103 - The 8 Elements of Practice Flow That Drive Growth

Good flow leads to great patient outcomes because more people stick with their care plan and are able to actually get where they're trying to go as far as their goals and what chiropractic is bringing into their life. And that's the whole reason we're talking about this, right? So flow is really important to our businesses and setting up for great flow and looking where we maybe have clunkiness in our process.

Hello and welcome to Build you'd Remarkable Practice Podcast. This podcast is dedicated to chiropractors who are in the seasons of launching and building their practice. Join myself, Dr. Lona and my co host, Dr. Bobby as we have conversations each week as it relates to building the practice of your dreams. And remember, you can have a remarkable practice as part of a remarkable life, not instead of one. We are here to lead you on the way.

Hey guys, welcome back to Build you'd Remarkable Practice Podcast and I am here recording today by myself. So Dr. Lana Cook here with you. I wanted to jump in. We've been talking a lot in my office. We just added a newer doc and we've been talking about flow and establishing great flow. And flow is one of the things that I know we'll also be training on at the upcoming immersion that's in Phoenix here in the US first weekend in March. So if you haven't grabbed your tickets yet, we would love for you to join. Join us. But flow is something that all of us spend quite a bit of time trying to figure out how to make the flow better in our office. And if you're listening into this and you haven't thought about this, hopefully this will give you some nudges to really think about it. Especially when you ever feel like you're stuck at a certain volume or things aren't growing. One of the things that I know in my history of the last 16 years that I will continually go back to is looking at, well, where is the flow off, right? How do we set up better flow? And there's a lot of tangible and non tangible elements of flow because flow is really like how's the energy moving? And how are we able to allow people to flow gracefully in and out for their routine adjustments for their visits and have the whole team in alignment doing what needs to happen so that it just feels good for everyone, right? And if something feels clunky in our process or like something was off or we get really backed up. Generally there's some issues in how things flow is working. And in TRP coaching we actually call the crazy eight elements of flow that we want to look at that could be goofing up your flow, goofing up the practice volume because people are dropping out because the flow is off. And before I learned these eight, there were other things that I just really went back to in practice. A if we had a great week or a great day or a patient appreciation day, especially, you know, that can be a great time to really look at when you get squeezed, when you see more people in a certain time period, like, what felt good, what felt hard? Where did the breakdown exist if we were to do that every day of the week? Like, where do the wheels fall off? Those are great questions to squeeze at your team meetings and certainly in different parts of, like, even your board meetings to look at. Like, yeah, I like. I like the question of, like, if I was given another a hundred visits a week tomorrow, or where does our process break down and spend some time chewing through that with your team and look at, yeah, where does the process break down? You know, where can we do that? No problem. And where would we have some real capacity issues? So that was something that I like to play, a game that we would routinely come back to when we look in our office, and then other parts, too. A mentor said early on to me that when you're trying to see more people, you actually move slower. And I thought, that's such a weird kind of reverse thought process. But what he meant is, you know, you're going to slow down to speed up, right? Your hands are going to move gracefully. You're going to identify the primary subluxations. You're only adjusting the primary subluxation. You're going to say what needs to be said. But we're not bantering longer than needs to happen. We're staying focused in our table talk. I remember when I was at around 200 visits a week, trying to see 300 visits a week, and I asked my mentor, do I grow another hundred visits? And he said to me, you talk too much and you're too slow. And it was fairly cutthroat at the time. I just remember thinking, okay, and I went back to practice and I realized, yeah, there were things that I was talking about that I didn't need to be talking about. There were, you know, definitely parts of my week where I was goofing up the structure in my office by either spending time in the front office, like, annoying the CAs, asking questions that could have been saved for a team meeting, or not staying organized and consistent with our huddles and when certain communications should happen so that can be part of where we're goofing up flow too. Right. And if you're somebody who identifies as kind of a micromanager with their team, likely part of how you micromanage is slow, is slowing things down and goofing up the flow. Because we're not in integrity with our focus being where it should be during what I would call uptime or flow time. During high priority, we should be adjusting for doing exams, doing anything that relates to patient care, but not upfront micromanaging the cas. Right. So we're going to go through these crazy eight today, and I just want to spend a few minutes on each one of them so that you can start to kind of give yourself an internal audit of how am I doing? And is part of anything that I say today part of what you need to address? Right. So why people might be dropping out of care can relate to these eight things that really can goof up your flow, which allows you to see more people in any given period of time. Time. So the first one's pretty self explanatory. It's location. And what does your location have to do with your patient flow? For instance, our second practice was downtown Hudson, Wisconsin in a little river city. And there wasn't much for parking. So if you already work downtown, no problem, you could just walk into the office. But if you had to find parking and it was at 5 o' clock on a busy summer night when everyone wants to come and eat downtown, that could certainly goof up flow. Right? Where people are late, people aren't on time, people can't find parking. And that was one of the challenges about that location. So location can be your parking is goofy. Your access into your office is challenging. Anything as it relates to just the, you know, the actual access of getting to your practice. Number two, your schedule. Is your schedule goofy. You know, everybody wants to come in when they want to come in, right? Which is usually when you first open, right before lunch, right after you open in the afternoon, and the busy times right after work. Right. So can your schedule allow for people to get in so that they can come in when it works for them? And so this can be one of the reasons we really need to work on efficiency in the office is recognizing that people will stick with care as long as it actually fits in their life. If it's that you only have openings at an inconvenient time for them, then you're probably not going to have the capacity and the volume you, you truly desire because you're too inefficient and people can't get in, which makes it be a complication in their schedul rub in their own schedule. So we need to make our schedules accommodating and we need to be able to see people efficiently so that they can fit chiropractic into their life, not have to fit their life into our chiropractic schedule, if that makes sense. Yes, they need to have skin in the game and show up and they have to do the work. But it's great if our schedule is fairly accommodating and people don't have to wait long, which is another one of these, which we'll get into C. Or the third one is the service, the team. Right. So does your team actually have the bandwidth to flee? And that can be a really important question. Like maybe you're recognizing like we're at a point where we need to hire another DC in order to actually truly have the capacity to serve more people. Or maybe we need to hire a tech CA because we're at that point where when we see another 10 visits a day, 20 visits a day, you know, the process starts to break down. And I think many times, especially those of us that are in the season of build, as we're first building our practice and we haven't had too much experience yet of adding employees can sometimes think that, well, when I get to this next level, that's when I'll hire. When in fact, in order to get to the next level, many times it's making the hire in advance. So asking yourself, like, can my team actually deliver the service to provide more flow to the office? You know, where is our capacity? Asking where the true capacity of my team is right now, in the hours that we work and in the model of chiropractic that we're delivering, do I need to make a. Do I need to train better? Do we need to look at what my team is doing during our scheduled hours? Like maybe we're just not well organized because we've been missing huddles. We've not been, you know, keeping diligent in our focus. So that can be a team related things. Have we not been having our weekly meetings to keep everyone on the same page? Those can all relate to where the team could be off, off the beaten path, if you will, for building more flow in the office and staying focused during patient uptime? The physical space, a big one. All of us are in different offices, maybe with a thousand square feet or 1500 square feet or 2000 square feet or 2500 square feet. And depending on how much square footage we have and how many tables we have and how many exam rooms we have to sometimes get creative with how flow is going to work in our office. So I have open adjusting open adjusting. With three main tables in the open adjusting bay, we're now trying to bring in a fourth. So we're having to get creative in how we lay out. We did open up a doorway that this was just done about three months ago, six months ago, somewhere in there to help with how people exit the adjustatorium. Because we were moving into kind of the next layer of volume for ourselves. And we realized that the biggest rub in our square footage was when people were like leaving the adjustatorium that they could get backed up. We made a few different tweaks to how we do the checkout process, especially as it relates to checking out on some of our longer appointments, like exams, ROFs, that type of thing. And it really helps so that that's not a buckling point for flow anymore. So when you look at your physical space, and that's why that question of like, if I saw another hundred visits a week, where does our space break down? Where does our team break down? Where does my schedule get over full? And how do I. How can we address these things? How can we open that flow back up? Right? So looking at your space, do you need another table? Do you need to open a doorway up? Is there a way that you could change how you flow through the office? At one point we used to flow reverse of how we flow in the office. Right now, as we took on another 500 square feet, it just changed how our office laid out. And so we had to change kind of our check in process quite a bit. And it led to growth. Right. So we have to be looking for these things. The next one is your adjustment flow. This is actually like when the person, do they get themselves on the table? Then do you walk up and you start doing your analysis? Like, are they already in the laying position? Are they sitting up? How do you want them? Do they know this? A lot of what we talk about as the break in adjustment day three, where we show them how to flow in the office sets up where the patient actually flows onto the table in a way where they can relax, take a few breaths. The doctor comes, they're already in a good position. So the doctor's not having to walk up extra steps to get the patient from the chair on the table. That type of things, all of that matters and is also how there can still feel like everything's moving nice and slow and like in a great rhythm without feeling rushed. If we can help the patient already be in the position we want them to so that whether that's us walking into a room or in our case where we have open adjusting us moving on to the next table, that flow feels good. And a lot of that is just teaching patients right from the get what you'd like them to do, which is what we train on it when we're training on day three, right? So the adjustment flow of I'm going to check your spine, you're going to be in this position, then I'll do the adjustment and I'll teach you something. And that wraps up what your adjustment flow looks like and doing that repeatably because repeatability also creates more referability because people know what to expect, right? And people love to know what they're going to expect because it allows them to tell their friend then, hey, this is what I love about this place. And this is, you know, I never wait. And the adjustments are great and they do a great job of teaching you about what's going on with your body. Those are all things that lead to not only great flow, but then obviously creating opportunities to be referable wait time. Right? That's the other thing is if people wait too long in the office, like they're not going to stick around either because they have important things in their life besides them making it into the office. Don't get me wrong, chiropractic is super important. Of course I know that. And so is what's happening outside the office in their lives. So wanting to make sure that our wait time is appropriate and staying diligent to work to keep that on schedule so that we're not making people wait, that is for sure a reason why people drop out of care if they're having to wait a long time. It's a major rub. And so having somebody that if that's your office that has issues with wait time, having the ca know how to help you stay accountable to staying on your schedule is important. And a lot of times refer back to what I said, right? We need to talk less and be more mindful of what's appropriate to be having for a table talk. And then the last part is that table mastery and this, you know, again is knowing how to be aware and cognizant of what's happening in your space. You know, if you're in a one doc model right now and you have multiple tables going at one time and then somebody is also coming Back in as an ROF or a RE exam or what have you. That table mastery is knowing how to prioritize. Okay, I'm going to adjust these two people. I'm going to then go in the room, I'm going to start the consultation, or I'm going to do this. These are parts of almost like learning in what order and in what sequence do I do things not only in table mastery of, like, what do I need to say while I'm, you know, adjusting this person to help them connect to what is happening with the adjustment. Obviously being able to actually do what we say we're going to do, which is deliver the. The art of the adjustment, but then also knowing, like, how do I want to flow? I used to call it Yahtzee time in the office when, like, lots of things were happening at once. Like 10 people walked in an ROF, showed up early or late, and then there's a RE exam that's happening. You know, babies need to be held. Like, that's the fun time in the office. And so we really have to work in our own mind to realize what would be the right appropriate flow to make sure that the least amount of people have to wait. And everything still flows really well. And that's an art form as a team. And that's why I say at the beginning, when I said, ask your team what would break down if we saw another 50 visits a week, another hundred visits a week. You know, imagine that many more phone calls or that many more text messages coming through, or that much more, you know, credit cards being swiped. Like, where does the process break down and how do I help each one of my team members have mastery in their role so that they feel good that they could flow in an appropriate way, more people through the office to receive what we are giving them so that they can access the benefits of chiropractic and have that make a difference in their life. So good flow leads to great patient outcomes because more people stick with their care plan and are able to actually get where they're trying to go as far as their goals and what chiropractic is bringing into their life. And that's the whole reason we're talking about this, right? So flow is really important to our businesses and setting up for great flow and looking where we maybe have clunkiness in our process or things that just consistently create rubs in either the floor plan or a need for another table or a team member that's maybe in the wrong position. And when we address these things and make those changes we get better flow and our office feels smoother. We might be even seeing quite a bit more people, but it feels better and that's fun. And that makes practice really fun. And that's how it should be. Practice should be fun. So just wanted to do a short episode and go back through, kind of ask yourself, you know, yeah, where is our rub? Where would we break down if we had another hundred visits? Go back through those, those eight different things. So location, schedule, your team, your physical space, the new patient process, and the process of your longer visits, the adjustment flow, your wait time. And then obviously, do you feel that you have mastery over your adjustatorium and your table management and your table talk. And you can share this with a friend who also needs to do a deep dive and look at where their flow is blocked. All right, thanks, guys. We'll see you in Phoenix very shortly here.

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