Category Archives: Practice Management

The Five Engines Driving Your Business Towards Your Goals

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A service business needs 5 different engines to become a Goal Driven Business

Having goals is not enough.

Your business needs power, and lots of it, to propel it to its goals. There are five primary engines that you need to drive your business to its goals.

  1. Customer Service and Outcomes
  2. Marketing
  3. Leadership
  4. Management
  5. Personal Power

Most businesses have a few of these engines already firing. However, in most cases, full power has not been realized. This means that you may not have enough propulsion to make it to your goals.

Let’s take a brief look at each one, and as we do so, consider how each one rates in your office: half on, fully on and functioning, or barely functioning?

Customer Service and Outcomes. As a doctor and provider, your primary focus is on providing the best service and outcomes possible. This is both in terms of the subjective satisfaction of your patients as well as the objective criteria expected in your results. But to achieve this, you need support, and this support is provided by the organization you put together as the CEO.

Marketing. As the CEO of your business, your organization must first generate customers. As a businessperson, marketing will always be your number one and primary focus. A business is dependent upon the customer. In fact, it could be said that a business is the customer. If you are not providing a service to people that pay you for your care, you do not have a business.

Leadership. An essential quality of the CEO is leadership. Leadership helps define the goals of the business and keeps the team inspired to reach them. It also insists that they are achieved.

Management. In most offices, I have seen attention placed on service, marketing, and leadership. Management, however, is often not given enough attention. Management works out how we achieve our goals. This can be a laborious and difficult process that most business owners just don’t have the time for. Plus, you are paid for your services, not for “managing.”

Personal Life Management. Lastly, often brushed aside, is how well your personal life is managed. Are you happy, and is your relationship with your family and friends healthy? Is your personal life in good order? Too often, because of the stresses of work, our personal lives can drift off in directions we later regret.

THE MANAGEMENT ENGINE

Using the Goal Driven System as explained in my book, The Goal Driven Business, you can learn how to get each engine fully firing so that you have abundant power to make it to your goals.

It has been my experience working with offices across the country that the weakest engine is always management. This isn’t true when the office is just beginning or stays at 40-50% capacity. But once the volume picks up, there are more details that need to be addressed. In addition to providing outstanding service, there is… everything else.

Management deals with “everything else.” And when it doesn’t or can’t, all these untended-to “Everything Else’s” start gumming up the works. Paperwork gets backlogged, phone calls and emails stack up, staff becomes disengaged, patient communications get cut short, and marketing gets put on the back burner. Soon, there is just too much work to do. This clogs up and limits your capacity to provide more and better service and adds more stress to you and the team.

The default solution, which occurs naturally, is a reduction of the volume of services to a more comfortable level. This is the Practice Roller Coaster, the syndrome that causes continuous stress and unfulfilled potential. Service volume goes up, it can’t be sustained comfortably, so the volume comes down.

But good management solves this. It takes you off the Practice Roller Coaster and allows your service volume to continue to increase, unimpeded. And with more services, with good management, there will be more profit.

Of course, if this was a simple solution, more offices would be seeing many more patients and doing much better. The fact is, it is not a simple fix as there are unseen barriers, booby traps, and dead ends that thwart your best efforts to streamline your management and procedures.

I cover this in my book, The Goal Driven Business. I shine the light on the hidden barriers and show you a path that, regardless of your personal skills and personality, you can follow and make it to your goals. The book covers a system of business development I call the Goal Driven System.

Of course, essential to effective management is having a manager! Oddly enough, there are no in-depth training programs for this role, and as far as I can recall, there never has been one. I cover the reasons for this in my book. Yet the ROI on an effective manager is 3 to 4 times, or more, than what you pay them

According to Gallup:
“Based on our largest global study of the future of work, Gallup finds that the quality of managers and team leaders is the single biggest factor in your organization’s long-term success.” (It’s the Manager, Clifton and Harter)

In October, we will be launching our first training program on the Goal Driven System that will include in-depth training for practice managers – and their CEO’s.

If you are interested, contact me  for more information about the Goal Driven System Program and how you can turn your team into Goal Drivers!

Meanwhile,

Seize the Day!

Ed

Tempus Fugit (time flies)

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As the ancient Greek reminds us, Time Flies — and July comes at us fast.

We are halfway through the year – 2021!

While enjoying the summer, I suggest you take a Half-Time Break and reassess, readjust, and recommit where needed. That is, reassess your progress so far this year.  Make any adjustments to your yearly plans. Recommit to your higher goals.

This is a team exercise. You can discuss with each team member first, but I would focus on the four categories below:

                What are the goals for the rest of the year?

  1. Yourself as a professional?
  2. The office as a whole?
  3. The quality of service/outcomes of your patients?
  4. Yourself personally.

You can reprint this and send it out to your team as a memo next week. Then, meet as a group in the following weeks to discuss.   Here are some tips you can pass on to the staff and doctors:

  1. Goals for yourself as a professional. How are you going to improve your level of competence as a support professional or doctor? What subjects do you want to study, or skills you want to improve, in anatomy, customer service, chiropractic, chiropractic history, marketing, health care in society, etc.
  2. Goals for the entire office. Review the mission, core values, and outcomes of our office, and from these, consider what improvement goals we could set for the next six months.
  3. Goals for the services we provide our patients? Consider such things as faster service, more complete outcomes, more fun for the patients, and more engagement with our mission.
  4. Goals for yourself personally. This is personal and can be private. It can be discussed, but that is optional. This might include such things as more time with nature, family, exercise, prayer, recreational reading, a new hobby, and travel.

Enjoy your summer but be PROactive and meet with your team to plan out the rest of the year. Keep it fun. You can meet at the lake, in the park, by the mountains or near the sea. Integrate health and an unquarantined life into your work meeting.

But remember… TIME WAITS FOR NO ONE.

Carpe Diem,

 Ed

ALSO, if you haven’t yet — buy my book now while it is still only $8. The Goal Driven Business.   It will help you achieve your goals.

The Goal Driven Business: A New Book by Edward Petty

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July 2021

 I went and wrote a book!Edward Petty displaying his new book, The Goal Driven Business

Took me more than 5 years.

Here it is:

It is called:

The Goal Driven Business
A New Business-Building Methodology That Is Simpler, Faster, More Profitable,
and More Fun Than Whatever You Are Doing Now

What the Book is About
The Goal Driven Business is a distillation of my 35 years of in-the-field work with business owners, doctors, and their teams from across the country. It also includes what we learned when we owned, with other providers, 22 practices here in Wisconsin and had to overcome significant financial, organizational, and clinical challenges – in which we ultimately profited.
Carefully reviewing what worked and what didn’t and correlating my observations with the results of other researchers, I was able to uncover certain universal practice principles I had not seen before. I was also able to isolate the hidden barriers that kept most hardworking doctors from achieving their full potential.

With this information, I put together a step-by-step map that any business owner could follow that, with good effort, could help them achieve their full potential. This a totally unique system of business development which I call the Goal Driven System. It is all covered in my new book, the Goal Driven Business.

What Others Say About the Goal Driven Business
The book has been receiving great reviews. You can read them at GoalDriven.com. Here are a few:

  • “A must read for doctors in private practice — read it and reread it, it is that valuable.” J. Peter Heffernan D.C. DPhCS.
  • “I wish I had this book 30 years ago!” Ann Metzler, D.C.
  • “The goal driven business is a “must have” for every business owner – the book is fantastic!” Cindy Munson, D.C.
  • “Mr. Petty, I have just finished reading your recent book “the goal driven business”. It is a masterpiece.” Maxwell Synsvoll, D.C.
  • “This book is more than just thorough. It’s the truth!” Tom Potisk, DC

Why I wrote the Goal Driven Business

  • Based on principals and Goal Driven. Too many offices are Personality Driven. In a Personality Driven practice, everything is dependent upon the owner. As the business grows, the burden on the owner can become too much. Stress increases, and production quantity and quality can suffer. So does income. Using the principles I observed, I worked out the natural system of business development that unfolds regardless of the owner’s personality. Knowing and applying this system in a Goal Driven Business, success is no longer dependent solely on the owner and their personality – stress decreases, and service and revenue easily increase.
  • The complete picture. As a consultant, I did not have the time to pass on all the information I had about business development in consulting sessions. As a result, clients would not get the complete picture. I also noticed that many key components to business success were avoided by other practice management consultants, books, and seminars. There are real barriers to success – and many are hidden. I reveal everything in the book — no stone was left unturned! I have charted a complete path and show you how to bypass the barriers and make the shifts necessary to reach your goals.
  • Only the best will survive. Market forces are eliminating individual businesses as monopolies continue to expand. We see more providers working for hospitals or competing with lesser skilled technicians. Large companies can dominate their markets through price, convenience, advertising, as well as “lobbying.” To survive, you need to provide world-class service and outcomes. Only the strongest practices that give the best service will survive and thrive in this decade. The Goal Driven Business shows you how to provide extraordinary service that creates extremely happy customers!
  • Your success is vital for our communities. It has become evident to me that many solutions offered by corporate entities are not always the best for the consumer. This puts the health of our communities and children at risk. Now more than ever, your patients – your neighbors – are better served by independent professionals like you whose help is not dictated or biased by titanic industry interests.

You must not overlook the grassroots power of goodwill when your patients receive excellent and genuine care. Like a stone dropped into a pond, there is a positive ripple effect that goes far beyond your office. This is why I suggest that one of the most effective methods in dealing with our challenging environment is to simply — help more people. Why not help 5 times more people? Why not help them become healthier and teach them about health? And why not earn much more? You certainly deserve it!

My book will show you how to help more people, earn more, and yet have more free time to pursue personal and professional goals. And in the bargain, you will have more fun.

And you will also help safeguard the health of your community for generations to come.

I have my book on sale for a limited time.
Usually $18, from
July 4th – Independence Day — to July 11th,
you can buy it for just $8.
Go straight to Amazon or through our website at www.GoalDriven.com

Get the book NOW!

Carpe Diem,

– Ed

P.S. A portion of all income from this book, and future training on the Goal Driven System, will go as a donation to the Children’s Health Defense (ChildrensHealthDefense.org).

Get the book! If you like the book, please post a review on Amazon. Buy more and give them to your colleagues.

The Future Belongs to the Best

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Time spent on business improvement projects in your "Goals Lab," or during down time. From GoalDriven.com (c)2021

A few years ago, a staff member at an I office visited confided in me and told me the following story:

“Our office was really slowing down last year. So, the doctor decided to take everyone out of town to a weekend practice management seminar. The speakers discussed really cool methods for doing our work. It was fun and we learned a lot. Plus, we also went over some great marketing ideas. We were all pretty excited when we returned to work after the weekend.

“On Monday, we agreed to get together at lunch to discuss how to implement what we learned. Some staff members were still dealing with patients, so our lunch meeting started 30 minutes late. Once we finally got together in the break room and started eating, we began a good meeting. We were interrupted with a few phone calls, and some patients started arriving early for their afternoon appointments. We had to cut the meeting short and didn’t get to discuss much of topics of the seminar, but we agreed to continue the meeting the following week.

“As it turned out, something always came up each week and… we never did meet again about the seminar.

“But we were still pretty pumped from the seminar and we had one of our best months ever. It was my job to clean the break room and, after a few months, I noticed that the binders of information we received at the seminar were still on the break room table, never opened. I stored them away for future reference.

“Now it is almost a year later, and everything is pretty much back to the way it was before we went to the seminar. The numbers are back down, some of us are a little burned out, and I don’t think we ever did implement anything from that seminar.”

—

Sound familiar?

I bet it does. I have seen it play out almost the same way countless times.

We are in the improvement business. We help people improve their health. We should be able to do the same for our business and for each other. In fact, if you are not constantly improving, your patients will seek practices that are.

In this new decade, apart from the many new events and changing tides of culture, technology, and mega-corporate influence, your future success is up to you. And it will be primarily based on the quality of your service and your outcomes – the experience your customers receive.

A report from a survey by Microsoft underlines this:

“As customer expectations continue to climb, it becomes more challenging for brands to set themselves apart from the competition. Markets are increasingly crowded, and both price and product are being steadily overtaken by customer experience as the number one brand differentiator” (Microsoft 2018, State of Global Customer Service Report).

More than any other short-term marketing tactics you may be using, only the best offices will thrive in the long run. And those will be the offices that are working on consistent improvement. Mediocrity could get you by in the past. But now, the future belongs only to the best.

But I have noticed that most offices just do not spend enough time consistently on improving their performance. After studying this for some time, I have observed a number of obvious and even hidden barriers that prevent us from working on improvement. I will explain what these are in a later article, but the following steps can help you ensure that you work ON your business to improve it, not just work IN it.

Your Improvement Clinic – Your Goals Lab

  1. Time spent on improvement doesn’t cost. It pays! Some business owners are concerned that time spent on improving the business or staff is too costly. It can be if the training or planning is poorly done. But remember that:
    a. Better team efficiency generates better revenue.
    b. Better trained and focused team members generate better revenue.
    c. Better outcomes generate better revenue.
  2. Head Coach. As the owner and CEO, you are also the Head Coach. How your team does – the business – is in large part based upon your coaching.
  3. Give it a name. In my new book, The Goal Driven Business (to be launched on July 4th of this year), I use the term Goals Lab as it is a location where you can go to work on getting to your goals faster. It could be your breakroom, a restaurant, a park, the reception area – anywhere really. You can call it your Practice Field, Improvement Dojo, or Mystic Garden! Just consider it a place and time that is separate from your time with patients.
  4. What gets done.
    a. Team meetings for communication, review, coordination, and planning.
    b. Team training and practice.
    c. One-on-one training and practice.
    d. Personal training, study, meditation.
  5. Schedule these routinely – weekly, monthly, quarterly, and as needed.
  6. No interruptions, no calls, 100% attention present.
  7. Be challenging. You don’t get better unless you question what you have been doing to see how it could be better.
  8. Go over this with your team. Let them know that they, too, are coaches. And players as well. So, improvement is a team activity, one that requires responsibility and professional discipline.

Your car mechanic can’t work on your car when you are driving it down the freeway. You can’t see patients while they are driving their forklift at work or cooking dinner for their kids at home. You need a separate time and place dedicated to work on improvement.

Your goal is to create an expert office that generates expert results and gives your patients the best experience they can receive from any other comparable health care business.

Imagine your business being so good that patients not only drive in from across town, or even across the state, but fly in from all across the country to receive your services. Imagine that there is such a demand for your care that you even build a motel next to your facility to accommodate the out-of-towners.

Well, there was a Doctor of Chiropractic who was just that good. His name was Clarence Gonstead. His advice?

“Practice. Practice. Practice. Never stop.”

Ed

Ed Petty - author

The Morale Virus: What doctors say and how they are combating it

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Over the last few months, I have been noticing a particular phenomenon in offices that I don’t think I have seen before… maybe ever. It is like noticing a slight hand tremor that you never knew you had or a buzzing sound from outside that has become increasingly loud and annoying.

2020 was a long year, a stressful one. And you all have been in the thick of it. Daily, seeing more people in one day than most providers see in a week – or more.

My old football coach, Johnny Pappa from Davis, made a big impression on me as a young freshman when he said: “When the going gets tough, the tough get going.” In my then youthful life, I had never heard such profound words. They still apply – especially to you. You are tough!

But stoicism has its limits. The cognitive dissonance can finally get to you.

One doctor expressed to me extreme frustration about two young and very healthy patients, who exercised, got adjusted, ate well, took their vitamins, but decided to discontinue taking their outdoor walks for fear of COVID.

Another doctor, venting his dismay, told me that he couldn’t bear to watch the medical bureaucrats talk about masking and vaccinations as the only remedies to COVID when he knew of so many methods that have been demonstrated to ameliorate the virus. “People are frightened and told to stay at home, don’t socialize, wear a mask if you go out, and wait for the vaccine. That’s it? That’s all you got for people? This really shuts people down.”

One doctor I talked to who, after dealing with depressed and suicidal patients, many of them vets, has become depressed himself. Another wonders what the hell is happening to our chiropractic colleges – have they all been taken over by medical bureaucrats? Is chiropractic finally squashed?

Your good nature can become frayed, your patience worn thin, and regardless of your professional composure and your disciplined countenance, the stresses can have an affect. I mention this because most of you are tough as nails – you have successfully dealt with many types of stressful situations in the past, as a doctor, professional, and for many of you, a business owner.

Morale Virus

So if you are feeling a bit off, recognize that you might be affected by a contagious “Morale Virus.” The Morale Virus is what I call the social sickness that occurs as an emotional response to continual fear-baiting. Frightened, your patients are told they can’t do this and shouldn’t do that.

The Morale Virus is not caused by hardship itself. It is caused when you are pushed into a corner and given no way to fight back. You tend to give up. (Or go stark raving mad!) (Reminds me of the movie, One Flew over the Cuckoo’s Nest when the star, McMurphy (Jack Nicholson), says: “You guys complain how much you hate it here, and then don’t even have the guts to leave! You’re all crazy!”)

There has been a constant assault of bad news emanating from officials and authorities. Yes, and I know the media plays a part — it is mostly owned and controlled by just a few rich people and corporations who have their own agenda — namely, more money. But still – no one buys boring newspapers. Sensation sells the news, and we, the consumers, buy it. We listen and read the “news” that riles us up and confirms our bias. Social media does the same, times ten.

Dirty Laundry (Song by Don Henley) 

I make my living off the evening news
Just give me something, something I can use

People love it when you lose. They love dirty laundry
We got the bubble-headed bleach-blonde who comes on at five

She can tell you about the plane crash with a gleam in her eye
It’s interesting when people die, give us dirty laundry

Morale Virus Disinfectant

Here are some ideas on how you can fight back, disinfect your office from this disease, and better help your patients regain their spirit of hope, kindness, and free enterprise. And yours as well.

Good Vibe Year

One doctor we work with likes to anchor her practice around a yearly theme. For 2021, she is calling 2021 the year of Good Vibes and has events planned to support this philosophy. And just to reinforce the idea, she has T-Shirts made that say Good Vibes. (And by the way, she has a bustling two-doctor office.)

Study. Acquire More Knowledge. Teach

Fear is often a byproduct of lack of knowledge – so arm yourself with the facts.

For example: Roommate 1: “Oh my god! (A panic shout is heard.) The television isn’t working and the game is on. What will we do?” (Drama ensues.) Roommate 2:(Calmly) “Check the remote for new batteries.”  Roommate 1: “Ah, that fixed it, thanks.”

Study, use critical thinking, avoid bias – your own and others. Go to the sources – research studies and from people who are actually working on what you are studying. Then, please educate your patients and clients on how to be happier and healthier. And educate your team, help them increase their knowledge. Arm them as well. Doctor comes from the Latin to docere – “to show, teach, cause to know.”

Leverage Point

What area in your office, if changed, will produce the most significant effect?

Obviously, first and foremost is the doctor. Each day should be a trip to the playground, the ski slope, the baseball field, the dance floor. Ideally, each day is a fresh opportunity to accept the privilege of helping as many people from suffering as possible, to teach them, and have fun doing so.

In most offices, I would also say it is your front desk. The front desk’s power is so poorly recognized in most offices that at least 20% or more production is lost. A vibrant, aggressively friendly, caring, mission and goal-oriented front desk can and will boost your volume – this week. Front Desk team members may need more support and less admin (billing) duties. They may need a better understanding of the mission and how your office is helping people.

Entrepreneur Harder

During cultural upheavals and shifts, entrepreneur businesses remain and often thrive. New opportunities open up. More established and larger companies are weighed down by dogmatic rituals, have high overhead and many vice presidents, and vast networks of suppliers. Change is difficult. But not for the entrepreneur. Most entrepreneurs are all too “change-happy.” You can adapt, innovate, and overcome quicker than companies who are afraid to or can’t. So what if in-person care classes are out for now? Get everyone on a Zoom class, give them a secret word. Test them when they come in again and if they answer correctly, give them a gift – a bottle of Vitamin D or a lunch at another patient’s business.

Stay Out of the Weeds

One doctor told me that her solution was to “stay out of the weeds.” To stay in her lane and just keep helping people and not get caught up in the storms of controversy. I suggest that this is the best course of action. You want news? Sensational news…? Just listen to your patients and staff and community. But stay on the fairway and don’t get sidetracked, mentally or in real life.

Goals

Stay with your goals. Goals are agreements that you made with yourself, and usually others. If you stay true to them, they will lead you out of the den of the morale sickness. Staying true to your goals is a point of integrity. Your goals are not in the weeds – they are straight ahead. Figure out new and better ways to get there or resurrect old ways that worked. Fall down 7 times, get up 8. Each day and each week — begin with the end in mind.

Your goals are in three categories:

  1. Financial. This includes marketing and production.
  2. Service. Developing individual and team expertise with constant improvement..
  3. Purpose. Your higher purposes, those goals outside of work that are greater than this week and that are most meaningful need to be integrated into your work-life.

The Future is Bright and Roaring!

We have seen harsher times. The past is easily forgotten, and we think we are in the worst of times. Well, the 1918 flu was much worse than COVID. Plus, we were sending our young boys to suffer in horror and die in the trenches in Europe in the Great War. But society prevailed and soon ushered in the Roaring 20’s, a time of economic growth and cultural freedom.

Prepare to roar!

Carpe Deum (Seize the Day)

Ed

Ed Petty - author

This is such an important subject, I encourage you to share it with your team and colleagues:  To print out a hard copy

Wisconsin License Renewal Requirements – 2020

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REMINDER:  Wisconsin License Renewal Credentialing Requirements

*Please Note:  Due to the pandemic, usual and customary continuing education requirements are waived this biennium.   However, even if you did not complete your hours, you still need to renew your license.

A review of the usual requirements follow:

Doctors of Chiropractic (DCs):

  • Continuing Education: Forty (40) hours minimum of state board-approved courses; four (4) of the 40 in nutrition
  • Maintain Current CPR

Starting now and prior to December 14th, renew online: https://online.drl.wi.gov/UserLogin.aspx

Chiropractic Technicians (CTs):

  • Continuing Education: Six (6) hours minimum of state-board approved courses

Starting now and prior to December 14th, renew online:  https://dsps.wi.gov/Pages/Professions/ChiropracticTechnician/CE.aspx

Chiropractic Radiological Technicians (CRTs):

  • Continuing Education: Twelve (12) hours minimum of state-board approved courses

Starting now prior to December 14, renew online:  https://dsps.wi.gov/Pages/Professions/ChiropracticRadiologicalTechnician/CE.aspx

TIP:  Keep your transcripts and file them safely, in the event of a continuing education audit.

Approved course listings can be found here:
https://dsps.wi.gov/Pages/Professions/Chiropractor/CE.aspx

All licenses (DC, CT, CRT) expire on December 14, 2020, at midnight.

Questions?

Contact Lisa Barnett
PM&A Consultant
920-334-4561

How to Defeat COVID: Be A HEALTH OUTLAW!

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“I will sell Chiropractic, serve Chiropractic, and save Chiropractic if it will take me twenty lifetimes to do it. I will promote it within the law, without the law, in keeping with the law or against the law in order to get sick people well and keep the well from getting sick.” — B. J. Palmer

What is it with all the bad news ALL the time?

Well, here is some good news: across the boards, practices are returning to their pre-COVID days. We monitor our clients’ numbers closely, and we see offices meeting, and in some cases, exceeding what they did at the same time last year! A few others are even hiring more doctors and staff.

What? Isn’t the world coming to an end?

Hell no! And here is why: people like you, and your patients, are, and always have been, rebellious. Health rebels! You question authority. (How dare you!)

What we are witnessing, for chiropractors and other non-conventional health offices, is nothing new. The good news and benefits of real health care are never promoted, and in fact, are suppressed. Got pain? Here, take some opioids. Back problem? We’ll just do surgery. Too much weight? We’ll suck the fat out. (yuck) Arthritis? Here, have some Vioxx.

You know what real health care is – and isn’t. And you know what? So do your patients. You can’t fool everyone all the time. And I would say that much of the world is with you, despite the massive media slant towards drugs and population crisis control. People are aware of organic food, for example, and so organic products and food stores have had explosive growth in the last 20 years. And supplements! The supplement industry has also seen mega growth and is expected to grow over 12% this year, according to Nutritional Business Journal*.

People know what side you are on – their side. They know what you stand for – health. You are the health doctors, coaches, and teams — curious, caring, and independent. You aren’t beholding to hospitals, a bureaucracy, or drug companies. This is what Dr. Zelenko cited as a factor to help him, and his colleagues come up with an inexpensive antidote for COVID that is 80-90% effective – so effective in fact, other countries are adopting it. I strongly recommend his YouTube videos, especially the one with Del Bigtree. (Link below.)

Here are some suggestions to Fight COVID:
How to Fight COVID: Steps for Health Outlaws

  1.  Goal: Get more people healthier.
  2. Stay on the offense. Stay true to your goal. Think about how you can help three times more people.
  3. Don’t let the negative few outweigh the positive many. Keep in mind, only a small percentage of bad things cause the majority of the bad news. (Pareto Principle – 80/20)
  4. Don’t get distracted by politics, or “I am right — you are wrong.”
  5. Be nice. Understand people are confused and frightened. Don’t call people sheeple, cowards, or selfish killers.
  6. Protesting is fine. Just don’t get side-tracked. Stay GOAL DRIVEN.
  7. Keep studying what is working. Mercola.com, Highwire with Del Big Tree, ChildrensHeathDefense.org, and others.
  8. Use your voice and educate others.
    a. Use Table Talk, your most powerful weapon when combined with excellent service and outcomes.
    b. Use newsletters. Genuine communication keeps the relationship and conversation going with you, rather than with the media or distraught neighbors or family members.
    c. Post on social media.
    d. Zoom workshops.
    e. Podcasts.
  9. Stay Well in Winter campaign. Consider promoting a health and conditioning program, Stay Well in Winter, to strengthen people for the seasonal flu and possible “2nd Wave” of COVID.
  10. Join or create a Health “Rebel” Alliance. Network with other providers in your area and form a health “conspiracy.” Chiropractors, acupuncturists, Holistic MD’s, Naturopathic Doctors, Biological Dentists, Exercise Trainers, Organic Food Co-ops, to name a few. Lead the way.

The chiropractic profession has been the largest and most active professional group standing up for true health for over 120 years. Absolute American and homegrown, your profession has been genuine guardians of health, and has withstood every attack imaginable. So, all this pandemic stuff is pretty routine for you guys and gals. And if this has made you Health Outlaws, I know that sits just fine with you.

Loads of sincere respect and thanks for crisis medical teams, as always. But keeping people out of crisis, out of hospitals is your goal, and ours as well. We share this goal with you and stand with you to help more people become healthier.

Thank you for all you do.

Ed and all of us at PM&A

Del Bigtree and Dr. Vladimir Zelenko 45 minutes
Deal Big Tree “Crimes Against Humanity” – with Dr. Zelenko and others, full presentation. 2:16

Nutritional Business Journal.

Have You Helped A Child Today?

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It’s a beautiful fall day here in Southeastern Wisconsin. Clear blue skies, the leaves are changing, and the temps are comfortably cool.

I wanted to take a few minutes of your time to introduce myself and let you know about an upcoming opportunity for you to make a difference in a child’s life both locally and globally.

My name is Linda Skiles, some of you already know me and some may not. I have been involved in chiropractic for the past 34 years in some way or another and a patient for most of my life. I began as a chiropractic assistant, graduating to an office manager, and now serve as the client services coordinator for Petty, Michel, and Associates, working with offices across the nation to promote PMA’s 3 Goals(sm)of methodology:

  • Greater Profit
  • Better Service
  • Higher Purpose

I am passionate about chiropractic and passionate about making our world a better place. Each and every day, I strive to find a way to live with a Higher Purpose. With that said, I’d like to invite you to help support my most recent mission.

Ed Petty and Dave Michel along with the Chiropractic Society of Wisconsin(CSW) have graciously given me the opportunity to collaborate with Wisconsin United for Freedom and Chiro Kid’s Day to host a “Kid’s Korner” at the CSW’s Fall Summit, October 18th-20th at the Wilderness Canyon Lodge Convention Center in the Wisconsin Dells.

The whole idea was born when I made the commitment to sell 600+ ornaments for the Khutsala Artisans of Project Canaan. A large task but achievable with your help.

Project Canaan is Heart for Africa’s 2,500-acre large-scale land development project being used to bring HOPE to the tiny Kingdom of Eswatini (formerly Swaziland) by focusing on four key areas: Hunger, Orphans, Poverty, and Education. It will provide training and employment, while supporting orphans and vulnerable children on the property and across the nation.

In 2013 my twenty-nine year old son, searching for a higher purpose in life, found Project Canaan and served as a volunteer missionary for one year as the bulldozer operator. I had the opportunity to visit while he was there and joined the Swazis in making jewelry. I continue to support their efforts through selling their beautiful beaded ornaments. 60% of the sales support the Khutsala Artisans’ daily living needs and 40% is donated to a local charity of my choice. Proceeds from the sales at the CSW Fall Summit will go to Oklahaven Children’s Chiropractic Center in Oklahoma City, OK.

In addition, I recently published my third book entitled, Nettie’s Fountain Pen – Another’s Days Writings. $5.00 from the sale of each of these books will go to Chiro Kid’s Day and Wisconsin United for Freedom.

Promoting the wellness of our children locally and globally is the theme of our booth. We will have informational material and resources available that focuses on the health of our children here in the US. I hope you will stop by, see what we all have to offer, and support our efforts.

Our children are our future! Can you help a child today?

If you are unable to attend the CSW Fall Summit but would like to purchase ornaments or books, please email me at linda@pmaworks.com

Sincerely,

Linda Skiles
262-749-0221

Links:
Follow my Journey at Project Canaan  – Oct 17th 2013 – Nov 1st, 2013
Oklahaven Children’s Chiropractic Center
Heart for Africa – Project Canaan
Wisconsin United for Freedom
Chiro Kid’s Day
Children’s Health Defense

Goals, Games, and Groundhog Day

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It is a New Year and already we are knee-deep in its work.

But it is a NEW YEAR and it is important that you take time out to make new plans and then review them often.

Life Works in Cycles

Each year in Wisconsin, the leaves fall and then the snow falls. But by July the strawberries are ready for the pickin’. Every month, we can see the full moon. Each day, we can see the sunrise – if it is not cloudy.

In human endeavors, we seem to follow this natural rhythm of following cycles. After we finish the 9th grade, we are ready to begin the 10th grade. We are excited to finish when we get out of school for the summer, and then again, eager to start the new grade when we begin again in the fall.

These are all cycles.

What would happen if you stayed in the 9th grade, year after year? How would you feel?

Yet, in our work life we fall into the trap of doing the same thing over and over and over. This is not the first unique and special patient you have ever seen…this patient is a customer just like all the others — just another case. Today is not the first day of the rest of your life, it is just like yesterday which is the same as a long line of days that go on and on. And on…

We get beaten down by the tedium, working endlessly for some forgotten purpose, as if the assembly line we were on never stopped and was always the same.

This is a major cause of stress.

Groundhog Day Syndrome

You can’t do one thing forever, like in the movie “Groundhog Day.” In it, the main character visits a town in Pennsylvania where everyone watches to see if a groundhog can see its shadow. This is traditionally on February 2 (This year, it is on a Saturday.) The only problem is, for this character, the day keeps repeating and repeating, the same each day. It drives the character to suicide, but even that doesn’t work. Finally, he falls in love and wins the girl and has a new life.

Anything in life that begins, it seems, must end. It can start again, but it must end so that a new iteration can be created. It is the cycle of life.

Goals and Games

This is an important factor in what is called Gamification. With the advent of computer games, design elements are added in to make the game fun, challenging, and motivational.

But games are nothing new. Baseball is a game. It has a season and games and innings. It has cycles. Games have been part of human behavior since the beginning. The Olympics started in 776 BCE.

One aspect of games that can be overlooked is the fact that they are just an activity for play. Play is something we do naturally as toddlers. As we grow older, this activity becomes structured into organized sports and games, but at the core is the desire to have fun. To play.

We can lose this sense of play when what we do has no end and no beginning. Persistence is a good quality, but it can lead to an enforced dullness that buries our enthusiasm.

It is important to keep in mind that in business, as in sports, keeping the perspective of play is more effective than bearing down on one’s duties with serious gravity. Practices that incorporate some of the components of a game into their operations are more productive and have a better time.

What are your goals for 2019? For the 1st Quarter? For this month… or for today? Higher numbers? New team members? Community wide outreach program? New training and greater knowledge?

As soon as you make a goal, you start a new cycle and begin a new game. Try to win. But you could lose. Either way, don’t get too serious about it and just be grateful to be able to be in the game.

Set new goals and play. Play — to win. Have fun. Smile a little more!

Special Promotions: When Your Motive Meets Your Mission

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When I was a boy and I would see scary things in the news, my mother would say to me, “Look for the helpers. You will always find people who are helping.” — “Mr. Rodgers” (Fred Rodgers)

Many offices (chiropractic, dental, etc.) hold special events, such as a “Kid’s Day,” a “Patient Appreciation Day,” an anniversary party, or in-office workshops. (We have links to examples below.)

The objective is usually to generate new patients, increase goodwill, and motivate existing patients. Sometimes these events are productive… and, as you know, sometimes they aren’t.

To be effective, you have to offer something that the patient, or prospective patient, considers valuable. It could be a workshop on practical health tips or a discounted service for a patient’s family member.

This is obvious and I am sure this is what you aim for. But there is another ingredient that you may not have considered that will make your events even more effective.

Link your promotions directly into your office mission.

Your mission is to help people. You may have it more fully defined in a “mission statement,” but it comes down to helping people achieve their health goals. Your mission is altruistic and socially responsible – you aren’t selling oxycodone at the pharmacy, high fructose corn syrup drinks at the grocery, or glyphosate at the local Round-up store. You are the good guys.

Your community will support you to the degree that they understand your pure altruistic motives. Why? Because the members of your community, by and large, are altruistic too. Your neighbors also… want to help people.

It is not a dog-eat dog world like social media or the “news” wants us to believe. Money is made from controversy and opposing sides and so it appears like we are fighting our local townsfolk… or should be. But behind all wars there are vested interests. Fear and anger motivate people and help sell media, advertising, and weapons.

But the truth is, the vast majority of us want the same things and we are not as divided as we have been manipulated to believe.

The organic food business has been growing, as have companies that sell organic clothes. Pesticides, herbicides and other poisons are not only bad to eat, they are also not healthy for the workers that bring these products to us. People are realizing this. “Fair Trade” coffee has become a major selling point. More companies are integrating social responsibility initiatives as part of their long-term strategies…for good reason.

In a study done in 2015, it was shown that consumers wanted to take personal responsibility for social and environmental issues and indicated that they looked to companies as partners in pursuing improvement efforts.

“The leading ways consumers want to get engaged with companies’ CSR [Corporate Social Reasonability] efforts are actions tied directly to their wallets, with nine-in-10 just as likely to purchase (89 percent) as to boycott (90 percent) based on companies’ responsible practices.

“If given the opportunity:

  • 80 percent would tell friends and family about a company’s CSR efforts
  • 76 percent would donate to a charity supported by a company they trust
  • 72 percent would volunteer for a cause supported by a company they trust
  • 72 percent would voice their opinions directly to a company about CSR efforts”*

How do you better apply this public trend?

You can encourage your patients to make appointments for themselves, and their family and friends, in exchange for making to make donations to a needy local charity. You can have them volunteer at a food pantry or a shelter with you and your staff – and offer all who participate a free service.

Integrate you mission in all your promotions on a regular basis and you will create a positive “network effect.” Other residents who volunteered will begin to promote your business on their own – even if they never step in to your office.

You should be way past working for United Health Care and Big Insurance. You should work for your patients and their causes – which are yours as well.

If you lead all your promotions with your heart, with your mission, with your higher goals, and deliver excellent outcomes with extra-ordinary services, your patients and your community will support you.

You are “The Helpers.”

Be true to your higher goals and all else will follow.

Ed Petty

*References:
•http://www.sustainablebrands.com/news_and_views/stakeholder_trends_insights/sustainable_brands/study_81_consumers_say_they_will_make_
• https://www.forbes.com/sites/sarahlandrum/2017/03/17/millennials-driving-brands-to-practice-socially-responsible-marketing/#61519f914990

Links to special promotions article and list of special promotions

Special Promotions-What They Are

List of Special Promotions-2018

The Merry-Go-Round: Planning for a Prosperous Practice in 2018

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Progress in practice is made by steady persistence and passion.

In Angela Duckworth’s new book, she calls this “Grit.”

Think of evolution, think of growing crops… think of growing children!  Whether it is child development or practice development, growth is achieved through steady and unrelenting nurturing and adjusting according to circumstances.

I recommend you take some time to do some planning before the New Year gets in high gear. January and February are good months to do this.  Do it by yourself – and do it with your team. But…

Don’t reinvent the wheel… Just make it go faster with less effort.

 The Vital Few

A few of our actions are always more productive than most of the other actions that we do. Unfortunately, we can get distracted and spend far too much time on activities that, in retrospect, just don’t give us that much of a return.

The “vital few” actions that have helped you the most will be camouflaged, even countered, by the “trivial (but useful) many.” This is a term used by Nathan Juran, famous for his approach to business and quality improvement and the Pareto Principle.

And, I would like you to consider this: In many respects, your business has succeeded in ways that – perhaps – you have not yet recognized.  Therefore, I don’t recommend abandoning all you did last year and start chasing the newest “shiniest” procedures that seem appealing.

The key is to dust off all your actions from 2017 – review everything you did — and see the great things that worked and the victories you and your team achieved.

Then, just find better approaches to do more of this!

Diamonds in Your Office

The idea of having diamonds in our backyard, a story made famous by Russell Conwell (1843 – 1925) of the 1800s, applies. There are many variations, but it goes something like this: there once was a man who wanted more wealth, so he sold his house and left in search of diamonds. Years later, penniless, he happened back to his village where he roomed at a shelter for the poor. The shelter was supported by a grant from a local resident. In inquiring who the resident was, the diamond searcher discovered that it was the person to whom he had sold his house.

One day he paid a visit to his old house, now renovated into a beautiful estate. He talked to the new owner who told him that he had become rich. He said that when he bought the house, he needed to do some digging in the backyard where he discovered thousands of diamonds.

The moral of the story is obvious: you already are rich – you already have the diamonds. You just need to polish them.

Many of the components of your future success are already in your office. But we overlook them, or use them once and then forget about them, like teenagers looking for the next new article of clothing to make a fashion statement.

As entrepreneurs, creatively – we are all looking for that next dopamine high… and seek the next new “shiny” thing.

You have a show on the road. Just make it better. Make it fresh. Set a new standard, and make a new game to “level up!” Add a few new things here and there, but keep doing what is working.

Looking for Your Diamonds

Review what has been working for you. Reaffirm it and keep at it. Look at what hasn’t worked that well and fix it so that it does, or drop it like barbell that you have been holding over your head for too long.

By yourself, and later, with your team, here are some areas to look into:

____1. Review Your Mission Statement. Does it apply? How? Does it need to be customized? Beyond your mission, what is your WHY? Does the mission satisfy this?
____2. What Are Your Outcomes? For example: “People relieved of pain, healthier, educated so that they can and will continue to improve their health… and refer others?” You can also define Minimal Viable (Valuable) Outcomes, e.g., “A patient who accepts care.” Etc.
____3. How Is the Office Vibe? This is determined by your values and how everyone is living up to them. Are these values posted for all to see and check how they are “measuring up?” Are they defined? Do we need to add more, change some, delete some? Should we better define each value? Should we add:

• Trust. Are we worthy of trust with our patients and ourselves?
• Mission Oriented. Do we help each other cheerfully achieve our mission – each day?
• How well are we living up to these?
• How can we live up to these better?

____4. How Were the Numbers? Up, or down?

• When the numbers went up, what did, or didn’t we do? How can we improve upon this?
• When the numbers went down, what did, or didn’t we do? Should we improve or discontinue those actions?

____5. Individual. What can each one of us do professionally this next year to improve our ability to contribute to our team and its mission?

Some of this should be on simple, brief checklists and memo’s. Add it to your Practice Playbook. Document it so that it can be referred to for training and coaching in the future.

Merry-Go-Round

Imagine that your practice is a merry-go-round, the kind you find at children’s playgrounds.

It takes a lot of energy to push it and get it going. But… once it is moving, it takes less effort to gradually get it going faster. And faster! And faster…

Take some time to review how you are pushing your merry-go-round. What procedures worked better for pushing it faster? Focus on these… Makes these better.

Go faster… and push less.

And as you do, watch those, including yourself, hold on tighter and smile bigger.

Enjoy the ride!

With admiration,

–Ed

Phyllis Frase to Speak at the Chiropractic Society of Wisconsin Fall Summit on Referrals and Retention

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p-frase-hs2

Welcome back to Wisconsin Phyllis!

We are excited to have Phyllis returning to Wisconsin to join us at the Chiropractic Society of Wisconsin Fall Summit.

The Fall Summit will be held October 21st through the 23rd at the Kalahari Resort in Wisconsin Dells.

Are you and your team registered?  If not you will want to as Phyllis will be presenting to doctors and staff all day Friday.  She will be covering the following topic:  

“The Secrets of Referrals and Retention”

What’s the secret? The pixie dust? The magic potion to creating patients that stay pay and refer for a lifetime?

In this class you will walk away with what makes a patient pay and value their chiropractic care. This interactive class will help you create great customer service and learn easy, solid systems and procedures that will take your practice to the next level.  Included is low stress, low cost marketing ideas that you can implement on Monday morning.

For more information on Phyllis visit: Our Experts

To register for the CSW Fall Summit visit: CSW Fall Summit 2016

 

Wisconsin License Renewal Requirements

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REMINDER:  Wisconsin License Renewal Credentialing Requirements

Doctors of Chiropractic (DCs):

  • Continuing Education: Forty (40) hours minimum of state board-approved courses; four (4) of the 40 in nutrition
  • Maintain Current CPR
  • State Approved Course Listings are updated regularly, and can be found at: DC Approved Courses

Starting in October 2016 and prior to December 14th, renew online:  DC Renew

Chiropractic Technicians (CTs):

  • Continuing Education: Six (6) hours minimum of state-board approved courses
  • State Approved Course Listings are updated regularly, and can be found at:
  • CT Approved Course Listing

Starting in October 2016 and prior to December 14th, renew online: CT Renew

Chiropractic Radiological Technicians (CRTs):

  • Continuing Education: Twelve (12) hours minimum of state-board approved courses
  • State Approved Course Listings are updated regularly, and can be found at:
  • CRT Approved Course Listing

Starting in October 2016 and prior to December 14th, renew online at: CRT Renew

TIP:  Keep your transcripts and file them safely, in the event of a continuing education audit.

All licenses (DC, CT, CRT) expire on December 14, 2016 at midnight.

Questions?  Contact Lisa Barnett, PM&A Consultant, at 920-334-4561

~~~~

Links

DC Approved Courses: https://dsps.wi.gov/Default.aspx?Page=b74564c8-7d6c-4258-9809-cd118336a9f5
DC Renew: https://online.drl.wi.gov/UserLogin.aspx
CT Approved Course Listing:http://dsps.wi.gov/Default.aspx?Page=830a2718-a0f7-414c-8e97-2481f983bc78
CT Renew: https://online.drl.wi.gov/UserLogin.aspx
CRT Approved Course Listing: https://dsps.wi.gov/Default.aspx?Page=bcfb3543-eb0a-46bf-ba89-8f1fe6d84325
CRT Renew: https://online.drl.wi.gov/UserLogin.aspx

Printable Version of this quick checklist of requirements. [LINK]

The Importance of Compliance in a Chiropractic Office – HIPAA, Covered Entity, OSHA, HITECH

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Lisa J. Barnett

Lisa J. Barnett

HIPAA, Covered Entity, OSHA, HITECH – – Compliance. What’s happening in the world of compliance and why do you as a chiropractor need to be educated and remain in the know? Find out below . . .

First and foremost, according to the Health and Human Services (HHS), chiropractors are included in the covered entity category, and this is regardless of whether or not you have received Electronic Health Records incentive monies. Covered entities are required by federal law to comply with all areas of protected health information and employee safety standards. Impact of non-compliance? In February 2016, a covered entity was fined $239,800 for non compliance.

Further, according to a March 2016 survey among small practices designated as covered entities, 60 percent of the 900 plus professionals surveyed are still unaware of pending compliance audits, and 58 percent have not appointed a securities/privacy officer in their practice. Audits to our profession are forthcoming, and we cannot opt out. Keep reading on how to safeguard yourself and your practice. Also keep in mind that it takes approximately 40 to 50 hours to develop and secure a compliance program.

The three main areas of compliance you need to be aware of, educated in, and be an active participant include: HIPAA, OSHA, and IT Securities.

Health Insurance Portability and Accountability Act
The Health Insurance Portability and Accountability Act (HIPAA) law of 1996 was enacted to improve the portability and accountability of health insurance coverage, and it brought individual privacy rights to patients and requires that we notify them of their rights. It also serves to eliminate fraud, waste, and abuse in healthcare. The focus here is to safeguard your practice by securing personal (patient) health information (PHI) and personal identifiers, be it paper or electronic (ePHI). This can include data encryption, secure messaging, compliant Cloud storage, compliant software, and unique password setups. One of the areas I assess when I visit a clinic is locating where the patient paper files are kept and if they are well out of viewing from others.

Your HIPAA requirements to be compliant at the clinic level include:

  • Designating a compliance/privacy officer whose primary responsibility is to ensure compliance with the regulations
  • Establishing and implementing at least annually, training programs for all employees and doctors.
  • Implementing appropriate policies and procedures to prevent intentional and accidental disclosure/release of PHI or ePHI. Encrypting your data for example will lower your chances of ransomware or cyberattacks.

OSHA
The United States Occupational Safety and Health Administration (OSHA) Act was signed by President Nixon in December 1970. It is designed to protect worker safety and promote healthy work environments. Some of you Docs have been involved in workplace safety and onsite workplace assessments in factories. Kudos to you! You were advocating OSHA’s mission by: Educating your client and their employees on workplace safety by conducting posture and ergonomic assessments, and finding the best ways for workers’ compensation patients to get back to work and continue contributing safely and appropriately within their restrictions.

At the clinic level (can be delegated), your requirements to meet OSHA requirements include:

  • Displaying the required workplace safety and employee rights posters for all employees to review
  • Establishing annual training for yourself and your employees. Local fire departments usually are able to conduct these trainings and are willing to include other participants.
  • Developing a written emergency plan in case of fire, severe weather, etc.
  • Drawing up an exit plan and post for employees and patients to see. See example below:

evacuation map

  • Developing written procedures (universal precautions) to minimize risk exposure to bodily fluids such as blood, vomit, saliva.
  • Obtaining Safety Data Sheets for disinfectants used at the clinic, as well as if you process X-rays.
  • Have handy your Quality Assurance X-ray manual, follow it, and ensure it is accessible to those who take/process X-rays.
  • Ensuring ergonomic workplace assessments are conducted at the clinic and documented. This could include posture screenings for your employees and requiring stretch breaks – for you, too!

Information Technology (IT) Security/HITECH

The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of HIPAA and the American Recovery and Reinvestment Act of 2009, was signed into law on February 17, 2009, to promote the adoption and meaningful use of health information technology. Section 1176(a) of the Social Security Act was revised during this timeframe to allow for significant monetary penalties up to $1.5 million for breaches/violations of protected health information. However, an interim revision (later known as The Omnibus Rule) set prohibitions on enforcing such significant monetary penalties if it was found in investigation that the covered entity did not know and with the exercise of reasonable diligence would not have known of the violation. In these cases, the breaches were punishable under the lowest tier of penalties, and further, prohibited the imposition of penalties for any violation corrected within a 30-day time period, as long as the violation was not due to willful neglect. A final ruling in January 2013 reiterates all of the above standards.

Your responsibilities to get IT Securities compliant include:

  • Assigning a securities officer
  • Conducting a risk assessment
  • Ensuring your EHR vendor and billing clearinghouse are HITECH/HIPAA compliant
  • Ensuring every vendor you work with has signed a Business Association Agreement with your office and you have those Agreements on file. These need to be updated at least annually.
  • Ensuring the clinic’s computer systems are backed up regularly, have virus-checking software, firewalls, and encrypted operating systems
  • Establishing securities policies and procedures, including on your social media networks.
  • Creating a disaster recovery plan
  • Creating a policy and procedure of notification, in the event of a data leak or leak of PHI/ePHI

Impact of non-compliance? Another covered entity was fined $25,000 for posting patient information online.

Feeling overwhelmed? We can help. Contact me on how you can get an initial Compliance Assessment and a Medicare Documentation Assessment with a Report of Findings sent to you, for a ridiculous low price of $299!*

References:

  • nueMD Cloud-based health information technology, http://www.nuemd.com/webinars
  • HIPAA Journal, http://www.hipaajournal.com/
  • United States Health and Human Services, http://www.hhs.gov/hipaa/
  • United States Occupational Safety and Health Administration, www.osha.gov/
  • Federal Register/Rules and Regulations Publication Vol. 74 No. 209
  • Federal Register/Rules and Regulations Publication Vol. 78 No. 17
  • Emergency Exit Diagram: www.steamwire.com business continuity templates

*Mileage cost may apply.

Your Most Important Set of Chiropractic Office Procedures

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An Introduction to the Practice Development Process of Continuous Improvement

A key difference between a successful and profitable chiropractic business and a roller coaster type practice can be traced back to procedures and systems.

Many practice problems occur because procedures are not established, consistently followed, and regularly improved.   This has been the secret to franchising. Starbucks may offer new products and services now and then, but for the most part, they follow their checklists and manuals of successful procedures.  The local New Age coffee shop down on the corner with the unemployed guitar player usually lasts for about a year before the owner’s savings and inspiration dry up, along with the last cup of coffee.

chiropractic practice playbook

Of all the categories of systems in your office, what would you say would be the most important?

☐Patient Accounts (Billing/Collections) Systems
☐Marketing Systems
☐Front Desk Systems
☐Therapy and Clinical Support Systems
☐ Doctor Systems
☐ Business Systems (Payroll, Financial Planning, Taxes,)
☐ Leadership
☐Office, Practice Management Systems

My guess is that you usually keep most billing procedures in place as… obviously, you need to be paid.  And, you will usually keep most front desk procedures in place. These deal with patients and patients are obviously in the office, or not. And you, of course, follow your clinical procedures.

Your marketing procedures come and go, at least they do in most offices. They are just not consistent. This is why I put together the Marketing Manager System in 2000. The biggest error in most offices with their marketing is that it simply isn’t done consistently.

But the most important category of systems is not so obvious. These are the management procedures and systems.  Why are these most important? Because they keep all the other procedures in place and are continually being improved upon.

Why do you think CEO’s are paid so much money? Because they are in charge of the management of a business and are able to increase its bottom line by the millions.  They have procedures that they follow and insist that others do as well. These procedures all add up to systems.

Over the years, Petty Michel and Associates has been very successful at increasing the revenues of practices. One of the reasons is that we implement what we call the Practice Development Process. It is a monthly system of management that gradually works to objectively improve the business, repetitively over and over.  It integrates into your current systems and does not take that much extra time.  But in the end, it saves you a great deal of time, extra work, and lost revenue.

To learn more about the 3Goals Practice Development Process: 3Goals PDP

The 3Goals Practice Development Process for Chiropractic Success

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Four steps to continuously develop and improve your practice

The Practice Development Process is a simple, yet powerful practice building system that can help take you and your business to its full potential of a systematized, team driven and profitable business.

Practice Development Process icon

It transforms your practice. Month by month, it helps move your practice to a more profitable service oriented business that runs at near full capacity – with less ups and downs that demand your time and extra work.

It is based upon the idea of constant improvement.   

The principle of constant improvement in management science has been a major factor in the success of large manufacturing corporations around the world. The success of the Japanese automobile manufacturing rests heavily on a process of constant improvement called Kaizen (kai = change, zen = good).    Motorola developed its own program called “Six Sigma”, a process of continuous improvement.

Kaizen

We have adapted these processes to be applied in practice management and call it the 3Goals Practice Development Process (PDP).

The Practice Development Process has four steps:

  1. Access
  2. Plan
  3. Supervise
  4. Document

Integrate This Process As Part Of Your Team Meetings. The first two steps, Assess and Plan, are usually done before or during the first staff meeting of the month. Supervision goes on during the month to ensure that the plan gets completed. At the end of the month, successful procedures are documented in a practice playbook for future training and assessments.

Your Consultant and Coach. This process is best done with your practice and business coach.  Each month, the two of you should work through step 1 and 2. During the month, your coach may also be able to help with the implementation of the plan.

THE 4 STEPS OF THE PRACTICE DEVELOPMENT PROCESS:
1.  Assess and Review.  At the end of the month, look over the statistics and note what areas improved and what areas didn’t. Then check what was actually done, or not done in each area. Use your departmental checklists from your Practice Playbook if you have started this.assess and review

Many business owners still manage without looking at objective indicators. They manage by emotions, mistakes, fear, “bright ideas”and  other flighty factors that ultimately hold a clinic back, or often just burn it out.

Effective clinic managers, like an athletic team coaches, base their actions first on actual outcomes and performance monitors. These are your daily, weekly, and monthly practice statistics. PM&A has developed a specialized form of review which is called Practice Analytics System which we display on our client’s personal Practice Dashboard’s.

This assessment also includes reviewing checklists of the key procedures and whether or not key duties were done.

  2 Plan. Work out the key areas you want to work on in the next month. Pick just one or two areas that will make the biggest difference and make a list of a few action steps that will help improve the area in your office you have targeted. Get the actions assigned with a date on when they should be done.

game plan

 

3 Supervise.  Regularly monitor the implementation of the action steps with yourself, your team, and your consultant. Provide help where needed to get them done.

4  Systematize. You do not want to keep inventing the wheel, so at the end of each month, document any procedure that worked well.

List all successful activities for each department and “lock them in” as standard operating procedures. Keep what works, throw out what doesn’t. Start with just a checklist of key procedures. Later, you can write or videotape a description of each procedure. It is from this that you will do your training and “coaching reviews.” Use your playbook often: refer to it and practice.

playbook

 

Gradually, you should have your own system of practice management and patient management and have it outlined simply in your Practice Playbook. For example, the “Smith Chiropractic System of Patient Management.”

 

IMPLEMENTATION SCHEDULE
Week 1. First Week of the Month: Do Steps 1 & 2 – Assess and Plan
Week 2. Supervise. Coordinate upcoming activities. Study and Train. (Optional: Separate Marketing Meeting)
Week 3. Supervise. Coordinate upcoming activities. Study and Train.
Week 4. Supervise. Coordinate on upcoming activities. Celebrate and party for a great month! Add to Practice Playbook.

 

REPETITION
Do The Practice Development Process Every Month.
The success of this process derives much of its power from a simple principle from Aristotle.

aristotle

“We are what we repeatedly do.
Excellence, then, is not an act, but a habit.”

This often referenced quote is from a series of lectures he was to have given at the Greek Lyceum on ethics (300 B.C.).   We could say, then, that continuing to do the Practice Development Assessment, and all of your procedures and systems, is ethical and leads to excellence. The contrary would also be true.

 

GOALS AND CONSTANT IMPROVEMENT
It is important to keep in mind WHY we are doing the PDP each month.

It is assumed we all want to improve, that improvement  is possible, and that we have higher purposes and goals.  Our patients do. That is why they see us and  we help them improve and get closer to their goals at each visit.

By consistently working the 3 Goals  Practice Development Process each month you, the practice, and each team member will also get closer to the higher goals each of you share.

goals sun

Kaizen: Constant Practice Improvement – From Wooden to Deming

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What improvements do you need to make in your practice for 2016?

Managing your practice is similar to managing a sports team in many ways. There are goals, rules, plays (procedures,) skill development, strategies, winning and losing. There is also coaching and training.

The teams that win the most constantly work to improve. But the improvements often focus on just the refinement of the basics.

One chiropractor I worked with told me stories about his experiences with John Wooden. Coach Wooden was a very successful basketball coach who coached the UCLA basketball team to 10 national championships over a 12-year period.

Here is what Coach Wooden has said:

“When you improve a little each day, eventually big things occur…. Not tomorrow, not the next day, but eventually a big gain is made. Don’t look for the big, quick improvement. 

Seek the small improvement one day at a time. That’s the only way it happens – and when it happens, it lasts.”

 

In Japan they have something called Kaizen. This means continuous improvement. Part of this was developed by another Midwesterner (Wooden was from Indiana), Edwards Deming (Iowa).

Kaizen

The Deming Cycle is a process of continuous improvement that helped grow the Japanese car industry in the 60’s to what it is today. For a long time, Detroit auto companies weren’t that interested in what Deming had to say – and, of course, we can see how that turned out for them!

Constant improvement takes discipline. Those of you who had to practice a musical instrument or an athletic skill in school remember the daily routine. Improving the little things can get boring and when a colleague calls with excitement about this new seminar or gadget or website, many doctors are off to the chase the “shiny things.”

Innovation needs to happen, certainly. But the real successful businesses and teams continually work to master what they already do.

Mastering the basics is always the key to success. Deliberate practice, study and good coaching. And this takes discipline and… a certain degree of humility to admit you can personally improve.

But since you are not a full time coach and mostly work IN the practice, you have to schedule specific times to work ON the practice. But what do you work on? ICD 11? (Yes… it IS on the horizon!) More E.H.R?

Well, maybe, but these are not the areas that will significantly improve your business over the long run and take it to the next level.

To help you uncover what should be improved, you can use our updated Practice Progress Grid. You can go over it with your team and plot where you were, where you are now… and then where you want to be next year! (Link is below.)

This can help reveal what organizational and engineering steps you need to build a better business machine for 2016.

In most cases, the improvements don’t have to be major. They just have to be continuously refined. But some areas that are holding you back from your goals can be hidden or overlooked.

If you want to dig deeper, we also have our Practice Development Assessment(PDA). It takes more time to complete but gives you a more complete analysis. (The link is below.)

The world is changing faster and faster. You have to constantly improve to keep up, let alone, to stay ahead. And if you don’t… well, your patients will be going to those offices that are.

From all of us at PM&A, we look forward to your continued improvements and to helping you get closer to your goals in the New Year.

Ed Petty

Link to Practice Progress Grid
Link to Practice Development Assessment (No charge for first 15 users, $25 thereafter.)

How to Create a Wondrous Practice Life

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FORTY ONE YEARS AGO, around this time of year (August 7), a twenty four year old managed to sneak up to the twin tours of the World Trade Center, shoot a cable to the other side, get it rigged up tight, and walk across it to the other side. Actually, he made 8 passes, performed dances and entertained an audience a 1/4 of a mile below. He finally came in when it started to rain.

He was arrested, but the the charges were later dismissed if he performed for children in Central Park, which he did.

I recently had the opportunity to listen to Philippe Petit (on August 7, 2015), now 65 years old. He gave a stirring presentation in San Francisco to chiropractic health professionals at the Wave, a seminar put on by Life West Chiropractic College.

Philippe was born in 1949 and still very active. He considers himself, among all things, an artist. But he also juggles, climbs rocks, fights bulls, fences, builds structures with 18th century tools and considers himself an accomplished equestrian.

He explained that he learned early in life to follow his passion and his intuition. But his creativity seemed to be overlooked or given little importance when he was young and so he felt that it must be illegal.

In his book Creativity, Philippe writes: “The creator must be an outlaw. Not a criminal outlaw, but rather a poet who cultivates intellectual rebellion.”

In his talk to us on August 7th, he offered some tips, or precepts that he thought might help us as they have helped him in his life.

He began by talking about his passion to pursue his goals. But right next to that, he emphasized the importance of tenacity. This was a word that included determination, discipline, preparation, and training to do what was needed to be done to achieve those goals about which you are passionate.

He exhibited this nearly a half a century ago as he pursued his goal to walk from one 1,300 foot tall building to another on just a wire. He started planning the walk when he was only 17 living in Paris. The Towers were not yet built. Certainly, the walk itself took immense focus at the time. But it lasted only less than an hour. The real work was in the planning and preparation and training. This took tenacity.

He stressed to listen to your intuition. When you have a question or a problem, listen to your gut and an answer, sooner or later, will visit you. But you do have to listen.

He emphasized simplicity in all that you do, but still be elegant. And don’t be afraid to make mistakes. This is how we learn and move forward. All this, of course, takes courage.

You have to believe in yourself. (Or as Dr. Jimmy Parker used to say, you have to have “FCB – Faith, Confidence and Belief.”) In your role of doctor, provider, and as a professional team member, you have to have faith in yourself and in the services you provide.

In our 3 Goals System of Practice Development, the Third Goal includes your greater purposes. These go beyond financial demands (Goal 1), which are necessary, or profession and business competence (Goal 2), which should be sought. But above it all are your Greater Purposes, your highest values — professionally and personally, that we really seek and that make life worth living.

We learn at an early age to quell our passions and creativity and to fall in line with convention. Obey and comply. And, to some extent, this is necessary for a society and a business to function. But in the bargain, we often lose our spirit. Our creative aspirations, our sense of fellowship with each other, and the outrage at the wrongs that we see — these gradually lose their importance. Our greater purposes become blunted — or even forgotten.

Certainly, this has happened to many people in your community as they “report in,” zombie like to the local drug store for “health care”, especially if it is promoting “free flu shots.” (Average drug prescriptions per person in 1993 was 7.1 In 2014 it was 12.2 And watch out for anyone over 50 where the average prescriptions used are 19, and over for those over 65 – 27. That’s right – 27 prescription medications per person. Average!2)

It is important to keep your greater purposes in sight and to respect them enough to keep them alive. They can and should be integrated into your professional life as you do not work in a factory assembly line as your parents or grandparents may have, or as those who produce your cool t-shirts and running shoes do now. For example, if you like children, have pictures of kids on your walls and have a special “Kids Day.” If you like running, put up pictures of runners and get your patients to join more running clubs. If you want to help the homeless kids in your town, promote a donation program for the local shelter.

Back at the seminar: I noticed that some of the presentations were held in ballrooms that had special, but temporary names. For example, there was the “The Reggie Gold” ballroom, the “Frank Sovinsky” ballroom, and the “Lloyd Latch” ballroom.

In the mid 1980’s, I worked for several years directly for and with Dr. Lloyd Latch. Though he didn’t promote it much, I am sure that he did have the largest chiropractic clinic in the world. While his personal production was high, the total office saw over 2,000 visits per week. The key was that he had created a wonderful team of doctors adjusting patients in 28 adjusting rooms and supported by a dedicate team of professionals.

And what was a key to his success? Over and over I heard Dr. Latch tell his doctors, and others who would visit, that success was “an inside job.”

I think this is exactly what Mr. Petit was getting at.

Success doesn’t come from the latest marketing procedure… it comes from deep inside. It comes from your heart, your passion, your imagination, and the tenacity to work and train daily.

Mr. Pettit says that there are –
“qualities inside all of us, that we are rarely encouraged to recognize
but that are essential to make our dreams come true, to plan, to construct a wondrous life.”3

IMG_1390 copy

Successful people learn from others, but ultimately take their own counsel.

As Philippe wrote:
“Observation was my conduit for knowledge, intuition my source of power.”3

So, follow your greater purposes and integrate them into your professional and work life. Allow your team members to also pursue their greater purposes – and you will see your practice become more creative, productive and wondrous.

Carpe Diem (seize the day),
Ed
———————–

  1. Generation Rx How Prescription Drugs Are Altering American Lives, Minds, and Bodies by Greg Critser (https://danmurphydc.com/Critser.pdf) , also http://kff.org/other/state-indicator/retail-rx-drugs-per-capita.
  2. www.imshealth.com/deployedfiles/imshealth/Global/Content/Corporate/IMS%20Health%20Institute/Reports/US_Use_of_Meds_2013/Percent_population_prescriptions_per_capita.pdf
  3. Creativity, the Perfect Crime. Philippe Petit

“Ichi-go Ichi-e:” The Springtime Secret to Improving Your Chiropractic Practice

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The best chiropractic businesses excel at the basics.  Too often we can take the fundamentals of practice excellence for granted and go off to chase the “shiny” things, forsaking the powerful potentials right in front of us.

So here is an organic reminder that you, and all of us, can immediately put to use to help us keep growing and groovin’.

Most of us enjoy spring…flowers blooming, birds singing. It is new. It is creative. It is a beginning.

Life goes in cycles – everything has a beginning, a progression, and an ending. Some cycles are longer – every twelve months the tulips come through the winter mud. Some are shorter – each day the sun comes up and we have a new cup of coffee. But nature endures through cycles.

Unfortunately, we don’t always follow nature in our offices.

If you are like most of us, you don’t really start your day.  It sort of happens and you just go along.  You walk into the office a see what the appointment book offers you. Based upon the urgencies of the morning, you make your way through to the afternoon until you can leave to go home in the evening.  But do you really end your day or does it linger with you as you go home, or even stay with you till the next morning?

Most of us are stuck in the blur of stretched out cycles that are blended one moment to the next so that there is never any real beginning or never any real ending. One phone call in the middle of a busy afternoon is very similar to the one you had in the morning…everyday for the last three years.  This adjustment to this patient is just too similar to the one you gave…3,000 times before. One moment blurs to the next.

Jim Parker, of Parker Seminars, used to talk about “PTC”, Present Time Consciousness, as a key element to practice success.  A practice can suffer because, over time, our consciousness gets stuck in past moments, strung out so that we have less consciousness in the here and now. When you greet your patient, you are not as “here” or as conscious in the present as you might have been the first month you were in practice, or the first week you were on the job.  And your patients know it, at least on a subliminal level. They can have a sense that you are disinterested in them and so end up leaving and looking for a doctor who is.

Each encounter with each patient should be new. It should be its own cycle. Each phone call, each adjustment should be unique, separate, as if it has never happened before.

The Japanese have a name for this: “Ichi-go Ichi-e.” Roughly, It means “one time, one meeting” — that this one time will never happen again. It is its own time. It is special.

What would happen to your practice if each day – today – was brand new?  Like spring. If this week was the first week you were finally able to see patients after years of preparation?

First of all, you wouldn’t be bored. You wouldn’t be burned out, worried, or angry. Why? Because you are just starting and you have a chance to create the practice anyway you want.

So, what causes us to lose our “PTC” and fall into doldrums? How can we stay in the “now” and be creative each moment we are with our patients, each other, and our loved ones outside of practice?

First, watch out for the backlogs. They are energy dumps. Try to complete your work when you are doing it. Patient notes, insurance reports, filing…try to get it all done as soon as possible. You see, when you start to put your consciousness into a cycle you don’t really get all of it back until you complete that cycle. So, every pile of paperwork and partially completed job that is lying around the office will gradually draw your attention into the past.

Spend a weekend applying the 4 D’s:  With each task: Get it DONE, or DELEGATE it, or DUMP it in the trash can. Not all jobs can be completed now, and so some can be DELAYED with a time noted to complete it.

Here are some other steps to make each moment new:

  1. Early to Rise. Begin your day a little earlier… with a walk or a book, some music, meditation or prayer.
  2. Morning Group Planning. Begin your day in the office with a case management meeting, reviewing who is coming in, what special actions need to be coordinated. Maybe add a joke to keep things from getting serious.
  3. End Each Encounter. After each patient contact, end the meeting in your mind.
  4. Interest. With each new patient contact, genuinely find something interesting and new about them – their appearance, their week, something about their story.
  5. Business Coach. Meet with your business coach and review your business and make plans for the next month.
  6. Get Away. Get away on a vacation with your spouse, or a sabbatical and seminar for yourself. ( I’m heading out to Cal Jam this week. Hope to see you there!)
  7. Un-Serious. Do things in your office that are different, fresh, and new. One office has a “fruity Friday” and offers fruit to the patients.   Avoid the deadly disease of “seriousness.” Tell a joke, be silly.
  8. The Four D’s (again): Do it, Dump it, Delegate it, Delay it. Avoid backlogs.

Some of this takes discipline and creating rituals to help ensure these actions take place

But you are part of nature and spring is already in your heart. You just have to let it out, like a song that is ready to be sung or a jig ready to be danced. You already have the creative spark of newness inside you.

So just breathe.. and let your spring happen today and each day.   And help others to do the same.

Carpe Diem and Happy Spring!

–Ed

Was Darwin Wrong? Happy Valentine’s Day!

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Was Darwin wrong? Let’s find out.

BUT FIRST CONSIDER THIS  WARNING:

You and your staff may have an uninspected cultural bias that is toxic to you and your office and is negatively affecting your best efforts.  This could be happening right now as you read this!

 How could this be?

Well, ingrained in our culture is the idea that to survive, we must compete and overcome others.  It is a win-lose world: either I win and you lose, or you win and I lose.

This idea had much support with the work of Charles Darwin.  Darwin’s perspective of evolution included the concept of survival of the fittest with a sort of “dog eat dog” theme.

However, recent studies suggest this is not entirely the case.

“When biologists look closely at nature they cannot help but notice cooperative partnerships that do not comfortably fit with the competitive struggle that is central to Darwinanin evolution.” (Darwin’s Blind Spot: Evolution Beyond Natural Selection, Frank Ryan)

This theory of cooperation in evolution was actually put forth 50 years before Darwin, by a Frenchman by the name of Jean-Baptiste de Lamarack (1744 – 1829), who established evolution as a scientific fact.

According to Bruce Lipton, “Not only did Lamarck present his theory fifty years before Darwin, he offered a much less harsh theory of the mechanisms of evolution. Lamarck’s theory suggested that evolution was based upon an “instructive,” cooperative interaction among organisms and their environment that enables life forms to survive and evolve in a dynamic world. (Biology of Belief, page 11)

But Lamarck’s ideas, which also included what is now called epigenetics, were cast aside and rejected until recently. So, instead of seeing that organisms in nature evolve symbiotically and cooperatively, Darwin saw that: “living organisms are perpetually embroiled in a struggle for existence. For Darwin, struggle and violence are not only a part of animal (human) nature but the principal “forces” behind evolution advancement.  Darwin wrote of an inevitable “struggle for life” and that evolution was driven by “the war of nature, from famine and death.” (Bruce Lipton, PhD, Biology of Belief) [my emphasis]

The idea of “survival of the fittest”, obviously, is not very cooperative. In an office, it can create brooding jealously, competitive back stabbing, fear and defensiveness, and make us objectify our patients as “cases” and statistics. It can create at a division between us and our patients — between each other.

I got to thinking about all of this as another Valentine’s Day approached. As it turns out, Valentine’s Day is observed all around the world and has been around for hundreds of years, even as early as 300 AD. And, it wasn’t always about romantic love. One legend has it that:

“… in order “to remind these men of their vows and God’s love, Saint Valentine is said to have cut hearts from parchment”, giving them to these soldiers and persecuted Christians, a possible origin of the widespread use of hearts on St. Valentine’s Day.” (From Wikipedia)

The Greeks had 4 different types of love:

  • Agape =Charity, or the love of Man for God or vice versa.
  • Eros = We all know this – romantic, intimate love.
  • Philia = Love between friends or family.
  • Storge = love of parents for children (Wikipedia)

Valentine’s Day is about love. Romantic love, sure but also about charity, generosity, compassion, caring – all kinds of love. And this takes us back to the notion that love, or a type of love, has been the basis for survival of all species on this planet – including mankind. Survival of life forms requires mutual support on some level – survival is cooperative and caring.

In many offices I have noticed a degree of an adversarial undercurrent. You can almost feel a sub-sub culture of “dog eat dog.”   You have experienced this, I am sure.  For example, if the mood is wrong, the phones don’t ring. Right?  When there is a high degree of compassion and care and good will for each other and for the patients, the phones start ringing.

To some degree , Darwin’s “war of nature” may be embedded in the culture of your office. Darwin was right about many things, but life evolved through cooperation and caring – not through war.

Look: Your patients want to survive better. Just find out what their goals are and help them get there.  They will need some education and coaching, sure – you have had thousands of hours of what they are just now hearing.  But care for them and do your very best to help them get to their health goals.

Your doctor wants to practice and live better – find out what she wants and help her get there. You may have to ask lots of questions and train and read and struggle at it for a while, but keep at it and you can make a big difference. In turn, this will help your patients do better – and of course, you do better as well.

And doctor, your team members want to do better and also have better lives – find out how you can help them do so – and do so.

As I mature, I truly see that this planet is getting smaller and that we are all in this adventure together, for better or worse.  Hopefully, for the better.  But there are no guarantees. If we are to get it better, it all comes down to what we can do here and now to help each other MORE than we have been.

The world can be a struggle, but we all have evolved because of cooperation, caring for each other, and love.  If we continue to do so, we can continue to evolve in our practice’s and business, and in our lives.

And have no doubt, Petty, Michel and Associates are in the mix as well. We love your patients, team members and you, and want to do all we can to help you survive and thrive.

Here are our best wishes to you that everyday – is Saint Valentine’s Day!

#  #  #

Love is patient, love is kind. It does not envy, it does not boast, it is not proud.  It does not dishonor others, it is not self-seeking, it is not easily angered, it keeps no record of wrongs. Love does not delight in evil but rejoices with the truth. It always protects, always trusts, always hopes, always perseveres. (From the New Testament, Corinthians 13:4-8, “love” is elsewhere replaced by the word “charity.”)