For rehab managers: how to set a productivity target that is fair from both sides
A rehab productivity target that holds up is designed, written down and checked against the day it implies.
How to set a productivity target that holds up starts with what time it is measured against and what counts as productive. Then decide how documentation and cancellations are handled, and write the method down. A rehab productivity target built that way can be explained to a therapist asking why. It can also be explained to a corporate parent asking whether it could go higher.
This guide is for managers. The site is built for therapists, so each step also shows how the decision looks from the therapist's side of the table.
Some targets were never designed at all. They were inherited from a predecessor, copied from a corporate standard, or chosen because 85% sounded about right.
Start with the denominator
Decide which minutes the target is measured against, and write it down. The defensible choice is paid time, which is the shift minus any unpaid break. A target on scheduled hours leaves out any paid time staff work after their scheduled finish. Total shift time including the unpaid break measures people against minutes they were not paid for.
The choice changes the result for the same work. Take an 8-hour shift with a 30-minute unpaid break and 383 treatment minutes. Against the 450 paid minutes, that day is 85.1%. Against all 480 minutes, break included, it is 79.8%, which is 5.3 points lower. The productivity calculator with lunch break shows both figures for any day.
From the therapist's side, a break left in the denominator reads as a 5.3-point penalty for eating lunch. Make the choice on purpose and state it.
Decide what counts, and be specific
List every recurring activity in your department and put each one in the productive or the non-productive column. The list includes evaluations, screenings, care coordination, family education, group and concurrent treatment, supervision, equipment, transport and documentation.
Disputes start where the list is vague. A therapist who doesn't know whether family education counts has to guess, and two therapists in the same department can guess differently.
Account for documentation explicitly
If documentation is non-billable and expected on the clock, it uses part of the day the target is measured against. As an example, take a 450-minute paid day with 40 minutes of documentation on the clock:
- 40 ÷ 450 = 8.9% of the paid day goes to notes;
- 450 − 40 = 410 minutes are left for everything else;
- an 85% target needs 0.85 × 450 = 382.5 billable minutes;
- 382.5 ÷ 410 = 93.3% of the remaining time has to be billable.
There are two honest options. Either build documentation time into the target, or state openly that documentation is expected outside paid hours. The second is a decision with legal and retention consequences. In the US, federal wage rules treat work that is "suffered or permitted" by the employer as work time, even when nobody requested it. Make that decision deliberately, in consultation, and in writing. The documentation time calculator shows what a daily documentation load adds up to over a year.
Choose the measurement period
A weekly or pay-period target asks for the same total as a daily one. Five 450-minute days at 85% need 1,912.5 billable minutes, whether they are counted day by day or across the week.
The difference is what happens on a bad day. Suppose a therapist loses a morning to a medical hold and finishes Tuesday at 70%, or 315 minutes. Under a daily target, Tuesday counts as a miss whatever happens later in the week. Under a weekly target, the 67.5-minute shortfall spreads across the other four days at about 16.9 extra minutes each. A daily target leaves no room to recover, which puts pressure on decisions that should be clinical, such as session length or mode.
The guide to weekly and pay-period averages covers the arithmetic, and the weekly productivity calculator works it out for a real week.
Account for cancellations and no-shows
Cancellations and no-shows are a scheduling and access problem. If the target makes no allowance for them, the department has decided that therapists carry them, even if nobody made that decision on purpose.
Measure your own rate of cancellations and no-shows. Then check the target against it. As an example, assume cancellations and no-shows remove 15% of the paid day on average, and the empty time can't be refilled. The most anyone can bill is then 85% of paid minutes. An 85% target would require every other minute of the day to be billable, with no documentation, meetings or setup on the clock at all.
The options are to adjust the target for your known rate of cancellations and no-shows, or to exclude documented cancellations from available time. A third option is to invest in ways of refilling cancelled sessions, such as a standing short-notice list. The guide to the cost of a cancellation turns a rate of cancellations and no-shows into an effective target.
How to set a productivity target: model the day first
Before committing to a number, model the day it implies. Start with paid minutes, then subtract the department's average documentation time and average non-billable time for meetings and coordination. What remains is the time available for treatment. Here is an example with an 85% target:
| Step | Minutes |
|---|---|
| Paid day | 450 |
| Less documentation on the clock | −40 |
| Less meetings and coordination | −15 |
| Available for treatment | 395 |
| Billable minutes an 85% target needs (0.85 × 450) | 382.5 |
In this example, 382.5 ÷ 395 = 96.8% of the available time has to be billable, before a single cancellation. One 30-minute cancellation leaves 365 available minutes, which is fewer than the 382.5 the target needs. On that day, the target can't be met.
Put your own department's averages into the same steps. If the result is close to 100%, the target is a permanent shortfall for the therapists working to it. The fix is either a lower number or a structural change, such as less documentation on the clock or fewer cancellations and no-shows left unfilled.
Set the assistant differential deliberately
If assistants carry a higher target than therapists, the non-billable duties that justify the difference should sit with the therapists. Where assistants also handle equipment, transport, coordination and setup, the differential measures a difference in duties that doesn't exist.
Review it against actual task allocation, not the job description. The assistant's side of this is in the guide to COTA and PTA productivity targets.
Publish the calculation
Write the method down and give it to staff. Include what is in the denominator, what counts as productive, the measurement period, how cancellations are handled, and how group and concurrent minutes are credited.
With the method published, a productivity conversation starts from agreed arithmetic. Without it, the first part of every conversation is spent working out how the number was produced, and therapists have less reason to trust it.
Review it once a year against your own data
Compare the target to the department's actual average. If nobody has met it for two years, the target is telling you something about caseload, scheduling or staffing, and little about your therapists.
Handling the corporate conversation
If the target was set above you, you may have to defend it upward as well as downward. The modeling above is what makes that possible. Here is an example of a professional answer: "Our target is 85% and our average is 83%. Our records show the shortfall falls on days with late cancellations. We are testing a short-notice list to fill them." Compare that with "We are below target and pushing the team", which invites the wrong kind of help.
Burnout and retention
In a 2024 UK survey of speech and language therapists, 55% said they had experienced burnout in the past 12 months. In the same survey, 39% were considering leaving their current role. In a US survey of physical therapists run in 2020 and 2021, 49.3% reported burnout. In a survey of occupational therapists in Ireland published in 2022, over two thirds had experienced burnout in the past 12 months. Almost half had considered leaving the profession.
Those surveys don't measure the effect of any one target. They describe the workforce you are setting it for.
What to watch for once it's running
- Group and concurrent use rising with staffing levels instead of clinical need. In US skilled nursing facilities, the Medicare Part A payment model is PDPM. Under it, group and concurrent therapy combined is limited to 25% per discipline (see group and concurrent therapy under PDPM). The joint AOTA, APTA and ASHA Consensus Statement on Clinical Judgment warns that overriding clinical judgment through inappropriate productivity standards may violate payer rules.
- Documentation timestamps outside working hours. If notes are regularly written at 9pm, the target is being met with unpaid time.
- New graduates staying well below the department average after their onboarding ramp ends. Check the length of the ramp before you judge the hires. How long the ramp lasts is your decision; the new grad therapy productivity guide shows one example of a first year.
- Leavers who had the highest productivity figures. Check their documentation timestamps. A high figure can be reached with unpaid time, and that cost doesn't show up in the productivity report.
Each of these signs is visible in data your department already holds. The team productivity calculator tracks a team's output against a goal for the period.