Tag Archives: practice

Failure to Follow Through

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It is the ‘follow through’ that makes the great difference between ultimate success and failure, because it is so easy to stop. — Charles Kettering

Failure to Follow Through

If it worked once it probably will work again

There is a management disease that many businesses, including chiropractic and other health practices, can suffer from. It is called “Failure to Follow Through.”

I noticed this at one of the first offices I worked with in Northern California – years ago. Their numbers were down. When I visited their office on a hot summer day, the reception room was empty, and few patients were scheduled. I noticed they had a thick binder of photos of patients and staff on the lower shelf of a dusty bookcase. The photos showed happy staff, doctors, and patients. There were also patient success testimonials, several years old.

We all met together for a staff meeting. I asked the doctor and staff if they could name a few specific actions they did back then. I said, “let’s start with marketing.”

Well, it turned out that they ran advertisements for a bi-yearly promotion. So I asked if they had done this in the last few years. “No” was their answer.

“What else were you doing at the time,” I asked. They said they always discussed financial and scheduling arrangements away from the front desk. Are you doing that now? “No.”

What else were you doing during that time? “We used to call the new patient after the first adjustment.” They also did progress exams. “Doing it now?” “No.”

The list went on and on.

Being the brilliant practice management scientist that I am, I encouraged them to re-implement what they had been doing. They did, and a few months later, the office was filling up again.

Practice Management

If it worked once, it probably will work again. Make minor improvements as needed, but why change the system if it is working?

Well, you can get bored, right? Or a staff member who knew the system left and their duties were not replicated by someone else. Or, everyone gets bored, so you feel the need to change things to bring excitement back into the office, and key procedures quietly start disappearing.

Discontinuing your successful procedures can create a roller coaster ride for your practice, with numbers going up and then down. And this can cost you thousands, even tens of thousands of dollars.

A checklist of successful procedures is essential, but that is not enough. They need to be reviewed regularly.

That, too, is not enough. We need to keep the practice environment fresh and lively while still maintaining those activities that are helping us grow and develop. We are not on an assembly line, and we are not robots!

I cover this in my book, The Goal Driven Business. (See Goal Driven Principle #17, Goals, Games, Groundhog Day). This is part of the Goal Driven System of practice development and includes checklists, reviews and coaching, and other components, such as gamification.

Gamification is a new term for an old principle: we like to play games! As video games became more prevalent, businesses saw that they could adapt elements of gamification to help engage employees and customers. Nothing new, really.

To make your office feel new again, you can think of a new promotion for this summer or new colors to paint the office. Spend a morning reviewing your goals, mission, and policies, and then go to a spa for a reward! One office creates a health theme each year and makes t-shirts promoting the theme for staff and patients.

Keep it fun — but stick to your winning ways.

Patient Management

ALSO… like practice management, patient management can also be affected by failure to follow through. Your patients need help to adhere to their treatment plan to achieve their health goals.

Stick-to-itiveness is simply being true to our goals.

Make improvements along the way and keep it fun. But help each other and your patients follow through.

Your goals are waiting for you!

Ed

In Praise of Geekiness

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Are you a chiropractic geek?

Are you a health geek?

Here is Merriam Webster: Geek: “…a person with a high level of knowledge or skill in a field…” “an enthusiast or expert especially in a technological field… [The word geek has] seen increasing use with positive connotations, showing membership in a specialized group (film geek, beer geek) rather than social awkwardness.”

I like the word geek because it indicates someone who specializes in a field and is so engaged that they are not especially concerned with keeping up with what is accepted conventionally. In other words, they are a bit of a rebel.

Steve Jobs, for example, was a geek. A core value of Apple was a “power to the people” idea, that anyone could have a personal computer, not just the big corporations.

Wouldn’t Clarence Gonstead have been a geek? It would be difficult to find many chiropractors who were, or are, as engaged in chiropractic as he was or worked as hard.

I remember years ago when talking with a chiropractor over lunch and all he could talk about was the X,Y,Z axis, something about Euclidean geometry, and bilateral symmetrical function. I was trying to keep up! But there he was, in practice for over twenty years, talking excitedly about the last few patients he had seen. He was a chiropractic geek, for sure.

He also had a million-dollar practice with a very strong practice manager.

Great athletes are geeks in their field, studying and training harder than most. Same with musicians or chefs.

But it is easy to get distracted from your game. Collections, bills, staffing, procedures, marketing, insurance, taxes, and everything that goes along with running a business can cut into your productivity and dilute your concentration on your services.

Don’t let it.

Only the offices that give the highest quality services and deliver the best outcomes will survive, let alone thrive. Organize your administration such that it does not dampen your eagerness to engage with each patient, and continue to study and enhance every detail of your clinical skill.

And as a plug, this is why I wrote the Goal Driven Business – to help doctors be doctors, unfettered by administration, and free to express their skills and interests in their profession.

Organize your office so that you can focus on the science, art, and philosophy of your profession. Do so that you can look at chiropractic and its results newly each day, as if you just discovered its powerful potential to help people become healthier. Go deep on every level and rediscover your profession again, for the first time.

Be a geek.

Goal Driven to seize the future,

Ed

Those Numbers: Do You Manage by Emotions or by Goals?

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scoreboard for statistics

It’s Monday morning. The staff is getting the office ready for the new day. And while doing so, they are wondering… “How is the boss’s mood going to be today?”

They are taking their cues on how the day will transpire based upon, at least in part, your emotional state.

Your team, as well, will often be tempted to manage their roles in the office emotionally, based on the circumstances in their personal lives.

There is nothing wrong with positive emotion. Emotion is a feeling “a mental reaction subjectively experienced” (Merriam-Webster). Some are more positive than others, such as joy, delight, cheerfulness, and others are more negative, such as anger, grief, and fear.

But emotion is reactive. Setting your sights and working for goals is proactive.

Your Scoreboard

Your practice numbers show you if you are headed towards your goals or away from them.

They can predict what needs to be done to improve your business and achieve your goals. They also keep everyone on your team informed on the status of the practice and included in its management.

There is a right and wrong way to use your numbers to help you achieve your goals.

There is, in fact, an entire methodology on how to use statistics to improve business performance.

Large companies use analytics to manage and improve their production in formal processes such as Kaizen, Six Sigma, and Total Quality Management.

In the Goal Driven System, we use a simplified version called GAP, the Goals Achievement Process, which works just fine.

At the beginning of each month:

  1. Review. Review your key numbers monthly at staff meetings. (This can also be done weekly to check on your progress.)
  2. Notice and support. Notice where the numbers went up. Then, plan a couple of action steps to support the areas that went up.
  3. Notice and fix. Notice where the numbers went down. Then, plan a few action steps to fix the areas that were down.

Remember that numbers by themselves are nothing. They are symptoms or representations of the quality and quantity of your outcomes. Don’t get so caught up with the “stats” that you lose sight of what the numbers represent. Expecting the numbers to improve without confronting and enhancing the factors causing the numbers is at best ineffective and, at worst, can be abusive.

But numbers can assist you and each team member to stay focused on the goals: your office mission, its values, and its outcomes.

In a Goal Driven office, your team takes its cues from the office scoreboard.
There is an art and a method to capture, display, read your statistics and apply what they tell you. This is not adequately taught to most doctors in business – or to employees. Yet managing by numbers is a fast and very effective method to keep your business improving.

We are creating a short training course to remedy this called Goal Driven Analytics for the Chiropractic Practice. Subscribers to this newsletter (you!) will be the first to hear about it.

In the meantime, stay true to your goals, and use your scoreboard to help you do so.

Seize the Future

Ed

Motivation

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No matter how many goals you say you have or how you write them out, unless you have the motivation to achieve them – you won’t.

“Motivation is the driving force behind the energy required to complete a task… a person’s willingness to exert physical or mental effort in order to complete a goal or set aim. (Psychology Dictionary.org)

This is a key element in a Goal Driven Business.

You first need to define your goals – and they must be practical as well as meaningful. But you also need the drive to achieve them. Without the drive, the motivation to get to where you want to go, you are just a poser in the business world.

(Case #345) The doctor and I had discussed a plan to motivate his team and increase production. This was many years ago. Over lunch, we had a team meeting to announce the plan to his other two doctors and about 10 support staff. He announced that if certain goals were met over the next 7 months, everyone could get a trip to Hawaii.

Everyone was shocked. Including me! The doctor and I had discussed a two-month plan for rewards based upon a modest performance improvement – but not Hawaii and not the increase in production he wanted. He came up with this on the spot during our meeting.

But that afternoon, amazingly, the phones lit up. People were calling in for appointments. (Never mind that this was an example of Innate or Quantum Entanglement!) As I recall, they had their best month ever. But unfortunately, they soon realized that the goals were unrealistic, they had little support to achieve them, and the doctor saw that he couldn’t afford it even if they did reach their goals. The practice subsequently went into a long-term slump.

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What is the lesson? Well, there are a few of them, but I want to focus on motivation.

While it may seem like people become motivated because of the “carrot,” or the reward, there are deeper reasons – or principles.

Edward Deci, along with others, put forth a new framework for motivation called Self-Determination Theory. Essentially, it states that we are all driven by intrinsic goals as part of our fundamental nature. Our reward comes from the satisfaction we feel from the achievement more than from any external prize.

These are the three intrinsic goals we all share:

AUTONOMY. We all want to play in our own sandbox! We need to feel in control of our own corner of the world. Just like we don’t like insurance companies intruding into our clinical decisions, staff does not like being micromanaged.

COMPETENCE. We all want to be superheroes! Deep down, the prospect of becoming more skilled, more masterful, and better able to be in control of our environment is a drive we all have.

CONNECTION. We all want to be part of something bigger than ourselves. This manifests in two ways: a) being part of and working with a supportive group or team, and b) working to help bring about something more significant than our paycheck or the accomplishment of our everyday tasks.

The office staff was excited to go to Hawaii, but this was not necessarily because they could lie in the sun. It was because it was a huge goal that gave them a very large sandbox to play in – together – to work for a very large result.

Self-Determination Theory is why games work. In Kevin Werbach book, For the Win, he discusses the subject of Gamification.

“For thousands of years, we’ve created things called games that tap the tremendous psychic power of fun. A well-designed game is a guided missile to the motivational heart of the human psyche. …monetary rewards aren’t even necessary because the game itself is the reward.”

Whether it is a sporting event, video game, or Sheepshead (a popular game of old-time Wisconsinites, so I’ve heard), we love our games. And I think we need them.

But it all goes back to the principles of Self-Determination Theory.

Remember when you started your business? The challenge that lay ahead? The new business card that identified you as the hero to conquer new plateaus?

Those drives are still there and can be rekindled, regardless of prior disappointments.

As Soon as You Make a Goal—You Have Created the Potential for a Game.

Win or lose, IF the principles of Self-Determination Theory are in place, you will be motivated and so will those with whom you work.

Apply these principles to yourself and your team – for the game, for the fun, and for the win!

Seize the Future,

Ed

For more information on how to apply self-Determination Theory, games, and motivating yourself and your team, please purchase the book,
The Goal Driven Business. [Link to sell page]

 

Goal Driven Job Descriptions

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playbook goal chart

In a Goal Driven Practice, Goal Driven Job Descriptions are short, fast, and to the point.

And they are used!

They help improve the quality and quantity of services and are motivational.

So, how is this different from other job descriptions?

Most job descriptions are usually a hodge-podge and catchall of unrelated tasks. For example, the front desk job description may include getting supplies, taking x rays, calling attorneys, and scheduling patients. Billing may include marketing and equipment repair.

Staff will do the tasks assigned but end up zigzagging from one function to another, losing focus on what they are doing, and often disengaged in their activities.

In typical job descriptions, the goals are not clearly defined, measured, nor are the expectations stated. Further, employees don’t always see or get recognized for the results of the work detailed on their job descriptions.

Yet another failing of most job descriptions is obvious – they just aren’t used.

Let’s look at how to power up job descriptions so that they are Goal Driven.

Many job descriptions contain the duties of several different roles. A role is an assumed identity. For example, in a restaurant, there are the roles of a server, cashier, dishwasher, and chef, or cook. In a small restaurant, one person may take on a number of these roles, and all these roles would be their job description. Hence the idiom: “chief cook and bottle washer.”

But to be effective, each role needs to be separated, well defined, and organized with the other roles.

In a Goal Driven Practice, job descriptions are broken down into different roles and described in job checklists.

The job checklist begins by clarifying the goals. This includes the mission, the outcomes, what is used to measure performance, and the level of performance expected of that role.

For example, for the role of Patient Accounts, the mission might be something like: “To help the patient pay for all of the services they received in such a way that they will continue to receive services.” The outcome might be a zero balance or “no accounts receivable more than 30 days.” The statistics used to measure this role could be the “percent of collections to adjusted services.” And finally, the expectation might be something like: “All patients very happy with the encounters with Patient Accounts and continuing with their services, with a collections percent of at least 95% of adjusted services average.”

We now list the most important procedures to achieve this goal. The CEO of the office defines WHAT the goals should be – that is leadership. But the manager and those working in patient accounts would work out HOW the goals would be achieved.

Encouraging the team member to define the best procedures to achieve their goals empowers them and gives them autonomy and responsibility for their role. According to Self-Determination Theory, real motivation is intrinsic. It comes from one’s desires and needs rather than external rewards or threats. Edward Deci, in his book Why We Do What We Do, says people “strive for personal causation.” (This is more fully covered in my book, The Goal Driven Business)

If the cook understands that their goal is to make tasty meals that the customers enjoy and for which they will pay, they can be more responsible for how best to achieve that goal.

A team member may have five or more roles, each with a job checklist, as part of their job description. As the doctor and owner, you may have 25! (And if so, that could be a big capacity barrier right there!)

Once the goals are clearly defined … and kept in mind, the rest of the checklist can be easily worked out.

Once per month or more, you or the manager can meet with each team member and do what we call a Coaching Review. This is a fast review of employee performance: at what they are excelling and at what they need to improve. In addition, the job checklist can act as an assessment.

But it is all geared around the goals of their roles. You also ask them what could be added or changed to improve both the quantity and the quality of their outcomes. They can make the changes to the job checklist and make sure you have a copy.

None of this takes a long time to do each month.

Management of your office is not just about getting procedures done. It is about constant improvement in the quantity and quality of their goals.

You may have told your patients something like: “If you do not make time for your wellness, you will be forced to make time for your illness.”

The same applies to managing your business. “If you do not take time to improve your procedures and your people to achieve the goals in their roles, you will be forced to make time to rebuild your practice.”

Steven Covey, in his book The 7 Habits of Highly Effective People put it simply and best:

Begin with the end in mind.

 

Ed

The Goal Driven Front Desk

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A dynamic front desk can increase your visits by 20%, maybe more if you have the room. On the other hand, a dysfunctional front desk can constrict the flow of patients and hold your office back.
I have seen instances of both.
There is much more going on and at stake at the front desk than most doctors and staff appreciate.
Ordinarily, you would think that the billing department is the most demanding. There are hundreds of details that need to be learned and followed with excellent discipline. This position requires professionalism and expertise.
But this function is not on the front lines of the constant patient, phone, and doctor interactions and interruptions. Managing patient accounts can be regulated and organized to maintain a calm and comfortable workflow.
Therapy and adjunctive services are often undervalued, but the patient flow is usually smooth, and they are not faced with unexpected patients or phone calls.
It is interesting to note that the front desk has the highest turnover in most offices.
But properly set up and managed, this department can be an engine of growth and stability in your office.
Let’s look at some of the more important attributes of the front desk:
  1. It represents you and your services. It is your ambassador to the world outside your office. The front desk reflects what you stand for and the quality of your services.
  2. It is the first and the last contact – and impression –with anyone in the office.
  3. It can convert inquiries to new patient appointments.
  4. Rapport and relationships. The front desk can provide world-class service to patients, improving patient retention, reviews, and referrals. (The 5 Rs)
  5. Direct marketing. The front desk can directly promote clinic services to patients, hand out coupons, and promote upcoming events to generate patient referrals.
  6. Team member support. The front desk can support the insurance department and all team members to create a positive, upbeat day every day.
  7. Case Management. The front desk can contribute to case management by relaying any comments or observations relative to the patient’s care to the doctors.
  8. Fully Scheduled Day. The front desk fills the appointment book and keeps it full.
Let’s imagine an ideal front desk and put it at a “5” on a 5 Point Scale.

 

5. GOAL DRIVEN FRONT DESK. The appointment book is full. The front desk staff are cheerful, having fun doing their jobs, and genuinely interested in every patient and phone inquiry. They sincerely care for each patient and non-patient. They have a strong intent on helping patients complete their programs by keeping their appointments. They personally and professionally want to achieve the mission of the office and encourage patients to help them accomplish this mission by bringing in family and friends. They also help the rest of the office achieve the office’s mission. They are sending out positive “vibrations” to help more people. They are proactive and Goal Driven.

 

Below this level, we find the front desk that is struggling.

 

2.5 A COPING FRONT DESK– The appointment book is 50-70% full. The front desk is trying, but it is not keeping up, which creates a bottleneck to patient flow. (Subluxated) Even though the staff wants a full appointment book, subconsciously, they don’t want any more work until they catch up.

 

2. A SLOW FRONT DESK. The front desk operates at a “comfortable” 40-50% capacity. The staff is pacing themselves, keeping up with computer tasks, insurance, and following the scripts for phone and patient encounters. However, they are mostly disengaged from the front desk and office goals.

 

1-2. GIVEN UP and BORED. I only describe this because I have seen this condition. The staff is ignored or badgered. In either case, they feel relegated to a 4th class employee. They hide out and pretend to work, essentially having quit and just waiting until something better comes along.

 

You can create a Goal Driven Front Desk. It is not achieved overnight, but once it is established, you’ll be close to a dream practice and a Goal Driven Business. We will cover some tips on how to create a Goal Driven Front Desk in another newsletter.

 

In the meantime, stay Goal Driven,

 

Ed
“Your brain sends out vibrations all the time, and your thoughts affect your life and other people’s. They pick up these thoughts and get changed by them.”
– Bruce Lipton (Biology of Belief)

The Morale Virus: What doctors say and how they are combating it

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Over the last few months, I have been noticing a particular phenomenon in offices that I don’t think I have seen before… maybe ever. It is like noticing a slight hand tremor that you never knew you had or a buzzing sound from outside that has become increasingly loud and annoying.

2020 was a long year, a stressful one. And you all have been in the thick of it. Daily, seeing more people in one day than most providers see in a week – or more.

My old football coach, Johnny Pappa from Davis, made a big impression on me as a young freshman when he said: “When the going gets tough, the tough get going.” In my then youthful life, I had never heard such profound words. They still apply – especially to you. You are tough!

But stoicism has its limits. The cognitive dissonance can finally get to you.

One doctor expressed to me extreme frustration about two young and very healthy patients, who exercised, got adjusted, ate well, took their vitamins, but decided to discontinue taking their outdoor walks for fear of COVID.

Another doctor, venting his dismay, told me that he couldn’t bear to watch the medical bureaucrats talk about masking and vaccinations as the only remedies to COVID when he knew of so many methods that have been demonstrated to ameliorate the virus. “People are frightened and told to stay at home, don’t socialize, wear a mask if you go out, and wait for the vaccine. That’s it? That’s all you got for people? This really shuts people down.”

One doctor I talked to who, after dealing with depressed and suicidal patients, many of them vets, has become depressed himself. Another wonders what the hell is happening to our chiropractic colleges – have they all been taken over by medical bureaucrats? Is chiropractic finally squashed?

Your good nature can become frayed, your patience worn thin, and regardless of your professional composure and your disciplined countenance, the stresses can have an affect. I mention this because most of you are tough as nails – you have successfully dealt with many types of stressful situations in the past, as a doctor, professional, and for many of you, a business owner.

Morale Virus

So if you are feeling a bit off, recognize that you might be affected by a contagious “Morale Virus.” The Morale Virus is what I call the social sickness that occurs as an emotional response to continual fear-baiting. Frightened, your patients are told they can’t do this and shouldn’t do that.

The Morale Virus is not caused by hardship itself. It is caused when you are pushed into a corner and given no way to fight back. You tend to give up. (Or go stark raving mad!) (Reminds me of the movie, One Flew over the Cuckoo’s Nest when the star, McMurphy (Jack Nicholson), says: “You guys complain how much you hate it here, and then don’t even have the guts to leave! You’re all crazy!”)

There has been a constant assault of bad news emanating from officials and authorities. Yes, and I know the media plays a part — it is mostly owned and controlled by just a few rich people and corporations who have their own agenda — namely, more money. But still – no one buys boring newspapers. Sensation sells the news, and we, the consumers, buy it. We listen and read the “news” that riles us up and confirms our bias. Social media does the same, times ten.

Dirty Laundry (Song by Don Henley) 

I make my living off the evening news
Just give me something, something I can use

People love it when you lose. They love dirty laundry
We got the bubble-headed bleach-blonde who comes on at five

She can tell you about the plane crash with a gleam in her eye
It’s interesting when people die, give us dirty laundry

Morale Virus Disinfectant

Here are some ideas on how you can fight back, disinfect your office from this disease, and better help your patients regain their spirit of hope, kindness, and free enterprise. And yours as well.

Good Vibe Year

One doctor we work with likes to anchor her practice around a yearly theme. For 2021, she is calling 2021 the year of Good Vibes and has events planned to support this philosophy. And just to reinforce the idea, she has T-Shirts made that say Good Vibes. (And by the way, she has a bustling two-doctor office.)

Study. Acquire More Knowledge. Teach

Fear is often a byproduct of lack of knowledge – so arm yourself with the facts.

For example: Roommate 1: “Oh my god! (A panic shout is heard.) The television isn’t working and the game is on. What will we do?” (Drama ensues.) Roommate 2:(Calmly) “Check the remote for new batteries.”  Roommate 1: “Ah, that fixed it, thanks.”

Study, use critical thinking, avoid bias – your own and others. Go to the sources – research studies and from people who are actually working on what you are studying. Then, please educate your patients and clients on how to be happier and healthier. And educate your team, help them increase their knowledge. Arm them as well. Doctor comes from the Latin to docere – “to show, teach, cause to know.”

Leverage Point

What area in your office, if changed, will produce the most significant effect?

Obviously, first and foremost is the doctor. Each day should be a trip to the playground, the ski slope, the baseball field, the dance floor. Ideally, each day is a fresh opportunity to accept the privilege of helping as many people from suffering as possible, to teach them, and have fun doing so.

In most offices, I would also say it is your front desk. The front desk’s power is so poorly recognized in most offices that at least 20% or more production is lost. A vibrant, aggressively friendly, caring, mission and goal-oriented front desk can and will boost your volume – this week. Front Desk team members may need more support and less admin (billing) duties. They may need a better understanding of the mission and how your office is helping people.

Entrepreneur Harder

During cultural upheavals and shifts, entrepreneur businesses remain and often thrive. New opportunities open up. More established and larger companies are weighed down by dogmatic rituals, have high overhead and many vice presidents, and vast networks of suppliers. Change is difficult. But not for the entrepreneur. Most entrepreneurs are all too “change-happy.” You can adapt, innovate, and overcome quicker than companies who are afraid to or can’t. So what if in-person care classes are out for now? Get everyone on a Zoom class, give them a secret word. Test them when they come in again and if they answer correctly, give them a gift – a bottle of Vitamin D or a lunch at another patient’s business.

Stay Out of the Weeds

One doctor told me that her solution was to “stay out of the weeds.” To stay in her lane and just keep helping people and not get caught up in the storms of controversy. I suggest that this is the best course of action. You want news? Sensational news…? Just listen to your patients and staff and community. But stay on the fairway and don’t get sidetracked, mentally or in real life.

Goals

Stay with your goals. Goals are agreements that you made with yourself, and usually others. If you stay true to them, they will lead you out of the den of the morale sickness. Staying true to your goals is a point of integrity. Your goals are not in the weeds – they are straight ahead. Figure out new and better ways to get there or resurrect old ways that worked. Fall down 7 times, get up 8. Each day and each week — begin with the end in mind.

Your goals are in three categories:

  1. Financial. This includes marketing and production.
  2. Service. Developing individual and team expertise with constant improvement..
  3. Purpose. Your higher purposes, those goals outside of work that are greater than this week and that are most meaningful need to be integrated into your work-life.

The Future is Bright and Roaring!

We have seen harsher times. The past is easily forgotten, and we think we are in the worst of times. Well, the 1918 flu was much worse than COVID. Plus, we were sending our young boys to suffer in horror and die in the trenches in Europe in the Great War. But society prevailed and soon ushered in the Roaring 20’s, a time of economic growth and cultural freedom.

Prepare to roar!

Carpe Deum (Seize the Day)

Ed

Ed Petty - author

This is such an important subject, I encourage you to share it with your team and colleagues:  To print out a hard copy

Keep putting your business THERE

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A tree withstands storms but continues with its systems.

Just a note here about procedures:

Keep the structure of your business – its policies and procedures — in place. As much as you can, stick to your usual routines.

Certainly, you want to integrate needed changes to prevent the spreading of the virus. And obviously, for many of you, patient volume has changed, so you may have to adjust your work hours and staff hours.

You do need to be flexible. Improvise — where needed, adapt, and overcome! (Paraphrase of Marine slogan!)

But do not let the virus be the tail that wags the dog!

Keep the recalls going. Keep the billing going. Hold staff meetings, if only by Zoom. Rally the team! Review numbers and SET GOALS. Give staff study assignments. If anything, increase your patient communication 5 times – or more.

Strengthen your network.

I bring this up as I have seen a few offices start to slack off on their procedures, and while this is understandable in many situations, it can be a slippery slope. This can set a precedent for neglecting other procedures. This is what leads to office anarchy and what I call “Procedural Atrophy.”

Procedural Atrophy is the gradual dropping out of procedures. For example, you used to call every new patient after their first adjustment and send out birthday cards. Then, you became so busy that you “didn’t have time” to do the calls or to makes sure the staff sent out birthday cards. Two years later, you wonder what happened to all your patients.

We are NOT victims. We will respond positively and use this opportunity to strengthen our resolve and our health network.

Hold true to time tested procedures during unusual conditions.

Stability breeds confidence. Your patients are looking to you to be the rock that they can count on.

Management’s job is to hold the structure of the organization in place. (And then improve upon it.) It may have to be abbreviated, economy of time, effort and money come into play, but … do the usual. Set your goals and stick to your successful procedures to reach them.

Do this, and after this storm passes — your business will be busier than ever.

Working now for the future,

Ed

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

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

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

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

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

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

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

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

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

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

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

 

SOME CHIROPRACTIC EXAMPLES:

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

 

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

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

 

REMOVING PRACTICE CONSTRAINTS

Here are some steps to take to remove bottlenecks.

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

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

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

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

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

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

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

 

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

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

Sometime

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