The Unconventional Metrics You Should be Using in Rehab Therapy Performance Reviews

Physical therapy is in a strange place right now. Burnout is rampant, the cost of education is higher than ever, and pay is stagnating at best. Talented therapists have resorted to jumping from job to job in search of an elusive salary bump.

Clearly, something is broken in our current system. When experienced PTs are making less than brand-new grads because they can never seem to land a pay raise, there’s something very wrong with the methods we’re using for physical therapist performance evaluations. That’s why I’m going to discuss some of the less-conventional metrics you can use in your performance reviews—ones that will help you retain your valuable employees by recognizing their impact beyond merely how many units they bill.

Continuing Education and Certification

Many of us are guilty of taking a few online continuing education courses to fulfill our CEU requirements and calling it a day. I’m not proud of it, but I am no longer treating patients, so this method works for me. But when your therapists and assistants start skipping in-person events altogether to attend online-only courses—perhaps because you never seem to notice when they gain extra skills or credentials—your patients might be short-changed.

Why not reward your therapists’ commitment to growing their own skill sets? Attending in-person continuing education courses is not cheap. Even if you cover the cost of the course, your therapists are likely paying out-of-pocket for hotels, car rentals, and food. And if you don’t reward them for that investment come performance review time, they’ll likely move on to somewhere that will.

How to measure it: You can create a simple rubric with various types of continuing education courses. One point is awarded for an online course, two to three points for an in-person weekend course, and four or more points for a longer course with respectable certifications. Then, all therapists need to do is fill out the rubric to receive credit for their hard work. This way, therapists who spend their vacation time gaining valuable knowledge and certifications can see their four-plus point earnings for con-ed go toward an “exceeds expectations” score in your assessment scale.

Professional Growth

Growing one’s physical therapy career extends beyond education and clinical skills. Your clinic can benefit greatly from those therapists on your team who opt to hone various non-clinical skills by:

• Teaching as adjunct instructors at local PT and PTA schools;
• Taking on public speaking engagements;
• Becoming social media influencers; and
• Running successful blogs or vlogs with informative content.

You can reward such therapists for their efforts during their annual performance reviews. Not only will they feel grateful that their employer actually appreciates their professional growth, but they’ll also likely stick around longer—and sing the praises of your excellent culture across their platforms.

How to measure it: It can be a bit challenging to quantify “being a social media influencer” or “running a successful blog,” so I recommend creating values for each type of professional growth you identify and value—and then assigning point values. If a therapist teaches on adjunct faculty, that might garner anywhere from three to five points on the review, depending on what the therapist teaches (and how often). Similarly, if someone runs a blog, you can assign anywhere from one to five points on the performance review, depending on factors like how many people visit the blog, how frequently the therapist publishes articles, and whether he or she mentions or promotes your clinic in the blog.

As noted above, these points could then be translated into the existing metrics you use for other measurements. For example, if you award someone an “exceeds expectations” for highest productivity, you can similarly award someone an “exceeds expectations” for scoring five out of five possible points in the professional growth area.

Operations

In most clinics, therapists and assistants contribute to more than just the well-being of patients, and it’s up to managers to recognize and reward that. Your team will often create and improve processes for workflow, EMR usage, documentation, and more. These same valued team members may step up to help out with chart audits—or take over scheduling duties and represent management at meetings when you’re on PTO.

If you’re not addressing these contributions come performance review time, you’re missing out on a valuable opportunity to recognize key players who may not shine in other areas (such as productivity). Keep in mind that the very processes these therapists create and improve will help improve overall productive time for everyone else, and that should make it much easier to reward your team for their efforts when it’s time for their performance reviews.

How to measure it: A point system works great here, too! In this case, you’ll want to consider the task and the frequency, so if someone completed one hour of chart audits per month on average, he might receive one point. However, if he completed four hours of chart audits per month on average, he would receive four points. For someone who takes the initiative to streamline EMR processes, you’ll want to be generous with awarding points; remember how much more productive the rest of your team will be because of it! Again, once you identify your equivalents of “needs improvement” and “exceeds expectations” (the extreme ranges in relation to point values), you can then assign those values according to how many points your therapists rack up.

Patient Outcomes

In most settings, standardized tests are used at the beginning and end of patients’ courses of therapy. A therapist might provide an Oswestry Low Back Disability Questionnaire at the start and end of the plan of care, and these metrics can certainly play a role when performance review time rolls around. These standardized assessments can help provide an objective look at how much patients’ self-perceived function and pain levels have improved after a particular therapist’s interventions. Bear in mind that this approach only works if patients mostly stick with the same therapist throughout the course of their care.

How to measure it: This one takes a bit of extra work, but you can audit your therapists’ charts and consider whether the therapist in question used an outcomes measure score at the beginning (one point), and end (another point) of each patient’s course of therapy. Then, additional points can be awarded based on patient improvement. At that time, points can be translated into your performance review metrics scale, falling anywhere between those two extremes of “needs improvement” and “exceeds expectations.”

NPS Data

If you’re the type who looks at hard data during performance reviews, you should definitely be tracking your—and your therapists’—Net Promoter Score® (NPS®). This metric is generally used to identify your most satisfied patients and leverage them to drive new business to your clinic. The NPS® is calculated by asking a simple question: “On a scale of 0 to 10, how likely are you to recommend our practice to a friend or family member?” Not only does this metric help you improve overall outcomes and minimize patient dropout, but it can also help identify which of your therapists most consistently produce raving fans of your facility. And that’s huge, because—as we all know—the word-of-mouth advertising that comes from those raving fans can be worth more than the rest of your marketing efforts combined.

How to measure it: WebPT recommends that, at various intervals throughout the course of care, you ask patients that simple question mentioned above, and score them follows:

• Patients who score 9 or 10 are “Promoters” (loyal);
• Patients who score 7 or 8 are “Passives” (satisfied, but not loyal); and
• Patients who score 0 to 6 are “Detractors” (dissatisfied).

Then, calculate the NPS by taking the percentage of of Promoters and subtracting the percentage of Detractors: NPS = % Promoters - % Detractors. Therapists whose patients score an average NPS of 90% or above would receive 5 points, those with 50% or above would receive 2 points, and those with 25% or above would receive 1 point—and, well, you know the rest! Five points would translate to “exceeds expectations”, while 0 points would fall under the “needs improvement” end of things.

Leadership

While most of us acknowledge the importance of solid leadership skills, such skills aren’t always recognized by managers during performance reviews. There are lots of ways your team can step up to bat in these leadership roles, including:

• Taking on students;
• Organizing and facilitating meetings;
• Initiating presentations and inservices; and
• Leading interdisciplinary teams.

While these roles might not translate directly into dollars, they do improve your facility’s overall quality of care, as well as its reputation in the local medical community.

How to measure it: It’s easy to track how many students your therapists mentor as clinical instructors (CIs), and you can also take into account the students’ scores of your therapists as mentors. As far as organizing and facilitating meetings, presentations, and in-services, you’ll want to let your therapists know that they’ll be awarded points for such endeavors. For something larger and more outside-the-box—such as creating and leading interdisciplinary teams—therapists can receive higher point values. After all, such initiatives often require extra time outside of normal work hours. Then, as noted, those points can be translated into more performance review-friendly terms like “needs improvement,” “meets expectations,” and “exceeds expectations.”

Clinic Growth

When is the last time you rewarded a therapist for bringing in new referrals? Some clinics take the approach that the reward for new referrals is having a full schedule, but that trivializes the very valuable impact that bringing in fresh patients has on your facility.

To be honest, many therapists don’t bother to seek out new patients or sing the praises of their clinic outside of work—after all, they often get nothing for it other than a packed-full schedule and no appreciation. There are many ways your therapists can help bring in new patients, including, but not limited to:

• Traditional physician marketing;
• Running booths at local events and races;
• Creating a blog or social media presence; and
• Repping your clinic’s gear in public.

By measuring and rewarding such efforts, your therapists will feel like more valued members of the team—and like they’re building something better than a mere patient mill.

How to measure it: While it’s fairly easy to track and reward things like traditional physician marketing calls and running booths at events, it can be a bit more challenging to track things like repping clinic gear in public. That’s why creating a special social media hashtag for your facility is recommended. Then, you can check the activity on the hashtag at the end of the year and see which of your therapists used it most while donning your gear. As with the other metrics mentioned, you can then award points accordingly and translate your point scale into the more commonly used performance review terms of “meets expectations,” “exceeds expectations,” etc.

Attitude

A positive attitude goes a long way toward keeping your team happy and encouraging your patients to continue visiting your facility. Maintaining a perpetual smile and optimistic outlook is easier for some than others, but nobody can dispute that a pervasive feeling of happiness throughout the clinic is priceless. When therapists make the effort to say “good morning” at the start of each day and ask about each others’ lives, their contribution to a happy workplace should be rewarded during performance review time.

How to measure it: Attitude is not always easy to quantify, so in this case, collecting other therapists’ and staff members’ feedback on the person in question may be the best route. You can have each therapist rate his or her peers on attitude using those more commonly used performance review terms of “needs improvement,” “meets expectations,” and “exceeds expectations.”

Traditional Metrics

I’ve covered a number of non-traditional metrics that you can use to create a more holistic view of your therapists’ performance during review time. However, I’m certainly not saying you shouldn’t consider more traditional metrics like productivity and patient satisfaction. After all, productivity can reflect efficiency and work ethic. However, you must keep in mind that high productivity does not necessarily translate to great patient care—nor does patient satisfaction directly reflect a therapist’s overall performance, as patient satisfaction scales often account for things like building temperature, decor, wait time, and other factors that are outside of your therapists’ control.

How to measure them: Each facility has its own systems for measuring patient satisfaction and productivity, but my biggest recommendation is to temper the use of productivity and patient satisfaction scores by including unconventional measures that are more reflective of factors within therapists’ control.

The take-home message is that when therapists’ performance scores are based solely on factors that are sometimes out of their control, you’re inadvertently causing staff to feel replaceable and expendable. By incorporating more non-traditional metrics into your performance assessments, you’re building a more robust, well-balanced, and happy team of therapists who will feel appreciated for their unique talents—and thus, will stick around for the long haul.

Meredith Castin, PT, DPT, is the founder of The Non-Clinical PT, a career development resource designed to help physical, occupational, and speech therapy professionals leverage their degrees in non-clinical ways.