Editor's Note: Dr. McAulay is Executive Vice President/Provost for Sherman College of Straight Chiropractic. He was in private practice from 1985 until 1998. His PhD is in Management from Temple University in Philadelphia, and he has taught the subject at the undergraduate and graduate level over the past five years. Published in a number of chiropractic and organizational journals, his research interests include professional and organizational commitment and conflict, total quality management and high performance organizations.
In the past 20 years, as concepts such as "re-engineering," "bottom-up management" and "quality management" have taken hold (first in Japan, then in North America), the blue chips have changed the way they work and manage. They've shifted their focus to the customer and developed ways to get input from the various groups involved in making their organizations successful. Chiropractors can benefit substantially by applying these same business principles in their offices.
The management revolution started in industry, moved to the service sector, and today is spreading to professional practice. Through a series of articles, I will outline the management transformation of the '80s and '90s, and present a case for why you should adopt some of the same practices to boost retention, increase referrals, and improve efficiency in your office. Throughout the series, we will explore how you can:
From the Industrial Revolution to the 1970s, American management focused on production efficiency. The old adage from Henry Ford that you could buy a car in any color, as long as it was black, was imbedded within management philosophy. The customer was not a variable in day-to-day management decisions, and mathematical models dictated decision-making.
With 20/20 hindsight, it is easy to see that the success large U.S. corporations enjoyed until the 1970s had very little to do with how well they were managed. In fact, many were successful in spite of themselves. By the close of World War II, the infrastructures of England, Germany, Japan and France were in ruins. The United States was the only major economy left intact that could supply millions of people with goods. Customer demand for products seemed inexhaustible, and managers didn't have to be concerned with issues like quality, customer satisfaction, and constant product improvements. The United States produced, and the world consumed.
Wake-up Call
The lack of competition led to unwarranted feelings of superiority and fostered indifference to the consumer - an attitude that dictated customer experiences as diverse as buying a toaster and having your teeth cleaned. The illusion of unchangeable success, with the provider in complete control and customers as passive recipients, was shattered in the 1980s. An American W. Edwards Deming, traveled to Japan in the aftermath of World War II to help the country rebuild. He brought with him a radical new concept of managing. The father of total quality management (TQM), Deming trained managers to focus on meeting customer needs, building effective work teams, objectively measuring results, and then feeding information back into continuous service and product improvements. It took years, but by the time he had spread his ideas throughout Japan, companies had begun using them to build better, less expensive cars, better televisions and VCRs, and a host of other consumer goods.
Rise of the Demanding Consumer
American consumers quickly became accustomed to Japanese products that were superior in quality to American goods, and cost less. With a taste of what was possible, consumers began demanding greater selection, quality and value in all their purchases. The responsive Japanese management style (built on Deming's concepts of TQM) allowed those companies to continually change to meet customer demands. During the 1970s gas crisis, for example, companies such as Nissan and Honda began producing smaller, more fuel-efficient automobiles. American consumers purchased them like hotcakes. It almost crippled the American auto industry, as Detroit kept stamping out large, gas-guzzling models, oblivious to customer desires.
As they watched profits drift overseas, American manufacturers eventually saw the advantages of Deming's new way of managing. In time, the concepts found application in the service sector, including higher education and health care. Today, they are spreading to professional practice, where astute practitioners are using them to meet customer needs and build successful businesses.
This series of articles will explore how the concepts of TQM can be implemented in the professional setting. Specifically, you will receive the tools needed to implement a total quality practice management approach in your office to increase satisfaction among current patients, increase referrals to build your practice, and boost retention.
A Chiropractic Case Study
Consider how TQM principles can apply to waiting times in your practice. In the old model, a chiropractor may have viewed a crowded waiting room as a positive sign of a thriving practice. TQM recognizes that today's patients will leave and find another provider if waiting times are unacceptable. Let's walk through how you might attack this issue using TQM principles.
First, get your staff intimately involved in articulating and solving the problem. You might have your CA use a stopwatch to measure the time it takes CA use a stopwatch to measure the time it takes patients to get into an adjusting room and receive care. Your staff will carefully monitor waiting times and look for patterns - peak periods of the day and bottlenecks that result when handling certain types of patients. They will explore all the factors that affect how long a person waits in your office. Then, with your input, they might design a brief written survey that asks such questions as, "How long do you wait, on average, before seeing the doctor?", "Have you ever left the office without receiving care because the wait was too long?" ,"Rank, on a scale of one to five, the importance to you of how long you wait to see the doctor," or, "How satisfied are you with the current waiting times you experience in this office?"
You and your staff can take this information and benchmark it against other health care providers and services. Call your colleagues and chiropractic college alumni. Ask them how long patients wait in their offices, and what they do to minimize it. Pay close attention (and ask your staff to do the same) when you visit your dentist, hair salon or medical doctor. You might pick up ideas about how to minimize waiting times, or how to make waiting a more pleasant experience. Bring your staff and patients together for an informal focus group or brainstorming session to generate ideas about how to improve waiting times. Provide light refreshments after hours and host a one-hour conversation. You will be surprised at the wealth of ideas your patients and staff have for improving your practice.
Following this procedure, one office came up with and implemented the following ideas. The CA started booking patients in 15-minute increments, rather than 10, during the peak early evening hours when there was no slack time in the schedule and patients seemed to get "stacked up."
The staff and chiropractor developed a code in which the CA would use the phone to beep the room one time to alert the doctor that more than two people were waiting in the reception area. This would let the doctor know that the visit would be completed as soon as possible, and "social" chatter was saved for the next visit. The office also implemented new techniques to better accommodate for the lengthy first visits of new patients, mailing all paperwork home to be completed before a visit. On very busy days, they also scheduled new patients outside of regular office hours.
At the same time, the office introduced several amenities that helped make whatever waiting patients did experience more comfortable. A telephone and computer were set up in the reception area so people could make local phone calls or access the Internet. Another innovative and inexpensive service included beepers that patients could take with them so they could do errands at a shopping plaza across the street until the doctor was ready to see them. A guarantee to be seen in 20 minutes (or the visit was free) also demonstrated to patients that the office was serious about serving them. Such services go a long way toward satisfying and retaining current patients, and can generate a distinct competitive advantage for attracting new ones.
Of course, problems and solutions are unique to every office. The key is not specifics, but the whole office working together to identify blocks within the system, with patient input to remedy those blocks, as part of a continuous quality improvement effort - making changes, getting feedback, and fine-tuning.
Through this series, you will learn how to transition from the old management system to the new one, in all aspects of practice management. See the chart on page 40 for a comparison of traditional management and TQM approaches, and a summary of the topics we will consider in future articles.
It is not necessary to employ expensive management consultants to master and implement the principles of TQM. They are easy to apply. Once learned, you will become your own practice consultant. You will also see how your staff and patients can act as consultants for you (and they don't charge for their advice; they gladly pay for your services while they improve your practice). I look forward to sharing information with you in the next article about implementing systems of continuous quality improvement.
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
