Dan, a newly licensed physical therapist, was working at a clinic where the organization had a clinical standard–to achieve at least 52 minutes and 4 billable units with each patient. He was told that...

Dan, a newly licensed physical therapist, was working at a clinic where the organization had a clinical standard–to achieve at least 52 minutes and 4 billable units with each patient. He was told that this was the expectation for maintaining productivity and that as a skilled clinician he should be able to work with any patient for 52 minutes. If he couldn't, then he should not consider himself a skilled clinician. It did not take long for him to experience moral distress as he was trying to balance his ability to make clinical decisions about patient discharge and accountability for being a good steward of healthcare resources in balance with evidencebased practice guidelines and now organizational expectations. His patient, Joan, had adhesive capsulitis of her shoulder and had reached all of her goals. Joan was well aware of everything she needed to do after therapy, was experiencing no pain, had achieved functional goals and was ready for discharge. Dan ended up keeping the patient for only 30 minutes and was confronted by the clinic manager for not maintaining productivity for that hour with that patient. Dan was following best practice clinical guidelines and believed that as a practising physical therapist, he had professional responsibility for patient-centred quality care along with being a steward of scarce healthcare resources.