Tag Archives: business

Do You Have a Chiropractic Practice or a Chiropractic Business

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jet breaking through the clouds

Break through the barriers and have both.

You have a practice if you are a doctor or a provider of any service.

Sooner or later, many of you must also create and run a business that supports your practice. This is where practice owners struggle.

It seems simple enough, but there is a wide gulf between a practice and a business that supports a practice.

Difference Between a Chiropractic and Healthcare Practice and a Chiropractic and Healthcare Business.

Let’s look at some key differences:

Goals:

  • The goal of a practice is to provide professional services and deliver outcomes of that profession.
  • The goal of a business is profit.

Structure:

  • A practice is structured around and dependent upon the owner/provider.
  • A business is structured around and dependent upon systems, including goals, policies, and procedures.

Scalability:

  • Practices are generally harder to scale because they depend on the limited time and expertise of the providers.
  • Businesses can be scaled more easily by replicating systems and hiring added staff to meet growing demand.

Succession and Sale:

  • A practice’s value is closely tied to its owner and reputation, making it challenging to sell or pass on.
  • A business, if well-structured, can run independently of its founder and can be sold or transferred more readily.

I spent 8 years researching the chasm between the practice and business models. I discuss this in my book, The Goal Driven Business.

You need to have a practice, of course. I define a practice as: “A network of relationships that are developed and sustained through communication and service.”

And so long as you are operating at 60% or less of your full capacity as a provider, your business concerns are manageable. You have the time to adjust and treat your patients, chat with them, and go to Costco for supplies. You are essentially a part-time provider.

To operate at full capacity, you need to create a business structure.

Organizational Barrier to Practice Growth

But doing so is like going from propeller airplanes in the 1940s to jets that go faster than 767 miles per hour, which is the speed of sound. The conventional airplane’s dynamics falter and control is lost as the speed increases. Many pilots lost their lives as their planes crashed in an attempt to break the Sound Barrier.

Similarly, there is a structural barrier, an Organizational Barrier, that causes growing practices to hit and likewise crash or stall.

The ideal is to continue nurturing your practice while gradually building a business infrastructure that allows you to operate at full speed, increase your profit, and still provide excellent service and outcomes. And at some point, pass it on profitably.

Despite the onslaught of advertisers that brag about million-dollar business owners in health care, real money is made by building an enduring practice supported by a solid business structure.

Love your patients and team, and improve your service. Strengthen relationships. Then, if you want to grow, schedule time to work on implementing the structural components for a business vehicle that will take you to your goals.

Want help in doing this? Contact me any time. Link

And read The Goal Driven Business.

Seize your future,

Ed

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How to Add Extra Services to Your Chiropractic Healthcare Practice

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two men discussing chiropractic therapy equipment

Avoiding Hidden Expenses in Scaling Your Practice

Do you want to improve your income and the quality and quantity of your services?

One strategy is to add a therapy machine — or another one — to your practice. You could also bring on another provider. This could add more services per visit and more visits per week, improving your income and the outcomes you get with patients.

Makes sense, right?

In theory, yes. In real life, not so much.

Properly implemented, more services from machines or providers can improve the quality and quantity of outcomes and improve the bottom line. However, the implementation must be done correctly. And often, it is not.

I have seen chiropractic clinics with the largest room in the office filled with therapy equipment that was rarely used. I have had heated discussions with doctors who would buy more equipment when they were not using what they had just purchased. And if the equipment is used, often there is insufficient staff or resources elsewhere: no one running the front desk department, marketing is sporadic, and patient treatment and financial plans are rarely or poorly done.

This gets even worse when hiring associate doctors. You have heard the stories, so I won’t elaborate. Group practices can work well, and we recommend them. In fact, I don’t know of one chiropractic management company with more combined experience working with associates than we have. Multiple-doctor clinics are one of our specialties. But they have to be done correctly, and they rarely are.

Let’s look at three principles to help you implement additional services correctly.

1. FOCUS AND IMPROVE YOUR CORE SERVICES

More therapy and more providers will not take the place of quality and well-organized services.

By expanding your services, you can dilute your unique selling proposition!

Starbucks did this back in 2006. They kept introducing new products, which devalued their primary brand. The baristas had difficulty keeping up with all the new products. They had to become fast-moving technicians rather than friendly conversationalists with the customers. Their statistics decreased until they simplified their services and focused on their core values and services. *

Before you add machines and providers, focus on your core services and improve those, which will also enhance your bottom line.

2. SIMPLICITY

More services can add more complexity. Richard Koch is one of the researchers I quoted in my book, Goal Driven Business. He says: “Because business is wasteful, and because complexity and waste feed on each other, a simple business will always be better than a complex business.”

A therapy unit, for example, even if it is “unattended,” requires supervision by the staff and you. And who will do it if it requires someone to apply the therapy? You can see the extra expense once you work out the details and the math.

Complexity can hide overhead. So, when adding more services, beware of adding complexity and keep the services as simple as possible.

3. LARGE BUT SIMPLE CHIROPRACTIC HEALTHCARE BUSINESS

A larger business provides more services and can generate more income. While Richard Koch recommends simplicity, he also supports growth:

“Because scale is normally valuable, for any given level of complexity, it is better to have a larger business. The large and simple business is the best.”*

Add more services to your practice, but keep these three points in mind:

  1. Improve what you have. First, focus on and improve your skills and those of your team. Invest in your team and yourself. This will enhance your bottom line and your services. Your goals are expertise and mastery.
  2. Keep it simple. Always work towards simplifying your procedures and your patient’s experience.
  3. Scale. Add services and scale your business. But first, plan it out ahead of time, examine the extra time, effort, and costs involved, and manage it well. (You can have us help!)

Keep expanding — but keep improving first. And keep it simple.

Ed

References

*https://hbswk.hbs.edu/item/starbucks-lessons-for-premium-brands

* The 80/20 Principle (Richard Koch)

—————————————————-

If your practice building efforts aren’t taking you to your goals, there are reasons — many of which are hidden from you.

Find out what they are and how to sail to your next level by getting and implementing my new book, The Goal Driven Business.

goal driven business building methodology

The Goal Driven Business,  By Edward Petty

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Let’s Hear It For Chiropractic and Kid’s!

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Petty Michel and Goal Driven Donation to Wisconsin Chiropractic for Kids How to support the health of our children

“History will judge us by the difference we make in the everyday lives of children.” Nelson Mandela*

Here in Wisconsin, the Chiropractic Society of Wisconsin, the primary chiropractic association, is sponsoring a Kid’s Day next week, which we are supporting.

Also, I am supporting it with donations from the sales of my book. Please consider contributing directly to the C.S.W. or buying my book (or 20 of them!).

If you look into it, how we treat our kids in the 2020s is probably worse than in decades past. The Styrofoam-like food, the toxins such as Glyphosate and Phthalates in our breakfast cereal, the nano plastics now in our blood, the sugar and seed oil, the escalation of Pharma drugs and shots, the social media, the list goes on and on.

Just look at the stats for health care in America, those that you can find. They are abysmal and getting worse. (I have links to some listed below.)

There are plenty of sources to learn about how we treat our kids, but as you can imagine, they are hard to find on regular internet searches. It’s a little like trying to find the truth about cigarettes or asbestos in the 1950s — you almost have to search out whistleblowers to find out what is truly going on. An e-book that was published in 2018 called The Sickest Generation, by Children’s Health Defense, is a good place to start. (Link below)

People in your community aren’t going to hear too much about this from the media or most corporate-paid doctors – though more independent physicians seem to be speaking out. This is why your work is so vital.

As a side note, promoting health care for kids can build your practice. Helping children get healthier is a great marketing and practice-building strategy.

But first and foremost, the primary reason to see kids is to help them stay healthy.

Chiropractic care can help young children with the bumps and tumbles they take as they grow. Young athletes especially benefit from adjustments. Other independent and naturally oriented health providers, such as those practicing acupuncture and Traditional Chinese Medicine, and functional and integrative medical providers can also be of great help.

But beyond chiropractic adjustments, education and support for a healthy chiropractic lifestyle is fundamental. Educate the parents and help the kids.

Consider contributing to the C.S.W. Kids Day program.

Also, consider encouraging your state association to develop a kids’ program, and if they already have one, please contribute to that.

Ed Petty

 

Link to Chiropractic Society of Wisconsin: https://www.chiropracticsocietywi.org/chirokids-day

Link to The Sickest Generation published by Children’s Health Defense, https://childrenshealthdefense.org/ebook-sign-up/ebook-sign-up-the-sickest-generation/

More links to references:

From The Sickest Generation

American children have never been sicker. Over half (54%) are suffering from one or more chronic illnesses.

The “4-A” disorders—autism, attention deficit hyperactivity disorder, asthma and allergies—have experienced meteoric growth, affecting children’s quality of life and con­tributing to premature mortality.

U.S. children are far more likely to die before their first birthday than infants in other wealthy countries and life expectancy is falling, driven largely by rising death rates in adolescents and younger adults. Suicide is the second leading cause of death in teens, half of whom are reported to have at least one mental, emotional or behavioral disorder.

The proportion of public school children using special education services is skyrocketing, with estimates ranging from 13% to 25% of school populations.

Mystifyingly, there is almost no outcry in medical, public health or government circles to find answers and solutions.

 

Goals for the Present

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Goals for the Present

Goals are about the future.

But sometimes, they are about the present – and respecting the past.

December is one of those times. There’s a distinct vibration that moves in this time of year, subtle waves of friendliness that sparkle like Christmas tree lights. Almost an instinct — whether connected to a Sunday service before the 25th, a Jolly Old Saint Nick, the candles of Hanukkah, or the winter solstice, we feel a sense of fellowship during this time of year.

With the traditions of other cultures over the millennia, people have gathered with a Spirit of compassion and celebration. People even take time to pause in war.

One example was the Christmas Truce of 1914 during World War I, when soldiers from opposing trenches laid down their weapons and initiated an unofficial ceasefire. The truce began on Christmas Eve and continued into Christmas Day, with soldiers exchanging seasonal greetings, singing carols, and even venturing into no man’s land to fraternize with the enemy. Troops from both sides shared food, tobacco, and souvenirs and engaged in impromptu soccer games.

I think this speaks to our fundamental nature, that we are supportive and kind when unprovoked by the agitations of those who might profit from our conflicts.

As a practice and business goal for your chiropractic and healthcare office, I suggest that this week and next, focus on the present and appreciate the many accomplishments of the past year. Consider your blessings – your patients, profession, teammates, and family.

The Future Can Wait

For now, take time for some gratitude and have a cup of kindness and good cheer.

And play some Christmas jazz. Man!

Below is a link to some mellow Christmas Jazz – 4-hour playlist. Christmas Jazz: https://www.youtube.com/watch?v=Dbgx5ChU3ZM

Carpe Diem,

Ed

How to Grow a Chiropractic and Health Business

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How to grow a chiropractic business

I was recently invited to my son’s wife’s family’s apple butter cookout. Yep, that’s right, cooking apples over an open fire. It’s a tradition.

It is also apple harvest season up here in the northern Midwest. You got yur Honey Crisps, Honeygolds, Snowsweet, Fuki, Jonathans and others. Lots o’ apples!

Harvest time.

I bring this up because, well, it applies to your office. Here’s how:

THE LAW OF THE FARM

There is a metaphor called the “Law of the Farm” or the “Law of the Harvest.” Stephen Covey refers to this in his book, The Seven Habits of Highly Effective People. (I include a link to a short video below)

The concept comes from the observation that apples come from farmers farming. An apple orchard requires tender, loving care over the entire year from growers who plan and carry out disciplined regular work to ensure a bountiful harvest.

Aside from occasional droughts or freezes, if your harvest is poor, it is not because of the “apple spirits,” or that maybe you had a bad childhood. It is because one or more of the necessary preparatory actions needed to produce the apples were not done.

There are no shortcuts. Getting angry with the apple trees does not help.

YOUR CHIROPRACTIC AND HEALTHCARE PRACTICE IS LIKE A FARM

The Law of the Farm, or the Law of the Harvest can be applied to your practice in the following ways:

  1. Long-Term Planning. Just as a farmer plans their crops well in advance, a business should set clear goals and strategies for the future. This includes defining your mission, the key values of your team that determine its culture, the outcomes, and production goals.
  2. Investment and Resources. Just as a farmer invests in seeds, land, and equipment, you must invest in your resources wisely. First and most important, invest in your people, including yourself: training, coaching, and hiring. Marketing, in one form or another, is always a necessity. Updating software and equipment, occasionally, or the décor of your office is also an investment.
  3. Consistency and Diligence. Sticking to what works is vital. This is why I recommend job checklists as part of the Goal Driven System. It takes discipline to keep doing what works, but consistency brings about confidence in your patients and your team. Daily tasks and routines are like tending to crops regularly.
  4. Patience and Adaptation. Just as a farmer must wait for crops to grow and adapt to changing weather conditions, chiropractic practice owners must be patient and adaptable. Success may not come immediately, and you will face unforeseen challenges. Being able to adjust strategies and remain patient when unexpected failures occur is critical.

Looking at your practice as something you need to grow to produce excellent outcomes is a useful exercise.

Patience can be tough to master as a business owner when you have invested everything on the line. But if you have done your preparation, as all farmers must do, most of your concerns are for naught.

The Law of the Farm is a principle from which you can draw many associations to your practice. As an exercise, you might discuss this with your team: How can we apply the Law of the Farm to our practice and improve our service?

APPLES DO NOT COME FROM THE GROCERY STORE

Similarly, happy patients, completing their chiropractic or healthcare treatment program, being relieved of pain, healthier, and referring others do not come from the new well-advertised social media ad campaign. All the shiny new ads and promotions don’t make up for the Law of the Farm.

There are no shortcuts.

You reap what you sow — and nurture and take care of.

We are all farmers!

Ed

PS I also discuss this in The Goal Driven Business, #15 Goal Driven Principles, page 262 Be a Farmer: Grow Your Business and Your Customers

Watch this short video about the Law of the Harvest.

https://resources.franklincovey.com/mkt-7hv1/law-of-the-harvest-2

The Truth In Chiropractic and Health Care Marketing

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The Best Known Marketing Secret
 
The more things change, the more they stay the same.
 
Artificial Intelligence is all the rage. For good reason. It’s set to change the world as the Internet did, maybe more so, and in ways we can barely fathom.
 
Geoffrey Hinton recently quit his job at Google to speak freely about the risks of AI. He and two other so-called “Godfathers of AI” won the 2018 Turing Award for their foundational work leading to the current artificial intelligence boom. He now says a part of him regrets his life’s work.*
 
His immediate concern is that the Internet will be flooded with false photos, videos, and text, and the average person will “not be able to know what is true anymore.”
 
What is True?
 
You can fool people some of the time, but success in chiropractic marketing and practice is ultimately based on trust.
 
You may already send your patients scripted texts, prefabricated emails, and even automated educational or sales videos. You may have a testimonial service that posts positive testimonials for you.
 
Yes, the world is becoming more automated, artificially “intelligent,” and virtual.
 
But at some point, your patient, or potential patient, will start to wonder… “is this communication from Dr. Smith, chatGPT, or a robot in China?”
 
You are the Truth
 
What is the truth in marketing?
 
In this age of increasing artificiality: you are the truth!
 
Images and voices of people can be faked. You can record your voice, type in a sentence, select an image of a person, and that person will vocalize what you typed, in your voice. The future is going to be amazing in its ability for fakery.
 
But overcoming this is simple.
 
Show up and meet people. In person. In real life. (IRL) Person to person, create relationships and from these, generate referrals.
 
People want community. They want relationships. They want a real person.
 
Sometimes you want to go
Where everybody knows your name,
And they’re always glad you came;
(From TV sitcom Cheers.)
 
Marketing in Truth
 
Marketing in real life is networking. Networking is getting to know people who know people.
 
The most immediate and obvious resource for networking is connecting with those people who know you, trust you, and probably even like you (lol). Your active patients, inactive patients, friends, and community members in business or in organizations, all add up to hundreds, if not thousands of people.
 
I recently saw a dedicated chiropractor I know promote a local BNI workshop. BNI stands for Business Network International. It was founded by Ivan Misner, who wrote the excellent book, The Best Known Marketing Secret. It is all about Word-of-Mouth advertising – networking.
 
Perhaps because of technology, or the COVID lock down, or possibly more nefarious reasons, friendly public in-person get-togethers have been declining.*
 
I think now, more than ever, networking is and will be a very effective form of marketing.
 
You can spend money on Facebook ads or advertise on other platforms. Now and then, go for it! But strictly speaking ROI, a structured and continuous networking plan can’t be beat. (Contact me if you want a few tips setting up your networking plan.) It may take time to develop, but once in place, it can almost run on its own, sending people to you who need your services.
 
In his book, Misner refers to a friend of his who says that we all are cave dwellers. We live in our cave houses, get into our cave cars, and go to our cave offices. I would add that we also live in our virtual media caves, whether social or Netflix!
 
His point is that there is a whole world out there if we just get out of our caves and meet people.
 
I have seen many different and effective forms of network marketing that work. I’ll go over a number of examples in the next newsletter to keep this letter short.
 
But consider this: AI will never replace you. And it will never replace the individual across from you.
 
And THAT…is the truth.
 
Stay Goal Driven,
 
Ed
 
 
References:
*77 percent of planners find it harder to attract attendees, while 73 percent report lower attendance. (Skift Meetings, 2022)
 
*https://archive.is/2023.05.01-091113/https://www.nytimes.com/2023/05/01/technology/ai-google-chatbot-engineer-quits-hinton.html

Spring Marketing Calendar

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spring marketing plan.

The Need for Marketing Never Goes Away

Daylight Savings Time starts in two weeks here in the U.S. And across the northern part of our Planet, Spring begins in 4 weeks (March 20th). Guess that would be autumn for you all in the southern hemisphere.

What a great time to plan your spring and summer marketing.

The Need for Marketing Never Goes Away

No matter how full your practice is, the need for marketing never goes away.

Marketing is business and business is marketing.

Putting something valuable in the marketplace that other people want and will pay for – that is marketing. And that is your business.

The type of marketing you do varies depending on the condition and circumstances of your business. If you are just beginning a practice, you must spend a large percentage of your time and budget on marketing, especially direct response marketing. If you have built up your business, the focus of your marketing can be more on retaining your patients, creating alliances, and world-class customer service and outcomes.

Marketing covers a broad spectrum of activities, but all are, or should be, designed to generate new patients and keep the ones you have.

Trends for the future indicate that, in the end, the best and surest marketing will be customer services and outcomes. The communication channels are so packed and manufactured that your messages will get lost unless you have millions to spend. And now we have AI marketing – ads that robots put together.

Therefore, the best marketing will always be personal – relationship based. You and your people — authentic and interested in your patients and the individuals in your community – delivering extraordinary service and outcomes.

Marketing Plan

Practically speaking, it helps to plan your marketing.

Plan your work and then work your plan, right? So, I have attached a sample marketing plan (link below at the end of the blog article) to help you outline what to do. It is a sample and gives structure to managing your marketing. We’ve used one like this for years, and it works. Make your own and customize it to fit your needs.

And stay tuned for a new service we will offer to help you with your marketing.

But for now, Happy Spring, and Plan your Future

Ed

Sample Marketing Calendar

Bruce Lipton and Physician Health Thyself

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Edward Petty with Bruce Lipton, PhD GoalDriven.com petty Michel and associates

Edward Petty with Bruce Lipton, PhD – GoalDriven.com – Petty Michel and Associates

Why doctors should stay Innately positive and healthy

Chiropractic is more than a mechanical act to improve a patient’s health.

I remember years ago attending a Parker seminar when Dr. Jimmy was still alive and seeing a large drawing describing “Innate to Innate.” A concept I believe he may have learned from Thurmond Fleet who developed Concept Therapy.

Bruce Lipton, PhD, is a cellular biologist, has taught at University Wisconsin Medical school, at Stanford, as well as Life Chiropractic College West. I have heard him speak on several occasions, read his books (Biology of Belief) and consulted with him personally about my book (The Goal Driven Business.)

I think Dr. Lipton expresses the concept of Innate scientifically:

There’s a concept in quantum physics called “entanglement,” which is when one energy source entangles with another so that they interfere with each other. This interference can be positive and harmonious, as with energy healing, or it can be negative.

Physicist Amit Goswami published an article in a physics journal showing that entanglement affects people. He had two people meditate together and then separated them into two chambers where they couldn’t see or hear one another. When one person had a light strobed by his eye, it caused the firing of a certain frequency in the brain. Remarkably, at the same moment, the other person’s brain also fired, even though he never saw the light. This proves what we intuitively knew, that the energies of people can affect one another.

What Goswami’s study demonstrated is that when two people become entangled, one person will conform to the energy of the other person. When one of them is a healer whose cells are vibrating at a higher level, the client’s cells become entangled, and their energy is lifted. That’s why that old saying, “physician heal thyself,” is so important, even though most don’t understand it: If the physician’s energy is going to influence or, in scientific terms, “entrain” the patient’s, the doctor’s must be higher. (source on blog)

I have seen examples of this in many of my office visits over the years. You might have an interesting discussion with your staff at a team meeting about how the “vibes” of the office affect the patients.

Has anyone pulled a patient file and the patient suddenly called? Have you ever had a great team meeting the phones start to ring? Have you seen a patient improve just because you felt connected to them?

So, please stay healthy and stay positive, in alignment with your greater purposes and greater powers.

And pass it on.

😊

Ed

Lipton: https://www.huffpost.com/entry/healing-over-the-phone_b_1011510

 

The Future

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It is a peculiarity of man that he can only live by looking to the future.
(Viktor Frankl)

Traditionally, the first of any New Year is an excellent time to take stock of the prior year and make plans for the year to come.

Goals

In business, there are two (three, but for now, we will look at two) types of goals for your business:

  • Production Goals
  • Organization Goals

Setting production goals for where you want to be 12 months from now is the easy part of goal setting. The hard part is working out the organizational support you will need to achieve your production and collections goals. It could be more than you think!

But keep this in mind:

chiropractic and your services are never the primary barriers to practice success.

It is always management. It is the administrative issues connected with organization, including marketing, that gum up the work, gets in the way, slows your business down and holds you back.

Motivation

Part of management is managing your motivation. Yep… motivation needs to be managed. Keeping your spirits high and your drive strong is necessary for an organization to flow.

And this takes us back to your goals.

Visualizing achieving your goals will stimulate your motivation – and your drive. If you can’t see any way to your goals, well, that can be depressing. But if you can… if you can envision accomplishing your future goals, you will be motivated.

Viktor Frankl

I reference Viktor Frankl in my book, The Goal Driven Business.
Speaking of his experience in a concentration camp, “As we said before, any attempt to restore a man’s inner strength in the camp had first to succeed in showing him some future goal…”

He also said, “Even when it is not fully attained, we become better by striving for a higher goal.”

For your goal setting for the New Year, I recommend you start with your higher goals, the 3rd type of goal, which are beyond production and organization. For example, what brings you bliss? What gives you meaning?

  • Time with family and friends?
  • More vacations to more interesting places?
  • Going for the WIN of your best production and collections year ever?
  • Building a church?
  • Getting a diplomate in nutrition?
  • Improving patient outcomes?
  • Speaking out about health issues more?

Begin with these goals – the higher, wilder, richer ones. Then, look at your production goals, then your organizational goals.

I encourage you to dream just a bit and look at next year as your playground. What higher, richer, and wilder adventures would you like to accomplish?

Have some fun considering these types of goals and all the ways you would like to achieve them. This will add zest and a special spirit to your production and organizational goals.

Help with Your Future

We want to help you with your future. Your work is important, and helping you achieve your goals has been a driving force and a higher goal within our company for over 30 years.

For 2023, we have a few openings for our Private Client status on our Goal Driven Program.

If you are interested in working with us, please reply to this email, and we will schedule a time to talk.

All of us at Petty Michel & Associates want to help you achieve your goals in 2023

Seize the Future! (Carpe Future)

Happy New Year

Ed

Reference. More information on this is covered in sections in The Goal Driven Business, starting at page 19 and page 116.

Practice Fundamentals – Communication and Control

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

It’s always the basics. The fundamentals.

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

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

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

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

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

Communication

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

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

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

Control

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

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

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

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

Management

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

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

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

Seize your future – with a smile!

Ed

Case Management for Better Service and Retention

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Start Each Day with Service First

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

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

Beginning Each Day With Service Goals for Each Patient

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

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

Case Management Meeting Procedure

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

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

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

More Than Case Management – Keeping It Fun.

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

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

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

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

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

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

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

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

It only works if it is done.

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

Over to you!

Carpe Posturum! (Sieze the Future)

Ed

Brutal Economics: A hidden expense.

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You have more expenses than you’ve probably considered.
 
Your biggest expense, like that old poster you have had in your reception room since 2012, has become invisible.
 
What is this big expense?
 
Well, one of the goals we work with in the Goal Driven System is the Full Capacity Goal.
 
This goal can be easily overlooked as we are focused on patient care, reimbursements, staffing schedules, vacations, and a thousand other tasks that require our attention.
 
The reason the use of goals is so effective in practice management is that they help you see the Vital Few from the Useful Many. (These terms are often used in reference to the Pareto Principle of 80/20.) The Vital Few are those factors (20% or less) that produce 80% (or more) of the results.
 
If you are not operating at close to full capacity, you are wasting money.
 
For example, if you could see, 160 patients in a week, given your schedule and good support, at $65 per visit, that would equal $10,400 per week. On a monthly basis, this would work out to be 640 visits and about $41,600 in revenue. This would be 100% Full Capacity.
 
You know from experience that your expenses are a lot higher than most realize. First, there are fixed expenses that you must pay out regardless of the performance of your business. And after everything and everyone is paid, after all accounts are settled, what is left over is yours.
 
At 70% capacity, that is not much. At 50% capacity, that is nothing.
 
Of course, you don’t focus on stats and money when you deal with patients as a doctor and as care givers.
 
But as a business owner, you must.
 
Numbers, analytics, Key Performance Indicators –– these make up your scoreboard and give you the best feedback to help you manage the performance of your business.
 
We carefully analyze our clients’ numbers each month and encourage they do the same. We also plot them on graphs and charts to notice trends. These are our x-rays.
 
Lately, we have realized that there is one number that gets overlooked in the hustle and bustle of business management. That is to what degree the office is operating at its full capacity.
 
In Goal Driven Analytics, we have been testing a “business capacitometer.” It displays, much like a speedometer or tachometer, the percentage of full capacity that the business is operating.
 
But you can easily do the same. Here is how:
 
  1. Weekly Visits. Determine the maximum number of visits you could see comfortably each week if you were reasonably supported with software and staff. ______
  2. Full Capacity Goal. Multiple this by 4 (I know, 4.3 is more exact): ___ This is your Full Capacity Goal.
  3. Percent of Full Capacity. At the end of the month, divide the number of visits you saw by your full Capacity Goal and you will get the percentage that shows you how the efficiency of your practice. E.G. You FCG is 800 and you saw 600 = 600/800 = 75%
Work towards maintaining 90% or above. Find the capacity constraints and remove them.
 
This is also very helpful if you have multiple providers – other associate chiropractors, massage therapists, other services, even your rehab or therapy departments. After agreeing on what volume would be full capacity, each month they can see their level of performance.
 
Last note: It is not about the statistics. While stats are your best indicator, remember … it is not the stat that is important — it is what they represent. A helped person!
 
Seize the Future,
 
Ed

 

The SPARKLING Practice and How to Achieve It: Synergy is the Key

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We just awarded a two-doctor chiropractic office employee the SPARKLE award for outstanding service to patients and team members for 21 years of service.

Why a SPARKLE award? Well, that was the term most frequently used to describe this team member.

The clinic owner said: “She has dedicated almost 21 years (7,440 days!) of her professional (& personal, let’s be honest) life to our practice & the pulse of our family and pediatric practice. Over those years we have walked many of life’s journeys together, and she has formed meaningful connections with our patients. We have shared laughter (SO MUCH laughter!), tears and everything in between. She has changed many lives in her nearly 21 years.”

sparkle award for teammateWhile she indeed does “sparkle,” so does the entire practice. And the sparkle of this office is a byproduct of its synergy.

I even feature their practice as a positive example in my book, the Goal Driven Business.

The owner, the doctors, and the staff are all committed to the goal of providing the best service possible to each patient. But their goals also include supporting each other.

According to Merriam Webster: ” ‘The whole is greater than the sum of its parts,’ expresses the basic meaning of synergy.”

In his 7 Habits of Highly Effective People, Steven Covey refers to synergy as Habit #6.

“Synergize is the habit of creative cooperation. It is teamwork, open-mindedness, and the adventure of finding new solutions to old problems. But it doesn’t just happen on its own. It’s a process…”

Much of the Goal Driven Business draws upon Covey’s work as I have seen his concepts help create a business that runs at full capacity smoothly.

His preceding two habits particularly apply:

  • Habit 4. Think win-win.
  • Habit 5: Seek to understand first, then get understood.

This chiropractic practice has formal communication systems, but they also communicate abundantly informally. And each team member has the goal of helping each other and the patients “win.”

In the end, it all goes back to goals. It always does. The owner keeps the goals, including the mission and core values, at the forefront of the team each week. Further, she sets an example by living these goals professionally and personally.

And as a result, staff are happy, patients are happy, and the office runs at full capacity, profitably and smoothly.

You can generate synergy in your office by improving communication and focus on win-win goals for the patient and for each other.

And make your practice SPARKLE!

Ed

PS. For help in creating a synergistic and sparkling practice, contact us!

The Missing Role in Your Practice

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The cause of almost all relationship difficulties is rooted in conflicting or ambiguous expectations around roles and goals. Stephen Covey

The reason many offices have a difficult time growing has to do with missing roles.

A role is the identity assumed to perform a series of tasks that produce a specified outcome.

In the hundreds of offices that we have visited over the years, the doctors take on essentially two roles: doctor and owner. This works in the beginning for a few years as the practice grows. In time, however, the practice begins to roller coaster. Numbers go up, then they go down, cycling up and down until everyone fatigues and just settles.

There are several causes for the Practice Roller Coaster. There are hidden barriers that hold an office back and sabotage its growth. These are covered in my book, The Goal Driven Business.

One of the barriers has to do with a missing role that most business owners overlook. Can you guess which one that is?

Let’s look at goals: What is the goal of a doctor? “A healthier person,” right?

What is the goal of a business owner? A secure and solvent business. Dividends from ownership.

What is missing? The doctor can achieve their goal by seeing 10 people a week. As a business owner, they can keep their overhead very low – perhaps working out of their home. But is that what you really want – to see 10 people a week out of your house? Overhead is low and you are getting good results. So, what is missing?

The CEO – the chief executive is the missing role. The goal of a CEO is a very profitable business that operates at full capacity providing world class service and delivering extraordinary results.

The CEO is the chief manager, leader, and marketer, which are the three functions that drive the business to its goals.

Sometimes we hear the doctor being referred to as the “boss,” but boss is not a well-defined role. “Boss” is generally recognized as the person who gives orders and makes decisions. However, it is an overlay of an existing role, as in a “bossy” doctor or “bossy” owner. The role of a CEO is much more than this.

Most providers are too busy providing services to do much managing – and besides, they are paid for their services, not their managing or leadership. Doctors are trained to manage patients, not businesses.

Still, this is a role that must be fulfilled as distinct and separate from the owner or provider roles if the business’s full capacity is to be achieved.

Three Functions of the CEO

The role of CEO includes these functions:

  • Leadership: Leadership is all about goals. It defines where you are going and why and helps everyone you work with embrace this knowledge with commitment. Leadership includes your mission, long-range plans, values, and … the insistence upon achieving them.
  • Management: Management deals with how to get to the goals. Management works to ensure that people and procedures are effectively working and improving.
  • Marketing. Marketing includes procedures and projects that help generate new patients/clients and retain them. Marketing is business, and business is marketing.

Once your practice is at least at 50% capacity, a couple of hours spent each week on effective leadership, management, or marketing activities as a CEO is worth 8 hours or more doing anything else. For example, time spent going to a seminar – perhaps 20 hours including the transportation, may increase your numbers for months afterward. A little can go a long way.

Because the role of practice CEO must be very part-time, we have developed the Fast Flow CEO System for the Goal Driven Business. This can take as little as 2 -3 hours per week, depending on the scale of your business. Here are five components of the Fast Flow CEO System:

  1. Get Out to Work On. Regularly take time to get out of the business so that you can work on your business.
  2. The CEO Works for the Business. The business does not work for the CEO. Sure, the business works for the doctors so that they can provide better service to the patients. But that is for the doctor. Sometimes called “servant leadership,” the CEO is the Chief Coach, helping others understand the goals and how to achieve them.
  3. Team Members. The CEO works to create team members who take on a portion of departmental management, marketing, and leadership.
  4. Manager. The CEO creates the role of manager and delegates a team member to assume this as a part-time role. The manager can take on much of the CEO’s daily and weekly duties.
  5. Study. The CEO studies leadership, management, and marketing to improve their skill as a CEO. Leaders are … readers!

Certainly, all this requires some skill and training – and coaching! But just clarifying the role of CEO and its expectations as distinct from the roles of owner and doctor (or “boss”) will significantly improve your chances of breaking out of the Practice Roller Coaster and achieving your goals.

Ed Petty

March 14, 2022

Tent Poster – Castles in the Air – Walden

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“I learned this, at least, by my experiment: that if one advances confidently in the direction of his dreams, and endeavors to live the life which he has imagined, he will meet with a success unexpected in common hours.  … If you have built castles in the air, your work need not be lost; that is where they should be. Now put the foundations under them.”         

Henry David Thoreau Walden

For a printable version of this tent poster click: Castles in the Air-Walden

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