Health Admin final review
Managerial skill set
- 4 major functions: planning, organizing, directing, controlling - technological skills
Servant Leadership Some Key Characteristics
- Active Listening - Ethical Behavior - Empowering - Community Building - Conceptualizing
Types of supervision
- Administrative - Clinical or professional practice
Organizational Change occurs when....
- An organization decides to adopt new practices - If there is a cultural change in the organization
When delegating client-related tasks to OT aide...
- Anticipated outcome is predictable - Stable client and environment - No judgments, interpretations, or adaptations to be made - Client has demonstrated previous performance ability in performing the task - Task routine and process are clearly established
Administrative Supervision
- Anyone can give administrative supervision: does not need to be an OT - Has to do with policies and procedures that are not clinical: Performance evaluations and Supervising staff
Who are change agents?
- Anyone who has the skill, power and influence to stimulate, facilitate and coordinate change - Can be formal or informal - Various levels of change agents
Who are change stakeholders?
- Anyone who is impacted by the change - Proximal stakeholders: these people are directly impacted by change; IE: pt, families of clients , the docs - Distal stakeholders: these people are indirectly impact; IE: the ambulance drivers, the shops around the clinic
Supervision of OT
- Based on education and training after initial certification; are autonomous practitioners able to deliver services independently - Responsible for all aspects of safety and effectiveness of the OT service delivery process - Accountable for the safety and effectiveness of the OT service delivery process - Encouraged to seek supervision and mentoring to develop best practice approaches and promote professional growth
Supervision of OTA
- Based on their education and training; must receive supervision from an OTR/L - Delivers OT services under the supervision of and in partnership with an OTR/L - Together with the OTR/L are responsible for collaboratively developing a plan for supervision
Servant Leadership Core Values
- Caring - Serving others - Trust in and appreciation of others - Empowerment
Communication Strategies to Reduce Resistance/Fear
- Clearly share reasons for change early on - Highlight the benefits and impacts of change - Ensure leaders actively communicate throughout the change process - Use various methods to communicate the message of change - Provide opportunities for dialogue - Repeat the messages of change periodically
Key concepts in Transactional Leadership
- Contingent Rewards - Management by Exception: active and passive
Why do health care professionals document?
- Create a Chronological Record of Services Provided - Comply with Reimbursement - Communicate - Demonstrate Clinical Reasoning and Decision Making - Data Collection - Courtroom Defense
Purpose of Guidelines for Supervision, Roles, & Responsibilities During the Delivery of OT Services
- Define supervision - Outline supervision parameters to be used by OT personnel
Healthcare Common Procedure Coding System (HCPCS)
- Developed by the AMA and revised yearly - Used by OT to report fabrication/fitting of orthoses Example: - wrist extension control cock-up, non-molded, prefabricated, off the shelf
Leadership
- Establishes a direction - Aligns people with goals - Motivates & inspires - Change agents - Focus on vision & change
Where does organizational change come from?
- External force - Internal forces
Performance review process
- Frequency - Scheduling - Contributors - Behavior directed - Feedback - Sign off
What are the general principles/responsibilities of an OT manager?
- Get the work of the organization done - manage in a constantly changing environment - be action and result oriented - generate energy and motivation - elicit trust in staff - communicate skillfully - understand and implement mission, policy/ procedures - ensure compliance with regulatory requirements - represent the profession
In transformational leadership, leader works with subordinates to...
- Identify needed change - Create a vision to guide the change through inspiration - Execute the change with the commitment of the members of the group - Raise the interests of individuals beyond self-interests to focus on the purpose and mission of the group
OTs can work to affect change that...
- Increases justice, equity, diversity and inclusion - Increases cultural humility - Improves service access and delivery - Embraces EB and Evidence Informed interventions and innovations - Increases client and family centered care - Improves outcomes - Increases the value of services
ICD-10 Codes
- International Statistical Classification of Diseases & Health Related Problems - Developed by the WHO - Used for medical/treatment diagnosis and some procedures Examples: - hemiplegia & hemiparesis following non-traumatic intracerebral hemorrhage affecting right non-dominant side - dysphasia following cerebral infarction
Barriers to change: Fear of...
- Loss of power - Loss of skills - Loss of skills + competence - Loss of income - The unknown
Barriers to change: Traditional & Set Ways
- Loyalty to status quo - Failure to accept need for change - Insecurity - Preference for familiar - Breakup of work groups - Different personal ambitions
OT personnel are expected to...
- Meet applicable state and federal regulations - Adhere to relevant workplace policies - Adhere to the OT Code of Ethics - Participate in ongoing professional development activities to maintain continuing competency
Considerations for CPT evaluation codes complexity levels
- Occupational profile and amount of medical record review - The number of performance deficits identifies that result in limitations or participation restriction - The type of clinical decision making - 1 re-evaluation code: 97168
Models of Communication
- Participatory Model - Programming Change - Integrated conceptual model
Management
- Plans and budgets - Organizes and staffs - Controls and problem solves - Focus on getting the work to achieve change
Motivation
- Process of providing a need or desire that causes a person to take some action - The act of inspiring others to move toward goal-directed action - Intrinsic and Extrinsic motivations
What is the relationship between leader and subordinate in Transactional Leadership?
- Relationship is "transaction" between leader and subordinates - Subordinates get (or do not get) something for completing tasks/getting work done - "Give & take"
CPT is used for...
- Report medical, surgical, and diagnostic procedures and services to various entities (e.g., physician, insurance company, accreditation organization) - Billing - Quality measure reporting - Research
Participatory Model
- Shared understanding/input into change process - Allows employees to process change by dialoging about it
Regulations for Supervising OTAs
- States vary in OTA supervisory requirements - OT/OTAs must be knowledgeable about, and comply with these requirements
Programming Model
- Top down approach - Formal dissemination of information
How do you ready an organization to change?
- Understand the need for change - Belief that change can occur - Commitment
Hot Stove Principle
- Warning: warmth from nearing the stove warns the employee of wrongdoing, provides supervisor with the time to reiterate expectations - Consistent: just as the heat from a stove is consistent, supervisor must be consistent with the staff members - Objective: anyone that puts their hand on a hot stove is going to get burned; fair and equal discipline - Immediate: immediate feedback and discipline ASAP; do not wait to discipline someone for something that happened months ago
Performance reviews definition
- appraisal of staff performance - often performed after probation and then annually
Purpose of performance reviews
- assess performance relative to standards/expects - identify areas for improvement - identify/develop areas of strength - provide a forum to develop plans for professional growth and development
Transactional Leadership
- based on the exchange between the leader and the followers to achieve goals - Focuses on the relationship between the leader and subordinates - Leader directs efforts of others through tasks, actions, and structure - Leader provides clear direction & expectation of tasks and work objectives - Leaders use reward/punishment
Inspirational Motivation
- communicates high expectations and inspires others to be committed to the shared vision of the organization - Set a high goal for the group, ensure it can be achieved if "we all work together."
Specific frequency, methods, and content of supervision may vary by practice setting and are dependent upon...
- complexity of clients - number and diversity of clients - OT/OTA skills - practice setting - requirements of the practice setting - other regulatory requirements
Idealized Influence
- conduct self in a manner that followers will take pride in being associated with and want to emulate - Role modeling: attributes (quality); behaviors (action)
Supervision
- cooperative process in which 2+ people participate in a joint effort to establish, maintain, and/or elevate a level of competence and performance - Process aimed at ensuring the safe and effective delivery of OT services and fostering professional competence and development
Practical uses of performance reviews
- determine competency - meet accrediting standards - merit raises - promotions - support termination: adhering to laws that protect employees against unlawful termination - recommendations
Supervision can help foster....
- growth and development - effective utilization of resources - creativity and innovation - education and support to achieve a goal
Types of disciplinary action
- hot stove principle - progressive discipline
Key concepts in Transformational Leadership
- idealized influence - intellectual stimulation - individual consideration - inspirational motivation
Unplanned Organizational change
- imposed on an organization - it is unforeseen & reactive
Management by exception: Passive Management
- intervenes after non-compliance or undesired behaviors occur - reactive - "root cause analysis" (what went wrong?)
Management by exception: Active Management
- monitors and identifies any potential deviations early and corrects before undesired behaviors occur - proactive - "failure mode analysis" (what could go wrong?)
Servant Leadership
- puts its emphasis on collaboration, trust, empathy, and ethics - Service to others is the main priority - The needs of others comes first
Performance review process: Frequency
- should be held annually and reflect the entire previous year - Employees should not be "surprised" by anything on their review - As a manager, you should be communicating with staff and not waiting until the yearly performance review to point out and correct mistakes
External forces
- social, political, cultural shifts - technological changes - workforce diversity
Internal Forces
- top-down from the leadership - declining effectiveness - deficiencies in existing systems - employee expectations
CPT Billing Modifier
- used to supplement information or adjust care descriptions to provide extra details concerning a procedure or service provided - they help further describe a procedure code without changing its definition Example - modifier "CO" (OTA) when a service is performed by an OTA
Progressive discipline
1. Verbal warning 2. Written warning 3. Suspension 4. Termination
OT CPT Evaluation Codes
3 evaluation codes based on level of complexity: - 97165, low complexity - 97166, moderate complexity - 97167, high complexity
Organizational Change
A modification or transformation of an organization's structure, processes, or services
How do you evaluate change in an organization?
By looking at activity and outcome measures
Extrinsic Motivation
Comes from external sources - Employee of the month, luncheons, celebrations - Studies have shown that money is not the only motivating factor for professionals, recognition is just as important
Kotter's 8 steps of change
Create a climate for change Step 1: Establish a sense of urgency Step 2: Create the guiding coalition Step 3: Develop a change vision Engage and enable the whole organization Step 4: Communicate the vision for buy-in Step 5: Empower broad based action Step 6: Generate Short-Term Wins Implement & Sustain Change Step 7: Never Let up Step 8: Incorporate change into the culture
Current Procedural Terminology (CPT)
Developed by the AMA and revised yearly
How do change agents drive change?
Empower - Communicate the Vision - Engage all Stakeholders Facilitate - Implement Support Systems - Provide Resources, - Train, Coach, Educate - Develop Systems, Processes, Procedures
CPT Moderate Complexity
Evaluation Code: 97166 Occupational profile: Expanded review of therapy/medical records; additional review of physical, cognition, psychosocial performance Patient Assessment: 3-5 performance deficits relating to physical, cognitive, psychosocial limitations/restrictions Clinical Decision Making: Moderate analytical complexity, detailed assessments, minimal to moderate modification of assessments, may have comorbidities
CPT High Complexity
Evaluation Code: 97167 Occupational profile: Extensive review of physical, cognitive, psychosocial performance Patient Assessment: 5+ performance deficits relating to physical, cognitive, psychosocial limitations/restrictions Clinical Decision Making: High analytic complexity, comprehensive assessments, multiple treatment options, significant modifications of assessments, comorbidities affecting performance
CPT Low complexity
Evaluation code: 97165 Occupational profile: Brief history relating to the presenting problem Patient Assessment: 1-3 performance deficits relating to physical, cognitive, psychosocial limitations/restrictions Clinical Decision Making: limited amount of treatment options, no assessment modification, no comorbidities
True or False OTs aren't responsible for the implementation of appropriate supervision, but the OTA also has a responsibility to seek and obtain appropriate supervision
False, OTs are ultimately responsible for the implementation of appropriate supervision
T or False OT Aides are primary service providers in any practice?
False, They are NOT primary service providers in any practice setting and do not provide skilled services
Activity Measures
How is change progressing? - Performance Measures - Compliance Measures - Speed of Adoption - Involve Stakeholders - Communicate - Adjust, but "stay the course"
Integrated Conceptual Model
Leader's communication style impacts subordinate's commitment to change
Do Services provided by Aides reimbursed by Medicare / Medicaid and Private Insurers?
No, Services provided by Aides are NOT reimbursed by Medicare / Medicaid and Private Insurers
Contingent Rewards
Rewards based on outcomes: Reward individuals meeting goals and achieving expected outcomes by providing positive reinforcement for a job well done
6 Basic Needs of Workers Related to Resistance & Fear of Change
Security, Inclusion/Connection, Power, Control, Competence, Justice/Fairness
Clinical Supervision
Should be done by someone in your profession
OT Aide provides what to the OT/OTA?
Supportive services and it may be client and non-client delegated tasks
What is the ultimate goal of change in Health Care?
Think of Quadruple Aim - Improves patient experience - Better health outcomes - Improved staff experience - Lower cost of care
Which leadership approach is being taken when a DME vendor with the highest % of sales is rewarded by his company with a bonus at the end of the year?
Transactional
An OT program wants to shift its focus from a traditional medical model to a client-centered model. Which leadership approach would you recommend they use to implement this change?
Transformational
T or F, Servant Leadership empower others
True
True or False Change can be planned or unplanned
True
True or False Evaluations are not timed procedures, but there are typical durations provided
True
True or False OTs & OTAs are equally responsible for developing a collaborative plan for supervision
True
Outcome measures
Were the desired results of change achieved? - Improved Client Outcomes - Productivity - Efficiency of Systems - Increased Satisfaction - Cultural Change
Performance review process: Sign Off
both the supervisor and staff member should sign off on the review
Non-client-related tasks
clerical and maintenance activities and preparation of the work area or equipment
Intrinsic Motivation
comes from within - Employee wanting to feel good about the work they're doing - Professionals are naturally motivated in this way - More necessary when you move higher up in position
What are Untimed codes
evaluations & re-evaluations; supervised modalities (e.g., paraffin bath); group therapeutic procedure codes
Performance review process: Scheduling
have a dedicated time and private space to show respect to the staff member
Individual Consideration
identify and develop individual's needs/strengths; acts like a coach or a mentor
Transformational Leadership
inspires and motivates followers to create positive changes and achieve goals
Performance review process: Contributors
involve the direct supervisor and will vary depending on work environment
Documentation of Supervision
may include: - frequency of supervisory contact - method(s)/type(s) of supervision - content areas addressed - evidence to support areas and levels of competency - names and credentials of the persons participating in the supervisory process
What is supervision based on?
on a mutual understanding between the supervisor and supervisee about each other's competence, experience, education, and credentials
Planned Organizational Change
results from deliberate decisions to alter an organization; it is intentional, goal-oriented, & proactive
Client-related tasks
routine tasks during which the aide may interact with the client
Performance review process: Feedback
should be constructive and instructive, and help the employee make a positive change
Performance review process: Behavior Directed
should focus on specific behaviors rather than personality traits
Intellectual Stimulation
stimulate and challenge thinking, assumptions; encourage innovative and creative problem solving
What are timed codes
therapeutic procedures, per 15 minutes
