American Speech-Language-Hearing Association

Knowledge and Skills

Knowledge and Skills in Business Practices for Speech-Language Pathologists Who Are Managers and Leaders in Health Care Organizations

Ad Hoc Committee on Business Practices for Speech-Language Pathologists in Health Care Settings


About this Document

This policy statement was developed by the Ad Hoc Committee on Business Practices for Speech-Language Pathologists in Health Care Settings, whose members include Lee Ann Golper (chair), Evie Hagerman, Pete Johnson, Ann W. Kummer, Patricia A. Rogers, John M. Torrens, and Janet Brown (ex officio). Alex Johnson, 2000–2002 vice president for professional practices in speech-language pathology, and Celia Hooper, 2003–2005 vice president for professional practices in speech-language pathology, served as monitoring vice presidents. This document was approved by ASHA's Legislative Council in March 2003.



Introduction

This knowledge and skills document is an official statement of the American Speech-Language-Hearing Association. The focus of this document is the knowledge and skills needed by organizational managers and leaders to fulfill their roles as they pertain to business practices underlying service delivery in health care.

Speech-language pathologists often rise to management and leadership positions in their organizations, but may not have had access to opportunities for formal continuing education in the areas of management and leadership. This document describes a continuum of knowledge and skill development for organizational managers and leaders in health care that is not typically acquired through graduate education in speech-language pathology, but acquired through on-the-job training, mentoring, and continuing professional education. Not all roles or elements listed in this document will be required in every management or leadership position.

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Role 1: Leadership

Knowledge required:

  • 1.a. The key principles of leadership (e.g., vision, communication, motivation).

  • 1.b. Where to find information and continuing education on leadership (e.g., Internet, publications, continuing education programs).

  • 1.c. The importance and impact of cultural and linguistic diversity on an organization, its customers, and the community it serves.

Skills required:

  • 1.1. Develop, communicate, and implement the mission, vision, values, and goals of the organization.

  • 1.2. Demonstrate effective interpersonal skills (e.g., respect, active listening, empathy) and ability to work strategically within the organization to achieve objectives.

  • 1.3. Demonstrate effective mediation and negotiation skills.

  • 1.4. Model desired organizational characteristics, culture, and values (e.g., adherence to professional and business ethics, discipline, teamwork, quality, positive attitude).

  • 1.5. Establish, implement, review, and revise policies and procedures.

  • 1.6. Develop awareness of, responsiveness to, and respect for cultural and linguistic diversity among and between staff and clients.

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Role 2: Performance improvement

Knowledge required:

  • 2.a. Performance improvement process (e.g., JCAHO's Dimensions of Performance Improvement).

  • 2.b. Outcome measurement tools (e.g., National Outcomes Measurement System [NOMS], Functional Independence Measures [FIM], patient satisfaction surveys).

  • 2.c. How to benchmark and apply performance improvement data to operational areas (e.g., clinical services, marketing, risk management) in order to achieve best practice.

  • 2.d. The importance of evidence-based practice in developing clinical protocols and practice policy documents (e.g., ASHA position statements, guidelines).

Skills required:

  • 2.1. Select and use appropriate outcome measurement tools (e.g., NOMS) to evaluate effectiveness of professional services and to implement needed changes.

  • 2.2. Apply outcome data in other operational areas (e.g., marketing, clinical procedures).

  • 2.3. Select appropriate performance improvement indicators (e.g., high-volume, high-risk, impact on organization).

  • 2.4. Implement performance improvement through facility specific methods.

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Role 3: Compliance and professional practice

Knowledge required:

  • 3.a. All applicable regulations related to voluntary and mandatory accreditation or certification processes for the facility/organization.

  • 3.b. Facility/corporate policies, procedures, and processes for preparing, implementing, amending, or deleting policies and procedures.

  • 3.c. Corporate Compliance rules and oversight.

  • 3.d. Requirements for privacy protections in electronic records and data management, and in all other documentation and communications (e.g., Health Insurance Portability and Accountability Act [HIPAA], Joint Commission on Accreditation of Healthcare Organizations [JCAHO]).

  • 3.e. Risk management.

  • 3.f. Requirements for due process for violations related to compliance or professional practice (e.g., ASHA's Code of Ethics, Scope of Practice in Speech-Language Pathology, fraud and abuse, licensure requirements, Americans with Disabilities Act [ADA], and policies and procedures of the facility/organization).

Skills required:

  • 3.1. Implement all applicable regulations related to voluntary and mandatory accreditation or certification processes for the facility/organization.

  • 3.2. Apply and ensure compliance with all facility/corporate policies and procedures.

  • 3.3. Prepare, implement, amend, or delete policies and procedures.

  • 3.4. Ensure adherence with Corporate Compliance rules.

  • 3.5. Comply with HIPAA regulations and all other regulations for privacy protection in electronic records and data management, and in all other documentation and communication.

  • 3.6. Participate in and ensure compliance with the facility/organization risk management program and processes.

  • 3.7. Follow the due process requirements for oversight and reporting violations in compliance or professional practices.

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Role 4: Personnel management

Knowledge required:

  • 4.a. Means for determining appropriate staffing levels and productivity for each position for appropriate time utilization and adequate revenue generation.

  • 4.b. Methods for recruiting, interviewing, selecting, hiring, orienting, and retaining professional and support staff.

  • 4.c. Competency requirements for each position, and methods for developing, testing, and monitoring competencies and performance.

  • 4.d. The performance evaluation process (e.g., supervising, coaching, motivating, and disciplining employees).

  • 4.e. The use of clinical advancement (clinical ladder) systems and the potential employer and employee benefit of these systems.

  • 4.f. Appropriate human resources regulations (i.e. Family Medical Leave Act [FMLA]), Department of Labor pay practices (i.e. exempt versus non-exempt employee practices, ADA, HIPAA).

  • 4.g. The organization's policies and procedures related to Affirmative Action and Equal Employment Opportunity (EEO) and strategies for managing a diverse staff.

Skills required:

  • 4.1. Monitor staffing so that there is a sufficient number of qualified competent staff to provide quality patient care.

  • 4.2. Determine the qualifications needed for all positions, develop performance standards, competencies, and job descriptions, and conduct annual performance evaluations.

  • 4.3. Assure that there are frequent opportunities for employees to discuss their goals, problems and ideas, and to receive feedback regarding their performance.

  • 4.4. Develop appropriate personnel policies (dress code, attendance, reporting incidents, etc.) and orient staff to policies and expectations for behavior and performance.

  • 4.5. Deal with discipline problems by documenting issues, mentoring the employee, and working toward resolution of problems.

  • 4.6. Ensure licensure renewals and certification of all clinical staff are current.

  • 4.7. Provide opportunities and support for professional development and continuing education for each employee, and ensure that each professional meets the continuing education requirements for certification and licensure, as appropriate.

  • 4.8. Monitor individual and overall productivity, and use appropriate strategies for maintaining productivity standards.

  • 4.9. Advocate for competitive and fair salaries.

  • 4.10. Maintain an environment that is safe, positive, supportive, and free of harassment.

  • 4.11. Recruit and retain a diverse staff who is sensitive and responsive to diversity.

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Role 5: Advocacy

Knowledge required:

  • 5.a. The legislative and regulatory process on the local, state, and national level, and the ramifications of legislative actions.

  • 5.b. The role of lobbying and lobbyists in the legislative process.

  • 5.c. The role of state speech-language-hearing associations and national professional associations (e.g., ASHA, ASHA Political Action Committee), patient advocacy groups, special interest groups, and opportunities for collaboration.

  • 5.d. How to influence the federal, state, and local legislative and regulatory process.

  • 5.e. Key issues that impact the organization, profession, and consumers.

Skills required:

  • 5.1. Educate, mobilize, and organize staff, other professionals, and consumers to take action on relevant issues.

  • 5.2. Gather data (e.g., outcomes, costs, benefits) from multiple sources to develop and/or disseminate consumer and professional advocacy resources.

  • 5.3. Effectively communicate, negotiate, and persevere with legislators and staff of regulatory agencies.

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Role 6: Marketing

Knowledge required:

  • 6.a. The definitions of marketing, sales, and promotion as they relate to health care.

  • 6.b. The components of marketing (e.g., consumer and market analysis, marketing plan, etc.).

  • 6.c. The external and internal activities to promote speech-language pathology products or services in a health care setting.

  • 6.d. The relationship-building techniques in order to increase referrals to speech-language pathology.

  • 6.e. Customer service and how to handle and benefit from customer complaints.

Skills required:

  • 6.1. Deliver products or services that satisfy customer needs and wants.

  • 6.2. Develop, implement, analyze, and modify appropriate market strategies (analysis of consumers, market, and competition; distribution; the 4Ps [Product, Price, Place, and Promotion] of the marketing plan; and financial analyses).

  • 6.3. Effectively engage in external education and promotion (e.g. office visits, brochures, paid advertisement, media coverage, etc.).

  • 6.4. Effectively engage in internal education and promotion (e.g. cross referrals, multidisciplinary staff education, etc.).

  • 6.5. Use strategies to effectively resolve and benefit from consumer complaints, and prevent reoccurrence.

  • 6.6. Provide superior customer service (e.g., attention to promptness, minimal interruptions).

  • 6.7 Effectively disseminate information on the availability of products and services to diverse audiences.

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Role 7: Accounting/Fiscal management

Knowledge required:

  • 7.a The organization's budget process.

  • 7.b. How to create a budget and measure variance.

  • 7.c. Accounting basics (e.g., cash-based, accrual-based, transaction types, consistency).

  • 7.d. The meaning of key accounting metrics (e.g., cash-flow statements; balance sheets; profit and loss statements; accounts receivable; accounts payable; net working capital; gross margin, earnings before interest, taxes, and depreciated assets ‘EBITDA’).

  • 7.e. The fiscal policies of the facility and department.

  • 7.f. The costs and revenue sources of the facility and their department.

  • 7.g. Reimbursement requirements (e.g., eligibility criteria, authorizations, billing/coding, documentation for different types of payers (e.g., Medicare, Medicaid, HMOs, PPOs, private health plans) and other private pay options and payment systems (e.g., Prospective Payments Systems).

  • 7.h. Key elements and obligations of contract development.

  • 7.i. Technology applications used in the accounting process (e.g., accounting software, spreadsheets, databases).

  • 7.j. The elements of a business plan or pro forma.

Skills required:

  • 7.1. Plan, create, implement, and measure budgets (e.g., operating, capital and salary) and variance.

  • 7.2. Analyze key accounting metrics as referenced above, and implement recommendations based on the analysis.

  • 7.3. Price services to be competitive and meet the fiscal goals of the organization.

  • 7.4. Identify both revenue enhancing and cost-cutting measures in line with organizational values while maintaining quality of service.

  • 7.5. Conduct cost-benefit analysis of products and services.

  • 7.6. Develop, implement, and update fiscally relevant management tools and processes (e.g., billing, coding, documentation, accounting).

  • 7.7. Develop, oversee, and manage contracts or obtain appropriate consultation.

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Glossary

Accounts Payable: Represents a liability in the form of a bill received from a vendor or other entity requiring payment for a good or service.

Accounts Receivable: Represents an asset in the form of an invoice to a customer for goods or services rendered.

Accrual-Based Accounting: The method of accounting where income and expenses are posted when they are incurred (i.e., when an invoice for payment due is sent to a customer or bill for expenses incurred is received from a vendor), not when cash changes hands (i.e., deposited or paid).

Affirmative Action: Identifying and increasing the underrepresentation of members of protected groups in an employment setting. Executive Orders required federal contractors who meet specific criteria to file written affirmative action plans.

Americans with Disabilities Act (ADA): Enacted in 1990, it gives civil rights protections to individuals with disabilities, similar to those provided to individuals on the basis of race, color, gender, sexual orientation, national origin, age, and religion. It guarantees equal opportunity for individuals with disabilities in public accommodations, transportation, state and local government services, and telecommunications. It also guarantees equal employment opportunities and requires employers to reasonably accommodate qualified individuals with disabilities.

Balance Sheet: A statement that reflects the assets owned by a company, liabilities owed to others and the accumulated investment of the owners.

Benchmarks: Performance indicators used for comparisons between organizations or programs. Benchmarks are the standards or targets that are derived from aggregate data or data from a peer group or competitor organization(s) and then applied to evaluate or improve performance. Examples of benchmarks include indicators such as: average billable hours per full time equivalent employee (FTEE); personnel costs per unit of service/procedure; inpatient lengths of stay by diagnosis; annual percent of staff turnover; ratios of support personnel to licensed staff; satisfaction survey data, etc.

Best Practice: Procedures and decision-making supported by efficacy, effectiveness, and efficiency data; the consensus opinions of experts; or outcome data.

Capital Budget: The money that a business plans to spend on capital investments (e.g., equipment).

Cash-Based Accounting: The method of accounting where income and expenses are posted when cash changes hands (i.e., deposited or paid), not when they are incurred (i.e., when an invoice for payment due is sent to a customer or bill for expenses incurred is received from a vendor).

Consistency: Accounting principle that requires an entity to maintain the same accounting conventions or rules every year. This helps to ensure that financial statements can be appropriately compared year after year.

Corporate Compliance: The organizational oversight, educational, and surveillance program for all matters within the organization relating to the protection of the public trust (such as protection of human subjects, compliance with all governmental regulations and the prevention and correction of fraud and abuse and conflicts of interests).

Due Process: The legally required processes, or necessary steps, for handling human resources transactions for recruiting, hiring, and disciplining staff, and for managing behavioral violations of any sort (such as sexual harassment, discrimination, fraud, and abuse, etc.).

EBITDA (earnings before interest, taxes, and depreciated assets): The measure of what an entity has made when interest, taxes, and depreciated assets are taken out of the equation. It is often used as a factor in determining the value of a business. Sometimes EBIT is used without depreciated assets and is sometimes referred to as free cash flow.

Equal Employment Opportunity: Making hiring decisions that are not based on the applicant's race, gender, sexual orientation, national original, religion, age, color, or disability status.

Evidence-Based Practice: Use of the current best research findings and/or expert consensus opinions to make clinical decisions about patient care. Levels of evidence include Class I: randomized controlled clinical trials; Class II: evidence from at least one well-designed observational clinical study with concurrent controls; and Class III: evidence provided by expert opinion, case studies, and studies with historical controls.

Exempt (Salaried): A pay designation based on the Fair Labor Standards Act (FLSA) (enacted in 1938). The exempt designation is usually for administrative, executive, or professional employees. In this case, for example, the employee is paid a salary for carrying out the assigned job responsibilities. If more than 40 hours are worked in a week, the employee is “exempt” from eligibility to receive overtime.

Family and Medical Leave Act (FMLA): Enacted in 1993, it guarantees that people who work for companies with more than 50 employees can take up to 12 weeks' accrued or unpaid leave a year for family or temporary medical leave under certain circumstances. The leave can be taken to care for a newborn or newly-adopted child, to care for certain seriously ill family members, or to recover from their own serious health conditions.

Fraud and Abuse: Intentional deception or misrepresentation of services or patient needs that may result in an unauthorized benefit to the patient, clinician, or organization. Includes accepting kickbacks, waiving copayments, billing for services not rendered, or using a fraudulent diagnosis to obtain coverage.

Goals: Statements of the outcome or results that a company expects to achieve in a prescribed time period. Goals are challenging, realistic, contain a completion date, and are stated in measurable terms. The goals support and help to achieve the mission and vision of the organization.

Gross Margin: The sum of all income or revenue minus the cost of goods sold. In health care the “goods sold” can be viewed as health care services provided.

HIPAA: Health Insurance Portability and Accountability Act of 1996. The privacy rule and electronic data interchange provisions of HIPAA set forth regulations designed to protect the confidentiality of all health care-related information and to mandate the format of all electronically stored and transferred patient data.

JCAHO: Joint Commission on Accreditation of Healthcare Organizations. An independent, not-for-profit accreditation organization that develops standards to improve the safety and quality of patient care and accredits health care facilities (hospitals, home health agencies, long term care facilities, ambulatory care, etc.).

Market Analysis: Analysis of consumers as a group, including where and how they access health services and how they are reimbursed. Market analysis focuses on the market size, trends, regulatory factors, competition, market channels (e.g., physicians, employer groups, and insurance companies, etc.), provider relationships and staffing requirements.

Marketing: Process by which individuals or groups obtain what they want or need by creating and exchanging products or services with others. Marketing is an ongoing process that involves analysis of the consumer's needs, identification of the health care market size and trends, competition, access to or distribution of the product or service, the marketing plan and the financial analysis of revenue, costs and profit.

Marketing Plan: A dynamic plan of action that defines and addresses the “5 Ps”: the product or service, the price, the place or access to the product, promotion and position or market penetration (e.g., percentage of patients served). Effective marketing plans are reviewed and revised on an ongoing basis.

Mission: Brief statement defining basic goals and the major tasks and activities of the organization and what the organization is about. For example, “provide quality patient-centered and family-centered services to communicatively impaired individuals.”

Net Working Capital: This is a calculation of a company's current assets minus current liabilities and is a measure of solvency or liquidity

NOMS (National Outcomes Measurement System): ASHA's database for tracking patient outcomes using seven-point Functional Communication Measures and scored by certified professionals at client admission and discharge.

Non-Exempt (Hourly): A pay designation based on the Fair Labor Standards Act (FLSA) (enacted in 1938). The non-exempt designation is usually for individuals who are not administrative, executive, or professional employees. In this case, for example, the employee is paid by the hour. If more than 40 hours are worked in a week, the employee is paid at least one and one-half times the regular rate for each hour over 40.

Operating Budget: The money that a business plans to use on a daily basis.

Profit and Loss Statement: A report that reflects revenue minus expenses as a positive (profit) or negative (loss) number.

Pro Forma: A plan that is made in advance to describe a future venture.

Promotion: The advertising or selling process that changes buyer behavior resulting in increased consumption of your product or service. Examples of promotional activities include TV, radio, newspaper advertising, consumer sales promotions (e.g., free speech and hearing screening, participation in a health fair or trade show), personal selling (e.g., case manager or physician visits), direct selling in catalogs or on the internet, and favorable public relations and publicity.

Risk Management: Systematic approach to identifying and reducing the occurrence of factors that put the patient or the provider at some risk (e.g., legal risk, risk of injuries or harm, or increased costs).

Sales: Convincing consumers to buy your product or service. It is a component of promotion. Personal selling involves direct contact with the buyer. Examples of direct selling include catalog, direct mail, and internet sales.

Values: Statement describing the basic beliefs from which the organization or corporation operates (e.g., “We put patients first”).

Variance: The difference between the budget and the actual spending in a given period.

Vision Statement: Description of the goals the organization seeks to achieve (e.g., “serve as a model and center of excellence in clinical service delivery”).

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References

American Speech-Language-Hearing Association. (1991). Considerations for establishing a private practice in audiology and/or speech-language pathology. Asha, 33(Suppl. 3), 10–21.

American Speech-Language-Hearing Association. (1994). Professional liability and risk management for the audiology and speech-language pathology profession. Asha, 36(Suppl. 12), 25–38.

American Speech-Language-Hearing Association. (1997). Preferred practice patterns for the profession of speech-language pathology. Rockville, MD: Author.

American Speech-Language-Hearing Association. (2001, December 26). Code of ethics (revised). The ASHA Leader, 6(23), 2.

American Speech-Language-Hearing Association. (2001). Scope of practice in speech-language pathology. Rockville, MD: Author.

American Speech-Language-Hearing Association. (2002). Confidentiality. In ASHA Supplement (Vol. 22, pp. 47–49). Rockville, MD: Author.

American Speech-Language-Hearing Association. (2002). Conflicts of professional interest. In ASHA Supplement (Vol. 22, pp. 51–53). Rockville, MD: Author.

American Speech-Language-Hearing Association. (2002). Drawing cases for private practice from primary place of employment. In ASHA Supplement (Vol. 22, pp. 69–70). Rockville, MD: Author.

American Speech-Language-Hearing Association. (2002). Ethical practice inquiries: ASHA jurisdictions. In ASHA Supplement (Vol. 22, pp. 71–72). Rockville, MD: Author.

American Speech-Language-Hearing Association. (2003). Knowledge and skills in business practices needed by speech-language pathologists in health care settings. ASHA Supplement, 23, 87–92.

American Speech-Language-Hearing Association. (2002). Prescription. In ASHA Supplement (Vol. 22, pp. 59–60). Rockville, MD: Author.

American Speech-Language-Hearing Association. (2002). Public announcements and public statements. In ASHA Supplement (Vol. 22, pp. 67–68). Rockville, MD: Author.

American Speech-Language-Hearing Association. (2002). Representation of services for insurance reimbursement or funding. In ASHA Supplement (Vol. 22, pp. 47–49). Rockville, MD: Author.

American Speech-Language-Hearing Association. (2002). Use of graduate degrees by members and certificate holders. In ASHA Supplement (Vol. 22, pp. 47–49). Rockville, MD: Author.

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Index terms: practice management, health care

Reference this material as: American Speech-Language-Hearing Association. (2004). Knowledge and skills in business practices for speech-language pathologists who are managers and leaders in health care organizations [Knowledge and Skills]. Available from www.asha.org/policy.

© Copyright 2004 American Speech-Language-Hearing Association. All rights reserved.

Disclaimer: The American Speech-Language-Hearing Association disclaims any liability to any party for the accuracy, completeness, or availability of these documents, or for any damages arising out of the use of the documents and any information they contain.

doi:10.1044/policy.KS2004-00073

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