Albert Einstein said, "In a crisis if I had only an hour, I'd spend the first 50 minutes defining the problem and last 10 minutes solving it." Chiropractors often contact me when they've hit a wall with a problem.Perhaps they've done everything they can think of to reduce staff turnover, but still have a revolving door and spend way too much time hiring and training new employees. Or maybe they've honed their marketing message so they are able to attract new patients, only to find those patients don't value the care they receive or stay loyal to the practice.
My experience with doctors who feel they've exhausted all of their problem-solving resources and have hit a dead end is that they're unable to correctly define a problem, they're suffering from a blind spot that leaves them unable to address the problem accurately, or they're confusing an isolated problem with an ongoing challenge. In any case, they often feel overwhelmed stuck, stymied and worn out. Here's why problem solving is such a problem and how it can be made easier.
Assessing a Problem
The first step in solving a problem is accurately defining or labeling it. Is the problem most closely tied to procedures, human resources, relationships, attitudes, perceptions or something else entirely? Is the problem acute or chronic? Is it mild, moderate or severe? Is it a narrowly focused problem or a systemic one? Getting a clear picture of the nature, depth and context of a problem helps put it in perspective. But that's just the beginning of the analysis.
The problem with problems is that when they are ours to solve, we overidentify and get so close to them that we lose the perspective needed to find workable and sustainable solutions. When we approach chronic problems based only on prior experience, we keep coming up with the same "solutions" we have in the past. If you take the time to carefully analyze a problem or challenge you're struggling with, you'll most likely find it has a lot of moving pieces. The ability to determine which piece or variable should be addressed first, second, third, etc., requires taking a step back from the situation. Once you do this, it becomes apparent which variables you have control over and which ones you don't. Eventually, the other pieces begin to fall into place, the issue becomes clearer and a solution emerges that has the potential to positively transform the situation.
Removing the Blinders
Having a blind spot means that you're not seeing a problem clearly. Perhaps you're focused primarily on the symptoms, you don't see how you're contributing to the situation, the meaning you're attaching to the problem has become an obstacle, or you're leaning toward a solution because it's one that you already know how to implement (all the world is a nail if you are a hammer). Here's an example of a doctor with a problem and a blind spot.
A chiropractor might feel that he has high staff turnover because he can't afford to pay employees as much as his competition, or offer an attractive enough benefit package to keep them from job hopping. Even if that is the main reason people move on to greener pastures, the problem likely runs deeper than simply how much the staff takes home in pay and benefits. The root of the problem may be, for example, that the doctor is operating from a position of scarcity, not only paying poorly, but also being stingy when it comes to rewarding staff with praise for a job well done, offering opportunities for on-the-job learning, or even encouraging employees to take an active role in helping make the practice more successful.
The doctor in this scenario might have a blind spot related to the language he uses or in how he manages his practice, either of which could be sending a message to staff that there is never "enough" to go around. Perhaps staff observes that the person they look to for leadership authorizes them to order only the bare minimum of supplies for the office, becomes grumpy on payroll day, or complains loudly when it's time to pay taxes. The subliminal message employees hear day in and day out is, "This practice isn't financially stable." That, coupled with the fact that their wages and benefits are not competitive, and that they don't feel appreciated in non-monetary ways, has them keeping one eye on the employment classifieds at all times.
Until this doctor can remove the blinders and recognize that his attitude and approach is stuck in "not enough" mode, he will continue to have trouble maintaining a quality team. Uncovering what's at the core of issues such as this is not easy, but it can be done. Taking the time to get to the root of a problem (rather than repeatedly analyzing symptoms and putting Band-Aids on them) pays dividends in the long run, not only for the doctor, but also for his staff and his patients, who will appreciate seeing the same faces at the front desk from visit to visit.
In addition to solving problems that seemingly have "no solution," going through the process of exposing the primary source of the issue and taking off the blinders by thinking creatively lays the foundation for being more effective and resilient the next time an "unsolvable" issue crops up. The goal is to move away from being habitually reactive or feeling stuck to being proactive, creative and confident that most problems can actually be resolved and that lasting solutions can be found.
Problems vs. Ongoing Challenges
As a society and particularly among members of the baby boomer generation, the belief that all problems have permanent (and easy) solutions is widespread. Yet there is a difference between problems that can be solved and ongoing or chronic challenges that must be managed. Dealing with insurance reimbursement is a classic example.
Because the rules and contracts are constantly changing, and because you have no control over the system (other than to opt out), this is an issue that you must learn to manage. Bemoaning the fact that the rules keep changing and the insurance companies work according to their own schedule doesn't help the situation. This is a case in which because there is no procedure, system or piece of software that will solve the issue of poor third-party reimbursement once you're under contract, you'll be impacted less by the "problem" if you stop resenting it and instead spend time and resources on keeping your systems up to date, training your staff and otherwise being proactive about responding to the ever-changing reimbursement game.
Another example of a management challenge relates to practice marketing and promotion. Every chiropractor dreams of the day when they will not have to spend any time at all focusing on keeping the schedule full. There are some doctors for whom this is a reality, but the majority must make ongoing efforts to attract new patients, because people are fickle and their circumstances change. They might move away, get new insurance coverage that doesn't cover chiropractic, change their mind about the value of chiropractic, or find a doctor they like better than you. So, marketing to keep patient volume at a sustainable level is not a problem to be solved. It's a challenge that requires ongoing attention.
Becoming Proactive and Creative
The reactive practitioner is almost always crisis-oriented, tries to fix problems using short-term tactics, and clings to what feels comfortable. The proactive or creative practitioner, on the other hand, tends to be open to new possibilities, seeks out support when needed, and looks for sustainable solutions to the challenges they face. Being proactive and creative requires the ability to define problems accurately, distinguish isolated problems from ongoing challenges, and maintain a healthy relationship with the problems and challenges you face every day. Honing these skills involves:
- Asking and answering questions about a situation from multiple perspectives
- Exposing and challenging assumptions
- Gathering data
- Being curious
- Narrowing or expanding your focus
- Looking for patterns
- Owning your part in the problem or challenge, and taking responsibility for the solution
So, where are you on the reactive versus proactive / creative spectrum? Where would you like to be? How would your practice be different (e.g., more profitable, more engaging, more beneficial to the patients you serve) if you were to focus on becoming more creative and proactive? I encourage you to reflect on your experience and honestly assess your usual approach to problem solving.
Making Peace With Problems
There are some complexities, paradoxes and polarities that cannot be fixed. There are dilemmas and challenges that can be managed, but not changed. The wisdom is in knowing the difference between what you can and cannot control. The fact that you have problems and ongoing challenges in your practice (and in your life) is not a measure of your current level of success, nor an indicator of future success. Indeed, identifying problems and solving them skillfully can create a "flow" experience and makes life absorbing. Being blessed with problems to solve builds confidence and resilience.
You can make peace with problems when you accept that they are an inevitable part of life, move beyond thinking that someday all your problems will be permanently solved, pick your battles carefully, avoid dwelling on problems to the point of diminishing returns or live in a state of denial, and keep situations in perspective by asking yourself, "Am I seeing this as an obstacle or as an opportunity?"
What Would Einstein Do?
Your ability to accurately define the problems and ongoing management challenges you face as a business owner, and approach those problems from a position of strength, could mean the difference between having a successful practice or one that feels like a burden to manage. You don't have to keep hitting your head against the same wall again and again, trying to solve "unsolvable" problems. There is an easier - and more effective - way to address your most pressing and stubborn challenges. It requires patience and a willingness to think differently. Einstein, wise man that he was, also said, "No problem can be solved from the same level of consciousness that created it." When in doubt, channel your inner Einstein.
Click here for previous articles by Shelley Simon, RN, DC, MPH, EdD.