Category Archives: Practice Management

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.”)

10 Practice Development Strategies for Chiropractors in 2015

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[If you think that you could make more money selling pharmaceuticals, injecting patients with vaccines and promoting flu shots in front of your office, these recommendations are not for you. For those matters, you might want to ask Palmer Chiropractic College or the Wisconsin Chiropractic Association for their opinions.]

What strategic moves should you be taking now to make sure that you have a better year in 2015 and in years to come?

After reviewing current literature and statistics, and based upon my observations and experience, I have put together a report which makes a number of recommendations that can be helpful to you. I have also included an extensive list of references for your further study.

The report contains a lot of information and so it is only for the serious practice executive. It will be a useful resource for you to refer to while you implement some of the suggestions I offer. Reading time is about 15 minutes. It offers new views on practice marketing, management, and leadership, with 25 specific recommendations.  To go straight to the main course, go here:

Here is a shorter version:

Executive Summary – 10 Strategies to Prosper and Flourish in 2015 and Beyond

1. Know Your Environment. The Medical-Pharmaceutical industries are spending more to dominate the market place. Their efforts are becoming more pervasive in reach and more covert in manipulation. At the same time, wellness statistics continue to grow. More people are turning to organic foods and are focused on wellness.

2. Marketing Positioning. My recommendation is to embrace the popular movement towards natural health and own it. Be its champion. You are the Healthy Life Doctors. This is your niche.

3. Unique Selling Proposition. Stay committed to your core services, but articulate your Unique Selling Proposition to your specific market niche(s). Not everyone is your patient. Select certain markets that are already reaching for your type of services: people fed up with drugs, baby boomers who want to stay healthy, mothers who want to avoid drugs for their children, athletes, employers who want healthy employees, etc.

4. Get More For Less. Watch your economics but don’t get stuck in a scarcity mindset. Central to economics is a return on investment -ROI. Invest in yourself and especially in making your support team expert professionals. Learn and apply the Pareto Principle (how 80 percent of your results come from just 20% of your efforts).

5. Insurance or Cash? Yes! Take insurance but don’t kowtow to the Insurance Cartel. There are millions of people who want help and can pay for it and are just looking for a solution. You have to let them know that you have their solution.

6. Shift from Personality Driven Practice to Team Driven Business. The successful offices of the future will be team driven and systematized. Each team member has to be an expert as a specialist, as a team member, and as a marketer. And each should try to achieve this as well. The doctor will delegate most marketing and administrative details to others.

7. Shift from Solo Practice to Group Practice. For those of you who are ready, you should join forces with other doctors in a group practice. This has not had a lot of success in the chiropractic profession as it has in other professions, but the time is right now to band together synergistically as brothers and sisters. There are many good reasons to do this now. However, it has to be set up — and maintained — correctly.

8. New Role: CEO and Leader. Why do CEO’s get paid so much? Because they can make such a positive difference in the business. Up to now in your career you have taken on administrative and marketing projects mostly from the role of doctor, or perhaps owner. The CEO role probably has not been emphasized. Shifting to the role of CEO changes everything. Growing a business becomes easier, you have more time available, and you make more money.

9. Seek Out and Integrate Your Greater Purposes with Your Business. The power for your office, and you, comes from those things that mean the most. This would include your family and your spiritual pursuits. But our world is smaller and we live in a networked economy and culture. Your office, in its own right, has to be a leader in your community and environment and contribute in some way beyond its walls. This also includes having a voice in your professional organization. Your greater purposes also include your personal hobbies. Since you are not working on an assembly line, many of these purposes should be integrated into your work.

10. Get an Executive Coach. Why does corporate America spend over a billion dollars on executive coaching? Because the return of investment proves to be at least 7 times, and in some cases, 10-49 times cost. Executive coaching doesn’t cost – it pays.

An executive coach is different from a clinical coach. An executive coach will help you be a better CEO – a better leader, marketer and manager who builds a team driven business which allows you to delegate most non clinical duties.  He or she will help you sort out what tasks will produce the greatest positive effects for your business, and help you get those tasks done. He or she will be your partner, counselor, confident, coach, teacher, drill instructor, and friend.

The future has never looked brighter, but the challenges are not slight. This makes your success all the more important – and sweeter.

Ed Petty

 

Swiss Army Knife of Chiropractic Practice Development

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Ever see a one of those Swiss Army Knives?

I have one. It shows up now and then in one of my drawers.  I always forget how many applications it has and I am always surprised when I keep pulling out more.

Well, there is a particular practice building tool that works like a Swiss Army Knife for your office.Swiss army knife isolated

It is inexpensive, almost free, yet this one tool serves many purposes more effectively than most anything else you can do in your office.

You could call it the Swiss Army Knife of Practice Development.

Once you, and your team, and especially your patients watch Bought, you will understand the power of the Swiss Army Knife of Practice Development.

This one tool can be your most effective marketing procedure. It can be your best therapeutic modality or ancillary service. It can also serve as your best tool to boost team productivity.

But like with my Swiss Army Knife, it can easily get taken for granted and NOT USED.

I can guarantee that IF you energetically use the Swiss Army Knife of Practice Development, your patients will stay with you longer, they will get healthier, your team will be more productive, you will generate more patients, and, yes, you’ll see your collections increase.

What is the Swiss Army Knife of Practice Development?

Education.

Education brings about an increase of awareness and results in a motivation to make a change. It does this for your patients in terms of improving their health, in motivating them to get others to use your services, and in helping to make your team even more purposeful.

You know chiropractic and what it does for people. Each day, miracles occur. It gets almost routine. You know how chiropractic works and you know why it works. Your patients do not. And most of your staff only have a general, and perhaps forgotten understanding.

By educating your patients you are fortifying them with knowledge that makes them aware of the power of your services and the importance of continuing care. It counteracts the propaganda they receive in the form of hundreds of ad impressions we all receive each day for drugs and bad food. It increases their awareness and will motivate them to not only continue with their care, but to benefit more from it.

This will, in turn, encourage them to bring in their family and friends to see you. They may even encourage you to speak to their work place or organizations.

Education can motivate your staff. I have seen numbers go up 25% quickly once the rest of the team was educated more on chiropractic and natural health care.

Lastly, education motivates you.

Education is your least expensive modality or ancillary service, it is the most cost effective marketing tool you have, and costs nothing to educate your staff.

Here are some sample actions to take to improve your educational activities.

  1. Look at your office as an educational facility even more than a care facility. You increase people’s knowledge so that they can take more responsibilty for their health, and for those they care about.
  2. Spend a hour or more each week studying. Read, listen to audios, go to seminars, have lunch with a colleague. Call your coach!
  3. Watch a movie with your staff such as Bought, Doctored, Food Inc., and then have a discussion period afterwards.
  4. Staff Meetings. Go over a case history or two.
  5. Patient Care Class.
  6. Start a Lending Library and position your office as an educational facility.  Even  if you lose a few books or DVD’s each month, it is worth it as your patients will see that you are serious about health and health education. Give each staff member a bonus for a book report presentation at a staff meeting.

There are many ways to educate yourself, your team, and your patients.  Done right, education turns into enlightenment and this will produce a greater return than many other activities you do.

Like a Swiss Army knife, health education serves many purposes. But also like a Swiss Army knife, it has to be kept out, used, not hidden away in the back of a drawer or on a bookcase.

The Most Cost Effective Tool You Have to Build Your Chiropractic Practice and Help Your Patients – and you probably are barely using it!

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what if I told you copy

 Forget about the roller tables, stretching bands, balance boards, traction devises, taping, decompression, protein powder, vibrating platforms, laser, lipo body sculpting, ultrasound, stim, tens, supplements, orthotics, etc.

Any or all of these may or may not be appropriate for your practice, but they should not be your first choice in providing a modality or ancillary service to your patients.

Think about this: what could you do for your patients, in addition to your adjustments, that would help them improve their health the most?

EDUCATE THEM

The more the patient knows about how chiropractic works – and how your services help them – the more motivated they will be in following through with their health care plan.

People don’t know about subluxations just like they really didn’t know about asbestos or cigarettes. It was a while ago but advertising was rampant on television and in print promoting cigarettes. MD’s were often used to legitimize the use of cigarettes.

Today, your patients are also being inundated with propaganda about food, drugs, and basic lifestyle choices that are not healthy, let alone not true. They are told that drugs are safe solutions for headaches, back pain, and other ailments when in many cases they are found to be poisonous. (Vioxx, Accutane, Cylert, Darvon & Darvocet, for example.) Nearly all the food they eat has various toxins, from aspartame in diet food to herbicides that linger (glyphosate, used in “Roundup” and sprayed on your kid’s schools playgrounds).

Educated patients are better equipped to keep to their treatment program and continue improving their health. Isn’t this what you want?

This is your #1 ancillary service.

#1 Marketing Tool
Educated patients are more motivated to refer those they know to you and to help you set up external events. They can become your ambassadors, field representatives and sales force. They know that someone with headaches, low back pain, or other odd symptoms may be helped by chiropractic and your services. They may be able to refer them directly, or you can help them by providing special workshops, special events, and opportunities for external programs at their place of work.

#1 Team Management Tool
All of this also applies to each of your team members as well.

We are all “numbed down” by a conventional lifestyle and a culture that is greatly manufactured by just a few large industries such as Big Pharma and Big Food that use media and government to achieve its ends.

And, frankly, we tend to take what we do for granted. Imagine a patient who had a headache for years and after your care is now pain free and can get a full night’s sleep and her relationships with her family have improved., etc.  Amazing, right?  But for us, pretty routine. We can end up being more concerned about billing her secondary or supplement insurance or keeping her scheduling than in just celebrating with her.

Almost anything you know about health care will be “new news” to your patients and probably many of your staff. Plus, we all tend to forget what we once knew.

What is the big difference with you from when you started chiropractic college and after you graduated (Besides debt) . THE difference was and is that you were motivated. And you were motivated because… you were educated and even more, you were enlightened. You were able to see things in people’s health conditions that you never saw before. And with all this understanding, you were now more motivated.

But in time, awareness can dim and so can motivation. New patients start dropping off, treatment plans get shorter, and the quality of staff performance erodes. The solution is to keep educating patients and team members so that they stay awake and motivated.

In other words, WAKE THE FLOCK UP!

Patient and staff education provide the best ROI of any activity you have. Modalities and extra services have many overlooked costs such as staff time to account and bill for the therapies, extra staff to apply the services, someone to take inventory of the products and to sell them, etc. Patient education is pretty much a no cost proposition. How much does a care class cost? Watching “Doctored” or “Food Inc. ” or “Bought” with your staff and then discussing it afterwards (that is very important), it is much cheaper than flying to Las Vegas.

And if you do it often and effectively, you will be able to afford that next seminar in Hawaii.

As the doctor, you are the CEO, the Chief Evangelizing Officer. I first heard this term from Guy Kawasaki, who was called this when he worked for Apple when the Macintosh was first launched in the early 80’s. Macintosh was trying to win over users from IBM computers to the Apple Macintosh.

You are creating converts to a chiropractic and natural health lifestyle.

Remember that education, both staff, patients, and your own education as well should cover not only what your services do, and how they do it, but WHY you provide these services. In fact, your emotional connection to the reason you do your services communicates the strongest.

WHAT TO DO
1. First, keep yourself aware and amazed at the innate healing power of the body and the great affects your services provide. Provide an hour or two of study for yourself each week. Just like you work IN your office, you have to work ON your office – and that includes yourself.

2.  Let yourself get emotional about what the FLOCK is going on!  Don’t be “correct”, well heeled and a good little domesticated “provider.” It is natural that you become somewhat “riled up” about the injustice that your patients and their family and friends experience in receiving “health care” or at the misinformation “fed” to people about healthy living.

3. Educate your team. Watch a movie with them and then have a discussion period afterwards. (The discussion is very important as it helps get everyone engaged in the process.)

4. Staff Meetings. Go over a case history or two.

5. Patient Care Class. There are many different names for this, but all patients get better, faster, and stay healthier longer if they know more about chiropractic and health. Make it a part of their treatment plan and bribe them with food!

6. Start a Lending Library and position your office as an educational facility.  Even  if you lose a few books or DVD’s each month, it is worth it as your patients will see that you are serious about health and health education. Give each staff member a bonus for a book report presentation at a staff meeting.

There are many ways to educate yourself, your team, and your patients.  Done right, education turns into enlightenment and this will produce a greater return than many other activities you do.

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Sage on the Stage or Guide from the Side: Chiropractic Seminars vs. Coaching – Which is Better?

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They both can be expensive, so what service gives the greatest “bang for the buck?”

I go to seminars. I like them. In fact, I hope to see some of you at the WAVE, sponsored by Life West  in San Francisco this weekend (8/1/2014).   (If you are going please contact me by calling the office number below and it will forward to my phone. It would be great to say “hi” in person!)

Seminars provide a good opportunity to get away. B.J. Palmer talks about this, of course, in his Rule Number #9. (1)

Also, by disengaging from your work, you can better re-engage in it when you get back. The science of this is discussed in a book called: The Power of Full Engagement.

Plus, networking. Nothing like meeting new people and hearing how and what they are doing and trading fish stories – even if they are often embellished.  (“Don’t tell fish stories where the people know you; but particularly, don’t tell them where they know the fish.” Attributed to Mark Twain.)

And, they can be entertaining.

Plus, you can learn things. Learning new things that work and unlearning things that don’t work is probably the MOST important skill you can have. And it is getting more important every day. Our world is changing SO fast that in order to keep up, you have to really spend time and money learning.

“The illiterate of the 21st century will not be those who cannot read and write, but those who cannot learn, unlearn, and relearn.” ― Alvin Toffler

However, there are drawbacks.

Seminars: the Sage on the Stage

First, there is the expense of the seminar.  Actually, by comparison, most chiropractic seminars are dirt cheap compared to other seminars that run into the thousands. The expense is in the travel. The hidden expenses add up considerably, especially if you take your staff, which you should now and then.

Then, there is the actual content – the information being imparted.  Much of it is motivational and that is nice.  However, the seminar speaker does not know you. He hasn’t been to your office, your home, talked with your staff or know your family. He hasn’t read your town’s newspaper or seen your patients.  He doesn’t know your situation.  He teaches you a procedure that sounds good in theory and may have even worked in his office 15 years ago, for a while.  He may be entertaining, or coercive.  But, often only 10% of what is taught at a seminar is applicable to you and your office.  And of that, very little gets implemented, and in two months, less than 5% of the seminar may be in operation at your office.   The following is an example that shows how much useful information gets reduced down to actual implementation in most offices.

Actual Value of Seminar (approximate percentages)

  • Motivational (can sometimes be excellent, but is very temporary.)
  • Percent of information verifiably valid:  70%
  • Percent of information comprehensible, heard, or understood: Of the 70%, one half is comprehended, heard, or understood, leaving 35%)
  • Percent of information applicable to your particular city, staff, patient base, your style and personality, etc.: Of that 35%, perhaps 15% isn’t applicable, leaving you with 20%.
  • Percent of information that can be implemented in your office: Of the remaining 20%, perhaps only half can get applied, leaving 10%.
  • Percent of information that gets applied:  In two weeks time, only 5% gets applied.
  • Percent of information that stays in application: After two months, only 1-5% percent of the original information is still applied.
  • If you had spent $2,000 on a seminar program, using the rough example above, you would have wasted all but 5%, or $1,900.

This example is a little harsh, I‘ll admit, but I wanted to make a point. But you know what? Even this small percent may still be worth attending the seminar.

Coaching – The Guide from the Side

Our company grew because doctors did not or could not adequately apply what they heard at the seminars.  Starting out many years ago, I remember seeing doctor’s shelves full of binders, VHS cassettes, and manuals that were barely touched since they were brought home from the seminar.

So, back in the late 1980’s, we came up with our niche and our identity, encapsulated in our tag line:

When Seminars Aren’t Enough sm

Good coaching, helps you and helps your team discover what systems work best for you, and then helps you make them better – over and over until your TEAM becomes expert.

A good coach, like a competent doctor, has the experience to quickly identify what needs to be worked on that can bring about the quickest improvements.  This is what we do.  We have become skilled at spotting the key leverage points (3) in an office and have developed new and effective methods to make the changes necessary for faster improvements.

But, we do this as your guide. We don’t impose a particular patient system into your office.  You are unique and what works for a doctor in Nebraska may not work for the same one in San Diego.  We help you discover what works best for you and help your team get better at supporting you.

A good coach trains, advises, nudges, listens, counsels, teaches, and when possible, even does some of the work.  And is this effective? You sure as hell bet it is! We have been doing this for nearly 30 years and those doctors that have worked with us know this to be true.

But the real reason for coaching is economics: bottom line, baby! Return on Invest. ROI.  Studies show a pay back of 5 to 7 times on your investment. We have certainly seen this occur. (3)

Like chiropractic, good care doesn’t cost, IT PAYS. Health IS wealth.  The same applies to education – and in particular – coaching. It doesn’t cost – it pays.

Seminars? Yes. Coaching? Hell yes!  But books and webinars and mentors as well.  A weekend of reading a book is a great investment.

In the end, you have to constantly study and learn to stay in the game. Success is, now more than ever, dependent upon constant never ending improvement.  You have to do this just to keep up, let alone to get ahead.

And if you don’t – well, your community and patients will be seeking a healthcare office that is.

References
(1)    Rule #9:  Every man owes it to himself, his people and his service to go away about every so often. The more detail he has, the oftener he should go. The more worries, the more he needs to go. The bigger his work, the longer his vacation should be. – B.J. Palmer    https://pmaworks.com/observations/2008/08/18/getting-away-rule-9/

(2)    Leverage Points  http://www.donellameadows.org/wp-content/userfiles/Leverage_Points.pdf , also: Eli Goldratt, The Goal

(3)    BUSINESS IMPACT STUDIES

  • Research conducted by MetrixGlobal on coaching at a Fortune 500 company showed that coaching produced a 529% return on investment and significant intangible benefits to the business. Including the financial benefits from employee retention boosted the overall ROI to 788%.
  • A landmark study commissioned by Right Management Consultants found a return-on-investment of dollars spent on executive coaching of nearly 600%. Executives engaged in coaching reported increases in productivity, improvement in relationships with direct reports and colleagues and greater job satisfaction.
  • According to a study by the Manchester Consulting Group, organizational benefits from executive coaching include:

Improved Relationships 77%
Improved Teamwork 67%
Improved Job Satisfaction 61%
Improved Productivity 53%

  • An International Personnel Management Association survey found that productivity increased by 88 percent when coaching was combined with training (compared to a 22 percent increase with training alone).
  • Studies completed by the American Society for Training and Development showed a ROI of 5 times the cost of coaching.

BUSINESS PRESS EXCERPTS

  “Many of the world’s most admired corporations, from GE to Goldman Sachs, invest in coaching. Annual spending on coaching in the United States in estimated at roughly $1 billion.”   Harvard Business Review

  “Coaches are not for the meek. They’re for people who value unambiguous feedback. All coaches have one thing in common. It’s that they are ruthlessly results-oriented.”          Fast Company Magazine

  “Business coaching is attracting America’s top CEO’s because, put simply, business coaching works. In fact, when asked for a conservative estimate of monetary payoff from the coaching they got….managers described an average return of more than $100,000 or about six times what coaching had cost their companies.”                                   Fortune Magazine

   “[A Coach] is part advisor, part sounding board, part cheerleader, part manager and part strategist.”    The Business Journal

   “Between 25 percent and 40 percent of Fortune 500 companies use executive coaches.”      The Hay Group International

  “Once used to bolster troubled staffers, coaching now is part of the standard leadership development training for elite executives and talented up-and-comers at IBM, Motorola, J.P. Morgan, Chase, and Hewlett Packard. These companies are discreetly giving their best prospects what star athletes have long had: a trusted adviser to help reach their goals.”                     CNN.com

  “In a 2004 survey by Right Management consultants, 86% of companies said they used coaching to sharpen skills of individuals who have been identified as future organizational leaders.”         Harvard Management Update

  “A coach may be the guardian angel you need to rev up your career.”          Money Magazine

http://transverseleadership.com/roi.html

Your Biggest Chiropractic Bill Each Month

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You may be overlooking your biggest bill. Most chiropractors do.

What is it? If you are in the upper Midwest or Eastern part of the US in the winter of 2014, it might be your heating bill.  It has been pretty cold.

How about personnel or marketing? Your lease? Staff benefits? How about your pay? (Probably not, I would guess.)

In running a chiropractic business, many doctors try to maximize the profit of their business by reducing expenses. They often get this idea from their accountants, and, from a certain perspective, it is a good idea. But accountants are trained such that their primary function is reporting income for tax purposes and not managing business finances.

You definitely need to review your Profit and Loss and Balance sheets regularly. Sometimes you can get carried away with expenses, not noticing that things are getting out of balance when you have 4 x-ray units, 15 computers and only 1 staff member.

But what your financial statements don’t show you, and what your accountant isn’t trained to see, is your ROI – your return on your investment.

And what is your biggest investment? (Pause while you consider this question….)

It is YOU.

And what is your biggest bill? What is your biggest expense?

It is the income that you could and should be making that you aren’t.

Your biggest bill is the amount of money you could be making if you were operating at your full capacity but aren’t.

Here is an example: Let’s say you are relatively healthy and are capably of seeing  200 patient visits per week comfortably. This excludes new patient visits.  This averages out to about 860 visits per month.  Let’s drop it down to 820 visits for vacation days, etc.  Now, let’s say you collect only $40 per visit, average. This would mean you would be collecting $32,800 per month.

Let’s leave aside the possibility you could collect more per visit and imagine that you are seeing 150 visits per week, or 645 visits per month, or 605 if we take out a few visits for vacation days (40 visits per month).  At $40 per visit, this leaves you with $24,200 per month, or $8,600 LESS than you should be making each month.

In other words, if you could and should be making $32,800 per month and you are only making $24,200 per month, you are essentially writing a check for $8,600 EACH MONTH, payable to “Inefficiency, Inc.”

You are wasting that much each month as a negative return on your investment on yourself.

This is so brutal to face that most doctors would rather look the other way.  But whether you squint at it, or not, the reality is there: you are wasting your hard earned cash each month that you are not operating at full capacity. You are throwing away a portion of the time, training, and sacrifices you have made to get to where you are now.

It is as if you are writing a check, each month, for the amount of money you should be making, but aren’t.

Savvy CEO’s and large corporations understand this.  They need to get the full measure out of their investments. As a result, they invest heavily into solutions that improve production and services so their business can achieve full capacity.

One investment that shows the greatest return is corporate training and coaching. This is a huge industry: corporate training grosses $138 billion yearly in North America and executive and business coaching is at $9 billion a year and growing.

Various studies show that executive coaching brings back a return of 5 to 8 times the investment.

Obviously this speaks to our services, but beyond us, coaching and team training help you get the most out of your biggest investment – you.

Read a book, go to a seminar, watch a webinar, participate in 4 Mastermind groups, and get an executive coach to help train and guide you. Invest in yourself so that you can take the necessary actions to reach your full capacity.

In today’s economy, you need to get more out of what you have.

Quit wasting money. Invest in yourself. You can afford it.

Ed Petty

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References

Chiropractic Team Tryouts: Tips on Interviewing Potential New Team Members

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tryout
 Tryout: a test of someone’s ability to do something that is used to see if he or she should join a team, perform in a play, etc. (Merriam-Webster)

 

We routinely help our chiropractic teams with the hiring process.

Getting the right players can make all the difference in whether you are a winning team or just a mediocre one.

 It is often difficult to find the right candidate for the job. The prospective employee is trained to be sweet at the interview and have an impressive resume and you are expected to ask her just the right questions that will evoke her true character. This is usually not adequate.

In addition to interviews, practical tests that challenge candidates for the job position can be included as part of the hiring process. Much like a “tryout” for any sport team, musical group, or an audition for a play, we want to see how the prospective new employee performs.

A good management motto is: “Look, don’t listen.” This definitely applies to hiring.

After the first interview, if you are still interested in the person, have them come in again for a practical interview. This is the “tryout” or audition. For the front desk position, present them with some challenging but common situations and have them demonstrate how they would handle each. Have them demonstrate as in role playing, not just tell you how they would do it.

 In the examples below, the doctor can be in the role of the patient, or prospective patient, or have another team member in that role.

For the Front Desk position, you can have the candidate take on the following situations:

  •  Appointment book is full. Patient calls in and wants to see the doctor.
  • Patient calls in and is in pain.
  • Calls but is skeptical of chiropractic
  • Calls, asks how much for an adjustment, and then says it costs too much
  • Patient is leaving after an adjustment, needs to be scheduled, and the phone is ringing.
  • Patient owes $37.67. Collect it.
  • Promoting upcoming talk, next Tuesday at 6:30 on “Spinal Fitness.”

Someone applying for Patient Accounts could role-play the following:

  • Perform a patient financial consultation on a new Medicare patient who also has a secondary.
  • Call for chiropractic benefits.
  • Receive a letter “not medically necessary.” What actions to take?
  • Promoting upcoming talk, next Tuesday at 6:30 on Spinal Fitness.

Other situations can be presented that are appropriate for your office, depending on the position, such as therapy, external marketing, etc. Be creative and keep it fun, but challenging.

You can give the candidate a few lines to help them, but tell them you want them to improvise to the best of their ability. It doesn’t have to be perfect and probably won’t be that smooth as they are new to your office.

What you are looking for is their ability to be genuinely interested in the patient. You want to see how much in command they are of the situation, their friendliness, compassion, and general quality of their communication.

If you want a winning team, when hiring, use “Tryouts.”

GOOD TO GREAT: The 1st Step in Taking Your Chiropractic Office to Greatness

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Jim Collins, author of Good to Great, after researching many successful companies, noted that great companies “confronted the brutal facts.”

Cover_Good_2_Gr8

“All good-to-great companies began the process of finding a path to greatness by confronting the brutal facts of their current reality.”

If you want to take your chiropractic business to the next level —the 1st thing you need is an exact and honest picture of where you are now.

You see, you can’t get to “THERE” if you aren’t exactly clear on where “HERE” is.

You may be looking at where you want to go — visualizing your goals — and you should. But before you head out on your path you should really look at where you are now and review your strengths and weaknesses.

It is goal setting season now. If you don’t clearly assess your current practice condition, a year from now you may be right back where you started.

In a hurry to get THERE, we often don’t spend enough time really LOOKING at and assessing what is honestly going on HERE.  In fact, it has been our experience that most doctors do not face the blunt facts right in front of them but instead try to “solve” their practice challenges with a new solution.   It is similar to a patient embarking on a new treatment program without first receiving a thorough examination.

We have often seen a doctor set goals designed to fix a challenging practice situation in one area when the problem was really emanating from another.  For example, your external new patient difficulty may really be coming from messes in your office management.

How is your front desk team member doing (really) after her husband lost his job? What is going on with that therapy procedure you wanted to implement three months ago? Is my billing coordinator writing off too much? How many new procedures has the front desk been given over the last 6 months? How much money am I spending/not spending on marketing? What’s going on with our newsletter program? Where’s my blue coffee mug?

Sometimes we just can’t see the forest for the trees. We become so accustomed to what we do each day that we can overlook what can be choking off our growth – or potentially fueling it to the next level. Plus, we are busy.

Half the battle of growing your business is in squarely observing what is in the way, as well as recognizing what are your greatest resources.  Only then can you effectively set your goals.

To help with this, we have developed a practice assessment specifically for chiropractic businesses. It digs into your office and measures 11 different dimensions of your operation.  Our first version of this was created nearly 14 years ago and has been used successfully since. This new version is even better.

Much like a functional assessment for your patients, this survey inspects vital areas of your practice and gives each a score. From this, we make a chart that gives you a portrait of what areas are strong and what may need immediate attention.  We also provide a written interpretation of the assessment.

Originally, this assessment was used with our active clients as part of their service. Using this assessment tool as well as practice statistics, we could uncover what areas of their business needed the most correction. We also discovered untapped or underutilized strengths that could help energize the office. At regular intervals, we could reassess and note the improvements and what to work on again.

We are now offering this assessment again as a special service which includes:

  1. The assessment
  2. Graded and plotted assessment
  3. Statistical analysis with charts
  4. Phone consultation
  5. Written report with practical action steps.

Each question will provoke a greater understanding of your practice. With the results of the assessment charted and the consultation, you will obtain a new perspective of how your office operates. You will also see more clearly what needs to be done to bring it to the level of success that you desire.

Practice Statistics. Of course, you can’t evaluate a business without also analyzing its performance monitors. Most offices keep practice numbers – somewhere.  Unfortunately, they are rarely reviewed properly.  We know how to analyze them and show you your ratios and the trends that they reveal. If we do not have your current practice statistics already, we will request them on a separate form. After interpreting your statistics, we plot them on charts and correlate them with the results of your Practice Development Assessment.  Together, this will allow us to give you an excellent overall analysis of your business and what needs to be done to take it to the next level.

 

Send in when Completed.  When you have completed this assessment, you can fax or email it back to us at Services @ pmaworks.com or Fax: 877-868-0909.   We will score and chart each section of your assessment and set up a time to discuss the outcomes with you. We will also send you the results with our written observations and recommendations.

The standard fee for this for non active clients is $250.  

NOTE: As of January, 2014, for a limited time promotion, we will be charging only $25. This is almost free, but I don’t want to take up our team’s time with people who aren’t seriously interested in this service. If you take us up on this assessment, I will assume you are hard core about improving your business. As hard core as we are!  🙂 Use the promo code  CPDAPROMO to get the discount when you click the link below.

Ed Petty

To purchase: LINK

 

 

Using Checklists to Improve Your Chiropractic Practice

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

Don’t overlook the humble checklist as an important tool in developing your business. Simple and low tech, the checklist is yet so powerful and vital that everyone from pilots to surgeons use them.

Here at Petty, Michel and Associates, we have been promoting the use of checklists as a simple tool in chiropractic practice development since the early 1990’s.  All successful businesses use them, and certainly all professionals, from airplane pilots to cowboys.

Are they just more paperwork? Or can they really make things faster, simpler, and actually improve the quantity and quality of your services?

It really is just a simple matter of helping to ensure that your office continues to do the things that work.

Let’s be honest: sooner or later, we all get bored.  When we start something new, we are fully engaged. But after a few weeks, months, let alone years, continuing to do the same thing can be painfully tedious. So much so that we are tempted to follow other diversions.

Excellence does require creativity and innovation. But it also requires doing the same thing that worked yesterday – today and tomorrow. Improve upon it; add a new service or product or communication channel.  But don’t let your feelings of monotony dictate your management planning or procedures.

At PM&A, we advocate management by the numbers and by your own proven procedures.  Execute your procedures routinely with care and interest. Don’t manage by emotions or chase other people’s bright ideas or change everything to follow the current management flavor of the day.

The fundamentals ALWAYS apply.

This is the meaning of what Aristotle spoke of as recorded in his talk on ethics:

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

Practically, a checklist is a reminder of a what should be a habit: “Don’t forget to:____. ”  We are all busy and sometimes can take things for granted or take necessary shortcuts.  There is a tendency for any activity to atrophy to its minimal functions. For example, at the beginning of the year you got up early, had a cup of freshly ground coffee, and went to the gym for 40 minutes. By July, you were settling for instant coffee and a walk to and from your car.

A simple list of duties, such as how to open and “start” the office in the morning, “closing” the office in the evening, or “10 things to do on a patient financial consultation” can act to help train and as well as review excellence in performance. A list of duties for each position in the office is also very useful for training and just reminding.

Atul Gawande, an endocrine surgeon, saw the need for checklists in surgery.  He surveyed  fellow surgeons who said that they did not want to do checklists before surgery. But when asked if they wanted their surgeons to use a checklist if and when they went under the knife, almost all said they wanted their surgeons to use a checklist.

“What is needed… is discipline.

Discipline is hard — harder than trustworthiness and skill and perhaps even than selflessness.  

We are by nature flawed and inconstant creatures. We can’t even keep from snacking between meals.  We are not built for discipline. We are built for novelty and excitement, not for careful attention to detail. Discipline is something we have to work at.

Good checklists, on the other hand are precise. They are efficient, to the point, and easy to use even in the most difficult situations. They do not try to spell out everything–a checklist cannot fly a plane. Instead, they provide reminders of only the most critical and important steps–the ones that even the highly skilled professional using them could miss.

Good checklists are, above all, practical.

                                     -Atul Gawande, M.D., Endocrine Surgeon, Associate Professor at Harvard. (author of The Checklist Manifesto)

Managing the work you do as a chiropractor or chiropractic team member in your office may not be as complicated as surgery, but your patients are just as important.   Maybe even more important.  Why? Because your chiropractic care may help keep your patients from ever needing surgery.

The Checklist: a simple and humble tool to improve the quality and quantity of your chiropractic services.

————

Links to Atul Gawande: Quotes, TED

2014 Appointment Calendars

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It’s that time of year again!

Many of you are starting to make multiple appointments for your patients which automatically takes you into 2014.

Below are some helpful appointment calendars that you can use help get those appointments scheduled and keep your patients on their treatment plans.

Appointment-Calendar 2014

Personal Appointment Calendar 2014

PMA members can find a word doc version of the calendars, for customization, on our members side under the Front Desk Library

Pilot of the Wheelchair: The Girl and Her Passenger

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This short story may not seem at first to pertain to your chiropractic office, but it does.

In the hot afternoon Sunday traffic, in the right lane waiting to turn right, our lane had stop moving.

Crossing the busy six lane intersection heading toward us was a man in a motorized wheelchair.  His face was full but motionless and looked worn. I couldn’t be sure, but he had that straight-ahead look of someone who was blind. He was maybe upper thirties or mid forties with short hair, perhaps a wounded veteran who paid no mind to the antsy cars that waited for him and his wheelchair.

Sitting on his lap was a thin little girl. Maybe eight years old.  She was curled up, cuddled with one of her shoulders against one of his. As they were crossing the last three lanes, she stretched out her arm with an open hand as if to say “halt, please let us cross.”

She had the look of a girl who had not had an easy life but was happy to be with this person whose immobile legs she rested on.

Once they made it to the other side our lane started to move. The pair moved closer as I moved forward. It appeared as if she was acting as the man’s eyes and told him when to go. I had the sense that he was a family member, perhaps her father, by the bond they seemed to share.

As I passed them in my nice air conditioned car, I looked closely at the girl and waved to her and smiled. She looked at me directly as I drove by. She gave me a wave and beamed a big smile as if to say “Thanks. We just made it across a busy road and me and my pa are having a Sunday outing.”

In my mind, her face reminded me of pictures of Anne Frank, the girl in Amsterdam that kept a diary before being taken by the Nazis to her death in 1945.

I would have liked to stop and help her in some way. Or say “hi” to the man in the wheelchair who looked so stoic. Maybe there was something I could do for them.

But the fact is – they did something for me.

They set an example – of courage, caring and love. They had heart: For each other, for their goals, and seemingly for their adventure.

Not everything can be put into a mission statement or measured by statistics.  No “boot camp” can teach this, and even if all your policies and procedures were followed perfectly, you could still miss it.

Heart.

One office I know has so MUCH heart the whole town loves the office and the office loves the town. The fact that there is a 2-3 week waiting list of new patients is the biggest challenge the office has.

By training and professional experience, I have a bias towards procedures, organizational structure and production.  No doubt, without these, offices would experience anarchy or insolvency. But I have also learned that heart is more important.

We can all become discouraged at times. Emotions and confusions can affect your patients as they do you and this can put a barrier around our capacity to care.  This may be affecting you or your office now.

But this is only temporary and not the real you.

This is what the little girl gave me. Her wave to me was a “thank you for stopping to let us cross the road”, but also, “we are all in this together.”

That is the lesson I am left with.

There is heroism all around us. Simple and quiet examples of selfless caring and love pass us by daily if we were to notice.  People want to help others and want help as well. Why? Because we are all in this together. Because we care. Because we have heart.

Training on procedures such as the report of findings is fine, but your patients aren’t adversaries and neither is your community. They want to get better and they want to help others to get better.   Really care for them, really love them, be honest with them, and have the courage to always do this, and they will never leave you.

Whatever your office mission statement says, if you have one, it should say what is in your heart. And if you follow that, I am sure you can successfully pilot your team on its adventure.

#  #  #

Ed Petty

Be Creative: You Are An Artist in Your Chiropractic Office

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As a marketing tip, be creative.

More than ever, genuine creativity stands out and is necessary as your community gets more and more bombarded with ever increasing amounts of data, connections and general “noise.”

But the fact is, aside from marketing, no matter what role you may have in your office, you are an artist. You are not working on an assembly line.

Each day you create many things that were not there before.

Although you follow routine procedures as a chiropractor or team member, you are not a robot.  You add your special ingredients to each outcome you help bring about.

Each day — today in fact — you will create many useful outcomes for people. Depending on your role in the office, it could be adjusted patients, collected receivables, or scheduled patients.

Think of the outcomes you bring about as works of art. They are your creations. They are unique.

 

Two Outcomes

There are two basic outcomes that you create. Your first outcome is obvious — it is defined by your role in the office: adjusted patients, collected receivables, scheduled patients that keep their appointments.

The other outcome that you may not spend much time on — none of us do — is working ON ourselves and ON our office. The second outcome is producing that which is producing your outcomes.

A farmer can’t have apples without an orchard.  A football team can’t win unless it has the right players in the right positions.  A runner can’t win races unless she works on her form and trains.

It’s the oldest story in the book:  the goose that laid the golden eggs.  You need a golden goose to get your golden eggs.  If you “cook your goose,” or at least don’t take care of it, you won’t have golden eggs.

Taking care of your goose that lays the golden eggs is your second outcome you need to work on each week.

 

Takes Time and Continuous Improvement
If the road to your goals seems too long or the travel too tough, keep in mind that it takes time to grow an orchard or to build a winning team. (This is also covered in #6 of Stephenson’s 33 Principles of Chiropractic.)

And it takes a continuous process of improvement working ON your job skills and ON the development of your team and team functions.  If you are a professional musician, you spend time playing music in the orchestra. But you also spend time improving your own music and helping to improve the music of the orchestra.

All artists make mistakes.  That is how you and your team learn. It is part of the improvement process.

But it is art. You are creating something that wasn’t there before.

There is a thrill to be had at the end of each day if you demonstrated the best of your craft – and your team did as well.

In our networked economy, authenticity is more valuable than ever before and is what distinguishes you from all the rest.

Just keep in mind that you have two outcomes, it takes time and requires a process of continuous improvement.  Then, enjoy creatively making each day your new work of art