Are Productivity Goals in Rehabilitation Practice Associated With Unethical Behaviors?
Justin E Tammany, Janelle K O'Connell, Brad S Allen and 1 others
PMID 33543042WHAT IT FOUND
Most clinicians observed unethical behaviors like inappropriate discharges or billing rarely or never.
However, skilled nursing facilities reported the highest frequency. Organizations emphasizing productivity over ethics or evidence-based practice had significantly higher odds of clinicians observing these behaviors.
Key findings
01Clinicians in skilled nursing facilities observed significantly more unethical behaviors than those in other settings, being 4.11 times more likely to observe higher than median unethical behavior.
02Organizations that emphasized evidence-based practice much less than productivity had 6.01 times higher odds of clinicians reporting high observed unethical behavior compared to those emphasizing evidence-based practice much more.
03There was a weak positive correlation between expected productivity rates and observed unethical behaviors, but the effect size for the difference between those with and without productivity standards was small.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study only surveyed physical therapists and assistants in Texas, so findings may not apply to other disciplines or states. The response rate was low (12.8%), which introduces potential nonresponse bias, although the authors found no significant differences between early and late respondents. Unethical behavior was self-reported via proxy observation, which may be subject to social desirability bias or underreporting. The cross-sectional design cannot prove that productivity goals cause unethical behavior, only that they are associated.
The easy way to misread this
Do not assume that all productivity standards lead to unethical behavior. The association between having a productivity standard and observing unethical behavior was statistically significant but had a small effect size. The stronger predictors were organizational cultures that explicitly prioritized productivity over ethics and evidence-based practice.