What gets measured gets improve
By Anthony Lombardi
Running a successful business – whether a chiropractic practice or a lemonade stand – is not easy. It requires unwavering level of commitment, because being successful today does not guarantee success tomorrow. Believe it or not, the success of your business depends on the most unreliable, unpredictable elements of existence – other people.
Support staff, associate health practitioners, (DCs, physiotherapists, RMTs) and of course, patients, are all different types of people your practice depends on to run efficiently and effectively. All of the above-mentioned have individual lives, different needs, diverse dreams, and ever-changing aspirations. So running a thriving, consistently profitable practice depends on how well you monitor, manage and measure what people do.
Contracts and conversations
In an earlier article (“You’re Hired, You’re Fired”), I outlined the importance of having solid contractual agreements with your associates and independent contractor therapists. Now I extend them to new incoming employees as well.
Since then, I have continued to refine the terms of those contracts to reinforce the importance of commitment to those who wish to work with me. For instance, in all contracts I now include a time period for which the contract is valid (i.e. 18 months, two-year or three-year contract, etc.). I do this with all of my associate DCs, physiotherapists, RMTs and support staff so they honour the terms and length of our agreement, which promote stability within the practice.
To support my intentions I also include a clause that outlines the penalty for terminating the contract early. Conversely, if the performance of the health-care provider is below my standards, then I have a clause that allows me to buy them out and end the contract whenever I wish. If you would like a copy of this revised contract to use as a template just email me (firstname.lastname@example.org) and I will send it to you.
Every six weeks, I have an in-person, one-on-one, 10-minute conversation with every DC, RMT and physiotherapist in my office. We discuss their clinical and business goals, and they put forth one thing they are looking to improve over the next six weeks. This way at every meeting we are measuring their progress, making them accountable and making them better.
I meet with each of my support staff every week for three minutes to review “checks and balances,” which keeps tabs on accounts receivables from insurance companies, billing procedure, and day-to-day operations. Having frequent conversational interactions shows your co-workers that you are serious about them and their development.
We see a myriad of patients – acute, sub-acute, chronic and maintenance types. A fundamental key to creating clinical success is making sure patients make follow-up appointments if it is recommended. It has been estimated that 41 per cent of chiropractic patients will self-discharge before their treatment plan is complete (Cox 2004, Back Into Research).
I measure this statistic for all health-care providers in my office. Ideally, I like to see patient compliance to our recommendations to be more than 90 per cent, but I am often content with anything above 80 per cent. Anything below 80 per cent needs improvement because this could demonstrate a fundamental problem with the therapist’s/DC’s clinical skills, their ability to clearly deliver a treatment plan, and/or their capability of assertively providing patient direction.
How a week builds
Measuring the week before, the upcoming week, and the week after that provides you with the information you need to predict how busy you will become and what areas of your clinic needs improvement. For instance, on the week of March 7th I saw 135 patients. Exactly one week before that I measured the March 7th week and I had 102 patient visits booked. Two weeks before that I had 26 patient visits scheduled.
I do this every week. I measure what’s been done and I measure what’s coming for every health provider in the clinic. This allows me to recognize trends, make predictions and, most importantly, make adjustments (no pun intended), which allow my practice to grow.
The concept of building a week is quite simple, really: go to work often and don’t take days off.
1. The first day
The beginning of the week sets the tone for the rest of week. So being mentally prepared is huge. Look over your schedule the night before and go over how you envision it progressing clinically in your mind. Preparing like this will pay dividends in the future. Then make sure you communicate your recommendations to your patients so they follow through in booking a follow-up appointment if they need one.
2. Say no to vacations
Taking frequent days off or starting your week on Mondays can put you at a disadvantage especially if you are just starting to grow your business. This is because Mondays will interrupt the flow of practice growth (see my article, “Don’t Pardon The Interruption”) as 14 per cent of Mondays are lost to holidays. So if you are serious about growing your practice be prepared to give up your long weekends and work the Saturday before the holiday Monday to make up for lost time. When I was growing my practice I worked two and a half years straight before I took my first full week off. Remember, do today what others won’t, so tomorrow you can do what others can’t.
Staying the course
Even after treating patients well, there will be many occasions where people will disappoint you. A staff member will steal from you, an associate health professional will leave you on bad terms, and a patient may even write an undeserved bad review about you – that’s life. The key is not to let these disappointments change the way you manage, monitor and measure the significant elements of your practice.
Our practice is a place where everything we know how to do is tested by the things we don’t know how to do. It’s the conflict between these dichotomies that creates growth and gives us meaning. Being aware of the reflection of ourselves in our work will allow our patients to see us on the inside. Now go to work.
Dr. Anthony Lombardi, DC, is consultant to athletes in the NFL, CFL and NHL, and founder of the Hamilton Back Clinic in Hamilton, Ont. He teaches his fundamental EXSTORE Assessment System and conducts practice-building workshops to health professionals. Visit exstore.ca for information.