Allison Jones
Good morning, good afternoon, and good evening. Welcome to the Therapy Matters podcast, your one-stop resource for expert insights and advice on everything therapy and rehab. I’m your host, Allison Jones, and today I am joined by Keri Dickinson, Director of Rehabilitation Services at Sturdy Memorial Hospital in Attleboro, Massachusetts. Keri, thank you for joining me today. It’s great to have you on the show.
Keri Dickinson
Thank you for having me.
Allison Jones
Excellent. So before we dive into our discussion, I want to take a minute to introduce you to the audience and give a little bit of background on who you are. So take a minute and just tell me a little bit about your background and your role at Sturdy Memorial Hospital.
Keri Dickinson
Sure. Thank you so much. I’m a physical therapist by degree. I started with Sturdy Memorial, now called Sturdy Health, back in 1997 as a very new shiny grad physical therapist. At that time, I worked in both acute care and outpatient settings. The role was split, and then I eventually moved into the outpatient realm.
In 2012, our director, at the age of 36, retired, and I moved into the director role. Just last year, through some growth and development within our service line, the title of the role was changed to Senior Director of Rehabilitation, more to describe the complexity of what it is that we do when you think about a health system, from the acute care setting all the way to the outpatient realm.
Allison Jones
Excellent. All right. So tell me a little bit about the type of services that Sturdy Health provides for your community.
Keri Dickinson
So as a whole, we are a community-based acute care hospital health system. We have our Sturdy Memorial Hospital, which has been around for 110 years now, I believe, and has grown to now include Sturdy Health Medical Group, which is primary care and specialty care, and within the specialty care, we have urology, rheumatology, oncology, orthopedics, and cardiology as well.
We are really trying to expand upon our cardiology services and our orthopedic and oncology realms as well, to be sure that we’re meeting the needs of our community. On the rehab services side, our primary focus is meeting the needs of our orthopedic caseload and those patients that are moving from the acute care realm, trying to meet them where they are and get them back to where they need to be from a functional status after being hospitalized. We’re working on further developing our rehabilitation programs as well.
Allison Jones
Okay. So, when we talked before, we talked a little bit about community-based access to care and sort of redefining your efforts and focusing on those efforts and your role. Can you tell me a little bit more about how you’re focusing on that and how you see sort of rehab as sort of the point where all care is sort of driving to?
Keri Dickinson
Yeah. When we were talking about it before, I think you’re talking about how I have this vision; they call it the Finding Nemo philosophy. If you remember, from the movie Finding Nemo, that the theory was that all drains lead to the ocean, that theory applies to rehab services in that all service lines will eventually touch rehab services. So if you think about it, not just the musculoskeletal piece but the whole human system, if there’s one aspect of our human physical system that isn’t working right, how can we help assist that?
One of the barriers to that is that, depending on the size of your organization and the size of your community, you can’t necessarily meet every single need just from a human point of contact. If you look at the actual service area that you serve, there’s no way that you’re going to be able to hire and accommodate, facility-wise, every single person that you need to. So how can we work together and collaborate with our private practice owners within the community? And kind of remove the barriers of trying to keep everything within the health system and start to work together so that access to care is access to care, regardless of where those referrals are going.
Allison Jones
Right. So how are you tackling that today?
Keri Dickinson
So one of the things that we just started doing was reaching out to our community providers. I mean, some of these referrals are already outside or already happening, but we’re having conversations with our community providers to see how we can work together, where their areas of strength are, and where our areas of strength are as well, creating efficiencies and workflows for those referrals so that our referring providers know where to send what. So that there is an even, steady workflow, and it’s not just handing a piece of paper to the patient and saying, Call these six places and see who can get you in the soonest.
Allison Jones
How are those relationships being developed? How are you creating those relationships?
Keri Dickinson
Picking up the phone and starting a conversation?
Allison Jones
Yeah, it’s that simple.
Keri Dickinson
It’s that simple. With Zoom now, it has been a little bit easier to get those times in to talk to people and have that face-to-face. So, it has been a little bit easier than just a cold call situation.
Allison Jones
What are some of the benefits of establishing those relationships?
Keri Dickinson
Well, it’s really keeping the community in mind from an access-to-care standpoint. If we take a look at what we’re experiencing here, and I’m sure other health systems are experiencing this as well, we have a specific workflow with our EHR where the referring source puts the referral in the system, and depending on what we consider the priority of that referral, some of those referrals are just kind of sitting there.
If we can tell the referring providers, these are the buckets of diagnoses that we want you to send to our community partners, and I don’t want to scare people by saying partner, but it is a partnership without, potentially, people being involved, and whatnot.
Then that will allow our health system to focus on areas that are a little bit more acute for the health system, like a Falls Prevention Program, which I neglected to mention before. What can we do to keep people out of the emergency department? What can we do to get people back into the workforce? Even focusing on our own employees from an access-to-care standpoint as well.
If you look at it broken down in kind of an algorithmic way, you can see how that’ll decant that referral source within the EHR and make it much easier, hopefully, for us to increase access to care right within our direct health system.
Allison Jones
Let me flip that. So what are some of the challenges or some of the barriers that you’re facing to make this a smooth process?
Keri Dickinson
From a shadowing standpoint, what I can see as a barrier is just the learning curve, potentially from our referring providers like primary care and specialty care. I guess to say old habits die hard. So from an education and training standpoint, sharing why it is that we’re doing this is going to be really, really important because we all have this viewpoint that we want to keep everything within our system.
We don’t want to refer out because we look at that as potentially losing patients and potentially losing revenue. But we really need to change the lens and look at it from an access-to-care standpoint. We can’t be everything to everyone. So, I think understanding the why and just the education standpoint and changing the workflow are going to be the biggest barriers.
And there might even be a little bit of an aspect of fear amongst our own rehab providers in that why are we sending these people out? Are we trying to shrink? And that’s not where this is coming from. We are really, really trying to get people to where they need to be in a more reasonable amount of time.
Allison Jones
Just sort of double tapping on the concept of sending people out and getting them access to the care that they need, when you do that, is there actually an opportunity to grow and increase your revenue by sort of expanding your network and sending patients to where they need to be and creating that model? Are you sort of opening up an opportunity to gain more patients by creating that type of model and setting yourself up for the future, like almost expanding your network there, so that you’ll have more patients coming in the future because it’s sort of a reciprocal type of model?
Keri Dickinson
Potentially. I mean, I think it depends on how you’re defining growth. So, the physical footprint of growth. Okay. From my understanding, that’s not where we’re at right now. Five years down the line, who knows what that will be? Growth from a relationship standpoint: 100%. That’s what we’re trying to do.
So I know that we’ve through the relationship that we’ve created with one particular practice, so and so was amazing at treating. Let’s throw a diagnosis that’s hard to get access to care like TMJ syndrome. We’re going to send the orders to that place, and then they’re going to say, Oh, we know this: Sturdy Health has an amazing lymphedema program. This person’s now experiencing this. We’re going to send. So from that aspect of growth 100%, that’s the true definition of collaboration.
From a financial standpoint, I think we can continue or start to work towards gaining back some of the referral sources, as those patients, like I was talking about, were coming from an acute care admission standpoint into the outpatient realm.
So when you talk about really specific things like the bundled payment diagnoses, those that have been and sniffs, that will truly help us gain back some financial recruitment from a payment standpoint because we’re keeping everything potentially in-house, if that makes sense.
Allison Jones
Yes. Yeah. Okay. Excellent.
Keri Dickinson
Did I answer your question?
Allison Jones
Yeah, absolutely. You said it much better than I did.
Keri Dickinson
Okay.
Allison Jones
But yes, it seems it makes good business sense to sort of go down that path and create that model. But I can understand where there might be some challenges and some potential roadblocks. Change is never easy. Change is not something that people naturally gravitate toward. It takes time and some proving out before you can move that needle.
Keri Dickinson
For sure, as the old saying goes, the only thing that is constant is change.
Allison Jones
Yeah, absolutely. So I know this is something that’s still fairly new on your end. At this point, are there any sort of measures or successes in place that you can say are working? or is it still too new to point to?
Keri Dickinson
For us, it is definitely too new to point to. But I think one of the things that we will be looking at is just being able to have a lesser number of referrals sitting in our system and being able to meet the more immediate needs of some of those acute-type patients. Who knows what this will shake out once we have it in place?
There might be some things that we’re not even seeing because the system is, for lack of a better word, bogged down. I do know that there are large systems that already work similar to that, but do they have a specific work flow in place? I’m not 100% sure, or is it just here’s the list of people who are in your area who go there?
I don’t know, but being able to like right now our own employees, if they’re injured, they’re really trying to because we are self-insured; they try to come to us for their service. And why not? We’re right there on campus. We can’t get to them soon enough. So they’re having to go elsewhere, which leads to a higher copay. Which means that your employees are not happy. So, once we can start to meet the needs of that realm as well, we’ll be able to figure out what more outcomes we need to be looking at.
Allison Jones
So that’s your first success measure.
Keri Dickinson
That’s a success measure with less in the system and not an 8-week waitlist.
Well, we’ll check back and make sure that we’re getting there. So tell me what other projects you’re working on that you’re really passionate about, because we talked about a few things that you’re really passionate about.
So I’m really excited. Again, I know that there are systems out there—many systems, from big systems to small systems—where we’re finally implementing our clinical ladder program. So I need to give a shout-out to the developer of that. Her name is Kathleen Farroba, and she worked really, really hard.
Modeling after nursing clinical ladders and doing a really amazing job at diving into what other facilities offer for clinical ladders in the rehab scope. So we’ve implemented that, and that is going to be number one. That obviously helps with retention, and we’re really lucky within our organization that we don’t have a ton of turnover within our department.
But more from an engagement and empowerment piece. Staff are really excited. We listened to them as far as the development piece and what’s really important, and yeah, so really, really excited. So we created a grid that you can use, and then there’s buckets where the clinician needs to touch upon depending on what rung of the ladder they’re going to.
And we really tried to tap into volunteerism, a little bit more of an outside-of-the-box type of thinking, which I think a lot of people are doing now. But mindfulness and work-life management. I know we use the term work-life balance frequently. I heard someone change the quiet to work-life management. because when you balance, you’re taking one to move it over to the other side.
And we want people to be able to manage between work and home. So it’s just kind of changing the viewpoint on that. So very, very excited to see where that goes.
Allison Jones
I like the whole management concept.
Keri Dickinson
It makes a lot more sense. Does it?
Allison Jones
It does. It really does. For those who aren’t familiar with the concept of the ladder, can you just explain that a little bit?
Keri Dickinson
Sure. So what is the clinical ladder? If you literally picture a ladder, we use the word rungs or level. So level one has a particular number; I believe it’s just two buckets that you need to touch on. So you need it to be more than your job description.
In rehab and probably in a lot of areas of health care, we’re all really high achievers. So in our job descriptions, we all tend to go a little bit above and beyond what that job description is at baseline. So, it was really challenging to think of how we could elevate it enough so that it wasn’t just the job description.
Keri Dickinson
We all should be doing things from day to day. And then, within the buckets, there’s a leadership bucket. There’s clinical practice excellence and volunteerism. Kathleen is going to be really upset with me because I’m not able to rattle these off. So within volunteerism, we’re trying to say that you don’t necessarily have to be volunteering within the organization. It can be something within the community or with your children. There’s a certain number of hours that we require to check off that box. Under leadership, it’s taking a student or onboarding a new staff member, and clinical excellence is any certification that is not required by the position. So CPR does not count. But like your dry needling, or LSVT,. Things like that are in that bucket.
So right off the bat, people who qualify will be able to check that box right at the start of implementation because they might have their CSCS, and then things like we have a rehab department newsletter. So contribute to that newsletter. Are you involved in any particular type of research? Let me see what else. So moving up to the second clinical ladder, it’s time to check things off. And then the third letter—I believe it’s eight. So with each rung, there’s more to do. And I think at the last level, it’s one thing in each category.
And then there’s a maintenance program. So for us, we’re doing a recertification every two years. So if you want to stay at one, you still have to do level one things every two years to maintain that level. It’s not a one-and-done thing because we’re really looking towards clinical excellence and personal development.
There is a monetary number attached to each rung as well, because, let’s face it, people don’t do things for free, and that’s okay. It has happened again to me. That’s why we want you to maintain it. So that’s that, in a nutshell. So it is really up to the clinician as to how far they want to go.
At the very upper level, once you get there, I’m going to not remember if it was level 2 or level 3, where you actually become part of the committee where you’re approving people’s applications for the next level. So it really is a clinician-driven program.
Allison Jones
And it’s completely voluntary. So you can choose to participate or not participate in it.
Keri Dickinson
Exactly.
Allison Jones
Excellent. And it gives you different opportunities to grow as a leader within the organization.
Keri Dickinson
100%.
Allison Jones
So, it gives the organization a way of retaining staff and giving them an opportunity to grow as leaders within the organization. And it gives your team members a way to continually develop their skills and give them a way to grow. So it’s a win-win, really.
Keri Dickinson
100% win-win. Truly the definition of what a win-win is. Organizationally, we are truly trying to become clinician- and physician-led. The viewpoint is that those doing the work see the areas that we can improve and empower. So this is definitely a big piece to that.
Allison Jones
Is this also something that is a newer program within Sturdy Health?
Keri Dickinson
For us, it is. Yes. So we’ve been bringing it to the table for 3 or 4 years now. I don’t remember if this is the fourth time. And it was finally approved. It could have been the third. The head calendar’s a little blurry. But in our nursing departments, they’ve had a clinical ladder for many, many moons.
Allison Jones
So it’s new on the rehab.
Keri Dickinson
It’s new on the right-hand side. Yes.
Allison Jones
Okay. And what has the initial response to it been?
Keri Dickinson
I think overall it’s good. There were, I think, some realizations in some of the difficulties that we’re enforcing, so who knows what will shake out? I think some of it was based on the way that we’re doing the bump in the salary, but with the explanation that we have to make sure that we’re staying within market value.
We can’t outrun the market because that’s not sustainable. The program would end up being cut if our wages were too high. So, being very transparent and open about why we’re doing it the way that we’re doing it, and then again, it’s up to the clinician if they want to do the work behind it, that’s okay.
Allison Jones
All right. Excellent. Are there any other passions that you have that you want to talk about?
Keri Dickinson
So another thing that we’re developing, and this is very much in the infant stages, is a shared governance council, again modeling it after the nursing world, where we’re working towards forming a committee of rehab professionals that will work together to come up with ideas and pathways for our department. And this means they’ll have inpatient members and outpatient members coming together, working as one council.
I don’t really know, but I’m envisioning it as a very different way of coming together because most organizations look at these as two separate entities, like two service lines, when really they should be one feeding the other. Once they start to come together, what brain babies are they going to be having to formulate because, again, they’re the ones that are doing the work and have led the leadership’s job, and this is not to be present. So it is truly clinician-based, and then they come forward and share ideas with leadership as a whole.
Allison Jones
So we are talking about the transition of care when inpatients go to outpatients and how to make that process smoother.
Keri Dickinson
Sure. Yeah, that’s definitely one piece. For just throwing something out there, our piece of the website from a rehab services standpoint needs a lot of work. Like, how can they work together to create content for our community when they’re looking at our website? What they’re seeing from the referral process is acute care and outpatient program development ideas.
And where can they tap into other resources within the organization, not just rehab services? Fall prevention is another great example of that. So that’s kind of what I envision, but again, my role has a say in the vision, but they need to lead the blaze, so to speak.
Allison Jones
Yeah. I really like how there’s so much collaboration that’s happening across different teams and organizations. And I like how a lot of what you’re doing is pulling from different groups. So, you’ve mentioned the nursing team has been doing this for a while.
They have this set up in their organization, and you’re sort of pulling from other groups that have had success with modeling. And it’s not about, oftentimes, recreating the wheel; let’s just use the wheel that we have and make it work for our system.
I love how you guys are modeling that to make it work for rehab and thinking outside of the box and being creative that way.
Keri Dickinson
Thank you. Yeah. I totally agree. And, again, I’m really excited to see how this shakes up. There’ll be some bumps and hiccups along the way, but that’s okay. You can’t wait for everything to be perfect in an idea state. You have to go for it and see what happens.
Allison Jones
I think it’s fantastic that you have support there to try it and potentially not be super successful but have the freedom and flexibility to make modifications and get it right. So it’s pretty exciting, and I’d love to check back and see how things are 6 months, 12 months from now, and how things are going.
Keri Dickinson
Yeah. It’ll be fantastic.
Allison Jones
Yeah. This is really exciting. When you talk about these new programs and new ideas, there is really no such thing as failure. It’s just learning. It’s iteration.
Keri Dickinson
Learning. Exactly. You’re iterating on it until you get it to where it should be. So, that’s super exciting. I’m anxious to see how it develops.
Allison Jones
A couple things are as we wrap up here. Another thing that I did want to talk about is that you are also part of the faculty of the LAMP Program, the APTA. So I wanted to take just a minute to talk about that and just give people a really quick background on what LAMP is.
Keri Dickinson
Sure. Thank you for bringing that up. So within the Academy of Leadership and Innovation, formerly known as HPA, within the APTA, we have two committees. One is the LAMP School of Management, and the other is the LAMP Institute for Leadership. I am a member of the LAMP Institute for Leadership Committee, the Lamp Committee. One of the things that we do is travel the country, teaching LAMP leadership and core strategies to people who are looking to grow.
So we have two programs. One is LAMP 101, which is called the catalyst for leading within. And what that course will take you on in a journey for turning the lens inward, because we believe, not just we but all of us, that you cannot lead without understanding more about who you are.
So, have you looked at your communication style and the way that you might have a default or tendency to handle conflict? We start the engine by developing your own personal mission and vision statements. We touch on time management and energy management, and then in LAMP 201, we work toward sharing tools and how to now lead others. So now that you know how you are and that there’s also. Sorry, in one-on-one, there’s a high component of learning about your emotional intelligence, which in LAMP we’ve been talking about for a really long time. And I know that is becoming a more common topic, which is fantastic, and so moving to 201, how to implement those and lead your teams.
So I know one of the things that we talked about, Allison, when we first met was that in the rehab world, we are all leaders by nature. The moment that you go out into the waiting room or walk into a patient’s room and say, Hi, my name is…” you are starting to lead that person. influence that person for the next however many minutes that you’re spending on their health and wellness journey.
It only makes sense that we are innately drawn to these types of programs and innately drawn to leadership positions. So think of everything that you do on a day-to-day basis and how that can directly work towards an official leadership title. We put titles on things. We need to put titles on things, but we are truly leaders, and having the knowledge and tools about how to move things forward is really, really important.
And that’s where the LAMP leadership programs come into play. On the LAMP management side, another fantastic program is one of the truly management pieces. So if you are looking to move into more of an official role, we talk about budget things, professional development, professionalism, strategic planning, and quality. These are all things that I really love to do.
It might not be some people’s cup of tea, but it is important for us to know, even if we’re not moving towards that official leadership role, so that you have an understanding of what people like me are telling you when we talk about strategic planning. The one amazing thing about the School of Management side is that they’ve just launched their board-certified health care executive program, which encompasses management essentials and advanced management concepts.
The projects that you do along the way, I think each one is six weeks. Sorry, Russell, if I’m screwing that up. It’s a hybrid model of cohort conversations and then independent learning, watching, and recording videos of the teachings of those modules. And then there is a giant test at the end to get that board certification. It was really exciting. This is the first certification type within the APTA that is purely leadership and management-focused.
Allison Jones
Excellent. Thank you for going over that. As we wrap up, what do you want to leave people with today?
Keri Dickinson
Oh, goodness. I think that’s a…
Allison Jones
It is a loaded question.
Keri Dickinson
Yes. It is a loaded question. I think that right now, from what I’m seeing, health care is really hard right now. It’s hard for a lot of reasons. Depending on the realm that you work in and whether you are really an empathic type of practitioner, it can be hard to leave the day when you come home.
Like, did I do a good enough job today? Oh, I wonder how Mrs. Smith is doing. She’s missed three appointments. Or I couldn’t see three patients because I needed to be in the ED for something else. So I think that we’re at high risk for a high level of moral injury if we’re not really focusing on that work-life balance.
So the message that I would give people is to keep doing what you’re doing. You can only do so much, and whatever it is that you do in that day, it is enough, and if you are really, truly struggling with that, find somebody to talk to because it’s really important. We cannot lose any more rehab professionals.
Things are really hard out there for those of us who are trying to hire, and that’s a little scary for somebody like myself who’s been doing this for a long time. So, just remember that what you are doing is enough.
Allison Jones
I think that’s a really important message. So thank you for that. Yes. Just going back to that work-life balance. That’s a really important message. What you’re doing is enough, and coming from somebody like myself, I get a lot of PT. I have some OT. My father just had a total knee replacement. He’s getting a lot of PT right now. I appreciate everything that this community does for myself, for my father, and for the community at large. So thank you to everybody for what you’re doing.
Thank you, Keri. We are out of time for today, but I want to thank you so much for joining us and sharing your story. I will check in and see how things are progressing because I am very curious to see how the programs develop. So, we’ll do a little check-in and see how things are going, but thank you.
Keri Dickinson
You have good things to report.
Allison Jones
I think so. I think it’s going to go wonderfully.
Thank you to our audience for tuning in to the Therapy Matters podcast, your one-stop resource for expert insights and advice on everything therapy and rehab. We look forward to seeing you in the next episode.
Thanks for listening to Therapy Matters. Do you like the podcast? Give us a five-star rating. Subscribe and tell all your friends about the show. Want to be a guest speaker or know someone who would be a great guest speaker? Contact me at marketing@raintreeinc.com. Therapy Matters is brought to you by Raintree Therapy and rehab’s favorite EMR. Raintree is the only all-in-one therapy EMR, delivering a complete and seamless end-to-end patient journey from first contact to payment to patient retention.
