235- Key Performance Indicators with Dr. Nathan Unruh

Welcome to the Evidence Based Chiropractor, where each week we deliver the latest chiropractic research and marketing strategies, all in the time it takes to get to your office. Now, here's your host, Dr. Jeff Langmaid.

Hello and welcome to the Evidence Based Chiropractor. I am your host, Dr. Jeff Langmaid. And on today's episode, we are talking about something that is critically important for your practice and that is the business of your practice. Not too long ago, I had the opportunity to sit down with Dr. Nathan Unruh of Sidecar and they have helped thousands of chiropractors around the world, really at this point with the business side of practice. I know all of us get into chiropractic. We are focused on the clinical, we geek out on the clinical. I even touch on the clinical and the research each and every week on this podcast.

And.

But to have a strong practice, to be able to continue to serve people, you also need to have strong systems regarding the business of your practice. This is where Sidecar has helped a lot of people. I have seen the Sidecar name at a vast array of conventions. I wanted to learn more about them myself and thankfully Nathan had the opportunity to sit down and chat with me. I think there is a lot you can learn in this episode and in this interview. Also, check out the episode highlights. We will have a variety of links for you to learn more about Sidecar. But without further ado, here's my interview with Dr. Nathan Unruh.

Hey, everybody. As promised, I am here with Dr. Nathan Unruh, Chief Experience Officer at Sidecar. Nathan, I really appreciate you taking some time to share with the docs today. And for any docs that are unfamiliar with Sidecar, I'll have you lead in right there. What isn't.

Great question. So here's a, you know, people ask us about Sidecar. Why would you name a chiropractic company Sidecar? And here's what it represents. If you look at a sidecar, you've got that little car sitting right next to that motorcycle. And so what we tell the people that we help and come alongside is we're there to guide them. And they, they're driving that motorcycle. They can, they got the accelerator, they got the brake, they can navigate the bumps, they can run right through the bumps, but we're here to guide them through those bumps. And so that's why we named it Sidecar. And really what Sidecar is, is it's an organization that's about, number one is business development. So what are the business development Procedures to really develop a business that's patient centric. What's going on with the marketplace right now? How do we develop a strong business? Number two is billing. We have a whole billing team, a revenue cycle management team that handles billing for doctors all around the country. And I think the other piece of this whole thing is a belonging, Jeff. As you know, as you get to talk to lots of different chiropractors out there, we're seeing associations that aren't as strong as they used to be. We see both national organizations and also at the state level. And as I look at that, it says, I think there's a lot of chiropractors that are looking for a voice. And I would contend, Jeff, that we're more alike as chiropractors than we're disalike. And we have a tendency in our profession to sometimes fight over turf, whether it be a technique or philosophy. But I know this at the common cloth that links us all is we're all small business owners and we have a responsibility. We feel at Sidecar to come alongside doctors, knowing that there's a lot of great doctors, great at healing, great at offering hope and inspiration to their patients. But you know what? They didn't teach us how to run a good, strong business. And I love thinking about your organization, about being about evidence based. Well, here's the thing. Let's bring some business evidence into the business of chiropractic to make sure that we see more doctors succeeding.

I think that that's so key. And there's a couple of things. Number one, you're looking at my notes because my second question was about the name, but you took it from me.

So.

But there's a couple of things there that I think you brought up that are really important to me. Number one is you started with the fact of patient experience, and I think that that is so critically important. And then how that ties in to what's lacking in probably, I'm going to estimate 90% of docs out there, their business development isn't where it could or should be, and they're not maximizing their tool set. Ultimately, you know, what we do with a chiropractic adjustment is so powerful. What we can and how we can impact lives is so powerful. But you have to have the patients coming in to make that impact and you have to grow a strong business to be able to do so. I'm imagining my question you're going to dive into this is how did, how did. Was this a frustration for you? How did you get started in all this, where did sidecar come from? How did you think about this? And what drove you to the point of where you are today?

Great question. So I've been a practicing chiropractor for 20 years. And my father, my brother, all chiropractors. My uncle's a chiropractor. And, you know, I graduated from school and started my practice. And I found myself one night, Jeff, laying in bed and staring at the ceiling, tossing and turning, seeing the little numbers on my alarm clock go from 12:30 to 1:30 to 2:30. I think we've all been through that, trying not to wake up my wife. And finally I sit up on the edge of the bed and I'm just frustrated, saying to myself, I hate my life. I get up out of bed finally, and I walk into the bathroom and I catch my reflection in the mirror, and I look at myself. I said, dude, you can't keep doing this, and you've got to make a change. And at that point in time, I made the determination to change. Because here's the thing, Jeff, I was angry at that time. I was angry at why did I become a chiropractor? I was angry at the school because somehow it was their fault that I wasn't successful. I was angry at the bank. I was angry at everybody but myself. I was also found myself just confused. I didn't know what I didn't know. I was taking seminar after seminar trying to become a better doctor clinically. And I thought that was the answer. But finally, that wasn't the only answer. Clinical competency alone wasn't going to make me successful then. I was also in a state. I found myself very bitter, just more like victim language. That's where I was. It was at that point in time when I looked at myself in the mirror and said, you've got to make a change, man. I started to read everything I possibly could about business. I started being around people that were good at business, both inside the profession and outside the profession. I started to put a plan together to understand. We talk about patient experiences. Well, what does that mean? What are the components of a great patient experience? Where's the evidence for that and how do I manage it? Through key performance indicators, not some of the old dogma that we see presented that's been around for 30 years or 40 years or even more. And so when I dove into that, and this was a point in time, Jeff, I was labored in debt. I had a family to take care of. I didn't know some days how I was going to stay open. And it was then when I made this commitment, I got on the other side of that, paid all my debt, started to run multiple chiropractic offices and started to scale my business. Started to use stuff like. One of our textbooks is the E. Myth Chiropractor. That was authored with Dr. Frank Savinsky, who is one of my mentors, who's now passed on, and he authored that book with Michael Gerber. And if you know anything about that book, it's still considered the E. Myth. The original E. Myth, considered one of the top five best business books of all time, no doubt. We took that information, we brought that into the chiropractic. And so when I did that and started to do that, got on the other end of it and ultimately became the business owner I wanted to be and the human being that I wanted to be. And so it made me real proud to be a chiropractor.

That's so impactful because. And I appreciate you sharing that, because I think there are a lot of docs out there that do play the blame game to a certain degree. And I imagine that a lot of the docs that you work with come in with some very common challenges that you have to address and overcome. Maybe dive into that a little bit. What are some of the common challenges, the common obstacles that you see as you get started working with a doc that just are these things that you know it's coming and you can't wait to see the results of after they start to address these things with you?

Yeah. So, I mean, great question. I think that, you know what we talk about a lot of our clients that come in, they're good docs. They got great hearts. You know what? They want to serve their communities. They're humble, they want to learn, they're open. But they find themselves frustrated because they're getting mediocre results. They're successful by some standards, but not by their own. And so they've tried things. They've tried practice management techniques, they've tried things. They've. They've heard things from people from platforms tell them to do certain things, and they just find themselves working harder, not enjoying the fruits of their labor. They want more time, they want more money. They want to pay off their debt. They want a good team, a team as good as they are dream team. And they really want also systems and procedures, and they want to really capture their dream that they always thought about being a chiropractor and live what we call an affluent lifestyle, which is really a flowing towards an abundant Supply to live the life that you desire and a life that gives you options. Now, that's just not. People think right away when I say that that's about money. It's much more than money. It's about the depth and breadth of the relationships you have. It's having a business that is flourishing. You're a thought leader in your community. You're seeing the new patients that you want to see, you're seeing the reactivated patients you want to see. And you're really proud to be a chiropractor. So these clients that come in with those agitations and those frustrations, we help them become confident business leaders. And once we start to get their brain wrapped around what does it look like to run a patient centric business based upon key performance indicators, allowing them to take a deep dive and do a business needs analysis and figure out their gaps, they're like going, oh, wow, I can now be a great technician, a great doctor. Now I'm a confident business leader, so I'm a good manager. And then we connect them back to that entrepreneur inside them that just wants to solve people's problems.

That's such a key aspect because one thing you touched on earlier that resonated with me, and everybody's different, but in general, what I've seen is the amount of letters sort of after the last name can be a reverse indicator of the amount of income, you know, as people get Doc, we as chiropractors get so caught up in being the best clinicians we can. But sometimes that technician mentality can take away from the entrepreneur. Doesn't mean don't be the best doc you can be, but it means that you also need to focus on. You need to have just as much passion, you should have just as much passion for ensuring that you can continue to serve. And the way that you do that is by creating, as you said, a healthy business and ultimately being able to serve people. One of the things you just mentioned that I want you to dive into a little bit are KPIs and key performance indicators. I think there are way too many chiropractors out there that track like zero of these, aside from what's left at the end of the week. Right. Maybe dive into your thought process on KPIs and maybe even give us a taste of maybe one or two that you think DOC should really keep an eye out for and that you guys train and coach on.

Yeah, I want to touch on. You just said something really brilliant there, Jeff. I mean, you just. And I hope everybody heard this Is that what you said? Is that they get so caught up in the technician? That was me. I bet you that's been you. I mean, you look at it and thinking, I mean, I had more shiny objects I was chasing. I'd go to seminars to the point where I walk out of some of the vendor areas and I feel almost greasy and I'm buying all this equipment. I mean, at one point in time, I was bragging that I knew 11 techniques. I wasn't good at any, but I had 11 of them. And so it's like you. But here's it. You have to be clinically a master. You have to master what you do to be good at anything. I don't care if it's a doctor, whatever aspect it is. But you also then have to be great business owner. And the number one responsibility, no matter how good of a doctor you are, no matter how big of a vision you have, you have one responsibility as a business owner, and that's to make a profit. And profit is not a dirty word, because if you can't stay viable as a business, you can't impact your communities. So therefore, when you start pulling apart key performance indicators, I mean, what's the typical statistics we always hear in the world of chiropractic? New patients, number of patients for per week, right? How much are you billing? How much are you collecting? Pretty standard, right? Even though those are good numbers, they're all downstream numbers. So therefore, how do we look at what we call leading and lagging activities? Leading and lagging, meaning how are we going to affect the business at multiple different levels and looking at a KPI dashboard to know, hey, are we really providing a great patient experience or are we not? So let's use one right now. Net promoter score, MPS score. Every one of us has been asked these questions we have now that I'm telling you it now on this discussion, you'll notice it more. It's what the Fortune 1000 companies use, and it's something we're introducing more to chiropractic of how do you start to measure your customer engagement? So, for instance, as you go through and look at the KPI, it really looks at three different components. Number one, do you have promoters? Number two, people that are passive or number three, detractors. There's a way to measure this, and we provide a dashboard in order to help measure this. But the goal would be for this score is that anything that's positive would be above zero is positive. 60 is really good, 70 is world class. Okay, we want doctors of chiropractic to become 70. Here's why that's important. That KPI then feeds into the other KPIs. If you want to see more new patients, you better have a world class customer experience. Unfortunately, we never go ask our current clients. Now, you got to be prepared when you ask them. You got to be prepared for what they're going to tell you.

Right? There's a catch. There's always a catch.

Yeah. So therefore, when we start to measure that number, though, here's the next KPI I love is the reactivated patient number. So your reactivated patient number should be 50% of your new patient number. And I'm going to tell you now, if you couple the net promoter score, the NPS score, you're going to see the fact that the people that are reactivated are going to be more than 50% because you didn't screw up the relationship in the first place.

Yep.

And so therefore, again, I'm just, I'm going high level with you here, Jeff, because we have like over 30 KPIs that we measure and we put into a dashboard. But that takes the emotion out of it because unfortunately, as chiropractors, we have a tendency just to operate via what's in the checking account and not with the logic. What's the evidence showing us right now in the business of how the business is performing? Let's be asking our customers, the patients that we serve, let's look at all the KPIs. How about the amount of time that the patient's in the office? How about the active retention number? Not the retention number. That's an old dogmatic statistic. So again, our take on key performance indicators is that you have to track them, but then you have to actually implement a training program to affect them. And so when we look at training and development, I'm always amazed by the number of doctors, as much training as they put into themselves from a technique. They don't have a business development system. I always tell doctors, whether you use Sidecar to help you on that or not find somebody to help you. And if some in, the key to it is these four things. You've got to have great content. Great content that has a proven track record, that has evidence, that shows a proven track record of success. Number two, repetition. Repetition is the mother of skill. So so many of us will go to these seminars and we'll sit in conferences and we think that's training. That's not training, Jeff. That's exposure. We get exposed to information, but we need repetition to really make it stick in the DNA of the organization. So you have to have a business development system that has repetition. The third component is role playing and being able to practice and role play. How do you practice and role play not just what you're doing with the patients, but all the way the patient flow state takes place, the financial accuracy of your business, how you're presenting insurance, the insurance benefits, how you're asking for payment, how are you handling the financial components of it and role playing all of those pieces and then also the fulfillment. How is your team answering the phone? You know, we do secret shoppers to our clients. Just merely how we answer the phone is. I'm amazed how that's overlooked. So again you need practice and role playing. And then the fourth component of a good business development system is accountability. The ability to track, measure and monitor it. If you can't track, measure and monitor it, it's a bad system. So just again as a review, great content, repetition, practice and role play and then you got to have accountability.

I love what you brought out there and the KPI that you started with I think is so impactful because and it tied directly into your personal story and your personal journey which is you know, going after always that I need new patients, I need new patients. And when we look at many docs offices, you know, they probably have seen enough people if they were had no trust and like factor, if they were consistently putting out great content to keep the communication going that their reactivated number as you said should easily be the goal. 50% or more. If you've seen a couple hundred, a couple thousand, I'm sure you know the data specifically. But if you've had a built a book of business of people that you've helped, it's not going to take too long if you're treating those people right, if you're giving a world class experience to have compounding growth as they know trust and like you throughout their lifetime. It doesn't mean you have to squeeze an orange in one week to get something out of somebody. It means that you're able to develop a relationship where they might choose to come in and out throughout time and, and that's okay. You can feel confident knowing that you're continuing your compounded growth by having great KPIs, by tracking, by holding people accountable and by putting out content. So I mean I love what you guys are doing because you're speaking my language is I guess what I would say.

Yeah, and I love what you just said, squeezing the orange. I mean what a great analogy you just said there because that's what we have done. Can we just allow people to be people here? Sometimes we want them to come in day one and we want to vomit all over them about what we know. How about we allow them to give them some information, let them get a win with what we do? Because as you said in the beginning, your chiropractic is so powerful, what we do, but we have to be better at how we deliver the business of chiropractic. If we want to see our business, if we want to see chiropractic as a profession grow, we want to see our individual practices grow. We want to see us become more thought leaders in our community. We have to communicate better, become communication masters. We got to make sure that we understand what people. Why people are coming to our office. And the number one reason that people leave the office, most people don't realize this is perceived indifference. 68% of people that leave our offices is because of perceived indifference.

Crazy.

That's a big deal.

It is. And there's an aspect that you just hit on that I'd like to drive deeper. And clearly I'm going to make the assumption you've read a couple books in your day because just your communication is so fantastic. And with that comes training, it comes experience. It's all of that together, right? So I'd love you. You touched on one earlier, and if you want to touch on the same one, I'd be more than happy if you wanted to go there. But, Nate, what's a book that that's really influenced you greatly and that you would say, hey, anybody listening to this podcast, you gotta pick this up because it's something that, you know, like the branch grows, so to speak. It really altered the course of my life, opened my eyes, and really set me on this journey. Because for a lot of docs, that first step, you know, it's just getting that momentum. For the first step, I'd love to hear a resource or a tool that you personally would recommend.

Okay. Can I give more than one?

Yeah, you can give more than one. Yeah. Yeah.

So I'm a voracious reader. I love to read. And again, I think that number one, the E. Myth, chiropractor should. Every chiropractor should read. It's one of our textbooks, another one we put out. Because right now I know a lot of your listeners are about evidence and marketing that get them to the door. Our other book we wrote just for the chiropractic profession is called Chrome. It's a book just about Marketing for chiropractors. So those are two resources that we've written. The third resource that we've written also is a book called Seven that one of my business partners wrote wrote and it's about managing your money. So those are three of the resources. But here's the other book that I would say outside of the ones that we've written is that you've got to go and look at the book, especially right now with dealing with a crisis, the Obstacle is the Way.

Okay.

It's a great shift. Ryan Holiday wrote the book. He also wrote a book called Ego is the Enemy. And I think that right there reading those two books, Obstacles the Way right now and Ego is the Enemy will help shift your mindset. Because here's the thing, I've studied all kinds of chiropractors and also successful business people. The things that come back every single time is consistent with the ones that are the most successful is they have a clear vision and they have a different mindset. And their mindset is much it has. They have huge hearts, they want to give, give, give. They got a huge hustle, muscle and they have humility. They don't have to be the smartest person in the room. And so they want to know that if they want to be around people, they want to read resources. And so I think if you go through those books, Obstacle is the Way, Ego is the Enemy, those two books written by Holiday and then our three books, E, Myth, Chiropractor, Chrome and Seven. There's five resources, five things to read that are absolutely fantastic for any chiropractor out there.

I love it. I would highly recommend checking those out. We'll also link those down below. We could talk for hours. I think we're definitely gonna have to do a part two, but in the interest of research and marketing and the time it takes to get to your office, I'll have you wrap by letting docs know you've stimulated interest for me. So I'm asking this most for myself as amongst the docs listening. Where can docs go to learn more about you? To learn more about Sidecar, where would you like to direct them? How can they get in the ecosystem?

Yes, I would go to psycharedge.com sidecaredge.com also on the front of that page is the little red button that says get started. There's our KPI guide. It's a guide that we wrote for chiropractors. If you take the time to read that 20 page KPI guide, it'll be able to get you something immediately can change your business. So that's where I would start. Go to the Sidecar Edge.com click on Get Started. There's a great resource just on KPIs that is awesome.

I appreciate your time. Everybody listening, head on over. I'm going to drop that link below. If you don't feel like your business acumen is where it should be, or even if you think you're doing great, I'm going to challenge you. Head over to Sidecar Edge. Hit get started. Check your KPIs, see what's going on. Get a better feel for your business. You're probably an awesome clinician if you listen to this podcast or you're watching this video. I'll go as far as to say that, but I got a sneaking suspicion that your business acumen can be stepped up a little bit. And check out everything that Sidecar's doing. They're doing some awesome work. And Nathan, I really appreciate, appreciate having you on today.

Thank you for joining us on this episode of the Evidence Based Chiropractor. If you want to grow your practice, come back for next week's episode. If you want to grow faster, visit theevidencebasedchiropractor.com and join our MD Marketing membership today.

Sam.