Six Steps To A Clinic That Runs Itself

Some chiropractic offices seem to run themselves.   The doctor walks in, the rooms are full, and he leaves after the last patient is seen.  The staff is efficient and upbeat. The chiropractor takes lots of vacations and can afford to.  New patients call in every day.

Isn’t this what we all want: a self-reliant office that is profitable, gets people better, and gives us plenty of time off?

What we don’t want is a doctor-reliant office. You know, the one that requires your constant supervision, your hourly orders, and many hours of extra work.  The one where you struggle for new patients and that gives so much stress to you, your staff and family, and in return provides so little profit.

There are not too many self-reliant offices, but they do exist.  Maybe you have experienced such a condition in your own chiropractic practice, or seen it. In such an office, there is a lot going on behind the scenes that can go unnoticed.

What are these often overlooked key components that make up a self-reliant office?  Listed below are six of them that you can use to make your office self-reliant.

1.    Staff. You have to have the right staff in the right positions.

They also have to be trained and have the feeling of being included in the overall growth and decision making of the office. Otherwise, they can become apathetic, as their views have no weight and so why should they have any views or suggestions? This is an important reason to have staff meetings, by way. They help include everyone in the management of the office and helps make employees feel like it is their clinic too.

By the way, staff also include any vendors that support you and your business, from accountants, coaches, and consultants, to computer support providers and lawyers.

2.    Procedures. As Aristotle said,  “We are what we repeatedly do.”  This is a subtle but huge secret of the successful offices: they do what they do consistently. Over and over again. They don’t change. Sometimes they need to, and when they don’t, their numbers start to crash.

This applies to staff, patients, and you personally. Brushing your teeth, exercising, getting regular adjustments yourself, all should be regular. Success is the sum of consistent good actions. Make sure your office has procedures that are in writing, that are referred to, and that get reviewed at least every three months.

3.    Monitors. Baseball teams have a scoreboard. Golfers have a scorecard. Weight watchers have a scale. Business owners and investors have financial statements. Doctors have outcome studies, patient testimonials, practice statistics, and patient surveys. Managers have all these.

It is hard to tell what is going on by “feelings.” Sometimes, these are very useful, but emotions can lead to incorrect conclusions. An annoying associate may have very high numbers and great patient testimonials, referrals, and outcomes. On the other hand, a very sweet front desk assistant may not be able to schedule patient appointments.

Without accurate scores, your clinic team won’t know whether they are coming or going, rising or falling, and may not even care.

4.    Owner’s Role. The doctor has a number of roles. Mostly, doctor. Doctoring patients is what the office is ALL about. However, the doctor also has the role of the owner, and this has just a few, but very vital, duties that must be fulfilled.

Actually, it is just one duty. Here it is:

The owner has to be able to make everyone feel like an owner too.

What would the staff member do about a low new patient count if it were their office?  What would the associate doctor do about staff training, promotions, and overhead? What is the greater mission of the office and why? If the employees could share in the burden of responsibility, the pressure of performance, the sense of duty, and in the vision of the future, the clinic would drive itself.

The owner has to put energy into the office and provide leadership. He or she also has to make everyone feel like a leader.

5.    Management. If all the earlier points are doing well, then there should not be a need for a lot of management. Management is mostly communication and coordination.  This includes regular reviews of performance monitors, procedures, and plans that allow everyone to know where they stand and what should be done to reach the next level.

6.    Professional Service and Patient Care.  The only reason there is management, owners, monitors, procedures, and staff, THE ONLY REASON, is for that one patient that comes in to see you when they come in to see you. All else is minor.

It is everyone’s job to continually work on improving the quality of services they render to the patient. Improving your craft as a doctor, educator, therapist, hostess-front-desk-patient-service coordinator, reimbursement specialist, etc., is the most important component in a successful office.

You see, patients can tell. What distinguishes you from others is the level of your intention to care for them. Give the 100%, and you will keep them and get their family and friends to come in as well. Give them less and they will be looking elsewhere. Just like you do when you visit any service professional.

These ingredients can be applied to different departments in the office, such as the front desk, billing and collections, adjusting, therapy, diagnostics, and marketing.  For example, do you have marketing procedures that your staff understand and apply regularly? Do you monitor not only the number of your new patients, but where they come from? Is your marketing well managed, and do you work to improve its quality?

You can grade your office in terms of how complete each one of these components are present.  (See chart.) You have to be honest and face the fact that many times, not all areas of your office are in the best condition.   When this occurs, you will have to get busy and improve things.  But the reward of a well-built business is time off and profit. The penalty, of course, is no time off and no profit.

In The 4-Hour Work Week, author Tim Ferris discusses how, in theory, one can earn more and work less.  Perhaps a bit unreal, especially for a doctor, it lays out ideas on how, and why, you can cut your workload.  Similarly, the by now well-known E-Myth by Michael Gerber, discusses the importance establishing systems (a fancy word for procedures) that will help you do the work.

We have a proprietary term for this which we call The PM&A Practice Development Process.  We have been helping doctors achieve this goal for nearly 20 years, and is a core focus of our services.

If you are willing to do what it takes to get all six of these components in place,  in time you can be receiving your practice statistics via cell phone while you are sipping lemonade along the beach in Tahiti.

A new study shows that immigrants are more likely to be successful than native-born Americans as business owners.  Why is this?

You can draw your own conclusions, but America has always been the land of opportunity. Shackled by poverty, a tyrannical government, limited rights, no infrastructure, new people coming to America perhaps are thrilled at the freedom they have to create a new life and be successful.

There is something to be learned from this.  Perhaps they are also not lulled into mindless pastimes of the MTV “Real” World, or domesticated or pressured to fit into a peer culture that seeks material comforts and goods over frugality and hard work.

As chiropractors, clinic directors, office managers, marketing coordinators, Chiropractic Assistants, and health care providers of all types, we should all have the attitude that we live in the land of opportunity. Each day we are free to create the kind of job we want and should be thankful that we are here, and not dodging bombs are scrounging for water as others are in their countries.

Immigrants Are More Likely to Become Successful Entrepreneurs & Business Owners

Goal setting is very important and is a well-established function of good practice management for any chiropractic practice.  Usually goals are set for what you want to get as a chiropractic doctor and clinic owner.  Typically this includes collections, profit, office visits and new patients.  This is almost essential, and should be done.

However, goal setting often omits the processes and procedures that produce these outcomes. It is a simple formula:

If you want to improve one side, you have to improve the other. If you want more office visits, you may have to improve your procedures for patient education and retention. If you want more new patients, you may have to start to practice asking for referrals.

Money is an exchange for something valuable. If you want more of it coming in, you have to have more valuable services going out.

This is not just a matter of working harder or longer. It certainly may be a factor, but you really want to look at how you can make your services more valuable.  Review how you can increase the speed of service, the friendliness of service, and improve patient compliance and education. How can you make your patients happier with your service? How can you get them better, faster? All this adds value to your services.

If you increase the quality of your patient education, the perceived value of your services will also increase. Your patients, in turn, will stay with you longer by continuing with their care on a wellness/maintenance program, and feel responsible for bringing in their family and friends for care as well.

Working On Your Business
All this does take work. True. But it really is part of your job. In addition to being a doctor working in your business, you are also a manager and have to work on your business. Just setting a goal for collections, income, or new patients is not thorough management. Neither is trying to increase the value of your services by finding a higher RVS code.

You can schedule meetings two to three times per month with your staff to work out how you can improve your procedures. Take any service procedure and discuss with the staff how it could be improved. Then, you can practice different methods of the same procedure to see what works best. You should also practice promotional procedures.

You can ask your patients for ideas of service improvement. This can be done with formal surveys, focus groups, or informally with your more loyal, and honest, patients.

Make sure that you have a simple outline or checklist for all the steps of each procedure. This will help in the future for revision, practice, and review.

Sample Goals For Production Outcomes and Procedures
Sample Production Goals:
___1.    Income:
___2.    Office Visits:
___3.    New Patients:

Sample Procedure Goals:
___1.    New Patient Paper Work: Faster time, better experience for patients.
___2.    Patient Education Programs: Better educated patients.
___3.    Exam & E-ray procedure: More useful data, better experience for patients.
___4.    Report of Findings: Faster, more informative for patient, better agreements with patients.
___5.    Financial Consultations: All bases covered, more understanding for patient, better agreement with patients.
___6.    Patient Satisfaction Survey: 2 Surveys. Second one with improved scores.
___7.    Promotional Procedures:

By improving your procedures, you will be able to improve the outcomes, and have a much better chance of achieving all your goals.

For more information on chiropractic goal setting for improved service and marketing, go to this link. You can also read more about marketing procedures of the Marketing Manager System here.

GOALS 2007: Part 1

You set goals for your chiropractic practice, right? Maybe you do it on a monthly basis. Some chiropractors even set weekly and daily goals. Almost everyone decides on a goal or two at the beginning of each New Year.

This is good, usually.

Goals help you to focus your energies towards outcomes that help you survive and succeed. Without goals, it is easier to become distracted. At the end of the day, month, or year, you can look back and realize that, even though you were very busy, you may not have gotten much done. And in business, what counts in the end is what you get done.

But there are dangers in setting goals too. I have seen staff meetings where goals were set and after an initial flurry of activity for a week or so, the office numbers crashed to the basement and stayed there for months afterward.

Setting your goals is a function of managing your business.  But just throwing out a number for a goal can be a lazy way to manage. It omits many key elements that have to be in place for goals to work.

Here is a list of seven critical factors that can help you achieve the goals you set for the New Year.

1. Set Time Aside to Plan Your Goals. Goal setting is working on your business. As a doctor, you spend most of your time working in your business. The ratio varies, depending on the condition of things, but it should never be less than 5% of your time, and can take as much as 30% of your time when you are just starting out, or rebuilding.
2. Outcome Goals First. Usually, goals are set for certain office statistics such as income, office visits, and new patients. These represent the results of excellent service and procedures. There are many other outcomes for which goals can also be set.

   These are simply numbers, of course, but they represent the outcomes of hard work excellently applied. We often look at these as “scores” that show how well our health care “team” played, doctor(s) included.  This puts it into a less serious but still highly focused frame of reference.

   The numbers are very important. They represent real outcomes that are not open to much interpretation.  The money comes in and you can pay your staff. If the money doesn’t come in, they are out of a job and you cant pay for your kid’s education.  Successful doctors watch the numbers daily. Doctors that are not successful seem to have distaste for monitoring their practice statistics.

   There is a downside to this: you can become so caught up in the numbers that what they represent gets forgotten. An office that becomes too focused on just the numbers can get overly stressed and fail.  The goals represent, ultimately, “helped people.”  To achieve your goals, you have to push sometimes. The key is to push on and care about what those numbers represent, and what makes those numbers go up, such as procedures.

3. Procedure Goals Second. Improve your procedures.  Set goals for improving certain organizational processes in your office, including chiropractic patient education, first day services, patient financial consultations, referral generation, and chiropractic marketing. (Our next article on goal setting focuses on this type of goal.)
4. People Goals. Your doctors and staff are going to be implementing the procedures. If you want better outcomes, and improved procedures, then you better also set a few goals to improve the skills of your staff. Regular monthly in-service trainings can go a long way to train staff. Videos, coaching, and an outside seminar every now and then also help. Keep working to upgrade the skills and motivation of your staff and set goals to do so. You can also set goals for hours of training each month.
5. Mission. This is the most important step of your goal setting.  Aside from your business mission, which is to generate profit, the mission you and your office are charged with as chiropractic doctors and staff should drive all that you do.  This actually is often worked out first before any goals are set.  However, working out your mission can sometimes become so visionary that you can lose track of what needs to be done in the next time period. To keep it real, work out your outcome goals first. Once you have worked out your mission, you then can go back to readjust any of your outcome goals.
6. Keep it Real. Aim higher, but not too high. Take a look at what you did at the same time last year and at the last time period (week, month, year, day).  Take into account any projects that may affect the goals. For example, if you are planning a vacation, lower the goals for that time period. Keep it real. Also, readjust your goal each month, week, or period. Don’t just keep it at the same level.
7. Systematized Review. A procedure we use in the Marketing Manager System(sm) (a marketing system for chiropractic offices) is very useful.  For each time period, we have worked out specific steps to accomplish three things:

Use these seven factors in setting up your goals and you will have a much better likelihood of achieving them and having more fun in the process.

Ed Petty

Always laugh when you can. It is cheap medicine.
Lord Byron

You probably don’t laugh enough.

And, just probably, there could be more humor in your clinic.

Sometimes offices can be downright grim. Stressed insurance staff, doctors working with an emergency case, patients running late… the list goes on and on. You may not notice it from the inside, but your patients do. Have you ever walked into a doctor’s office that seemed less than happy or friendly? How about a dentist’s office?  You don’t really want to return to an office that is stressful and tense.

Laughter is good medicine, or rather, good therapy. It is good for patients, employees, and doctors.  It helps make the work day go smoother, tasks seem easier, and goals more obtainable. And more fun to achieve.

Even if you are not good at telling jokes or making them up, you can work on it. And that can be funny too! At least for others!!

ACTION STEP

Start each staff meeting, or your morning case management meetings with a joke. Have your staff take turns.  (No mean or off-color jokes.)

Telling jokes can help you to take the gravity and stress out of your work. Successful practices, and people, tend to be lighter hearted than those that are worried and very very serious.

Sometimes when you start laughing you can find more things to laugh about. Try it sometime.  You can always check out our “Breakroom” for a joke or two. They may be a little corny, but that is funny too.

P.S. April is National Humor Month. Click here to learn more.

Change happens.  And you either are making the change happen and evolving your business, or the change will happen to you and to your practice. It is a matter of either being proactive or unresponsive.

Too many offices seem to be changing, but they are actually caught in a kind of neurosis: compulsively putting out fires, and like a dog chasing its own tail, never getting anywhere.

Other offices go to the seminars and read the books, and talk about improvements, but never really change. They stay stuck and hide in their comfort zones, doing business the way they did back last century.

You have to change. All you have to do is look at other business models for examples. We have a McDonalds a few miles from our office (who doesn’t?). It has been there for many years. A new Panera moved in near to it. It is a beautiful and convenient restaurant with all the things people want now: upgraded coffee, salads with chicken, and some no-fat bread. Oh yes, with Wi-Fi (wireless fidelity).  And it is very busy.  So what is McDonalds doing? About two weeks ago heavy equipment moved in and started demolishing the building. Today, it is completely destroyed and plans are underway for building a new McDonalds with a new design and improved features. I assume with Wi-Fi and fancy coffee.

Peter Drucker, one of the world’s foremost management consultants who recently passed away, said that “business has only two functions — marketing and innovation.”

You have to change, or to put it better, you have to innovate.  And you have to market.

We have recently talked about the process of Continuous Improvement. The Japanese call it Kaizen. We have begun implementing a process called Continuous Improvement Reviews (C.I.R.), which is an adaptation of some of our basic consulting procedures that have been so effective. The CIR looks to be a vital tool for improving practice innovation and marketing. We will be posting more information on how to do the process in the future.

A new month is coming and it is time for a change. Time to innovate and market and grow your practice.

A fill in chart of the Six Components To A Self-Reliant Chiropractic Clinic

[ Download/View File ]

You can use this worksheet to help you implement a process of continuous improvement in your clinic.

It is not enough just to have goals.

It is a good start, but there is more.  In fact, just setting goals does not work. You have a staff meeting and decide that in the New Year you are going to see 400 Visits per week average and 30 new patients average.  Then you go back to work. That’s great, but it’s just not enough.  Plus, you have probably done this before so it becomes boring at best, or at worst, brings to mind past failures.

Just setting goals is lazy management. Like General Motors.

You have heard of them. They make cars, like Chevrolet, Cadillac, Buick, Pontiac, and the Hummer, to name a few.  Each year they set production quotas and they once dominated the world.   Over the years their market share has been shrinking, their stock has been shriveling, and they continue to close plants and lay off workers.

Toyota, on the other hand has been growing for decades and  is now predicted to overtake General Motors  as the number one car manufacturer in the world.

Toyota sets goals and quota’s, sure.  But they do something more. They set improvement goals and implement a process to reach these goals.  They call this process KAIZEN. It translates roughly as continuous improvement.

As a business, you either continue to improve, or you eventually die.  It is not enough to improve once every five years. It has to be continuous. You are either improving your clinic this year, or your patients may be drawn to an office that is. That is the way the market works.  You should review the level of your efficiency, patient care and service, promotion and public relations, patient education, and staff training and see if there is room for improvement.

You don’t have to make big improvements, but you have to constantly work on it.  It has to be a process or system of improvement, with incremental tweaks here and  there,  working out the bugs as you continue to grow.

Real business improvement also requires that each team member work on improving themselves personally.  Better health, greater fitness, more education, new hobbies, better relationships, etc., all add up to an improved team and an improved office.

Chiropractic is the improvement profession. This is an added benefit for anyone working in chiropractic because it supports constant professional and personal improvement.

There are many benefits that come from a process of constant improvement. And the consequences of not setting and working improvement goals? Ask a recently unemployed GM worker or stock holder.

Make the 2006 your Year of Improvement.

ACTION STEP. Have a staff meeting and make a list of at least 5 areas in your clinic that you want to improve on over the next three months. You can download a worksheet to help you do this (click here) .  Discuss each area with your staff, and assign each one a grade on a scale of 1-10. Set a goal to improve this part of your clinic in the next three months. Next, have each staff member and doctor do the same for 5 areas of their lives. Have them grade each area, and set an improvement goal for the next three months. The last step of the meeting would be to set a date for the next meeting, three months later.

Repeat this drill every three months for a twelve month period.