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Dynamic Chiropractic – November 18, 2008, Vol. 26, Issue 24
Dynamic Chiropractic
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Dynamic Chiropractic

Planning for the Future in Uncertain Times

By Shelley Simon, RN, DC, MPH, EdD

To say we are living in uncertain times may be the understatement of this young century. The economy - and every market associated with it - continues to be unstable, a situation that has everyone on edge to one degree or another.

My clients are talking about it; my friends and colleagues are talking about it; and you can't turn on the radio or television without hearing yet another negative economic headline. Being bombarded with constant doom and gloom makes it hard to think about planning for the future. But plan you must if your goal is personal and professional success.

In the face of this level of uncertainty and instability, is it possible to continue growing your chiropractic practice? The answer is yes, if you focus on being strategic rather than reactive, generative rather than reticent, and flexible rather than rigid in the way you interpret current conditions and plan for the future. When our current reality is shaken by external conditions, it can be an excellent opportunity to take a deep breath, get back to the basics of practice success (not to mention personal financial management), and - believe it or not - consider taking a few calculated risks. If you focus on strategy while everyone else is obsessing over what new tactic or quick fix to try, the stress you feel today may turn out to be positive if it motivates you to reassess and recalibrate your practice for long-term success.

You Are a Futurist

Professional futurists are paid handsomely to look at trends, analyze data, develop scenarios, make forecasts and advance theories either on behalf of clients, or for their own research or scholarly endeavors. Interestingly, even though you're probably not paid to peer into the future, you are also a futurist. We all are. As "philosophers of foresight" we're continually pondering, planning and plotting strategies for our futures, sometimes based on instinct or intuition, or after having conducted analysis and developing scenarios. Just as often, however, we make important decisions about the future based on past experiences, false or incomplete data, fear or denial. When conditions are changing rapidly, as they are now, this sort of decision-making will not result in the outcomes you most likely want.

Having a clear understanding about how you habitually think about the future can help you plan and make wise choices today that will positively influence your practice long into the future, even during uncertain times. Being aware of your own point of view, mindset, and tendencies is critical for processing information and making good decisions in an increasingly complex and turbulent health care environment.

When it's time to look ahead for practice success, you could hire your own futurist (pricey), visit your local psychic (fun, but probably not effective), or attend another practice management seminar (been there, done that). A more effective strategy, however, would be to study and apply the four steps I'm about to share with you. Here they are: (1) Increase your awareness. (2) Gather pertinent data. (3) Learn and apply scenario development. (4) Make an action plan based on steps 1, 2 and 3.

Step One: Awareness

This step involves understanding how you perceive and approach planning, make decisions and take action. This is the inner work that determines your outlook, the inner research that shapes how your future unfolds. It's important to recognize the thought and behavioral patterns that determine how, when and why you move forward. If you're encouraged when you imagine how your practice will look a few years from now, you'll make different choices than if you are habitually discouraged or pessimistic. If you focus positively on the results you desire when you embark on a new program, service, or marketing effort, you'll likely have a very different outcome (assuming, of course, that you also take effective action) than if you go in fearing the worst.

See which of the following statements apply to you. The ability to recognize your usual approach to planning can help you better understand how your attitudes either limit or support your change efforts.

  • I make plans based on past experiences. If it worked once, it will work again.
  • I just work as hard as possible and hope I'm doing the right things.
  • I never make a decision until I have all of the data  - and I mean all of the data.
  • I plan for the absolute worst and occasionally I'm happily surprised. 
  • I just assume everything will work out. So far I'm OK.
  • I am always on the lookout for opportunities. I'll try anything once.
  • I never plan. I believe in living for the moment.
  • I don't want feedback. I make my own decisions.
  • I am guided by my intuition and tend to make decisions quickly.
  • I make a plan and then stick to it, no matter what.

Consider for a moment how your beliefs and attitudes work either for or against you. Perhaps you're someone who won't make a decision without all the data and you've discovered over time that operating this way works perfectly for you. Or maybe you always assume that "everything will work out," even though you have evidence to the contrary. The attitudes you have about the future have a direct and significant impact on the results you achieve. For example, if you are in the "I never plan" camp, efforts to grow your practice will probably not be very successful because practice marketing, by its very nature, requires strategic planning coupled with specific action steps.

Step Two: Gathering Data

Making good decisions about the future requires having access to a broad range of meaningful information. Gathering data entails much more than looking at your numbers, although that's part of it. Consider collecting information using all of the following methods as you look ahead and plan for the continuing growth and development of your practice.

Read widely. Study chiropractic journals and trade publications, but don't stop there. Concern yourself with at least the basics in business, economics, demographics, politics, social trends and technology. Notice what's on the best-seller lists. Scan the covers of magazines you don't ordinarily read. Bookmark major newspapers and spend a few minutes reviewing the headlines each day. As you begin to notice trends or when new ideas come to you, make notes for later reference. Pay particular attention to anything that might have an impact on your practice in the near or even distant future. What are the driving forces influencing your profession? Are there advances in technology on the horizon that could make something you currently do obsolete? What's the latest in personal health, wellness and self-care?

Listen to your patients. What are your patients beginning to question or ask you about? What new concerns do they have? What are they telling you they're reading in the lay press about health and health care? Are they changing how they make decisions about their care based on the economy or other factors? You have the equivalent of a focus group in your office every day. You don't have to conduct extensive interviews to get a glimpse into what patients are thinking. Just pay attention and ask good questions. As you listen, try to objectively assess whether the service you provide is being perceived as valuable, or if it's falling short.

Talk to your colleagues. Especially if you are in a solo or very small practice, it's easy to become isolated, circle the wagons and be wary about exchanging ideas with other chiropractors. This is not in your best interest. Network with professionals in your field (and from outside your field as well) about the trends they're noticing and how they're planning for the future. Be willing to share your own views and insights. Choose your associates wisely, but don't operate in a vacuum.

Look at your practice. Look at the numbers, review patient satisfaction and retention, calculate staff turnover and assess your finances. What do you see? What are the trends? What do the data really reveal? What is your return on investment for recent marketing efforts? How has your practice model changed or stayed static over time? Where do you need to update or reinvent? What kind of outcomes data should you be collecting and acting upon?

One of the most difficult aspects of data gathering is looking at "what is" instead of seeing only what you'd like to see. It's very easy to magnify data that support our current point of view, make us feel good or allow us to avoid doing anything new. On the flip side, some people react negatively to a single data point, even though it may be only a blip and well within the normal ebb and flow of practice statistics. Then there are those among us who have an uncanny ability to minimize or ignore data that suggests we need to make serious changes. As you gather and assimilate information you think might be useful for planning the future success of your practice, keep an open mind and base your decisions on facts rather than emotion. By doing so, you'll be able to do effective scenario planning and achieve more of the outcomes you desire.

Step Three: Scenario Development

This is a tool used by futurists, strategic planners, financial analysts and others who try to predict and prepare for the future. Scenario development does not have to be complicated. Scenarios are essentially stories about how the future could potentially unfold. To weave these stories effectively, you must be willing to suspend certain beliefs as you spin several versions of the future and try to imagine the implications of each one. By inventing and considering a variety of possibilities - ideally rich with detail - you bring forth previously unimagined plots as well as pitfalls and obstacles you might not otherwise have considered. Done at a practice retreat and/or with staff members, scenario development is both enlightening and empowering.

Here's an example of how to do scenario development. Let's say you've heard a rumor that a major employer in your area is about to switch to a health plan that does not cover chiropractic care. You stand to lose 20 percent of your patient volume. What do you do?

Gather the facts. Can you find out if the rumor is true? If it is, what's the timeline? Exactly how many patients would this impact? Are these patients you'd like to retain if you could? What would your numbers look like if you lost all of those patients?

Make up stories. In your mind, on paper or brainstorming aloud with your staff or partners, make up all of the stories you can about the situation. Good stories have protagonists and antagonists, complications, plots and subplots, more complications, twists and turns, and surprise endings. Have some fun creating all of the possible ways the story could unfold and eventually conclude.

Create contingency plans for each story ending. For each of your story endings (rumor is false = happy ending; rumor is true = dramatic ending causing you to swing into action; something altogether different than what you'd heard happens = surprise ending), develop contingency plans, including initial action steps. For example, if the rumor is true and one possible course of action is to launch a new marketing effort, you would want to do research, draft a plan, create a budget and timeline, and get staff and other resources in place to support the endeavor.

The goal of scenario development is to map out alternative action plans based on all plausible futures so that you can effectively manage, regardless of how things play out. The process also helps you shape the future because it gives you more insight into possibilities that promote good decision-making along the way.

Step Four: Taking Action

Whatever your motivation is to change - a decline in numbers, failed marketing efforts, high staff turnover, career dissatisfaction - when it's time to take action toward a more positive future, there are a few key points to remember.

First, be sure you're taking actions that will have a positive impact upon your future in the long run, rather than just taking actions that offer immediate gratification. Identify long-term objectives and create a plan you can realistically implement over time to achieve those objectives. Second, get a clear picture of exactly where you are now versus where you want to be in the future. This way, you can measure your progress as you implement your plans. Third, factor in your own (and your staff's) work style, skill sets, and strengths so you don't inadvertently create a plan you'll never be able to execute. Fourth, be flexible. Don't give up at the first sign of struggle, but be willing to change course if conditions change. And finally, challenge yourself. Hold yourself accountable (or hire a coach who will hold you accountable) to do what you say you want to do. Actions that result in a positive future require sustained effort and commitment.

The Future Is a Question Mark

We can't know with certainty what will happen tomorrow, next month, or a year from now related to the economy, the health care system or anything else. Maintaining balance between living in the present and planning for an uncertain future isn't always easy, but it's a worthy goal. If you focus too much attention on "the now" and neglect long-term planning, you're likely to find yourself struggling. If you put all of your attention on how your practice could or should look at some point in the future, you diminish your daily satisfaction and may fail to recognize opportunities that are right in front of you.

As you plan for a successful future in your practice, keep the four steps in mind. Become more aware of how you assimilate information, plan and make decisions. Think strategically, not just tactically. Base decisions on having looked objectively at trends and data. Imagine different scenarios and take actions that are most likely to result in the success you're striving for. Stay accountable to your goals and remain flexible and willing to change strategies as conditions change. And as you plan for your future, don't forget to enjoy today.


Click here for more information about Shelley Simon, RN, DC, MPH, EdD.

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