The Nerve System as a Management Metaphor
by William D. Esteb
Like the nerve system that coordinates the functions of the organs and tissues of the body, your office needs a management system to coordinate various office functions. And like the body's nerve system, a management system can work only when there is no interference. Here are some "neurological and orthopedic tests" you can run on your management system to check for interference.
Consistent policy. Imagine what happens when the stomach has food to digest, but isn't sure it should. Or consider the confusion that would result if the liver and kidneys wanted to trade places for a day or two. What would happen if the heart started pumping in reverse?
The lack of consistent policy is the number one frustration voiced by chiropractic assistants. It undermines the effectiveness of the entire office. Having a written office policy manual is the first check. Yet, having an office policy manual neatly typed in a three-ring binder on the shelf is no assurance of consistent policy! In fact, having a written policy that is not followed is more frustrating than unwritten policies that are at least consistent.
Action step. If you don't have an office policy manual, get one. First, brainstorm the topics that you'd like to see covered and then share your list with the staff. Then start writing. Keep each policy short and to the point. As you write, make sure you test each policy by asking yourself, "How will this policy enhance the function (after all, health is 100% function) of our office?"
Already have an office policy manual? Pull it out, dust it off, and go through each policy and ask yourself, "Is this real?" "Is this being followed?" and "How does this policy enhance the function of our office?" Your mission is to detect inconsistencies between the intent of each policy and the behavior or conduct of the doctor and staff who vow to follow it. If it's not being followed, there's a reason. Often this discrepancy is because the various members of your health care team don't know or understand the benefits of having and executing the policy as written. Maybe things have changed since the original policy was written. New staff personalities may be involved. Reaffirm the value and workability of each policy.
Absolute standards. Running a successful chiropractic office takes more than someone who can adjust and someone who can schedule appointments. And it takes more than "just doing a good job." In fact, what is a good job?
What if your heart decided to beat only on Mondays, Wednesdays, and Fridays? What if your stomach decided to digest your meals only partially? What if your lung capacity was cut in half whenever you wanted to talk? If certain functions are not performed to an absolute standard or don't reach a certain threshold, the functions are useless.
What are the absolute standards that guide your job responsibilities? How many rings can the phone ring before it sends a message of disinterest or disorganization to a potential new patient? How long can a patient expect to wait before the wait becomes an issue shaping their impression of the office? How old can a reception room magazine be before it suggests out-of-date clinical skills? How quickly and how accurately should every staff member be able to confirm a patient's account balance? In what way is each patient rewarded for their first, second, fifth, or tenth referral to your office?
Action step. Setting absolute standards is one way to know if we're doing a good job. Without establishing a standard, we simply react to the ebb and flow of daily routine and are always trying to "fix" some aspect of the office. Start timing how long a report of findings really takes. Track how long patients really wait. Measure the performances of your team so you can establish a standard. Ultimately this will simplify your job and improve patient satisfaction because everyone knows what to expect. What gets measured is what gets done. McDonald's may have "Billions and Billions Served" on their sign, but they haven't stopped counting!
Connectedness. The flaw with many medical research projects is a disregard for a holistic look at the body. Those doing heart research overlook the impact of their findings on other organs or systems of the body. How many times have we heard how the "cure" with its side effects was more harmful than the disease?
To coordinate the functions of your office successfully there must be an "intelligent" nerve supply. This nerve system is the leadership and management direction provided by the doctor, combined with his or her ability to communicate it persuasively. Being an office "manager" is not what many doctors aspired to be. If they could wave a magic wand so all they'd have to do is adjust and do their clinical work, there would be a line at the magic wand store.
Action step. It's human nature to put off those things we dislike the most. Take an inventory of what's not getting done. Narratives? Recalls? Thank-you cards? Re-exams? Collections? Spinal care classes? New letterhead? Consistent patient education? New phone system? Use a staff meeting to develop a list of the things you know you should be doing, but aren't. Then take each item and brainstorm a list of benefits for doing it. How does doing it benefit the patient, the staff, the doctor, the future of the office, or the future of the profession?
If you don't enjoy the management side of chiropractic, consider ways to simplify your practice and systematize it. That's what a procedural manual is for. What do you say on the telephone? How do you trace insurance billing problems? Who reorders X-ray film? When and how? How do you make a new patient feel comfortable on the first visit? What do you do if a patient misses an appointment? Guidelines regarding these and a million other day-to-day activities and procedures should be in writing. Until they are, training new staff members, handling vacations, and coping with rush hours are a constant source of stress and confusion. Procedural manuals explain the "intelligence" of the office so everyone can see the master plan. The growth of your practice and the satisfaction of being free to work with patients and inspire them (the fun stuff) is most effective after your management system is in place.
Outcomes. This is related to setting absolute standards, but also considers the long-range effects of our daily activities. What outcomes are you hoping to achieve by being involved in chiropractic? Check your answer against the seven equities of life: mental, spiritual, financial, family, career, physical, and social. What can you, or should you, expect to achieve in these seven areas through your work in chiropractic?
Chiropractic is more than just getting patients out of pain. That's relatively easy. What are you hoping to accomplish with every patient besides clear up the symptomatic picture?
One doctor I was working with realized he wanted to practice chiropractic for another 35 years. Beside simply improving a patient's spinal biomechanics, he and his staff identified the strong desire to create "lifetime friends" as one of their office objectives. Yes, they wanted to change each patient's attitudes and awareness of health. Yes, they wanted to rehabilitate each patient's spine. Yes, they wanted lots of children under chiropractic care. But the overriding concern was to create lifetime friends.
It changed their management approach. With a 35-year perspective, they modified their recall system. With a 35-year outlook, they made investments in their physical plant and upgraded their office environment. With their newly identified passion to create lifetime friends they found new purpose and clarity in their daily activities.
Action step. Have each staff member identify the outcomes they hope to enjoy in the seven equities by participating in your office. Then, get together at a staff meeting and share them. Celebrate the diversity! Recognize that these fundamental values are what motivate us. Develop ways to help each other achieve these values as you work beside one other. When each individual's values are compatible and reinforce the office objectives, a career emerges. Otherwise your job and your life are nothing more than a series of short-term relationships, empty of meaning and passion.
Awaken the passion in you! Like learning to walk, the first thing you must do is have the desire to move, to be somewhere different. Movement is an integral part of growth. And yet growth, with its accompanying changes, is one of the most frightening things we do. Like learning to walk, we may fail at first. Fortunately, that didn't stop us as two-year-olds, when failure was less important than moving and growing! And we did move and grow--as long as there wasn't any interference.
Buy the book
A Patient's Point of View
Originally published in 1992
240 Pages
US $19.95
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