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Dynamic Chiropractic – September 24, 2007, Vol. 25, Issue 20

Five Office Challenges, Five Easy Solutions

By Michelle Geller-Vino, CA

All chiropractic offices have a variety of challenges, including staffing issues, time management, insurance problems, new patient inflow, marketing strategies and more. Therefore, improving productivity is crucial for practice growth.

Realize that experts to help and guide you in these specific areas are easy to find - and after all, why try to reinvent the wheel if it already has been invented? Here are a few challenges many offices face and some easy strategies to handle them.

Proper Training and Hiring Techniques

One of the most important characteristics of an exceptional teammate is personality. That is why it is vital to hire someone with a firecracker personality. Experience is not necessary simply because with proper training, anyone can learn and adapt. Look for traits such as punctuality, coaching ability and high energy. This always makes more sense than hiring someone because they can type a certain number of words per minute or because they have an extensive resume. When you outline a clear job description, an employee knows what is expected of them. Clearly defining office policies makes an employee aware of requirements and prepares the employees for the things the doctor will not tolerate, such as tardiness and personal phone calls. This is similar to a report of findings with a patient where the doctor outlines the care plan before the patient begins. Making sure that all teammates get along definitely will affect the practice as well. Creating a strong commitment up front will get everyone off to a great start!

The staff is the backbone of the office. Weekly team meetings are essential because they provide a time to refine and improve the way the office runs and constantly keep the lines of communication open. Consistent training allows for the staff to be efficient and effective and always improves patient satisfaction.

Leaky Bucket Syndrome

Occasionally, an office might experience what is known as leaky bucket syndrome - when patients simply slip through the cracks. There are, and will always be, patients who cancel or miss appointments and do not want to reschedule for many different reasons. Obviously, some of these patients never return to the practice. How does your practice keep track of these types of patients? Do you use a tickler file? What system does your office use for recalls and retention? Usually, when a patient misses an appointment, that specific patient's name stays on a recall list until they either come in or a member of the staff reschedules them.

Utilizing a computerized software program allows the staff to set reminder pop-up messages on certain days and times, which ensures patients are not forgotten. Computerized scheduling makes it easy to schedule, reschedule and keep track of patients so your practice doesn't suffer from leaky bucket syndrome.


Doctors seem to forget to ask for referrals. However, they always want their existing patients to refer! "If you don't ask, you don't get." CAs usually have excellent rapport with patients. That's why the CA can easily be taught how to ask for referrals. We all know when a new patient comes into our office not feeling well - we can see it in the way they walk, talk and respond to us. We also notice when a patient is feeling better by the way they walk and talk, and the way they communicate with their body language. There are even times when we see it more clearly in their appearance, including how they dress. The perfect time to ask for a referral is when the patient is noticeably feeling better. The CA may start by simply saying, "Mrs. Smith, you seem to be feeling better. Look how pretty your hair is looking" or "You are moving so much better, and we love to see that in our practice - it happens so often!" Then proceed to say, "You must know someone who has been suffering from headaches (or whatever they came in for), who we could help like we have helped you." Many times, since the patient is feeling better, they are very receptive to giving the name of someone to call. This is a great way for CAs to get existing patients to refer others.


Since marketing really is about relationship building, it is important to remember that there are two kinds of marketing: internal and external marketing. Internal marketing is when we are doing something within the practice to bring new patients in the door. Internal marketing can be patient appreciation dinners, internal health workshops on a variety of health and wellness topics, Mother's Day and Father's Day events, holiday celebrations, baking contests, recipe contests, ladies' pamper nights and so much more! Internal marketing helps solidify relationships with existing patients, get those patients to refer others and bring in patients your practice has not seen in a while.

External marketing is things that are done outside the practice to bring in new patients. Being creative and having fun is the best way to externally market the practice. Creating a series of workshops on which the doctor can speak relating to health, wellness and safety topics is a great way to gain exposure in your community. Schools, businesses, organizations and corporations would welcome the doctor if they knew it was part of your community awareness program and there was no cost involved. Networking with other health care providers is another form of external marketing and a great way to build relationships in the community.

Creating a well-rounded marketing calendar is easy. Creating events to do inside and outside of the practice is fun for the whole team.

Timing Is Everything

Doesn't it feel as if there are never enough hours in the day? Do you actually plan your day? What time do you wake up, go to sleep or do your laundry? Isn't it true that if we manage our time effectively, we can find more time to do the things we want and need to do? If we schedule and prioritize when and how we do our chores, it sure seems easier. If we have a clear description of our responsibilities in the office, we can schedule the time to tend to them. Does each team member know and understand their job description? Is it defined and carried out? It is a perfect time to re-evaluate the jobs of the team, find out where the holes are, and prioritize each and every task that occurs during the course of the day to make the practice run effectively and efficiently.

Awareness is such a valuable aspect in a practice. If you are aware of the challenges your office faces, then you are on your way to creating the simple solution to turn things around. The above challenges are common issues many practices face. However, you might find that your office faces different challenges simply because every practice is different. The key here is in understanding that awareness is the first step to effective change. Once you are aware of what needs to be changed, your office will be on its way to efficiency and productivity.

Click here for previous articles by Michelle Geller-Vino, CA.

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