3 doors to your practice

The Three Doors To Your Practice

Recently we promised in another article to discuss the Three Doors To Your Practice. If you haven’t already read the article ‘What Chiropractors Do Wrong’ then you can also find a link at the bottom of this post.

So what are the Three Doors to Your Practice. Quite simply they are metaphorical doors to explain where patients/clients come and go through your practice.

The Front Door is obvious, it is where New Patients & Clients come into your practice, it is the life-blood of any practice. A growing practice needs to have a busy front door, with lots of internal and external marketing activity such as referral programmes, google Adwords, local screening events, social media activity etc. There is more on specific tips for keeping your front door busy HERE.

It is the other two doors that get forgotten, and if they are not checked, can mean that your business is a bucket that you regularly fill with water, but it is strewn with holes. The Side Door is very important, especially if you are new in practice, or want to improve the quality of care that you offer your clients, which should be everyone.

Any client that does not complete your initial recommendation is said to have left through the side door. For example, someone with a lumbar disc herniation is given an initial recommendation of two treatments per week for six weeks before a formal re-assessment. The patient stops coming to you after four weeks and you do not hear from them again.

Firstly, you or your staff need to make contact and find out the reason; it could be that they are so happy with their progress as they feel 100% better and felt they had gained all the benefit that they needed at that time. You then have a choice to thank them and say that the door is always open if they need you again; maybe even ask for a google review if they are singing your praises!

Perhaps you could choose to say that conditions like this do not always repair in-line with symptomatic improvements, so whilst you are happy that they are feeling so well, you are concerned that the problem hasn’t been fully stabilised and either suggest that they keep to their original programme, or give you a call if they feel ANY regression; making sure they do not wait too long to come in. Of course each situation will dictate which course of action that you take. Nonetheless, once you have spoken to them you have gained some feedback, tied up loose ends and left the patient with a positive message; the aim is NOT to convince them to come back into your office.

The other scenario could be that they had not felt any improvements and didn’t want to continue paying for treatment. Again, you can use this to educate the patient about their condition, explain the healing process and how it takes time, and re-iterate that this was all discussed at their initial visits, and that we are only part way through the programme. If the patient still doesn’t want to continue with care, I then respectfully accept their decision, but do not negotiate on my recommendation and tell them that the door is always open for them.

In my experience with over 100,000 treatment session, I am clear that a patient that drops out of care can often feel embarrassed to come back with their tail between their legs and say you were right; can we start again. So I try to make it easy for them by keeping my integrity and reiterating what I had said at the start of their care, sharing the progress that I think they are making clinically, whilst respecting the decision that the make, and showing them that we are there for them regardless on when that may be.

If you look at statistics in your practice, which can either be tallied up manually or with some practice management software, it will be clear to see if you are losing a lot of patients through the side door. This will mean that you constantly have to work on people coming through the front door in order to keep your business stable. The side door is such an important concept to monitor, but it doesn’t stop when you have the stats in front of you, the work then begins.

Bring up the stats at a team meeting and brainstorm all the reasons why people might be leaving through the side door. What can you do lessen this number? Perhaps your feedback shows you that your opening hours are too restrictive, or that patients can never get an appointment with you, so find it impossible to keep to your recommended schedule. This is a good problem to have, and maybe its time to look for an associate to work with you, especially one that is prepared to work Saturday mornings, as your feedback tells you that this would be very helpful to patients.

There could be some staff training topics that come out of the meeting. For example, what do the reception team say when a patient phones up to cancel an appointment? Do they let the patient take responsibility for keeping to the practitioners schedule, meaning weeks could pass before their next treatment when they are due in twice per week. Or do they make sure that the patient is still on track, limiting the lapse between cancelled appointment and the follow up booking.

The meeting could trigger a need for even deeper self reflection… perhaps your recommendations are just not appropriate, or how you convoy them isn’t working, Maybe you are so grumpy that patients can’t bare to spend more than a few visits with you. Although hats off to any staff members that are brave enough to tell that to their boss!

The side door can never be bolted shut, people make decisions to stop treatment for a multitude of reasons, many outside of your practice. The aim is to minimise those things that you have either direct control over (say your office hours) or an influence over (what your team say on the phone).

The final door to consider is the BACK Door, and is mostly relevant to any practices that have some form of ongoing maintenance or wellness programmes for their patients. The back door is said to be open when your clients complete your initial phase of treatment, receive your rehabilitation or wellness/maintenance recommendations, and then leave anyway!

You may not run a maintenance practice or even believe in the concept, and in this case, there is nothing wrong here; your practice is a tunnel with an open front door leading to happy healthy patients walking out the back door. However most practices in this day and age have some form of maintenance option which can range from a weekly, monthly, quarterly or bi-annual check-up. With most patients understanding the benefits to keeping their body in check with a professional. If you fit into this category, then you will also need to keep note of your back door statistics.

This might all sound like a lot of complicated statistics to measure, so unless you have software that can show you at a click of a button, the most simple way to review this is to find the average number of visits that each patients comes to your practice. Your patient visit average, known as a PVA can be worked out by dividing the total number of patient visits for a given period by the number of actual people in active care (including maintenance patients)

Obviously each patients recommendation varies, but lets say that your average initial treatment phase is 6-8 treatment visits; so if the PVA – patient visit average is 14 then you can make some assumptions that the average patient continues into some form of additional care beyond your initial recommendation. The opposite would be true if your initial treatment phase is 24 visits but your PVA is 6, then your side door is wide open and you might want to ask your staff if they think you are grumpy!

I have worked with very well established Chiropractic clinics where the PVA is close to 100. These practices have a very strong wellness base with thousands of patients in long-term active care. Only a small percentage of the weekly patient numbers are those in the acute stages of care. The benefit to this form of practice is that it is far less tiring for the practitioners (acute patients are much harder work, everyone knows that) it is relaxed and enjoyable as you build meaningful relationships with your patients, often seeing whole family’s, even several different generations of the same family. Lastly, it makes the business far more stable! I work with many practices that have busy diaries a year ahead, and others who have a patchy diary in two weeks time, booking from week to week. The later form of practice is very unstable, it may still be busy and profitable; but it hasn’t got roots. It is your decision what kind of practice you want to have for yourself, but my gut tells me that a stable business lets you sleep at night and lets you give the patients the best level of care. I know whole-heartedly that once I started to earn a lot more money, I managed to get myself out of the way. Meaning that the needs of my family were met, they were met on the first few days of the month; so I was able to treat patients because I loved what I do, without the staff wages and overheads hanging….. overhead! – Of course feel free to leave a comment below and tell me that you would never consider your own financial gain when discussing a patient’s treatment recommendations. Great, you are a better person than me, or a robot. I have worked in healthcare for nearly 20 years and now I coach practices across the world and run the world’s biggest Media Marketing agency for the healthcare sector, plus my own private practice! So I’m going to be real and say the things that people think and feel, but do not say – I point at the elephant in the room. I know all too well that when you are not making ends meet and you are having restless nights worrying about finances and a patient walks in with a complicated chronic condition, who wouldn’t metaphorically rub their hands together. Just because it is healthcare, it doesn’t make profit an ugly thing.

In Summary, make sure your front door is wide open, attracting as many new patients as you want and need. Keep your side door as closed tight as possible; try to work out why people leave your practice before you have finished your work with them. If you can get an honest answer they may surprise you, it lead to some big changes for me personally, within myself as well as in my practice.

Finally decide what kind of practice you want, if it’s a symptom/complaint/pain based practice, then you are good to go; your practice doesn’t even need a back door. However if you want a wellness or maintenance based practice its just as important to look at the back door. You may think you are a maintenance practice but if your PVA closely resembles your average treatment phase recommendation; in this case like it or not, you are a pain based practice. What can you learn from that? At the heart of much of the discussion will be patient education. Are your patients fully educated to make an informed decision to continue visiting your practice, if not – why would they invest time and money when they are unsure of the benefits to them! If you said to a gym member “l spend a year working out in the gym, then stopped and couldn’t understand why I got fat again” they would laugh at you. This is because they know the need for an ongoing investment – but not everyone is so clued up on what you do for them. If they think you are taking their pain away, then the natural thing to do is stop coming to your office once the pain stops!

Final tip, if you want to know peoples perception of your practice, at the end of your initial treatment phase ask them to complete a progress review form. Ask them to score their improvements on a scale of 0-100 and other clinically related questions. Next ask a couple of open ended questions such as “in your own words can you explain what [insert your name] has been trying to achieve in your treatment sessions” also, “can you tell me what specifically was wrong with you when you first came to our practice” and finally “in a few words, please explain what a Physiotherapist/Physical Therapist does etc”. Use the answers to better educate your patients about their health and your practice. Education is the key to empowering your patients to make better choices, to giving you a fun place to work, especially once the front desk team are part of the education process and lastly it gives you a business with deeper roots.

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