The Human Impact of Increasing Productivity

A lot of what we provide as clinicians cannot be measured in productivity percentages or in dollars and cents. Empathy is one of those things. When you’re valued on your ability to extract every possible billable minute out of every hour, empathy inevitably ceases to be a mandatory requirement for caring for another human being. At best, it gets treated as an inconvenience. At worst, it’s actively discouraged. 

I can still hear my old director saying, “What were you doing talking to that family member on the phone for 20 minutes? You can’t bill for that unless you're physically in the room with the patient!”

The relentless pursuit of productivity metrics shifts our focus away from "what is best for the patient" to "what is the most efficient way to treat in the allotted time.” 

Consider the qualitative data from recent clinician surveys. One practitioner bluntly admitted that they "actively avoid any non-billable time with patients and families, despite that time being in the patient’s best interest.”

Picture an experienced SLP literally dodging eye contact with a worried family member in the hallway because stopping to answer a question for five minutes would somehow negatively impact their daily metrics. And they’ll likely have to hear about it later. 

Upton Sinclair once said, “It is difficult to get a man to understand something, when his salary depends on his not understanding it.” When a CEO’s salary depends on a facility’s bottom line, they are only going to have eyes for the things that increase that bottom line. And they’ll ignore everything that doesn’t. 

Let’s use the concept of commission or delay of nursing care as an example here. Data reveals that nurses in Intensive Care Units (ICUs) demonstrate significantly lower missed care and higher ethical performance than nurses in general inpatient wards. Why would this be? 

Because ICUs typically maintain better, safer staffing ratios (E.g., 1:2). This enables nurses to act ethically, whereas general units are often subjected to unsustainable ratios up to 1:8. In these areas, nurses may skip steps or take shortcuts; not because they want to, but because they have to in order to get everything done. It’s just the inevitable outcome of working in a system that deprioritizes what’s actually important: Keeping patients safe and healthy. 

This juxtaposition between what a clinician wants to do and what they actually do creates a kind of cognitive dissonance. A clinician’s moral compass pulls them in one direction, but the weight of the processes, procedures, and culture engineered by the financial department pulls them in another. 

This cognitive dissonance takes a toll on clinicians. No healthcare professional actively or intentionally turns their back on their patients. But when the system prevents ethical action, moral distress is the result.

Metrics and Ethics

It is a common administrative defense to frame productivity standards as simple business metrics. You may have heard administrators tell you that at the end of the day, this is a business. If we don’t make money, we can’t stay in business. I know I’ve heard this many times, especially in the nursing home setting. 

Administrators are trying to tell us that we should be able to easily separate our trained, clinical, and ethical decision-making from the financial pushes and pulls that come from within our organization. 

But recent data proves that financial incentives are directly driving unethical behavior. In the 2026 Magid & Donohue survey, 90% of respondents had a formal productivity goal. In other words, almost everyone. Even more alarming, the vast majority of these respondents found these goals “difficult” or “very difficult” to meet.

The worst part is that the data reveals a direct, statistical correlation between having difficult or inappropriate productivity goals and the sheer number of unethical behaviors reported in the workplace. In fact, respondents reported observing an average of 3.3 distinct unethical behaviors in their clinical environments. 

And high productivity doesn’t only impact the clinician. The psychological impact is real, and burnout is widespread, of course, but unrealistic productivity standards also impact the quality of the care patients receive. This shouldn’t be surprising when financial metrics dictate the treatment instead of the patient's actual medical needs. 

Financial incentives are influencing patient outcomes. Not the other way around, as it should be. The tail is wagging the dog in ways that directly impact patient care and patient safety.

Deny Your Ethics or Lose Your Job

Let’s get into the details now. What do these unethical, financially driven behaviors look like on the floor? According to the data, clinicians report feeling immense pressure to engage in practices that directly violate their professional oaths. Some of the most frequently reported ethical violations include the following.

• Providing an inappropriate frequency or intensity of services to patients just to hit billing quotas.

• Placing patients on their caseload who objectively do not meet the criteria for skilled care, essentially treating healthy people with the sole purpose of generating revenue.

• Inappropriately limiting the time spent on critical evaluations because payment policies simply do not reward the immense time and effort put into making a correct diagnosis.

• Falsifying documentation, coding services inappropriately, or even altering records to appease internal reimbursement policies.

In one survey, 16% of practicing clinicians openly admitted to falsifying or changing documentation to misrepresent the time spent or services delivered (Bennett et al., 2019). Professional organizations across all healthcare disciplines are acutely aware of this problem. Professional codes of ethics set practice standards centered on advocacy, accountability, and patient-centeredness. 

Core biomedical principles—such as beneficence (acting in the patient's best interest) and nonmaleficence (doing no harm)—universally dictate that clinicians must not follow arbitrary corporate directives that compromise the patient's well-being. In short… Put the patient first, before all else. Especially before the financial spreadsheet. 

Further, we are instructed not to exploit clinical resources for the sole purpose of serving business interests. In fact, clinical ethics require what’s referred to as "behavioral fidelity," which means professionals are obligated to speak up when care is compromised and sustain a patient-centered approach.

This all sounds great on paper, but this ethical framework can very easily lose its foundation in the real world where it faces a barrage of attacks. For example, how can a clinician possibly ignore productivity requirements and instead advocate for patient-centered care when their own livelihood is on the line? 

Data shows that 70% of surveyed clinicians report facing negative consequences if they fail to meet their employer's productivity targets. What might “negative consequences” look like? How about losing your job for one?

I heard about a clinician who knew a patient needed more time, but also knew that pushing back on productivity expectations could put her job at risk. She kept doing the math in her head: how much care could she give without drawing attention, how far could she bend before someone noticed, and what would happen if she spoke up? That’s what makes these systems so hard to challenge from the inside — the pressure isn’t just clinical, it’s personal, and the consequences can feel like they’re hanging over every decision.

Strict productivity requirements cast a shadow that covers everything we do, including the things that bring the most value to the patients themselves. The whole system sets our patients and us up for failure. Next week, we’ll get into what clinicians are currently doing to make ends meet in this crazy environment. I’ll see ya there.

Feeling like you want to make a difference as an SLP, but don’t know where to start? Learn more about my new course, Be The Change.