Sell Your Job

(Sally is screaming in my ear, "If you don't give me that report, there's no tomorrow").

You are accurately and efficiently mapping your work with persons served, through your documentation and oral communication with all stakeholders. When this discipline of communicating what you see and do in SLP clinical work addresses all the stakeholders ' needs, you are taking a large step towards selling your job and growing its future. Selling, marketing, branding, advertising, supporting, managing - you will do it all happily because you help people's lives improve. Because you commit to promoting your clinical services with honesty and integrity, your services will thrive and model best practices for the entire service system. What is the place for both honesty and integrity in your marketing efforts?

* Primary to your sales job is constantly improving the quality of your daily clinical work: your planning, designing, evaluating and treating, writing, communicating, meeting, etc. set the standard, - so, if you did no more than high quality work daily in the trenches, your practice sustains vitality and you will be a valuable resource for persons served. We earn our salaries and our fees, with juggling a host of responsibilities towards meeting obligations as SLP's, as employees of larger offices and departments, themselves within larger educational or healthcare institutions. Though we have our moments as "cogs in the machine", where daily routines can resemble repetitive tasks that seem to be sapped of human touch or creativity - this is the reality of today's workplace. Your training and energy invested in clinical practice need not suffer, from the productivity required to share your data on persons served with all stakeholders. Do your job well. 

* The stakeholders who most influence your bottom line; - the referral sources; the support circles for the persons you serve; the payers;the program administrators higher in the organizations of which you may be a part; the customers of your organization - they all should hear from you and your colleagues regularly, about the value you add to the lives of persons served and the viability of your organization. Those communications can include individual, small group and large arena presentations; letters, essays, interviews and features you submit to media, both inside and out of your institutions; participation in committees, organizations and projects that help your organization meet its goals. Do not stand still. 

* If you let others in your organization micro-manage the operations of your SLP practice, to the exclusion of your supplying data and suggesting quality improvements, there is no real continuous improvement. Conduct single - subject studies. Collect local norms on your assessments. Be part of a normative study a test publisher is undertaking on a commercially available assessment. Collaborate with clinical and research colleagues, to help answer big questions re: the science of what you do. Lead cross-disciplinary community events to touch larger and more diverse community groups, for a diverse coterie of community needs - we all are part of a bigger world. Do keep moving forward. 

Discipline for Closure

I see that the new President danced to the tune "My Way", during one of his inaugural balls this past weekend. When the persons you serve feel their uniqueness had been honored for a successful outcome, and that our evidence based practice patterns give assurance of quality, reflecting the trends of the population - then the persons served feel this SLP has done the work their way. Our therapeutic alliance successfully cemented, we are there to give focus and assurance for quality service.

Quality service dictates that we communicate our work well, in addition to training persons to swallow and communicate. We are charged with clear and omnipresent responsibility to document and transmit our clinical visits, with time windows smaller than larger. With documentation and sharing amongst the stakeholders grown large in importance for today's SLP clinicians, being a better SLP requires calm daily discipline to get the writing done. I speak with the bitter pill of experience on this issue, lodged in my valleculae. The years have taught me to drink, drink and drink SOME MORE til the job is done. Here are some ingredients in that pill, so you may not have to suffer my gagging and such.

* Expect, demand, and hold out for someone to MENTOR you through a new documentation routine, after it is introduced. Who wants to be singled out as the one who got it horribly wrong? Make sure, if you are being exposed to a system or procedure, that you are working with a peer or clerical staff or supervisor who will invest in your success. Ask questions! Ask the dumbest questions!! If you see a step in the routine that seems illogical or confusing, say so. The worst they can do is discipline you. Since you are expected to make this part of your workday as an SLP clinician RICH, FERTILE SOIL that is tilled  EFFICIENTLY, make sure you are both well trained and supported in doing the writing well.

* How do you do it well? Knowing the procedures after being mentored for their emerging mastery, you BUDGET your time during the clinical day to get the writing done. Think forward from the time of your visits with your persons served: there are folks in business operations who want to see the daily numbers; there are medical people who benefit from your data and interpretations to move forward; there are clinical coordinators who wish to make treatment of persons served as smooth as necessary. Your notes and reports are extremely vital cogs in the machine that help keep these parallel processes moving, towards the outcome all desire for the persons served.

* And then, how do you write a succinct, clear and focused note or report? Write a lot, so that you are not intimidated by the tasks of writing a lot on a daily basis. Train to relax during the writing task, so that you do not lose your focus for the information you will be sharing. As your work requirements may ask for specific wording to make a point in the person's clinical narrative, you may discover some recursive or stereotypic language helps you make the clearest statement with the least possible struggle. Like it or not, healthcare documentation is under the same push for productivity that drives the entire US economy. If we can write more widgets, while making the widgets clear, powerful and timely, then we are achieving the primary goals for our person served: giving her/him the business!

Know the Normal

So - when we're personalizing therapy, we can adapt behavioral activities from treatment sessions to work in concert with the person's frame of mind (or theory of mind), her/his preferences for daily living, and the pressures to think economically and efficiently to "git er done".Diane Ackerman, in writing about the stroke rehab program she helped sculpt for her husband, Paul West, helped stimulate his creative uses of language - in his pet names for his wife - as well as his being a career "wordslinger", as a novelist and essayist. Ackerman noted throughout ONE HUNDRED NAMES FOR LOVE the limitations of "speech therapy"; treatment approaches that demanded convergent thinking, instead of bolstering his strengths in divergent thinking.

We need to give  people grip holds for using their strength! Not only will they do word of mouth marketing for you, after you've given them a shot, - but you've also gotten greater opportunities for buy-in with work outside the person's comfort zone.

When you are proficient in tailoring your treatment to the individual you have learned - see also, how your person served resembles the population. Your role as a clinical scientist requires you then attempt replication of the most evidence based interventions for the impairments in question. Have you developed the best treatment plan? Its quality will be a cross-check of your baseline diagnostic impressions.

How well are you selecting goals and activities? Know all the demographics that matter for your person served.  Is the treatment plan one used for most people of similar age? Educational level, occupational or social history? Are you sure the outcome of the person served is what you would see in persons of similar profile? Every genetic mutation in the population, according to Siddhartha Mukherjee, is just a variation in the population data. Know the central tendencies, and know the variation for your population in your service area. What are strategies that may help?

* Do a baseline population survey for your clinic's market area, and update at least every five years
* Compile LOCAL NORMS on all the diagnostic measures used with your population, and maintain the data as the databases grow.
* Hold periodic public events for your clinical service, where persons who are not consumers learn about your services and share evidence of their own skill sets.

 "We are more alike, my friends, than we are unalike" - Maya Angelou

Never Stop Learning

Our professions being hybrids of many scientific perspectives, there is a lot for the professional to do to keep skills sharp and responsive to the needs of persons served. We find our roots in child development, psychology, dentistry, counseling, electronics, linguistics, gerontology, radiology and many other disciplines. I am not kidding when I initiate a marketing talk with anyone I see, and say that SLP's motto should be "everything but obstetrics".

A classic example of our diversity of perspectives on communication is found in the current issue of JOURNAL OF SPEECH, LANGUAGE and HEARING RESEARCH.  Papers on cognitive load, Parkinson disease, vowel acoustics, stuttering in children, early literacy, adult dyslexia, self-assessed hearing handicap and cochlear implants fill the pages. Before the journal had been transferred to a totally online platform, you needed a good meal before lifting its hard copy. It encapsulates much about the breadth of the professions.

We practitioners can therefore tack our professional sloops into the winds churned up by many theoretical storms: we can attend university or online classes; attentively fill auditoriums of continuing education events; seek out and digest books, journals, newsletters and blog posts; we can go to our local experts to build and reinforce our skill set.  If we have burrowed deeply into the work and discovered some things, we can even become the local experts!

 The clinician who spins and grinds with the daily grind of clinical work will soon discover, that there is so much learning to be done with every person you serve! That is, you get to know your clients and patients through their life history and their daily interactions with their environments - not just their needs for their treatment plan. This makes treatment functional and personalized, as medicine that takes into account a person's genetic predisposition is now termed personalized.

When a child after TBI wants to learn to eat a "Chicago hot dog" again, you train on component skills the teen needs to successfully swallow the ingredients and textures in the Chicago dog. Perhaps: the final session held at the ball park! If there is a senior with dementia on your caseload, whose best days including records made by Glenn Miller, having "Moonlight Serenade" in the air during a treatment session can make sessions golden.

Personalized therapy: it feels really good when the clinician does it right. Getting more and more mindful in treatment when you are learning a person's life for the best treatment plan, requires you never stop learning. 

In Case Sally Is Right

Sally Brown of "Peanuts" - she was and is a bell weather spirit for all of us who don't often have the courage to jump into the abyss of life. When she ran about the family home that one Sunday morning, and echoed the admonition of that TV golf announcer: "If he doesn't sink that putt, there's no tomorrow"....we saw and felt pure childlike existentialism. "There's no tomorrow!", she exclaimed to every one in particular. All of us have our Sally moments, even this blogger. For the next few weeks, we'll use the Sally scenario to review as succinctly as possible; if there were no tomorrow - how to be a better speech-language pathologist right now!

The topics we will cover include:

* Never Stop Learning
* Know the Normal
* Discipline for Closure
* Sell Your Job
* Live Your Passion
* Look in Deeply
* Grab the Ledge
* Teach the Secrets
* Tell Their Stories
* Lead Every Day

We'll get this done before 'tomorrow', Sally!

Hello in there

The coffee had just started to kick in as I entered the Headquarters building that morning. After I hung up my coat and collected the day’s schedule, I knew I would need all the energy stored in that black miracle drug. I was working the day watch out of Dementia Division, but I knew that on some days – I felt more like the person who could not find my way, than the persons whom I had committed to serve. 

I had been given this case of a 90 y/o woman who had seemed to divorce herself from reality. Just stepping away? It wasn’t that simple a modus operandi for her, but I had seen that since she had returned home from the hospital, she was not engaging with her staff and friends as she had before. The assignment was to help her find a path to the rest of her life – through contact. 

She reminded me of either “Abbott” or “Costello” from the recent sci-fi movie “Arrival”; I watched her initially, using a strange way of discourse with persons familiar to her. She screamed. She glared! She didn’t react to statements or questions directed to her. How would she make a connection with her loved ones, and with those charged with keeping her healthy and safe? Soon, after meeting with the woman and having an initial conversation, I realized it would take quite a few visits to develop a vocabulary we could easily share. There was a lot of pressure to get this accomplished by her staff, however. She was even considered for a transfer from her assisted living unit to the “dementia” unit.  Pressure!  How would that help the connection? How to solve the puzzle? 

Then, later that day, I happened to walk by the communal dining area, to my lonely sandwich at my desk to type reports. My case was eating with her peer group, and – without any special equipment, and without any staff coaxing her out – she was having a normal conversation about the food, and about her day. It was happening! No special drills. No expensive equipment. There was just – simple connection.

John Prine sings, - just waiting for someone to say: Hello in there; HELLO. I would always chuckle when I heard that chorus sung on the radio, on a college FM station. Now, seeing my patient in her natural state, - I understood the line, - what it meant to call into the space a person occupies when her/his spirit withdraws, and hope you get an answer. I understood what effort it takes most families to realize, this is reality and this is our loved one, and we’ll do our best, loving the person she/he is now and the person she/he will become, as best we can. We’ll have our language to use, and we’ll keep sharing and – one day, she may do something helpful for us. The shift is changing now.