Primary contact physiotherapy in emergency departments can reduce length of stay for patients with peripheral musculoskeletal injuries compared with secondary contact physiotherapy:

Abstract

Objective

To evaluate if direct physiotherapy assessment and management of patients presenting to emergency departments with musculoskeletal injuries (primary contact physiotherapy) results in reduced length of stay without any increase in adverse effects compared with secondary contact physiotherapy, where patients are seen by a physiotherapist after initial assessment by a doctor.

Design

Prospective non-randomised controlled trial.

Setting

Three metropolitan emergency departments.

Participants

Adults (n=315) presenting to emergency departments with peripheral musculoskeletal injuries were allocated to primary or secondary contact physiotherapy; 306 participants completed the study. Patients with serious pathology, open fractures and spinal pain were excluded.

Intervention

A single episode of physiotherapy.

Main outcome measures

Primary outcome measures were patient length of stay, waiting time and treatment time. Secondary outcome measures were re-presentations to the emergency department, imaging referrals, patient satisfaction and emergency department staff acceptance.

Results

Primary contact physiotherapy resulted in a reduction in length of stay of 59.5minutes [95% confidence interval (CI) 38.4 to 80.6] compared with secondary contact physiotherapy, with a reduced waiting time of 25.0minutes (95%CI 12.1 to 38.0) and a reduced treatment time of 34.9minutes (95%CI 16.2 to 53.6). There were no differences between the groups in imaging referrals or re-presentations. Patients strongly agreed (≥82%) that they were satisfied with their management, and 96% of emergency department staff agreed that primary contact physiotherapists had appropriate skills and knowledge to provide emergency care.

Conclusion

Experienced musculoskeletal physiotherapists working in emergency departments can be the first point of contact for patients with simple, semi-urgent and non-urgent peripheral musculoskeletal injuries, resulting in decreased waiting times and length of stay for patients without any adverse effects.

Is pelvic floor muscle training effective when taught in a general fitness class in pregnancy? A randomised controlled trial

Cite this article

Abstract

Objectives

Pelvic floor muscle training (PFMT) following vaginal assessment of correct contraction can prevent and treat urinary incontinence in the peripartum period. The aim of this study was to evaluate the effectiveness of PFMT instructed in a general fitness class for pregnant women.

Design

Single-blind randomised controlled trial.

Setting

University-conducted primary care study.

Participants

One hundred and five sedentary primiparous women randomised to a general fitness class including PFMT (n=52) or a control group (n=53). Ten and 11 women were lost to follow-up in the exercise and control groups, respectively.

Intervention

Twelve weeks of training comprising twice-weekly 1-hour fitness classes including three sets of eight to 12 maximal pelvic floor muscle contractions. The control group received usual care.

Outcome measure

Number of women reporting urinary, flatus or anal incontinence.

Results

No significant differences were found in the number of women reporting urinary, flatus or anal incontinence between the exercise group and the control group during pregnancy or at 6 weeks post partum.

Conclusions

No effect of PFMT was found when the exercises were taught in a general fitness class for pregnant women without individual instruction of correct PFM contraction. Low adherence and the small sample size may have contributed to the negative results. Further studies are warranted to assess the effect of population-based PFMT in the prevention of urinary and fecal incontinence.

Accounting for Time Making Best Use of a Precious Resource

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How are you using timesheet data?

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However compensation is calculated in your organization, people's time costs money. That's why employers need to know that their people are at work for the right hours. It's also why, in many cases, they need to know what their people are working on when they're there.

That's why factory and shop staff have to clock in and out, why lawyers and management consultants fill in timesheets, and why project managers running multiple projects allocate the proportion of their time spent on each project to different project codes.

Without an appropriate time recording system in place, you have no way of billing for hours worked, you have no way of improving the accuracy of fixed price quotations, and you can't tell which projects are profitable, and which ones you should never rerun again.

In this article we'll look in detail at the benefits of accounting for time, we'll discuss the various approaches to time recording that organizations can use, and finally we'll show you what you need to consider when deciding what type of time recording is right for you.

Why Record Time?

For Payroll

In its most basic form, workers track the time they spend at work by using a time card to "clock in" on a machine. The machine records the hours worked, and the information is sent to payroll for processing.

Clocking in is generally used in factory, retail and other environments where there is traditionally a certain mistrust of "shop floor" staff: it implies that they can't be trusted to arrive on time and work a full shift. On the other hand, the practice can protect both employees and their supervisors: by clocking in, an employee can be confident that they won't be falsely accused of late-coming, and they also know that the system will immediately pick up on any overtime payments they're due. Meanwhile, supervisors are freed from "roll call" duties, and can focus on more value-added work.

For Invoicing

Law firms, accountants, consultancies, and other professional services firms(whose principle activity is to "sell time") need their staff to track and account for time accurately, so that they can invoice their clients correctly.

To Identify Productivity

Professional services firms also want their people to maximize the amount of time they devote to generating revenue, while minimizing the amount of time spent on administrative duties. By tracking time, they record how productive each person is by measuring the proportion of each day that he or she spends on chargeable work.

Another aspect of this relates to when work is sold to the client at a fixed price: if the consultant or lawyer doing the piece of work can do it faster (at the same quality) than a colleague who is on the same salary, they'll obviously be able to move on to the next project sooner, and earn more fee revenue for their firm. Again, time recording reveals people's productivity levels.

Finally, recording the time spent on fixed price work allows the firm to analyze how accurate their estimating process is. If it turns out that work is regularly taking longer than expected, even when highly efficient people are doing it, this obviously eats into profits. On the other hand, if the reverse is true, businesses may lose work because their bids are uncompetitive.

To Understand Internal Costs

Even when work is not being charged out to clients, organizations need to know what different activities cost. This applies both to project-based work, and to "business as usual" activities such as accounts processing.

Time recording in these cases helps organizations identify what proportion of their costs are overheads and what proportion operational, and how this changes over time. They can calculate the full cost of a marketing campaign. Or they can assess whether a non-strategic function such as payroll might cost-effectively be outsourced.

By collecting this type of information, you're also in a better position to plan future projects. Using time-tracking data gives you a more accurate picture of how efficiently your team will perform a set of tasks.

Finally, time tracking allows you to identify trends. You can see what categories of work are being done more or less. Ultimately, the more information you gather about your organization, the better you're able to understand and manage your business.

Types of Timekeeping Systems

• Card clocking – People often think of this system first. Traditional time clocks used punch cards that were stamped with the time and date at the beginning of a worker's shift, and then stamped again at the end. Time cards were then sent to payroll to be processed each pay period.
• Today, this information is usually sent electronically, and can be tracked very accurately. There are portable systems that can be taken to different work sites – for example, in the construction industry. There are even biometric devices that use fingerprint recognition. This type of system provides added assurance that the person "clocking in" is actually in attendance.
• Time sheets –Time sheets are used to track items like attendance, break time, project time, and billable hours. They may include hourly rates and expense information. This then helps you evaluate time by worker, task, project, and client. Time sheets are very customizable, and can be tailored to meet the exact needs of your organization. They can either take the form of a spreadsheet, or a special time-tracking application that's part of the organization's accounting software.
• Computer-based time recording – These are computer applications that track the time someone spends working on specific projects or with particular clients.
• There are two categories of software. The first type allows you to switch back and forth between tasks. This way, you can track hours per project, distinguish between billable and non-billable tasks, manage absences, calculate overtime, and print reports automatically. (Wikipedia has a comparison pageof some notable time-tracking systems.)
• The second type runs in the background of your computer and records exactly what you're working on each second of the day. The software operates by continuously taking screen shots, and it allows you to quickly recall what you worked on, and for how long. (TimeSnapper has a free version that you can download.)

Do You Need a Timekeeping System?

Some organizations have no choice but to use a timekeeping system. If you charge time to different clients or different projects, then you must keep track of the hours you spend. Clients often want to know that you have a reliable system in place, so that you can bill them fairly.

For organizations that have a choice, it's important for the benefits of timekeeping to outweigh the costs. Keeping track of workers and checking on what they're doing every minute of the day is not reason enough to establish a timekeeping system. If you're tracking time because of a lack of trust, then there are probably much larger issues to address.

Timekeeping systems can be expensive. There may be an up-front cost of purchasing equipment and software, and there's also the cost associated with taking time to track your time. It's therefore important to conduct a propercost/benefit analysis to determine whether you need a timekeeping system.

Even the simplest spreadsheet solutions take time for workers to complete on a regular basis. If you ask workers to track how they spend their time, make sure that information is used in some meaningful way. Before you ask workers to track their time, make sure that you know why you want to track it, how you'll use the information, and whether the analysis will lead to changes and improvements.

Key Points

In many organizations, people's time is the most costly resource. It is therefore often essential to monitor the use of time within your organization. By doing this, you can see how and where time is being spent, and you can identify trends in its use. From there, you can improve productivity, profitability, and customer service.

There are many timekeeping options available, from simple manual time sheets to sophisticated software solutions. Each has its benefits and associated costs. Before implementing a timekeeping system, analyze the costs versus the benefits to determine what's best for your organization.

The RATER Model Five Ways to Measure Service

The RATER Model

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Five ways to assess your service.

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How do you assess the quality of the service that you give to your customers?

You might ask focus groups or do a customer satisfaction survey. Or you could look at the number of complaints you get, or analyze the time it takes to answer customer queries.

While all of these can be useful for assessing what people think of your service, using unstructured approaches like these can lead you to miss areas that are important to your customers.

This is where the RATER Model can help. This useful tool highlights the areas that you need to focus on to provide great customer service. In this article, we'll explore the model, and we'll look at how you can use it to improve the service that you provide to your customers.

Tip:
Remember that customers can be internal to your organization, as well as external. So this model is relevant in a wide range of scenarios.

About RATER

The RATER Model was created by professors Valarie Zeithaml, A. Parasuraman, and Leonard Berry, and published in their 1990 book, "Delivering Quality Service."

The model highlights five areas that customers generally consider to be important when they use a service. These are:

• Reliability – your ability to provide your promised service consistently, accurately, and on time.
• Assurance – the knowledge, skills, and credibility of staff; and their ability to use this expertise to inspire trust and confidence.
• Tangibles – the physical evidence of the service you provide. This could be buildings or offices, your equipment, employees, and the communication or marketing materials that you use.
• Empathy – the relationship between employees and customers.
• Responsiveness – your ability to provide a quick, high quality service to your customers.

By focusing on these five areas, you can analyze and improve service.

Tip:
The RATER Model is a simplified version of the SERVQUAL Model, which was first created in 1988. Nowadays, you must also consider the state of your online presence, as well.

Depending on the importance of your online channels to your business, you can consider this under the tangibles heading (even though your online presence isn't strictly "tangible"), or you could have a separate area for this. (We add questions relating to these in below, even though these were not part of the original RATER model.)

How to Use RATER

A good way of using the RATER Model is to carry out a Gap Analysis using each of the five dimensions. You can then come up with a plan for improving the way that you serve your customers.

To do a Gap Analysis, you identify the following in each of the five areas:

• Future state – the "place" you want to be to provide exceptional service.
• Current situation – how you currently provide your service.
• Next Actions – how you'll move from your current situation to your future state.

You can use the following questions as a starting point for thinking about each area:

Reliability

• How well do you provide the service that you've promised to your customers?
• Are your systems and processes robust and reliable?
• Is service delivery consistent and timely, across all service channels (including online)?
• Could you improve the quality of your service in any other way?

Assurance

• Do staff have the skills and knowledge needed to deliver a good service?
• Do your people need any further training or development?
• Do staff inspire trust in customers?
• Is your service safe and secure?

Tangibles

• Is the physical evidence of your service (products, packaging, marketing materials, website, offices, staff appearance, and so on) attractive and appropriate for your customers?
• Are your website FAQs useful, comprehensive, and up to date? And can people talk to a human being if their questions haven't been answered, or if your website is broken?
• As well as managing traditional channels and your website, are you properly handling queries and feedback through Twitter, Facebook, LinkedIn and other online services?
• Does physical or virtual evidence fit with your organization's brand?

Empathy

• Do your people build good relationships with customers?
• Is all communication with customers clear and timely?
• Do staff show empathy with customers? Do they understand why empathy is essential for providing a great service?
• Do your people genuinely care about customer needs?
• Are staff able to see things from a customer's point-of-view?

Responsiveness

• Do you provide a prompt service, which is easy to access?
• Do you manage complaints and feedback appropriately?
• Are staff always willing and able to help customers?
• Do you resolve customer issues and problems satisfactorily, and in good time?

When you identify your future state and your current situation, it's important that you talk to your customers to understand their experiences and expectations fully.

Where you can't talk to customers directly, use tools such as Customer Experience Mapping to see your service from their perspective. You can also use Reverse Brainstorming to explore possible service improvements, and Benchmarking to compare your performance with similar organizations or services.

Tip:
There is arguably some crossover between some of the elements of the RATER Model. Don't worry about this – just aim to do a thorough analysis in each of the five areas.

Key Points

The RATER Model was created by professors Valarie Zeithaml, A. Parasuraman, and Leonard Berry. It highlights five areas that customers consider important when they use a service. These are:

1. Reliability.
2. Assurance.
3. Tangibles.
4. Empathy.
5. Responsiveness.

You use the model by doing a Gap Analysis in each of the five areas. From this, you can plan how you'll improve the service you give to your customers.