Outcome vs Output in Physio.
The universe is constantly throwing various dichotomies at us. Asking us to choose between two extremes that never exist in isolation is both unfair and impossible. Red or white wine? Rent or buy? Cats or dogs? Making such decisions invariably means ignoring context and simply choosing one that reflect you at that specific moment from your particular viewpoint (consider how your wine choice depends on what you are eating). Unless of course, if it’s choosing between Seinfeld and Friends. Clearly the answer is always Seinfeld. Always.
Another false dichotomy came to mind after reading an interesting article titled, What Your Future Employees Want Most (Harvard Business Review online, May 31st 2021). It made me reflect on the choice between outcome and output in Physiotherapy. The article reported that ‘86% of employees said they would prefer to work for a company that prioritises outcomes over output.’ It went on to say that ‘New employees want to work for a company that cares less about the qualified work output they are able to produce, and more about the impact they can deliver to the business in a holistic sense’. Interesting.
Doing the great Physio thing of extrapolating research findings to match my situation, I wondered if Physios would feel the same. I asked myself, ‘would I prefer to to work for a business that values the quality of my healthcare over the number of patients I see? The simple answer was yes. However, a more complex answer also appreciates that I work within the ecology of a clinic and unless I am seeing patients, then there is no business to work in. Right?
Does this have to be the case though?
Recently, Patient J came to clinic, referred by a previous patient. Concerned about ongoing neural symptoms in her hand from a diagnosed cervical disc injury, she came in anxious to work out what to do next. By the end of the session we had set up a plan to see a neurosurgeon due to a likely peripheral nerve injury being the driver of her symptoms. Letters were sent, phone calls made and the patient ended up having her peripheral nerve entrapment diagnosed and surgery planned. All up, I saw Patient J once. Just an initial appointment. In this question of outcome versus output, clearly the right call had been made. Yes, I am praising myself. Further appointments / treatment was not the answer for Patient J. However, with the only metric measuring my work performance being output i.e. number of appointments, then there is a valid point that in this case I have underperformed.
If I’d asked Patient J to continue with further appointments, she would have attended. From a business point of view this would have been a seen as achieving a good level of output. Who wins in this situation? Patient J doesn’t. My clinical reasoning doesn’t. The business does. Is that what healthcare is about?
Managing these challenges become a daily occurrence in healthcare and one I see younger clinicians struggle with. (Note to younger clinicians, this challenge never goes. You simple deal with it a bit better). Unfortunately, simply choosing outcomes over output doesn’t sustain a viable case load, let alone a business. However, I don’t think it is solely the place of clinic owners to come up with a way to measure and value outcomes over output. We as clinicians need to consider viable options that acknowledge the quality of our work, not just the quantity.
A reasonable starting point would be to celebrate your wins, write those letters to build your network and reputation, track those personal referrals from previous patients, highlight the positive feedback you receive. Build a treasure trove of outcome data, demonstrate the quality of your work and we can possibly close the gap between these two extremes.