9-608-070
REV: JANUARY 9, 2009
Reading Rehabilitation Hospital: Implementing
Patient-Focused Care (A) (Abridged)
Rachel Pflum, Director of Rehabilitation Services at Reading Rehabilitation Hospital (RRH),
examined therapist utilization for the previous year. Although there had been some improvement
from the extremely low levels of 1997, billable hours for 1998 remained far below the hospital’s 75
percent target level. She wondered whether the move toward “patient focus” was responsible for the
low level of utilization. She hoped not. Patient focus was touted in the healthcare industry as a way
to improve the quality of care.1 Under the leadership of President and CEO Clint Kreitner, therapists
had been reorganized from traditional disciplines into interdisciplinary service lines, each focusing
on a group of patients with a particular set of diagnoses. Unfortunately, therapist utilization had
dropped precipitously once that reorganization was fully implemented and still had not recovered.
Leading Change
Clint Kreitner was brought in as CEO of Reading Rehab in 1993 from outside the industry.
Although he had spent three years on the board of RRH prior to his appointment as CEO, his
knowledge of the healthcare industry was admittedly slim. He had spent the early part of his career
as a naval officer, and in the years prior to accepting the post at RRH, had been a respected
entrepreneur with four successful start-up companies, three in the information systems industry.
When Kreitner arrived at RRH, he inherited what appeared to be a stable organization. He noted:
The hospital was doing well. It had an awesome reputation, a dedicated staff, and no debt.
Everyone thought this would go on forever, but my instincts told me we were too complacent.
Over fifty percent of our inpatient referrals came from one large hospital, the healthcare
industry was inflicting unsustainable double-digit annual increases on the U.S. economy, and
we were going about business as usual. I don’t think you could have built a better scenario for
trouble over the horizon.
1 J. Philip Lathrop, Restructuring Health Care: The Patient-Focused Paradigm (San Francisco: Jossey-Bass Publishers, 1993).
________________________________________________________________________________________________________________
Professor Jody Hoffer Gittell and Mason Brown (MBA 1997) prepared the original version of this case, “Reading Rehabilitation Hospital:
Implementing Patient-Focused Care,” HBS No. 898-172. This version was prepared by Professor Roy Shapiro. HBS cases are developed solely as
the basis for class discussion. Certain details have been disguised. Cases are not intended to serve as endorsements, sources of primary data, or
illustrations of effective or ineffective management.
Copyright © 2007–2009 President and Fellows of Harvard College. To order copies or request permission to reproduce materials, call 1-800-5457685, write Harvard Business School Publishing, Boston, MA 02163, or go to http://www.hbsp.harvard.edu. No part of this publication may be
reproduced, stored in a retrieval system, used in a spreadsheet, or transmitted in any form or by any means—electronic, mechanical,
photocopying, recording, or otherwise—without the permission of Harvard Business School.
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Reading Rehabilitation Hospital: Implementing Patient-Focused Care (A) (Abridged)
Kreitner’s opinion that RRH was headed for difficult times was not universally shared. His lack
of healthcare industry experience made it easy for staff members to assume that his concerns were
not well founded. Pflum explained the staff’s reaction,
We knew Kreitner from his activities as a board member, but were skeptical about his
ability to lead an established healthcare organization. Shortly after he arrived he began to hold
forums with the hospital staff to communicate the need for change. His approach was to open
the books, financial and otherwise, so that everyone could see the same things he could. This
kind of communication was a first for us, and not typical of our industry. Frankly, it made
many of us uncomfortable. Many of us had been in the industry for 15 or 20 years, and here
was this new guy telling us we were in trouble. The staff just hoped he didn’t know what he
was talking about.
Rehabilitation Services
Founded in 1961 as an acute rehabilitation hospital, RRH had 82 beds, 116 therapists and $25
million in revenue in 1998. Most patients came to RRH after treatment of an illness or injury at an
acute care hospital. The job of a rehabilitation, or “rehab,” hospital was to restore basic functioning,
such as walking, climbing stairs, getting dressed and feeding oneself. RRH used well established
Functional Independence Measures (FIMs) to assess a new patient’s functional status and set goals
for that patient’s functioning upon discharge (see Exhibit 1). For example, RRH might admit a
patient who had recently received orthopedic treatment for her hip at an acute care hospital. RRH’s
job was to provide therapy and other services to help that patient achieve a full range of motion in
the hip so she could go back to work or home to her family. Patients with head injuries or strokerelated disabilities required more complex, intensive services, but in all cases the goal was to help
patients leave RRH functioning as independently as possible.
RRH, like other rehab hospitals, also differed from acute care hospitals in being smaller than most
of them. RRH’s annual revenues of $25 million compared to more than $200 million for the largest
and $45 million for the smallest acute care hospital in its region.
RRH admitted patients with a wide range of diagnoses, including head injury, stroke, spinal cord
injuries and orthopedic problems. Depending on their diagnoses, patients received care from
providers in five to eight disciplines. All patients received care from physiatrists (physicians
specializing in rehabilitation), nurses, social workers, and physical and occupational therapists.
Patients with diagnoses such as head injury or stroke also received care from psychologists, cognitive
therapists and speech therapists as needed.
Since 1996, RRH had measured the effectiveness of its inpatient care by benchmarking with other
rehab hospitals along three key dimensions: average length of stay, increase in functional outcomes,
and patient satisfaction. In 1998, RRH's average length of stay compared favorably to the national
average, which was 21 days for essentially the same mix of patients that were admitted to Reading
Rehab. Even so, RRH was able to achieve nearly the same increase in the level of functional
independence (see Exhibit 2). RRH patients were also more satisfied with the quality of their care,
compared to a national benchmark (see Exhibit 3).
Nevertheless, total patient days had declined over the past eight years, with a particularly steep
drop in 1997 (see Exhibit 4). The decline in total patient days was due to shorter lengths of stay
rather than to fewer patients. RRH was proud of its ability to achieve greater improvements in
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patient functioning in fewer days, but because RRH was reimbursed by payors for its costs, fewer
patient days meant less revenue.
Mission and Purpose
RRH, a subsidiary of Adventist Health Ministries, Inc., was a not-for-profit organization in
Pennsylvania, sponsored by the Seventh Day Adventist churches. Like most health care
organizations, the well-being of the patient was the number one priority of RRH and its sister
companies. RRH’s affiliation with the church made its commitment in this area even stronger. RRH
staff and leadership saw the hospital’s rehabilitative mission as going beyond physical healing to
include spiritual healing as well. The organization’s values, as well as strategic and operational
decisions, were strongly influenced by this vision. As outside influences began to have a greater
impact on RRH’s business, this commitment was put to the test. Kreitner explained,
As much as we wish we could do what we do for free, as the competitive landscape
changes, it has become more and more important to recognize that this is a business. Like any
other business, if we can’t provide quality service at a competitive price, we won’t be around
long enough to do anyone any good. Finding the balance between mission and real world
business practice is one of our greatest challenges.
Pressures from Managed Care
The 1980s and 1990s saw healthcare costs escalating out of control with adverse consequences for
both the federal budget and U.S. corporations. Corporations and the federal government were the
primary payors for healthcare services in the United States. The government responded with
changes to Medicare, a federal insurance program for the elderly, and Medicaid, a government
insurance program for the poor. For example, in 1983 Medicare introduced a Prospective Payment
System (PPS) under which standard payments were made based on a patient’s diagnosis, regardless
of the institution’s actual costs. Medicaid, funded through state budgets, declined in funding over
the 1980s and 1990s, reducing the level of reimbursements to those providing healthcare to the poor.
One of the most significant innovations affecting the U.S. healthcare industry was the rapid
emergence of “managed care.” Until the 1980s private health insurance plans allowed patients to
choose their own doctors. Doctors were free to prescribe any treatment consistent with accepted
medical practice and to determine fees for such treatment. There was very little incentive to manage
costs. Under this fee-for-service (FFS) model, the role of the insurance company was simply to “pay
the bills.” This all changed in the 1980s with new state laws that allowed insurance companies to
negotiate prices directly with health care providers. In an attempt to reduce costs, managed care
organizations (MCOs) adopted a more business-like approach for delivering care. The idea was to
get doctors and hospitals under contract at discounted prices and then control the use of services by
managed care health plan members. Typically, patients chose a primary care physician (PCP) from a
predetermined list of participating doctors. The PCP would serve as the “gatekeeper” for the patient
and would determine what specialty and other services the patient could access. Members were
normally restricted to the services of a limited number of affiliated healthcare providers. These
changes meant hospitals had to perform tasks more efficiently so costs did not exceed payments
received from MCOs.
Acute rehabilitation hospitals like RRH were cushioned from some of these changes in the
healthcare system, at least for the time being. Acute rehab hospitals were reimbursed for all billable
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costs up to a limit based on their 1986 costs. This limit was considered more generous than the limits
imposed on acute care hospitals that, in many cases, would be paid less for giving the same
treatment. Most RRH patients were on Medicare, and the more generous Medicare rate was a
distinct advantage for RRH relative to the acute care hospitals. There was some incentive to keep
actual costs lower than the allowable charges per patient, however, since Medicare would pay the
rehab hospital an incentive payment equal to a portion of the difference between their average actual
cost per case and their limit. “At times, we could keep patients twice as long as we do, and get
reimbursed for it," noted Kreitner. "But we can't afford to get lazy. So we strive to keep costs down
and maximize incentive pay, rather than maximizing the reimbursement.”
Competition and Market Conditions
RRH was the only acute rehabilitation hospital operating in its market, Berks County,
Pennsylvania. Three acute care hospitals and a number of nursing facilities and home health
agencies operated in the same market of about 340,000 people. The largest acute care hospital,
Reading Hospital and Medical Center (RHMC), held a dominant position with 57% of market share.
The other acute care hospitals, St. Joseph’s Medical Center and Community General Hospital, held
24% and 13% respectively, and RRH approximately 6%. Together, these four hospitals had 1,200
patient beds in 1998— 82 of these beds were at Reading Rehab. Target occupancy rates in the
industry were 75 to 80%.
Though rehabilitation hospitals like RRH were cushioned from some of the direct impact of
industry changes, at least temporarily, they were still affected indirectly through the effects those
changes had on their traditional partners. Rehabilitation hospitals traditionally were intermediaries
between upstream acute care hospitals and downstream organizations like nursing homes, home
health care providers and outpatient rehab facilities. About 98% of RRH’s patients were referred
from local acute care hospitals and trauma centers, with the balance being referred by their
physicians directly from home or from nursing homes. After being discharged from RRH a large
majority of patients went home, though some were sent on to nursing homes.
As these traditional partners felt the need to expand their business in the face of managed care,
RRH and other rehab hospitals were being “squeezed” from both sides. Many industry participants
believed that keeping a patient in their system throughout the continuum of care could create new
efficiencies as well as fill empty beds. Instead of referring all patients requiring advanced
rehabilitation services to RRH, the acute care hospitals were keeping more of the patients in need of
less intensive rehabilitation. As the growth in Medicaid per diem rates leveled off, traditional nursing
homes also began to integrate backward and offer many rehab services themselves, after gaining
skilled nursing facility licenses. If acute care hospitals and nursing homes in RRH’s market chose to
provide more physical rehabilitation services, RRH’s position could be jeopardized.
Still, as the only currently licensed provider of acute rehab services in Berks County, there were
some services that only RRH could provide to the local market. RHMC had already approached
RRH about buying RRH’s rehab license, which Kreitner valued at $6 to $8 million. Under current
regulations, before granting a license for a new acute rehab service, the state of Pennsylvania
required a healthcare organization to obtain a certificate of need (CON) proving a need for additional
services. Thus, to some extent, the need for a CON limited the kinds of rehab services others could
provide. However, this law was up for review at the end of 2000, and it was uncertain whether it
would continue to protect RRH’s license.
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At the same time that RRH faced increasing competition in its product market, the hospital also
faced a highly competitive labor market for therapists. “The unfavorable supply/demand balance in
the therapist labor market has hung over us like a black cloud during the entire time I’ve been with
RRH,” said Kreitner. “We constantly live in fear that our therapists will bail out en masse and as a
result, the organization will be brought to its knees.”
The Rehabilitation Process
The basic elements of the patient rehabilitation process at RRH had remained unchanged for
many years (see Exhibit 5). First, patients were admitted from upstream providers, typically an acute
care hospital. Based on the diagnosis made by the referring hospital, care providers from multiple
disciplines were scheduled to evaluate the patient, including a doctor, nurse, social worker, physical
and occupational therapist, and in some cases including a psychologist, speech therapist and/or
cognitive therapist. These evaluations involved interactions between the patient and care providers
to determine the type and intensity of rehabilitation needed, as well as the planning that would be
required to prepare the patient to go home.
Interdisciplinary team conferences were the traditional way of coordinating patient care across
disciplines in a rehabilitation hospital. Each doctor held a weekly conference for his or her patients.
Staff members from other disciplines went to all conferences relating to their patients (i.e., one per
week for each doctor whose patients with whom they worked). In the conference, they made joint
assessments regarding patient treatment, progress and discharge. Ideally, the team conference
resulted in an integrated care plan and eventually an integrated discharge plan for each individual
patient.
Based on the integrated care plan that emerged from the conference, the patient was scheduled to
receive specific types of care and therapy from each member of the team. For example, a head injury
patient might receive physical therapy early in the morning, then occupational therapy, and then
speech and cognitive therapy in the afternoon. Nurses were responsible for reinforcing therapy goals
as they cared for the patients in the unit. Therapists and nurses were responsible for documenting
the patient treatments they administered as well as patient progress. Social workers met with
patients and their families to prepare for a smooth discharge.
As therapy and discharge planning progressed, staff members responsible for that patient
continued to meet weekly in conference to discuss the patient's progress. Where necessary, changes
were made to the therapy plan, and the rehabilitation process continued. Prior to discharge, the
group met again in the scheduled weekly conference to determine the patient's readiness for
discharge, and to choose the appropriate discharge destination. The doctor then discharged the
patient either to home, often with outpatient or home care, to a nursing home for extended care, or
back to the acute care hospital for additional treatment.
Process Improvement
When Kreitner assumed leadership of RRH, he and Pflum began to question whether team
conferences were adequate for effectively coordinating patient care across disciplines. First,
conferences consumed valuable staff time. Although conference time was billable, it was billable at a
lower rate than the time spent evaluating or treating patients. Even more problematic was the
infrequency of conferences, especially given patients’ shorter and shorter lengths of stay. The weekly
schedule for conferences could result either in delays in treatment (and therefore discharge), or
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Reading Rehabilitation Hospital: Implementing Patient-Focused Care (A) (Abridged)
worse, inconsistency among treatments provided by the different clinical disciplines if they decided
to proceed with therapy prior to establishing or updating an integrated care plan in the scheduled
weekly conference.
To find a new approach for coordinating patient care, Kreitner implemented a Continuous
Improvement (CI) initiative. He explained,
Rehabilitative care requires a lot of coordination across disciplines. But people still thought
in terms of being a good nurse or a good physical therapist, for example, rather than being part
of the bigger picture. I took the perspective of long-term comprehensive organizational
transformation. The first step in this transformation was education.
In 1994 a Kaizen Council was created to introduce continuous improvement concepts.2 Senior
managers went on "field trips" to manufacturing firms to talk with them about their continuous
improvement efforts and to begin drawing parallels to healthcare. As many staff members as
possible were sent to seminars and asked to read numerous articles and books on the subject. At the
end of the year a two-day educational program was developed called "The Kaizen Experience." The
program was presented to everyone in the organization, including the trustees. Out of this
educational initiative came a change in the basic approach to patient care.
Patient-Focused Care with Service Lines
In 1995, Kreitner and Pflum reorganized the hospital around service lines to deliver “patientfocused care.” Staff members were assigned to interdisciplinary service lines, each focusing on
patients with a particular diagnosis (see Exhibit 6). With service lines, staff members were
specialized not only as physical therapists, for example, but as physical therapists who worked only
with stroke patients, together with occupational therapists, speech therapists and others who were
also focused on stroke patients. This shift to patient focused care also meant that staff members were
reorganized within the hospital in order to have entire service lines located on the same floor. Pflum
explained:
Patient-focused care is a philosophy of service based on a notion that the episode of care is a
complete experience rather than just solving a medical problem. Patient-centered care regards
the patient as the customer. He or she has a need and is paying for a service, and this service
should be delivered with the patient’s convenience in mind—not the caregiver’s. We needed
to organize around our patients and their diagnoses rather than around our disciplines.
The service line is ideal for getting doctors, nurses and therapists to work together in an
interdisciplinary way to treat particular patient groups. Rather than organizing around our
disciplines, we are trying to organize around patients’ needs.
The implementation of this “patient-focused” reorganization continued through 1996 and was
largely complete hospital-wide by the end of that year. Over time, interdisciplinary coordination
seemed to improve. Ongoing coordination among staff members resulted in care plans more often
being reconciled and put into action outside of the weekly team conferences. Pflum explained:
Under the new approach, you do everything to maximize the experience of patients with a
particular diagnosis — say head injury. As a physical therapist, your teamwork is with the
2 “Kaizen” is a Japanese term, popularized by its practice as a part of the Toyota Production System. “Kai” means “change” or
“the action to change; “Zen” means “good”.
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nurses, doctors, occupational therapists, speech therapists and so on who work with head
injury patients. You coordinate care plans and therapy with them.
Some occupational therapists and physical therapists are beginning to do their evaluations
together, to avoid so many duplicative questions for the patient and to come up with a more
holistic care plan before the team conference. That was unthinkable before.
“We were apprehensive at first,” said one physical therapist, “but I don’t think any of us would
give up relationships with our occupational therapists now.”
Therapist Tasks and Patient Variability
Unfortunately, after implementing service lines, by 1997 RRH was falling very short of its
therapist utilization target—six billable hours per eight-hour workday, or a 75% billing ratio. RRH’s
75% target was fairly standard in the acute rehabilitation industry. Billable hours included therapy
time as well as time spent in team conferences and time spent doing patient evaluations and
documentation. Under normal conditions, it was expected that therapists would spend 25% of their
time on tasks that were not billable. While certain administrative tasks could be scheduled flexibly,
the majority of tasks that were not billable (such as supervising student therapists, writing up patient
discharge summaries, and attending committee meetings) needed to be done at proscribed times.
Therapists at Reading Rehab typically worked five days/week for eight hours/day, 50 weeks/year.
In 1998, they earned, on average, $60,000/year in wages and benefits, although there was significant
variation around this average.
According to Jim Lumsden, Director of Operations, the problem was simple. “Because staff
members only work with one kind of patient now, we can’t always fill their time.” Therapists who
had once been available to work with orthopedics or head injury or stroke patients were now
available to work with only one type of patient. He believed that the benefits of improved
coordination, including better information hand-offs and scheduling across disciplines, were being
overwhelmed by the increase of staff necessitated by service line specialization.
The basic problem, Lumsden believed, was that the number of patients in each service line varied
from day to day.
If we knew we had fifty patients on a given day, and we knew their diagnoses,
how long they would stay, and who was coming next, we could try to staff for that.
But we just don’t know how many patients we’ll have from day to day or what their
needs will be.
Because RRH could not control its sources of patients, leveling demand for services was
impossible. Lumsden explained, “Unlike manufacturing companies, our inventory is people, so we
can't just stack them in the parking lot and wait until we have the staff to treat them.” The problem
of variability was exacerbated in recent years, as patient lengths of stay became shorter and shorter.
Shorter lengths of stay were more sensitive to variability, and left less time to schedule needed
therapy.
With the pressures of managed care, it had become more difficult to pass along the costs of
overstaffing to the payor. But understaffing was also costly. The RRH admissions department tried
hard to make patient referrals as convenient as possible for referring hospitals, and did not want to
risk RRH’s relationships with them by turning down referrals due to inadequate staffing.
Understaffing was also undesirable because patients who missed therapy sessions would progress
more slowly toward their goals, or even lose ground. Furthermore, patients in acute rehab were
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Reading Rehabilitation Hospital: Implementing Patient-Focused Care (A) (Abridged)
required to receive a minimum of three hours in aggregate of therapy (physical, occupational, speech
and cognitive) every day, according to Medicare regulations. Lumsden explained,
How well we meet the three-hour target directly affects our designation as an acute rehab
hospital. If a Medicare audit were to show that we’re not providing the required three hours
of therapy, Medicare could revoke our designation.
With some of the administrative staff, some flexibility had been achieved through part-time
contracts, but this was not possible with the therapists. Lumsden explained,
Say a patient isn’t admitted from the acute care hospital when expected. Or say it’s just the
normal day-to-day variation. What do you do with the staff? You can’t just have them do
nothing. You can’t send them home with no pay. They’d quit because they have so many
other opportunities.
Though service lines seemed to improve the coordination of care and increase patient focus and
patient satisfaction, as planned, they also appeared to decrease utilization. Given the competitive
healthcare environment and RRH’s mission, Pflum felt they did not have the option of achieving
quality at the expense of efficiency, or vice versa. Could therapist utilization be improved within the
context of service lines? Or would RRH be forced to find another model? With the most recent
disappointing utilization results in hand, Pflum headed for her daily meeting with Kreitner and
Lumsden.
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Reading Rehabilitation Hospital: Implementing Patient-Focused Care (A) (Abridged)
Exhibit 1
Functional Independence Measure (FIM)
Independence
7 Complete independence (Timely, Safely)
6 Modified independence (Device)
L
E
V
E
L
S
608-070
NO HELPER REQUIRED
Modified Dependence
5 Supervision
4 Minimal Assistance
3 Moderate Assistance
HELPER REQUIRED
Complete Dependence
2 Maximal Assistance
1 Total Assistance
Self-Care
A. Eating
B. Grooming
C. Bathing
D. Dressing—Upper Body
E. Dressing—Lower Body
F.
Toileting
Upon
Admission
Upon
Discharge
Upon
a
Followup
Spincter Control
G. Bladder Management
H. Bowel Management
Mobility
Transfer:
I.
Bed, Chair, Wheelchair
J.
Toilet
K. Tub, Shower
Locomotion
L
Walk/Wheelchair
M. Stairs
Communication
N. Comprehension
O. Expression
Social Cognition
P. Social Interaction
Q. Problem Solving
R. Memory
TOTAL FIM
NOTE: Leave no blanks; enter 1 if patient not testable due to risk.
Source: Research Foundation, State University New York.
aFollow-up evaluation conducted 90 days post-discharge.
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Exhibit 2
Reading Rehabilitation Hospital: Implementing Patient-Focused Care (A) (Abridged)
Patient Statistics and Functional Independence Measures (1998)
Reading Rehab
Hospital
National Sample of
Acute Rehab Hospitals
71
68
Mean Age (years)
% of Males
41%
42%
% of Females
59%
58%
Mean FIM Gain During Stay
27
28
% Discharged to Acute Care Hospital
4%
5%
% Discharged to Nursing Home
8%
11%
88%
82%
% Discharged to Home
Reading Rehab Hospital’s case mix was comparable to that of the national sample.
Exhibit 3
Quality of Care Survey Results (1998)
Reading Rehab
Hospital
Percent of Patients Willing to Return
National Benchmark
97.6%
91.0%
Patient Perception of Quality
8.7
8.0
Patient Perception of Teamwork
8.8
7.8
Patient Perception of Organizational Values
8.8
8.2
Patient Perception of Community Relations
9.2
8.0
This survey, “The Quality Inventory,” was designed and conducted by E.C. Murphy, Ltd. All variables except the first are
measured on a 10-point scale.
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Reading Rehabilitation Hospital: Implementing Patient-Focused Care (A) (Abridged)
Exhibit 4
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Patient Days by Diagnosis, Total Patients Admitted, Therapist Data, and Billable Hours
Diagnosis
1995
1996
1997
Head Injury
Stroke
Spinal Cord Injury
Neurological Conditionsa
Multi-Trauma
Orthopedic Care
Arthritis
Amputation
Pain Syndrome
Debility/Otherb
Cardiac Care
Pulmonary Care
Total Patient Days
Total Patients Admitted
5,137
7,615
1,200
951
361
7,121
399
1,620
279
1,541
555
256
27,035
1,292
4,645
6,268
1,360
1,153
698
7,775
267
2,341
574
1,329
398
259
27,067
1,328
2,941
5,612
1,090
854
497
7,189
201
1,436
417
1,742
657
236
22,872
1,247
3,311
5,320
1,112
752
620
6,198
206
1,979
387
1,596
760
330
22,571
1,237
107
112
117
116
162,543
164,925
125,624
130,026
Number of Therapists Employed
Total Billable Hours
1998
a Neurological conditions include laminectomies, meningitis, multiple sclerosis, Parkinson’s disease, etc.
b Debility is generalized weakness. Other includes burns, congenital disorders and unknown diagnoses.
Exhibit 5
The Patient Rehabilitation Process
REA DI NG
REHA BI LI T A T I ON
HOS P I T A L
UP S T REA M
P ROV I DERS
DOWNS T REA M
P ROV I DERS
Home Care
Acute Care Hospital
Outpatient Surgery
Primary Care
Admit Patient/
Assign to Staff
Evaluate Patient/
Plan Care
Weekly
Conference
Daily Therapy/
Documentation
Discharge
Patient
Outpatient Care
Nursing Home
Acute Care Hospital
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This document is authorized for use only in Prof. Peeyush Pandey, Prof. Anurag Tiwari & Prof. Aditya Sahu's PGP14_OM-I at Indian Institute of Management - Rohtak from Jun 2023 to Dec
2023.
This document is authorized for use only in Prof. Peeyush Pandey, Prof. Anurag Tiwari & Prof. Aditya Sahu's PGP14_OM-I at Indian Institute of Management - Rohtak from Jun 2023 to Dec
2023.
Organization Charts Before and After
T h e ra p is ts
T h e r a p is ts
O r t h o p e d ic s
A r t h r it is
A m p u ta t io n
P a in D e b ilit y
S e r v ic e L in e
Speech
T h e ra p is ts
Speech
T h e ra p y
D e p a rtm e n t
T h e ra p is ts
P u lm o n a r y
C a r d ia c
S e r v ic e
L in e
C o g n it iv e
T h e r a p is ts
P s y c h o lo g y
D e p a rtm e n t
S o c ia l
W o rk e rs
S o c ia l
S e r v ic e s
D e p a rtm e n t
S o c ia l
W o rk e rs
S o c ia l
S e r v ic e s
D e p a rt m e n t
N u rs e s
N u r s in g
D e p a rt m e n t
N u rs e s
N u r s in g
D e p a rtm e n t
W o r k e r s , n u r s e s , a n d p h y s ic ia n s w e r e a s s ig n e d to s e r v ic e lin e s , b u t c o n t in u e d to re p o rt to t h e ir d e p a r t m e n ts .
T h e r a p is ts
T h e r a p is ts
a S o c ia l
S tr o k e
S e r v ic e L in e
H e a d In ju ry
S e r v ic e L in e
S p in a l C o r d
N e u ro -In ju ry
M u lt i- T r a u m a
S e r v ic e L in e
O c c u p a t io n a l
T h e r a p is ts
P h y s ic a l
T h e r a p is ts
P a tie n t F o c u s a
O c c u p a t io n a l
T h e ra p y
D e p a rt m e n t
P h y s ic a l
T h e ra p y
D e p a rtm e n t
D is c ip lin e F o c u s
Exhibit 6
P h y s ic ia n s
M e d ic a l
D e p a rtm e n t
P h y s ic ia n s
M e d ic a l
D e p a rtm e n t
608-070
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