Optimizing Outpatient Physical Therapy

Overview

Management at a local hospital was concerned with operations at an outpatient location providing Physical, Occupational, and Speech Therapy due to an increase in staff turnover and productivity issues, missed appointments, and a growing backlog of patients who needed appointments. Pathstone Partners was asked to assist as part of a broader engagement to develop detailed findings about the current state of operations, establish strategies to increase staff productivity, and reduce patient backlogs and the current 30% patient no-show rate.

Pathstone Approach

Pathstone evaluated several different key areas to determine key strategies and anticipated benefit throughout the engagement.

First, management interviews and department walkthroughs were conducted to collect qualitative and quantitative information about the general management of the department and current pain points. The team learned that there is difficulty scheduling current resources with flexible start and end times, which has led to many FTEs falling short of their full-time status. The team also observed that patient scheduling tends to taper off in the early afternoon, with 1:00 – 3:00pm having the most open appointment times.

Staff schedule reviews and staffing to demand analyses were conducted to further evaluate operational challenges. Findings showed that staffing is not equally allocated throughout the week, PT/PTA ratios vary by day, lunches are scheduled at the same times, and a majority of first shift staff staff generally arrive 30 minutes prior to appointments on any given day. Assessment times are currently scheduled randomly throughout the day, and PTAs are not “first up” for non-assessment scheduling. Furthermore, busy days and non-busy days are currently staffed similarly, creating challenges.

Staffing to Demand Analysis

The Pathstone team leveraged this information to make several recommendations to the hospital management team. First, we recommended expanding Saturday hours to both allow staff to work up to their full FTE status and to accommodate the current patient backlog that usually builds on Saturdays.

Additionally, patient scheduling adjustments, weekly (and daily) staffing to demand processes, and skill mix realignment has led to significant improvement for the outpatient facility.

Impact

By revising staffing schedules and developing assessment blocks where PTs are available, the facility increased throughput by 10%, and created 6 more appointment slots per week. Double scheduling patients during high no-show times (weekday mornings), adding a 24-hour auto-dialer to remind patients vs. the current 72-hour manual reminder process, and adding a $50 no-show penalty saw an additional 15 appointment slots created per week and reduced the vacancy rate from 30% down to 5%.

As the outpatient facility settles in with these new processes, staff turnover decreased resulting in $100k of wage savings, utilization (+10%), revenue (+10%), and productivity (+15%) all increased, and the hospital system achieved a total financial benefit of $350K.

Key Takeaways

Scheduling, Scheduling, Scheduling: A significant portion of the facilities’ operational difficulties could be boiled down to misaligned schedules, from patients to PTs and PTAs. Breaking down the various scheduling components led to opportunity identification across each stakeholder, while also uncovering synergies between them.

Look Inwards First: It can be tempting to look at external factors or the need to bring in new staff to fix existing problems. By focusing internally, the outpatient facility was able to achieve significant financial benefit without any impact to its current staff. If an assessment has never been done, optimization efforts tend to be very effective, often providing critical insights into day-to-day activities that may otherwise go unnoticed for long periods of time.

Flexibility: To maintain improvements and identify new opportunities, it is critical to continually monitor and improve upon Key Performance Indicators (KPIs) that have been studied for this facility. Setting up processes to adjust staff schedules that align with changes in patient demand patterns will ensure this facility continues to operate at maximum efficiency for years to come.

Outcomes

Improved skill-mix, resulting in $100k in wage savings
Decreased no-show rates
Improved total utilization by 10%
Improved productivity by 15%
Increased revenues by 10%
Total annual financial benefit of $350k