This is the last post in a 4-part series on the business opportunities in balance. In the post “The Business Case for Better Balance,” I wrote that being the best at balance is a competitive advantage and includes excelling in 3 areas: knowledge (see 5-Point Check of Balance Knowledge post), equipment (see List of Must Have Balance Equipment), and balance systems. In this post I will expand on balance “systems” – with systems being the way a facility goes about caring for patients with balance problems. In your current system does everyone do their own thing (bad)? Or do you have a framework that provides structure to clinicians and patients (good)?
SYSTEM SIDEBAR: A system is made up of inputs, actions, and outputs. Inputs are what goes into the system, e.g., what information or materials are brought in the door. The action is what happens, or what changes are made, to the information and/or material. Lastly, these changes result in an output, or alterations in materials and/or information. The better the design of the system, the more accurate and consistent the output.
To be the best at balance rehabilitation, the patient must receive consistent and effective care – the result of a well-designed balance system. A discussion on applying systems theory to balance care is included below:
- Inputs. In rehabilitation, our inputs are the patient and any accompanying medical information (insurance coverage, family report, test results, medical records, etc.). While cannot pick our patients, we can exclude patients that are not appropriate for a given facility. For example, if the patient has positional vertigo, and the facility does not have competency in this area, then the patient is better served going to a different facility. Taking time to document exclusion criteria, as well as, stating standards for medical information needs, will help avoid getting poor inputs into the system. Document and share with referral sources your target patient population. Let patients know in advance what information they need to bring to their first day of therapy. In short, put safeguards in place to help ensure good inputs into your balance system.
- Actions. What we, as facilities and therapists, do to patients and their medical information is the action part of the balance system. Example actions include reviewing the medical information, asking additional questions (symptom surveys, intake forms, etc.), completing clinical exams (ROM, strength, balance, neurological testing, etc.), administering standardized tests (TUG, Berg, Tinetti, etc.), formulating treatments, providing care, performing rechecks, updating treatments (based on results of rechecks), and discharging patients. In respect to balance care outline the following:
- Which surveys and standardized tests are administered and when?
- How is information from surveys, tests, patient reports, and clinical exams utilized to pick balance exercises?
- What are prescription parameters (frequency, duration, intensity) for balance training?
- How are balance exercises progressed?
3. Outputs. The outputs include the changes made to the patient and their medical records. Changes to the patient include both physical (better balance) and cognitive (educated on fall factors, instructed on balance systems, etc.) changes. Typically these changes are documented in the medical records resulting in changes to medical information. Information changes include reports to other medical providers, patients, billing, etc. As part of balance system outputs, how outcome data is stored and used should be documented. If therapist and program performance is tracked, it should be clear how poor performance is detected and corrected.
The competitive advantage of a well-designed balance system will include, to name a few, consistent patient experiences, effective patient interventions, and strong patient outcomes.