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Dynamic Chiropractic – November 18, 2010, Vol. 28, Issue 24

Practice Then, Practice Now, Practice in the Future

By Shelley Simon, RN, DC, MPH, EdD

Though the nature of chiropractic practice has changed dramatically within just one generation, much of what doctors want from their careers has remained constant. Practitioners still want to deliver a unique brand of high-quality care to a growing segment of the population.

They still have a passion to be the best they can be as clinicians and as leaders. They continue to be devoted to helping people. And they still want to have healthy, successful practices. So while practice goals may be the same as they were in decades past, the path to achieving those goals has evolved.

Thriving in a changing world requires embracing continuous transition as the new norm, letting go of old expectations and mindsets, developing creative strategies and flexible systems, and being clearer than ever on how to deliver value to patients. Let's take a look at how practice has changed, what we can surmise about the future, and how to navigate an effective course toward that future.

Practice Then

Until just a few years ago, practice management and marketing strategies were the same whether you were in Seattle or Saginaw, whether you worked solo or in a 10-person group, and with little regard for the vision, individuality and goals of the practice owner. Consultants made a pretty penny essentially saying, "I did XYZ and I was successful; now you do it, too." Doctors used to expect their practices to grow in a linear fashion and, based on one or two slow months, would panic and toss out goals, their vision and their marketing plan, and run off to yet another seminar to find "the answer."

Failing to recognize that each patient is unique and that savvy people see through scripted messages, until recently many chiropractors still trained staff to use scripts to get patients in the door. The old way of engaging patients in care involved convincing, coercing, cajoling and controlling them into seeing things from the doctor's point of view. Patients who didn't comply were considered "difficult" or "not interesting in helping themselves." 

This doctor-focused approach worked well for many doctors for many years - until patients became more sophisticated, discerning, and informed. Chiropractors who hold on to this outmoded practice style often find themselves with fewer and fewer patients, not to mention unsatisfying careers.

Practice Now

Today, chiropractors recognize the need for innovative business models, better self-management, and quality outcomes. They also understand the degree to which patients are in the driver's seat, and that they must work to transform their staffs into teams. Here are some characteristics that are common in today's modern practice:

  • Cyclical growth. Every practice has peaks, valleys and plateaus. Doctors who are successful plan for this reality and don't throw the baby out with the bathwater every time they have an off week or month.

  • Doctors who take their own development seriously. Maybe it's the Tony Robbins effect, but chiropractors of all ages have come to realize that to be successful in business, they must be successful as human beings. Doctors who used to spend time and money on weekend seminars to learn the latest practice-promotion tricks are now investing resources in improving their self-awareness, emotional intelligence and communication skills, in addition to honing clinical skills and business expertise.

  • Focus on quality, evidence and outcomes. Because they now have the data to compare their outcomes with those of other practitioners, chiropractors are using this information to improve their own clinical effectiveness and become more competitive. And they've learned that patients with good outcomes are the best marketing tool they have in their arsenal.

  • Teaching trumps preaching. Patients have access to a great deal of information today, and they're intent on continually increasing their knowledge base. From their doctors they want clear guidance and advice that is customized to their individual needs. The days of telling patients what to do and assuming they'll say, "Yes, doctor," and follow through are pretty much over. Chiropractors with long-standing, loyal, engaged patients take the time to educate each person they see to the degree that is appropriate, using information that is tailored for each stage of care.

  • Teams are valued. The most successful practices have grown beyond employing a collection of individuals who do a variety of tasks. Instead, they have teams. More and more, doctors are appreciating the value of recruiting and retaining quality people who are able to function as part of a true team. (For the record, providing your staff with snazzy, matching uniforms does not constitute having a team.)

As you can see, today's practice has moved away from command and control and toward cooperation and collaboration. This empowering shift in human dynamics is aligned with the chiropractic paradigm and supports the philosophy we have embraced for decades. We were ahead of the curve, and can now build on this strength to meet the demands of the future.

Practice in the Future

It's been said that you don't have to try to predict the future if you're in a position to create it. What do you want your practice to look like in five, 10, 20 years? How will you stay competitive in a world in which patients are comparing you with other chiropractors using Angie's List and Facebook? How much time and energy are you willing to invest in creating your ideal practice of the future?

The successful practice of the future will be collaborative in the true sense of the word and will reflect a partnership paradigm. Look for practices to become much more: (1) patient-centered, (2) relationship-based, (3) doctor-inspired, and (4) team-driven. Let's look at each one of these elements.

  • Patient-centered. This simply means that the emphasis is on the patient. What do patients want? What are they willing and able to pay for? What motivates them to actively participate in their own care? What's in it for them to choose you as their health care provider? Patient-centered practices will be focused on lifestyle management, health coaching, and facilitating the individual's inherent capacity to heal. Whole-body care, vitalism, holism and empowerment will be more than buzz words. The entire organization will be designed around meeting the needs of patients, with bi-directional communication and partner-based decision making at the core of the model. Positive, measurable clinical outcomes will be more important than ever.

  • Relationship-based. A high level of mutual respect will be the hallmark of tomorrow's practice. Doctors and staff will appreciate that patients expect to engage with a health care team they know and trust over time. The doctor's role - that of expert, coach, advisor, motivator, etc. - will shift based on each patient's greatest need in the moment. This model will recognize the power of the relationship as a healing and transformative force for both patient and doctor.

  • Doctor-inspired. Successful practices going forward will be the ones in which the mission, vision and direction are clearly communicated by the doctor. Staff and patients alike will appreciate the chiropractor who has the ability to inspire and motivate. The leader of the future will consistently demonstrate congruence in word and action. In addition, tomorrow's visionary practitioner will move beyond tolerating change and learn the value of embracing it. They will become "change hardy" by developing resilience and cultivating creativity.

  • Team-driven. Under this practice paradigm, the staff will function as an empowered, cohesive body and understand the importance of being patient-focused and relationship-based. They will feel a high degree of ownership in the mission, vision and success of the practice. Each person will be clear about their role and have a firm grasp on what is expected of them. Open dialogue and constructive feedback will be customary, as will mutual trust and respect. The character of the office will be one of, "We're confident and we're in this together."

Formula for Success

The practice of the future will require a new formula for success, but it's a formula that each practitioner must define for him or herself by answering questions such as: What does success mean to me? What constitutes sustainability? How much growth is enough? What are my most important professional and personal values? Your formula may look very different from that of the doctor across town; however, there are three factors that will likely be woven into every success formula:

  • Positive patient experience. People's expectations are high. To be occasionally "wowed" with good service is no longer enough. Being consistently wowed is what's required now, and that means having patients who are actively involved in their care and participate in creating their own experience. According to Pine and Gilmore in their book The Experience Economy, "Experience provides a memorable offering in which the 'guest' must actively and individually participate." Think Disney. Think Starbucks. Think Southwest Airlines.

  • Good outcomes. Delivering tangible results to patients is essential, because even though they have a positive experience with your practice, what they'll talk about to others is what you helped them achieve. No one will tell a friend, "Well, my neck still hurts a lot, but you should try my guy because he's really nice and the staff is so on top of things." What you want your patients to say is more along the lines of, "I can't believe how much better my neck feels. I'm not exhausted at the end of the day anymore from fighting the chronic pain. This guy is amazing, and his office staff makes getting in and out so easy."

  • Authenticity. Technology overload and the virtualization of so many aspects of our lives make authenticity all the more noticeable, and all the more appreciated. Phony e-mail, robocalls, 800 numbers answered by phone trees that lead to nowhere, and rampant corporate and political deceit are making people thirsty for authentic, trusting, personal encounters. Being honest in all your dealings, transparent with your agenda, congruent in what you say and what you do, and fully present during patient visits will set you apart in a crowded field of health care practitioners.

You Are the Expert on Your Practice

Chiropractors participate in consulting processes, marketing programs and year-long practice management courses over and over, only to find the results short-lived and unsustainable. But you know your practice. You know what has worked and what hasn't. You know what you need to do. Even if you're not absolutely sure what you need to do, you know that more of the same isn't going to work moving forward.

Ask yourself the following questions to determine what will move you toward a successful future: (1) Which strategies, methodologies, and beliefs are you clinging to that, although useful at one time, no longer serve you? (2) What would patient-centered care look like if it were employed consistently in your practice? (3) How can you have superior relationships with patients and staff? (4) What interpersonal skills do you need to cultivate to become a more inspired leader and develop your team to its fullest potential? (5) What kinds of experiences do patients currently have when they come to your practice, and what experience would you like for them to have? (6) How confident are you in your clinical gifts and ability to deliver quality outcomes? (7) What would it look and feel like to be completely present and authentic with each patient you see?

Set aside some time between now and the end of the year to honestly evaluate yourself and your practice, using the points covered in this article and the seven questions above. In January, I will challenge you to take your practice to the next level of excellence in an article about setting priorities to achieve sustainable success and greater personal and professional satisfaction.


Click here for previous articles by Shelley Simon, RN, DC, MPH, EdD.

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