Why Am I Doing FOTO

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Why Am I Doing FOTO

• Building Commitment

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Solutions

• Eminently qualified to discuss every sort of
  practice problem !
• Including implementing FOTO
• Working on solutions all the time !!
• FOTO has been continues to be a solution for
  me

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Making good judgments when one has complete
data, facts, and knowledge is not leadership -
its bookkeeping. Dee HockBirth of the
Chaordic Age
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IDC2

• Information societal Diversity X societal
  Complexity2
• Dee Hock
• In 20 years we have
• 1000X better algorithms
• 500,000X more computing capacity / individual
• 500,000,000X more mobility of information
• The world (and FOTO) has the capacity to
• Receive, store, transform, and transmit
  information
• Bookkeeping
• Only YOU can choose to utilize it or not.

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Information Evolution Creating Revolution

• FOTO began and must continue to evolve
• I need the information
• I need and want it faster
• I need and want it simpler
• I need and want it more complex
• I need and want it all and we want it now for
  each patient episode!!
• I must change..I must not perpetuate old ways,
  but seek new ways, and no one will ask my
  consentits an information revolution that is
  part of a natural evolution.

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INFORMATION??Did I believe I needed this
information?

• Why am I a part of FOTO?
• Why am I making my therapists deal with this
  extra paper work?
• What good are the indexes?
• Did I know?, Could I explain them? Could I use
  them?
• Every therapist has a 90 pt satisfaction..so?
  Anyone at 100? I have a therapist at 99.27!
• I had to sell myself, I am the FOTO Champion on
  the value added to my Facility/Co?
• If you show one tiny flaw in your belief the
  entire process is subject to failure from your
  lack of total commitment.
• You must choose to LEAD the FOTO parade!

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Why the need and want of information?

• For me it was to embrace change in my practice so
  I could help people improve the quality of
  their life.
• The one constant is change

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So what do we do with all this information?

• We challenge ourselves to manage our practices
  with it
• We use it to make ourselves better
• We tame it by admitting our mistakes
• Mistakes are toothless little things if you
  recognize and correct them. If you ignore them,
  they grow fangs and bite!

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Therapists choose where to be led

• In a very real sense, followers lead by choosing
  where to be led
• Will they believe the s?
• It is simply raw data until it is used
• to induce a new way of practicing into the
  therapist
• who will then choose to change,
• choose to improve,
• choose to learn more,
• choose to manage self.

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I believe

• The patient must understand the reason they were
  sent to PT! SoI have to tell them!
• I have to help them understanding their goals,
  their part in the rehab process to attain them,
  and that I am working for them and with their MD.
• Patients need to be sure they do not feel theyre
  wasting their time or their - we both have so
  little of either!
• FOTO assists me in understanding my patient!
  Physical, mental status, social skills, etc.

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Leaders Serve

• We choose to follow
• Choice is essential.
• I used to Gather info
• count what I did to pts i.e.
• US, Ther Ex, ES, gait training,.. And counted
  big deal!
• Why was I doing it? Did it help me in any way ?
• Was the patient cured? How could I know?
• I wanted a better way to count ,to measure my
  effectiveness.
• FOTO helped me once I chose to follow their lead!

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Would I get good Outcomes?FEAR!

• I found out early not to be afraid!
• FOTO is the patients perception of the care they
  are receiving.
• Patients will evaluate me as I evaluate them!
• Thats fair and good!

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The Patient Leads

• 50 of the time I should manage myself
• 25 of the time I should manage my superior ( the
  pt as boss delight them!)
• 20 of the time I should manage my peers
• 5 of the time I should manage those over whom I
  have authority.

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IssuesFOTO helps answer Patient Centered
Questions Confidentially

• Did patient complete their care or self
  discharge?
• Did patient feel as if they were helped?
• Did the patient feel supported cared for?
• Were the goals I set for the patient met?
• What did the predictor/trend report tell you
  about the patient?
• What did you learn?

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T.S. Elliot said

• We will come full circle to the place from which
  we set out and see it for the first time.
• What would I find on this FOTO journey?
• Would knowledge, rapport, science, believing be
  important.. count me in or out ?
• Where would I go if I found outfull circle?
• Would my eyes see and ears hear the truth from my
  patientsWould it hurt?

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So

• FOTO gives me information
• I choose to utilize it in ways I will share with
  you today.

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Implementation

• It Never Ends

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The Beginning

• Early problems will occur
• Give it a year
• FOTO is a rolling year
• Familiarize yourself
• Quarter End Edit reports tell you whats missing
• What Quarter End Edit Report? Find it!

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Barriers

• We know we are good do not need FOTO
• This information they ask patients is
  confidential! Pts wont share!
• FOTO is not valid or reliable
• Too much time and
• Way too much paperwork
• These s have to be wrong my pts are sicker than
  these reports show..oh my!

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Barriers will go away

• I want a shoulder course my OI is too low!
• Patients think it is good we ask how they feel
  about the care!
• FOTO is valid and reliable ask Dennis!
• Cadi software is free and what a timesaver
• Risk adjustment gives me great look at my
  patients severity. Im not good with the elderly

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Train

• 3 Ts at TTC Teach, Train, Test
• Teach why and what
• Train how Judy Judy Judy..trains you!
• Test results with FOTO reports
• Then learnand lead to new levels by
  re..teaching, training, testing

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Training

• Training with the Why! The Y is what it takes to
  make FOTO Yours!
• How it helps therapists see themselves as
  patients see themrapport! Isnt caring and the
  patient believing in you the real cure? The best
  medicine??

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Getting Buy In

• I had to reach agreement with each
  therapist..eyeball to eyeball one on one
• What I wanted and needed meant little if the
  therapist did not see the value and buy into the
  plan and agree to participate
• Persuasion not compulsion was fundamental.

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Questions Daily

• I ask Joy How many new patients did we see? Did
  we get them in FOTO?
• Joy asks FD How many new pts? How many new did
  we get into FOTO ?
• FD asks PM and Therapist Did you get your new
  pts into FOTO?
• When s are low helps to do this every day
  builds habit!! On job training!

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This question only gets stats!Need Participation

• The other ?s
• Are you using the intake to write your fx goals?
• Are using fx expectations in POC?
• ARE YOU SHARING INFO WITH PATIENT?
• Linda G s email to Katie D!
• Ken horrid FOTO my personal talk with him

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Implementation

• It Never Ends
• Its Managing with the Data

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Outcomes Evaluation Process

• Look at Group Roll-Up compared to Aggregate
• Look at each Facility compared to Aggregate
• Look at each Facility compared to Group
• Look at each Therapist compared to their Facility

What do you see? Where are the scores better?
Where are the scores worse?
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Managing With Outcomes

• Analyzing the Outcomes Profile lets you
• Manage Practice
• Manage Individual Facilities
• Manage Therapists

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Facility to FOTO

• I look at each facility compared to the nation
  and ask
• Does this facility measure up?
• Why not, what am I willing to do about it?
• If scores are low
• Train? CE course?

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TTC Facility to Facility

• Each office gets an opportunity to see how they
  stack up to each other
• Competition is good!!
• Ideas percolate as they try to improve
• Signs about FOTO show up
• People start to ask did you get a FOTO on that
  case?
• If I see a trend that is bad I take real action
• On the yearly eval
• One on one meetings
• Involve everyone

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Investigate Further
Whats Next?

• Compare All Offices Over Time
• Look at OI by Impairment Category compared to
  Overall
• Look at OI by Therapist Over Time
• Compare Medic (real) number of Intakes to number
  in FOTO (for efficiency and effectiveness) by
  Facility and Therapist

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Start over and over???If OI is low

• ask ?
• New Staff? Hurts Fac
  s
• Staff changes FD,PM,PT?? Hurts Fac s
• Lose trained staff? Hurts Fac s
• Computer down? Hurts Fac s
• CADI down? Hurts Fac s
  
• Network down? Hurts Fac s
• ASK? ASK? ASK????????!!!!

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OI High

• Praise and lots of it to all teammates
• Use as mentors to teach..
• Share their process to help others not doing as
  well
• Heaven or Hell (joke)
• Future to reward with

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Therapist Issues to Manage

• Are my therapists participating? Medic to FOTO
  data - we set benchmarks
• Improving overall and by impairments category?
• Hows the Quality within the practice?
• Our QAwith FOTO
• Are they using the Predictor report, trend
  report?
• Katie on POCs and DC summaries

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Quality Can not wait

• Concurrent QA audit on cases where the pt has 3
  visits over the predicted at intake
• ASK WHY case is over helps thinking!
• Is it appropriate or not?..Action
• We are trying to manage cases as we go not just
  retrospectively when an ADR appears

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More Quality

• If I find the personal OI is so bad this quarter
  I ask FOTO for special report
• FX scale report to see the rest of the story
  ..breaks it out in detail .(this PM)
• If Satisfaction is below the FOTO mean (I freak)
  then ask for special report
• I get a PT satisfaction report (this PM)

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Stuff to never forget

• Rolling 12 months of data
• Edits help see our mistakes give them out!!
• ASK if therapists got their report
• Danna
• Ask what they see in the report
• Ask about plans to change
• USE the data all the time

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Communicate

• by email, by phone, by fax, by carrier pigeon, or
  smoke signals but talk about the good and bad
  parts of FOTO out loud and clearly!!
• I always find something good to say
• Proud your getting cases into FOTO
• Talk the walk it makes the journey enjoyable I
  really like my staff and I want them all to do
  well!
• I tried to induce not compel change.

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Manage with the data

• Share the data
• Ask Questions! Seek answers!
• Can very severe pts get better with therapy?
• Unit FOTO
• of pts 146 17,881
• OI 159.24 111.35
• What about slight?
• pts 163 17,480
• OI 37.20 23.23

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My reporting needs were beyond what FOTO gave me

• I needed to see all the therapists side by
  side..who could mentor?
• Facilities side by side ..whos best?
• Therapist alone over time improving?
• Facility alone over time improving?
• Co improving?
• Compare all to each other ,to TTC,and to regional
  FOTO

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Trish

• She took the reports and reformatted in an excel
  spread sheet and saved me hours of hand work!!
• She keeps it up quarter after quarter!
• You may need a TRISH!!!

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FOTO is Everywhere

• Bottom of the Co ,Facility, Individual PT
  PLs..Profit important.
• Money motivates neither the best people nor the
  best in people. It can move the body and
  influence the mind, but it cannot touch the heart
  or move the spirit.
• FOTO means Quality as felt by the Patient
• Very important!

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Everywhere (cont)

• Therapist Evaluations..
• yuck in past didnt do
• Too subjective if objective too easy to loose a
  PT!
• now I feel Yearly, ¼ ly, 3R eval form
• (see hand out) objective and helpful!!
• Are Done one to one gives everyone an opportunity
  to focus on what we all believe is critical to
  our success..
• FOTO is there!!

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FOTO, It makes You Crazy
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Handout Review

• FOTO reports
• _at_
• TTC

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Caring

• Nobody
• cares how much you know
• until they know how much you care.
• Keith Kleven said
• He treats celebrities
• I admire Keith and share this philosophy

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Colon Powell

• Leadership is the act of accomplishing more than
  the science of management says is possible!

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Will and Grace

• With the will to succeed and the grace to
  compromise, all things become possible.
• Who do you need? Will or Grace?
• I needed both
• FOTO on therapist annual reviews...accountable
• QA compromise not 3 over or under, just over (for
  now anyway!)

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Leaders

• Both Confident and Modest
• Authentic walk the walk.. not just talk
• Listeners.. because they are curious not
  grandiose
• Good encouragers and are never satisfied
• Make unexpected connections
• Provide direction not answers
• Not in control not really in charge - are in
  touch and out in front
• Protect people from danger and expose them to
  reality

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Leaders (cont)

• Make change and stand for values that do not
  change..expendable /precious
• Lead by example
• Do not blame, they learn..
• Today fellow leaders learn all you can about FOTO

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Implementation Managing With Data

• Use up the speakers with every question you have
  so you can return and lead your facility to
  better outcomesOur Profession needs you!

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