Do you ever feel like you’re expected to deliver patient outcomes like a McDonald’s drive-through?

The next time you’re at a fast-food restaurant and you’re thinking about ordering a “value meal” think twice whether it’s really a good deal or not. 

Value meals are commonly used by fast-food restaurants to facilitate bundling, up-selling, and grouping items together at a lower price. As the healthcare industry moves toward value-based care, bundled payments are a popular pricing model for sharing risk and accountability.

Are bundled payments healthcare’s version of a “Happy Meal”?

Perhaps it’s just me becoming a grumpy old man, but it seems I’m frequently expected to dish out low cost, convenient, ‘fast food’ physical therapy.

You probably know what kind of care I’m talking about. The quick and easy recipe-driven therapy that provides immediate gratification. It fills you up (and your schedule) with empty calories but leaves both you and your patients needing something more substantial.

The fast-food business model has forced its way into mainstream America in all parts of our economy including physical therapy. This phenomenon been researched and analyzed. The term McDonaldization has come define its cultural influence on society.

We are going to take a closer look at the McDonalization of physical therapy and ways you might avoid the downside of its dehumanizing effects.

The McDonalization of Healthcare

 

McDonaldization, as described by George Ritzer in his book The McDonaldization of Society is the process by which the principles of the fast-food restaurant business practices come to dominate more and more sectors of American society as well as of the rest of the world.

Ritzer writes that our various social institutes have gradually become infiltrated by a bureaucracy’s dehumanizing effects.

McDonaldization affects the organizations we work for and get paid by. You may feel trapped by your organization’s values, priorities, goals and work culture. But in the end it cannot control the interaction you have with your patients.

You can choose to overcome McDonaldization’s influence once you understand it and develop strategies to rise above its irrationality.

The Dehumanization of Physical Therapy

 

In the past, healthcare was much more simplistic. I can remember our family doctor making a house call to provide care to our ailing mother. Dr. Medlar knew all his patients and their families names, they were his neighbors. He delivered me and all my siblings at the local hospital and was genuinely concerned for our welfare.

Over the years modern health care evolved into a large bureaucratic organization. All it takes is a visit to your doctor for a routine problem or a trip to an emergency room to experience McDonaldization’s influence for yourself.

Our patients feel McDonaldization’s dehumanizing effect when they are immediately asked for their insurance card, prescription and instructed to fill out a stack of forms. The front office staff may know more about the patient’s deductible and co-pays than the patient’s preferred name and family.

How to Overcome the McDonaldization of Physical Therapy

 

In order to minimize the forces of McDonaldization on the services we provide, we’ll look at it’s four key components and turn them to our advantage:

• Efficiency
• Quantification
• Increased Control
• Replacement of Human by Non-human Technology

1. Efficiency

Efficiency is managerial focus on minimizing the time required to provide individual treatments as well as the whole department or clinic’s operation.

This is why we feel the constant demand for productivity. Rising costs and decreasing reimbursements have influenced managers to prioritize short-term efficiency rather than long-term effectiveness.

Focus on being effective. According to Insights Squared, Being effective is about doing the right things while being efficient is about doing things right. If you feel presssure to do more with fewer resources then optimizing the effectiveness of your treatments may be the way to go.

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2. Quantification

Quantification is a focus on quantifiable objectives (counting things) rather than subjective ones (evaluation of quality).

Therapists are being pushed to prove their value through measuring and tracking patient outcomes. Insurance companies obsession with big data is shaping how physical therapy is delivered, often at the expense of the patient experience.

Focus on providing the highest levels of patient satisfaction. Measure your patient’s willingness to recommend your services to others through a Net Promoter Score.

3. Increased Control

Increased control within the healthcare industry is very important. Management implements quality control measures to ensure workers all act the same on a daily basis.

Doctors and therapists like control over their patients care and well being. We determine the treatment goals, stress patient compliance rather than empowering patients have ownership of their treatment.

Empower your patients. Help them identify their goals for therapy. Put their goals in a prominent place in the chart. Encourage your entire staff to do whatever is needed to reach them.

3. Replacement of Human by Non-human Technology

McDonaldization does not require a skilled workforce. It gives preference to the use technology to reduce or replace human employees wherever possible.

Skilled labor in a McDonaldized environment is devalued and eliminates the workers bargaining leverage. Repetitive and routinized procedures replace the need for skilled reasoning and decision making.

The overuse of provider extenders like nurse practitioners, physician, and therapy assistants are a means of reducing or replacing highly skilled practitioners.

The rapid rise of telemedicine is evidence to providing long-distance virtual solutions without human contact.

Use your assistants and technology wisely. There is no substitute for your clinical reasoning and decisions. An intimate understanding of your patients ever changing condition, circumstances and motivations are essential in providing a remarkable patient experience.

Be Reasonable

Ritzer explains in his book that McDonaldization narrow focus on rationality actually produces irrationality. He writes:

“Most specifically, irrationality means that rational systems are unreasonable systems. By that, I mean that they deny the basic humanity, the human reason, of the people who work within or are served by them.”

Many of you have no doubt experienced the irrationality and dehumanization of a healthcare bureaucracy run amuck. For the sake of our patients, I encourage you to look around you to find ways to reduce the impact of the McDonaldization on physical therapy.

As I conclude this post, I’m reminded of a McDonalds drive-in employee near my home. She performs her duties consistently with warmness, grace and a smile. We all cross paths with people like her. 

I think to myself how does she do it.

I’ll drive out of my way to get coffee from her window because of the human interaction we share. I desire to be that type of person at my work day after day. Hopefully you do too. 

What is one way you can overcome the effects of McDonaldization on your practice?

 

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Paul Potter is a physical therapist and mentor who lives in Lincoln, Nebraska, with his wife, who is also a therapist. They have four daughters. For more than 35 years he successfully managed his own private practice. He now shares his knowledge and experience through teaching and mentoring therapists who want to have their own practice. 

He has authored On Fire: Ignite Your Passion with a Cash Therapy Practice and the Cash Practice From Scratch Course. His website PaulPotterpt.com is dedicated to helping therapists achieve professional and financial freedom. Connect with Paul on his website or on LinkedIn paulpotterpt. You can also get more free resources at CashPracticeFromScratch.com

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