Are Productivity Goals in Rehabilitation Practice Associated With Unethical Behaviors?

Objectives: To evaluate the presence of productivity goals among licensed rehabilitation clinicians and their relationship with observed unethical behavior.

Design: Exploratory, cross-sectional survey.

Setting: Online.

Participants: Licensed physical therapy clinicians (N=3446).

Intervention: Not applicable.

Main Outcome Measure: Participants completed an electronic survey regarding use of clinical productivity goals. They rated the frequency in which they observed 6 unethical behaviors on a 7-point Likert scale in their practice setting from 1=never to 7=always. An overall observed unethical behavior score was calculated by summing these scales.

Results: The response rate was 12.8% (N=3446), with analyses showing low risk of nonresponse bias. Many respondents (73.9%) had a formal productivity goal. Most (89.4%) reported observing some form of unethical behavior, but many (68.6%) reported it occurred "rarely" or "never." Those in skilled nursing facility (SNF) settings reported higher frequencies of observance and were 4.1 times more likely to report more unethical behavior than the median compared with all other settings. A positive correlation existed between expected productivity rate and rate of unethical behaviors observed (ρ=0.225; <.0001). Amounts of organizational emphases on ethical practice (ρ=-0.509; <.0001) and evidence-based practice (ρ=-0.492; <.0001) were negatively correlated with total observed unethical behavior.

Conclusions: Use of productivity goals in rehabilitation practice is significantly related with rate of unethical behavior observed. Frequency of observed unethical behavior in rehabilitation practice was very low overall. Organizational culture appears to be a greater predictor of observed unethical behavior than any individual clinician-related characteristics. The SNF setting displays the greatest areas of ethical concern.