“Productivity — the amount of output delivered per hour of work in the economy — is often viewed as the engine of progress in modern capitalist economies. Output is everything. Time is money. The quest for increased productivity occupies reams of academic literature and haunts the waking hours of C.E.O.s and finance ministers.”  – Tim Jackson, ecological economist and professor of sustainable development at the University of Surrey

I am an occupational therapist and six years ago I also became a small business owner. My parents were hard-working entrepreneurs, so I had lots of early exposure to the ways of business. Our dinner table conversations often included discussions about bills of lading, sales reports, delivery dates and inventory. I learned the essential nature of a sustainable business: more money coming in than going out.

I understand that healthcare is an industry. Whether the hospital, outpatient clinic, rehabilitation center, skilled nursing facility or home health agency is set up as a not-for-profit or as a traditional business, if it runs at a deficit it is unwell and ultimately unsustainable.

In my parents’ business the main measure of success was selling goods at a profitable rate, while maintaining low-as-possible overhead costs. Each quarter they would hope to do a little better than the one before. Some years were better than others, but over time they became skilled at figuring out how many lawn mowers or hedge clippers to order, and ways to keep their employees productive even in the Midwestern winter (answer: sell snow shovels and Christmas trees instead of lawn equipment).

Healthcare professionals typically view our main measure of success as the degree to which we help those we serve. The organizations we work for usually highlight patient care in their mission statements, on their websites, in their marketing videos, on the walls and in their brochures. Many even give small awards to employees who demonstrate excellence in meeting patients’ needs.

But there always exists the unspoken agenda that is not posted on the wall or website. That agenda is, of course, the financial bottom line, the lifeblood of any business. We must all be concerned with this reality, but I question whether sucking the life from the key mission-agents is the best way to go about it.

But there always exists the unspoken agenda that is not posted on the wall or website. That agenda is, of course, the financial bottom line, the lifeblood of any business. We must all be concerned with this reality, but I question whether sucking the life from the key mission-agents is the best way to go about it.

Too often it is as if the tail (keeping the organization financially well) is wagging the dog (at the expense of the publicized mission of that organization). Thinly staffing hospital units when patients are very sick is very risky. Demanding therapists to produce 90-100% billable hours during their work shifts is untenable and cruel, and I question its utility even from an economic standpoint.

Economist Tim Jackson states, “…we’ve become so conditioned by the language of efficiency. But there are sectors of the economy where chasing productivity growth doesn’t make sense at all. Certain kinds of tasks rely inherently on the allocation of people’s time and attention. The caring professions are a good example: medicine, social work, education… the time spent by these professions directly improves the quality of our lives. Making them more and more efficient is not, after a certain point, actually desirable. What sense does it make to ask our teachers to teach ever bigger classes? Our doctors to treat more and more patients per hour?”

I think it’s time for a push back. I ask that our middle and upper managers and professional associations openly and persistently question and resist the notion that the best way to cut costs and make money in healthcare is by reducing the most highly trained, intrinsically motivated professional care providers into overworked technical drones. Given clear rules and parameters, we can work within the boundaries of insurance regulations and reasonable resource use.

“…resist the notion that the best way to cut costs and make money in healthcare is by reducing the most highly trained, intrinsically motivated professional care providers into overworked technical drones.”

As healthcare professionals we should work together as teammates, with our patients, to determine what they need and how to efficiently and effectively deliver it. Our patients expect individualized, professional care when they come to us. They are there because something has gone terribly wrong and they desperately need help, or because they are hoping to forestall a health crisis. When they are admitted we have entered into a covenant to provide them with expertise and kindness.

As care providers, our “productivity” is the frequency and degree to which we succeed in making our patients’ lives better. Health administration needs to stop trying to skim nickels and dimes for the bottom line by short-changing our patients and micro-managing the clinical practitioners. Our unique professional knowledge, skills, judgment and compassion are the most valuable commodities they have.

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