The Clinic Owner Strategy To Improve Clinician Productivity w/o Spending More Time At The Clinic

So, everyone, I'm super excited. We got Daryl Yardley here. He's one of my all time favorite, you know, mentors, to help clinicians to be able to not only improve patient outcomes, but also be able to, like, you know, increase productivity and actually make more money, you know, and so I use Darrell over the years, like, so much with, like my clinics. And yeah, I thought it'd be great to actually bring them. Bring him here. We're going to make this session very focused on owners, but the content is actually directed towards clinicians. Right, Darrell?

Yeah, yeah. The. Really, the kind of, the, the thought process around it would be a little bit more about trying to get into the minds of our clinicians and how do we actually support them to, to help them, you know, be more productive and drive even better outcomes.

Yeah, I love it. I love that. And so. And maybe type in the chat, you know, when was the last time you had a conversation about your clinician's productivity? You know? Right. Maybe type in the chat, you know, like, was it like a month ago or was it never? Was it one year ago?

Right.

You know, Heather. Wow. Today.

Right.

Danielle's this week. Wow. And it could be anything. It could be about, like charting, you know.

Right.

Think about using treatment plans, you know, not bringing your charts home. Right. Erdem is like this week. Sheldon's yesterday.

Right. A couple of weeks ago. This is great, Rick, because I think the concern that we've always seen over the years is like, oh, I haven't had a conversation with them for a year, or I haven't had a conversation for months. This is great. And I think having these weekly discussions, I guess the challenge would be if it's kind of negative and it's out of the blue, it makes it a little bit difficult. And as a clinician, we tend to be sensitive to that. But if it's a consistent meeting rhythm, actually, that'll be. That's great to see this. Yeah.

And I've noticed this over the years, Darrell. It's very tricky as an owner to have productivity talks with your clinician.

Right.

You know, because they always see you as like, the owner is all about making money. And so all your intentions seem to be about, like always making money. And I didn't go to school to make money, you know, and then there's always that, like, clash that they don't listen to you or there's other motive, you know, if that agrees with you, type 100% in the chat. If that's something that, like what I just said, resonate type 100% in the chat. And Darrell, like, what would you say working with like thousands of physios.

Right? Yeah, yeah. I think the, the biggest challenge is, is that the context is different or the context isn't very clear. Right. So when I meet with a lot of clinicians that I meet for the first time, I usually tend to get the response like, oh, that's the meaning behind that potential key performance indicator. And I saw Blair right. In the chat too, like, what are those key indicators? The key thing is you got to find indicators that motivate the clinician, and most of them have to be focusing on measuring patient outcome as opposed to business outcome. But if we really are able to look at those two pieces, the context that we may share with the clinician is very much the same context that we need to look at it from a business standpoint. But at the end of the day, the focus is on behavioral metrics first. We sometimes skip that step and go right to operational metrics, and it creates that clash even more. So.

Yeah, And I think it's also like, even if you had those behavioral metrics, it's still very difficult for an owner to have these talks with clinicians.

Right.

You know, because, like, just for all the reasons that we talked about it, and for me personally, what I found over the years is that when you bring in, like experts from the outside into your practice, whether as a coach or a mentor, and help you translate, like, you know, your business objectives to like, patient objectives, that has been game changing, you know, and, and that's why I'm so excited to have Darrell, like, on this talk, because that's what Darrell used to do for me, everyone, you know, Darrell was my business translator into patient outcomes. And he was like the guest speaker or he was the coach we brought in to work with clinicians that actually increase, like, their, their, their, their productivity in a way that didn't seem like it came from the owner, you know?

Right.

So if you're excited about today's talk with Daryl, type Darrell in the chat. Everyone, I'm super, super pumped about, like, what Daryl's gonna show through you. And what Daryl does is, yeah, he does this with like the 375 clinics inside the clinic, accelerate community. And that's kind of what we do. And we spend a lot of time, everyone, to be able to like, you know, train team members, training clinicians, training clinic directors. We train marketing coordinators or training front desk people and also owners on how to actually manage, you know, run clinics and also be the Best versions for yourself, you know. And so, yeah, I'm, I'm super, super pumped to get going on this, Darryl. So you're going to give us a sneak peek of like what it looks like, you know, in week one, in one of your 30 day challenges, right?

Yeah, for sure. Enrique, I just want to share one thing on metrics. I had a session this morning with some of the clinicians in boot camp and I asked, I said, what's the, what is the cancellation rate that your owner wants you to have? And it was sort of this a little bit. I think it's like 8 to 10%. And we kind of went through all these strategies because we're seeing this growth of the industry right now. You know, we're starting to see this increase in cancellation rates across the industry and by the time we finish the actual steps of, you know, how to create structure and you know, what to say, what's the script and what's the appropriate follow up, how do you support your, you know, your administrator? At the end I was like, well, what do you want your cancellation rate and your falloff rate to be? And it was exactly the same as what the owner wanted. But it took us an hour just to sort of bring those two worlds together. And it was just something that took us a little bit to figure out, okay, what's the impact on patient care? What's the impact on patient outcome? How do you avoid all this time on indirect care and drive more time towards direct patient care, which is what we all really went to school for. So I think just the one thing that I would sort of share on top of this, Rick too, just getting the opportunity to work with you over the years and with lots of the clinic owners in the clinic accelerator community is we've also seen some of their leaders with some training and supports as well, create really extensive and beautiful training programs that have helped them recruit, help them retain staff and actually help them see go from one clinic to multiple clinic locations just by investing in their team and in the right leaders. So really exciting to see that stuff. But Rick, just before we kind of dive into this, just a thanks again for supporting me and getting this webinar on the ground. I know there's a lot of work that goes into these, so thanks for you and your team. But let's try to create quite a bit of discussion around this. We will talk about what week one of working on sort of this retention strategy we're going to talk about today. But I want to create a little bit of context and Get a sense of where everybody actually is at when they're thinking about this. So here's going to change this question though, a little bit because of who's on our call. So I'm going to, I'm going to actually ask a question in the chat is how many of you have this as when you were back in your clinical position before you became an owner, let's say, and for those of you as a clinician, right now, how many of you have the same motivating factors as a clinician? So as an owner, do you have the same motivators as your clinicians? Yes or no? And as a clinician, do you feel that you have the same motivating characteristics as your owner? Right. So it's kind of interesting, Eric. Like there's quite a few no's coming through, so. Yeah, yeah. And Heather's is good. There's some similarities, but they're not quite the same. Right. Which is actually quite powerful. Right. So here's the thing. Erdem. Same thing. Yes and no. The question is, is it because some days you have to put your owner hat on and your business owner hat, and then you don't, you know, you kind of have to not just have a clinician hat on, but at the end of the day, if I was to ask you why you became a clinician, do you think now the motivating factors would be a little bit closer together? So if you go back to the days of what was my mission when I first went into PT school, Cairo School, RMT school, do you think you'd be a little bit closer in alignment now with your clinicians? Yeah. Heather, Heather, just make sure you switch your chat to everyone because that's a good, good thing that you're saying there. So you're starting to see these yeses come out really not that far apart. The difference though is it's always about having that, you know, that conversation, as Rick said, and actually coming back to create a bit more of a common ground. We don't have to change our motivating factors because sometimes some of our motivating factors people just may not understand. Like, like I have a 24% overhead that I have to manage so my team can do what they do best, which is treat patients. Okay. But here's one thing that I'm going to throw out there. What's, what's one word that describes how you guys feel when a patient, you know, comes back, as many of you I know on this call are still treating, you have full schedules, what's one word that describes how you feel when a patient comes in, brings you cake, brings you treats, you know, actually gives you a handwritten thank you card. Their kids draw you a picture. What's one word that describes how that makes you feel? Rick, what are your thoughts with what you see there?

Appreciated. Joyful.

Great.

You know.

Right? Yeah.

You know what's amazing with this, Darrell, is that I think this is why most people don't like being owners.

Right.

You know?

Right.

And they choose to treat because they don't get the same type of like, feeling with their staff, but they get it with their patients, you know, feeling appreciated.

Yeah. Last, like when I go to the clinic on front end, like, hey, what's your fall off list? No one's going to be like, oh, I'm so glad Darrell's here today. Right. But we're going to look at how many graduation photos came through, what treats are in the back office, and it's good. But here's the one thing where there's a lot of similarities. How many of you feel that your clinicians would choose a similar word as you? To me, it's sort of a give, Rick and I kind of a yes or a no. And I do think there's truly here, there's a, there's a ton of value. And again, trying to find those similarities because again, this is probably one of the best forms of recognition and even for some of you guys, I'll just get you to reflect on this, but some of these patients that have brought you in cards and cake and treats, we didn't even get them better, but they still actually were really thankful for the efforts we had. We will unfortunately not be able to fix everybody. And again, fixing is a word we'll save to the end of this because I don't know if we actually will fix a lot of people like we used to in the past and some of that thinking. But here's the question is, you know, and this is. And again, we don't have this, you know, typically we'd see this in a little bit more of a video. But the reality is, is if I said to you, how many of you want more cake in your clinic? And if we said the same thing to our clinicians in clinic, how many of you want more cake? I just want to see you guys type cake in the chat. If everyone would like to see more cake and treats and thank you cards and handwritten or hand crafted pictures from like little kids. Right. For sure. There's your common ground. Right. So now Go ahead.

Cake and sugar is our common ground, Darrell.

Yeah, yeah, that's okay. Obviously, just, you know, be mindful of how much you have. But here's an interesting thing and I'm going to go back and I'm going to teach you about a little bit of structure. So this is sort of, Rick's always taught me these like marketing funnels, which I don't understand. So my job is to take something that Rick gives me some good context with and then I put it into a clinical, in clinical mindset. So this is, you know, if we were to think about all the patients that are coming into our clinic, we know in our clinics, for the most part, majority of growth in our clinic is actually already inside of our four walls. If we could just retain and focus on the ones that are already in our practices as those patients, there's tons of growth there. Right. But if we look at the way that this funnel is set up, you know, for what comes into the practice, we don't always see the same level of success coming out of our practice. Okay. What happens if we as a, you know, collaboratively inside of our clinic, focusing on the same thought process around. We actually want more cake and treats and pictures to come out of our, of a care plan and a patient's experience through our clinic. So instead of having all these little leaks coming out of this funnel when, if we were able to capture and poke and, you know, plug some of those holes, so we actually see more positive output coming out of that funnel. Right. Because you guys, as owners, this is a big frustration for many of us is we bring tons of patients in and it's expensive to do that, but we don't all of a sudden see the same focus and emphasis on putting a lot of value with how people exit our business. Right. Because that's where our reactivations come from. That's where returning new people come back in through family and friend referrals, word of mouth referrals, I could have asked the same question at the very beginning. So instead of saying to you guys, how do you feel when you get a treat cake, thank you card, what does it feel like if you guys get another patient to refer a family member or friend or you started to treat three generations from one family, there is no other form of recognition that makes us feel that we've provided a valuable service. So again, these are the things that we need to focus on. But, but one of the things that I can say when we look at physio clinics and what I see when I'M working with a lot of clinicians and owners is there's very little structure inside of a practice. Because the minute we start talking about structure, the world becomes corporate. And everyone would go to be like, oh Rick. Well you know, he started PT Health, he sold PT Health, he's so corporate. But the truth is, structure doesn't equal corporation. Right. Structure is important for us to follow. And if you think about a lot of us when we were young clinicians, we were trained to do an assessment, a very specific way. We were taught structure. But then as we start to practice, clinical experience seemed to teach us that we no longer needed structure. But unfortunately, when it comes to operations and what I would consider as patient journey operations, structure is actually important. Because going back to Blair's question earlier, Blair had asked like, what are the right metrics? Well, if I look at patient experience, I need to be able to measure a very specific key point in a patient's journey from when they enter my practice. How do they actually book after I prescribe a plan of care, how do I retain those individuals and do I have a safety net in place to capture them? So I actually know how many of my patients that have entered my practice successfully graduate before they actually complete their plan of care or complete their plan. And inside of here we know that we have a significant amount of patients who will secretly self discharge behind our backs. And they may not all be negative outcomes, but if you and I. So let me give a sense to this for you guys. If you started to talk to your clinician tomorrow about their self discharge rate, how many of them would see that as a negative? Just write negative in the chat. If you would be concerned that they would see that as you focusing on just a very negative aspect of their practice. Yeah, like it's. What do you think, Rick?

Yeah, negative. I think. Yeah, I think, I think any of these business metrics that you talk about self discharge, like pva, like when you talk about a lot of this stuff, like they all comes off as negative because they don't understand the context and it's plus the owner saying it.

So the motives. Right. Yeah. And the thing too is rapport happens right here at the initial assessment and as soon as I start and we'll talk about these magic questions before we finish today. This is where there's a great possibility of building rapport. You're not going to get trust until the patient starts treating or until we start treating that patient. But at the end of the day, if I said that your self discharge rate was 20%. What's your graduation rate? It's 80%. So if I want to get you to focus, as Evan put it in the chat, just talk about the cake, I want you to become even more known in your community, in our community. I want to help you. I want to support you. I want to get this to 85% of your patients who are successfully completing their plan of care. Don't talk about this. There is no way to sweeten this discussion. You're just telling me that my. I suck and I'm not going to, you know, I'm just dwelling on the negative here and think about this too. So even think about the last 10 patients that you guys have seen that have come to your practices. Right. Do you, do you tend to reflect on the nine that actually did amazing and had great outcomes or do you just focus on the one that you're just like, oh, I can't figure that person out. Oh, that one was not a really good interaction that day. Right. We tend to focus on the negative. So our job as owners is to focus on that cake. And I'll give you sort of a little tip because most of you are owners on the call is when we focus on this aspect here, if you really want to see your PVA go up. Most of us, if we look at the data, we have at least a 2 plus retention, increase in retention and number of visits just by looking at those who successfully complete their plan of training care. In some clinics, it could be as high as six. Okay. And we're not even talking about the clinics that are able to build wellness models and health and prevention programs and become family physios kairos family rmts. Like that's a whole other world at this point that we're not going to dive into here. But again, it's about teaching people the context. And one of the most important aspects of things for us is going to be can we get people to actually, even at, you know, at the time of the initial assessment, actually use a plan of care so we can actually communicate well with patients. So we're going to do a little, a little spin here. So Rick, you're, you've been a patient multiple times in the past, right? What, what makes you, like, why do you come and see a physio? Or why do you go and see your rmt, which I think you see your RMT like once every two weeks or once a month or something like that, right?

Oh man, I spent a lot of money on allied health.

Yeah. So just as Rick's going to Kind of share with us why he does that. Why don't you guys put into the chat what do you think is the number one reason people come to see us as clinicians? Right, because you guys are all still practicing. Right. So Jake, relief pain. That's an interesting one. Connection. Yeah. John, get a part of the life back. Good. You must have listened to week one. Good. All right, Rick, what's the number one reason you go?

What's that? Well, so I'll tell you. The last time I went to see Nicole, my physiotherapist, the main reason I went to see Nicole was that like I hurt my hand, right? And I really want to like, and I really want to start paddleboarding again, you know, with my daughter, you know, because my daughter loves paddleboarding, right? So the main reason, yes, I had wrist pain in hers, blah, blah, blah, you know, and I normally would have sucked it up. But the real reason of me actually picking up the phone and calling Nicole was because I want to start paddleboarding with my daughter again.

Nice. So your why wasn't just because of pain? You know, pain, yeah, your wrist hurt, but it stopped you from doing something that you actually loved, right? Something that matters to you in life, correct?

Yes.

Yeah. So here's a question, I'm going to change this question as well. What percent of your clinicians cases so new assessment comes through the door similar to Rick. What percent of those of your clinicians you think know the emotional reason of why someone like Rick has walked through the door? So meaning that, you know, they just said, oh, Rick has wrist pain versus Rick's most meaningful aspect of his life right now is actually being blocked. So Lori's 50, that's actually pretty good. Lori Terry, 50. This is great. John 10. You'll get better for sure. But here's the thing. If you move that needle even 5%, that's huge, right? So again, be very cautious that you're like, well, you can't go from 50 to 100, but if you go from 50 to 55 or from 50 to 60, and all you have to do is actually ask a couple pretty straightforward questions and you'll start to get this information. Okay? But the one thing that I would say, how many of you have seen a referral like this in the past, right? So just maybe give me a yes or no in the chat. You know, we get a script from a physician somebody had mentioned earlier too, is a doc didn't know have enough knowledge around MSK. So just like, yeah, 76 year old man, 18 month history, shoulder pain, lots of wear and tear over the years. Was blue collared individual. Yeah, we've all seen this particular individual. How many of you have treated this type of individual for this condition? First two lines only. Yeah. But here's the truth. None of us should have treated this individual for this particular condition. Many of you will recognize this. And we do this much into greater detail in week one where we actually look at this video. And this video went viral at Christmas time last year. And I know definitely it did in our community as well. And I didn't show it today because usually it gets everybody emotional. But the key thing is, is this individual is kind of. I made up that script based on what I thought I would have seen in the past, right. As a. As a physio. But what this individual was really focusing on at this point in time was his motivation was to actually be able to carry on potentially, you know, a family tradition of having his granddaughter be able to lift above his head, away from his body to put the star on the Christmas tree. Right. And there's tons of emotions probably even just coming back for many of you, because here's the key thing is what this gentleman's true focus was to do his home program to work out in his, you know, in his shed, basically was being able to identify what matters most in life to this person. So sometimes when I'm working with my team specifically, and then those individuals in boot camp, I'll challenge them. Is like, of your six assessments you did last week, how many of your patients do you know enough about to figure out who they would put in that picture frame? This gentleman had a picture of his granddaughter, and that was in that frame. That's what matters most in life, you know, to Rick, it's not necessarily, you know, saying to him, hey, make sure you bring in a picture of your daughter into the clinic. It's probably on his phone, but you better believe I'd be like, hey, I want to see your, you know, picture of your daughter from Halloween when I see you on Tuesday. Don't miss that appointment, right? I want to see you. I want to. I want to see a picture of you on your paddle board. Right? These are all the things. But if you just focus on the wrist, and that's what we base someone's plan of care on. They're not going to complete that plan of care as soon as that risk starts to feel better. Rick's busy. Rick's got other priorities. Okay? So what I'm going to suggest everybody as well, is that you know, the whole premise of what we do is about the why. Why are patients coming through our door? What matters most in life to, to each individual patient. And the one thing that I will often hear from a lot of clinicians is, well, sometimes my patient won't give me that information. Fair point. But the reality is lots of people aren't going to trust us. Right? But they don't know us. Okay, so here's one thought. If you, how many of you, in your sort of interactions with patients or patients with your clinicians, how many of you have had the conversation with your staff around being able to identify the patients? Why just write emotional in the chat if that's a focus in your conversations with your staff, because now I'm going to get you good. And then erdem. That's because you were first. When you think about, though, how are you measuring whether that conversation, though, is actually changing their behavior? And Ali, for you, I know you're just new to the CD role. How are you going to know same thing. Whether that was conversations you're having or actually changing clinical practice or if they're going through. What my wife would say to me is, in one ear, out the other ear. Okay, okay. And Ali, great. Or Bailey, great thing too, like starting with why. But if you think about it, and if you guys, you know, recorded how each of us does an assessment at times, there's drastic difference between someone who is going in with this mindset to get information versus just going in there to ask questions. Okay, so let's do a little exercise together. Some of you may have seen this before because it's something I think is just so well done by a very young clinician. Let's say, for example, let's pretend this is Rick's story. Rick comes into the clinic, my wrist hurts. Stop me from performing a downward dog pose and yoga because I can't weight bear through that wrist. I'm unable to attend any further yoga classes for the next month. Give me a score on this one from 0 to 10 on how well we've identified why this patient's coming to clinic. Zero is like, this is terrible. Ten. That's actually really good. You know, subjective question where we've got some good information. Excellent. That's good. But here's so some good info. Now what I want you to think about is how many of your clinicians would move on and now start going into either the next set of questioning or go into their objective exam. So let's just put objective in the chat. If you think Most people would move on.

Yeah, I think most people would move on. Right, like this. Just like a standard, like question you.

Asked and you like the response, but.

They don't, they're not pulling the end in.

Right? Yeah. And here's. And for those of you that haven't had to listen to me before, I'm just going to stop the screen share for a second. What would be your next question you would ask? Throw that in the chat. So let's pretend this is Rick in front of you. I can't participate in yoga because it hurts when I put, when I weight bear through my wrist. What's your next question? How does that make you feel? Okay, potentially. Right. So that's close. What else? What are some other things that you'd want to know? Next question. Okay, so Laura, you're getting closer, you know, investigating a little bit more about the yoga. Like what's, is there friends there? Is it a social outing? Melissa, great. Why do you like yoga? Right. And again, if you look at this, it's actually no, no, she's not, she's on a different call. I can tell. And this is the thing, right, is getting to the next part, which is just we got to ask the why. Right. So remember, we were trained in a way and I can comment in physio. So you guys have a read of this. And this was a clinician who was out of school for three months. And I, and I honestly said to him, when he actually was presenting this case to me, I said, oh my gosh, this is amazing. I would have stopped at interview question number. I was good. I was done. I knew what I had to do. You know, can't weight bear through the wrist. Probably some sort of instability in the carpus. Good enough. Probably, you know, some sort of interdigital ligament problem. I would have wiggled it a little bit, stress test it and I would have said, okay, sounds good. I'll see you twice a week for the next two weeks. But I didn't, I don't have a relationship with this. I don't know anything about them. Right. So the same thing that I would say to Rick. Rick, why is paddle boarding so important to you? This young clinician knew well enough to say, tell me a little bit, like, why is yoga so important to you? You could see that this one is a little bit of a social component for sure, right. As Lori had said. But the main thing, this is something that actually helped them on the wellness side, the happiness side may help them manage their mental health. So if you think about this. This starts to get pretty deep. Now, if I was to get you guys to score this. Now how would you score your clinicians if they were able to get this amount of detail on the emotional driver of why someone was coming into our clinic? For every single assessment that you could have spent up to, I don't know. Rick, what do you think is a good marketing dollar to spend on a new patient to come through the clinic?

Yeah. 40 bucks.

50 bucks. 40. 50 bucks just for a phone call. You still have to convert that patient right at the front desk and then get them into our chair. We have to pay our front desk. We got to keep your lights on. Getting a new patient in the clinic is very expensive. So how would you guys rate this subjective interview now on a scale of 0 to 10. Or dem is high standard. This is excellent. And if you could move all of your clinicians and same as what Cassie said, there was like, some of my clinicians would stop there, some would continue. We need to understand what's happening here. But remember, all of your clinicians, especially in the physio world, were trained to not really ask open ended questions. We were trained to get a subjective interview done really quickly because we knew that that was probably a question going to be on our ridiculous national exam. And we were trained to do things fast. We were not trained to actually, you know, as well as we'd like to go into deep motivational coaching, pull information from people. But we don't treat body parts. We actually manage and we care for people and people are complicated. And here's just typical things that we see over the years of why people are coming to our clinic. Rick, you know, I made this list long time ago, right? Is play with your kids, play with sports that you love. You know, be productive, the office, not rely on pain meds. When you get out of bed in the morning, have sex with your partner. Again, like no one with pelvic girdle pain that I see and the tons of hip patients that I see, no one tells me that my hip hurts. I already know that. They're all telling me what their partner beside them is. I don't have a really good relationship with my partner anymore and I need you to help me fix that. Okay? So. And I think too, as Laurie said, we're actually a little bit. At times we don't like to go too deep into the emotional stuff. Right. But unfortunately, that's what makes somebody decide to come into our clinic. When was the last time you saw somebody for an acute injury? Like I Hurt myself two days ago. And they came into the clinic that you didn't see as a previous patient. When was the last time you saw that acute injury that you didn't, you know, Rick hadn't seen you before maybe three weeks. Right. But if you were to say, what's the average amount of time that patients have a painful condition before they come in to see you as a clinician? How many weeks or months?

Years, maybe.

Years? Yeah. You know, four to six weeks. Potentially three months. Four to six weeks. Like. And if you think about it too, is some of us have. We're seeing this reduction in the amount of time people have had symptoms for because they've been to your clinic before. They're actually reactivated patients or someone had told them how great you are and they actually suggested you go into the clinic. Right. And see. You know, you got to go see Danielle. She's like the best physio in all of North Bay. Right. But the reality is, is something has to happen for in their life for them to all of a sudden decide, I'm going to give up my time, my effort, my money, like, even for Rick, I'm going to give up time away from my family in order to come in and go to physio twice a week or to go see my Cairo a couple times a week.

And you're going to make me do my home exercise program, too.

Yeah. So this is sort of an interesting piece and everybody will kind of challenge us on sort of this, you know, this, this treatment planning philosophy. Right. But the truth is, is that the data out there, we need to make sure that we're able to identify to patients that we have actually understood their story. We've given them the opportunity to share their story. Right. And we're able to actually move forward by preventing presenting them with a plan. So how many of you in the clinic, in your clinics right now, just write treatment plan? If you actually have some form of. Whether it's a written an electronic version of a treatment plan tool in your. In your practices. Allison does great. Stephanie does great. Good. We're starting to see that. How would you rate the quality scale of 0 to 10? 0 is not good. 10 is like amazing. Rate the quality of every treatment plan that's actually handed to your patient.

I love what Glenda wrote there. I think a lot of people have it, but no one's using it.

Right, good. Yeah, Great, Glenda. Right? That's perfect.

You know, like getting clinicians to use a tool that you've implemented. Because watching on this webinar Right.

And it doesn't work. That's right. And think about it too. Like, so, you know, you know, Chris, when it's used, it's eight. Right. And again, the key thing is, is, you know, eight can become a nine, you know, six could become a seven. And all those things start to add up in order to make sure that patients are truly understanding what's happening in the clinical clinic. But a lot of it will still come down to buy in. And here's some, some data that I have. So every time I actually run this four week challenge, I ask people, you know, do you currently have a tool in place at your clinic? We're still sitting around a third that will say no. Okay. But here's the other thing that makes things a little bit challenging. How many patients? So this is. Yes. So about 30%. And this, what's cut off here, guys, is, is. And I was involved with the development of the tool. Almost 40% are saying, yes, we have a tool, but I wasn't involved in the development. So it's actually hard. So if I was to say to each of you that you're going to come and work with me tomorrow, and I have a totally different treatment philosophy and a tool, it's going to be a lot harder to start to actually use that tool. Right. And in many times when I go and I work with clinicians, I'm like, oh, what version of your treatment plan tool are you on? And people are like, oh, it's still my first one that I've been working, you know, I've been using for a year. Year. This tool has to evolve. It's like a living organism. Okay, so how many of you have actually have a new version since the very first time you rolled out your treatment plan? Write in the chat, what version of your treatment plan tool are you on? Nice. Evan 4. Yeah, we're on Evan's 4.

Yeah, 1 or 2. Right?

Yeah. And we're moving into version 6 come Q1 of 2022. Now if, if you're on version 1, like in your case, Ali, don't worry about it. The thing is, is, you know, where do you start to create some structure to get more involvement? And maybe my biggest tip for a lot of you is include some patients in that development. Okay. You want to get much better buy in from clinical staff. Have, have patients guide some of the evolution in your, in your actual patient operations. Okay, So I think we've kind of talked about this. The main thing is, is, you know, we have to make sure it's very clear who this tool is used for. This tool is for the patient. This is not. Not an administrative process. This is not, you know, this is not the. The business owner that's deciding that this is going to help us make more money. And this is the other key thing. This is a patient centric tool. And, you know, we won't make Rick share his story again, but he already. I kind of knew I'd get him to get us down to this level is, you know, how would this individual go home and tell their family member, you know, whether it's their partner, their parent, their child, their girlfriend, their boyfriend, you know, what it is that they just learned from physio, what it is, or from their chiropractor, from their rmt. Like, what are you going to be dedicating this time for? Right. And if you see the part that I highlighted here in Rick's case is really just about my family is so grateful for what you do because I'm now able to get back to what was actually most meaningful for him in life. Okay.

And if I was going to add to that, what I loved about the paper treatment plan was that, like, you know, my physiotherapist gave me something physical. Right. You know, that I could actually share with my family. And also I had something physical to actually bring back and look at, you know, whereas, like, if it's on email or whatever, like, I'm not gonna look at it again, you know, and so that was really powerful from, like, my standpoint. And I hear that a lot within owners in our community, but that the PA treatment plan, actually, although it's old school, it's.

It's.

It's way more powerful, you know, so.

Yeah, and I think the, the part that's kind of interesting too, Rick, on that note, you know, when you think about people who do it verbally, and this is something I always ask, but there's some really good evidence out there that shows that what people will remember, the more we tell them, the less they remember, and the less that they remember or, sorry, that even what they do remember, it's actually remembered incorrectly. So we can do as good of a job as we want and we attempt to do, but if it's too verbal, what the evidence would say in the medical literature is that we actually have to supplement it with something written or done visually. Okay. So something for sure to think about. Okay. Email. Yeah. Allie, in certain. Lots of clinics are doing it through email. Some people are actually taking photos of it on their phone and sending that home with patients. Right. Obviously, you know, be mindful of your privacy laws. But. But again, there's just different ways to move around things to get it done. So one of the things though that I would suggest is when you think about it from a patient centered side of things, how many of you would put up are kind of receiving the flag from clinicians, like, I don't have time to do this. Like this is, this is the reason why I would, you know, Rick, I'd love to do it for you, but I still don't have enough time in my clinical assessment. Blair. Of course, Yep. All right, here's something that's kind of interesting and I'll share this with you. And I had a lot of debate with a clinician and she was awesome and young clinician, but again, kind of really structured with how she was trained. And I said to her, I said, you know, what is, what's it going to take for me to get you to think slightly different, where you've got 45 minutes or 60 minutes to assess. If I could find a couple areas where I could reduce some of your objective testing and get you to spend a little bit more time to focus on communicating that plan of care for this patient, identify why they're coming in, break it up into milestones, focus on what the goal is to graduate with our expertise. What will it take? And she was like, oh, you know what, I'll try it. And she did it. And then she got this email back because just like you had mentioned in the chat there, Ali, as she said, her current structure was, Rick would come in to see me as a clinician, I would email him, thank him for coming, I'd give him his exercise program and very few people would ever get back to me about stuff. And I would see them hopefully in the future sessions. But here's somebody that's been around, you know, this patient had seen multiple clinicians in the past and this became her aha moment. And this is what really came out of this, you know, yes, she did her typical strategy, which was exercise manual therapy at the end of her assessment. But it was really that what you have to focus on is what mattered most to this patient. Right. Not what mattered to me as the therapist. For what I had to deliver was understanding what this patient's expectation, expectations were. And in this case, thank you for the active listening, putting a plan together and recommending a follow up schedule. Okay, so again, this is one of those really interesting things as we tend to have our own biases around feeling salesy this individual was coming to us for expertise. Okay. And, yes, this will take a lot of time to get people to appreciate and understand. And, yeah, maybe there is a scenario, as Sheldon said, that, you know, we do separate, you know, separate sessions for exercises. I think that's suitable. I very rarely do exercises in my first initial consult, too. But we just have to be careful that we don't all of a sudden start dictating to clinicians how they treat because they. They want autonomy. So the key thing is, is getting them to realize what is most valuable to a patient at that particular time. And here's what some of the evidence would tell us. You know, how do we drive optimal value, especially in that very first interaction? We need to tailor treatment that meets the preferences of patients, and we have to manage their expectations. And this is something that we actually go in and do a deep dive in week two when we start to actually educate people on how do you identify and how do you address expectations? Because there's a ton of evidence and literature around it as we speak that really looks at how do we improve patient therapist communication. And majority of how we get people to successfully complete a plan of care is having very clear guided communication and giving the patient a little bit of autonomy actually, in how we actually use their collaboration, their input, to actually map out that plan of care. Okay. I don't take away everything that I need to do, but I actually give them the floor in shared decision making so they feel like they're actually part of the plan of care. So what I'm going to leave you guys with is these four things, but I'm going to, because we've got lots of experienced people in the chat. What do you think is the most important question that you need to ask your patient in that initial first consult? What's the question that needs to be answered by us as practitioners? Rick, let's go to you first. If you think about a magic question that's going to help us build rapport and trust, what question do you want me to answer before you leave my office in the first 40 minutes?

Am I going to be okay?

Yeah. That's a good one. Laurie, what's going to be the plan? Yep. Oh. What's causing the pain? Yeah, like, what's wrong with me? Perfect. Why do I have pain? How long will it take? Perfect. Erdem. Perfect. Right. And if you look at the way that most of us as clinicians eventually started into our career, we never really told people how long it was going to take. We were afraid it was going to be too salesy. Right. Or if we did say, hey, Rick, it's going to take you actually three months to get you back paddleboarding for an hour on the ocean with your daughter. You might be like, holy. Holy shit. Really? An hour? I mean, three months to do an hour. Yeah, but that's okay. But we got baby steps to get there. Okay. What else do you see in there, Rick?

I love what Alexandra wrote there. Like, you know, I think, you know, like, you know, I think on your. I think it's really important to set the expectations, like from day one of what that looks like and that plan of care and how long it takes. Most people don't talk about. They wing it week to week, you know.

Right.

But as a consumer, you don't want that. Like, you want to know, like, hey, what do I need to do? How long is it going to take? You know, and when can I start.

Doing my stuff again? Yeah. And the thing too, which is actually interesting. Ali, that's perfect, right? What are the expectations for day one and what are some of their expectations moving forward? And it's tricky because it's not actually a comfortable question for us to be asking, asking all the time. But here's what we've seen in, you know, over the years. Some of this is obviously anecdotal based on experience. Some of it is actually people would tell you is documented. But here are the top four questions that we would need to ask. And in this situation, as Rick said, you know, what is. What is actually wrong with me? Right. So how many, how many of your clinicians do you think would be able to tell patients what is actually wrong with them? Throw it in the chat. Let's say of 10 assessments this week, how many of those patients would leave our. Leave your clinic knowing what is wrong with them?

Five.

Okay. And I guess. I guess there's a thing. It's actually still okay to not know what's wrong with somebody because maybe it's super complex. But to me, even just saying, hey, we may not really know yet, but we're going to figure it out together. I still accept that as, you know, someone getting some reassurance of what's wrong with them. Okay. So I think this is important because if you have patients leaving your practices and they don't really know what's wrong with them at this point, you haven't had an opportunity to reduce fear, anxiety, provide reassurance. Like, those are key things that, you know, the evidence is telling us that we actually need to be able to actually help solve for the consumer. But here's another interesting question. If you don't really know what's wrong with that patient, how long until they come back in for their first follow up visit? What do you think that would look like on average? Like is it the next day, is it within a couple days, is it with a week apart, what would you say? Throw that in the chat. So you haven't even been able to ask that question yet and someone's waiting another week to get an answer. Right? So that's for me. You know, if we want to be able to establish expertise, right, and build rapport and trust, we actually need some frequency with patients. Okay. So next thing for us to do is, you know, am I going to be okay? There's that question Rick had talked about, there's that reassurance. So same thing. And we don't, we're not going to go through each of these. But I want you guys to reflect on, you know, our practices and what we've done really well and how we can support our clinicians even further. You know, do you know how to fix me? Right. I think there's a lot of evidence that suggests that we should move away from this fixer mentality and just focusing on biomechanics. So again, can we reframe this? Can we pre frame them in a way of saying, you know, what can I as the patient do to make this better? You know, what can I as the therapist offer to make it better? Okay. And I do think this is the one that's most important. This is where we'll wrap things up, is, you know, what actually is the plan? If you look at that email back from that patient and things that we've heard from Rick today, patients actually want to know what the follow up plan is. There may be some resistance and some uncertainty around what's the frequency of that plan. And there's a need to actually have conversations around barriers, limitations, objections in order to include the patient and share decision making model. But what's very important is to know is the patient is going to want to know the plan and how much is this going to cost me? How many of you though do you think that as a clinician or your clinicians themselves would be stuck at thinking that the cost piece is about money? Just write money in the chat if they think that the cost piece is about money. Rick, what do you think is the biggest barrier for somebody to continue going to therapy?

Yeah, it's tricky. There's so many.

Right. What do you think said number one time. Yeah. So 100% time is. It outweighs money probably about three to one. And the reason I can prove this is I ask clinicians every single month, what's the number one reason people stop coming into therapy. It's time. Then we also ask people, you heard it from Rick. Rick's like, you asked me to do all this stuff at home, like these home exercises. You know, I got to, like, watch videos and recordings. I got to drive 45 minutes to come to the clinic. This is. We actually ask a lot of patients, and there's a lot of behavioral change required. And yeah, it certainly does cost money. But the problem is, is we make assumptions that it's the only barrier that people will have as buddy. Okay? And Glenda, you're right. There is going to still be patients who will say, I'm out of funding. Okay? But it's not as often as we think, and maybe it's the ones that we dwell on, but this is where we actually have to get clinicians very comfortable asking. Asking these particular questions. Okay? And knowing more than it just goes beyond what's actually in. In. In the actual interaction on just funding versus time. Last thing, though, is this is what you got to get your. All of your staff to think about, is as a clinician, we're actually our best treatment technique and our best caseload builders. It's not what's all about the hard skills. Hard skills are obviously critical and important. Important, but you're your best treatment technique. And this is one of the big things that we always look at. And people will ask me all the time, you know, can we talk about pba? You know, I don't often talk about pba. I showed you sort of where I would focus, you know, graduation rate versus self discharge rate. But, you know, these individuals are seeing a change in their pba. These individuals are seeing a change in how busy their schedule is. It's not actually because, you know, I'm teaching them specifically to increase their pba. They're actually putting these processes in place. This individual that I was working with, her clinic owner themselves, was like, I don't know what you've been changing, but it's working. What have you been doing? And this individual who is one year out of school was actually teaching some of the senior clinicians in her practice for the owner how to actually see the value and the rationale to actually provide a treatment plan and start to really focus for patients on what is the plan. And basically answering those magic questions because whether you have been out of school for Many, many years, and you've got great experience, or whether you're a junior clinician, we all can see some major, significant improvement.

That was awesome, man. That was awesome. Hey, everyone. What was your biggest takeaway so far from Darrell? Type that in the chat. You know, I'm just curious. What is your biggest takeaway?

From what?

Just Darrell's talked about that in the last, like, 40 so minutes. Right.

You know. Right.

Evan's like cake. Right. Getting to the patient. Why?

Right.

You know what else in there I.

Like, erdem's, too, is, you know, moving away from, like, patients for people. And people are complicated, but people are very much customers of our expertise.

If you start talking like this to your.

If you're.

If your clinicians start talking like this to their patients or you start talking to your clinicians like this, you know, you will move the PVA numbers, right? But if you use like, the PVA metrics or these business metrics, like, on your staff, you know, and they're already, like, worried about what you say, like, you're not gonna. That's why you're not getting those type of results, you know, so.

Okay. And the thing too is to remember, you gotta almost be like our. Like, for those of you that have kids, right? When your kid keeps asking, like, why, Rick? Tell me why. Tell me why. We just gotta get into the same habit, you know, Rick, Paddleboarding. Rick, tell me why paddleboarding is so important to you. Just get used to that habit.

Okay, cool. Cool. How many are you excited about what we talked about today? Give me score of 100. How many people are you excited about what we talked about today? Awesome. Because I think this is game changing. If you really sink this in, you know, right. How many people are overwhelmed type overwhelmed in the chat, you know, type overwhelmed because, you know, Darrell went through a lot. There's a lot in here. So I think it's, you know, okay to be overwhelmed for as well, perfectly whelmed. I love that.

Jake, you know, for joining, I appreciate. I know it's a busy time in your days, so. And Rick, thanks for you for hosting.

All right, see you everybody later. Okay, bye, everybody.

Blair, of course, yeah. All right, here's something that's kind of interesting, and I'll share this with you. And I had. I had a lot of debate with. With a. With a clinician. And she was awesome and young clinician, but again, kind of really structured with how she was trained. And I said to her, I said, you know, what is. What. What's it going to take for me to kind of get you to think slightly different, where, you know, you've got 45 minutes or 60 minutes to assess, and if I can find a couple areas where I can reduce some of your objective testing and get you to spend a little bit more time to focus on communicating that plan of care.