Beyond the Basics Shelley Simon, RN, DC, MPH, EdD About the Columnist Other Articles

5 Strategies to Redefine Success and Move Beyond the Survival Mentality

Chiropractors love success stories. Recently I had the opportunity to witness evidence of this during my state convention. It was late afternoon after a mandatory six-hour continuing-education presentation on record-keeping and documentation, the content of which seemed to evoke a temporary bout of generalized anxiety disorder among the participants, me included. In an effort to end the day on a more upbeat note, I wandered over to a small room where three chiropractors were presenting interesting and compellingly successful cases from their practices. I watched the head-nodding, excitement and interest that had been absent from the earlier session.

While the documentation expert provided excellent information we all needed to hear, clearly it was clinical success stories that brought participants to engagement, aliveness, vitality and attention. This led me to wonder about success stories and chiropractors' response to such stories.

Is it validation and acknowledgment of our experience and skills by patients, peers, and other professionals that we get excited about? Are success stories evidence that we have a viable practice? Or are our successes, large and small, what keep us going in the face of the challenges associated with being in practice today?

Asking myself these questions led me to even broader ones: What constitutes success today? How do chiropractors define success, what are their benchmarks, and how do they recognize it when they achieve it? Is success an event or a continuous journey? Is it evidenced by objective, external factors such as patient volume, number of referrals received, and how much revenue the practice generates? Or is success largely an internal experience that is subjectively "measured" by one's sense of well-being, purpose and satisfaction? Most likely, it is a unique combination of both objective and subjective factors.

This line of inquiry brought me around to thinking about how the definition and experience of success has shifted for chiropractors over the past decade or so. Those of us who have been in the field for a while remember that "back in the day," chiropractors were flying high with growing practices and more than enough money flowing in to keep those practices running smoothly. Today, for far too many practitioners, success has come to mean surviving by working harder with each passing year just to hold on to what they have.

As this attitude has permeated chiropractic (and health care in general), we've unwittingly redefined success as maintaining what we've created and staying afloat for another year. I'm here to assert that there is more to life and practice than treading water while waiting for the next calamity to befall us.

Success Is Still Possible

I was speaking with a client recently and asked her to rate her professional satisfaction 11 years into practice. Because I have so many conversations about diminished or significantly declining practice and personal satisfaction these days, I half expected to hear her say she was happy just to still be in practice given the external constraints and regulations, difficulties getting reimbursed for services provided, and the current economic situation that exists today.

Instead, she said her satisfaction was at the highest point that it had been over the course of her entire career. She said her satisfaction is "trending upward." With so many chiropractors lamenting about survival, burnout and stress, listening to this DC describe her experience and how she was feeling was like a cool, gentle breeze on a hot, humid day.

Later, I began to reflect on what made her different. What was she doing or how was she approaching her practice and life that made her feel like her satisfaction level was on the rise, rather than on the decline? Here's what I came up with:

• She is engaged, present, curious, creative, up to date, willing to change, and clear about her purpose and vision.
• She is networked, rather than isolated.
• She has perseverance that comes with the understanding that the gap between where she is now and where she wants to be in the future is best managed by creative tension and by taking actions that are aligned with her purpose and vision.
• She manages herself, and when she finds herself straying into a negative internal conversation or is being triggered by any one of a number of demands, she remembers why she is in practice: to serve and to make a difference.
• Perhaps most important is the fact that she hasn't given up on her own definition of success just because the world around her has changed. She knows what she wants and she's getting it.

Diminished Vision: Content With Surviving, Not Succeeding

In my experience working with many health care practices, small businesses, and organizations over the course of three decades, I have, in recent years, been increasingly hearing a lot of survival-oriented talk that I referenced a moment ago. Language like hanging in there, waiting it out, lucky to still be in business, and what do you expect in this economy has become the unfortunate norm. The result of this way of thinking and speaking has been a diminished vision for what success means.

I was in my car one morning late last year listening to an NPR broadcast about the wars in Iraq and Afghanistan. What I took away from the commentary was that since clearly, the U.S. was not going to vanquish the enemy (who is the enemy, anyway, aside from a constantly evolving and moving target? – not unlike the "enemies" of a healthy chiropractic practice), the definition of success has become to keep the bottom from falling out, rather than to "win" the war.

Averting disaster is apparently the new definition of winning. Is this really our benchmark for success and greatness? Is keeping disaster at bay by putting out one fire after another and surviving crisis after crisis your benchmark for practice success? I'm concerned that a diminished vision associated with a primary goal of averting disaster has become an epidemic among chiropractors.

In the face of practicing with increased transparency, vulnerability, regulation and competition for resources and consumer dollars, many practitioners are hopelessly resigned, stressed, emotionally fragile and/or burned out. When we live with chronic stress, unmet expectations, resentment and loss of control, the tendency is to move our goalposts as a coping mechanism.

Five years ago you might have had a goal of increasing your practice volume by 15 percent each year; today that goal might be 5 percent – or just keeping the patients you already have and not losing ground. This way of thinking puts you on the path to compromise, mediocrity and a failing (or at best, unsatisfying) practice.

Diminished or negative visions about future success are a by-product of viewing everyday challenges as burdens, being reactive rather than proactive, and problem-solving the wrong problems. Author Peter Senge refers to this phenomenon as a "shifting the burden" dynamic in which there is ultimately pressure to lower vision because of frustration, emotional tension and a delay in achieving success. In this dynamic there is, according to Senge, a "subtle reinforcing spiral of failure to meet goals, frustration, lowered vision, temporary relief, and pressure anew to lower the vision still further." Not very uplifting, eh?

Moving From Survival to Success Thinking: 5 Strategies

At one time you had optimism, curiosity, hope and the ability to envision a successful future. You can get those feelings – and the actions that go with the feelings – back again. Senge says that truly creative people use the gap between their vision and their current reality to generate energy for change. Too often, instead of moving into a creative and visionary mode to deal with an unsatisfactory current reality, we fight against reality, live in the past, engage in magical thinking, and dial back our definition of success.

Here are five ideas intended to support you in moving from survival-based thinking into success-based thinking, away from contraction and toward expansion, and out of fear and into empowerment.

1. Review your purpose. You're smart; you could do anything you'd like to do to earn a living. Why are you in practice? Review your practice purpose, mission and vision to determine what, if anything, needs to be changed. It's possible that what you thought you wanted for your practice is different today than it was two, five or 10 years ago. It's OK to make revisions to your master plan from time to time; just be careful not to operate from a place of diminished vision as you do so.
   


2. Revisit your definition of success. Think back to why your went into chiropractic to begin with; what you hoped to achieve by being of service to your patients and what personal gains you envisioned for yourself and your family. Without going down the negative path of, "But everything has changed for the worse since then," take the time to rewrite your definition of success, including two or three concrete goals to work toward for the remainder of this year. Don't forget to brainstorm how you will monitor and measure movement toward achieving your goals.
   


3. Do things differently. There's an old saying that if you keep doing what you've always done, you'll keep getting what you've always gotten. What is the difference that will make a difference for you? For some of us, it is about changing an attitude or mindset; for others it may be creating and executing a strategic plan for changes in technology, staffing or marketing. For others still, it may be doing less, rather than doing more.
   
   In his best-selling book, The Power of Habit, author Charles Duhigg cites a Duke University research paper published in 2006 that "found that more than 40 percent of the actions people performed each day weren't actual decision, but habits." Observe yourself over the next several days looking for clues about what you are doing habitually that is working well (e.g., reviewing your schedule each morning before seeing patients, exercising most evenings after work, going to sleep at a decent hour) and what you are doing simply out of habit that you'd like to change (e.g., rolling into work with only seconds to spare before seeing your first patient, wasting time on the Internet during office hours, having that third drink in the evening).
   
   Too often, we don't recognize and alter unhelpful habits and patterns until one disaster or another forces us to adapt and create a new way of working or being. Focus your attention on doing more of what you know is good for your practice and yourself, and less of what you know is only adding to your frustration or dissatisfaction. And remember that learning to unlearn is a valuable skill.
   


4. Don't keep all your eggs in the work basket. Much is written about practitioner burnout, and for good reason: it's a real issue. The clients I work with who are ultimately the most successful pay attention to work / life balance; have interests, activities and relationships outside of work that they enjoy on a regular basis; and make time to take care of themselves – physically, emotionally, and spiritually. Not only will all work and no play make you dull; it will also make you unhealthy, lead to resentment toward your practice and patients, and result in professional burnout.
   


5. Practice perseverance. I'd like to think that having read this far, you are feeling somewhat more optimistic and hopeful about the future, while also recognizing that refocusing on a successful future requires a shift in attitude, and that such a shift requires effort. Hold on to the positive thoughts you have in mind now and spend 10 minutes writing down five actions that will help you persevere toward long-term success when challenges arise and you feel yourself slipping into unhelpful behaviors and negative thinking.

Your list might include things like reading or listening to something that you find motivational; calling a colleague who is also on a path to success; scheduling a special staff meeting for the sole purpose of reviewing your practice goals; or arranging a session with your coach or mentor.

What success stories would you like to be sharing with your colleagues the next time you gather for an educational program or convention? Success, in spite of all of the challenges practitioners face today, is still possible, but only to the degree that you're willing to do what's necessary to be proactive and maintain positive vision for what success really is – for you.