 6. What are your objectives, and what course of action will you take to achieve them? SUMMARY
In spite of the divergence of the two situations described, the underlying focus on reciprocal needs satisfaction can be detected. Traditional methods of problem solving may no longer be producing the results needed. Marketing techniques applied in unconventional arenas like health care can make tremendous differences, as risk-taking and creativity set programs apart from the others. Occupational therapists should apply marketing approaches to the solution of administrative problems.
Gilkeson, Clem, and Webb
Occup Ther Health Downloaded from informahealthcare.com by Chinese University of Hong Kong on 12/26/14 For personal use only.
REFERENCES 1. MacStravic RE Marketing health cam. Germantown, MD: Aspen Systems Corn. 1977 i.. Gilkeson E Occupational therapy leadership potential can be developed rrmmin Octhroueh marketing techniaues. In Cromwell (Ed). Work-RelatedPto" cupa&nal hem&. ~ew'york:The ~ a w o n hP ~ S ,1985
