Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

A pervasive culture of time constraints in health care

Hannah T. Todd, PT, DPT
Conditions
August 14, 2022
222 Shares
Share
Tweet
Share

Picture this. A patient in a hospital or rehab facility has just finished exercising with therapy. He is thirsty, and he thinks he might as well ask for a snack now because he will be hungry in 30 minutes. His therapist sets him up in his wheelchair (brakes locked), tray table with all necessities positioned in front of him, with his call bell within reach. As she approaches the door to leave, she turns and asks, “Is there anything else I can do for you?” The patient nods and asks for a refill of his water cup and some peanut butter crackers. The therapist grimaces. What should she do?

To a sane person who doesn’t work in health care, this is not an obvious moment of ethical dilemma. Just go get the water and the crackers. It might take two minutes round trip. Maybe three if the therapist stops to talk to a nurse. Patient satisfaction is achieved, the therapeutic alliance is strengthened, nutrition and hydration are achieved, and besides, why would the therapist have asked in the first place if she didn’t want to help?

The problem is that health care is a business, and people in charge want to “optimize” employees as though they are components of an assembly line. Each staff member should be utilized to their highest degree only, and there should be just enough staff to do the job without excess expenditure. This might seem like sound business practice until you actually go through the experience.

In the eyes of health care as an optimized business, a therapist should not be getting snacks and water. That task is not skilled therapy, can’t be billed, and could be done by anyone. So, therapists are instructed to increase their “productivity” ratios in therapy team meetings by politely refusing this request. Therapists should offer to press a patient’s call button instead and then leave the room to do actual therapy instead of water retrieval.

But, nursing is also part of the business, and they are being optimized too. They are counseled to turn off any call light as soon as possible, partly because the time to call light response is measured and partly because emergencies can be detected faster if every call light in the facility isn’t blinking at once. So, the very busy nurse or nursing assistant races in to turn off the call light even though he is in the middle of helping someone else and can’t grab the water or snack right that moment. The patient has been asked what he needs by multiple providers now, and multiple providers have declined to meet that very basic need. But each provider has been counseled to act this way by their respective managers, all in the name of optimizing time and metrics, none of which measure whether the patient ever receives fresh water to drink after therapy.

In the book Compassionomics, the authors share a fascinating research study about helping behavior. People in seminary school were told that they needed to go to another building – either to give a talk about seminary jobs or to give a talk about the Good Samaritan Bible story. Some seminary students were given instructions just to head over, and some were given instructions to hurry over because they were already a few minutes late. Each student encountered a man slumped over in the hallway on the way to his talk. Interestingly, students in the hurry-up scenario only helped 10 percent of the time – even when they were going to give a talk about helping behaviors in the Good Samaritan story! Students in the control group helped 60 percent of the time. The researchers did note that many students who did not stop to help did appear agitated when they arrived at their destinations.

This study on helping behaviors is directly applicable to the above clinical scenario. Much like potential clergy, health care workers have a real heart for people. We want to help people in pain and who need help. We know intuitively that people who are treated with kindness and understanding get better than people who are treated by someone who stares at a computer screen and never looks up. We also know this concretely through research.

But, there is a pervasive culture of time constraints in health care. With staffing levels “optimized” to provide just enough patient care, and appointments scheduled close enough together to maximize profits, and (in therapy at least) reimbursement tied to time-based billing codes, as well as an ever-growing list of documentation/administrative requirements, we all feel pressured for time. Every single player in the health system is a seminary student given a warning not to be late to give a talk about helping behaviors. We have patients in the waiting room, documentation waiting for us at home after a long day of work, and productivity requirements hanging over our heads (and often tied to our paycheck). It’s basically in the job description to do as much as possible in as little time and not “waste” any minute on the clock. The health care system that we work in is priming us not to be compassionate.

This does not result in good care. The patient in our above scenario might wait for two hours for his glass of water and peanut butter crackers. Cynically, I sometimes believe that health systems hope for that because then the patient’s family member might come and sit with them during the day, taking care of these less medical but no less important tasks at zero cost to the health system. Unfortunately, the result of this time-crunched system is providers who face an ethical dilemma every time a patient makes a reasonable request that falls outside of the provider’s very limited scope.

In reality, no one is unqualified to get a glass of water and some snack from the nurse’s station. But in this health care world that sees providers as tools for production instead of humans employed to help other humans, anyone over qualified to pour water is encouraged not to do it. Providers want to help but are sandwiched in between too many patients and too many overhead pressures to be efficient. Much like the agitated seminary students who did not help someone in need, providers who feel they have to say no to reasonable requests and bids for connection in the name of “productivity” experience burnout, moral injury, and compassion frustration.

I want to emphasize that messaging around time constraints impacts helping behavior. If giving people an imaginary time constraint effectively extinguishes their helping behaviors, and our whole system is based around the idea that no one has enough time to complete their jobs, how can we expect people to provide compassionate care (or at the very least have good patient satisfaction)? Even if time constraints in the system don’t change, management can still dial back the “hurry up” messaging and productivity shaming. This will decrease the conflict providers feel when they want to respond with compassion, improve patient care and satisfaction, and improve employee retention.

Hannah Todd is a physical therapist. 

Image credit: Shutterstock.com

Prev

Preserving humanity in the ICU [PODCAST]

August 13, 2022 Kevin 0
…
Next

I didn't know her name until it was over

August 14, 2022 Kevin 0
…

Tagged as: Practice Management

Post navigation

< Previous Post
Preserving humanity in the ICU [PODCAST]
Next Post >
I didn't know her name until it was over

More by Hannah T. Todd, PT, DPT

  • Confronting weight bias in health care

    Hannah T. Todd, PT, DPT

Related Posts

  • How social media can help or hurt your health care career

    Health eCareers
  • It’s time for a comprehensive universal health care system in America

    Sagar Chapagain
  • It’s time we think about health care differently

    Praveen Suthrum
  • Why whole person care is needed for better population health management

    Trisha Swift, DNP, RN
  • Why health care replaced physician care

    Michael Weiss, MD
  • Health care is expensive. It’s time to treat the cause.

    Dr. Meg Hansen

More in Conditions

  • The power of coaching for physicians: transforming thoughts, changing lives

    Kim Downey, PT
  • Unlocking the secrets of cancer conferences: an end-of-life counselor’s journey among pharmaceutical giants

    Althea Halchuck, EJD
  • An obstetrician-gynecologist reveals the truth about reproductive planning and how to navigate society’s expectations

    Yuliya Malayev, DO, MPH
  • Nose-brain connection: The surprising link between allergies and mental health revealed

    Kara Wada, MD
  • Is the rise in mental illness due to greater awareness or a true increase in incidence?

    Zahid Awan, MD
  • A patient’s perspective on the diminishing relationship between doctors and patients

    Michele Luckenbaugh
  • Most Popular

  • Past Week

    • A patient’s perspective on the diminishing relationship between doctors and patients

      Michele Luckenbaugh | Conditions
    • Unmasking wage disparity in health care: the truth behind the Elmhurst Hospital physician strike

      Kevin Pho, MD | KevinMD
    • Why affirmative action is crucial for health equity and social justice in medicine

      Katrina Gipson, MD, MPH | Policy
    • How electronic health records preserve patients’ legacies in the words of oncologists

      Marc Braunstein, MD, PhD | Physician
    • Unmasking the brutal reality of gun violence in America: a call to action for unity and meaningful change

      Osmund Agbo, MD | Policy
    • Emulating Michael Jordan’s winning mindset: a path to success for health care professionals and entrepreneurs

      Harvey Castro, MD, MBA | Physician
  • Past 6 Months

    • The growing threat to transgender health care: implications for patients, providers, and trainees

      Carson Hartlage | Policy
    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
  • Recent Posts

    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • Why doctors aren’t to blame for the U.S. opioid crisis [PODCAST]

      The Podcast by KevinMD | Podcast
    • Raw humanity on night float: inspiring patient encounters and overcoming challenges

      Johnathan Yao, MD, MPH | Physician
    • Is AI the solution for the shortage of nephrologists? ChatGPT weighs in.

      Amol Shrikhande, MD | Tech
    • Unlocking the secrets of cancer conferences: an end-of-life counselor’s journey among pharmaceutical giants

      Althea Halchuck, EJD | Conditions
    • Why HIPAA is failing and what you need to know to protect your data [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • What Drug Did FDA Just Approve for COVID?
  • PET Scan for Alzheimer's Dx; Predicting Colon Cancer Survival
  • What Happens When We Classify Kids' Weight as a 'Disease'?
  • Sotagliflozin Gets FDA's Blessing for Heart Failure
  • Cardiorespiratory Monitoring Can Be Telling of Outcomes in Extremely Preterm Infants

Meeting Coverage

  • No Access to Routine Healthcare Biggest Barrier to HPV Vaccination
  • Trial Results Spark Talk of Curing More Metastatic Cervical Cancers
  • Cross-Border Collaboration Improves Survival in Pediatric Leukemia Patients
  • Monoclonal Antibody Reduced Need For Transfusions in Low-Risk MDS
  • Less-Invasive Surgery for Pancreatic Cancer Proves Safe, Effective
  • Most Popular

  • Past Week

    • A patient’s perspective on the diminishing relationship between doctors and patients

      Michele Luckenbaugh | Conditions
    • Unmasking wage disparity in health care: the truth behind the Elmhurst Hospital physician strike

      Kevin Pho, MD | KevinMD
    • Why affirmative action is crucial for health equity and social justice in medicine

      Katrina Gipson, MD, MPH | Policy
    • How electronic health records preserve patients’ legacies in the words of oncologists

      Marc Braunstein, MD, PhD | Physician
    • Unmasking the brutal reality of gun violence in America: a call to action for unity and meaningful change

      Osmund Agbo, MD | Policy
    • Emulating Michael Jordan’s winning mindset: a path to success for health care professionals and entrepreneurs

      Harvey Castro, MD, MBA | Physician
  • Past 6 Months

    • The growing threat to transgender health care: implications for patients, providers, and trainees

      Carson Hartlage | Policy
    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
  • Recent Posts

    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • Why doctors aren’t to blame for the U.S. opioid crisis [PODCAST]

      The Podcast by KevinMD | Podcast
    • Raw humanity on night float: inspiring patient encounters and overcoming challenges

      Johnathan Yao, MD, MPH | Physician
    • Is AI the solution for the shortage of nephrologists? ChatGPT weighs in.

      Amol Shrikhande, MD | Tech
    • Unlocking the secrets of cancer conferences: an end-of-life counselor’s journey among pharmaceutical giants

      Althea Halchuck, EJD | Conditions
    • Why HIPAA is failing and what you need to know to protect your data [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...