I’ve covered elsewhere what Productivity is and how to measure it, so here I’ll focus on why it is absolutely critical to identify, educate, and engage all stakeholders in advocating for appropriate productivity targets. By doing so, the RT leader will optimize her chances of successfully implementing a productivity system in their organization that is standardized, validated, accepted by all communities of interest, and provides both the ability to measure her department’s productivity as well as benchmark with other similar RT departments. What’s absolutely critical is that if the RT leader doesn’t select valid productivity metrics and engage each key stakeholder, the chances for obtaining valid clinical staffing complement are jeopardized.
With regard to identifying stakeholders, I’ll suggest that key decision-makers and decision-influencers exist within the organization as well as outside the organization. The list that I use for my starting point includes the following internal and external stakeholders:
- RC Department Leadership
- RT Medical Director
- Performance Improvement
- Executive Management
- Ensuring that a valid productivity system is implemented and properly utilized starts with the department director/manager. It is imperative that the RT leader demonstrate that time-based standards that are validated is the only methodology to use. I’ve expanded on this in “How are Respiratory Care Department metrics selected?”, but will suggest that the RT leader access two valuable AARC documents: 1.) Best Practices in Respiratory Care Productivity and Staffing White Paper , and 2) Best Practices in Respiratory Care Productivity and Staffing Position Statement
- Without question, the RT Medical Director is the most important ally to RT leaders in advancing the utilization of a valid productivity system. Not only is the RT Medical Director most closely attuned to respiratory care operations, but being a physician, your medical director has a high level authority and credibility within the senior executive team and medical team. It’s important to show your medical director that only validated time-based metrics accurately capture the time required to provide high quality respiratory care services. Likewise, it’s important to educate her as to why other metrics (e.g. procedures, CMI, ADC) are not appropriate metrics and that they could result in suggesting a reduction in clinical staff.
- Performance Improvement (PI) professionals are important because their primary function is to measure and assist in optimizing care efficacy and efficiency. If the PI professional with whom you are working is a clinician or former clinician, it will make the education much simpler than if not. In many organizations, the PI professional will be the one that serves as the point of contact between your organization and external consultants and benchmarking companies. Educating them as to which metrics are valid and which are not valid is key to enlisting them to support you.
- With respect to executive management, there are several professionals that play an integral role in the selection and utilizing of productivity systems. The CEO and/or the COO are typically the executive that leads the system in the creation and adoption of internal productivity systems. Additionally, they are involved in the selection of benchmarking system and engaging external consultants. Since many of these executives do not have a clinical background, it is even more important for RT leaders to clearly communicate the differences between a valid productivity metric and all others. All too frequently, we see posts on AARConnect that a new executive or an external consultant is suggesting a reduction in clinical staff based on a particular metric, which may not be a valid metric as previously discussed. Other senior executives, especially the Chief Nursing Officer (CNO) play an important role. Since CNOs have a clinical background, they will understand the differences between valid metrics and others and can be one of your strongest allies. The senior HR executive and her team should be considered a valuable asset in helping you as an RT leader in assisting you to determine the appropriate complement of clinical RTs. With labor shortages looming larger, your HR professionals understand the cost of turnover that can result when clinicians are asked to achieve inappropriately high productivity targets.
- Finance professionals are interested in assisting clinical leadership in managing the greatest component of most hospital’s operating budget: Human Capital. The Senior Vice President and her team of financial professionals should be educated as to the variety of productivity metrics and which metric they should endorse to measure your clinical staff productivity. They understand fixed and variable costs and can assist you to develop a clinical workforce that can flex to patient demand. It’s imperative that in the construction of the budget that they utilize valid productivity metrics, since your performance in flexing up and down your clinical staff in response to changing patient demand will be built into the operations budget for which you will be held accountable.
- In addition to all of the support provided by our professional organization, the AARC provides us with a validated system to measure productivity, the Uniform Reporting Manual (URM). Created decades ago and updated on a regular basis, the URM provides RT leaders with a comprehensive list of procedures, definitions, and validated time standards that can easily be integrated within your department’s productivity system. What differentiates the AARC’s URM from other systems is that the time-based metric is the result of a scientific process that draws upon service delivery by hundreds of hospitals across the nation to create a time standard for each procedure. The time standards are arrayed according to adult, pediatric, and neonatal procedures, with the time standards being vetted according to a standardized process. In short, the AARC’s URM is considered as a national industry standard and RT leaders should utilize this as part of their messaging to stakeholders to adopt this system as their organization’s productivity system.
- Health care consultants are increasingly engaged by executive leadership to identify best practices, remove unnecessary services, improve revenue cycle, and measure/improve productivity. With regard to productivity, these consultants utilize a number of metrics as noted above. What they may not realize is that their preferred metric may not be the best measure of RT productivity. For example, if Average Daily Census (ADC) is utilized, the RT leader would be expected to flex staff according to changes in overall hospital census. However, since RTs don’t care for all patients in the hospital, changes in census may have little to no impact on their staffing complement. What RT leaders need to do is to educate the consultants engaged by executive leadership and engage them to utilize the most appropriate metric.
In order to advocate for appropriate productivity targets, it is critical that RT leaders educate and engage every stakeholder. All stakeholders must understand that the best means to measure productivity is based on time, that procedural time is the result of service intensity, and that some procedures have variable times that must be incorporated into the productivity system in order to account for the total clinical complement required for their organization. Once each stakeholder is educated, it is far more likely that they will be engaged to assist the RT leader in developing and managing productivity systems that match the clinical complement to the patient need and demand for services.
Meet The Expert
Garry W. Kauffman, RRT, FAARC, MPA, FACHE
Garry W. Kauffman, RRT, FAARC, MPA, FACHE is a registered respiratory therapist with over 40 years of experience. Garry was selected for the AARC Fellow (FAARC) based upon his contributions to the profession at the national level.
Garry received his MPA from The Pennsylvania State University, and achieved the distinction of board certification in health care (FACHE) from the American College of Healthcare Executives.
Beginning his career as a bedside clinician, Garry has served in clinical, educational, and administrative roles in a variety of healthcare organizations and venues from short-term acute carehospitals, physician practice, ambulatory services, and long-term acute care hospitals. He formedKauffman Consulting, LLC and is the manager of this health care consulting company.
Garry is recognized for numerous journal publications, author/co-author of respiratory care textbook chapters, and as a frequent speaker at the state and national level. Garry has served his profession at the district, state, and national level where he has served in the AARC House of Delegates, AARC Board of Directors, and AARC President. Garry has served his profession in various volunteer roles as the AARC Chartered Affiliate Consultant; AARC Benchmarking Committee; AARC Advanced Practice RT Task Force; AARC Strategic Planning Committee, Respiratory Care author/reviewer; AARCTimes author/reviewer, AARC Uniform Reporting Manual, and ARCF Education Recognition Award Judge, among others.
Garry’s focus continues to be on communicating the value of respiratory care services delivered by Respiratory Therapists by connecting the science of respiratory care, documenting outcomes secondary to our services, and communicating our value to key stakeholders in the health care system.
Garry Kaufmann is a paid consultant of Vapotherm.