"Hi! It's good to see you again. Is everyone well at your house? Thanks for coming today to speech therapy. Is there anything you want to talk about - about our last time together? Do you have any questions about what we have been doing in your program? If not, do you feel you are getting better? *DISCUSSION*"
"I'm glad to hear what you think. I want to talk with you about the next step in what we do together...."
Here begins a tale about negotiating with your speech therapy patient. No matter the age, gender, the presenting conditions, the locale of your CSD services, your clinical model or even your business model - you will have the need to make deals and set commitments with your patient through your encounters. If establishing a context with the patient allows you to say "This is what I want to do", then - negotiating a plan for treatment allows you to say "Let's do this". In an ideal world, your patient does all you ask in a reasonable time period. This is not an ideal world.
The question is: Why do you negotiate? To set the path for the clinical program, and to adjust to any unexpected changes in the same program. Another question worth asking is - why make such a big deal out of negotiating? If you have determined your patient needs "A", "B" and "D", that should be enough. "It's time to work" may be the message you want to get done, but your patient may have other needs and agenda that emerge as replies to your message: "Can't we do this some other time?"; "It is too hard!"; "I'd much rather play a game"; "I need the bathroom!", or "Are you sure this will work?"
Your negotiating with the patient keeps the message of your evaluation visit fresh; namely, that a change in function that the evaluation had found, can be remedied through special strategies and techniques. Therefore: "If you can't do this for more than five minutes, then - let's work for five minutes and take a break". Or: "Remember that the speech test said, you can make this sound in everyday conversation when you _____". Or maybe: "Your voice won't improve solely with the passage of time; you need practice on deep breathing to sustain a louder voice!".
It sounds as if negotiation in the CSD clinical encounter is service after the sale. After the evaluation is done and after the course of treatment is charted; - there are continual opportunities to refine and reinforce the message: first, "I care about you. We have formed a relationship. Part of what I see as my role in the relationship is to help you grow and change. Let's keep on track, by working on the things we found will help you." And, second - "I have plenty of time to hear what you need to say. Healthcare (or education) may seem rush, rush, rush - but communication is what I do. It is the essence of my work. Tell me what you need".
Sunday, April 19, 2015
Sunday, March 29, 2015
Establish a context
Blogger ' s note : this post is the 5th in a series that follow the outline of "Closing the Sale", originally posted to this blog on 1/24/15.
Context. Milieu. Mutually Supportive Environment. "A Clean, Well-Lighted Place". "What I Want to Do", one of my first submissions to this platform, made my eureka moment at conducting the therapy session, front and center. There is not just the treasure collected by a session that has proper context and focus; that has resonant and reverberant boundaries, working to distill actions and thoughts of the person served.
The desire for context and perspective, on the needs of persons who receive our communication sciences and disorders (CSD) services, is crucial for intervention reaching its maximum effectiveness. Is there any there, there? Does this work actually impact real life? Does it impact THIS PERSON's real life??
Why would you need to establish a clear context in therapy sessions? It is part and parcel with the need to teach others about the profession. There is also a need to establish and maintain an environment conducive for learning. With the unrelenting pressure for cost containment in SLP services, the clinician has an obligation to stay organized and on track to get the work done for persons served.
Teaching others about, and promoting the profession: through improved clinical outcomes we create our best ad campaign. Our customers are not only the person served, the family, the referring professionals or the professional community, -they are also the general community who may never consume your services. The clinician who helps her/his client stay focused, and working toward goals, makes the Sale of SLP as a community service that much easier.
"This is what I want". No matter what the client's age or needs, our training and experience allow CSD clinicians to move from this initial proposal; to "What I Want to Do"; - then finally, "Please do this". At its core, our profession is one involved in helping transforming people's lives. The ease of our completing our work with each person served, assures that the personal transformations actually take place. They are the reasons many of us entered the profession. We want to serve others.
The persons in charge of CSD programs may be CSD professionals, yet many times they are not. You as a CSD professional, and your managers, want to know that you manage every clinical case efficiently. If you work for yourself, or if you are part of an interdisciplinary team, controlling your expenses of materials and time helps keep the lights on. Keeping the lights on, in turn, let's your market area know you are open to serve them. When you can serve more of the community - then you have the opportunity say once more, as the authority: now, today....
Context. Milieu. Mutually Supportive Environment. "A Clean, Well-Lighted Place". "What I Want to Do", one of my first submissions to this platform, made my eureka moment at conducting the therapy session, front and center. There is not just the treasure collected by a session that has proper context and focus; that has resonant and reverberant boundaries, working to distill actions and thoughts of the person served.
The desire for context and perspective, on the needs of persons who receive our communication sciences and disorders (CSD) services, is crucial for intervention reaching its maximum effectiveness. Is there any there, there? Does this work actually impact real life? Does it impact THIS PERSON's real life??
Why would you need to establish a clear context in therapy sessions? It is part and parcel with the need to teach others about the profession. There is also a need to establish and maintain an environment conducive for learning. With the unrelenting pressure for cost containment in SLP services, the clinician has an obligation to stay organized and on track to get the work done for persons served.
Teaching others about, and promoting the profession: through improved clinical outcomes we create our best ad campaign. Our customers are not only the person served, the family, the referring professionals or the professional community, -they are also the general community who may never consume your services. The clinician who helps her/his client stay focused, and working toward goals, makes the Sale of SLP as a community service that much easier.
"This is what I want". No matter what the client's age or needs, our training and experience allow CSD clinicians to move from this initial proposal; to "What I Want to Do"; - then finally, "Please do this". At its core, our profession is one involved in helping transforming people's lives. The ease of our completing our work with each person served, assures that the personal transformations actually take place. They are the reasons many of us entered the profession. We want to serve others.
The persons in charge of CSD programs may be CSD professionals, yet many times they are not. You as a CSD professional, and your managers, want to know that you manage every clinical case efficiently. If you work for yourself, or if you are part of an interdisciplinary team, controlling your expenses of materials and time helps keep the lights on. Keeping the lights on, in turn, let's your market area know you are open to serve them. When you can serve more of the community - then you have the opportunity say once more, as the authority: now, today....
Sunday, March 8, 2015
Watch your time!
So many reality television shows now - and reality shows now inhabit a huge percentage of our TV time - engage us in competition. Build this! Cook that! Find this faster than the other contestants! And RUN, RUN, RUN while you do it. Slog through the mud! Outlast, outwit, outlandish! But working with speed is a hallmark not only of the world of television, but also the workaday world of you and me.
Professionals in speech-language pathology now find themselves in work environments where, at the interview for a new position, they are told uniformly that the work day is "fast paced", - demanding a lot of focus by the applicant. Where do the fast pace and high productivity demands allow for an additional emphasis on service quality, during the clinical day?
Powerful real-time time management is an indispensable tool for today's clinical professional. The pressures for maximizing reimbursement and minimizing costs are equally seen across the spectrum of modern healthcare. Yet, quality doesn't have to be sacrificed to meet today's standards for productivity.How can this work?
The people you are entrusted to serve; they still deserve high quality healthcare. To meet the productivity targets and likewise give persons served the best possible outcomes, keep a few principles in mind:
* Become confident in your clinical skills - no matter where you are in your career, prepare your case work to the best of your ability. If you are a new clinician and continue to receive mentoring : depend on it and use it, without fail. See many, many cases having similar presentations. When you have your own script for the clinical presentations you may see most often in your practice, you will most easily detect clinical cases that are atypical 'outliers' from your script, requiring their special attention.
* Get your work done - when the visit starts, some minutes rightly get used for checking in with the person served. Have communication skills ready, to signal a transition to the activity you have planned : "what I want to do today...". Remember to keep your client's spirits high with the proper reinforcement schedule. Periodically check in to ask: is this making sense, what we're doing? Do you think you are getting better? Can you practice what we are doing between times we meet? Give the client when attention starts to drift, the best preparatory set. When time approaches to end the session, help the client focus on what has happened and what should come next.
* Manage your non productive time smartly: when you are confident in your clinical skills, and when your visits allow you to get your work done, then you are able to use the remaining time in your workday well. Be on time. Prepare for your day. Communicate with everyone who will impact your clinical work. Between shifts, take good care of yourself physically and mentally. We work hard , and helping others in need to better communicate and swallow - it takes good care, to take good care of the persons served.
In the final analysis, time is a human Invention. When your client has a need you can serve, you give them every minute they deserve. Manage this human invention using wisdom, focus and joy for what we are allowed to do.
Professionals in speech-language pathology now find themselves in work environments where, at the interview for a new position, they are told uniformly that the work day is "fast paced", - demanding a lot of focus by the applicant. Where do the fast pace and high productivity demands allow for an additional emphasis on service quality, during the clinical day?
Powerful real-time time management is an indispensable tool for today's clinical professional. The pressures for maximizing reimbursement and minimizing costs are equally seen across the spectrum of modern healthcare. Yet, quality doesn't have to be sacrificed to meet today's standards for productivity.How can this work?
The people you are entrusted to serve; they still deserve high quality healthcare. To meet the productivity targets and likewise give persons served the best possible outcomes, keep a few principles in mind:
* Become confident in your clinical skills - no matter where you are in your career, prepare your case work to the best of your ability. If you are a new clinician and continue to receive mentoring : depend on it and use it, without fail. See many, many cases having similar presentations. When you have your own script for the clinical presentations you may see most often in your practice, you will most easily detect clinical cases that are atypical 'outliers' from your script, requiring their special attention.
* Get your work done - when the visit starts, some minutes rightly get used for checking in with the person served. Have communication skills ready, to signal a transition to the activity you have planned : "what I want to do today...". Remember to keep your client's spirits high with the proper reinforcement schedule. Periodically check in to ask: is this making sense, what we're doing? Do you think you are getting better? Can you practice what we are doing between times we meet? Give the client when attention starts to drift, the best preparatory set. When time approaches to end the session, help the client focus on what has happened and what should come next.
* Manage your non productive time smartly: when you are confident in your clinical skills, and when your visits allow you to get your work done, then you are able to use the remaining time in your workday well. Be on time. Prepare for your day. Communicate with everyone who will impact your clinical work. Between shifts, take good care of yourself physically and mentally. We work hard , and helping others in need to better communicate and swallow - it takes good care, to take good care of the persons served.
In the final analysis, time is a human Invention. When your client has a need you can serve, you give them every minute they deserve. Manage this human invention using wisdom, focus and joy for what we are allowed to do.
Sunday, March 1, 2015
The relationship you forge must be primary
You go into work one morning in the speech therapy department. Others may call it the therapy department, or the speech-language pathology or rehab department - irregardless, that morning the secretary hands you a case file and says "We need an evaluation done and written by noon". There are thirteen other persons on your caseload already, each with their own paperwork and logistical needs. But, hey, let's get this evaluation done in the morning, when the patient is relatively fresh. What could go wrong, and how to prepare for the contingencies?
It starts with our stock in trade: Communication. Though we feel the pressure of time and someone watching us during the daily caseload grind, at the moment we meet that new customer - she or he is the center of our attention. The relationship we develop and maintain with the person largely determines what the outcomes may include. If you as an SLP have a good working relationship with the person, then what you might ask of that person, she/he may more likely follow whatever lead you provide. Some specifics on relationship-building, that begins with the first encounter at the evaluation:
BE HONEST. Tell the person referred you are sent (using the authority of the referring physician's order if necessary) to describe the person's skills for communicating, or thinking or swallowing. Explain in a manner the person can understand, the processes and mechanics of the evaluation and treatment planning process. Describe each step you are taking concisely, with its rationale. When you are done, explain the data analysis as possible while you are still online (in the evaluation setting). If data requires further offline analysis, offer to supply the interpretation as soon as possible.
BE EFFICIENT. Collect as much of the history information prior to entering the assessment setting. Have your interview questions polished and in a framework; insert additional questions to flesh out impressions as necessary. Practice your formal testing before the first visit, so that you have a routine that allows you to get the data and process it with the person present - when it is possible. Have your report writing procedure ready to start as soon as possible after the visit is over.
BE REASSURING. Given your data analysis and interpretation, your job is then to supply the recommendations and "close the sale". When you follow the guidelines of our Code of Ethics, by not guaranteeting results of treatment - but instead, by painting the picture of how treatment is systematic and designed to help the person function better - you have the best opportunity to show that therapy matters. If therapy is not an option, and you may see the person again, reassure them that you are available again if needed. If you are to treat the person, let them know that the standards for communication you set at the first visit, will continue throughout her/his association with you.
As the relationship continues and grows: Stay honest. Work efficiently. Always reassure your patient that she/he can count on YOU.
It starts with our stock in trade: Communication. Though we feel the pressure of time and someone watching us during the daily caseload grind, at the moment we meet that new customer - she or he is the center of our attention. The relationship we develop and maintain with the person largely determines what the outcomes may include. If you as an SLP have a good working relationship with the person, then what you might ask of that person, she/he may more likely follow whatever lead you provide. Some specifics on relationship-building, that begins with the first encounter at the evaluation:
BE HONEST. Tell the person referred you are sent (using the authority of the referring physician's order if necessary) to describe the person's skills for communicating, or thinking or swallowing. Explain in a manner the person can understand, the processes and mechanics of the evaluation and treatment planning process. Describe each step you are taking concisely, with its rationale. When you are done, explain the data analysis as possible while you are still online (in the evaluation setting). If data requires further offline analysis, offer to supply the interpretation as soon as possible.
BE EFFICIENT. Collect as much of the history information prior to entering the assessment setting. Have your interview questions polished and in a framework; insert additional questions to flesh out impressions as necessary. Practice your formal testing before the first visit, so that you have a routine that allows you to get the data and process it with the person present - when it is possible. Have your report writing procedure ready to start as soon as possible after the visit is over.
BE REASSURING. Given your data analysis and interpretation, your job is then to supply the recommendations and "close the sale". When you follow the guidelines of our Code of Ethics, by not guaranteeting results of treatment - but instead, by painting the picture of how treatment is systematic and designed to help the person function better - you have the best opportunity to show that therapy matters. If therapy is not an option, and you may see the person again, reassure them that you are available again if needed. If you are to treat the person, let them know that the standards for communication you set at the first visit, will continue throughout her/his association with you.
As the relationship continues and grows: Stay honest. Work efficiently. Always reassure your patient that she/he can count on YOU.
Sunday, February 22, 2015
Stephen Covey got it right
Blogger' s note: Thanks to Jenniffer Weigel of the Chicago Tribune, for the inspiration for this post - "Outgrowing a Mentor: Navigating the Delicate Business of Moving On"
I complete another mentoring assignment soon with a new CSD professional. I noticed at work the other day, that this mentee feels good about being more independent. How do I know this? It was her asking less questions of me, or more to the point - she has moved to ask, when needed, questions of her peers and other staff. Earlier in my career, this would have been an almost painful moment - when the mentee left this training opportunity for greener employment pastures. All the energy put into this person, learning the fundamentals of doing a clinical job; this person is gone. I had been making the experience about me, and not keeping the focus solely on what the student needed.
The nadir of this whole mentoring evolution, came for me when one young person was facing a happy event in her personal life . I had been hoping for an invitation to the event, but - it did not come. Even though I had been this person's mentor in an employment setting prior to this one, I had also misread the level of our communication. I never told her that I had been disappointed. I had realized very clearly, how a mentoring experience needs its consistent borders and its skill set.
A character in my most favorite TV (cop) show once said: You've been around this dump for seven years and you still ain't learned the key to good murder police, which is this: Whatever you see, whoever's around you; you keep them at a distance.
What I learned about good mentoring to close the deal; to make it easy for me to continue to take on mentees; it was- "Begin with the end in mind", popularized by the late Stephen Covey in _The 7 Habits of Highly Effective People_. How I adapt this concept to persons I mentor, is to modify a discussion with most of the persons I serve: "One day, you're going to be rid of me. That is the natural consequence of your success in what we do".
From that point on, early in the relationship, I help the mentee learn the skill set of a speech-language pathologist - beginning with the end in mind.
I complete another mentoring assignment soon with a new CSD professional. I noticed at work the other day, that this mentee feels good about being more independent. How do I know this? It was her asking less questions of me, or more to the point - she has moved to ask, when needed, questions of her peers and other staff. Earlier in my career, this would have been an almost painful moment - when the mentee left this training opportunity for greener employment pastures. All the energy put into this person, learning the fundamentals of doing a clinical job; this person is gone. I had been making the experience about me, and not keeping the focus solely on what the student needed.
The nadir of this whole mentoring evolution, came for me when one young person was facing a happy event in her personal life . I had been hoping for an invitation to the event, but - it did not come. Even though I had been this person's mentor in an employment setting prior to this one, I had also misread the level of our communication. I never told her that I had been disappointed. I had realized very clearly, how a mentoring experience needs its consistent borders and its skill set.
A character in my most favorite TV (cop) show once said: You've been around this dump for seven years and you still ain't learned the key to good murder police, which is this: Whatever you see, whoever's around you; you keep them at a distance.
What I learned about good mentoring to close the deal; to make it easy for me to continue to take on mentees; it was- "Begin with the end in mind", popularized by the late Stephen Covey in _The 7 Habits of Highly Effective People_. How I adapt this concept to persons I mentor, is to modify a discussion with most of the persons I serve: "One day, you're going to be rid of me. That is the natural consequence of your success in what we do".
From that point on, early in the relationship, I help the mentee learn the skill set of a speech-language pathologist - beginning with the end in mind.
Monday, February 16, 2015
The People We Serve Deserve Quality Services
Speech - language pathologists have more opportunities than ever for exciting, rewarding work with persons of all ages. The US Bureau of Labor Statistics has projected growth of new jobs in our field of between 10-19%; this growth would be spread ideally across all the work settings where SLP's are found. In healthcare and in the educational arenas, there is so much good work to be done; so many inroads to be made with both children and adults in all settings; - so many opportunities for persons served from all socio-economic groups to improve their quality of life. If it were the case that new graduates, or vetted professionals looking to change their work setting, moved to fill all the positions that needed filling - it would be a wonderful world for our field.
But new grads often go for their perfect job at clinical fellowship time. They're often the "sexy" speech jobs, one that have the glamour afforded them by high technology being used, or the most "romantic" diagnoses being explored, or in the work settings that are exciting places to be - often, an urban center. Some clinical positions require, or their job requirements demand, more autonomy and initiative then a clinical fellow or new professional may be equipped. Some worksites are less than desirable for persons seeking a job, due to the physical surroundings, the demographics of the patient mix, or the budget available for an SLP to do her/his clinical work. With limited space to address all the issues related to - not having enough quality SLP's in all the work settings that need high quality professionals - ; all that need be said is: everyone deserves quality SLP services, be they in the educational or the healthcare sphere; low or high socio-economic status; child or adult. But how to achieve - the parity that is needed among work settings!
There are time-tested strategies for attracting both new professionals and vetted ones, to less than the most sexy work settings. Grants augment salaries. Student loans can be reduced or forgiven. Benefit packages swell and shrink, as a function of the largesse of the institution's governing body. Travel? Free housing? Continuing education budget? These budget gems disappear from budget lines as quickly as they appear - from this blogger's experience. So if you are the successful candidate for this job - you have had some incentive waved like a carrot before your face. Beyond that, you have to love those jobs you start, so the difficulty in filling the jobs remains high.
I can only speak for myself. Being in a clinical job that I want to continue, means that I have found a sense of mission about the work. Mission often compensates for the lack of benefits, or of glamor or of sexiness in the work setting. Working with a sense of mission helps you see the operation of a clinical setting, above and beyond the day to day contact with patients/clients. You see what keeps the lights on, and you see the interplay among professional, skilled and semi-skilled labor that heightens your awareness of how cultures work - cultures like THIS work culture. How it works, when it works best, for the persons served - is that you as a professional do, what needs to be done.
But new grads often go for their perfect job at clinical fellowship time. They're often the "sexy" speech jobs, one that have the glamour afforded them by high technology being used, or the most "romantic" diagnoses being explored, or in the work settings that are exciting places to be - often, an urban center. Some clinical positions require, or their job requirements demand, more autonomy and initiative then a clinical fellow or new professional may be equipped. Some worksites are less than desirable for persons seeking a job, due to the physical surroundings, the demographics of the patient mix, or the budget available for an SLP to do her/his clinical work. With limited space to address all the issues related to - not having enough quality SLP's in all the work settings that need high quality professionals - ; all that need be said is: everyone deserves quality SLP services, be they in the educational or the healthcare sphere; low or high socio-economic status; child or adult. But how to achieve - the parity that is needed among work settings!
There are time-tested strategies for attracting both new professionals and vetted ones, to less than the most sexy work settings. Grants augment salaries. Student loans can be reduced or forgiven. Benefit packages swell and shrink, as a function of the largesse of the institution's governing body. Travel? Free housing? Continuing education budget? These budget gems disappear from budget lines as quickly as they appear - from this blogger's experience. So if you are the successful candidate for this job - you have had some incentive waved like a carrot before your face. Beyond that, you have to love those jobs you start, so the difficulty in filling the jobs remains high.
I can only speak for myself. Being in a clinical job that I want to continue, means that I have found a sense of mission about the work. Mission often compensates for the lack of benefits, or of glamor or of sexiness in the work setting. Working with a sense of mission helps you see the operation of a clinical setting, above and beyond the day to day contact with patients/clients. You see what keeps the lights on, and you see the interplay among professional, skilled and semi-skilled labor that heightens your awareness of how cultures work - cultures like THIS work culture. How it works, when it works best, for the persons served - is that you as a professional do, what needs to be done.
Saturday, January 24, 2015
closing the sale
"OK - you see that we have to keep many things in mind, during each day
spent as a speech-language pathologist. We are expected to produce revenue, so
that every success we see with the patient's function should accumulate
alongside the successes with business volumes. That business perspective we
can't ever lose, but neither can the business side be the predominant reason we
do this work. We are here to help people; it's the reason many of us agreed to
carry hefty student loans to begin our careers. So - if you need some guiding
principles that help you meet the twin objectives, fiscal and clinical, here
are some suggestions: -"
"The people we serve deserve quality healthcare".
"To get the best outcome for people with whom we work, the relationship you forge with them must be primary".
"Making progress towards the desired outcomes requires excellent time management”
“Establish a context for the activities you bring to each session: WHAT I WANT TO DO TODAY IS…”
“You are required to negotiate with the resident on the plan along the way”
“Complete necessary documentation of the plan's progression in a timely manner”
“Do not forget to train the patient, family and all who will be involved in assuring the plan's successful completion."
“Are you aware of the rules and regulations set by payer sources that influence how you do your job? Get a working knowledge of them”.
“Acronyms, jargon and shorthand, oh my! Learn the language of the persons with whom you are communicating, and speak or write in the language of your audience”.
“If you serve a person, by breaking down a single act they do not perform well into its components – then train the person to perform those components very well, without training the person to incorporate the components back into daily life – how has your work benefited the person?”.
“When you give someone a direction on performing an act – why not show them how YOU would do it? Provide a model.”
Persons who have difficulty initiating an action you want to see: Cue them first by saying “I want you to __________________”, instead of saying “Would you _______?”.
“Let’s address each of these principles for meeting both the fiscal and the clinical objectives”.
"The people we serve deserve quality healthcare".
"To get the best outcome for people with whom we work, the relationship you forge with them must be primary".
"Making progress towards the desired outcomes requires excellent time management”
“Establish a context for the activities you bring to each session: WHAT I WANT TO DO TODAY IS…”
“You are required to negotiate with the resident on the plan along the way”
“Complete necessary documentation of the plan's progression in a timely manner”
“Do not forget to train the patient, family and all who will be involved in assuring the plan's successful completion."
“Are you aware of the rules and regulations set by payer sources that influence how you do your job? Get a working knowledge of them”.
“Acronyms, jargon and shorthand, oh my! Learn the language of the persons with whom you are communicating, and speak or write in the language of your audience”.
“If you serve a person, by breaking down a single act they do not perform well into its components – then train the person to perform those components very well, without training the person to incorporate the components back into daily life – how has your work benefited the person?”.
“When you give someone a direction on performing an act – why not show them how YOU would do it? Provide a model.”
Persons who have difficulty initiating an action you want to see: Cue them first by saying “I want you to __________________”, instead of saying “Would you _______?”.
“Let’s address each of these principles for meeting both the fiscal and the clinical objectives”.
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