The Loss that Led Me to Focus on Patient Experience in Chiropractic
In chiropractic school, we are taught to examine, identify problems, create care plans, and to adjust patients. A lucky, or more prepared, few of us may have taken outside seminars to learn about strategies to bring more patients into our office, billing tactics to increase revenue, or practice management techniques. Yet, for all that we learn, the hours and years we put in to become Doctors of Chiropractic, we are never taught the most important part of having a truly successful business. We’re never taught to focus on the patient experience. Just out of chiropractic school, I was no different. I was running what I believed was a successful practice. I was helping a lot of patients and making a lot of money.. At the same time, I was trying to wear too many hats – business owner, staff manager, doctor. Things were falling through the cracks without me knowing until it was too late. I will never forget the day one of my patients came in and told me he was thinking of killing himself. No doctor is every really prepared to hear something like this, much less, a young doctor, still learning. My patient’s name was Chris and he had come to see me for low back pain, something chiropractors see every day. He had received his report of findings, had proceeded with care, and was getting great results and relief from the pain. At his words, I felt shock. I asked what had happened. The story he told me was incredible. After coming to the class that I held for new patients, he had decided to turn his life around. Hearing the chiropractic message and learning how his health affected every aspect of his life as well as his family’s life, he had made a life-changing decision. He quit drinking. He quit drugs. He was going to get healthy for his wife and children and he was going to do it cold-turkey. But now, he felt like taking his own life. After listening to Chris’ story, I was amazed that he had been affected so deeply by the chiropractic message and thankful that he had truly understood it to the point that he was determined to change his health to improve the future for himself and his family. And, I’ll admit, I was proud that my class, my words, had been good enough to change a man’s life. Yet, how could someone who had understood the message on such a deep level now think of killing himself? Chris and I spoke about what he was feeling and how, after the years of punishment his body had been through, it was natural to have difficulty trying to achieve homeostasis again. I explained how the chemicals in his system had been affecting his whole life, including his thoughts and how things were now trying to balance out as his body fought to move toward health. He understood. He got it, just like he did the chiropractic message, and we continued care. Then came the day when I realized that Chris had not been in for a visit in a while. Chris had understood the chiropractic message so completely that he should have been a patient for life. I pulled his chart to find out what had happened. That is when it became clear that once again, something important had fallen through the cracks. Chris had missed appointments, yet we had not followed up with him. His care plan had expired and his billing was not in order. These things that are so vital to patient retention had been missed. I immediately called Chris to find out how he was and to set up an appointment for a follow-up. That is when I found out that Chris was dead. He had taken his own life, just like he had talked to me about. That is when I knew with complete certainty that the systems we had in place were not enough. We tried to call patients who missed appointments, follow-up on care plans, pre-arrange billing with patients, and so many other tasks every single day. Yet, sometimes, my staff became overwhelmed or simply forgot. Other times, they would give up calling a patient who had not responded. And, so many of our systems relied on memory, leaving my staff and I to juggle all of the responsibilities, hoping no one dropped the ball. We only knew to follow-up with patients when I or one of my staff realized someone had not been in to see us for a while. We only knew to check on insurance claims when someone remembered we had not been paid. I knew that other industries used different technologies and software to manage the customer experience. Yet, the Chiropractic profession had no software to manage the Chiropractic patient experience effectively. There were many chiropractic software companies and practice management softwares available. However, not a single one broke down the patient experience into manageable tasks. And, not one offered one simple daily report to let the doctor know whether the necessary tasks had been performed. Instead, they all forced the doctor to wade through piles of reports, to check each individual aspect of the practice, an ineffective and time-consuming chore, at best. To find a solution, I had to go outside of the chiropractic profession, to find out what big businesses use to manage the customer experience. Since that time, I have dedicated myself to finding a better technology to break down and manage every aspect of the patient experience and making it available to chiropractors. And, so that I would never forget the man who first opened my eyes to the necessity of managing the Chiropractic patient experience, I named my son Christian in his honor.
Overcoming Workflow Bottlenecks
Traffic Jams Can running the right reports improve workflow bottlenecks in Dr. Ben’s practice? “Mrs. Wilson!” Pam said, looking up as Carmen came through the door. “Did I hear you talking about me?” Carmen asked her husband playfully. “I was hoping you could come to lunch with me.” “Dr. Ben was talking about our workflow bottlenecks,” Pam put in. “Workflow matters,” Carmen said. “And I think you also should be talking about scalability. Naturally you pay full attention to one patient at a time, but for the sake of the practice you have to be able to look at the big picture and identify the bottlenecks in your workflow.” Pam was silent. “We’re speechless,” Ben said. “I’m glad to see you, of course, but I have no idea what you’re talking about right now.” Pam darted a glance at the patients around them and welcomed a new patient. “Should we be discussing these things in front of them?” she asked quietly when she was free again. “It’s business,” Carmen shrugged. “Your practice is growing because you give your patients excellent care. So you want to continue doing that. How could they object?” She stepped behind the desk and looked over Pam’s shoulder. “For example, can you run a report that shows all the tasks that are coming up tomorrow and who is assigned to do them, and what tasks are still left from today?” “Honey, I don’t think you should be–” Ben began, but Pam stopped him. “I’ll just pull up the list of reports I can run,” she offered. “There’s no sensitive information there.” “There sure are a lot of reports!” Carmen said, her eyes widening. “New Patients, No Shows, No Future Appointments–” “There are lots of patient reports,” Pam agreed, scrolling down the page, “and then we also have things like Inventory, Billing, Patient Balances, Third Party Vendors…” Ben joined them in staring at the screen. “Is that going to help us identify bottlenecks in our workflow?” “I only run a few of them,” Pam admitted. “Mostly, I don’t really know how to set them up the way I want or how to use them once I run them. I think they’re open to interpretation, too, because sometimes they make me think we should do something but the partners don’t agree — sorry, Dr. Ben!” “That’s okay,” he said. “I know what you mean. Often we partners don’t agree with each other, either. It’s like we’re all looking at different information.” “Reports like these are for analysts,” Carmen said firmly, “not for doctors and nurses. You can’t expect to look at a couple hundred lines of a Tasks and Events report and see what you need to do next.” “Plus,” Pam added, “it’s hard for me even to figure out which report to look at. If we’re talking about how smoothly the work goes, I know that a lot of the tasks we do involve multiple aspects of the practice, not just one of the things listed on those pre-made reports.” Ben took his wife’s arm. “We’ll get out of your way now, Pam,” he said, “but thank you for your help.” “How much time do you spend on those reports?” Carmen asked her husband as they walked. “Hardly any,” Ben shrugged. “As Pam said, I don’t really understand how to use them. Plus, I don’t exactly have lots of free time — and I’d rather have lunch with you.” Can running the right reports improve workflow bottlenecks in Dr. Ben’s practice? Disclaimer: For HIPAA compliance, all characters appearing in this post are fictitious. Any resemblance to actual persons or actual events is purely coincidental.
Improving Practice Workflow and Accountability
How can Dr. Ben improve workflow and accountability in his chiropractic practice? Ben smiled reassuringly at his patient, snapped the file closed, and headed to the office. “I think I might need a translator for this patient,” he said. “Of course, Dr. Ben,” Pam assured him, picking up her phone. Ben headed back down the hall with long strides, but when he had finished with the patient, he returned to talk with his office manager. “So, Pam,” he began — and then stopped while she answered a phone call and handed a clipboard of forms to a new patient. “Sorry about that,” Pam smiled. “What can I do for you?” Ben lowered his voice. “Would you say things are going smoothly in the office? I noticed that you were able to provide a translator immediately and it looks as though you have everything under control.” “I pride myself on looking like I have everything under control,” Pam assured him. “And mostly I do, even if sometimes I’m like a duck.” “A duck?” “Gliding along the water on top and paddling like crazy underneath,” Pam laughed. “Seriously, I think things are going pretty well. We have issues. What chiropractic practice doesn’t? But overall it’s good.” “What issues do you see?” Ben pursued the question. “Sometimes we have to search pretty hard to find the information we want,” Pam said promptly. “I’m still waiting for that new software we’ve been talking about.” Ben nodded. “I just haven’t gotten around to it.” “And it would help a lot if staff could really know what their daily workload was going to be. Everyone just comes in and waits for me to tell them what to do. If I don’t have time to tell them anything, they don’t do anything.” Pam’s eyes widened. “I think they’d rather be able to take ownership of their work and get the satisfaction of accomplishing things and being part of the team instead of just hanging around in case they’re needed, but the work just isn’t set up that way.” “The work just doesn’t happen that way,” Ben said. Pam’s face alerted him that he had raised his voice and he lowered it again. “Like the translator — we don’t know ahead of time when we’re going to need him.” Pam looked doubtful. “I’m not so sure that’s true. I mean, it’s not like Mrs. Vargas suddenly didn’t understand. Maybe we should have a note in her file. Maybe we should ask people when we make the appointment. Maybe we could even cluster the appointments of people who might need a particular translator.” Ben frowned. “I feel like we’re getting off track here. Isn’t this just one little thing?” “Yes,” Pam agreed, “but every day is made up of those little things. We do some stop gap thing to solve a problem and after a while it becomes what we do. It’s hard to hold people accountable when they never know what they’ll be accountable for.” “I see your point,” Ben said. “It’s like what my wife calls ‘workflow.’ You’re telling me the work isn’t exactly flowing.” Pam smiled. “I’m not sure that’s what workflow means, exactly, but yes, I guess that’s another way of saying we’re just paddling like crazy under the water.” Disclaimer: For HIPAA compliance, all characters appearing in this post are fictitious. Any resemblance to actual persons or actual events is purely coincidental.
Practice Growth Through Chiropractic Software
First Impressions Does Dr. Ben really know how to run his practice growth? Ben sat on the bench in the museum’s Impressionists room, staring at a giant canvas. His wife and son were strolling around the room, talking about details in the other paintings, and he knew that Carmen was having to focus so much on Jonathan that she probably wasn’t getting the full experience of being in an art museum. But somehow he was having trouble getting out of his own thoughts enough to enjoy time with his family. Even surrounded by amazing works of art, he was thinking about work. “Thinking about work?” Carmen asked, coming to a stop beside him. Jonathan climbed up on his lap. Ben had to laugh — it was uncanny how Carmen could read his thoughts sometimes. Although it seemed as though he was always thinking about work lately. “I guess,” he admitted. “I thought things were going well,” Carmen said, sitting beside him. “They were. They are,” said Ben. “I just feel like every time I get my problems solved, they regroup and come back at me.” Carmen gazed at the flowers on the wall. “Can I be perfectly honest?” “Of course!” Ben was surprised. “Aren’t you always perfectly honest with me?” “I try to strike the balance between honest and supportive.” Carmen darted a look at Ben. Jonathan, worn out from walking, was half asleep. “I think you don’t know as much about running your practice as you need to. Maybe not as much as think you do, even.” Ben frowned. “That’s honest, okay. Maybe not supportive.” “I’m not saying anything about how you treat your patients. I’m just saying it’s not really scalable.” Ben looked inquiringly at his wife. “Managing a small practice where you see a few patients a day is not the same as managing a growing practice. You want growth, of course, and you’re a great chiropractor, so you get more patients — and you have a crisis while you figure out how to serve them all. Then you add a partner or another staff member, and you have a crisis while you figure out how to pay for them and how to manage them. Then you get more patients so there’s enough money to go around, but then you have another crisis figuring out how to keep track of everything. Your practice grows, but you sort of go from crisis to crisis.” Ben looked back at the peaceful flowers in the painting. From crisis to crisis was a pretty fair description of how he felt. “We want growth,” he said. “We need it, even. We have to think about Jonathan’s future — lessons, sports, even college tuition. And we have to think about our retirement, and let’s face it, we want and deserve a certain kind of lifestyle. I don’t think that going back to the way things were my first year in practice is the solution. You’re right, though — I felt a lot more competent back in those days.” “What about the technology solutions we’ve talked about. Have you invested in them, yet?” “We’ve done a few things,” Ben said slowly. Now that he thought of it, though, a lot of the new tools they’d talked about were still being talked about. “I know I couldn’t have handled the growth of the pizzeria if I was trying to make all my pizzas with a bowl and a wooden spoon,” Carmen said. “You need good tools.” She stood and stretched. Ben picked up his sleepy son and put an arm around his wife. “I think I’ve had enough of the Impressionists,” he said. “But what you said definitely has made an impression on me.” “Good,” Carmen smiled. Does Dr. Ben really know how to run his growing practice? Disclaimer: For HIPAA compliance, all characters appearing in this post are fictitious. Any resemblance to actual persons or actual events is purely coincidental.