Management by Ancipation

by William D. Esteb

Information, according to those working in the Massachusetts Institute of Technology's Media Lab, is "any difference that makes a difference." Anticipating the future is the surest way to make a difference in it.

The context for doing business changed when we entered the Information Age, yet many businesses still conduct business using an Industrial Age approach, providing tangible commodities to a price-conscious market. Organizations that cling to outdated ways of doing business or fail to anticipate broader customer expectations in the Information Age are likely to experience unexplainable resistance, stagnation, even failure. Price is not everything!

Information packaging

Aside from the effect of the oil shortage of the mid-70s, automobile industry analysts suggest one of the reasons for the successful Japanese invasion was the way the Japanese built, and continue to build, more information into their automobiles. Been in a showroom recently? Detroit is making great strides, but compare dashboards. Do you want to sit in front of an outdated American mechanical contraption or your own jet fighter with digital read-outs? Besides wanting better gas mileage (an intangible), a large portion of the population is choosing the more densely information-packed environment offered by overseas manufacturers like Honda, Nissan, and Mazda.

In the Industrial Age, customers chose from "commodities" with many uniform aspects. Price was one of the most distinguishing characteristics. Henry Ford summed up the prevailing attitude of the time with his arrogant, "They can have any color they want as long as it's black." In the Industrial Age, the efficient, low-cost producer had a competitive advantage.

That's not necessarily so today. In a time of rapid change, we all seek some type of predictability. In fact, the more uncertain, competitive, or challenging the environment, the more quickly we look for sources of stability or an unchanging benchmark we can trust. When looking for ways to reduce the variables, price can often take a back seat to quality. Qualitative factors explain many brand preferences and buying habits. We want our "things" to last in a time of tremendous change. We want quality.

Our interest in quality things (tangibles) extends to the services (intangibles) we purchase, too. And we expect increasingly better service as the price of the service rises.

Defining quality

Quality, which customers always define in their own terms, is an intangible dimension of any product or service. I remember shopping for stereo equipment 10 years ago. Pouring over the technical data, I compared the frequency response and signal to noise ratios, looking for the best set. Today, the technical specifications of most stereo equipment exceed the ability of my ears to distinguish. Now what do I do? I have to rely on the intangibles of brand name, trust in the salesperson, reputation of the store, convenience, the color and size of the cabinet, and other subjective factors that have nothing to do with its ability to reproduce music! The same is true for chiropractic.

Information in a chiropractic office is a significant intangible, shaping patient perceptions about quality and even their recovery time. A recent study among surgical patients in a Minneapolis hospital who were told, in detail, the nature of the post-operative symptoms they were likely to experience, recovered as much as a third faster than those not given a complete explanation. (Thriving On Chaos, Tom Peters, pp 97.)

Informing chiropractic patients of possible reactions or sensations is routine in most offices. Great! Anticipating other patient problems or questions in advance is important, too. When you do, you build credibility and communicate quality and thoughtfulness for an industry perceived as mostly philosophical, expensive, intuitive, highly subjective, and non-scientific.

An easy-to-anticipate situation is when the patient decides not to continue care, or at least not as frequently as the doctor's clinical experience suggests. As the time grows near, the doctor and staff keep their fingers crossed, secretly hoping the idea of rehabilitative care "takes."

Then the staff sees the writing on the wall as patients start showing up late for their appointments. Then "forget." Or become "too busy." It happens with a large percentage of patients, at a time when patients finally get what they wanted by starting care in the first place. Yet, as the subtle pressure of continuing with rehabilitative care is applied, patients feel like losers because they've "let the doctor down" or worse, see non-symptomatic care as a doctor's unethical profit ploy. Either way, the doctor, the patient, and chiropractic lose.

A "prenuptial agreement"

What would happen if, like the surgical patients, you discussed this chiropractic "postpartum" phenomenon during the early stage of care? The objective would be to make the saying good-bye part easy and non-confrontational. Not only would it be a great springboard to talk about the value of rehabilitative care early on, you'd get your agenda out in the open, reduce stress and misunderstandings, and avoid a sense of failure at a time when, even if patients don't opt for long term care there is reason to celebrate chiropractic's most fundamental success--relief of pain. Anticipate what patients go through when they get what they want. Explain that "someday you're going to start wondering how much longer you're going to need chiropractic care..." Mention different ways patients disengage from the office. Then tell them how you'd like them to handle it. Reach a "prenuptial agreement" so you can part friends.

The ability to anticipate is a rare and valuable skill, preventing potential office problems, patient complaints, or situations that interfere with the intangibles of quality, timeliness, or the perceptions of service, attention, organization, and responsiveness. Doctors and staff members with this learned ability improve patient rapport and experience a greater sense of control in their offices and their lives.

By not anticipating the "separation" day, you adopt an emergency lifestyle that increases the feeling of helplessness that often evolves into burnout. Jumping from one brush fire to the next is a stressful way to practice, requiring us to show up at the office with the equivalent of a management suit of armor. A protective suit of steel helps deflect the "slings and arrows" of an unpredictable day. Seemingly uncontrollable circumstances shape the direction of each moment. The day ends with the doctor exhausted, frustrated, and numbed by everyone else's agenda.

The ability to anticipate can be broken into several stages of logical thought. It's the same process, whether you're producing a major patient education video with unpredictable talent or creating a culinary masterpiece for an important dinner party.

Visualize Outcomes. The first step is the most important and overlooked: visualize the outcome you want. Often we enter important interactions with an unusually high level of spontaneity; we become bystanders to the outcome, inventing what we want, believe in, or will support, in real time. Moreover, we often get trapped into the status quo, easily describing what we don't want, but giving little thought to what we'd like to specifically replace it with. The result of this oversight is a string of negatively-worded desires, "I want less stress," or "I don't want to get behind." What do you want instead of less stress? What would be less stressful? The first step is to articulate, in detail and in positive terms, the ideal scenario you want. In this example, what we might want is a smooth-running office in which patients feel they are well cared for and only wait X number of minutes or less.

Devise a Plan. Next, devise a plan to accomplish your outcome. A plan consists of two components: resources and time. The frustration comes from ignoring the finite limits imposed by both--the time it takes to implement specific procedures or techniques and the limitations imposed by office space, layout, the number of doctors, and other resources.

Identify Contingencies. Then, identify every possible failure in the execution of your plan. In advance of your "performance" at 5:30 p.m., list every possible contingency. Cancellations, new patients, and last-minute emergencies are obvious, but what about other influences? Weather, telephone problems, talkative patients, crying children, missing staff members, etc. Use a staff meeting to brainstorm possible response scenarios and solicit ideas from those not directly in the line of fire. They will be less likely to fall into the "we've-always-done-like-this" mind-set and new solutions can emerge. Maybe you've reached your maximum capacity during peak hours, necessitating strategies to increase off-peak volume.

Anticipating patients' needs during the different phases of their care is a crucial skill that builds trust, and, along with active listening, is a fundamental way to demonstrate a "we care" attitude. It is a way to recover control of our destiny in the pursuit of the most honorable calling of all--serving others.

Buy the book
A Patient's Point of View
Originally published in 1992
240 Pages
US $19.95

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