Painless Physio Practice: Essential Systems for Health Clinic Owners

You can have a people problem and there are four reasons why people don't perform. Number one is that they don't know what's expected of them. Number two is that they don't know that they're not performing. So we haven't gone and said you're not following the system correctly. Number three is that they can't, so we need to train them. And number four is that they won't. And that's when we do have a people problem and we need to invite them to express their talents elsewhere.

If you work in a health practice, so that's a physio osteo chiro in the allied health space, you're going to want to really listen into this episode today. We're going to explore the most critical systems and processes that I think every clinic needs to nail. And I'm joined by Cecilia Champion from Painless Practice. She's the managing director there and has been for over 16 years. So she knows exactly what it takes to run a highly functioning practice. She's a lover of systems and systemology, so I couldn't be more excited to be joined with her. So firstly, welcome to the call system.

Celia, thank you so much. Dave, thank you for having me.

Yeah, maybe just to start, can you tell us just a little bit about what Painless Practice does and how you. You coach people in the space?

So we help our clients on the business side of their practice. So we. We're not practitioners. In fact, I do have a practitioner now that's just joined me who does some. She, she's a physio but she also does some coaching, so that's great. But we generally help on the business side of the practice. So.

Business planning, growth strategies, leadership support, patient retention and then very. A very big kind of area is exit strategy planning. So it's kind of thinking, you know. Yes, take your business one day and, you know, if you want to sell it, what does a business need to look like in order to sell that business? So that's kind of. We start with that as soon as we start working with the client. That's one of the first questions we ask is what does your exit look like? Yeah, so we work on all sorts of non clinical side. I suppose the only clinical bit that we get a little bit involved in is a patient communication.

Yeah, I find the exit stuff really interesting, particularly when we're thinking about.

You know, practitioners, because they do the technical work, oftentimes they're seeing the clients and they're building a business where they are the business For a lot of them. And they don't think about this. I don't know if there's any. Yeah. Any key things that jump out at you. I suppose you just have to start thinking about this and building the business so that it works without you.

And, you know, they might be. It might be that the practitioner decides, actually, I just do want this to be a lifestyle business. I do want to be the practitioner and accepting that maybe the value of the practice is just not going to be as. As much at the end of their journey. A lot of practitioners are actually reliant on their practice as their pension. So a lot of practitioners don't have, you know, when you go into private practice, you might have. You might have, maybe you've worked at the NHS and you've got a bit of a pension from the NHS that's there, but it often isn't enough for when you want to retire and stop working. So a lot of the time practitioners are reliant on being able to sell the practice and unfortunately, sometimes that penny only drops when they getting like two, three years out of, you know, wanting to retire and come to us and say, I want to sell my business and they are generating 90% of the turnover.

Yes.

Then we've got to kind of work with that and start bringing, you know, kind of looking at the value and then looking at the work that's needed to. To grow that business so that it's got a better prospect of sale.

Yeah, definitely. In my line of work, focusing in on the systems piece, I know it's a critical step to get those core processes down so that tasks can be delegated, so that you remove that key person risk and hopefully move beyond the solo practitioner and build something that's got a bit more value here. So I think the session that we'll jump into, where we'll walk through the critical client flight, will be really helpful for practice owners. Generally, when I'm working with someone, we kind of just capture the current state and best practice. And why I was keen to chat with you was we can actually dive into best practice. So rather than where someone's at, you know, we oftentimes just get someone to stabilize where they're at and make it repeatable. But with you, I think we got the opportunity to go a lot further and say, what are the key systems? What do you see works best across all of the businesses that you work with? And I think that'll be really helpful. So I'll bring up the iPad in a sec. But if we pick a Practice owner and a hypothetical. I think we've kind of bounced around some ideas before thinking perhaps a physio.

The critical client flow that we're going to design. Now can you explain or describe the practice owner, like the type of business they would have that this would be ideal for? Like what situation are they in, what sort of team members do they have and yeah, maybe a little bit about their business.

Okay, so if we just choose a practice owner, let's say they're physio, they are probably still working mostly in the business. Maybe got a team of, I don't know, let's say four or five physios, maybe work for them or maybe maybe they have more. But you know, let's say they have the equivalent full time, four or five. So they might have lots of part time physios or they might even have other practitioners in the practice as well and they might have front of house team or they would have a, like a call answering service.

Yeah, yeah, perfect. All right. I think that's going to speak to a large number of practice owners. So let me share my screen and.

Jump into this. Yeah, we'll just walk through.

The critical client flow here. Very good. And if thinking through the lens of that person, how would you define like their ideal client, their dream client, what, what characteristics would make it a dream client for physio?

So I'd say definitely one of the things would be that they are self paying and insurance. I mean there's some insurance companies that are, that are fine to work with but there are some that just drive the prices down and it's just not good for the practice. So I'd say self paying and patients that are motivated to get better and are willing to be part of that journey and not just.

Kind of expecting to be fixed.

Yeah, and things, any sort of demographic, things like it's probably male, female, married, single age, anything like that that kind of would stand out as an ideal.

Probably someone just again around the self paying thing. Someone with more disposable income.

Yes.

So I guess, you know, without being generalistic, you're probably looking at say I don't know, let's say 40 to 60. I mean, you know, the retired community often have a lot more disposable income than the working force and you do get some younger, younger clients that are motivated to get better, motivated to keep in their sports. So therefore are happy to spend money for a physio.

Yes. Yeah, perfect. And what do you think? Because the physio is going to offer a variety of services And.

I'm imagining people come to them with a variety of different needs. What would be like a really common.

First port of call or first product or service that that physio would sell to that person.

So they'd have an initial assessment and then they would have a course of care, let's say a course of physio care and they might then integr evaluate some SNC and they might have, let's say Pilates classes.

Yeah.

And maybe I'll focus this critical client flow in on. Let's do that. Just like the assessment, they've obviously that individual, the self paying, motivated 40 to 60 year old has got some ailment that they've thought, right, I need to chat with a physio about and there's some sort of assessment and then course of care that would follow that.

Yeah.

So generally like what are some of the best ways for physio to gain attention of their target audience?

So word of mouth is usually quite a significant one in, in most practices.

Yeah.

And then I'd say the next one would be their website and Google Ads.

Yeah.

And then a lot of physios have developed really good relationships with other clinical people. So like consultants and GPs and you know, any, any other kind of clinical professional.

Yeah. Okay. Almost like referrers.

Yeah. So they're some best practice ones. I know sometimes.

Business owners, when they hear different channels and think about what they've got, sometimes if they struggle to come up with some, it can be an indicator and you're like, oh well maybe that's why you don't have good lead flow because you haven't yet dial in some of these lead generation methods once the physio grabs the attention of that target audience. Like I'm assuming if someone is looking for an assessment and they've got a pain, then they're searching for that solution to that pain. So they might be seeking out a physio in the area or running some searches. So I can see how Google Ads would be a really good fit there. What is generally the first sort of port of inquiry? Like is it probably through the website or the phone or.

Yeah, yeah. So I mean a lot of physios now have online booking which I think, you know, public respond to. I know if I want to book something it's irritating if you have to wait for the next day to phone.

Yes, yeah.

So you know, online booking is a big one and then, and then like, you know, it could be the initial phone call.

Yeah, perfect.

And then some people do have inquiry forms on their website as well. But I'd say the online booking and the phone call are probably the two that are most used.

Yes. Yeah. And then what generally happens, like, I'm assuming, you know, off the back of the phone call.

Like before, like, is there any sort of. I suppose it's not really qualification, like they're booking in to come for the assessment, which is effectively.

Where the course of care is determined. So there's not a very long sales cycle here.

No, I'd say where you have clinics, say, let's say, like I've got, I work with some speech and language therapists as an example, and some neurophysios and sometimes their.

Port of entry is a case manager. And then the sale process will be longer where they'll be involved in having to give a quote and get it approved and get approved by the solicitors and, and that's a longer sales cycle. But for a, for an MSK physio, people are looking for a solution to their problem. If your website tells them that you're going to help them, they're going to book online.

And then is there any manual work or anything that's done in the background at all as far as setting up a CRM or, you know, I'm assuming maybe when they do the online booking that kickstarts, you know, or does that kind of happen when they come into the practice? Then they might fill out some forms. Like what generally what happens after that? Online booking or appointments made.

So if, if it's an online booking, there'll be an automation where they'll get new patient forms to fill in. You know, they'll get the confirmation of their appointment, they'll get some information about the cancellation policy, they'll get information about what to wear and then, and then the ideal system would flag up, would automatically flag up if that patient hasn't filled those in before their appointment so that they can get in touch with them.

Yeah. Okay. So some sort of like new forms, I think. I mean, the great thing about the physio here is.

It'S not. And I, and I compare it to some other businesses, it's almost like that doctor patient relationship where they're the trusted advisor and we, you don't need some big long sales process writing out proposals and following people up and all that is very heavily simplified.

Yeah. I guess where there is a tiny bit of sales process maybe is where if they don't just directly book online and they phone the clinic and they're not quite sure if they can be helped. So Then they need to make sure that they've got a really well versed receptionist on board that is absolutely, you know, knows the business and knows what, what they treat and what they can't. And if they can't answer the question that they very quickly offer to get a physio to get in touch with that patient. So there's, that's where the sales process might come in, in the section. And that's super important to have the right systems in place and have those front of house team members really, really well trained.

Oh hey, I know you're tuned in right now, so I'll keep this super quick, but you like awesome YouTube videos, don't you? Well, there's not really that many YouTube channels that create great content about how to systemize your small business. So I want to make sure that you catch every video that I publish. So if you haven't already, firstly give this video the thumbs up and then go ahead and subscribe to my channel. You can even hit the bell notification to make sure that you're the first to know when I publish anything. So go ahead, do it right now. I'll wait a sec and then I'll transfer you back to the video.

Yeah, perfect. I'll split out then. Maybe the phone booking with the online booking, I mean someone could come via either channel but I think there'd be a worthy system there to catch. And then yeah, they get some new patient forms. They get sort of into the system to make sure that it may be some sort of automated follow up or.

At least some sort of flagging if some forms are missing or they're not quite well prepared for that session and then they arrive at the. So that probably even happens before. And then I'm assuming also when they.

Suppose in between them, in between them filling in the forms and send, you know that they, they get sent, they'll get a 24 to 48 hour reminder.

Yeah.

Before they arrive.

Yeah. And then when they get in there there's.

There'S often like some sort of greeting process or something. I'm assuming that the receptionist probably has a process for the way that she does the greeting.

Yeah. So either they'll have a receptionist that does a greeting. I do have some clients now who have gone quite tech and so they've got like an app and the patient can book in on, on their app and they can then check in when they get to the clinic. Some people put iPads that people just check in on. But yeah, either it's a, it's a greeting by the person or there's a some form of check in. Even if the check in is your practitioner will be with you in a while. Please have a seat as a sign on the reception desk is what I've seen as well.

Yeah, I think that sounds good. And then there's the session itself where that's when they do the assessment. And I'm assuming there's probably a little bit of a process in that. There's probably some different steps and milestones like obviously do the assessment but then they'll need to make recommendations on next steps. Does all of that happen in that session or.

Yeah, mostly. So they would do the. They'd kind of take the case history and they'd conduct an assessment.

So some clinicians and especially chiropractors will maybe have their assessment and then they'll get the patient back in for another appointment to do the reporter findings. I'd say most physios, so in this context that we were talking about a physio clinic, they would be doing the assessment and then probably explaining to the patient what their findings are and giving them treatment recommendations.

Yeah, perfect.

And then the best practice with that is that the patient gets something in writing. I just find that patients are a lot. Physios retain their patients better when the patients have received something in writing just because the patient's not going to remember.

Everything and that's post or they do that in the session and they walk away with something.

So some of my clients will actually have pre printed treatment plans. I keep it super simple. One page that they complete and they scan in for the. To. To keep on the patient's notes and the patient actually takes it away with them. I'd say in most cases people get it post session and now with AI notes often that summary is generated while. While the patient, while the practitioner's taking the notes. And the practitioner will just need to check through that summary and then send to the patient.

Yeah, love it. And then are they booking in the next session at that first session or is there a follow up or best practice?

Yes, book in the session. And actually even if you, if the clinician knows that the patient needs say three to four sessions, they try and book blocks of those sessions in so that the patient gets the right care in the right interval of time. Especially if they're busy clinicians.

Yes. Yeah. You mentioned something that caught my interest. I'm curious to know.

Where in this you're seeing AI start to.

Introduce tools to speed things up. I think you mentioned the.

In the session itself for the notes. But are there any other areas where you're like, oh, new tools are popping up for clinicians that really help.

So it's mainly patient notes, which I've got quite a number of clients using now, which they just save. So it saves so much time. And then the other thing that practitioners are using quite frequently is ChatGPT. So using ChatGPT to generate newsletters, to generate, to generate systems, policies, procedures, processes.

Yes. Yep. So AI is kind of going in up near the website stuff. AI is going down.

Yeah. The other thing that we're starting to see an impact on is just like the, the, the success of Google Ads had started dropping like kind of across the board. And it was because.

Like when you searching for something, Google are, are pushing down websites that are mostly AI generated. So.

Like kind of our, our marketing arm are looking at, you know, just making sure that that's not being, that our clients aren't being impacted by that. So changing the wording on the websites, adding more frequently asked questions, making sure that they're getting lots of Google reviews.

Yeah, yeah. I love that when we look at that because I think that flows really easy to kind of follow along. And I think someone can, as they're watching this, they'll start to think about where in their process the holes are and they'll start to go, ah, I haven't really thought about what is the process behind this box because each box I feel can end up becoming a process. Where do you see are the most common issues when it comes to practices? Like what, what areas do they struggle with the most in the critical client flow?

I think the rebooking actually.

Where we fall down a lot where like patients fall out of care and then there's like. So, you know, when I started working with a client, they say, oh yeah, we run a cancellation list once a month. And I'm like, well, if I'm in a episode of care at the beginning of the month and I don't turn up for my third treatment on the 1st of September, what are you doing? Only following up with me on the 30th of September, like I'm supposed to be seeing you once a week.

Yes.

Leaving for a whole month is too long.

Yes.

So I think that's a really, really key area of like the patient retention section. So like that making sure that you're getting your patient rebooked, making sure you've got a system to catch patients that fall out of care. Because, you know, as a physio, if you're treating 40, 50 patients a week. You're not going to remember. Oh, Celia was supposed to be here this week. I didn't see it. Maybe three or four weeks time. You might think that's really weird. I haven't seen Celia. I wonder how she's getting on.

Yes. Yeah. That feels like very low hanging fruit as well because, I mean, it's massively.

Low hanging fruit already.

Come along. Signed up. You've already, already diagnosed the issue. They've started the treatment plan and really somewhat committed at that point in time. Once, once they've started, you kind of. It's like taking antibiotics, you've got to go all the way through.

Yeah. And that's also where there's, there's a problem in, in terms of, say, for instance, let's say you've got a physio that's just started with you and they just come out the nhs. And in the nhs they really strained, so they can't actually give as much care as they would like to give in under the nhs, but they've got to get the patient out as quick as possible. And so they come with that mindset of we've got to get the patient out as quick as possible, whereas a private patient's not coming for that service. And also because in the NHS there's no money changing hands with the physio and the patient, it, it makes it harder for the, for the physio coming into private practice to think, oh my gosh, this patient's going to be paying me £600 for a course of care. That's a lot of money. And so they almost subconsciously try and under recommend, if that makes sense. So that's a big, that's a big hole and we need a process for that.

Yes, yeah. Does that happen in the, that first checkup session like that? That's also part of the challenge, which is they're not recommending what's best for the client.

Yeah. They're kind of getting them to book the next appointment without saying, look, you know, you are going to need probably four to six treatments. Let's get them booked in so that we can get you back to playing golf.

Yes, yeah. Are there any other places that you think they struggle with? So definitely, once they've got the client and working with the client to make sure they keep coming back. And then they're also fully recommending what is going to get the client the best outcomes. Are there any other spaces where, again, just common areas of challenge for physios?

Probably the marketing area. You know, I think you know that. So I think just making sure that you've got a decent website. And again that kind of comes down to maybe sometimes some money mindset stuff where they think I'll save money and make my own website and then it doesn't work properly and it doesn't look great because they weren't, they're not graphic designers.

So that, that fear of spending money on, on, on marketing.

Yes.

Is quite a big thing as well. And, and then just also like once your website's there, like what do you, what do you need to do to maintain it? And you know, if you've got someone else that's maintaining it, fair enough. But you know, there might be things that like you have a system in place that you make sure that you're asking for X number of Google reviews every month or you're adding blogs or adding FAQs or you know, doing something on your website if that's, if that's what you've got to be doing.

Yeah, yeah. I love that. I think, I mean.

Everything that you've said here makes sense. Like I feel like it's common sense and I know common sense is not always that common and sometimes just seeing it visually for a practice owner, they'll then go, oh, okay, well that explains why I'm having certain challenges in my business. I don't have a system for generating leads or thinking about how those new inquiries are coming in or I'm not maximizing the potential of the existing clients that I've got. And these really are just a collection of systems I'm imagining. Like this is effectively what you've built up over the years is just figuring out which pieces work for a practice owner and then helping them install it systematically.

Yeah. And even things like another area suppose for the smaller practices is not being able to afford to have a front of house, house team and then thinking that launching machines enough and it's not, you know, they'll be losing new patients. So you know, putting a system in for that is really important. And then the system for the call answering service is really, really important. You know, we've just, we've been, there's there, there was a, there is a call answering service that have been working for years in the sector and they, they were, they were taken over not, not so long ago and the service has just kind of like dropped.

Yeah.

Bottom. And, and, and I think in some senses it's just that the systems haven't been, either they haven't been re. Explained to the new team members or they've just not been implemented. I don't know what there's, there's a problem then got to look and say what's, what's fallen over here.

Yes. Yeah, yeah, I love that. I always think every problem in business is a systems problem. So if the new team aren't running with it, then yeah, it's got to be something to do with a recruitment system, an onboarding system, a training system or.

You can have, I guess like a people problem. And I kind of look and say there are four reasons why people don't perform. Number one is that they don't know what's expected of them. So we need to give them the system and show them how, you know what, what's expected. Number two is that they don't know that they're not performing. So we haven't gone and said you're not following the system correctly. Number three is that they can't so we need to train them. And number four is that they won't. And that's when we need to, that's when we do have a people problem and we need to invite them to express their talents elsewhere.

Yes. Yeah, I love that. I'm excited to get your thoughts on the new Systems Champion book because that, that's, that's the way I've kind of explored it. It's almost like. And how do we systematically remove those excuses? So someone can't say but I didn't know or I didn't know it was expected of me or I didn't know how, like you want to get rid of those excuses and then it makes it much easier to manage someone and deal with, you know, the most challenging of I don't want to, which, which sometimes can mask a lot of other reasons, but it's definitely more of a performance management at that point in time. So. Yes, well, exciting. Well, I don't know if there's any final things you'd like to leave us with or anything for practice managers that you'd like to mention in closing.

You know, I think so. I think one of the, obviously we've spoken about the patient retention as being quite a low hanging fruit and something that we can fix quite easily. The other area that I think practitioners really need to be proactive with and not kind of reactive is the recruitment process. So a lot of the time it's just, oh, let's advertise, get someone in, have a bit of a chat and then you end up with the wrong person. And so I think there's, there's a real skill in recruiting and interviewing and selecting and then obviously the leadership part of it of it's not abdication by you, just. Okay, here we go. Here's a room. Here's your. Your clients. You're delegating those clients to your physios and you need to have those one to ones. And I almost say, you know, you've got to treat your, your business as your most important patient and that means that you need to have your one to ones with your team members. You can't push them out because a client, suddenly you need to see a patient and then suddenly you haven't had your one to ones with your team members for three months. So that's. That again is a big area that, that needs systems.

Yes. Yeah, yeah, I love it. As you start to expand like the critical client flow really only captures how the business really delivers value and makes money. But there's other pieces that need to be explored. From the HR piece to the management piece to the finance piece. There's. Yeah, I think. Yeah. Well, what I'll do, I'll appreciate you diving in today. I know this is going to be really helpful for some of our practice owner clients. I'll also pop a link through to.

Painless Practice. So if people want to explore a little bit more about the work that you do, is the best place just to send them to the painless practice.com website.

Yeah. Or they can email me directly. Celiainlesspractice.com.

Yeah, fantastic. All right, well, thank you so much for your time.

Well, thank you, Dave. Thanks so much.