The Patient-Driven Practice
by William D. Esteb
There seem to be two kinds of practices: The patient-controlled practice and the patient-driven practice. These two extremes apply to chiropractic practices, advertising agencies, accounting firms, and other professional service organizations. Advertising agencies can be reduced to "order takers" by clients who constantly threaten to pull their big budget accounts. Accountants can become mere number crunchers for increasingly unappreciative clients. And chiropractic doctors can become slaves to skeptical patients who ransom the doctor's self-esteem.
The patient-controlled office hasn't evolved past Start Up, a short-term condition typically experienced within the first several years of practice. The survival of the patient-controlled practice seems uncertain, existing on a hand-to-mouth 90-day cycle. A late insurance check and panic about payroll emerges. This struggle can plant a seed of self-doubt that may germinate into the doctor questioning the validity of chiropractic itself!
Statistics occupy an inordinate amount of time and attention in the patient-controlled office. While statistics have a place in monitoring the health of a business, statistics shouldn't warrant any more interest than an occasional glance at the rear-view mirror while driving down the highway. When you fix your attention on where you've been, you can lose sight of where you're going.
The patient-controlled office
The patient-controlled office is led by a patient-controlled doctor. This well-intentioned doctor takes personal responsibility for each patient "getting it" and following through with what is best for the patient. It's this deep concern and caring attitude that sets the doctor up to be patient controlled. Buying into the patient's problem is a real temptation by professional caregivers. Not that you should coldly offer clinical advice without regard to patients' feelings, but when you assume responsibility with a more than objective professional interest in their conditions, you let patients off the hook, teaching them that their problems are your problems. (If you see their compliance as only a meal ticket or statistic, it is your problem!) This "den mother" status sets in motion a whole series of patient management procedures that teach patients they don't have to take responsibility for themselves. In a sense, this institutionalizes their health, placing unnecessary burdens on the doctor and staff. Strange as it seems, passing up the temptation to be the patient's "friend" can be one of the first steps in shedding the heavy yoke of patient control.
When patients hear the C.A. making recalls, they learn that some patients don't show up for their appointments, undermining their confidence in the decision to keep theirs.
The patient-controlled office teaches patients that the doctor's time is not valuable because it too easily accommodates walk-ins.
The patient-controlled office adopts a policy of being available to patients for a grueling 12 or 14 hours a day.
The patient-controlled office has inadvertently communicated to patients that they are buying the doctor's time-not the doctor's talent. Patients expect 14 minutes of the doctor's time and when they don't get it, they get angry or feel shortchanged.
The patient-driven office
The patient-driven office is significantly different. The doctor and staff recognize they cannot "serve humanity." They have accepted the fact that they won't even meet "humanity." They've chosen a more reasonable approach by focusing their attention on a narrower segment of their community. It sounds impossible from within the grasp of Start Up, but the practice actually grows in size by not trying to be all things to all people. These offices get to know a group of patients which may be distinguished by age, complaint, income, profession, health attitude, or some other qualifier. They enjoy serving this group because of similarities in values, tastes, outlooks on life, or some other common denominator. They learn patients' buying habits, likes and dislikes, where they live, what hours of the day they are available for care, and other aspects of this target market. In this way, patients "drive" the practice in a positive environment based on mutual respect.
Sensitive to the characteristics of this intended market, the doctor outlines the kind of practice he or she wants. The doctor takes an active role in shaping the direction of the practice, by not automatically embracing the status quo simply because, "We've always done it that way before." Or "So-and-so up the street doesn't do it this way."
For example, look at the practice hours issue. Not that we should model chiropractic after medicine, but what other health care professional sanctions the exhausting practice hours seen in chiropractic? It may look good on paper, doubling your potential volume by tapping the "rush hours" at both ends of the day, but consider the cost. Typically two overlapping staff positions are needed to cover the entire day. Some staff members don't even know every patient's name! But consider the personal toll on your family relationships and your own life. No wonder so many doctors and staff are experiencing some form of burnout-there's no time for families, hobbies, or a life outside the office.
Get a life!
Here's how one doctor escaped the hours trap. Because he especially enjoyed spending the mornings working out and being with his new family, he wanted to begin practice around 10 a.m. and finish around 7 p.m. in the evening. Going against the textbook formula, as new patients entered the practice, he had their appointments scheduled in the late morning, afternoon, and early evening appointment slots. The few patients that asked for early morning appointments were denied. Gulp. But there were fewer than he expected. Most new patients have no idea what hours chiropractic doctors keep or should keep. After about three months the roll-over was complete. One day each week he kept the grueling 14-hour schedule to accommodate maintenance patients who had been with him for a long time.
Did he lose any patients? A few. But the satisfaction of having his mornings available for replenishing his energy and having a personal life has been more than worth the cost. Moreover, his practice is growing because he enjoys it for the first time in years and his infectious energy has inspired patients and staff alike.
Hold a patient focus group
One of the techniques used to ferret out the likes and dislikes of your target market is to hold a focus group. Adapted from market research techniques used in the business community, a focus group is an independently supervised meeting of patients. Prior to the session, a list of questions is developed to help reveal information the doctor and staff would like to know. The focus groups I've led have been held during the lunch hour, without anyone from the office in attendance. Six or seven patients, who represent the kinds of patients the doctor is especially interested in serving, are invited to a restaurant or neutral, non-practice location. With their anonymity protected, I stimulate patients through a series of rhetorical questions. After about a half hour, when their defenses are down, most patients respond quite openly about various aspects of their office experience. This kind of information is very valuable for making course corrections in office procedure, and usually affirms 80% of what is currently going on.
A focus group session can be led by a trusted patient, business associate, or a close doctor friend from a nearby community. One doctor in Maine decided to get everything out into the open and selected about a dozen ideal patients for a light lunch at the practice and hosted the session himself. He explain that everyone in the room had something in common and as an office they wanted to attract more people like them. The reaction was overwhelmingly positive with lots of good ideas being presented. A secondary gain was experienced, too. In the next few weeks, these same patients were responsible for a huge increase in referrals. Participants in a focus group feel a new sense of "ownership" and involvement in the practice. The doctor intends to repeat this process every six or nine months with a new group of patients!
It's important to choose a specific time and setting for patient feedback because, all too often, patients are busy or perceive the doctor is and they won't volunteer the really good ideas or subtle problems that stand in the way of referrals, or even compliance.
In the patient-driven office, the doctor determines what kinds of services he or she wants to provide that could be perceived as a benefit by the target market and provides them. As the patient-driven office sees more and more patients in alignment with its purpose, it is more willing to refer certain kinds of patients elsewhere. Survival isn't a question anymore. Being held hostage by insurance companies isn't a factor. Having to "sell" chiropractic is no longer necessary.
A common denominator in the stress-free, patient-driven practices I've visited is a systematic patient education program. Education is among the easiest ways to remove the doctor/staff burden of being responsible for patient compliance. It's their health, not yours. When patients actively choose the kind of care they want after fully understanding the nature and severity of the Vertebral Subluxation Complex, the practice becomes a real joy to run. If you neglect to explain fully a patient's problem and its ramifications, you will have to continue badgering patients to make their appointments.
Running the patient-driven practice is like driving a car. With a destination in mind, you start slowly, pulling into traffic. As you shift gears, your clinical skills respond confidently for you. Entering the passing lane you purr along the countryside, sharing the view and enjoying the journey with others who have discovered this wonderful profession called chiropractic.
Buy the book
A Patient's Point of View
Originally published in 1992
240 Pages
US $19.95
Not a reader? Bill reads his favorite chapters from all 10 books on Bill's Best. |
