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Section 7
Track #7:Getting PT, OT, and Speech Schedule Coordination

Table of Contents | NCCAP/NCTRC CE Booklet

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Note-Taking Exercise

Name a therapist or other staff member who intimidates you:


An opportunity to be casually friendly:


Write a statement of what you are not intending:


What are the first three steps in establishing a relationship with one of the Therapies or another staff member?





Transcript of Track 7

On the last track we've talked about how your administrator, director of nursing, other department heads and staff see you.  Obviously, you have different body posture, distance, facial expression, smile, and voice tone with a staff member with whom you are extremely friendly, as compared to another you don't care for.  We have focused a lot on nursing, so let's focus outside of the nursing department.  Let's talk about that other staff member with whom you may have such a warm, cozy relationship.  Usually the therapies have back to back appointments, and communication with them is more structured due to their perhaps part-time status in the facility, and distant location of their therapy room.

If you don't have PT, OT or speech in your facility, perhaps think about the front office or your dietary department.  You are now asking the speech therapist to change the schedule she has with Mabel, so Mabel can attend the Bible study that her church conducts weekly.  This is another track I hope you will review often, so the content becomes second nature to you.

You may not even know the speech therapist's first name.  Perhaps all you know is that she seems very curt and very businesslike as she rushes down the hall. Now, this might be in your case, the PT, OT, or if you don't have these therapies, think of someone else.  In short, you are intimidated by Ashley, the Speech Therapist.  When I have you turn the CD player off, take a minute to think about your relationship with the head of one of the therapies, or if you do not have rehab in your facility, another department besides nursing, by whom you are intimidated.

Remember, as pointed out on the previous track, if you're going to ask someone for something, it's hard for them to care about your request, if you don't care enough to even know their name.  So Step One in coordinating with the therapies, to put it bluntly, is… "to get them to give a damn you have to give a damn about them first."  Let's get past the therapist's first name.  Is your Ashley married?  Single?  Have children?  Live in town?  Live an hour away?  What does she watch on TV?  Hobbies?  Favorite food?  I could go on and on, but I think you get the point. Since you know, down the line, you are going to be asking this department head to reshuffle their schedule, don't you think it would be a good idea to go out of your way to find or create opportunities to establish a personal connection with this individual?  This is hard with the therapies, especially because they are located in a separate area, and are usually busy with back-to-back appointments.  So, look, and I mean really look, for opportunities to be casually friendly.

Ask yourself the following question.  "Am I afraid to ask Ashley to change her scheduled speech appointment for Mabel because I will appear too forceful, and maybe damage my practically nonexistent relationship with her?"  If so, you may be thinking, "Gee, how do I tactfully cushion or soften my request so as not to sound like a bully, like I'm trying to run her department.  I don't want to upset or anger the speech therapist!" 

Your second step after at least finding out the therapist's name and smiling a couple of times in the hallway is to schedule a meeting, similar to the meeting you had with your administrator and your director of nursing.

This tactful cushioning or softening skill regarding making your request is to position yourself so as not to appear high-handed or demeaning their position as a department head. I have found the best way to do this is by first Stating What You Are Not Intending.  It could be wise to use this method when you expect a negative reaction to what you have to say.  Saying what you are not intending during the initial exchange is easier than trying to back track through their assumptions after the fact.  What do I mean by stating what you are not intending?  Statements like “I don’t want to be rude,” or “I don’t want to inconvenience you,” can help reassure them that you mean no harm by what you are about to say.  Let me repeat that.  .  Saying what you are not intending during the initial exchange is easier than trying to back track through their assumptions after the fact. 

Stating what I am not intending is probably my favorite softening skill, because it has worked for me in many instances.  After you have scheduled an appointment and have provided the speech therapist, Ashley, with a brief, one-page copy of the regulatory guidelines that state that schedules are to optimize residents' participation in activities, providing it is not counter-indicated in their medical treatment plan, you tell Ashley what you don't want to have happen concerning the administrator and director of nursing. 

Before you get to your statement of what you don’t intend, you might preface the statement with a statement of empathyEmpathy is letting others know that you are sincerely sympathetic to their side of a situation.

The Activity Director stated to Ashley, "I know you are busy all the time, and you are only here three days a week, and operate on a very tight schedule."  In short, empathy is putting yourself in the other person's shoes, see their workday as they see it. 

Now here is where your statement of what you don’t intend comes in.  You then state, "I don't mean to throw a wrench into your schedule."  Let me repeat that.  You empathetically state, "I don't mean to throw a wrench into your schedule."  So, do you see how you are stating what you don't want to have happen?  Saying what you’re not intending during the initial exchange is easier than trying to back track through their assumptions after the fact. 

Now that you have established a casually friendly relationship with Ashley by, first, scheduling a meeting with her, second, providing her with a hard copy of the guidelines regarding the alteration of therapy schedules to make it possible for the resident to attend activities; third, stating empathy with her situation, and fourth stating what you are not intending; next you state what your intention or request is.  You state, "Mabel's church group conducts Bible study on Wednesdays at 2:00.  I noticed her speech time has been rescheduled, so she is no longer able to attend the Bible study."  The last step is to ask a question in the form of your request.  "Could Mabel’s time be switched with another resident’s so she could attend her church's Bible study?

So why go to all this trouble if you have a close-knit friendly supportive facility?  None of this may be necessary.  Maybe all you need to do is pass Ashley in the hall or state at care plan conference, "hey, I need you to change Mabel's schedule."  And Ashley will reply, "Sure!  What do you want to have it changed to?"  However, I have provided you with all of the steps to prepare the way for your request assuming you have no relationship at all with her.  Feel free to repeat steps, add steps, or delete those that aren't appropriate for your relationship with this individual.

 By following the above plan, or one you devise similar to it to fit your style, you minimize the risk that the person you are requesting to reshuffle their schedule will become resistant by saying, "I can't do that."

Note, I said minimize the risk.  So, what if Ashley says that is the only time she can fit Mabel into her schedule?  Let's talk about resistance to change.  You might propose a solution.  You might ask, “Would it be possible to have her switch time with another resident, like Harry that comes in the day before?”  If it is convenient, it is helpful if you observe who flows in and out of the speech therapy room so you have a couple of residents to suggest.  Let's say your Ashley is really playing hard ball and she states something ambiguous or unclear like, “For billing purposes I have to see Mabel at that time!!” which of course makes no sense.  So you state, "Gee, I didn't know that. You mean there is a different billing rate for seeing a resident at 2:00 on a Tuesday?"  Do you see how crazy and illogical this conversation is getting when actually the Speech Therapist does not like you suggesting a schedule change? 

So withdraw at this point.  Track 9 will provide you with further information regarding handling incidents of noncompliance.

What is the Gem of an idea that you got from this track?   This track, like the others, is so extremely content dense I am sure you will want to strongly consider replaying it more that once to actually implement some of the specific techniques suggested.  Remember just listening won't change any thing related to your goal of gaining cooperation from staff.  So when will you replay this track?  Turn the CD Player off and write “replay track 8” in your planner now.

On the next track we will examine Grumbling, Complaining, & Over Apologizing!

Forward to Track 8
Back to Track 6

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