Can I Meet My KPI's? - Productivity Measures
- The Little Physio
- Apr 5, 2019
- 4 min read
In a recent post by different blogs and even by the APTA, an article was put into the limelight by Tammany et al. (2019), “Are productivity goals in rehabilitation practice associated with unethical behaviors?”. In short, the article found productivity goals was associated with unethical behaviour, and in contrast, settings with an emphasis on evidence based practice observed fewer unethical behaviour.
The paper confirms some of my own, other colleagues and friend’s experiences in their practices. The paper was also a great stimulator for reflecting on what productivity goals or key performance indicators are set for workplaces and whether they are good or bad.
Key performance indicators - Clinical outcome measures
In any given job setting, realistically, there will be a way to measure an employee's performance at work. These measures are known as key performance indicators and may also be called ‘productivity goals or measures’.
Key performance indicators are similar to clinical outcome measures we use to determine what deficits are in a patient/client and whether we are making changes to their condition. Outcome measures are also useful tools to motivate a client to continue working through their rehab or to demonstrate a measurable change has occurred in their condition. Key performance indicators, like clinical outcome measures, can motivate an employer to professionally develop and to build the business.
When I read the paper by Tammany et al. (2019), I reflected on some key performance indicators I have heard of in different health settings came to few conclusions. Here are some performance indicators:
Client retention rate
Number of new clients booked in
Number of word of mouth referrals
Billings per month
Stock items sold
Number of clients discharged/bed availability
These indicators appear to be reasonable but after a conversation with a wise friend and career consultant about performance indicators, I think not. Why, you may ask?
The performance indicators listed are not realistic as they are not within an employees direct control.
For example, in the clinical setting we are unable to control patient compliance/adherence to a home exercise program or their commitment to attend physiotherapy rehab sessions until WE deem them in a condition to be discharged. When we think of word of mouth referrals, this is dependent on two things, firstly the treated client passing on your details to another person and secondly, this person then booking in for and attending a consult with you.
Unrealistic performance indicators not within an employee's control leads to a few problems. One is that the employee may push for unnecessary treatment to meet retention rates or number of consults per month. This then sets up an environment where an employee is going to fail if in that given month or quarter they encounter clients who just want to do their own thing.
Another problem that arises is the push for more treatment which may be in conflict with the employees values, their ethical values (think moral injury) and having unattainable goals, is asking for burnout.
The SMART system
So, what are realistic performance indicators within an employee’s control? One way to start thinking about more balanced indicators is to use the SMART system. This is not an unfamiliar concept to those in the rehab setting. When creating performance indicators, or when interviewing in a job, ask yourself, are the indicators Specific, Measurable, Attainable, Realistic and has a Timeframe. These indicators should also not consist only of measures that are directly related to billings or the bottom line, as this suggests to the employee the employer’s sole focus is money driven and their professional development or wellbeing is not crucial to the job. It may also not capture the employee's other strengths which contributes to business performance.
Let’s re-look at key performance indicators and see if there are alternatives. Here are some:
To complete three external professional development courses annually
To complete 90 percent of follow up emails within two days of the initial consultation
To complete clinical notes within 24 hours of the consultation
To complete one education article every quarter
Another one to consider would be the client outcomes. Are clients getting better? Has the clients goals been met from the treatment sessions? This way one is also capturing the quality of the service as opposed to just quantity.
Final thoughts
It all seems pretty straightforward when we see things as black and white. However, as with many aspects of life, whether this is on a personal or professional front, grey areas exist. The trickiest part perhaps, is striking a balance between sustainable business performance and managing an employee’s performance realistically...keeping things balanced in the books so employee’s have jobs and having happy and healthy employees can be a tricky gap to bridge.
I don’t have a solution for bridging this relationship, if you have suggestions on this, please like and leave a comment on The Little Physio Guide Facebook page.
Further information
Tammany et al. 2019 - Are productivity goals in rehabilitation practice associated with unethical behaviors?https://www.sciencedirect.com/science/article/pii/S2590109519300011
APTA opinion
Catherine Itman Consulting
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