"Be empowering of yourself" was speaker Lynn Steffes' theme in her opening address at ASHA's 2012 Health Care/Business Institute, held in April in Memphis, Tennessee. She stressed the importance of respect for oneself and one's clients in both business matters and adult health care. She also noted that the field of health care is changing, often in sudden and unexpected ways, with a general shift toward outcomes measurement.
"We have to continue to demonstrate our value and outcomes," said Steffes, president of Steffes & Associates, a national rehabilitation consulting service based in New Berlin, Wisconsin. "We have to elevate the way people view us, and the way we do that is by having individual respect—for ourselves and our profession—respect for our colleagues, and the clients we serve." And, Steffes added, acting respectful is not enough. "Try to engender not only the behavior of respect," she said, "but the attitudes behind it."
In 23 adult health care and 13 business institute sessions, SLPs learned about numerous ways respect can affect practicing speech-language pathology and running a business.
Holistic, Innovative Views
Presenters in the conference's adult health care track emphasized the importance of knowing speech-language anatomy from head to toe. "Understanding anatomy and physiology is crucial to becoming the best treating clinician you can be," Douglas Hicks told a packed audience. Hicks, director of The Voice Center and head of speech-language pathology at the Cleveland Clinic Foundation, warned clinicians against thinking of anatomy in terms of a single function, but rather to consider the entire system's function.
Hicks explained that because the common name for the larynx is the "voice box," the structure is often done a disservice. "Most people think, ‘Okay, so it's only role is voice,'" he said. "It's one of the important roles, but it's one of several." Hicks urged SLPs to broaden their thinking about the voice box, taking into account all the other things it does—breathing, swallowing, waste elimination, airway clearing, airway protection, and others. "If you think a broader view," Hicks said, "you'll have a broader perspective on how to interpret patient problems."
Similarly, Caryn Easterling promoted a broader view of esophageal disorders, one that anticipates how various disorders might interact in a patient. Although esophageal disorders are not strictly part of the SLP's scope of practice, Easterling believes SLPs have a role to play. "We still need to be aware of how esophageal dysphagia will affect oropharyngeal dysphagia and swallowing disorders," said the University of Wisconsin–Milwaukee professor. "And in the absence of oropharyngeal findings, we're still excellent referral sources for other medical professionals."
Even before his talk began, Joe Murray displayed an affinity for solid evidence. He used a polling system that recorded and tabulated audience responses to questions, displaying the results on screens moments later. The chief of audiology and speech-language pathology services at the Ann Arbor VA Medical Center explained the polling system's appeal: "People who might be shy about raising their hand to report their clinical practice or their opinion have an opportunity to respond in an anonymous way, without feeling threatened." And it allows Murray to collect information that might otherwise be lost.
Murray's session revolved around the variability inherent in swallowing studies performed by different clinicians, and ways to achieve a greater degree of standardization. "There's a great degree of variability we don't understand yet," Murray said. For that reason, the polling system has instructional value too. "The goal we have is to demonstrate variability in the interpretation of swallow studies," he explained, "and the polling system demonstrates variability more readily than hand-raising. We're using it as an instructive tool, also, to try to calibrate people's judgments, and see how they agree by the end of a session. We need standardized interpretation of swallow studies."
A greater degree of standardization was also a central tenet of Nancy Swigert's three-hour documentation workshop, held Sunday morning. Swigert, director of speech-language pathology and respiratory care at Central Baptist Hospital in Lexington, Kentucky, recommended clarity and completeness as the goals of documentation. "What you're writing on a particular day may seem very clear to you," she said, "but it also has to be clear a month from now, a year from now, five years from now. Every necessary element needs to be there, so that it's understandable to non-speech–language pathologists at any point in the future."
Money on Their Minds
In one Business Institute session after another, a single topic was on every presenter's mind. At the opening of Rem Jackson's session on Saturday morning, he proposed to the audience that as private-practice owners, they provide services to clients. No one disagreed. "And in return for those services, you receive...?" The president and CEO of Top Practices, LLP, trailed off as a bemused silence filled the room. "Anyone?"
After a few moments, one audience member ventured, "Money?"
Jackson's face lit up. "Yes! Money!" He continued, "Money is okay. Is anyone here against it?" to appreciative laughter. But Jackson, like other presenters, urged private practitioners to make sure their finances were no laughing matter.
"Operating cash is usually what kills a company," said John Torrens, an SLP who holds a doctorate in business administration. He shared what he considered to be the biggest concern for private practitioners: "To be able to solve a problem or alleviate a pain for somebody at a price they're willing to afford, in a way that's different enough from the next best alternative."
Because money is the central concern, presenters also urged SLPs to know what they're getting into. Mindy Newhouse described her central message as, "Keep your eyes open. It's a challenging time." Newhouse, co-founder and co-director of Communication Matters in Newbury Park, California, made it clear that private practice is a business, not a hobby. "There are a lot of rules," she said, "and things we don't have control over that don't necessarily make sense to us from a clinical/health care/education model, but that's the reality. In the current climate—economic and otherwise—it's challenging."
John Torrens agreed, stressing how important it is for SLPs to have a plan. "It's worthwhile to do the market industry research," he said. "It's often not good enough just to say, 'Hey, I've got the credentials and the referrals.' You just want to know what you're doing."
To learn more, visit ASHA's 2012 Health Care/Business Institute webpage.