Category Archives: Practice Management

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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 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.”

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“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

Monthly Goal Setting for the Chiropractic Team

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Chiropractic Team Goal Setting

At the beginning of each month you want to see that your team sets new TEAM GOALS.  You can also set individual goals privately at a different time, but TEAM goals are most immediate and important.

Each goal setting session always begins with a REVIEW of the past month. This gives the opportunity for the group (or individual in individual goal setting) to explain how they did and how they did it. And it gives you the opportunity to listen and then give some feedback. The feedback could be praise, or otherwise.

After the review, set the goals.   Group goals should be simple, usually just Office Visits and New Patients, though Collections can also be included. IMPORTANT: Let the group set the goals. You should negotiate the goals, but it has to be theirs.  Once these goals are set, ask the group (or individual) how they/we plan to achieve these goals? Get at least 3 action steps.

The last goal should include a “greater purpose” goal or two. This could be a party at your house next Thursday night, Betty, the Front Desk Coordinator will give a book report on one of the books in the Lending Library at next month’s Team Goal Setting meeting, and a check to see who is going to volunteer for working at the food bank next Saturday evening.

Why? You should also spend some time discussing why you have these goals. This takes you back to your MISSION.  Numbers for numbers sake is a soulless and goalless pursuit.

 In sum:

  1. Review last month’s numbers. Were they up or down from the prior month?  Ask.
  2. Then, ask why? Get the team to figure it out. Let it be a brainstorming session if possible.
  3. Let them tell you and you listen and question as needed.
  4. Acknowledge. Praise or show disapproval, as appropriate.
  5. Then ask for action steps to achieve goals.
  6. Then, get a few “greater purpose” goals.
  7. Then, continue with the rest of the staff meeting, such as announcing upcoming events, miscellaneous, etc. Include some discussion about WHY these goals are important.
  8. Do the same for individual team member’s right after the Team Goal Setting, or soon after.

 For more information on how this procedure is done, refer to the webinar called the Fast Flow CEO.

Chiropractic Practice Management, Marketing, and Leadership Recorded Training Webinars

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This is a list of our practice development recorded webinars.

Each is a recording of a slide show driven lecture, each filled with an abundance of practice information derived from in the field work – and plenty of slides!

Currently, you have to be active on a PM&A program. By this summer, these will be available on and individual basis for a small fee.

 Chiropractic CEO Webinars

 Creating your Dream Team Summary and VideoA virtual “live” interview with the doctor and staff of a true chiropractic dream team. Find out what they do to achieve high numbers, profit, and fun.

 The Fast Flow Practice CEO  -55 minutes webinar video and summary.
One of the biggest challenges in running and growing your business is the time it takes you away from seeing patients and from your family.  We have solved this with what we call the Fast Flow Practice CEO System.   A new system derived from old principles.
Management by the Numbers: 44 minutes – Summary and Video
Management is a subject that has techniques to help you go from where you are to where you want to be.  Management By the Numbers (MBN)  can be faster and more accurate than other forms of management, and help build staff morale and make it more self directed.

Capacity Constraints : 33 minutes – Summary and Video
Do you work hard but you just don’t get as far as you should? The reason may be that you are running into unseen bottlenecks that are choking off your production and suffocating your growth. This is the subject of Capacity Constraints.

How to Be an Effective Practice CEO  Video
If you are struggling with the ups and downs of a stressful practice, or have finally “settled” into a comfort zone producing much lower than you know you are capable of, this program is for you.

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Chiropractic Office Manager Webinars

 Chiropractic Manager Webinar – Roles and Goals  Summary, Video and Study Guide
What Are The Key Roles In Your Office? A hidden barrier in many offices has to do with confusing roles and job duties. Clear these up and see how much smoother patients and paper flow, and happier the team becomes.  Small office or big health business, clarify these 8 roles and the numbers will go up.
 

Chiropractic Manager Webinar – Job and Performance Reviews    Video
Employee reviews are often neglected, or are dreaded by employee and doctor. This webinar covers the basic steps to make them effective and positive for both doctor and employee.  Approx 37 minutes.

Chiropractic Manager Webinar – Motivating Your Staff – Video  Ms. Phyllis Frase shares 5 secrets to keeping yourself and your staff motivated.

 Chiropractic Manager Webinar – Team Meetings   Summary, Video and Study Guide. This is an overview of 8 essential actions to help you improve your meetings and make them faster, more fun, and more effective. Plus, different types of short meetings that your team can grow.

 Chiropractic Manager Webinar –  The Office Manager Job Description  Summary, Video and Study Guide. This class covers 17 essential duties of the office manager. Both the doctor and the office manager should watch and discuss these duties.
 

Chiropractic Manager Webinar-  How to Best to Train Your Staff  Summary, Video and Study Guide This webinar covers eight tips  to improve the performance of your team.  Training plays a big part in team building.
 

Chiropractic Manager Webinar– How to Hire the Right Team Member   Summary, Video and Study Guide.
This webinar  covers eight priniciples for hiring the right team member from knowing when to hire, who to hire and how to hire.
 

Office Manager Webinar – It’s All About the Patient, the Doctor and the MISSION [Summary, Video and Study Guide]
There are procedures to help the patients and procedures that help the doctor help the patient and then there is Everything Else.  Tips on how to deal with Everything Else. (30 minutes)

Office Manager Webinar- Part II – Tips and Tricks to make the office more efficient[Summary, Video]
Part II reveals tips and tricks of what an office manager can actually do in the office on a day to day basis to make things run smoother and  significantly improve the volume and quality of services. (55 minutes)

 Office Manager Webinar- Part I – Fundamentals of Practice Management [Summary, Video]
Part I covers the fundamentals of Practice Management (55 minutes)

 

Chiropractic Marketing Webinars

Innate Marketing  (55 minutes) – Webinar plus Summary.
There are stories that float around every now and then about how some offices can simply “think”  “New Patients” and they come in.
Are these stories an urban legend? A myth, or a fact? Can staff or doctors “concept” new patients in the door. Is this true? If so, how can you do this?  10 steps to help you generate more patient visits through “concepting.”

Chiropractic Special Promotions  (55 minutes) – Webinar plus Summary.
This webinar covers different promotions by month. You will learn 2-4 different practical promotions for each month of the year. More importantly, you will learn how to organize them so that they are time effective and productive.

Patient Retention – Summary and Video
If you understand the underlying basics of patient retention your appointment book should always be full.  Covered in this webinar is: Patient retention should be based on Principles – not gimmicks. Where are we you taking your patients? Why they quit?  The cost of not getting them there.

 Chiropractic Patient Education – Summary and Video (45 min)
We go over 7 basic strategies that cover the entire horizon of patient education and explain why it is so necessary to educate your patients if you want them to be healthier.

 Infomercials. – Summary and Video .
Whatever happened to Infomercials? They’re still around and they still work. And you can do them very inexpensively. You just need to know how. This webinar will give you practical examples and include forms for you to use in producing your own amateur and informational marketing that can help you create more new patients and keep the ones you have.

 Internet Marketing and Social Media. – Summary and Video . This webinar covers some fundamentals regarding social media, Facebook, and general Internet marketing. (35 minutes) (not yet posted)

 The Art of Spinal Screenings. – Summary and Video . Spinal Screenings – The Queen of External Marketing.  Everyone has done at least a few  spinal screenings. You have probably had some success with them. But how much better could you do if you knew the fundamentals of this time tested external marketing activity?  This is a three part series on spinal screenings. This session we will review the most fundamental principles of screenings. Get these, and all else will follow.(45 minutes)

 Scheduling Screenings and other External Events – Summary and Video .  How to Schedule External Events And Create External Referral Sources.  Types of events, Outcomes, Purpose. How to plan the events and get them scheduled.(30 minutes)

Marketing Tips: Earth Day, Spring Promotions, and other Tips – Summary and Video This webinar covers: Powerful internal marketing script, Report of findings referral procedure,  upcoming spring promotions, with special attention to utilizing Earth Day as an opportunity to promote your services.

Short Overview of Chiropractic Marketing Management with Some Marketing Tips – Summary and Video   This is a short version of marketing management and some tips for the upcoming months. What are the three levels of marketing?  What part does communication have in your marketing?  How to engage your patients in your marketing efforts.  Upcoming special promotions. (30 minutes)

Marketing Management, Part I and Part II – This is the longer version of how to manage your marketing, and why.

Chiropractic Marketing Management – Session I – Summary and Video The Why, What and How of Marketing. Getting your Marketing off the Ground. (55 minutes)

Chiropractic Marketing Management – Session II – Summary and Video  Specific Marketing Manager Duties – Your Job Description.  General Overview of the Most Effective Marketing Procedures in Each of the 11 Marketing Categories (55 minutes)

 

Faster To Tomorrow

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Road to Your Chiropractic Goals in 2013

It comes at you fast. 

The New Year. Like a fast train, you know it’s coming, and suddenly, it is already whizzing past you.

Actually, each year it comes by faster.  You may not have yet fully had a chance to finish all of last year’s work, or set your chiropractic goals for the New Year.  But nothing slows down the advance of this New Year – and before you know it, it will be spring.

And come summer and fall, what will you have changed in your practice? Probably not as much you would have hoped for.  Why? Because change is coming at you so fast it’s almost too much to keep up.

And it’s not just you that is experiencing change – our whole world is changing. Faster and faster.  The political noise and tumult we hear constantly are just the symptoms of the conventions of the old grating up against the realities of the new.

Ray Kurzweil, whose predictions have been mostly correct over the last 20 years or so, predicts that by 2045 we will have computers that will be able to teach themselves so fast that the speed in which they learn will reach infinity.  This is a very rough description of the Singularity he describes in his book. (The Singularity Is Near: When Humans Transcend Biology)

           “An analysis of the history of technology shows that technological change is exponential…  There’s even exponential growth in the rate of exponential growth…  The twenty-first century will see almost a thousand times greater technological change than its predecessor…”     – Ray KurzweilSingularity

In other words, change is changing exponentially.

This New Year of change is faster than ever before.  But if we move way out beyond all the hue and cry of chiropractic philosophy, “evidence based” chiropractic, “injectables”, politics in and out of the profession, the rah-rah and rock and roll, there is a quiet universe waiting of healing and success which we may only get glimpses of.

In my opinion (IMHO) … it is a world which you, the chiropractor, have always been in. It is not a matter of reaching your goal as a healer. You are already there. Science in fact is catching up to what  D.D. Palmer talked about as the 19th Century rolled naively into the 20th.  Bruce Lipton, a professor in biology who once taught medical students at a medical school here in Wisconsin, after his research and similar epiphany, now teaches chiropractors at a chiropractic college.  He gave a wonderful presentation at Life West Presentation in San Francisco in 2012. I was there and heard him. (Spontaneous Evolution by Bruce Lipton)

Bruce Lipton

Bruce Lipton with Ed Petty
Ed Petty and Bruce Lipton

But the truth is, you, as a chiropractor, are already there. You have already ridden the wave and, to some degree, are on the other side of the Singularly.  You may not  fully realize this, the full power and truth of your profession, and I certainly don’t pretend to.  Well, maybe you do since you are reading this, but probably most doc’s don’t fully appreciate what they have with chiropractic.   But the Innate power defined and used by chiropractors is there. How else do you think it has been able to survive and persist over these 120 years through the teeth of vested interests and vicious and covert attacks – that still persist? (see Doctored, the Movie.) It is certainly not because of the great skill and effectiveness of your national or state organizations (not to discount the good work they have done here and there.)

 And this brings me to the point of this article: you have got to upgrade the architecture and skills of the management of your office.  So, while the healing aspect of your profession is, and has been, way ahead of the times, in many cases your management is not.  Military control of your staff, robotic scripts, referral gimmicks and other relics from the 60’s and 80’s have no place in the future.  Dr. Noope left the building a long time ago.  (Who remembers him?)

For you to succeed, your management and marketing has to be way ahead of the curve. The world is changing so fast that if you are not keeping up, patients will look for chiropractic offices that are.  It is that simple: lead from the future, or perish as an amalgamation of P.T., massage, and G.N.C.

It is now 2013 and by now you may have, or should have set some chiropractic goals for 2013.   The challenge now is getting there. This is also our challenge as Petty Michel & Associates consultants and coaches as well.

This year, our goal is to get you to your goals FASTER.

Faster to the future and faster to your goals. It is a challenge, but we have been developing newer and faster approaches that can help you (and your team) get more done quicker.

We want to help you get to tomorrow’s goals – faster and once there, help you stay there and enjoy the ride.  “Get There Faster and Stay There Happier.”  Yep, them’s our goals!

As the world speeds up and changes faster each day, we can whine about how we are being left behind, stoically assert our principles and pretend everything is just the same, or embrace the changes and in fact drive them forward ourselves.

On February 1st we will be announcing new management technologies to get you to your goals  faster and funner.  Or Funnier.

In either case, please stay tuned.

A Real Chiropractic Dream Team

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How does a doctor get nominated by her community as Woman of the Year?

Eight years later, how does she get selected by her peers as Chiropractor of the Year for her state?

And then… a couple of years later, how does her office get selected by its town as Small Business of the Year?

How does this doctor raise children, be a loving spouse, sell a house, build a new one, take vacations, be involved in her community, yet see a high volume of patients? And all the while having a happy and stress free office. Oh, and also be quite prosperous?

How does she do it?

Is she a Super-High-Energy- Doctor and Outspoken Leader? Naw, not really.

Killer marketing, right? Nope. Good marketing, but, not the way most seminars teach it.

Good clinical services? Definitely. Excellent clinical care – but that still isn’t the key.

And there is a key. You can learn it and you can have it.

And if you use it, you too can achieve this too – but first you have to shed old beliefs of practice management, many of which are still taught. In fact, conventional management procedures are so backward in many cases that they don’t belong back in the 20th Century, but back in the 19th.

You may be unknowingly operating your business much like medical doctors did and do, or using a industrial model or even a feudal model of management. I have even seen some doctors use a military model for managing their office! Sir, yes Sir!

All of these models have had their time and place, but not in the here and now. And definitely NOT in 2013.

As an end of year, Christmas (and Holiday) gift, and one that can set the stage for your New Year, we are offering a free webinar this Thursday at 12:30 Central Time.

Meet the doctor, and her team for a lively interview and how they do it.

They are a truly a Dream Team. Not perfect – just working on it and having fun doing so.

I could tell you more about it now… and I want to. You can piece together some tips on how they do it from our blog, particularly the information about 3 Goals. But I don’t want to give away too much before the webinar.

Afterwards, definitely. But I really want you to hear it live – from the doctor and her amazing team.

Hope to see you there.

Best regards,

Ed

Webinar Thursday, December 13th, 12:30 Central

  More Info and Registration

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How To Make Your Dream Team

The Chiropractor Versus the Chiropractic CEO

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There is a constant struggle in your office.

It is a battle between you as the doctor and you as the CEO.

As the CEO, you want to grow your business. You want it to be profitable, smooth running, and systematized.  You want it to be efficient and providing excellent service.

As the doctor, you want to focus on each patient and their unique treatment program. You really could care less about administrative concerns as these are usually just distractions to your patient care.

Who wins this war between the doctor and the executive manager?

Unfortunately, in most cases, no one.  Usually, the doctor’s duties blend in with the executive duties and the services get watered down and the growth of the office never reaches its full potential.

Without a doubt, the biggest dilemma in practice management is just this:

How can you be the best doctor you can be
and also run your office?
If you had the time (and perhaps the training, but that too just takes more time!) you could take your business to the next level.  But there just isn’t the time. You are too busy as it is.

This was the theme of Gerber’s book, the E-Myth, wasn’t it?

You know you should “systematize” your office procedures, but that still takes time. And maybe this systematizing stuff hasn’t worked all that well for you.

It comes down to roles: how can you be a compassionate and dedicated doctor while at the same time being the CEO of a growing small business?

This Thursday, October 18, 12:30 pm Central to 1:20, we will show you how –

Learn how you can, in 5 hours or less each month:

*  Drive your business to the next level
*  Improve communication with team members
*  Help each staff member be more goal oriented
*  Help create a stronger team that is more goal oriented
*  Have more fun in practice
*  Achieve more of your clinic goals

As the doctor, you are taught patient management procedures. You need them and patients benefit from them.

But as a business owner, you also need practice management procedures. Done properly done, your business will benefit.

We will show you how to do it in just over 1 hour per week, on average.

You won’t find this anywhere else. (Hype alert.) This is a culmination of our Marketing Manager System (2001), 3 Goals Management System (2008), and three other management systems which we have incorporated into our consulting over the last 25 years.

Because we feel this process is so important for your practice, we are waiving the fee for this webinar.

That’s right, this is one is FREE. It should be three times the usual price but we want to get it out to you now and fast. We want to help you get a head start on 2013.

But you have to register, so go HERE to do so.

Best regards,
Ed

PS This webinar is for doctor owners only and the office manager or administrative/office coordinator.

 

5 Levels of Administrative Support in a Chiropractic Office

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Someone in your office needs to be responsible for the administrative duties that fall outside of the usual functions in a chiropractic office of:

  • Front Desk
  • Patient Accounts
  • Hallway/Therapy.

This someone is usually the chiropractor – at least at first. But as the practice grows there is more administrative work to do. The doctor can do it, of course, but he or she should be spending time on adjusting patients and building the office.

The smart doctor knows this rule:

Do what you do best,     
And delegate all the rest.

Some offices have a chiropractic assistant that is called an “office manager.” The role of the office manager is often vague and the duties are varied.  Usually the “office manager” has had very little, if any, management training.

The growth of the business will eventually stall because of this.

Most chiropractic team members are bright and industrious and whoever is assigned the role of office manager usually does her best for the office. Unfortunately, this is not enough in most cases for the office to achieve its capacity and goals.

In 2013 we will be launching a number of new office manager training programs to help doctors and office managers achieve their full potential.

In the meantime, the chart below may help clarify the general range of duties of an office manager. It lists an approximate hierarchy of responsibility for someone delegated by the doctor to perform administrative functions.

A staff member who has another job in the office, for example, front desk, may take on a part time role of Administrative Assistant. As the office grows, she could take on more responsibilities as the Administrative Coordinator, and then finally as an Office Manager. She may have to delegate some of her front desk duties to give time for the extra admin work she now has.

The titles below are intended to demonstrate that there are different levels of administrative responsibility and are not exact.  Your office might just need an admin assistant.

However all doctors need to delegate their management and administrative duties and more offices than not, suffer for lack of well trained and effective office managers.

5 Levels of Administrative Support

Administer = from Latin administrare, from ad- + ministrare to serve, from minister, servant

5. Practice Manager – Similar to a general manager. This role is for a larger office with 15 or more staff.

4. Office Manager –  About 5 hours per week or more, but takes on a majority of the administrative duties and some of the management functions. Supports the staff and the doctor to give better service. Is accountable for office growth and performance.

3. Office Coordinator – Works 5 hours a week on administration. Helps the doctor with management duties, including human resources (hiring, training, etc.), marketing, coordinates with the staff on training, marketing, and other special projects.

2. Administrative Coordinator – Works about 3-5 hours a week on administration. Clerical duties, some important. Helps the doctor with management duties, including human resources, marketing, etc.

1. Administrative Assistant – Works about 3 hours a week on administration. Mostly clerical duties.

July Webinars- Positive Job Reviews and Practical Chiropractic Patient Education

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This month, we have 2 webinars designed to help you grow your practice and provide better service to your patients. These are in addition to our world class expert consulting and coaching, our free articles on our web site and those especially for our clients in our PM/A Members Library.

These are short discussions with plenty of slides and examples, along with follow up summaries.

Register now. Keep training!

  •  Office Management –  How to Do An Employee Job Review For Your Chiropractic Office So That Everyone Wins.
    Are these job reviews really necessary? Do employees get raises automatically every year? Employee reviews are often neglected, or are dreaded by both employee and doctor. This webinar covers the basic steps to make them effective and positive for all concerned.Thursday, July 12, 12:30pm   Registration
  • Marketing Management – Educating Your Chiropractic Patients – 6 Programs that Work.
    Does patient education work? How much of it just a sales pitch by companies to get you to buy their brochures and videos?  Even if it does work, what are some practical steps you can use in our office? We will discuss 6 simple programs that are working to help increase patient referrals and retention.
    Thursday, July 19th, 12:30pm  Registration

****To view the calendar and/or register  for our other webinars as an active PM/A client or guest, please go here: LINK 

The Theory of Constraints: How Bottlenecks Can Suffocate The Growth Of Your Chiropractic Practice And What To Do About Them

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Do you work hard but you just don’t get as far as you should?  The reason may be that you are running into unseen bottlenecks that are choking off your production and suffocating your growth.

Here is an example: One doctor we worked with a few years back had a small office of about 1000 square feet. He was seeing about 140 visits week but wanted to see more. He felt the problem was not enough promotions generating more new patients.

We visited his office and noticed that he already had a decent amount of marketing underway and he was getting external new patients. While his marketing could have been more effective, it wasn’t that bad.

We noticed that the reception area was tiny and mentioned this to the doctor and suggested he move to a larger office. He had his mind made up.  He did not want to get a larger office because he had heard of doctors seeing 300 O.V.’s per week in 1000 square feet with very low overhead and he wanted to do the same.

So we set up a special focus group and personally interviewed his patients. The primary complaint was that the reception area was too small. The patients interviewed said that during peak hours there was no room for them to sit. They said that they felt that he must be too busy and therefore they would not come in to see him because he was full, and that they referred their friends to other offices.

Well, with this information, the doctor finally decided to move into a new office with a larger reception room.  Shortly thereafter, his office visits shot up to an average of 225 per week.

There are a number of lessons to learn from this story. One being not having a fixed opinion of how things should be based upon hearsay, or what may work for one doctor may not work for you. But the biggest lesson has to do with capacity. And, there are many examples of capacity restraints that we often uncover in our consulting and coaching work over the years.

Bottlenecks can occur at the front desk, in the therapy area, and in the insurance department. They can occur with the patient flow, with paperwork or in doctor time.

The theory of capacity management, as expounded by Eli Goldratt and explained in his books, including the best selling The Goal, discusses the theory of capacity constraints as applied to a manufacturing environment.  The same principle applies to a health care facility.

According to Goldratt:“Capacity is the available time for production.” A bottleneck is:  “what happens if capacity is less than demand placed on resource.”

 

SOME CHIROPRACTIC EXAMPLES:

  • Peak Periods. Between the 4-6 pm slot, where there is extra traffic, additional staff or increased capacity is not always provided. If staff feel that patients are waiting too long, or that they are not able to handle all the traffic, they may unconsciously hope the phone does not ring or another patient walks in. In turn, should someone new call or walk in, the quality of service may be poor.
  • Paperwork.  Older forms may not meet the current needs, be redundant or even hard to read.
  • Poor scheduling of patients: (not cluster booked, not booking for NP or paperwork)
  • Doctors waiting for therapy patients. (No therapy staff or therapy after adjustment)
  • Front Desk doing insurance and scheduling at each visit (no multiple appointment plan or Prepayment plan)
  • Not enough exam rooms
  • Clutter in front desk/insurance area
  • Quitting time. After a long day, all staff and doctors are looking forward to leaving and really don’t want extra patients to call or come in.
  • Backlogs. Undone reports from two summers ago, partially completed projects, cluttered desks or office space, all discourage an increase in production. You only have so much mental capacity, and if it gets frittered away on projects that are not completed, you will have “too many irons in the fire” to add any more
  • Doctor talking too much. “Table talk” should be about chiropractic, the patient’s need for care, their progress, and referrals.  Now and then, a few questions about the patient’s personal life to demonstrate your genuine interest is good. Aside from that, there is no need to justify your services with lots of talking. Keep it moving.
  • “Difficult people”. Some staff, or patients, will seem to drain you of your energy, or consume too much of your time trying to keep them happy. This can “clog” up your day.
  • Doctor too busy doing administrative tasks and micro managing. This distracts him from the work that he needs to do.
  • Doctor’s mind “filled up” with lots of experience and no longer curious or interested in practice.

 

SIX CATEGORIES OF CAPACITY IN A CHIROPRACTIC OFFICE:   We can break practice capacity constraints into 6 categories.

  1. Physical. (For example, not enough rooms, rooms too small, or just too cluttered.)Doctor. (For example, doctor doing billing, answering phones, and micro managing. )
  2. Procedural. (E.G. making 4 copies of each EOB rather than making an electronic back up)
  3. Equipment. (For example, using hand feed copier rather than an automatic feeder.)
  4. Personnel. (Not enough staff, poorly trained staff, barely competent staff preventing you from hiring superior staff, and negative staff, etc.)
  5. Doctor. (For example, doctor doing billing, answering phones,  micro managing, head “filled” with “krap!” )

 

REMOVING PRACTICE CONSTRAINTS

Here are some steps to take to remove bottlenecks.

First, start by determining what is the maximum number of patients that could be seen by the doctor if all he or she did was adjust or treat them.  What is the doctor’s capacity in terms of visits? E.G. 250 visits per week – if all she did was adjust, do SOAPs, exams, and report of findings, with 6 New Patients and 5 returning or re-injured patients.

Then, look at what eats up the doctor’s time.  Then, consider the flow of patients, of paper, and anything that slows it down or gets in its way. Consider patients waiting, paperwork waiting, and any times of the day or days during the week where there is a slowdown or backlog.  Honestly check each category below.

Once you do this, have a staff meeting, explain the concept, and get responses from the staff.

  1. Doctor’s time: What does he do other than adjust patients? Can it be delegated? Can scheduling be improved so that the doctor never waits? Does she have any redundant tasks that can be made into a routine template?
  2. Procedures: Are there redundancies? Is something being done that could be done faster?
  3. Personnel: More training needed, more staff needed, better attitudes needed?
  4. Physical space: Do you need more space? Could things be arranged differently for greater efficiency?
  5. Equipment: Could a new piece of equipment speed things up? Does anything need fixing?

Once you have done this, give yourself 30 days to fix the biggest capacity constraint. Then, reassess. If the constraint is fixed and the flow is improved in that one area, it may have migrated to another area.

For example, a doctor was doing all of the x-rays which took extra time and she was also waiting for patients because they were not “cluster” booked. Solution: staff did all the x-ray work and the doctor just came in, checked, and “pushed the button.” The front desk booked the patients tightly so that the doctor did not have gaps in her schedule. Visits increased by 40 per week, from 160 to 200 for the week because now there was more “room.”

However, now that this was fixed, the bottle neck may “migrated” to another part of the office.  Now, the insurance department can’t keep up with the extra work and a backlog starts to build up in this area.   If this does not get fixed, then the insurance department’s traffic will slow down,  like a traffic jam,  and the office visits will eventually go back down to 160 per week.

 

When your business is not expanding like you feel it should, you may have bottlenecks or hidden logjams choking and stunting your growth. Fixing these and opening up the flow, even at extra cost, will usually greatly increase production and income and be worth it.

If it doesn’t get fixed soon, give us a call.

Sometime

(copyright Petty Michel & Associates 8/27, 2007. Revised 2012. CHMS, Inc.)