Are Productivity Goals in Rehabilitation Practice Associated With Unethical Behaviors?

Predictive Factors of State Licensure Board Disciplinary Actions in Occupational Therapy

IMPORTANCE

One primary function of occupational therapy state licensure boards (SLBs) is the discipline of ethical misconduct by licensed occupational therapy practitioners. However, SLB sanctioning is poorly understood by practitioners, regulators, and the public.

OBJECTIVE

To identify predictors of occupational therapy practitioner sanctioning outcomes in the United States.

DESIGN

Retrospective study; all public final consent orders and database entries provided online by SLBs were analyzed. Supervised gradient boosting machine learning, logistic regression, and contingency tables were used to generate odds ratios for variables associated with each sanctioning outcome. Multinomial testing was used to identify attribute overrepresentation among cases and national practitioner distributions.

PARTICIPANTS

A total of 2,400 cases were analyzed across 47 states and Washington, DC.

INTERVENTION

None.

OUTCOMES AND MEASURES

Numerous complaint and respondent attribute variables were collected from final consent orders and database entries.

RESULTS

Complaint reason, practice setting, and complaint source had the highest influence on predicting sanction outcome; geographic region, number of complaints in a given case, and length of investigation in months were secondarily influential. Being male or a certified occupational therapy assistant was associated with higher odds of severe sanctioning outcomes.

CONCLUSIONS AND RELEVANCE

Disciplinary actions against occupational therapy practitioners were determined by numerous contextual factors; however, the most influential factors were complaint reason, practice setting, and complaint source. These results provide direction for exploring factors that predict sanctioning outcomes in the United States and also provide occupational therapy practitioners and SLBs a basis of applied outcomes that may improve implementation and education regarding clinical practice ethics. Plain-Language Summary: Occupational therapy state licensure boards (SLBs) are responsible for disciplining licensed occupational therapy practitioners for ethical misconduct. SLB sanctioning is poorly understood by practitioners, regulators, and the public. In this study, we identify the factors that predict the sanctioning outcomes of occupational therapy practitioners. The results may help state regulators, educators, and national associations more effectively act in a way that protects the public faith in occupational therapy services by providing contextualized information on practitioner behaviors that result in specific sanctioning outcomes. The study findings also provide occupational therapy practitioners and SLBs a basis of applied outcomes that may improve the implementation of and education regarding clinical practice ethics.

Categories of the Patient-Specific Functional Scale Activities in Chronic Neck Pain and Their Relationship to the Neck Disability Index

Intoduction: Common outcome measures for chronic neck pain are the Patient-Specific Functional Scale (PSFS) and the neck disability index (NDI). The primary aim was to categorize the top-rated, patient-selected functional activity limitations of the PSFS to determine if there were consistent limited functional activities for individuals with chronic neck pain and how these compared to the constructs of activities on the NDI. The secondary aim was to determine the relationship between scores for individuals who completed both the NDI and PSFS. Design: A retrospective review of data extracted from the electronic medical record, EPIC, within two hospital-based outpatient physical therapy clinics within a health care system. Methods: Retrospective analysis was performed on individual's characteristics, self-selected functional activity limitations, and total scores of the PSFS and NDI. Most common categories of self-selected functional activity limitations were developed by practicing physical therapists. These functional activity limitation categories of the PSFS were compared to the activities of the NDI. Mean PSFS total scores were correlated with the NDI total scores with Spearman's test. Results: Participants were individuals with chronic neck pain from January 2013-September 2018 (n = 2283). Movement-based activities accounted for 60.8% of the functional activity limitations of the PSFS with the top functional activity limitations being cervical motion and exercise (32%). The PSFS total score moderately correlated with NDI (r = -0.50, p = <0.01) which may relate to the differences in constructs of the NDI and the top patient-selected PSFS functional activity limitations found in this analysis. Conclusion: The results suggest that individuals with chronic neck pain present with similar categories of self-selected functional activity limitations that differ from activities of the NDI. Additional research is needed to improve outcome measures to capture patient-selected functional activity limitations and an individual's pain experience.

Practitioner Burnout and Productivity Levels in Skilled Nursing and Assisted Living Facilities, Part 1: A Descriptive Quantitative Account

IMPORTANCE

Understanding burnout among practitioners in skilled nursing facilities (SNFs) and assisted living facilities (ALFs) while considering contextual factors may lead to practices that enhance therapist and patient satisfaction as well as quality of care.

OBJECTIVE

To examine productivity standards and burnout in the context of setting and role, as reported by therapy practitioners in geriatric settings, and to explore relationships between productivity standards and perceived ethical pressures.

DESIGN

Cross-sectional online survey with descriptive data.

PARTICIPANTS

Practitioners (N = 366) included occupational therapists, physical therapists, speech-language pathologists, and occupational and physical therapy assistants working in SNFs and ALFs in the United States. A survey integrating the Maslach Burnout Inventory: Human Services Survey for Medical Personnel (MBI-HSS) and questions addressing demographics and contextual factors was distributed via social media.

RESULTS

Of 366 practitioners, 20.5% were burned out, exhibiting extreme scores for Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA) on the MBI-HSS. Significant relationships between productivity requirements and EE, DP, and PA, after accounting for covariates, were evident. Significant relationships between productivity standards and five of the six ethically questionable behaviors existed. Role affected productivity requirements, specifically between therapists and assistants, whereas setting did not.

CONCLUSIONS AND RELEVANCE

Productivity standards and related pressures are associated with concerning aspects of burnout among practitioners working in geriatric settings. Advocating for change in defining productivity and incorporating positive support in the work environment may assist in reducing burnout and turnover rates and improve patient satisfaction and care. Plain-Language Summary: This research highlights the prevalence of burnout and perceived pressures related to productivity requirements among occupational therapy practitioners working in skilled nursing and assisted living facilities.

Ethical Conflict and Knowledge Hiding in Teams: Moderating Role of Workplace Friendship in Education Sector

Ethical conflicts arise when there is no unity between the team members and shared ethical priorities. This study aimed to identify the relationship between ethical value unity, team knowledge hiding, the relationship between the lack of shared ethical priorities and the team knowledge hiding. Workplace friendship was taken as a moderating variable to check its regulating role between the ethical conflicts and the team knowledge hiding. Data of this study were collected from the staff working in different colleges and universities. There are a total of 480 responses collected through convenience sampling technique and analyzed under a five-point Likert scale. The partial least squares-structural equation modeling (PLS-SEM) technique is used in this study. The key reason was that this approach has the fewest requirements for data normality and is a better tool for evaluating exploratory connections empirically. The output of the measurement model assessment confirms that all measurement scales are reliable. The result indicates that there was a significant and positive relationship between ethical value congruence and knowledge hiding. It was also established that there was a relationship between lack of shared ethical priorities and knowledge hiding. Workplace friendship moderated the relationship between ethical conflicts and team knowledge hiding. This study extends the literature on ethical conflict and knowledge hiding behavior. This study highlights that one of the main reasons for knowledge hiding behavior at the team level in the organization is which helps the business practicians for a design of an effective strategy to mitigate the knowledge hiding behavior in the organization.

A Focus on Ethical Value under the Vision of Leadership, Teamwork, Effective Communication and Productivity

The new economy and the knowledge-based society brought significant changes in all the areas of our daily lives. Also, the COVID-19 pandemic and the COVID-19 crisis implicated tremendous transformations in all the domains, on the one hand, threatening the balance of our society and, on the other hand, challenging the dynamic of the new economy development and the rhythm of the societal modernization. In these delicate times, the all-important relationship between ethics, leadership, teamwork, effective communication, productivity, and performance is brought to the attention, in particular, due to its benefits for our society, taking into consideration the pivotal advancement that a well governed relationship of this type could provide to the knowledge-based economy. The present research describes the implication of ethics in leadership, teamwork, effective communication, and productivity, which includes the application of ethical values as university graduates assume the role of each of the mentioned dimensions of study in the organizations. The absence of research that relates ethics to these four elements simultaneously was noticed. This information is essential to know how these dimensions influence the organizational level. The sample that included 410 university graduates was applied in Baja California, Mexico, and the industrial nucleus of great relevance, bordering California in the United States of America. The data was obtained using a questionnaire. A reliability and validity analysis of the measurement instrument was carried out in terms of the ethical values associated with the dimensions mentioned using the exploratory factor analysis by the principal components method. Qualitative items were also analyzed using the constant comparison method. The results obtained in this research provide a greater perspective and practical knowledge and support of usefulness and practical reality to businesspeople and employees, leaders and university graduates; and also extensive to students, teachers, and human beings in general, in order to be better prepared to give and apply solutions with their consequent ethical and productive achievements desired by all. Additionally, this current research has the purpose to raise the will to understand, at a higher level and at a more in-depth degree of knowledge, the relationship between ethics, leadership, teamwork, effective communication, productivity, and performance, in the attempt to foster a creative and innovative business environment, based on a robust and sustainable business administration and business competencies, capable to position at higher ranks the strengths, opportunities, aspirations and outcomes that today’s new economy is due to offer and diminish the dangerous effects of the COVID-19 pandemic and the COVID-19 crisis in all the domains.

Burnout and intent-to-leave in physical therapists: a preliminary analysis of factors under organizational control

METHODS

Twelve hundred PTs were sent a survey packet including the 20-item Ethics Environment Questionnaire (EEQ) and additional items inquiring about contemporary practice factors. Returned packets (n = 340) were analyzed utilizing correlational and regression analyses to determine relationships between ethical environment, burnout, intent-to-leave, productivity standards, billing and coding requirements and ability to provide pro-bono services.

RESULTS

There was a strong correlation between PTs' view of organizational ethics and burnout (T_{b =} -0.55), and a moderate correlation between organizational ethics and intent-to-leave (T_b = -0.43). There was also a strong relationship between burnout/intent-to-leave and practice factors such as productivity standards, billing/coding policy, and organizational provision of pro-bono services (p ≤ 0.01). Finally, there was a moderate correlation between PTs' view of organizational ethics and practice factors such as productivity standards (T_b = 0.46) and billing and coding policy (T_b = -0.45).

CONCLUSIONS

Contemporary practice factors such as productivity standards and billing/coding practices are related PT's perception of ethical workplace environment and both are related to PT burnout and intent-to-leave. Factors identified in this study related to burnout are all under organizational control.

Patterns of video-based motion analysis use among sports physical therapists

OBJECTIVE

Examine video-based motion analysis (VBMA) use among sports physical therapists.

DESIGN

Cross-sectional observation.

SETTING

Survey, online-platform.

PARTICIPANTS

American Academy of Sports Physical Therapy members (n = 261).

MAIN OUTCOME MEASURES

VBMA use frequency, reasons for use, facilitators/barriers, tools used, factors associated with use.

RESULTS

194 (74.3%) used VBMA but 163 (84%) use it for ≤ 25% of their caseload. Most (57.7%) used their personal device to capture VBMA. Commonly cited reasons for use were movement analysis (93.8%) and patient education (87.6%). Barriers to use included time (30.7%), unfamiliarity with device/equipment (19.2%), and lack of device/equipment (18.4%). Younger age, advanced training, and greater time spent with return patients were each associated with use. For every 5-year increase of age, there was a 12% reduced likelihood of VBMA use (OR = 0.88; 95% CI = 0.77-1.00). Board-certified sports clinical specialists were more likely to use vs. those without additional certifications/degrees (OR = 3.27; 95% CI = 1.33-8.02). Spending 30-59 (vs. <30) minutes with return patients increased the odds of use (ORs range: 2.71 to 3.85).

CONCLUSION

Most respondents used VBMA, albeit infrequently. Those younger, with advanced training, and spending ≥30 min with return patients were more likely to use VBMA. Future research should investigate whether VBMA use enhances patient outcomes.