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LEARNING OBJECTIVES
Discuss the management needs of professional employees.
Distinguish between utilization management and case management.
Discuss the role of managers in utilization management and case management.
Determine the status of quality care and outcomes in contemporary healthcare.
Analyze physical therapy practice for quality dimensions and defects.
Analyze quality measures and models.
Analyze factors contributing to patient satisfaction.
Discuss managers' roles in protecting patient rights and identifying patient responsibilities.
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The amount of direct patient care that a manager engages in varies widely. Solo physical therapy practitioners may spend at least half of their time in patient care while middle-level managers in large organizations may be one or two steps removed from direct patient care. Others may fall somewhere in between. In all instances, managers have indirect responsibility for all of the patient care provided by their subordinates. They must have a plan for monitoring the processes and outcomes of that care and patients' responses. This chapter addresses patient care responsibilities of managers that are not included in other chapters: managing professionals, utilization management, case management, quality care, patient satisfaction, and patient rights.
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Managing Professionals
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Healthcare managers do not have direct responsibility for individual patient–therapist interactions. Instead, direct patient care responsibility belongs to each physical therapist and extends to other staff members that the therapist directs and supervises. The Guide to Physical Therapist Practice reinforces the importance of the supervisory relationship.1 The guide states that all physical therapists of record remain responsible for all aspects of a plan of care although they may direct physical therapist assistants to perform components of that care. Their deciding if and when to utilize the physical therapist assistant should be based on ensuring safe, effective, and efficient care at each treatment session. They must provide oversight of documentation for all services delivered by support personnel as well.
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In all settings, physical therapists currently have a great deal of freedom in day-to-day patient care. They are individually accountable for the care of the patients and the ongoing collaboration and consultation with other health professionals involved in the care of a patient to coordinate a patient's goals and the plans to meet them.
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Needs of Professionals
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It should be no surprise that professionals who assume such a high level of responsibility for the care of others do not really require much management to fulfill their clinical responsibilities. They control their own work to a high degree after assignments have been made and may even have a great deal of control in selecting the patients they will care for in some settings. This autonomy in clinical decision-making is confirmed by the recent trend for rehabilitation managers from one discipline to manage professionals from others. The shift to business rather than clinical roles of healthcare managers reflects the level of ...