Random Compliments

Random compliments throughout the week... a great way to help your team members be the best they can be.  Make the compliments sincere and specific.  I make a list of my employees and I make a point to give each member 1 random compliment during the week.  I put a mark by each person's name as I give the compliment so I make certain that each member gets a compliment.  It's important to let your team members see how great he/she performs.  I give more compliments as I see fit, but I have to be certain to give each employee at least 1 each week.  Sometimes the random compliment is something just whispered in the therapist's ear after a fabulous transfer.  Other times the compliment might be given in front of the team during a meeting or over lunch.  Whether given in private or public a compliment is vital to the health of your overall team.

Mud Slinging

Don't allow yourself to participate in arguments within your facility.  Other managers, family members, etc may target you...may accuse you of all sorts of things.  Rise above the mud throwing.  Validate his/her feelings and refer them to your supervisor.  If someone yells at you and says "I think your department is going to get us audited - look at those therapy minutes..one day they get 45 minutes and the next day 90 minutes and then the following day they get 30 minutes of therapy".  To this I would respond "I know right?  Therapy minutes change so much from day to day depending on patient needs and our RUGs schedule.  I appreciate your concern and I'll keep it in mind as I plan schedules.  If you're really worried and want to talk to someone about it - please feel free to contact my supervisor".  I also lower the volume of my voice when speaking with someone that has raised theirs.  This instantly helps them lower his/her voice so they can hear me.  When the mud starts flying... get to higher ground.

Different Parts Make a Spark

Different parts of an engine (when running together properly) create energy together.  It's all the different point of views/opinions etc that make a team strong.  Often when I lead seminars, I place a jar of jellybeans in front of the group and I ask everyone in the room to guess how many are in the jar.  Then I add up all of the guesses and divide to get the average number.  It's usually VERY close to the correct amount.  It's the sum of all the different opinions that make a strong rehab team.  Sometimes members become so upset that another member doesn't agree with him/her...so I do this training for them to help them understand that it's the individual differences that make the team strong.  Help your team see each other's opinions/arguments as a strength and watch the "warfare" /gossip etc dissipate.  

Team Engine

Often when I consult for team building, I find a director that doesn't care about the individual parts of their team.  They think each person should do their job and think that if they just take care of their own job duties that the team will work perfectly.  A team is like an engine..if you don't take care of the individual parts, then the engine will not purrrr along as it should.  It will clunk along and sometimes bang really loud.  It will run slower then its potential and will take a lot more energy to keep it going then it should.  Tend to each person... learn what motivates each member and what each person needs from you as their leader.  Take care of the parts and watch your engine run at peak performance.

Medical and Treatment Diagnoses for Therapy

It's always difficult to zero in on an appropriate medical diagnosis and then to produce an accurate treatment diagnosis during your evaluation for therapy.  Common medical diagnoses errors involve codes like UTI.  A simple UTI is curable with antibiotics and rest for a few days.  When a UTI lands a patient in the hospital and then in a SNF for therapy - that goes beyond a simple UTI.  There is an underlying problem that was made worse by the infection resulting in his/her need for therapy.  An underlying problem may be anything like COPD, CHF, arthritis, Parkinson's, Dementia, diabetes, malnutrition, etc.  The average person doesn't contract a UTI and then end up in a SNF to get therapy so he/she can go back home.  Find the underlying condition and code it appropriately to assure you don't get a denial on your billing.

Cluttered Space Cluttered Mind

Like lots of stuff?  That's great, but leave it at home.  A cluttered space results in a disorganized therapy team and financials will never soar.  When the gym is a mess then therapists feel unprofessional and get lazy or just plain stop caring.  Clean up the space and make a home for every piece of equipment.  If you have games etc in storage bins - they'll never get used.  Therapists use what they see and whatever is handy to grab.  Make your gym user-friendly.  Manage your space - take care of your staff - spoil your patients - watch financials climb.

Chatter Box

Another killer of a great manager is the perception that he/she is a chatter box.  That all they do is sit around and talk on their phone or down the hall or in someone's office...talk talk talk.  The team sees it as a lazy manager.  If you want to be a great manager, then pick up the pace when you're walking around the department and down the hall.  When the team sees that you are in  hurry when scurrying around the facility, then they will perceive that you are as busy are they are.  If your team's perception is that they do all the work and you do nothing... you won't have any power of persuasion with them... you'll be a useless manager.  Stop the chatter and step up the pace if you want to be a great leader.

Communication

As managers we require constant communication from our employees on what's going on with the patients.  But as managers we have the largest responsibility when it comes to giving communication.  We have to be accountable to follow up on patient appointments, communicate changes in discharge plans, report changes in condition to other departments, report projected therapy completion dates, report new medications or upcoming appointments to our staff...it's our responsibility to carry to communication from our team and even more importantly to carry all incoming information to our team in a timely manner.  Too many times when I enter a facility as a consultant, one of the biggest gripes I get from facility staff and therapy staff is the manager isn't doing this basic function and it creates all kinds of chaos.  It also creates distrust and a general feeling of dislike toward the manager.  Create systems for fulfilling communication - don't rely on your memory to communicate everything to everybody.  If you can't think of systems to do this for you - then carry a small notebook around with you and write everything down immediately and cross it off when you've communicated it.

Lions in the Den

I heard from a friend that she has a therapist in her department that has "taken over" and the rehab director won't stand up to this would be dictator.  This has happened to many of my past departments when I have left.  The new director doesn't stand up and take charge so the employee with the strongest personality takes over - because someone has to and no-one is around to keep him/her in check.  How sad - how unfortunate for the rest of the team.  Financials falls apart and people quit.  A used to be strong team is no more all because the new director doesn't have a backbone.  Some managers think that being liked by their employees is the same thing as being respected and they couldn't be further from the truth.  Respect is earned and it comes by running a well oiled team - one where everyone feels a part of something greater - they each feel needed and important.  They respect their leader because he/she is a real "leader" and not just another friend.  The lions will circle and devour the rest of the team if the lion tamer doesn't keep them at bay.

Documentation

So much of our therapist's time is spend doing documentation and unfortunately much of it is of poor quality.  Teach your therapists the difference between a goal and a functional objective.  A goal might read something like "Patient will demonstrate 3+ strength in bilateral upper extremities" and the intermediary will say "So??"  A goal that reads something like "Patient will propel self to diningroom and other locations within 150 ft radius of her room 80% of opportunities" would be a functional objective.  This type of goal matters to the patient and to the reviewer because it will make a huge impact on the patient's quality of life and ability to live more independently.  I'll be discussing more topics surrounding documentation in upcoming posts.

Weed Your Garden

I view my therapy team as a "garden" and sometimes you get a weed in your garden.  If you don't remove the weed, it will drain the energy out of the rest of your garden.   A weed affects everyone on the team.  They stir up trouble every chance they get.... point out everyone else's flaws... determined to "right the wrongs" in the department.... gossip... criticize.... ignore the rules.... WEEDS!  What do you do with a weed?  You could spend hours on end trying to change the weed... teach it to grow the right way... and produce the right fruit.  But in the end a weed is a weed and it will never be a productive plant.  Get rid of your weed and the rest of your garden will flourish.  Try to recognize the difference between a struggling plant and a weed.  A great manager can tell the difference when someone is trainable and when it's hopeless.  Don't waste your time on a lost cause...  spend your time pruning the other plants (training them) and watch a department come to life.

Accountable

Always be accountable to your therapy team or nursing staff or patients.  Identify who your customer is in your job position.  When someone asks for something, I do my best to get it for them immediately or I ask them if I can get it to them at ____ time.  And then I do it.  If I can't get it to them by the time I gave them, I notify them right away and give them the new timeline.  Accountability can make or break the relationship between employee/manager, patient/therapist, manager/nursing/administrator.  When employees get "put off" indefinitely and many requests they give go unanswered... they start giving up and regard management as a joke.  When you as a manager answer requests and get information immediately for your team, their respect for you will grow and they will feel more secure following your leadership.

Validate

When correcting an employee's actions or asking him/her to do something different with procedures, correct briefly and validate the other strengths the employee demonstrates. So if I have an employee that leaves early without telling me, my response to him/her would be something like "Hey Diane I need to speak with you. You left early yesterday and didn't let me know...Helen could've used your help because she was overloaded. I know that is unusual for you as you are always so thorough with everything you do - I admire that". Or it might sound something like this: "John you left early yesterday and didn't tell me - don't let it happen again.... hey I like what you did with Henry today...what a difference!!" I don't use the word "but...." because it just erases anything positive that you just said. I also don't lead with the compliment and follow with the correction because he/she will remember the last thing you said longer than the first thing you said. Correct quickly/briefly.. and then validate strengths.

Bottom Line

Don't be too wordy when answering your staff. Use brief and to the point instructions/ answers. When you become too verbose, the person you're speaking to is thinking "I get it all ready" :) A coach doesn't use a lot of words, he gives you what is important and he expects you to use logic/ reasoning skills to figure out the rest. A good director is a good coach... you're leading a team not teaching a classroom. Lead like this and you will earn your team's respect... and you will generate top revenues.

Productivity

Many directors try to hammer the point of productivity into their team members only to find that their financials start decreasing even worse. When you try to "force productivity" you actually kill the mood in the department and instead of using low productivity as an educational opportunity - you've now told your therapists that the only thing important to the company is how much he/she bills. Instead I approach a low productivity therapist with a question.... "I see you busy all day...it's difficulty for me to believe that you're sitting in a chair 4 hours a day doing nothing, yet that's what your numbers are saying". Then sit back and listen to them agree with you giving you the opportunity to help them find the areas they are under billing or ways that they can become better time managers. They walk away feeling good about your view of them as busy workers and a pocket full of ideas to implement that will improve their numbers.

Refusals

Often therapists try educational approaches and ultimately try sending in the business office or administrator to reason with a patient that is refusing. Most of the time refusals are a symptom of executive dysfunctions and should be handled by an OTR or SLP. A therapist must establish rapport before treating a patient with early Dementia or executive dysfunctions. This time of establishing rapport can be documented as "Skilled graded approach to engage patient participation in full therapy plan of treatment". Another goal might read as "Patient will participate in environmental engagement activities 80% of opportunities indep". Those activities that you use to establish rapport can include something as simple as getting the patient his/her favorite soda or something else that is important to the patient. Sometimes you can interact with someone else at the patient's meal table to demonstrate you are trustworthy. Another way is to join him/her at activities and allow the patient to teach you how to do it. Allowing the patient to be the expert in one area, will go a long way to build trust so the patient will be willing to allow you to be the expert in another area. It's about building trust.

Observations and Analysis

I'm always astonished at how little time therapists spend observing and analyzing the carry-over of learned therapy techniques and the strength/flexibility they are working on with the patient. I hear frequently from therapists about how busy they are and how little planning time they feel they have. When I ask them if they spend time during their sessions observing the patient as he/she walks and participates in other activities...all the time analyzing what needs to change in his/her program/goals...the therapist always stares at me blankly. Sometimes we forget that our most important skill is our ability to analyze abilities and plan a skilled treatment plan.

Let's Share Information

With all of the many changes in the Sub-Acute therapy setting, everyday duties can appear overwhelming at times and confusing. Feel free to ask questions, give advice, and hopefully as we share information our jobs will become easier. This blog is for therapists, directors of rehab, MDS Coordinators, and anyone else that is involved in therapy in the SNF setting. Welcome!

Introduction

I am a Speech-Language Pathologist with over 20 years of experience. I work for an amazing company; Transitions Rehab as a Clinical Educator. I have worked in nearly every facet of the Sub-Acute Rehab world and still learning something new everyday. I've worked all over the country and the therapy world is smaller than you might think. We all have similar frustrations, but fortunately we all have different strengths which we can share to make our careers more successful and less challenging.