Consulting Versus Coaching
by William D. Esteb
The greatest crime in chiropractic is the often complete oversight of chiropractic colleges to give students even the rudimentary management direction necessary to exchange their valuable healing skills on a win/win basis with patients. As private enterprise intervenes to fill this obvious need, distorted values and non-clinical concerns can be interjected into the doctor/patient relationship. The lack of management savvy has spawned an industry which, if the average patient knew existed, would stop chiropractic in its tracks.
If you have a practice consultant, are preparing to renew your relationship with one, or are looking for some outside help, consider these points:
Purpose of having a consultant. Some suggest that the personality and intuition helpful in building patient trust and creating a relationship conducive to healing run counter to good business sense. What many doctors fail to realize is that they are a small business first and a doctor of chiropractic second. Without the ability to successfully run a small business, you do not get the opportunity to truly help patients. Everyone knows a doctor or two who is a great adjuster but who has failed repeatedly to run a practice. We also know of great business minds who perform their clinical routines with bone crushing elegance. Either extreme results in a less than optimum arrangement between the doctor and patient.
Many doctors needlessly sabotage their bottom line and their self-esteem with a lack of sound business skills. One of the fundamental responsibilities of a practice consultant is to help equip the doctor with a systematic way of making business-related decisions. These guidelines should be specific as well as general. Specific, so the doctor can successfully hire and fire staff, provide leadership, negotiate with a landlord, or improve collections. General, so the doctor can appropriately respond to a wide range of situations and not have to run to the consultant with every little problem.
Mutually agreed outcomes. The unfortunate thing about most consulting relationships is the lack of a mutually agreed upon outcome. When a patient enters your office suffering from a set of symptoms, an outcome is mutually decided. Other outcomes may be desired, yet go unspoken. These "hidden agendas" can get in the way, distort behavior, and obscure intentions sufficiently to result in disappointment.
Until these specific, measurable outcomes are on the table, you run the risk of being manipulated, waking up a year later without any real qualitative or quantitative changes, or worse, finding that you've acquired a dependency upon an expensive outsider. It's no secret that the not-so-hidden agenda among most consultants is to get the doctor to re-up at the end of the contract. And while a high percentage of re-ups suggests a satisfied client base, are there continually rising personal or professional goals? There must be accountability. If you just want to be part of a group or feel like you "belong," join a country club!
The consultant's philosophy. What kind of chiropractic "baggage" does the consultant carry into your relationship? What are their interests and motives? What gives them a sense of fulfillment? These are questions usually asked of the doctor and should justifiably be asked of the consultant, too.
Using the seemingly obscure skills of running a business as an entry point, an alarming number of consultants use this opening to indoctrinate a doctor and staff with a pseudo-religious-philosophical dogma that, under any other circumstances, would be laughed off. But packaged with the "Secret to Practice Success" and exploiting an insecurity about business things, these ideas even seem to make sense! Even so, you shouldn't have to renounce your religious beliefs to get the kind of practice you want.
There are worse things than a consultant with an axe to grind! What about the consultant still living in the 60s before the influence of the baby boom generation, HMOs, and an insurance industry increasingly out of reach for more and more people? Or more terrifying, the doctor turned consultant who has based his empire on the "I-had-a-million-dollar-practice-and-so-can-you" approach to practice management. Cookie cutter solutions don't work because...
Times have changed. The new patient-building techniques of the past no longer work on the highly-educated, image- and quality-conscious baby boom generation that dominates our culture. The marketplace has changed, and for the most part chiropractic management consultants have begun to languish. Countless management firms haven't anticipated the post-insurance environment around the corner. Their clients are being led to the slaughter by being taught to simply do more of what used to work.
Wellness and preventive lifestyles aren't fads. They are sign posts that point in new directions and have important ramifications in the "why" and the "how" of delivering chiropractic care. It's not that solutions from the past no longer work, they're just not appropriate if you're interested in working with the "influencers" of your community and enlarging your practice beyond the frustrating socio-economic group that responds to "free" spinal exams, hot dogs, and Coke.
The only thing a consultant can afford to be dogmatic about is helping facilitate the doctor's individuality. That requires more than just philosophical neutrality, it demands a non-critical attitude. Not just to uncover what is wrong, but to enhance what is already there. That's a significant difference.
Coaching versus commanding. Like chiropractic that attempts to uncover the underlying causes of a health problem, consultants have the responsibility to get to the root of the practice's problem. Treating the symptoms is the easiest way to create a dependency relationship and not make a difference in the doctor's level of satisfaction or degree of fulfillment. Getting to the underlying causes is paramount. In a small, closely-held business, this often means having the courage to admit that the problem is the doctor--not some esoteric procedure or super-duper report of findings. The consultant must have the courage to tell you the truth.
Today, the ability to develop and nurture a coaching relationship is critical to success. No longer is the do-as-I-say school of management effective. Yes, it takes time and trust. Moreover, it often takes resources outside a single consultant to get the job done. In light of the fact that experts indicate 75% of our families are dysfunctional and most of us are co-dependent upon food, sex, alcohol, power, and dozens of other things, an effective coach must be willing and confident enough to refer to other specialists.
Frankly, not every doctor is coachable. Yet, since the highest calling of any doctor is to help prevent what he or she treats, a doctor's consultant has the same responsibility. Look for a consulting firm that wants to put itself out of business. And then start doing business with them!
Buy the book
A Patient's Point of View
Originally published in 1992
240 Pages
US $19.95
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