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Solving the Practice Puzzle – Part 2


January 2, 2009
By Canadian Chiropractor Staff

Topics

Who is the coach for you?

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The first part of this article examined differences between a chiropractic coach and a chiropractic consulting service and how one or the other might benefit a DC’s practice. Some questionable coaching practices were also examined.  Although the general feeling that arises from the profession is that hiring a coach or practice consultant is not, inherently, a bad thing, chiropractors must be vigilant in choosing the coach, or service, who can best address his/her practice needs/goals while embracing the individual DC’s outlook with respect to fulfillment, balance and success. 

“In order to gain the most from your coaching,” notes Barbara Sturm, a Michigan chiropractor and coach to DCs in Canada and the U.S., “it’s imperative that your coach really hears you so that the plan, and goals, you co-create reflect what you want and how you want to get there.”

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 But, how many chiropractors have poured countless dollars into a coaching/consultant relationship offering limited benefits? At times, this certainly may be a function of the coach/consultant’s lack of adeptness. But, the dynamics through which the DC searches for this type of assistance may also have something to do with the outcome.
In the second part of this article, a process for scouting the optimal practice management guidance system will be examined.  Of course, the author acknowledges that there are many different ways in which to go about this – but the point, here, is to highlight the salient features that might make the quest more worthwhile for the chiropractor.

Defining ‘you’
This first step is crucial to success in almost any venture.  A chiropractor should not embark on seeking help with practice management issues without first having established three things: 

  • a definition of who he/she is, as a practitioner, an employer, and a person,
  • the differences between where he/she is and where he/she would like to be (this comprises practice and personal challenges, needs and goals),
  • that he/she owns the practice and, therefore, is the one responsible for the direction of that practice – and, in fact, his/her life, in general.*

Why is this so important? If a DC passively hands him/her-self, and the practice, into the hands of an outside element expecting a magical transformation, then that DC will certainly experience disappointment. This will be true regardless of how erudite or talented the coach/consultant is. Improvement, refinement and achievement must be a journey that is shared by the DC and the coach/consultant, wherein the DC’s individual values and aspirations lead the way, and the coach’s blend of training, experience and ability provide realistic, practical and ethical tools for reaching these destinations.1 

Once a chiropractor has worked out the purpose and direction for a practice enhancement relationship, and has decided which type of service would be the most useful – coach or consultant (see Part 1 of this article) – it is time to research individuals or groups to work with. 

Elements to investigate
Training
The question of how your coach or consultant has trained may be considered a mechanistic one, addressing only one dimension of their potential merit. Nonetheless, it may offer some insight as to whether that individual is the right one to work with.

Janice Hughes – who was quoted in Part 1 of this article – notes that this is a question seldom asked by chiropractors, and points out the answer received might be one of many. 

“Some people ‘fall into’ coaching,” says Hughes.  “They begin to teach those around them about their own systems and, before they know it, their helpfulness develops into ideas that seem to really benefit DCs in practice – and so they begin coaching professionally.”

“Others,” continues Hughes, “enroll in one of various available training certification programs where they may learn one, or more, of the many different coaching methodologies.”

One of the most prominent educators of coaches – a group whose credentialing is fast becoming the most sought after, for coaches of all fields and professions – is called the International Coach Federation (ICF). In existence for over ten years, the ICF strives to train career coaches – for all disciplines – who meet international standards of practice. The ICF aspires to support the development of coaching as a self-regulating and distinct profession on an international level, and has developed its education and credentialing with this goal in mind.  The interesting thing about this group is that it stands independent of all the disciplines for which it trains coaches.  At this time, over 4,000 coaches, worldwide, hold ICF credentials.2

This growing roster includes Dr. Brian Kleinberg, a DC in Thornhill, Ontario, who notes, “The coaching profession, which is about 15 years old, is not fully regulated at this time so, in truth, anyone can refer to themselves as a coach and conduct coaching services.  The ICF has set standards of practice and core competencies that every credentialed coach must be trained in, examined in and pledges to uphold and practice.”

Kleinberg adds, “The vast majority of life coaches practicing today are now seeking credentialing, and within a few years, just as we have rigidly enforced regulation for chiropractors through our provincial colleges, I suspect that the title of Life Coach will require a licensure, as well, through standardized credentialing.”

Kleinberg states that his training as a coach does guide him to be co-active with his clients – that is, he strives to help the client discover the best answers so he/she can take ownership of the actions taken.  This, he notes with conviction, is a very empowering process.
“Effective coaching unblocks what’s blocked, or de-clutters what’s cluttered,” Kleinberg says. “The outcome should be a life of exciting new challenges, growth and achievement. To this end – and while I have no doubt that many coaches are doing a valuable service to their clients – you as the chiropractic consumer of coaching services should be aware that there is an important distinction to be made between credentialed and non-credentialed coaches.”

Experience and location
Also of interest to the DC questing for a practice consultant or coach might be the experience(s) which that individual brings to the table, and where he/she is located**.

In terms of experience, there are a few particulars which might prove revelatory.  The obvious are expanse of experience – number of years or of clients –  references and testimonials from other/previous clients – both satisfied and unsatisfied – and which DCs the coach has successfully worked with in the past.  This last feature points to the coach’s area of specialization, in terms of what sort of needs, goals and paradigms are best served by his/her coaching methods, values and approaches. 

It might be worth considering a coach’s country of location, as well, when scouting out whom best to work with. With the current potential for relationships afforded by the internet, and the international accessibility of any location by phone, any DC can, theoretically, work with any coach, anywhere.  But, does a coach from out-of-country truly understand the environment, in which a practice is situated, enough to guide the DC in a meaningful and relevant fashion?

When asked about potential differences in coaching DCs in Canada versus the United States, Janice Hughes rose to the occasion.

“Yes, there are definitely differences in practice needs and goals when you work with a Canadian versus an American chiropractor,” Hughes says.  “Billing and compensation systems are different for the two groups.  Coding issues are more detailed for Americans and compliance to these is important. Canadians mostly have cash-based practices.  These particulars may result in some variations in practice.  For instance, the way a Canadian chiropractor communicates with patients will be different – he/she will place a lot of emphasis on his/her own education and how to best talk to patients who are paying out of pocket for services they want to understand clearly. As well, beliefs and attitudes toward care, and taking responsibility for one’s health, vary slightly between the two countries’ systems.”

Therefore, if a DC is investigating the possibility of working with a coach who is based outside of his/her country, it might be worth investigating how well that coach understands the environment in which the DC is trying to grow, both professionally and personally. 

Other considerations
Regardless of training, coaching method, experience, etc., coaches and practice consultants will agree that a DC must strive to work with someone who:

  • is adept at effective communication,
  • can properly assess the DC’s needs,
  • respects the DC’s paradigm and who he/she is,
  • has a value system that resonates with the DC 
  •  practices ethical strategies, and
  • who “walks their own talk”. 3

Janice Hughes adds that it also might be worth asking whom the coach is coached by? The choice of the coach, for his/her own support and growth, can be revelatory in terms of the values and paradigm of that coach. 

One chiropractor’s model
At the outset of Part II of this article, it was pointed out that there are several ways to choose a chiropractic coach or practice consultant.  This also applies to choosing CE practice management courses offered through the various chiropractic colleges – an option which is beyond the scope of discussion for this article. The article has been an attempt to collate and discuss those elements which seem common to coaches/consultants and DCs in terms of what the relationship should entail and how it should progress, but is, by no means, the final word on this subject.

Dr. Patrick Milroy, who practices in Halifax, Nova Scotia, has devised a graphic (Figure 1) to help him sort out what he might glean from any professional development activity, be it clinical/practice management CE courses or coaching services.  The graphic considers doctor satisfaction and fulfillment from these activities, but also takes into account how participating in them will impact on patient satisfaction.  (See Figure 1.)

 graph  
   

“The graphic can help me discern who the coach is that I want to work with,” explains Milroy.  “Ideally, I want to implement that which plots close to doctor and patient satisfaction on the two graphics.  To maintain a healthy balance, for any given issue, there should be a high patient satisfaction and a high doctor satisfaction.” 

Milroy points out that this graphic can be used to assess just about anything that a chiropractor wishes to implement into practice – the closer one can plot to both doctor and patient satisfaction, the more likely it is that the DC is making a good decision in choosing that strategy for his/her particular practice.

“If issues are not so easy to discern, then plotting it out on paper can help” says Milroy.

Practice management and enhancement activities draw from DC’s store of time and money, and, so, should be relevant, ethical and practical and should be aimed at sustainable, positive outcomes for the doctor and the practice, including the patients who seek care. Some of these outcomes will be objective and measurable while others may be in the realm of the subjective – one set is not to be considered less meaningful than the other when deciding which strategy, individual or group to work with.

“I have come to the conclusion that any controversy comes from a fundamental difference in the values and beliefs that each chiropractor embodies in their practice,” says Milroy. “Complicating the controversy is the skill set of the chiropractor and the overall office environment. I am not at all opposed to coaching/consulting, but I am careful of what I bring into my life and practice.” •

For article with references, please visit  www.cndoctor.ca.


*Renewing and strengthening one’s sense of purpose, accountability and leadership is something that a coach can help with and this is touched upon throughout the article. The point, here, is that a DC must embark on practice improvement strategies with the conviction that direction should be defined by the practitioner, and supported by the consultant.

**Practice consultants will be, at least, somewhat local as they should be present in your office to work with you and your team.  Therefore, the consideration of country of location, here, applies more to coaches.


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