I’m Sorry… Who Are You Again?

And Then I Went Home and Talked About Productivity

Because apparently the universe has a sense of humor, after spending the week running from patient to patient, I went home and had a tutoring/mentoring session with a Level II fieldwork student. Learn more about tutoring and mentorship.

And what were we talking about?

Productivity.

She was struggling to meet the productivity expectations at her fieldwork site and was worried about what that meant for successfully completing fieldwork.

So there I was, after spending the week feeling completely drained by my own caseload, explaining productivity to a student who was worried she wasn't doing enough.

And part of me wanted to say:

Girl, SAME.

Because almost 12 years into this career, can I manage a caseload better than I could as a student?

Absolutely.

Does that mean a 16-patient day suddenly feels normal?

Absolutely not.

And as we talked through her concerns, I found myself thinking:

Productivity is complete BS.

Okay.

Maybe that's slightly dramatic. 😂

I understand why productivity exists. Facilities have to run. Therapists have caseloads. Patients need to be seen. We need to manage our time, get our documentation done, and actually do the jobs we're being paid to do.

I'm not saying none of that matters.

But after almost 12 years in occupational therapy, I still think there's a huge disconnect between how nice and neat productivity looks on paper and what an actual day in healthcare looks like.

Because we're not machines.

We're working with people.

Wait… What Exactly Is Productivity?

If you're an OT or OTA student and someone has started throwing around terms like 75% productivity, 85% productivity, billable minutes, treatment minutes, concurrent treatment, point-of-service documentation and approximately 37 other things you don't remember learning in school…

Welcome.

Basically, productivity is looking at how much of your paid day is spent doing work your facility considers productive, which is often your billable treatment time.

Exactly what counts, how productivity is calculated, and what percentage you're expected to meet can vary depending on the setting, employer, payer, and facility policies.

But let's keep the math simple.

Say you're working an 8-hour paid day.

That's 480 minutes.

If your facility expects 85% productivity, you're looking at roughly 408 productive minutes.

That leaves about 72 minutes of your paid day for everything else.

And this is usually the point where students go:

Wait…WHAT?

Because what happens during those other 72 minutes?

Well…

You have to get from one patient to another. Someone isn't ready. Someone needs to use the bathroom first. Someone is at an appointment. Someone refuses. Someone is in pain. A family member stops you in the hallway. Nursing needs you. Your DOR needs something. You need to find equipment. You need to talk to another discipline.

And, oh yeah, you have documentation.

Then there are the very human things that don't always fit neatly into a schedule.

A patient wants to show you a picture. They want to tell you something that's important to them. They need more time to understand what you're asking. They're having a bad day and need a little more patience.

Now, some of those things may absolutely be part of skilled care or allowable documentation depending on what you're doing, the setting, the payer, and your facility's policies.

That's why I'm not going to tell you there is one magic rule for what “counts.”

But here's the bigger point:

Human beings do not operate according to your productivity spreadsheet.

The Part Students Don't Always See Coming

I think productivity can feel especially brutal during fieldwork because you're trying to learn how to be a therapist while also learning how to do everything fast enough.

And when you're new, everything takes longer.

Of course it does.

You have to actually think through your treatment plan. You might need to look something up. Your notes may take forever. You're still figuring out where everything is. You're learning how to talk to nurses, other therapists, patients, families, and your fieldwork educator.

Then Plan A doesn't work and you're standing there trying to figure out what Plan B is.

Meanwhile, an experienced practitioner may walk into a room, notice several things right away, change the treatment on the fly, educate the patient while they're doing the activity, and already have half the note organized in their head.

That doesn't mean the experienced therapist is magically better at time management and you're terrible at this.

We've done it thousands of times.

That's a HUGE piece of productivity that I don't think students always give themselves enough credit for.

Efficiency develops with experience.

You're going to get faster.

Your treatments are going to come together faster. Your notes are going to get easier. You're going to get better at changing directions when something doesn't work.

But you have to actually do it over and over again first.

Productivity Should Not Mean Rushing People

This is the part I care about most.

Productivity matters. It is part of working in healthcare, especially in settings where your employer has specific expectations around billable time.

But that percentage should never become more important than providing safe, ethical, patient-centered care.

We use therapeutic use of self for a reason.

Sometimes someone needs patience.

Sometimes you need to explain something again.

Sometimes your patient is scared.

Sometimes they're in pain.

Sometimes the treatment you planned is absolutely not happening that day and you need to change course.

That's part of being a therapist.

And yes, you still have to learn how to manage your time while doing all of that.

That's the tricky part.

You have to figure out how to be efficient without making your patient feel like you're trying to get them off an assembly line.

So… How Do You Actually Get Better at Productivity?

If you're on fieldwork and struggling with productivity, I don't want your takeaway from this article to be:

Well, productivity is stupid, so I'm just going to ignore it.

Unfortunately, no. Nice try. 😂

You still need to learn how to manage a caseload.

Start with the things you can control.

Look at your schedule before you start treating. Know which patients need to be seen at certain times and where you have some flexibility. Have a backup plan because Plan A will, at some point, completely fall apart.

Learn where your supplies are. Ask your fieldwork educator how they organize their day. Work on getting your documentation done efficiently without cutting corners or sacrificing accuracy.

And when point-of-service documentation is appropriate for the patient, setting, payer, and situation, learn how to use it well instead of trying to recreate your entire day from memory later.

But one of the biggest things I tell students is to start paying attention to where you're actually getting hung up.

Are your notes taking forever? Are you spending too much time planning treatments? Do transitions eat up your day? Do you freeze when Plan A doesn't work? Are you spending 20 minutes trying to come up with the perfect treatment when a perfectly good treatment would do?

That's the stuff I want you to look at.

Because just saying, “I'm bad at productivity,” doesn't really tell us anything.

Why are you struggling with productivity?

That's the question.

Once we figure that out, now we have something we can actually work on.

Here's What I Tell My Students

Your goal during fieldwork isn't to magically function like someone who has been practicing for 10 years.

You're learning.

And yes, part of becoming a practitioner is learning how to manage a caseload, document efficiently, change your plan when something isn't working, prioritize what needs to happen, and keep your day moving.

So learn productivity.

Learn the math. Know what your facility expects. Ask questions if you don't understand how they calculate it. Work on becoming more efficient.

But don't let a percentage convince you that taking an extra minute to listen, educate, problem-solve, or treat someone like an actual person means you're bad at your job.

Because after almost 12 years in occupational therapy, I can tell you this:

Some of the most important parts of this job don't fit very neatly into a percentage.

And now, if you'll excuse me, I have 16 patients to remember.

Hopefully by name.