Look around you. The way you perform your duties as a respiratory therapist (RT) is not the same as it was ten or even five years ago. Every year it seems that RTs are called to do more with less. And unfortunately, there doesn’t seem to be any possibility of these high therapist-to-patient ratios improving anytime soon. What must individual RTs do to grow respect for their profession at a time when their valuable skills and knowledge are becoming less visible due to having less time to spend with their patients? The answer is that RTs must strive for excellence in every facet of their professional lives.
The key to excellence is having the keen ability to evenly balance between focusing on improving critical thinking skills, providing exceptional customer service, improving quality of work life, and being good financial stewards of resources. Focusing on one of these essential components to the detriment of the others is the quickest way of achieving mediocrity. If the respiratory therapy profession is going to grow and thrive within the 21st century, every one of its members must seek balance between each of the preceding four quadrants of excellence.
1. Focus on Customer Service
It is a simple fact that in the US today, patients have many choices in regards to where they receive their healthcare. Patients no longer have to put up with poor customer service; they can simply choose to go elsewhere. It is crucial, therefore, that RTs represent their profession in the most respectable manner possible in order to help their employers maintain a competitive edge. The more RTs improve the marketability of their employers, the more value and clout they will hold in times of organizational downsizing.
Listening to hospital administrators continually stress the importance of customer service sometimes has the tendency to make frontline clinicians believe that the higher-ups are more concerned with customer service than clinical quality. But those who think that there is a wall of separation between clinical quality and customer service should rethink this idea. Customer service is directly proportional to the perceived quality of healthcare that patients receive. The majority of patients who receive respiratory therapy do not understand the technical components of their therapy. This is because people only understand what they see and hear. If patients are not educated about their therapy and why it’s important, they will not understand the value of RTs in their overall plan of care.
As with any other economic market, the financial health of any healthcare organization is directly related to the number of patients they serve. The more patients who go elsewhere to obtain better service, the more these employers will lack the ability to hire additional caregivers and purchase new capital equipment. In the end, it is the patients who suffer. Therefore, RTs should be customer service champions within their healthcare organizations–not only for their own personal job security, but for the well being of their patients.
2. Focus on Quality of Worklife
The easiest way for respiratory therapists to foster good quality of worklife is to be exceptional communicators with everyone on their healthcare team. More times than not, RTs tend to feel “used and abused” because their place within the healthcare team is not respected until a patient’s airway is compromised. However, the respiratory therapy profession is not intentionally overlooked. The old cliché, “Out of sight, out of mind” plays a huge role in answering this seemingly disrespectful attitude toward individual respiratory therapists. Spending the majority of their time in their own particular fields of expertise sometimes blinds other healthcare professionals to the insights and skills of other professions.
RCP’s can help offset this trend by taking every opportunity to educate their fellow healthcare professionals about the knowledge, skills, and interventions that they have to offer. This can be accomplished in a way that is as simple as assessing the patient and discussing their findings and recommendations to all who are involved in their patient’s plan of care.
3. Focus on Financial Responsibility
RCP’s should embody financial responsibility. If the profession is to gain more and more national recognition, those who fall under its banner must be frugal with their resources–especially in uncertain financial times. Unfortunately, some RTs fail to understand the delicate balance between clinical quality and the financial health of the organizations for which they work.
Respiratory therapists can begin to change this unhealthy outlook by viewing their administrators as fellow members of the healthcare team who are also suffering from similar challenges. Just as RTs are required to provide more care with fewer therapists, healthcare administrators continually have to seek creative ways of providing quality services in the midst of ever-shrinking revenues.
Individual RTs can do their part in saving valuable resources by utilizing supplies in an efficient manner, limiting nosocomial infections by practicing good infection control techniques, and giving an honest day’s work for an honest day’s pay. Showing up to work on time as scheduled not only saves the hospital money through reducing overtime expenses; it first and foremost benefits the patient. Chronically being late or absent from work infringes upon timely and consistent patient care. Dependability, on the other hand, demonstrates a high level of professionalism and respect for the patients in need of respiratory care. The more RTs contribute to a healthy bottom line, the more valuable they will become to those who are responsible for keeping their healthcare organization financially strong.
4. Focus on Critical Thinking Skills
How many times have you heard a fellow therapist say, “If those bean counters in Administration would quit focusing so much attention on the bottom line and spend more resources on improving clinical quality, things would be a lot better around here.” Although having the necessary tools available is crucial to providing good patient care, clinical quality does not magically improve just because there is more money available. Good clinical quality is fundamentally the result of a strong, honest work ethic that is demonstrated through a continual devotion to improving one’s self and one’s profession.
Throughout the coming years, respiratory therapists are going to continually be asked to be more productive with fewer resources. However, this trend will not be because hospital administrators do not want to hire more employees, it will be because the number of practicing RTs will not be able to match the demand that the retiring Baby Boomer generation will inevitably place on their services. RTs will have no choice but to adapt.
One specific way in which we will see the respiratory care profession adapt to the coming changes in healthcare will be through the process of becoming less technical and more therapeutic. This shift will naturally occur as RTs begin to use more of their time employing their critical thinking skills to determine the best plan of care for their patients, and less time in the technical aspects of their jobs that may or may not have been beneficial for those they serve.
For example, Kingston of Miamisburg (KOM), a skilled rehabilitation and long-term nursing facility in Miamisburg, Ohio, opened a respiratory therapy department in 2014 to improve the quality of care of their chronic lung patients. This was an exciting and very progressive move by Kingston since insurance providers reimburse for nurses to provide respiratory therapy, and offer no additional benefits for the services of respiratory therapists. Because Kingston had to find the right balance between financial health with clinical quality, it was decided that the best way to achieve this would be to have respiratory therapists focus less time on providing routine care and focus their attention primarily on timely patient assessment, education, and the recommendation of evidenced-based care to their patients’ providers. After two years of building the program, KOM proudly boasted of having a zero percent return-to-hospital rate for their Chronic Obstructive Pulmonary Disease (COPD) patients for the first three quarters of 2016.
What follows is another example of the value of RTs focusing their critical thinking skills. After permitting their RTs to apply their critical thinking skills through respiratory therapist-driven protocols for their adult patient population, Marion General Hospital in Marion, Ohio saw a decrease in the average length of stay (ALOS) for their COPD population (4.37 in 2001 to 3.93 in 2002), as well as a significant drop in the ALOS for their patients receiving mechanical ventilation. This drop in ALOS not only reduced therapist-to-patient ratios but more importantly decreased their patients’ chances of suffering from further complications such Ventilator Acquired Pneumonia (VAP). From 2001 to 2004, MGH has had only one incident of VAP.
Strong technical skills will always be essential for RTs to be successful, but their assessment skills will be of greater value as their workloads shift from being less consumed by routine treatments to becoming more consultative in nature. As a result, respiratory therapists will want to focus on continuing their education in ways that will improve their ability to critically think; otherwise, those who are weak in this area may find it difficult to stay afloat in this new, fast-approaching healthcare market.
Being only one member in a group of thousands may sometimes cause us to question if giving our best is really all that important in the whole scheme of things. It is during these times when we should recall the many ways in which Respiratory Care has been very good to us, our families, our teams, and the patients we serve. After all, where would Mr. Blue Bloater or Mrs. Pink Puffer be today if it was not for the RTs who serve on the frontlines of healthcare?
How then do we stay focused on making the most of our professions in uncertain times? We do it by acquiring the ability to balance between developing good critical thinking skills, focusing on providing good customer service, improving our quality of worklife, and being good financial stewards of resources. Focusing on all four of these essential components is the quickest way of achieving excellence both for ourselves and for our profession.