Effect of Discontinuing the Administration of Supplementary Electrophysical Agents Before and After Physical Therapy in a Medical Institute’s Outpatient Rehabilitation Program

In Japan, orthopedic outpatients receive electrophysical agents, in combination with physical therapies, before and after physical therapy. Electrophysical agents, such as electrical therapy and thermotherapy, aim to relieve pain and improve muscle tone, and, therefore, may play an important role in enhancing the effectiveness of rehabilitation.(1)

Many facilities provide electrophysical agents for pain relief. Other facilities provide treatment systems that aim to improve rehabilitation outcomes by using electrophysical agents before and after physical therapy as a supplementary pain relief treatment. However, evidence of the efficacy of electrophysical agents is inconsistent, and their effectiveness in the treatment of some diseases remains controversial.(2) As a result, many patients who receive supplementary electrophysical agents before and after physical therapy continue treatment despite an unclear therapeutic effect. Concern has been raised regarding the workload of rehabilitation assistants who administer these electrophysical agents, because an increased workload may cause other work-related problems. Additionally, in Japan it is difficult to profit from administering electrophysical agents before and after physical therapy because the cost cannot be calculated when they are used for pain relief.(3) As a result, a facility’s operational efficiency may decrease, affecting its sustainability, especially in smaller companies.(4) From a management perspective, careful consideration must be given to the cost and efficacy of using supplementary electrophysical agents before and after physical therapy.(5)

This study aimed to investigate how discontinuing the administration of supplementary electrophysical agents before and after physical therapy in an outpatient rehabilitation program at a medical institute (orthopedics) affected the facility’s operations, the operational efficiency of employees, and employee job satisfaction.

Materials and Methods

Study Design

This retrospective study examined changes in operational outcomes before and after discontinuing the administration of electrophysical agents at a medical institute that had previously used them before and after physical therapy as part of its treatment system. Operational outcomes that were evaluated included patient visits, employee work efficiency, and employee satisfaction with working hours. Participants were patients who visited the medical institute for treatment between July 2021 and June 2023 and all employees of the medical institute during the same period. This study complied with the ethical principles of the Declaration of Helsinki and was conducted with the utmost consideration for protecting the participants’ privacy. This study was approved by the Ethics Committee of the Kanazawa Orthopedic Sports Medicine Clinic (Kanazawa-OSMC-2024-005).

Study Procedure

Figure 1 shows the treatment contents and changes at the medical institute from July 2021 to June 2023. In July 2022, the use of supplementary electrophysical agents before and after physical therapy was discontinued. We evaluated the effect of this change on the number of patients visiting the medical institute, employee work efficiency, and employee satisfaction with working hours.

Patient Visits

We used ippo (Mediacl-I, Inc., Tokyo, Japan), a cloud-based EMR service, to record each time a patient visited the medical institute. Patient visits for pain relief treatment, patient visits for rehabilitation, and the total number of patients were tallied daily, and the average number of patients per day was calculated for each category. Additionally, patient visits before and after the discontinuation were compared between rehabilitation and pain relief treatment visits.

Work Efficiency

The average length of stay for patients who received pain relief treatment was used to indicate work efficiency. The time was recorded from when the clerk was logged into the system at reception to when the accounting clerk pressed the “last update” button. Based on these data, daily stay time per patient was averaged to indicate work efficiency.

Questionnaire

We created a questionnaire based on the global scale described by Yanchovska et al.,(6) to evaluate employees’ satisfaction with their working hours and administered it to all employees. The questionnaire items were used to evaluate the degree to which employees were satisfied with their daily working hours using a 5-point Likert scale (1: very dissatisfied, 2: dissatisfied, 3: neutral, 4: satisfied, 5: very satisfied). The questionnaire was administered in September 2021, immediately after discontinuing the administration of electrophysical agents, and again in October 2023 to reevaluate the short- and long-term effects of discontinuing the administration of electrophysical agents.

Statistical Analysis

Microsoft Excel was used for statistical analysis. Basic statistics were calculated to confirm the distribution of the data. We used paired t-tests (normally distributed data) and Wilcoxon signed-rank tests (non-normally distributed data) to compare data before and after the discontinuation of supplementary electrophysical agents in physical therapy. Data on operational efficiency also were analyzed using the same method, and the change in the average length of stay before and after discontinuing the administration of electrophysical agents was examined. In all statistical procedures, the significance level was set at less than 5%, and p-values below this level were considered to indicate a statistically significant difference.

Results

The total number of physical therapy visits to the medical institute significantly increased, from 201.1 ± 12.0 to 232.3 ± 14.8 (p < .001) after the discontinuation of supplementary electrophysical agents (Table 1). Additionally, the number of rehabilitation visits per day significantly increased, from 128.3 ± 3.9 to 139.3 ± 12.6 (p = .009), and the number of visits per day for pain relief treatment, including with electrophysical agents, also increased significantly, from 39.7 ± 6.9 to 64.5 ±4 .0 (p < .001). Furthermore, the number of rehabilitation visits increased by only 8.5% ± 8.9%, whereas the number of pain relief treatment visits significantly increased, by 65.7% ± 21.8% (Table 2). The average increase in the rate of visits for pain relief treatment was significantly higher than that for rehabilitation visits (p < .001).

The average length of stay was measured as an index of work efficiency to examine the effect of the change on work processes. The average length of stay before supplementary electrophysical agents were discontinued was 46.3 ± 41.0 minutes, but after discontinuation, it significantly decreased, to 26.0 ± 19.0 minutes (p < .001) (Table 3).

The combined percentage of employees who were “very satisfied” and “satisfied” with their work hours in 2021 was 29.6%, which rose to 36.5% in 2023. In contrast, the percentage of employees who were “dissatisfied” and “very dissatisfied” significantly decreased, from 37.0% in 2021 to 13.3% in 2023 (Table 4).

Discussion

This study examined the effect of discontinuing the use of electrophysical agents at a medical institute (which had provided these treatments to patients before and after physical therapy as part of an outpatient rehabilitation program) on the facility’s operations, work efficiency, and employee satisfaction with work hours. Previously, rehabilitation patients also received electrophysical agents before and after physical therapy. The electrophysical agents were administered by rehabilitation assistants, not physical therapists. Additional patients also were receiving electrophysical agents for pain relief treatment, separate from their rehabilitation but also administered by rehabilitation assistants. When the administration of electrophysical agents by the rehabilitation assistants before and after physical therapy was discontinued, the number of patients visiting the medical institute for pain relief treatment increased significantly more than the number of patients visiting for rehabilitation. Additionally, the average length of stay — an indicator of work efficiency — decreased by about 20 minutes, and employee satisfaction with working hours improved after the administration of electrophysical agents was discontinued.

The number of patients visiting the medical institute increased significantly after the discontinuation of supplementary electrophysical agents, from 201.1±12.0 to 232.3±14.8, an increase of approximately 30 patients per day. The number of patient visits for rehabilitation increased by approximately ten patients per day, from 128.3±3.9 to 139.3±12.6 (p=0.009), an increase of 8.5%±8.9%, while the number of patient visits for pain relief treatment (including electrophysical agents without physical therapy) increased by approximately 25 patients per day, from 39.7±6.9 to 64.5±4.0 (p<0.0001), an increase of 65.7%±21.8%. This confirmed that the increase in visits for pain relief treatment was significantly higher than that for rehabilitation (p < .001). In addition, the average length of stay was shortened by approximately 20 minutes from 46.3 ± 41.0 minutes to 26.0 ± 19.0 minutes (p < .001), a significant improvement. These analyses showed that the increase in pain relief treatment visits was significantly higher than that for rehabilitation visits.

The decrease in average length of stay can be attributed to the reallocation of employee resources to pain relief treatment and the simplification of their work due to discontinuing the administration of supplementary electrophysical agents before and after physical therapy. Mbau et al.,(7) cite the prevention of unnecessary care and the provision of high-quality care as necessary factors for improving operational efficiency in medical institutions,(7) and Maritan et al.,(8) state that the reallocation of employee resources contributes to improving corporate performance. Kasim and colleagues(9) point out that more complex work requirements are associated with lower work efficiency and that simplifying work requirements can improve efficiency. Regarding patient satisfaction and wait times in orthopedic clinics, Glogovac et al.,(10) reported that patient satisfaction significantly decreases when wait times exceed 30 minutes. Cantor et al.,(11) stated that improving work efficiency may improve the quality of medical services.

We can infer that when electrophysical agents were administered before and after physical therapy, work processes would have been more complicated, and the medical institute’s overall operations would have been inefficient. In this study, discontinuing the administration of supplementary electrophysical agents reduced work complexity and allowed employees to focus on their primary clinical tasks, which improved the quality of medical services and patient satisfaction through a shorter average length of stay. Moreover, we propose that the shorter average length of stay may have contributed to the increase in visits for pain relief treatment.

In this study, employee satisfaction with working hours increased slightly, while dissatisfaction with working hours decreased significantly after administration of supplementary electrophysical agents before and after physical therapy was discontinued. This suggests that discontinuing the administration of supplementary electrophysical agents may have brought about favorable changes in the work environment for employees. According to Hellín Gil et al.,(12) the main reasons why employees are dissatisfied with their work hours include long hours, excessive workloads relative to work hours, and administrative tasks other than patient care. Such workloads lead directly to a decrease in employee job satisfaction. In addition, Jeon and Choi(13) reported that while job satisfaction is related to customer satisfaction, customer satisfaction does not affect job satisfaction. The provision of too many services to customers may result in employees feeling their workload is excessive, which causes mental stress and, consequently, increases their dissatisfaction with work hours.

We suggest that discontinuing the administration of supplementary electrophysical agents before and after physical therapy contributed to streamlining employees’ work requirements and created an environment in which employees could concentrate on their primary medical tasks. Because employees no longer needed to perform additional tasks related to administering electrophysical agents, they experienced fewer mental and physical stressors, presumably contributing to increased satisfaction with their work hours. Furthermore, the reduction in work burden caused by discontinuing the administration of supplementary electrophysical agents before and after physical therapy allowed employees more time to concentrate on their primary tasks, improving the quality of medical services.(14) This may have given employees a greater sense of fulfillment in their work, which may have increased satisfaction with their work hours. Such a review of additional tasks may improve employee job satisfaction as well as the medical institute’s operational efficiency. Rationalizing the provision of services may reduce employees’ feelings of excessive work burden, which may, in turn, contribute to long-term employment stability and improved employee mental health. We propose that medical institutes carefully review the provision of ancillary services and appropriately manage employee workload and stress as important factors for improving job satisfaction and the quality of medical services.

Conclusions

This study examined the effect of discontinuing the administration of supplementary electrophysical agents before and after physical therapy in an outpatient rehabilitation program on the management and work efficiency of a medical institute, as well as on employee satisfaction with work hours. Discontinuing the administration of these agents significantly increased work efficiency, the number of patients visiting for rehabilitation, and, in particular, the number of patients visiting for pain relief treatment. In addition, our findings suggest that employee satisfaction with work hours improved, and reducing work burden lowered employee stress. Management should review the administration of electrophysical agents, because discontinuing their provision may improve the quality of medical services and increase employee job satisfaction.

Practice Implications

Based on the results of this study, medical institution executives and middle managers should regularly evaluate workflow and revise it as necessary to improve work efficiency. Workflow improvement is considered to be the foundation for providing more appropriate medical services to patients by reducing the workload of employees and reallocating resources. Furthermore, increasing work efficiency may improve employees’ satisfaction with their working hours, and is expected to contribute to the improvement of quality of patient care. Such efforts can be an important factor in promoting sustainable growth for healthcare organizations as a whole.

References

1. Watson T. The role of electrotherapy in contemporary physiotherapy practice. Man Ther. 2000;5(3):132-141. https://doi.org/10.1054/math.2000.0363

2. Page MJ, Green S, Mrocki MA, et al. Electrotherapy modalities for rotator cuff disease. Cochrane Database Syst Rev. 2016;2016(6). https://doi.org/10.1002/14651858.CD012225

3. The Ministry of Health Labour and Welfare. Conceptual Chart of Insured Medical Treatment. www.mhlw.go.jp/english/wp/wp-hw3/dl/2-009.pdf

4. Damnjanovic AM, Dimitrijevic V, Nesic S, Miskic M, Mrdak G, Arsic SM. Risk influence of employee productivity on business failure: evidence found in Serbian SMEs. Sustain. 2023;15(6):1-17. https://doi.org/10.3390/su15064705

5. Abe Y, Goh AC, Miyoshi K. Availability, usage, and factors affecting usage of electrophysical agents by physical therapists: a regional cross-sectional survey. J Phys Ther Sci. 2016;28(11):3088-3094. https://doi.org/10.1589/jpts.28.3088

6. Yanchovska I. Scales for measuring employee job satisfaction. Mech Transp Commun Acad J. 2022;11(1):31-38. www.researchgate.net/publication/363090288

7. Mbau R, Musiega A, Nyawira L, et al. Analysing the efficiency of health systems: a systematic review of the literature. Appl Health Econ Health Policy. 2023;21(2):205-224. https://doi.org/10.1007/s40258-022-00785-2

8. Maritan CA, Lee GK. Resource allocation and strategy. J Manage. 2017;43:2411-2420. https://doi.org/10.1177/0149206317729738

9. Kasim T, Haracic M, Haracic M. The improvement of business efficiency through business process management. Econ Rev J Econ Bus. 2018;16(1):31-43. www.econstor.eu/handle/10419/193881

10. Glogovac G, Kennedy ME, Weisgerber MR, Kakazu R, Grawe BM. Wait times in musculoskeletal patients : what contributes to patient satisfaction. J Patient Exp. 2020;7:549-553. https://doi.org/10.1177/2374373519864828

11. Cantor VJM, Poh KL. Integrated analysis of healthcare efficiency: a systematic review. J Med Syst. 2018;42(1). https://doi.org/10.1007/s10916-017-0848-7

12. Hellín Gil MF, Ruiz Hernández JA, Ibáñez-López FJ, et al. Relationship between job satisfaction and workload of nurses in adult inpatient units. Int J Environ Res Public Health. 2022;19(18). https://doi.org/10.3390/ijerph191811701

13. Jeon H, Choi B. The relationship between employee satisfaction and customer satisfaction. J Serv Mark. 2012;26:332-341. https://doi.org/10.1108/08876041211245236

14. Nylenna M, Bjertnaes ØA, Saunes IS, Lindahl AK. What is good quality of health care? Prof Prof. 2015;5(1):1-15. https://doi.org/10.7577/pp.909