What to say in supervision when your productivity is below target
Your own figures, calculated your employer's way, turn a performance conversation into a workload conversation.
When your productivity is below target, say what your own figures show and ask where the gap comes from. Work the figures out the way your employer does, so the conversation moves from effort to workload.
Without those numbers, the meeting tends to become mostly apology and a promise to try harder. With them, there is something specific to change.
Before the meeting: know your own figures
Walk in able to state four things.
Your productivity, calculated the way your employer calculates it. Use their method, not the one you prefer. If you can't reproduce their number, the meeting turns into an argument about arithmetic. The therapist productivity calculator takes your shift length, unpaid break and treatment minutes. The guide to how therapy productivity is calculated sets out the different methods.
Your documentation time. Two weeks of rough tracking is enough. Record the minutes on the clock and off it separately. The documentation time calculator turns a daily figure into weekly and yearly hours.
Your non-billable time, by category. List cancellations, patients declining, medical holds, patients off the unit, waiting for equipment and meetings you covered. Present them as data. The pattern across two weeks tells you more than any single day.
The department average, if you can get it. As an example, suppose you are at 78%, the department average is 79%, and both are below the target. That is a department-wide gap, and both of you should know it before the meeting starts.
Productivity below target: what to open with
Try something close to this: "I have been tracking this since the last report. Here is what I am seeing, and I would like to work out where the gap is coming from."
That opening shows you took the issue up before being asked to. It puts data on the table first. It also makes the meeting a joint look at where the minutes go.
Things that weaken your position
"Everyone is struggling with this." It may be true, and it sounds like deflection. Bring the department average as a number instead.
"The target is unrealistic." Even where it is accurate, it sets you against a figure your supervisor may not have set and may not be able to change. Aim at the inputs, such as the schedule, which they often can change.
Mentioning in passing that you document at home. It explains your numbers. It also makes unpaid work look normal, and it can create problems for you and for your supervisor. Raise unpaid time on purpose, as its own item on the agenda.
Apologizing again and again. One acknowledgment is professional. Repeated apologies tell your supervisor you accept the shortfall as your fault.
Things that strengthen it
Ask how the figure is calculated. Your supervisor may need to check. The answer may show that the unpaid break is in the denominator, which the guide on whether the lunch break counts against productivity works through. It may show that billed units are being converted to minutes at 15 each. Under the US Medicare 8-minute rule, one unit covers anywhere from 8 to 22 minutes of timed treatment. A units-times-15 figure can therefore differ from the minutes you delivered (see therapy units to minutes). Either finding affects everyone in the department.
Bring one concrete proposal. Examples are a protected documentation block or the first patient moved 15 minutes later. Others are evaluations spread across the week instead of stacked on one day, or a change to the cancellation policy. A supervisor who can't move the target can often move the schedule.
Ask what the department counts as acceptable. "If I am at 82% but my documentation is current, my outcomes are good and no patient has complained, is that a problem?" The answer tells you what the department values.
Ask for the numbers in writing. It is a routine request, and it means the next conversation starts from an agreed baseline.
The consensus statement on clinical judgment
Sometimes the pressure to reach the number starts to shape treatment decisions, such as session length, group or concurrent mode, or which patients are seen. AOTA, APTA and ASHA, the US professional associations for occupational therapy, physical therapy and speech-language pathology, published a joint Consensus Statement on Clinical Judgment. It addresses clinical judgment overridden by employer pressure to meet quotas or by inappropriate productivity standards. It says this "may violate payer rules, be in conflict with state licensure laws" and can even amount to fraud.
If a request in the meeting would change what you judge a patient needs, say so, and write down that you said it. The consensus statement is a US document. Outside the US, look to your own professional body's standards of practice.
If the answer is "be more efficient"
You will sometimes get a non-answer. Try: "I want to do that. Which of these should I spend less time on?" Then list them: evaluation write-ups, family education, the extra ten minutes with the patient who is frightened of falling.
The question is a fair one, and it makes the conversation specific. If none of those items can go, the shortfall is a resourcing question, and the meeting can move on to the schedule.
Keep your own record
Note the date, what was said, what was agreed and any figures quoted. Productivity conversations recur. With a record, you can say "we agreed in March that I would take the evaluation block and we would review in June." That is stronger than two different memories of the same meeting.
Preparing the one page
If you take anything into the meeting, make it a single side of paper. A longer document is likely to be skimmed. Four blocks fit on it:
- your productivity figure, calculated their way, with the method stated;
- your documentation load, split into time on the clock and time off it;
- your non-billable time by category, averaged across ten working days;
- one proposal.
Your supervisor may have to report the conversation to their own manager. A page they can forward unchanged carries your figures into that second conversation in your words.
When it's more serious
If the conversation moves toward formal performance management, or you are asked to work unpaid, record what is said and get advice. In the US, federal wage rules treat work that is "suffered or permitted" by the employer as work time, even when nobody requested it. The US Department of Labor and your state labor office handle questions about hours worked, and the guide to unpaid documentation time covers the detail. Elsewhere, your union, where one exists, or your professional body is the place to start.
A productivity target is a performance expectation. Unpaid working time is a legal question. Keep the two apart, in the meeting and in your notes.
If nothing changes
Sometimes the target stands, the schedule stands, and you are expected to absorb the difference.
At that point the decision is yours. You can accept the job as it is, or start looking, and either can be the right call for you. The option to avoid is absorbing the gap with unpaid work indefinitely while assuming something will change on its own.
Keep your notes from the meeting either way. If you do start looking, use the interview questions in the guide to therapy productivity targets by setting. They help you avoid the same arrangement in your next job.
This is general information, not legal or employment advice. Your employer's policies and the law where you work decide what applies to you.