Repositioning

by William D. Esteb

Everyone who has heard about the UnCola is familiar with concepts of repositioning. Repositioning isn't some new manipulative technique or esoteric practice management procedure. Repositioning is merely a marketing term that describes the process of recognizing a consumer's perception of your product or service and creating a new and better perception to increase its acceptance or utilization. Understandably, chiropractic is a prime candidate for this process. And for those doctors actively pursuing what is now a mainstream marketing strategy, the clinical rewards are significant.

Regrettably, repositioning is something each individual doctor must do. We can't throw money at state or national associations and make it happen as efficiently as it can in your office. Each doctor must recognize the process and implement it in everyday interactions with patients.

Take inventory

First, the current market position must be objectively determined. What does the general public think about chiropractic? Is chiropractic mainstream? Is chiropractic scientific? When would you consult a chiropractic doctor? When would you discontinue consulting one? And that's just for starters. There's no room for wishful thinking or delusions when taking inventory of the general consumer's attitudes and perceptions of the profession. The question is, what do you do with this information?

There are many factors which have contributed to the current lower rung position of chiropractic on the "health care ladder," filtering the kinds of patients that show up in your reception room. And if there is one thing large companies like Procter and Gamble, Apple Computer, and others have learned is that, once you're "positioned" in the consumer's mind and you're not near the top, you can rarely get to the top. You can rarely "improve" your way to the top. You can't advertise your way to the top. Nor can you simply be "right" and get to the top. You're stuck in your position--unless you change the rules.

One solution is to create a new ladder.

Now, remember that these "ladders" are merely a preferential listing of products or services in the minds of consumers. We each create them based on our own perceptions, experiences, and attitudes, and those of our friends. If this still seems obscure and unrelated to the events you see in your office, read on.

Building a new ladder

When you create a new ladder, you actually create two ladders. One for you and a redefined ladder for those you left behind. Remember what the soft drink 7-Up did? They were buried at the bottom of the "soft drink ladder." With no way to significantly increase their market share, they repositioned their product as the UnCola. It is a position still used today. Overnight, what had been the soft drink ladder became the Cola ladder and this new thing called the Uncola ladder. Coke and Pepsi still fight it out on the Cola ladder and Sprite is giving 7-Up a run for their money on the UnCola ladder. And it continues. Today there is the diet cola ladder, the caffeine free ladder, the 10% fruit juice ladder, and permutations of many others. Consumers position products and services on these imaginary ladders. With so many ladders for so many different products these days, most people can hardly keep up with more than the top rung or two of each ladder. That's how buying decisions are made while walking down the 100 foot soft drink aisle at the supermarket.

Using the ladder analogy, you'll agree that chiropractic has been under-utilized and is situated near the bottom of the "health care" ladder. Renaissance International and others have been the pioneers in the creation of a new ladder for chiropractic called the Well Patient Care ladder.

Announcing the well patient ladder

And as in the case of the soft drink ladder, the old health care ladder becomes the Sick Patient Care ladder. Now we've got a fighting chance. Since we've invented the Well Patient Care ladder, we can be at the top. That doesn't mean we can't lose our position, but at the moment of creation we can be number one. We must be careful for there will be other health care professions joining us on the Well Patient Care ladder.

What does all this ladder business mean on a daily basis in the typical chiropractic office? Look at the unrepositioned patient profile. Under the Sick Patient Care model, the patient enters the practice suffering from some type of pain or symptom, and immediately upon relief or the expiration of insurance coverage, the patient leaves. Has significant spinal rehabilitation and muscle retraining occurred to prevent the original condition from returning? Probably not. Has the patient's Sick Patient Care perception been modified? No. Are the kind of referrals this patient is likely to produce going to be any different? Of course not. We can reposition chiropractic in our minds, but we must still reposition chiropractic in the minds of the patients who come to your office. They may enter your practice with some kind of symptomatic condition, but you have the responsibility to change their perception of chiropractic while they are in your office.

More than wishful thinking

Simply wanting patients to stay longer beyond short-sighted insurance coverage isn't enough. Patients must see the benefits of continuing their care past the "I'm feeling better" stage, learned from a lifetime of exposure to the Sick Patient Care model.

Communicating the long-term damage of myopathology, histopathology, and pathophysiology can offer the clinical reasons for ongoing wellness care beyond the mere relief of symptoms. When patients see references to chiropractic care lasting a lifetime, or newborns and children under care, a new precedent is set. This shift is called repositioning.

Doctors and their staff must be repositioned before patients can. Not only must you accept that spinal rehabilitation is possible, you must offer patients proof that this phenomenon of long-term Well Patient Care occurs in your office. Do you have the courage to take post X-rays? Or have you rationalized that structural changes don't occur? Are you using empty X-ray view boxes to show examples of before and after X-rays documenting that your patients get symptomatic results and continue on with wellness care? Do you offer a fee structure that makes Maintenance Care affordable and counters the financial barriers sanctioned by insurance companies? What kind of affirmation are you providing patients who continue beyond insurance coverage? How is a patient's non-symptomatic progress documented in this new Well Patient Care model?

Statistically, retention figures become a way to monitor your success in repositioning patients. But let's face it, not every patient is available to be repositioned. However, those who "get" the repositioning message usually refer others with similar mindsets. And that's how you start getting patient visit averages in the 50s, 60s, and higher.

Repositioning our profession for increased utilization will not come from association mergers, a new gimmick, or a slick public relations campaign. It will happen one office at a time, one patient at a time.

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

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