Tag Archives: gonstead

PTC and the Subtle Art of Being There

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It was in the 80s at a Parker Seminar, which was in Reno that year, that I first heard the term.

In the opening session, Dr. Jimmy Parker talked about PTC. I was attending as a guest with a chiropractor who introduced me to chiropractic. What an introduction!

Dr. Parker explained that PTC stood for Present Time Consciousness. (Parker had quite a few of these abbreviations!) He explained that a doctor could deliver a much better adjustment if their attention on the patient were in the present time, not thinking about past issues or on future concerns.

I have come to learn that this is a vital but easily overlooked skill.

You can tell when someone is 100% paying attention to you, or maybe not quite, or maybe not at all. And this makes all the difference in the patient’s trust in you, how long they stay with you, and whether they refer others to you.

But maintaining PTC can be challenging in a high-volume chiropractic office or any health office. How many thousands of adjustments does it take until all patients start blending into to one?

A doctor who worked with Clarence Gonstead told me about one evening when he was shadowing Dr. Gonstead. It was around 9 p.m., and the reception/waiting room was full. The doctor said to me that he exclaimed to Dr. Gonstead that his waiting room was still filled with patients. He said that Dr. Gonstead turned to him in the hallway before they went in with the next patient and said, emphatically, “No. I only have one patient, and that is the one I am with now.”

That sounds like he was present with each patient, and perhaps that is at least one reason he was so successful as a chiropractor.

I have seen more than a few techniques, or hacks, that help keep doctors, and support staff, in the present with each patient. For example

  • Completing the visit.  Some doctors soundly end each visit, often confidently saying, “That was a good adjustment, and I am satisfied.” Ending one visit before starting the next visit creates a micro-break, a little space between visits.
  • Break up the day. Different approaches to breaking up the day seem effective. For example, busy offices usually have varied but ritualized lunch breaks. These might include such activities as weight training or exercise, marketing, team workshops, lunch with the spouse, guitar practice, you name it. Mid-morning and mid-afternoon 5-minute breaks can also be helpful. (Stay away from social media!)
  • Remove distractions. You want to remove distractions that can pull your attention to future challenges or past mix-ups.  Pre-shift and short weekly meetings can be helpful in this regard by sorting out administrative issues so that you are free to focus on patients – in the present.
  • Cricket clicker! I remember one doctor telling me that he used a steel clicker, a “cricket clicker.” He would click the clicker just before the next patient visit, which would help him mentally begin the next visit.  (Whatever works!)

I suspect that this is a high-level technique. One for the masters. It can’t be canned. Perhaps it is beyond technique. When accomplished, when you are totally present, the patient innately feels that you are there for them and them alone, and this perhaps speeds their recovery.

I would be interested to know how you maintain Present Time Consciousness. You can add your thoughts here on our blog.

Staying engaged in the present for a better future!

Ed

The power for creating a better future is contained in the present moment:
You create a good future by creating a good present. (Eckhart Tolle)

The Best That Ever Was?

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Just imagine… imagine that you have SO many patients that you need to move to a larger office to accommodate them all.

A few years later, once again, you are seeing more patients than your office can hold, so you build the office of your dreams – a custom designed 19,000 square foot clinic. And the patients keep coming, so you bring on other doctors. Some days, you and the doctors see 600 visits.

Since patients travel to see you from all over the world, you build a motel next to your office. You also set up a limousine service from the nearby airport to your office.

Could you do this?

Clarence Gonstead did. Here, in Wisconsin, from the 1920s to the early 1970s

What made him so successful?

He was an expert. He was a master at his art. He was committed and focused on his craft and his outcomes.

A founder of a chiropractic college would later say that Dr. Gonstead was not a “commercial chiropractor.” He didn’t focus on management or marketing – just chiropractic. (As a management consultant, I can only wonder how expansive his operation would have grown had he had managers as dedicated and competent as he was!)

He was focused on results and said: “Our future will be our results.”

According to people who have studied exceptional performance, there are definite ingredients needed to become an expert, all of which are available to you. And by the way, “natural talent” is not one of them. Let’s look at each one:

  1. Deliberate practice.
  2. Coaching and training.
  3. Commitment to being an expert.
  4. Support from family and friends.

 

  1. Deliberate Practice. Knowledge is fine, but it is skills that are needed. Skills are acquired through a specific type of practice, which Anders Ericcson calls “Deliberate Practice.” This is not just going through the motions of hitting a golf ball, for example, if you are a golfer. It is going beyond your comfort zone and making mistakes and learning better methods.
  2. Coaching and Mentoring. Ericsson points to Tiger Woods for an example of the importance of coaches and mentors. Tiger’s father, Earl, an avid golfer himself, was a teacher of young boys and had a passion for sports. He started training Tiger at an “unthinkably early age.”
  3. Commitment. It is obvious but often overlooked, that to be an expert, you must want to be one. Deliberate practice and study require work and is not comfortable. Tiger used to train 13 hours a day, according to one of his coaches, Hank Hanley. (Golf Digest)
  4. Support from Family and Friends. Support can bolster individual efforts to succeed. Tiger’s dad was Tiger’s champion, as was Brett Favre’s dad, Irv, the famous football quarterback. Parents, spouses, and friends can play a major part in helping to bring about expertise in others.

It doesn’t matter what method of adjusting you use, or if you are a dentist or a chef or a cello player. It does matter if you are an expert. Achieving a high level of skill is not always fun or easy, but the rewards are worth it.

Tiger Woods was recognized as the world’s top-ranked golfer in the first 10 years of the 21st Century. He then fell into a slump with domestic issues and physical injuries. But with continued training, he came back to win his 5th Master title and 15th Major title at the Augusta National Golf Course just last weekend! (By the way, Tiger also praises chiropractic for his success!)

I have seen the ads, and I am sure you have as well, on how you can be a laptop chiropractor, travel the world, and make “six figures.”

I love the Internet and laptops and do travel the world and have nothing against being wealthy. But you are a doctor, a provider of service and outcomes, and if what you deliver is not exceptional and extra-ordinary, then the world will pass you buy.

There has been a great “shake-out” occurring in commerce. We have seen it happen with retail – where now the Internet and Walmart dominate. The store on Main Street is shuttered. This will be happening to the service industry as well. Only the very best will survive. Don’t fall for schemes that promise to get rich with easy effort.

What should you do?

You should become the best in the world.

You should work tirelessly, like Tiger Woods and Clarence Gonstead, to become the world class masters.

And as Clarence Gonstead said,

“Practice. Practice. Practice. Never stop.”

Sincerely,

Ed

PS
If you have the time, I encourage those of you who use Dr. Gonstead’s method, and even those who don’t, to come by his clinic in Mount Horeb and listen to some of the stories of those who worked with him directly.

And especially… bring your team.

“My Time with Clarence Gonstead DC”
4 Speakers who Learned and worked with Gonstead

Link to a poster on Facebook

Time and Place

  • Friday, April 26th, 6:30 PM (Free!)
  • Gonstead Clinic of Chiropractic
  • 1505 Bus. Hwy. 18-151 E, Mt. Horeb
  • (608) 437-5585

Also, during the weekend, the Gonstead Methodology Institute is sponsoring a “GCSS Knee Chest Extravaganza.”

Link to more information.

How to Deliver Goal Driven Extra-Ordinary Customer Service (Part 2 of 2)

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“Our future will be our results.”     Clarence Gonstead, D.C.

How do we overcome these barriers to extra-ordinary service?

Let’s first define “service.” Service in a professional service firm or professional practice includes two categories:

A. Outcomes. These are the results from the provider.
B. Customer experience. This comes from what the customer experiences as they move along their pathway through your business.

Let’s begin with your goals.

1. Define and Commit to Your Highest Goals.

To create world class outcomes and service, you first need to review your most senior goals. Then, you have to ensure everyone understands them, agrees to them, and commits to doing everything possible to achieve them.

Setting purposeful goals over a lunch meeting does not take into account the sacrifice and effort that will be necessary to achieve them. You may commit to your own goals, but like New Year’s resolutions to go to the gym, you get distracted and discontinue after a few weeks. Some of your team may say they understand the goals – even agree to them – but in fact are only passengers along for the ride.

So, you should review and recommit to your goals each week. Be insistent, allowing for shortfalls now and then, but not compromising in the long run. Be true to your goals or make new ones. Spend time on these three:

a) Mission
This is the purpose of your office. It should be short and to the point and should include something about excellent service and outcomes and helping as many as possible.
b) Core Values
These are the standards for professional behavior and performance. List what values you consider most important in providing health care.
c) Patient Outcomes
Define where you are taking your patients. Relief care only? Or are you taking them further to better health and wellness?

Be true to your goals.

2. Outstanding Outcomes Come from Expertise

Because of your clinical skill, you can produce wonderful outcomes. But can you do even better? Here are some masters in their field as examples of professionals that never stopped improving their craft:

Music: Pablo Casals

Pablo Casals was a cellist – regarded as the best that ever lived. He was born in 1876 in Catalonia, Spain. In 1963 he was awarded the Presidential Medal of Freedom by President John F Kennedy, and in 1971, two months before his 95th birthday, he performed for the United Nations and accepted the U.N. Peace medal.

Casals was talented, but he practiced daily. There is a story about Casals and his training regimen:

He [Casals] agreed to have Robert Snyder make a movie short, “A Day in the Life of Pablo Casals.” Snyder asked Casals, the world’s foremost cellist, why he continues to practice four and five hours a day.

Casals answered: “Because I think I am making progress.”

Food Preparation: Chef Jiro Ono

If you want and value good sushi, Chef Jiro Ono is your guy. He was 92 at the time of this writing. He still works in his small restaurant in Tokyo that holds only 20 people at a time. The waiting list can be over a year. Still, at his age, he works on perfecting every aspect of the sushi, from selecting the exact right fish early at the fish market, to the exact texture of the rice. And every night he considers how he can improve on that day’s production. He is considered the foremost sushi chef in the world. (Jiro Dreams of Sushi, David Gelb 2011 documentary, Wikipedia)

“Once you decide on your occupation… you must immerse yourself in your work. You have to fall in love with your work. Never complain about your job. You must dedicate your life to mastering your skill. That’s the secret of success…… Even though I’m eighty-five years old, I don’t feel like retiring.” Jiro Ono (Jiro dreams of sushi, 2011)

Health Care: Clarence Gonstead

Clarence Gonstead was a chiropractor, born in 1898 and grew up in Wisconsin. In 1923, Dr. Gonstead graduated from Palmer Chiropractic College and began practicing. In 1939, he built a new chiropractic office in Mount Horeb, Wisconsin.

Because of the growth of his practice, a new Gonstead Clinic of Chiropractic was completed 1964. It was a two-level facility with 29,000 square feet. In 1965, adjacent to the new clinic, a full-service motel was built. Gonstead’s reputation as a remarkable chiropractor had spread beyond the United States and he had patients flying in from all over the world. To assist these patients, he set up a limousine service between the Madison, Wisconsin, airport and the Gonstead clinic about 30 miles away. Patients with their own private planes could fly in and land at Gonstead’s personal airport located next to his home on the outskirts of Mount Horeb.

With no marketing, his practice grew so that that he was seeing over 250 patients per day, working six-and-a-half days a week. He often treated his last patient at 2:30 in the morning.

Gonstead studied and improved his craft. He was not, as a founder of a chiropractic college would later say, a “commercial chiropractor.” He was focused on results and said: “Our future will be our results.”

Eventually, he began teaching others his system which is now recognized around the planet as one of the most effective and popular forms of chiropractic technique. He encouraged other chiropractors to study and to “Practice. Practice. Practice. Never stop.”

So, be like Jiro, Pablo, or Clarence! Use “deliberate practice” and look to see how you can improve your skills and methods so that your customers can achieve their goals faster and better.

Never stop improving your craftsmanship.

3. Delegate Administrative Duties to a Goal Driven Team

It is almost impossible to focus on excellent patient outcomes and run a growing business at the same time. You need a strong support infrastructure. This means professional team members that are trained and motivated to apply procedures that are both simple and effective.

Chiropractic works. Not having a smooth-running support structure is the primary element that is in your way from developing your practice to its full potential.

This has been the major focus of our work over the last 30 plus years. We have found that the better the support, the better the outcomes and the happier the doctor and staff.

Improve your people and systems.

4. Create an Upbeat and Supportive Work Environment

“If you go into any organization that’s customer-facing, you can tell in five minutes when the employees are feeling abused. They retaliate on the customers.”   Jeffrey Pfeffer, professor at Stanford University

The way the employees are treated directly affects the service that they will provide to the customer.

Sure, work can be stressful at times. Maybe someone snaps at someone else. This happens in any high-performance activity. But as long as we all share the same mission and values, we can address our personal slights to each other and move on.

It is everyone’s responsibility to create a cheerful work environment for each other. If you are having fun, so will our patients.

Smile more — and make work fun!

5. Give Your Patients Information. Educate Them!

“If I’d asked customers what they wanted, they would have told me, ‘A faster horse!’.” Henry Ford.

Of course, you give people want they want – what they consider urgent and important.

But people didn’t want a faster horse, they just wanted faster transportation. Horse, car, airplane… they wanted to get to where they wanted to go – faster. They just didn’t know about how simple, fast, and easy a Model-T was.

You must show them through education that you have what they want and need.

Most offices provide relief. That is what the patient is aware of and willing to pay for. But since you are providing a product that is not tangible using procedures that are invisible, your customer may have a difficult time understanding anything beyond the “quick fix.”

They may know they want more but lack the understanding of what is available.

I know I need to pay my taxes, but what I really want is to pay as little as possible. I also would like to contribute to my children’s education. With some education, my accountant could make me aware of different strategies that would take me to my full goal.

“Customers are thirsty for more information and knowledge,” according to studies by ThinkJar, a customer strategy consultancy.

To deliver your best and complete outcomes, you need your patient’s motivation to do so. It is a path and a partnership that you travel together.

The better that they understand their condition and your unique remedy, the easier it will be for you to help them achieve the best outcome possible.

The more they know — the further they’ll go!

6. Making the Patient’s Experience Extra-Ordinary

Making the patient experience “WOW” takes a team effort.

If studies show that customers discontinue a service mostly because of a lack of interest on the part of the service provider — and your own personal experience validates this fact, then the solution is simple. Just be genuine and interested in your patients. Be empathetic. Take the time to be totally present, in the “now,” and have “present time consciousness.” You only have 1 patient, and that is the one you are with, or about to see.

Then, when you practice with your team at team meetings, focus on this: the level of honest interest, curiosity, and care.

Practicing scrapes off the “barnacles” that attach to us all as we soldier through our work days. Here are some training tips for working on improving customer service with your team:

a) Review the Customer’s Journey

Lay out the pathway to and through your services. Do this with your team.

This begins even before your patients contact you. Who are they? Mom’s, seniors, kids? What brings them to you? What other solutions have they tried before they came to you? Get to know them and empathize with their condition.

b) Flow Chart

Then, list the sequence of actions, or a flow chart of what occurs from first contact through their first service and leaving. Drawing this out with your team will expose many areas for improvement.

c) The Walk-Through

Against this flow chart, you and your team can now look at where you can add more benefits for your customers.

I have found that practicing a “walk-through” reveals many hidden plusses – and embarrassing weaknesses, in service. The doctor or a team member takes on the role of a customer. They then travel some portion of the patient pathway with the usual team in their roles, acting as if they are dealing with an actual patient.

You are guaranteed to find areas where service can be improved.

d) Add More Value

Bain Consulting, an international management company, identified 30 different elements of value relative to consumer needs in an extensive study. They categorized these customer values into four categories:

    • Functional values, such as quality, variety, time efficient, simplicity, reduces effort, and reduces cost.
    • Emotional values, which included entertainment and fun, aesthetics, rewards, and attractiveness.
    • Life Changing values which included affiliations, community, and greater purpose.
    • Social Impact. An industry example was Tom’s shoes, a shoe company that donates a pair of shoes to underprivileged for every pair purchased by a customer.

In their research, Bain noticed that the companies that had the highest ratings on the most values had more loyal customers than the rest. They also found that these companies had faster revenue growth than others.

Good service pays. Great services pay even better!

With this in mind, look again at your flow chart and notice where you can add more value to your services. Start with the direct service to your customer, the “functional” areas of your business. For example, how could your customers receive their services:

  • Faster
  • More conveniently
  • Less expensively
  • With less effort
  • With greater simplicity
  • Receive child care while in the office
  • And also acquire a understanding their condition and their care program

In the next category that Bain used, what kind of “emotional” values could you add, including:

  • Fun and entertainment
  • Rewards
  • Design/Aesthetics
  • Attractiveness
  • Reduced Anxiety

The next two categories relate to higher purposes. “Life changing” and “Self-transcendence,” including:

  • Affiliation/belonging – Create a wellness or health club, have patient barbeques and get togethers.
  • Social Impact – Schedule yearly events to help the less fortunate, clean-up drives, and health and environmental causes.

In the years to come, Customer Service will take the lead in all your marketing efforts and will be the factor that sets you apart from comparable alternatives.

Edward Petty