The Patient Handoff

Posted on March 13, 2023 by Edward Petty

doctor and two women introductions.

Improving your patient’s experience.

There are subtle and brief moments in your practice when you and your team can earn or lose your patient’s trust. It can make the difference between your patient agreeing to your care program or finding a reason to delay the decision.

Excuses can be easy to dream up. There are hundreds of reasons why someone can’t, or won’t, agree to a care plan or follow through with their care. But the reasons presented may not be the actual ones.

Surveys show that customers cease their relationship with a business when they experience an attitude of indifference on the part of the employee or business. People hate to be ignored.

You know this, so you ensure you and your team communicate well with patients at the front desk and during the report of findings and case presentation. These are obvious communication events.

But just as important, but not always as obvious, is the communication that occurs when the patient is transferred from one staff member to another.

This is called the Patient Handoff.

For example, the doctor has spent time reviewing the exam and imaging findings with the patient and correlated them with their history. The doctor explains the health issues and the care plan to the patient. The patient nods in agreement. With other patients now waiting to be seen and the doctor feeling rushed, the doctor may leave the patient and ask another staff member to schedule the patient for care and to work out their finances.
It would take another 3-5 minutes for the doctor to introduce the patient to another staff member and relay the key information to them in front of the patient. It would be minutes well spent.

“Hi Betty (Patient Accounts Specialist). This is Sam. He works out at the same gym as I do over at Acme Fitness. He wants to keep up with his workouts so I have worked up a treatment plan to help him recover from low back injuries. I’ve included the info in the back (hands written report to Betty). Could you schedule him for his appointments and discuss his payment options?”

“Sam, any questions or comments?”

“No.”

“Ok, great. I look forward to working with you here at the clinic and also at the gym. See you soon.”

After the report of findings is a handoff event that can be too easily cut short or skipped altogether. Another handoff I have often witnessed omitted entirely is introducing the new patient to their therapy and rehab services.

We are all in a hurry, but these patient care transition points hugely impact how your patient experiences you and your clinic.

In sum, patient handoffs help with the following:

The continuity of care ensures that the patient receives consistent and appropriate care throughout their treatment plan.
Minimizing misunderstandings or errors in their care.
Improving your patient’s satisfaction and trust in you and your clinic.

Take time to do thorough patient handoffs, and you will see retention improve, referrals increase, and happier patients.

Working towards a healthier future,

She Wanted to Teach Chiropractic Staff

Posted on February 21, 2023 by Edward Petty

Greater Prosperity through Goals, Leadership, and Teaching.

woman teaching to a crowd Effective leaders are, first and foremost, good teachers.
We’re in the education business. — John Wooden

Greater Prosperity through Goals, Leadership, and Teaching

A highly productive and prosperous chiropractic clinic always has a goal driven team for support.

Motivation is directly linked to goals and leadership. When anyone pushes their way towards their goals, they are leaders. And one of the primary methods of leading is through teaching.

This is how you lead your patients to their health goals – you educate them at the initial report, the progress report, and each visit where you Table Talk!

In a Goal Driven Practice, eventually, everyone takes a leadership role. And leaders teach.

Teaching, in and of itself, is motivational.

She Wanted to Teach

I will never forget an outstanding example of this, though disappointing in some ways.

One of our clients hired a woman to be his office manager. She had big goals while working at another chiropractic office but was not encouraged to pursue them. So, she found an office, one that we worked with, where the doctor supported her mission.

She was a powerhouse on the front desk, but also worked with the staff and the doctor on improvement projects. She told him that she would work with him for one year, and if the numbers reached a certain level, she would replace herself, receive a substantial bonus, and move on. However, she had a bigger goal in mind. She wanted to begin a team training program for other chiropractic staff throughout the state.

We worked together on this plan for the entire year. The office was already busy and doing well. But after she started, we saw the volume increase significantly. She was a great team trainer, and after a year, she won her first game. The numbers increased on a sustained basis by over 20%. The owner was very pleased.

The disappointment occurred when she visited doctors around the state to encourage them to have their staff train with her. She also promoted her services to the state association. The reception in all cases was mild. She could not convince the doctors or the association of the advantages of having their staff on a professional training program.

She eventually took a high-paying position at a corporation in another state.

Teaching is Leading

As the chiropractor, and the Clinic Director, you are a leader – and a teacher.

In a Goal Driven Practice, you also want each team member to be a leader. The fact is, in their own way, they want to be leaders. Maybe not on the stage or in front of an orchestra, but leading by actively pushing their way to their goals and the office’s goals as well.

Each one of your team members has professional and personal goals. Just like you do. These goals should align with the goals of the office. You can help to unleash the power of these goals, for yourself, and for each team member, in the following ways:

1. Accept the fact that pursuing goals is leadership. And a function of leadership is teaching.

2. Do your own in-office seminars. Teach your team how to achieve the goals of the office, and especially, why.

3. Meet with each team member and help them write down their professional and, optionally, their personal goals. Then, help them achieve these goals.

4. Have them teach. For example:

a. At occasional staff meetings, one team member can give a presentation on some aspect of their job, a core value of the office, or a chapter in a book or a video.

b. In one year (or two) after they are hired, require all staff to help you give the first half of a lay lecture.

A Goal Driven Practice is not dependent upon the doctor. Instead, it is dependent upon goals and, as such, is more profitable, provides better service, and is more fun to work in.

Seize the future and your goals,

Also, read my book! 😊

*https://www.expressionsofexcellence.com/ARTICLES/wooden_interview.html

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The Generosity of Service

Posted on February 14, 2023 by Edward Petty

How to be happier and more prosperous

One of the unique characteristics of Petty, Michel & Associates is that we visit offices and provide on-site coaching based on what we see.

I remember one doctor whom we worked with for several years. When I visited his office, as soon as he saw me, and the minute he was free, he’d say, “Ed, come on over here, let me check you.”

He didn’t ask permission.

He saw many patients in the morning and the afternoon and always took time over lunch for a workout.

He was focused on adjusting anyone in his sight. Patient after a patient. And because he was so focused, he communicated with certainty and authority and earned the trust of his patients.

If you can strip away from your mind all the administrative tasks, worries, and challenges and just focus on seeing patients, you’ll be happier and see more people.
All the “other stuff” slows down doctors, the administrative tasks that seem to multiply exponentially. Your mind can be either dominated by business concerns — or by the joy of giving and serving.

You have the skill and ability to help others, which must be honored and given full reign to be expressed to its total capacity. It shouldn’t be withheld or hoarded.

A well-trained team and a practice manager are vital. They allow you, and the other providers, to practice your art while they care for everything else.

I have talked to many doctors who visit third-world countries and flat-out adjust 100-200 people in a day. No admin interruptions, just individual after individual, courageously providing service and practicing their craft without concern about reimbursement. They have told me that they would get into a “Zone,” or into a flow… and experience an intense kind of present-time consciousness that they don’t experience in their offices.

Dr. Sid Williams, who founded Life Chiropractic University in Georgia, promoted the idea of “Lasting Purpose,” which was defined as “to give, to love, to serve in abundance without expecting anything in return.”

Being generous doesn’t mean giving your services away. Generousness is a mindset of abundance. It is not withholding your gift and craft but practicing your art freely and abundantly.

To do so, train your staff to take care of everything else and delegate the admin tasks to them. We can help with this. But it first starts by committing to a value of service generosity. In our company, Petty, Michel, & Associates, one of our core values is delivering services in “Abbondanza,” Italian for abundance.

In physics, every action has a reaction. This is also expressed in ancient texts: the more you give, the more you receive. You’re persuaded each day to get lost in admin concerns. Don’t. Get “lost in service.” Admin details need to be tended to, but only during non-patient time, and most should be delegated to your team.

Be a Giver and be generous. Educate, care for, and help more people. Take on this attitude, and you’ll have more fun and be more prosperous.

*Sid Williams quote: https://lifewest.edu/dr-sid-williams-honored-in-life-wests-sid-square/

Your Patient’s New Year’s Goals

Posted on January 4, 2023 by Edward Petty

Your patients’ goals are why we are here.

They are why your staff came to work today and why you went to your last licensing seminar.

Your patients’ goals are why you have a practice and are in business.

So, what are your patient’s goals? What do they want?

On the surface, it is usually to relieve discomfort or pain.

So, like you do, after your initial consult, exam, and imaging, you tell them the cause of their pain and present your treatment program. They nod in agreement, and you begin care.

But when the patient sees the staff member to work out their finances and scheduling, they may have a glazed look and not be too sure what you just told them. Something-something about submarines, or joints, or spondy low dices.

The next week you wonder where they are. Your front desk does recalls. You spend money on more marketing to get more new patients.

You may have experienced a version of this in the past.

And at home, the patient may even feel that they got what they wanted or thought that they wanted. Maybe they feel better. But did they really get what they wanted?

There is a quote questionably attributed to Henry Ford: “If I’d asked customers what they wanted, they would have told me, ‘A faster horse!'”

I get the point. But what people wanted, though they did know about a Model-T, was to travel faster with less horse poop.

You know that four adjustments, in most cases, won’t provide the health solution that the patient needs. But your patients don’t know what you know!

Was that why they didn’t come back for another visit, because you didn’t educate them enough? No.

Was it that you did not motivate them enough? No.

An excellent book on sales that I recommend is by Harry Browne, The Secret of Selling Anything. Brown points out that people are already motivated.

You don’t have to motivate your prospective patient when you initially see them. You just need to discover what is already motivating them.

This takes place in your initial consultation and history, which I feel is the most crucial part of the new patient onboarding process.

Brown offers these three steps.

Discover. Discover through intense listening what they want. For example:

What do you consider most important for you about your health?
What do you think is the biggest problem regarding your health?

These questions, and others, open the door to understanding what the other person wants. And if they know you understand them and are authentically interested, they will be more inclined to listen to you and trust you.

Summarize. The second step is to summarize what the patient said about what they want. This brings out what they said on the table so that you both can agree. For example:

So, as I understand it, you are looking to get rid of the pain, not for just a week, but altogether so that you can get back to playing polo with your grandkids, correct?

Now you both can agree on what they want.

Solve the problem. The third step is educating them on what you have found after your exam and imaging. But you direct the education to exactly what they especially want. Now they are interested because you are addressing the motivation that they already had.

This is a simple procedure that is genuine and caring. Not always easy to find these days, so you will stand out from others by using this method.

I would even spend time now and then rehearsing this. Even the pro’s practice.

Brown is not the only person who has offered this procedure as it is so fundamental. But we can never be reminded of the basics enough. He also said:

…the secret of success is:

Find out what people want and help them to get it.

Help your patients achieve their goals in 2023, and they will help you achieve yours.

Seize 2023!

2023 Medicare Fee Schedule

Posted on December 19, 2022 by Linda

Shown below is information regarding the 2023 Medicare Fee Schedule for Wisconsin Providers only provided by NGS Services and also a link to CMS.gov for fee schedules in other states.

Wisconsin Providers: Here is the 2023 Medicare Fee Schedule for your perusal. Please make this accessible to you and your staff.

Onboarding for New and Veteran Employees

Posted on December 13, 2022 by Edward Petty

Just Focus on Goals and Expectations

The way you set up the initial relationship with your new employee will directly determine how well they perform in the first year of employment.

I don’t think that this is given enough consideration. You are in a rush to fill a position, and once you have done so, you are now just happy that it is done so you can get back to seeing your patients.

The new employee is given some training, but since everyone is busy, it is very brief and short-lived. As a result, the productivity of the new hire is held back.

New employees are not like plug-and-play appliances. Everything is new to them. The staff, the patients, the jargon, the flow of traffic, the procedures — all these which you take for granted, are to them, new.

The prospective new staff member never really knows what they are walking into. Is this going to be their best or their worst work experience? So, despite their smiling cooperation for the first few weeks, underneath, they may be worried that your business is not for them.

It can take 8 to 12 months for a new staff member to gear up to full capacity and performance. But the critical period in my observation is the first three months.

Orienting, training, and acclimating the new employee to their new job, new team, and new business is called onboarding.

Onboarding – the First 3 Months

You want each team member to be happy working with you and operating at close to their full capacity. This is what you want for yourself, right?

Once you make the decision and the new person is hired, your management work just begins.

A systematized onboarding procedure helps the new employee feel safe, that this is where they belong, and that they are important to you and your office.

As a result, a deliberate onboarding process will “increase new hire retention by 82% and improve the productivity by 70%.” (zippia.com)

I have seen this in action – both the right way and the wrong way!

We provide an onboarding checklist for our clients (which we are updating), but here are some fast tips:

1. Checklist. Assign the new employee a list of actions to be completed over the first 3 months that include orientation, study, and training. The checklist should also be assigned to a veteran staff member to help the new employee get through the checklist.
2. Ongoing meetings with the owner/doctor. You want to have the new employee have a good understanding of you and your history, goals, and plans to achieve them. Do this over lunch or coffee.
3. Relationship with goals. You want the new employee to have a relationship with the goals of the office. Go over:

a. The mission of the clinic and why this is the mission.
b. The clinic and team’s values. Who we are and how we are. (For example, we are care-aholics!)
c. The outcome of the clinic’s services. For example: happy, healthy patients.
d. Mission and outcome of their specific role.

4. Expectancy. They need to know that achieving the goals for their specialized role is what is expected. How they do it is important, but that they achieve them is most important.
5. Regular (weekly or biweekly) coaching reviews.

Re-boarding

You can do a version of this every 12 months with your key veteran staff. Why not?

Next to your skills, your reputation, and your patients, YOUR PEOPLE are your most valuable asset in your practice. Take care of them, especially when they begin, and they will help you take care of the practice.

Practice Fundamentals – Communication and Control

Posted on December 7, 2022 by Edward Petty

“Get the fundamentals down and the level of everything you do will rise.”
— Michael Jordan

It’s always the basics. The fundamentals.

This is what all efforts to improve performance – and health — go back to.

All of your efforts in practice management boil down to communication and control.

All the books on procedures, patient management, and practice management can be distilled down to communication and control. Those are the basics you need to get to your goals and those of your patients.

Doctors, and staff, that have excellent communication with their patients have many referrals and a busy practice.
Doctors who communicate well with their staff have a happy and full practice.
Doctors that have positive control with their patients see their patients succeed.
And business owners that have proactive control over the office – are prosperous.

Of course, the inverse of these facts is also true. Whether out of fear, confusion, or fatigue, when these fundamentals are not administered, things don’t go well.

Communication

I was recently helping a doctor and the practice manager improve their patient financial consultations. The manager and doctor had worked out what to say that they liked. They called it a “script.”

A few months passed, and I noticed their patient retention had not improved. Neither had collections or other metrics. When we did some training on how the patient consultations were performed, we found that the staff focused on the memorized script, not the patient. Their communication was robotic, and they never got to know the patient. We replaced the script with a simple outline and let the staff get to know the patients. Visit average and collections improved.

Good communication is alive, interested, and empathetic. It results in understanding.

Control

Another office we worked with complained about low collections. They had plenty of new patients — the veteran doctor got great results. After investigating, we found that the report of findings and treatment plans were rarely completed, and scheduling was hit-and-miss at best.

And that’s not all. The doctor and staff often came to work just a few minutes before patients came in. Sometimes they came in late.

This office was out of control — and so were the patients.

Positive control is moving a project, patient, or condition from one status to a predetermined goal. This is what a procedure does. A well-run business has procedures, protocols, and systems that it adheres to achieve its daily and weekly goals.

Management

Management is implementing effective procedures, with excellent communication, to achieve goals.

In all your practice improvement efforts, check first if the procedures are being done, and then if they need to be improved or removed. Then, look at the quality and quantity of communication used to implement the procedures.

Improve the fundamentals — your patient and team communication and control — and you will have a prosperous and happy 2023.

Seize your future – with a smile!

What gets measured gets done

Posted on November 29, 2022 by Edward Petty

Your Goal Driven Analytics Scoreboard

Sometimes you can’t see the forest for the trees.

Sometimes you think things are worse than they are.

But then again, sometimes you think things are going better than they are. And then, BANG! Poop hits the fan!

What is the best way to determine how your business is doing?

Your Scoreboard

Your numbers are the best indicator of your Key Performance Indicators. They are your dashboard. Your Google maps. Your altimeter, as you take your business off the runway and up towards your goals.

In our consulting work, too often we see major management changes based on a minor error, hearsay, or emotions. This can have long-term devastating results.

On the other hand, improvements that show up on the stats can be ignored if no one is watching them.

One office we worked with continued to see an increase in new patients referred from a local gym. But amidst the busyness of the daily patient care, they hadn’t noticed. Since we closely monitored their numbers, I saw this increase in new patients from a local business on their New Patient Tracker. After discussing this with the doctor and manager, they finally took action to strengthen this valuable relationship. Last I heard, they are continuing to get referrals from this location.

You can miss the good things — as well as the coming crash. Numbers help you predict what needs fixing before things get ugly and what needs reinforcement to keep the good times going.

Ultimately, statistics tell you if you are moving towards your goals or away from them.

Unfortunately, most offices do not keep clear and consistent track of their numbers.

As a result, business owners do not get the information they need to manage their business properly. Software can spit out reports which can help, but they are not enough. And usually only partly used, if at all.

Here are some fast tips for your stat analysis scoreboard:

Key numbers. Monitor numbers week-to-date and month-to-date, especially new patients, visits, charges, and collections.
Individual providers. If you have multiple providers, find some way to measure their production. This can help both of you manage performance.
Percentages. Use percentages, such as visits divided by new patients, to give you an idea of how long your patients are staying with you.
This year to last year. You should be able to compare this year-to-date with last year-to-date.
Line charts. We use line graphs plotted over a couple of years. These clearly show what is trending — up or down.
New patients. Track the sources of your new patients as well as the types of new patients.
Weekly reports. Have someone in your office give you a daily, or at least a weekly and monthly statistical report.

Keeping statistical analysis in place has proven so valuable for offices that many clients have asked us to keep providing their stat analysis for them years after completing an intensive service with us.

While this is not a major service we offer, we realize how useful it is in our Goal Driven System of management.

Therefore, we have decided to start offering our Goal Driven Analytics program as a service to more offices.

We are only taking 5 new clients on this program for now, first come, first serve. It is moderately priced and, as most of our clients can verify, managing by the numbers is invaluable. To learn more about the program, we’ve posted some more info, with the link below. If interested, just reply to this email, and we can set up a time go over the details.

But whether we provide you with your statistical analysis or you set it up yourself, I can’t recommend a more valuable management tool for managing your business profitably. Not only is it effective, but it is fast!

Your analytics scoreboard will help you smoothly navigate to your goals.

To your greater prosperity,

More info on the Goal Driven Analytics Scoreboard.

Grateful for the Future

Posted on November 22, 2022 by Edward Petty

Gratitude is not only the greatest of virtues, but the parent of all others.
(Cicero, Prolancio, 100 BC)

As many of us in the U.S. prepare for our annual Thanksgiving events, I wanted to offer a short perspective.

Daily events challenge us, and we struggle to deal with them as best as we can. Events in our offices as well as in our communities, country, and the world can be daunting.

So, it helps to pause, more often than we do, and appreciate the advantages we have from those who have come before us. Likewise, to be grateful for the people we know: our family, friends, and those with whom we work. And, of course, our patients. In small ways and large, we all help each other.

But I also want to mention our future and the opportunity it gives us all.

As we move through the Holidays and winter sets in up here in the Northern Hemisphere, the New Year comes at us again too soon. We live in uncertain times, but as business owners and health mavericks, now is not the time to hunker down as if to hibernate and hope that any storms that occur may pass us by.

They won’t. But we can prepare and seize the opportunities that lie ahead.

Forward-minded entrepreneurs always find a few new approaches to making things better while many business owners remain on the sidelines, wary of jumping into the game and fully committing.

The future offers us the opportunity to play and enjoy the thrill of creatively making a difference, however difficult.

So, enjoy the Holidays, and all those close to you, near and far, in the present and respects to those who have passed. Take time to nourish yourself and those around you. There truly is much to be thankful for!

But while doing so, also appreciate the freedom we all have to make a better practice and a better life in the years to come.

Seize the Day and Seize the Future. (Carpe Diem, Carpe Futurum)

With Gratitude for all you do,

Ed, and all of us at Petty Michel

Chiropractic Patient Education Prompters – Table Talk Grows Your Flock

Posted on November 9, 2022 by Edward Petty

Imagine this scenario:

Written on a white board near the chiropractic patient adjusting area:

Last to show and the first to go.

Patient: Hey Doc, what does that mean, written on the white board there?

Doctor: Hi Sam, glad you asked. Just a reminder for me to explain that pain usually shows up after a health problem is present for a period of time, and usually goes away or lessens during the early part of our program of care. In other words, the pain can go away but the issue that caused it can still be present.

Patient: Oh, I got you! So, even though I am feeling much better, I better stick with the program, is that it?

Doc. Yep!

===

You know patient education is important. It improves outcomes. It improves retention. It improves referrals.

This is a simple procedure to improve your patient education: Assign a creative staff member the task of writing images or sayings that prompt the patient, or prompt you, to talk about a health subject. That’s it!

It prompts TABLE TALK.

Table talk is the BEST form of patient education and, for that matter, promotion. It comes from you, the doctor, during the most transformative time in your office.

Here are a few sample subjects you could post on a white board near your adjusting table:

How does chiropractic work?
Above Down Inside Out
Dr. You
Does chiropractic help with headaches?
Last to Show First to Go
Time, Repetition, Effort! [It takes time to restore your health, it has taken a long time for you to get into this condition. It takes repetitive work, like orthodontics. We will give you our best effort, you will have to do the same,]

Add a drawing now and then:

How is pain like an iceberg? (Draw an iceberg. [Iceberg Symptoms on top of the water, cause below in the water.]
How is spinal health like a rusty hinge? [This is when your vertebrae wears away when it becomes stuck.]
What happens to your tires when they are out of alignment? [Disks wear out faster like tires out of alignment.
Car Parked a garden hose. [When the hose is stepped on or kinked the water does not flow 100%. The same is true when you have a subluxation and your nerves are impinged. This affects everything your nerves are connected to.]
Safety Pin.
Orthodontics.

Just so you don’t get too serious, add a joke now and then:

I had to turn down the landscape company today…

****They wanted too mulch

The bartender says “Sorry, we don’t serve time travelers in here.”

****A time traveler walks into a bar.

===

This procedure doesn’t cost you. Like chiropractic (or our consulting!), it pays!

But only do it for two months at a time, otherwise it will lose its novelty for you, the staff, and patients. Run it 2- 3 times each year.

Once a month, meet with your team and come up with some new patient education prompters. This is also another way to educate your team in the process.

Keep the conversation going.

The more they know, the further they’ll go.

And seize the future.

Improving Patient Follow Through: The new patient log and checklist

Posted on November 1, 2022 by Edward Petty

Working with different offices, we are always reminded of the fundamentals that apply universally. For example…

Once your patient has committed to getting better, it is your job, and everyone else on the team, to help them achieve their goals.

But in the busyness of everyday office interactions, essential steps along the way can become abbreviated or dropped out altogether.

At one office I recently visited, the patient visits and income were diving downward on a monthly trend. And this was occurring even though the new patient volume had been pretty steady.

When I inquired with the front desk staff, they told me that patients were sick, had money problems, were busy, and blah blah blah.

I asked if this was a new phenomenon. Did patients suddenly become poor, was there a new pandemic? What?

Didn’t get any real answers, as they were busy on the phones doing recalls trying to get people back in the office. The doctor wasn’t sure what was happening. To his credit, he loves adjusting and focuses on providing outstanding care – which he does, usually at a high volume.

Long story short, after investigating, I discovered that the doctor had changed up his treatment procedure slightly, and staff positions had changed. As a result, new patient financial consultations had dropped out. The patients had been getting excellent care but had no idea about their payments and were only scheduled for one visit at a time.

This was a pretty big change! A critical procedure just silently disappeared without anyone really noticing. (Sometimes it is hard to see the forest for the trees. Plug: Consulting doesn’t cost. It pays!)

Everyone at the office is a veteran, hard-working, and goal driven. A great team. But this missing procedure was costing them thousands and preventing patients from getting the full benefit of care.

We implemented several solutions that have worked for other offices.

One solution was the New Patient Log and Checklist. I gave them a sample to customize. It is a lined sheet on a clipboard. Each new patient is listed vertically on the left column, followed by other columns stipulating key actions that should occur on each patient. The Log would include such things as:

Report of findings and Tx Program.
Multiple appt. card.
Financial Consult.(When, by whom.)
First adjustment call.
Attend NP workshop.
Source.
If referred by patient, what is pt.’s name?
Thank you card to referring patient?
Type [ WC, PI, C, etc.]

You could add more columns, but the most vital aspect of this Log is this: it must be assigned to someone. You and the team can review the NP Log during your morning meetings or at weekly team meetings.

One of the lessons here is to always look for what you and your team are doing or not doing before you look to the environment for why your practice may be slipping – or booming!

And help your patients achieve their health goals by ensuring that they complete all the steps necessary along their health journey to achieve their goals.

Stay Goal Driven for a happier future!

PTC and the Subtle Art of Being There

Posted on October 25, 2022 by Edward Petty

It was in the 80s at a Parker Seminar, which was in Reno that year, that I first heard the term.

In the opening session, Dr. Jimmy Parker talked about PTC. I was attending as a guest with a chiropractor who introduced me to chiropractic. What an introduction!

Dr. Parker explained that PTC stood for Present Time Consciousness. (Parker had quite a few of these abbreviations!) He explained that a doctor could deliver a much better adjustment if their attention on the patient were in the present time, not thinking about past issues or on future concerns.

I have come to learn that this is a vital but easily overlooked skill.

You can tell when someone is 100% paying attention to you, or maybe not quite, or maybe not at all. And this makes all the difference in the patient’s trust in you, how long they stay with you, and whether they refer others to you.

But maintaining PTC can be challenging in a high-volume chiropractic office or any health office. How many thousands of adjustments does it take until all patients start blending into to one?

A doctor who worked with Clarence Gonstead told me about one evening when he was shadowing Dr. Gonstead. It was around 9 p.m., and the reception/waiting room was full. The doctor said to me that he exclaimed to Dr. Gonstead that his waiting room was still filled with patients. He said that Dr. Gonstead turned to him in the hallway before they went in with the next patient and said, emphatically, “No. I only have one patient, and that is the one I am with now.”

That sounds like he was present with each patient, and perhaps that is at least one reason he was so successful as a chiropractor.

I have seen more than a few techniques, or hacks, that help keep doctors, and support staff, in the present with each patient. For example

Completing the visit. Some doctors soundly end each visit, often confidently saying, “That was a good adjustment, and I am satisfied.” Ending one visit before starting the next visit creates a micro-break, a little space between visits.
Break up the day. Different approaches to breaking up the day seem effective. For example, busy offices usually have varied but ritualized lunch breaks. These might include such activities as weight training or exercise, marketing, team workshops, lunch with the spouse, guitar practice, you name it. Mid-morning and mid-afternoon 5-minute breaks can also be helpful. (Stay away from social media!)
Remove distractions. You want to remove distractions that can pull your attention to future challenges or past mix-ups. Pre-shift and short weekly meetings can be helpful in this regard by sorting out administrative issues so that you are free to focus on patients – in the present.
Cricket clicker! I remember one doctor telling me that he used a steel clicker, a “cricket clicker.” He would click the clicker just before the next patient visit, which would help him mentally begin the next visit. (Whatever works!)

I suspect that this is a high-level technique. One for the masters. It can’t be canned. Perhaps it is beyond technique. When accomplished, when you are totally present, the patient innately feels that you are there for them and them alone, and this perhaps speeds their recovery.

I would be interested to know how you maintain Present Time Consciousness. You can add your thoughts here on our blog.

Staying engaged in the present for a better future!

The power for creating a better future is contained in the present moment:
You create a good future by creating a good present. (Eckhart Tolle)

In Praise of Geekiness

Posted on October 18, 2022 by Edward Petty

Are you a chiropractic geek?

Are you a health geek?

Here is Merriam Webster: Geek: “…a person with a high level of knowledge or skill in a field…” “an enthusiast or expert especially in a technological field… [The word geek has] seen increasing use with positive connotations, showing membership in a specialized group (film geek, beer geek) rather than social awkwardness.”

I like the word geek because it indicates someone who specializes in a field and is so engaged that they are not especially concerned with keeping up with what is accepted conventionally. In other words, they are a bit of a rebel.

Steve Jobs, for example, was a geek. A core value of Apple was a “power to the people” idea, that anyone could have a personal computer, not just the big corporations.

Wouldn’t Clarence Gonstead have been a geek? It would be difficult to find many chiropractors who were, or are, as engaged in chiropractic as he was or worked as hard.

I remember years ago when talking with a chiropractor over lunch and all he could talk about was the X,Y,Z axis, something about Euclidean geometry, and bilateral symmetrical function. I was trying to keep up! But there he was, in practice for over twenty years, talking excitedly about the last few patients he had seen. He was a chiropractic geek, for sure.

He also had a million-dollar practice with a very strong practice manager.

Great athletes are geeks in their field, studying and training harder than most. Same with musicians or chefs.

But it is easy to get distracted from your game. Collections, bills, staffing, procedures, marketing, insurance, taxes, and everything that goes along with running a business can cut into your productivity and dilute your concentration on your services.

Don’t let it.

Only the offices that give the highest quality services and deliver the best outcomes will survive, let alone thrive. Organize your administration such that it does not dampen your eagerness to engage with each patient, and continue to study and enhance every detail of your clinical skill.

And as a plug, this is why I wrote the Goal Driven Business – to help doctors be doctors, unfettered by administration, and free to express their skills and interests in their profession.

Organize your office so that you can focus on the science, art, and philosophy of your profession. Do so that you can look at chiropractic and its results newly each day, as if you just discovered its powerful potential to help people become healthier. Go deep on every level and rediscover your profession again, for the first time.

Be a geek.

Goal Driven to seize the future,

Case Management for Better Service and Retention

Posted on October 11, 2022 by Edward Petty

Start Each Day with Service First

Do you want a fast, simple and very effective procedure that

Improves patient retention
Improves patient referrals
Improves patient service
Improves team coordination and morale.

Beginning Each Day With Service Goals for Each Patient

Too often, we start our days by first looking at the appointment book when the patients are already waiting for us. The staff may not know what special needs each patient has, or they may have been told something by a patient that should be passed on to the treating chiropractor.

A brief review of each patient can help coordinate patient services with the entire team.

Case Management Meeting Procedure

Meet with your team about 20 minutes before you see the first patient each morning. Review the patients individually that are coming in that day. You may not need to go over every patient, especially if you have a full book.

Discuss each patient and what the goal of their next visit should be. Do they need therapy or rehab procedures? What kind? Is it time for their progress exam? Did they voice a concern to a team member that you need to know about? Do they need another financial consultation or educational materials? Should they bring in their spouse?

You can also discuss new patients – what do we know about them? Are they a friend of Rihanna or Marge Simpson? Do they live in the high-rent part of town or in a trailer down by the river? Are we all looking forward to meeting them?

More Than Case Management – Keeping It Fun.

Aside from case management, the morning meeting helps get the day started. Everyone can see how each other is doing, say Hi, and be on deck all set for the day.

I have seen chiropractic offices do short exercises (practice what you preach!), such as a plank or wall sit exercise.

I have seen jokes told. For example, everyone is assigned a spot on the Bad Dad Joke Rotation. One joke per day. The most joke for the week (the best one) gets free lemon and beet juice!

You can set reasonable goals for the day – new patients, visits, case completions, etc.

You can add a motivational quotation or review the mission or a core value.

I have personally seen this applied in many offices. Often, the primary chiropractor would get to the morning meeting first, and anyone who came in late was duly noted!! One office did this procedure in the morning and then again before the afternoon crowd came in after lunch.

Assign this as a procedure to your manager, case manager, or front desk coordinator. But make sure you support it 100%.

I have seen case management meetings work for a few months and then, like many procedures, fall by the wayside.

It only works if it is done.

In the end, everything we do is to help each patient reach their goal of better health, and this is the ultimate goal of case management meetings.

Over to you!

Carpe Posturum! (Sieze the Future)

Goals, Motivation, and Discipline

Posted on October 4, 2022 by Edward Petty

“People often say motivation doesn’t last.
Neither does bathing — that’s why we recommend it daily.”
(Attributed to Zig Ziglar)

I want to thank you for continuing to subscribe to this newsletter.

It has morphed into a kind of Tuesday’s Tips for Goal Drivers.

It includes weekly practice development tips, reminders, nudges, and even sometimes…insights. We include what we have seen that works, or doesn’t, in all types of chiropractic and other offices.

This newsletter has gained momentum over the last year from the publication of my book, The Goal Driven Business. It is written for that part of us that strives to achieve our goals.

The value of goals just can not be overstated. But “goals” cover a wide range of concepts and so can become confusing or even worse, boring.

But by frequently reconnecting with WHY you do WHAT you do, what you do becomes easier and more effective. And even more fun.

Why you do what you do is your motive — or your motivation.

Motivation to achieve your goals is senior to organizational procedures — but still needs organization to support its drive. When organization fails, as it often does, motivation is weakened. And organization is directly dependent on having the discipline of doing what needs to be done.

I don’t see the subject of discipline brought up too often in practice management conferences or discussions. It’s embarrassing, perhaps. Whether it is coming in late to see patients, not doing a thorough case review, or neglecting your support team, the little oversights can take a toll on our motivation.

Attending new seminars can give you a temporary buzz and momentarily motivate you. But unless you and your team have the discipline to stick to your values and procedures, the drive to your goals will lose its energy.

In his book Good to Great, Jim Collins talks about how successful businesses create a culture of discipline. He says, “It all starts with disciplined people…Next we have disciplined thought. You need the discipline to confront the brutal facts of reality, while retaining resolute faith that you can and will create a path to greatness.” “Finally, we have disciplined action.”

In a less academic way of saying the same thing, Mike Rowe said, “Work ethic is important because, unlike intelligence, athleticism, charisma, or any other natural attribute, it’s a choice.”

The way to stay motivated is to stay true to your mission, values, and procedures and to frequently take time to face the “brutal facts” of your performance and your WHY.

Like bathing, the process never ends… and keeps you clean!

Seize your future,

Reactivation: Fast, easy, and healthful promotion.

Posted on September 27, 2022 by Edward Petty

This promotion has rarely failed. It is simple, fast, and not gimmicky. It is aimed at patients who have not been in for a while.

Patients drift off, and life gets in the way, but your patients still know you, like you, and trust you. And, like all of us, they could now use a nudge to improve their health.

So why not send them a personal letter? In your own words, tell them to get their rear back in here so they can stay in the best of health for the winter months.

Special promotions work best if they are linked to a genuine cause. In this case, the cause is National Chiropractic Month and also the fact that you have a sincere desire to ensure that people you have seen in the past continue to do well.

Special promotions also have an offer. It could be a free service or a discounted service, or the fact that your payment will serve as a donation to a worthy charity. It could also just be special Halloween organic pumpkin cupcakes from your local bakery (give the business a plug for a discount!) when they come in.

Make the offer for the entire month of October, or perhaps just for the last week.

Headline the letter with something like

It’s Chiropractic Checkup Time

October is National Chiropractic Month

You can then, for example, use your own words to say:

Our records indicate that you may not have been in to see us for a while. If that is the case, I’d (for multiple doctors – we’d) love to see you and like to offer you…[your offer.]

Remember, postural and spinal problems are often present long before any pain occurs. Therefore, getting a periodic chiropractic exam is good health insurance to ensure you remain healthy. Chiropractic is great for helping with back pain, headaches, arm and leg pain, and many other problems.

But even if you aren’t experiencing pain now, don’t wait until you have a problem. I sincerely believe the old saying, “An ounce of prevention is worth a pound of cure.”

You can also encourage them to make appointments for their family and friends.

Even if you have all the patients you can handle, this is still a good reminder for those you have seen to stay healthy.

Because that is their goal as well as yours.

Seize the future,

Staff as Support Professionals and Experts

Posted on August 30, 2022 by Edward Petty

staff experts as professionals “No company, small or large, can win over the long run without energized employees who believe in the mission and understand how to achieve it.”
Jack Welch, former CEO Boeing

There is a direct relationship between motivation, skill, and the outcomes achieved in your practice.

One doctor we work with told me that, after being in practice for over 30 years, he is now getting better results than ever before. I have watched him continue to train, study, and practice his skills over the years. As a result, he feels he is on a whole new level of expertise. He has discontinued most of his external marketing efforts. He routinely sees 100 visits per day and has brought in another doctor to help.

But you, as the doctor, are only ½ of the equation. The other half is your staff. Even if you are the best in your state, if your team is not equally as skilled and motivated in their areas, the quality and quantity of your services will be impacted.

You want everyone on your team to be professionals on the road to becoming experts.

They may not know that this is what is expected. Perhaps they consider their job is, well, just a job. Some doctors refer to their staff members as secretaries or girls. I know! The early 1960’s still lingers.

A Big Shift from Employee to Expert

Make a shift in how your employees view themselves and how you view them as well.

I have been recommending to doctors that when they interview potential employees, they let them know that in 1 year, they are expected to give part of the lay lecture to patients on health care.

I also recommend that staff study and report what they learned at staff meetings. This lets them know that they ARE professionals, should be knowledgeable and need to take responsibility for what they know.

Also, teaching is another approach to learning, as in the adage: “To teach is to learn twice.”

To stress the importance of training, I sometimes ask a staff member to answer some basic questions about chiropractic when I am at a team meeting. For example, I might ask them to define “subluxation,” or “what are the effects of a subluxation,” or what does “pain is the last to show and the first to go” mean? Often, the staff member stumbles or can’t answer. After a tense moment, I lower my head and look at the doctor. Then, I help the staff member with the answer so they don’t feel bad.

I teach a specialized exercise program part-time. Have for years. I have learned that the student’s performance is directly linked to how well I have taught them.

Your Employees are Your Students

Your employees are your students. This is often overlooked by clinic owners and here is why: they are focused on just 2 roles — doctor and owner/entrepreneur.

However, there is a 3rd role most doctors are reluctant to fulfill, which is the manager or CEO.

As CEO, you are responsible for the training and coaching of your team and hence, their performance. This is a style of management sometimes called Servant Leadership or Servant Management.

You want and really need an expert support team. A team of experts support the doctors will greatly improve the quality and quantity of services and make your life much easier. To achieve this, you’ll need to take on the CEO role. At first, this may seem to add extra work to your already busy week. But in time, things improve.

Done right, you will have a Goal Driven Practice driven by a Goal Driven Team. Still, there are real barriers to becoming a Practice CEO and creating a support team of Goal Driven experts.

Look for our new program in 2023 where I will teach the Fast Flow CEO System as part of several Goal Driven trainings for next year.

And if you haven’t purchased The Goal Driven Business yet, do so. Required reading!

Seize your Future,

If you are interested in being part of a limited number of offices trained in Goal Driven Management and the Fast Flow CEO System, click here for updates in the months to come.[ special email category]

The Value of Creating a Practice Community

Posted on August 23, 2022 by Linda

Where everybody knows everybody else’s name

Do your patients consider your practice so cool that they want to hang out with you more?

Do they come in early just to soak in the vibes and chat with other patients?

Do you have a practice club?

There are sizable benefits to creating and sustaining your own practice community. The fact is you probably loosely have one already. It is a rich resource that, if better organized and cultivated, can improve patient retention and referrals.

People want to be part of something larger than themselves. This includes belonging to a group whose values they share. Edward Deci, Ph.D., says it is an intrinsic, innate motivation we all have.

A practice club, or organized community relations program, strengthens your connection with each patient. But in addition, it builds relationships between your patients and even non-patients who are supportive of your practice.

I grew up in a small farm town. We had a very busy barbershop. It was always full of men, smoking cigarettes and talking to the barbers – and each other – about the comings and goings of our small town. I think my dad dropped in at least every other day. The barbershop had created its own interactive and slightly exclusive club.

As a more organized example, the motorcycle company Harley-Davidson established the Harley Owners Group, nicknamed HOG. You must own a Harley motorcycle to belong, and then you are eligible to attend many events the company sponsors and receive discounts on all its products. I know a few HOG members, and they are loyal to the brand and share a bond with each other. And they are active, servicing their bikes and using Harley products.

Organizing Your Community

You can sponsor your own “rallies” and probably have. Patients attend, see you and your staff outside the office, and get a chance to talk. But even more, they can connect with other patients. This is how your practice network strengthens.

You can better organize your community by delegating someone to be your Community Services Coordinator for a few hours every month. They would plan and implement various events, with everyone on staff would participating.

In addition, they could start an online club, such as a private Facebook Group. Your patients would be invited to join, as well as local businesses who share your values.

In my experience, most community-building efforts rarely amount to much because there is no one in charge to keep the group energized. Events are “one and done,” with little follow-up. This contributes to the Practice Roller Coaster effect. They do work at generating referrals and improving retention, for a while, but the energy created ebbs away.

Authentic newsletters, events, phone calls, a social media group, success stories, and special bonuses help keep the community humming along.

Network Effects

Network Effects is an economic term. It simply means that the more people use a company’s product or service, the more valuable it becomes. The larger your network becomes, the better the service improves. And the better your services improve, the larger your network becomes.

It is momentum related. Think of a flywheel or pushing a car with a dead battery. (ugh). Once you get it going, the going gets easier.

From my favorite HOG advertisement:

“It’s a free country. Live like it.
Screw it, let’s ride.”

And also,

Seize your future,

Want to improve your community building? Schedule a call and we can look at options. To schedule, go here.

In the Sierra’s

Brutal Economics: A hidden expense.

Posted on August 1, 2022 by Edward Petty

You have more expenses than you’ve probably considered.

Your biggest expense, like that old poster you have had in your reception room since 2012, has become invisible.

What is this big expense?

Well, one of the goals we work with in the Goal Driven System is the Full Capacity Goal.

This goal can be easily overlooked as we are focused on patient care, reimbursements, staffing schedules, vacations, and a thousand other tasks that require our attention.

The reason the use of goals is so effective in practice management is that they help you see the Vital Few from the Useful Many. (These terms are often used in reference to the Pareto Principle of 80/20.) The Vital Few are those factors (20% or less) that produce 80% (or more) of the results.

If you are not operating at close to full capacity, you are wasting money.

For example, if you could see, 160 patients in a week, given your schedule and good support, at $65 per visit, that would equal $10,400 per week. On a monthly basis, this would work out to be 640 visits and about $41,600 in revenue. This would be 100% Full Capacity.

You know from experience that your expenses are a lot higher than most realize. First, there are fixed expenses that you must pay out regardless of the performance of your business. And after everything and everyone is paid, after all accounts are settled, what is left over is yours.

At 70% capacity, that is not much. At 50% capacity, that is nothing.

Of course, you don’t focus on stats and money when you deal with patients as a doctor and as care givers.

But as a business owner, you must.

Numbers, analytics, Key Performance Indicators –– these make up your scoreboard and give you the best feedback to help you manage the performance of your business.

We carefully analyze our clients’ numbers each month and encourage they do the same. We also plot them on graphs and charts to notice trends. These are our x-rays.

Lately, we have realized that there is one number that gets overlooked in the hustle and bustle of business management. That is to what degree the office is operating at its full capacity.

In Goal Driven Analytics, we have been testing a “business capacitometer.” It displays, much like a speedometer or tachometer, the percentage of full capacity that the business is operating.

But you can easily do the same. Here is how:

Weekly Visits. Determine the maximum number of visits you could see comfortably each week if you were reasonably supported with software and staff. ______
Full Capacity Goal. Multiple this by 4 (I know, 4.3 is more exact): ___ This is your Full Capacity Goal.
Percent of Full Capacity. At the end of the month, divide the number of visits you saw by your full Capacity Goal and you will get the percentage that shows you how the efficiency of your practice. E.G. You FCG is 800 and you saw 600 = 600/800 = 75%

Work towards maintaining 90% or above. Find the capacity constraints and remove them.

This is also very helpful if you have multiple providers – other associate chiropractors, massage therapists, other services, even your rehab or therapy departments. After agreeing on what volume would be full capacity, each month they can see their level of performance.

Last note: It is not about the statistics. While stats are your best indicator, remember … it is not the stat that is important — it is what they represent. A helped person!

Seize the Future,

STARTING your day- Goal Driver procedure: Case Management

Posted on July 5, 2022 by Edward Petty

We are starting a new month… and the 2nd half of the year.

For all doctors and practices, the action of STARTING is important.

In fact, how you start your day is more important than you might realize.

Too often, I have seen doctors rush into the office in the morning and not greet their support team. I have even seen doctors come in late after their patients had been waiting to see them.

In most cases, the doctor’s attention is already somewhere else and not on STARTING the day with their team. They are still CONTINUING from the previous day so that workdays seem to blend together. Mentally, I am sure this brings about extra stress — feeling like work never ends or that you must toil endlessly on an assembly line that you have no control over.

Instead, make each day new. Yes, this is a cliché, but that doesn’t diminish its importance. You create your new and unique day. If you don’t, today just blurs into a continuation of earlier days.

It really all goes back to GOALS. You should START each day with the end in mind.

Goal Driver Procedure: Morning Case Management

We recommend that you start the day with your team 15 minutes before patients come in. Review the numbers and flow for the day, and coordinate patient care. This is a kind of case management meeting. Set goals for the office for that day. Tell a joke.

Morning case management meetings are a great tool to help improve the performance of your practice. Assign this to your manager, put it on a checklist, and make sure it gets done each day.

Now, for a joke: What sits at the bottom of the sea and twitches?

A nervous wreck.

(Let that sink in!)

Carpe Posterum (Sieze the Future)

Observations

observations from our travels in the world of chiropractic

Category Archives: Chiropractic