Taking Responsibility
by William D. Esteb
One day I discovered some strange stains on the walls of my four-year old's bedroom. "What happened?" I asked.
"I don't know," mumbled Eric evading my glance.
"What caused these funny stains on the wall?" I repeated.
There was a long pause. "The Ghostbusters were chasing a third class vapor and mutagen got stuck on the wall," he said with perfect diction and a completely serious expression.
I'd never heard of third class vapors (or second class vapors for that matter), but I suspected that Eric had something to do with the strange greasy stains on the wall, and wasn't prepared to admit it. With further questioning we got to the bottom of things and my suspicions proved correct. Even four-year olds are fast to blame others for their own actions. No wonder we have problems trying to reclaim our economy, our schools, and our environment. The problem is most of us are unprepared or reluctant to assume responsibility for our actions.
I think it was Thomas Jefferson who said that a democracy was impossible without educated citizens. More recently it was the leader who turned around S.A.S. Airlines, Jan Carlzon who observed that without information employees can not take responsibility, and with it they can do nothing but take responsibility. Responsibility comes from having information. It's hard to have one without the other.
Few want to assume responsibility. If Richard Nixon had just admitted it was his fault (leadership), or if the president of Exxon had admitted that it was his fault (lack of enforced standards), we would have viewed both differently. But when we can see and smell the smoking pistol and encounter denial, we are especially unforgiving!
Many of the burdens we place on our enormous government bureaucracy are the result of citizens unwilling to take responsibility. Since I don't expect to see a dime of the money I'm submitting for social security, I am forced to assume responsibility for my own financial security upon retirement. Countless laws are passed and require enforcement because we are unwilling to assume responsibility for our actions. Everything from littering, bankruptcy, child support, and the mandated use of seat belts to the types of containers we can store gasoline for our lawn mowers are described by some law.
Do these laws assure that we'll buckle up for that short drive to the grocery store and avoid unsafe gasoline containers? Probably not. You can't seem to legislate common sense and personal responsibility. Oh, we can punish those we catch, but repeat offenders from drunken driving to rape have become something of a cliche'. Even extreme forms of punishment seem ineffective in imparting a sense of responsibility.
When Magic Johnson announced his HIV infection and assumed responsibility for his actions, his respect and impact soared. When football player Lyle Alzado assumed responsibility for his actions and admitted his brain cancer was the likely result of his use of illegal steroids, we admired his courage, even though the consequences were tragic. It's easy to accept responsibility for our successes, but it is rare to accept responsibility for our failures or shortcomings.
One of the great challenges you have working with patients is helping them assume responsibility for their conditions and mentoring them to make informed health care decisions in the future. The most successful at this are doctors who have high patient visit averages (PVA). This statistic, also known as "retention", is derived by taking the total number of monthly visits divided by the number of new patients that month. This approximation, while not perfectly accurate,is much more practical than going through all the patient files and counting the number of visits since they began care. Because it has the result of an averaging effect, months in which there is a significant influx of new patients send the figure downward. Likewise, when the number of new patients is down, the figure advances upward. Each monthly PVA should be averaged with the preceding 11 months to give you a more accurate idea of whether you're moving up or down.
Offices that have high PVA share several things in common:
1. Excellent communication skills. Patient education is a cornerstone of these types of offices. Appropriate patient education gives patients a complete understanding of the full nature and severity of their conditions. Without this appreciation, patients do not return to the office after their symptoms disappear. Patient education is critical.
2. Outgoing personalities. Everyone with patient contact in these offices is outgoing and clearly excited about chiropractic. Their passion is contagious and it makes them attractive for patients to be around. These doctors quickly build rapport and avoid scolding patients when they miss appointments or admit they're not doing their exercises. Patients find their enthusiasm and openness compelling.
3. Fast and effective adjusting procedures. Because these offices are even more responsible than their patients, they respect the patients' time. Patients are taught they are buying the doctor's talent, time. Patients meet a doctor who is ready to listen, but focused and relatively uninterested in Aunt Martha's car troubles or last night's televised awards program.
4. A team mentality. What's really remarkable in offices with high retention figures is the way they treat their staff. Ask staff members what they do and invariably they say they work "with" doctor SoAndSo, not "for" doctor SoAndSo. Big difference! This also translates into lower turnover, higher job satisfaction, and a career orientation. How can you expect patients to stay, if you can't even pay your staff to hang around?
5. High levels of self-esteem. Self-esteem is the undercurrent of all successful marriages, successful families, and successful offices. With adequate amounts of self-esteem these doctors are quick to regularly question the status quo, implement change, and look for better ways of doing things. When they make a mistake they willingly admit it (take responsibility) and blame themselves when the stats turn downward--not the staff, the weather, the insurance companies, or other outside influences.
6. Ability to run a business. Regardless of how good of an adjuster you are, if you can't run a business, your ability to share your valuable skills and make an impact in your community is severely reduced. These doctors create systems and document them clearly in procedure manuals so everyone's attention can be on the more important aspects of patient care, patient communications, and patient motivation instead of handling exceptions and dealing with the latest emergency.
7. Long term view of the future. All of these offices plan to be in business for many years. None are looking for a quick financial killing, early retirement, or career change. With this long-range outlook they are less bothered by patients who refuse to take responsibility and drop out of care prematurely. They congratulate the patient for considering chiropractic and make sure the patient knows they are always welcome back should their condition return (which is highly likely). Many offices report that it may take some patients as many as three or four times of beginning and then discontinuing care before they finally understand chiropractic well enough to assume the responsibility necessary for a chiropractic lifestyle. What's the hurry?
You can only assume responsibility when you are willing to search for and acknowledge cause instead of being distracted by symptom. The number of new patients you get is a symptom. How long they stay with you is a symptom. High turnover at the front desk is a symptom. Patients not "getting it" is a symptom. When patients don't refer others it's a symptom. When you're having fun in the service of others--that's a symptom too. Until you and your patients trust each other enough to recognize the cause, you are destined to repeat the frustrations of the past. Getting to the e not only encourages responsibility, it makes each of us more responsive.
Buy the book
My Report of Findings
Originally published in 1993
240 Pages
US $24.95
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