Maximizing productivity is, of course, critical to success in the business of speech-language pathology. Unfortunately, the very word tends to evoke negative visceral reactions in managers and clinical staff.
Much of this reaction stems from frustration at being pulledin competing directions. Time spent on nonbillable tasks—such as scheduling, dealing with insurance and performing clinical documentation—often interferes with the ability to achieve high productivity goals. Perhaps the biggest stressor is that speech-language pathologists in most centers are evaluated, at least in part, on their overall productivity levels.
At Cincinnati Children's, we sought to reduce this stress and frustration and at the same time boost our clinical productivity. We started by identifying the following core principles in our business practice: First, SLPs should focus on work that requires their professional degree and license. They should see only the types of patients for whom they have particular expertise and experience. Meanwhile, leadership should minimize SLPs' nonclinical, nonbillable tasks. And finally, scheduling should be done only by support staff charged with making sure schedules are full, and that cancellations and no-shows are well managed.
To realize these principles, we strategized to:
- Take the burden of scheduling off SLPs. Professional schedulers do all our scheduling, though SLPs provide input on how their schedules are set up. Professional schedulers are cheaper and more efficient at scheduling than SLPs. Our scheduling staff and leadership meet weekly to ensure that all schedules are full for the following week. Because SLPs do not do the scheduling, they no longer have the burden of worrying about their productivity. Most important, this arrangement allows SLPs to see more patients and generate more revenue.
- Schedule patients based on each SLP's competencies and interests. As a result, the SLPs can get the job done more efficiently without having to "read up" before seeing the patient. A side benefit is that they feel more confident, are happier and provide better service to patients.
- Schedule patients at the family's convenience. Our schedulers interview families about barriers to regular attendance and schedule around them. Based on interviewing, they may schedule appointments after school, in the evening, every other week or in defined therapeutic blocks (eight weeks, 10 weeks and so on). This process greatly decreases cancellations.
- Compensate for no-shows and cancellations. With a goal of 65 percent billed time per week, most SLPs are scheduled at 82 percent. If an SLP's typical cancellation rate is low, the scheduling percentage is decreased. Scheduling staff manage all cancellations, no-shows and changes of schedule, and they communicate with families on behalf of SLPs.
- Recruit student volunteers to support SLPs. In our student volunteer program, undergraduate and graduate students commit to at least four hours per week at Cincinnati Children's, during which they may fulfill their observation requirements.
- Simplify clinical documentation, including evaluation reports, progress reports, treatment plans and daily notes. Our "customers," who include physicians, other SLPs, other professionals and families, don't want to read a detailed manuscript about each patient. Also, we can't afford to have SLPs spend time typing a long document for each patient. Therefore, we've streamlined our computerized documentation—clinicians can complete it quickly and the reader can focus easily on the summary and recommendations.
- Leave insurance authorizations to insurance specialists. Our SLPs have limited responsibility for dealing with third-party payers.
- Encourage staff to take time off around the holidays and on snow days. These are times that families often cancel, reducing productivity for SLPs who come in.
- Hold meetings online. When not face-to-face, meetings typically take less time and there is no wasted time in traveling to and from the meeting site.
- Offer continuing education courses online. Staff can earn needed CEUs during time otherwise lost due to canceled appointments.
- Maximize staff buy-in. Our SLPs understand that we need to keep our business viable. Our monthly newsletter contains the revenue and expense data from the previous month for each location and our division as a whole. This information helps our SLPs see how they are doing as stakeholders in our success.
By considering these principles and using these simple strategies, our visit per full-time-equivalent metric in 2012 was 12 percent higher than it was five years ago. We have increased our revenue-to-expense ratio, increased access to our services and even improved staff satisfaction. Perhaps these strategies will also work for you.