Dynamic Chiropractic – August 18, 2000, Vol. 18, Issue 18

Benchmarking - Not Just for the Fortune 500

DCs Reap Benefits by Studying Colleagues, Competitors and Other Professions

By Brian McAulay
What kids often label "copycat" behavior on the playground has entered corporate boardrooms under the moniker of "benchmarking." Benchmarking is used by leading international firms and top managers to improve products and services.
It can also be used effectively by chiropractors to enhance their practices, and is one of the simplest and most cost-effective techniques for improving performance, Benchmarking is all about seeking out others who do something exceptionally well and finding ways to incorporate their techniques, tailoring their proven approach to your specific needs and style. Whether you want to enhance your patient education skills, improve collections, cut down on insurance paperwork, motivate your staff or design an effective advertising campaign, effective benchmarking can help you learn from those who have already succeeded in those areas.

For doctors of chiropractic, benchmarking means studying the methods other chiropractors, dentists, medical doctors, accountants - even your local bank, supermarket and movie theater - use to provide outstanding services. By comparing how you handle various challenges in your practice with those of other businesses that excel at those activities, you can "copy" their effective techniques and dramatically reduce your learning curve - saving a lot of time, money and headaches, and reaping major improvements in your business.

Know Thyself

Before you can benefit from benchmarking, you must clearly identify and articulate what you want to learn and improve. Most likely, you continually monitor your practice and already know those areas in which you aren't performing as well as possible. Or, you may be frustrated by external factors you can't seem to manage effectively. Start by taking an in-depth, critical look at one aspect of your practice that needs the most work, or that would provide the biggest benefit (in terms of financial rewards, stress reduction, time savings, increased enjoyment, etc.) if you could substantially improve it. You may be facing an obvious problem at the moment, or you may want to consider an area in which you want to elevate your performance to a higher level. Ideally, this step should be part of an ongoing, proactive process of self-evaluation and improvement.

It's probably most effective to explore benchmarking through a case study. Consider the "one hit wonder" chiropractor: "Dr. X," a young doctor in practice just three years, began to notice a disturbing trend as she struggled to build her practice. She attracted a large number of new patients and frequently saw them through to the report of findings. After the result of findings, however, she often did not perform follow-up care. She knew she needed to address the issue right away or risk decreased revenue, increased expenses for additional patient recruitment, and a declining reputation if dissatisfied patients spread complaints to others in her community.

Dr. X's first step in "adjusting" her efficiency was to carefully define the problem and gather the data that showed where she stood. This provided an objective measure for future improvements. She reviewed all of her patient records to tabulate how many patients persisted with care six months following the ROF, compared with those who left the practice within one month or less. Armed with concrete statistical information, she was able to gauge the impact of any improvements she implemented based on her bench-marking activities.

Once you decide what you want to improve, make sure you can articulate it. Write it down in a clear, one-sentence description. A specific goal provides an effective starting point to enable you to choose the most appropriate experts or mentors for your particular needs and to focus your conversations with those who can help. You might choose very different mentors if you want to know how best to attract new patients, compared to those helping to figure out how to retain long-term patients. The chiropractor in our example might specify that she wants to improve patient retention following the ROF, such that 75 percent of patients persist with care to at least six months. Now she's ready to find the doctor who excels at the report of findings and patient retention.

Finding the Right Resources

Your spouse and closest friends may often serve you well as confidantes, or sounding boards, and those who will listen attentively and let you "blow off steam." They are not necessarily the best people to consult for on-target advice for improving your practice. Even if you have a mentor you admire, who has helped you in the past, that person is unlikely to be the one to consult on all aspects of your practice. Many of us make the mistake of consulting the same person or small group of people all the time, regardless of the issue. It makes more sense to seek out those who are especially accomplished in the area in which you need improvement. If you want to learn how to write reports that get paid, it makes sense to consult someone who's already succeeding in that area, but don't assume the person also knows how to write compelling advertising copy.

The most effective techniques for identifying potential benchmarks are the simplest: observe and ask. Once you have a clear idea about what you want to improve in your practice, it will be uppermost in your consciousness, and you will be alert to people and places that excel in this area. Talk to your closest chiropractic colleagues and ask them, "Who do you know who has strong patient retention in their practices?"

Expand your circle and contact faculty from your alma mater and ask their advice on alumni they know who are particularly strong in certain areas. Faculty are likely to remember their most talented students in any subject areas, such as communication skills, adjusting technique or x-ray know-how. Most likely these same people have continued to hone their skills and would be happy to talk with a fellow alumnus about them. Network with other chiropractors at meetings and conferences and ask straightforward questions about how colleagues handle certain aspects of their or her practices. If you ask with sincerity and respect, the vast majority of your fellow contemporaries will answer with honesty. If necessary, talk with chiropractors in different markets, at national conferences or telephonically, and they will not view you as a competitor.

Seek out the speakers at chiropractic conferences and ask one or two succinct questions when they have five minutes at the conclusion of their speech or at a break. Many are quite gracious about sharing specific ideas in response to a concise, courteous question. Some may even allow you to interview them on the phone at a set time.

You can also benchmark in a more covert fashion, by simply observing how other offices perform the more public aspects of their practice. Evaluate and learn from the advertising you see. Call other offices and observe how the staff interacts with you. Visit other chiropractic and medical offices and look for creative ways they are using their physical space to handle patient flow. Talk to your patients about experiences they've had with other chiropractors or medical doctors.

You can also frequently find great ideas outside the chiropractic profession. Observe how your bank performs its public relations functions. Did they win your loyalty through a premier banking package for professionals? How does the staff interact with you when you enter your local branch? Watch and learn from movie theaters that handle traffic flow well, supermarkets that have exceptionally friendly staff, and mechanics that speak in lay language. Every day you encounter people and organizations that perform certain tasks exceptionally well. Some of their techniques might translate well to your office.

Network with neighbors, friends, alumni from your undergraduate institution and relatives who are managers in other industries. For example, if your brother-in-law is a copywriter in an advertising agency, pick his brain about the hallmarks of outstanding sales copy. Or, better yet, ask him to arrange a phone or in-person interview for you with the agency's founder, president or top copywriter. More often than not, you'll be surprised that people are happy to talk about what they love and do best to an interested audience.

The chiropractor in our example talked with the lead practice management faculty at her alma mater and got the names of several graduates who were outstanding patient educators and communicators. The alumni office provided their office phone numbers and she was ready to "reach out" to these experts.

Asking the Right Questions

Once you've identified willing mentors with whom to benchmark, you need to prepare powerful questions that make effective use of your interview time. With your specific area of interest clearly and succinctly defined (even written down in one sentence), start by asking an open-ended question such as, "How do you educate new patients," "How do you prepare effective insurance reports," or "How do you recruit staff who stay?" After they've shared the first thoughts that come to them, get more specific with your queries.

Dr. X prepared written notes about what she wanted to find out and specific questions she needed answered. She called her prospective benchmarks and introduced herself, explaining that she would like to observe a ROF. She explored the entire systems the other chiropractors used; she examined their paperwork; she inquired about the wording and visuals they utilized in talking with patients; then she asked about follow-up procedures the offices used.

The research enabled Dr. X to see firsthand how those who excel at educating and retaining patients do it. She learned enough through several phone calls and two sessions, observing ROFs to transform the processes she used in her office. Her only expenses were a few long-distance phone calls, minor travel expenses incurred visiting offices about an hour from her market, and a few modest gifts she sent to her benchmarks to thank them for sharing their time. What she learned was invaluable in building and improving her practice.

Dr. X's most important revelation came from observing other chiropractors engaging their patients in a dialogue about how chiropractic care might benefit them. She realized she had been lecturing her patients about the reasons she found most compelling for treatment. She wasn't connecting with them about the issues that most concerned them. So, they listened politely and appeared to understand her message, but there wasn't enough personal motivation for her patients to allow her to follow through with care.

The information Dr. X gained from other chiropractors was used to turn her ROF around. She developed an active listening style and used open-ended questions that helped patients come to their own conclusions about why they wanted to be under care. She reorganized her office schedule so that ROFs were only done after hours, when she was not distracted by other appointments and activities of the office. She also developed customized information handouts specifically geared to the individual patient. She followed her appointments in a few days with personal letters to individuals welcoming them to the practice and reiterating some of the reasons they talked about for obtaining care. For example, a letter might read, "With your hectic day caring for three small children, I certainly understand your need to keep your body working in peak shape. Your plan of care at Smith Chiropractic will help you achieve that goal."

Build Your Bridges

One of the keys to effective benchmarking is showing respect and appreciation for those who help you. Treat your colleagues with respect and they will feel happy to have helped. If you simply take the information and run, they may feel taken advantage of (and may not be willing to help the next time you call). Each benchmarking interaction should be followed by a personal note thanking the individual for his or her time and expertise. Mention specific ways you plan to use their advice, and update them on how it is impacting your practice. People like to know that the wisdom and time they shared is appreciated, and that they have been helpful.

Putting the Information to Work

Benchmarking might sound like common sense but few people do it; therefore, few realize its power. Many avoid benchmarking activities because they don't want to admit they aren't absolute experts at running every aspect of their practice. Others are afraid colleagues will reject their request for help. But few people reject a sincere request for their informed advice on a topic at which they excel.

Weave the information you gain from benchmarking into other aspects of your office management activities. Share the information with your staff and get their feedback on incorporating the new ideas into your office environment. Talk to your patients and get their input. Then monitor the impact and measure the effectiveness of your changes. Continue to tweak your processes so you can continue to improve.

If you have developed and nurtured a mutually positive relationship with your benchmarking sources, you will be able to talk with them again in the future to ask follow up questions as you refine your activities and tailor them to your office. And one day when a colleague calls to ask your advice about an area in which you excel, you will return the favor.

Benchmarking is just one technique to use to continually improve your practice. I look forward to sharing information in the next article about other techniques and how to employ them to continually fine-tune your practice.

Brian McAulay, DC,PhD
Executive Vice President, Provos
Sherman College of Straight Chiropractic


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