Putting the Serve Back in Service

The holidays are over, the hustle and bustle have died down, and there remains only the drone of television's "talking heads" spewing their never-ending stories of despair, and of course, the ever-present negative headlines in the newspapers predicting doom and depression. Pick almost any newspaper, magazine, trade journal, newsletter or Internet site; the headlines all seem about the same: "Stocks Are Down - Layoffs Are Up," "Bailouts Are Not Working," "Unemployment Is Rising - Net Worth Is Falling," "World Markets Gripped by Fear and Despair," "Shoppers Are Buying - But Mood Is Subdued." The list of depressing headlines goes on and on.

Quite commonly, the news also includes reports clearly designed to raise the bar on shock value: Black Friday holiday shoppers trample a Wal-Mart worker to death in an uncontrolled, frenzied stampede to buy a limited sale item. Many respected franchises are closing and others are filing for bankruptcy, so do not purchase gift cards, because many companies may not be in business next year. And yes, even Santa Clauses are having a tough time finding employment! (What a cheerful item for the little ones.) Is it any wonder this media-made depression and despair are ubiquitous?

Before you decide to stop reading, I assure you this is not going to be an article filled with "feel-good" platitudes that ignores reality. This is an article about pragmatism and solutions, and yes, perhaps even some insight into doing things out of your "comfort zone" and thinking outside the "alarming outlook" box of, "Oh my God, the profession is doomed."

I am not going to discuss the current world quandary, the government bailout(s), the greed and corruption on Wall Street, the insanity in many board rooms across America, the incredible propagandizing of fear from almost every media outlet, or the unrealistic expectations of what our newly elected president can or cannot do. In these cases, most of us can exert little or no influence upon the outcomes. We can, however, influence and control what goes on in our offices every day. So, let's talk about some choices we can make, some attitudes we can change and some cost-effective things we can implement to take advantage of these changing times.

Take Advantage of Trends

There is no doubt that trends are emerging every day. The key to taking advantage of these trends is to observe them and then make the right choice(s) as to how to proceed. If you have not yet read Megatrends by John Nesbit, I highly recommend you do so, because the trends he discusses were not discovered first in metropolitan areas or on Madison Avenue, but rather by observing headlines in newspapers and watching tiny changes in small-town America.

To fully appreciate trends, it is important to do several things: 1) recognize that trends are occurring, whether we observe them or not; 2) internalize the trends in order to use the knowledge; 3) gather the necessary information to incorporate the trends into your office; 4) help your staff prepare; and 5) take advantage by assuming a proactive role. Observing consumer behavior during the current economic crisis provides an excellent example and study of trends in action. Clearly the old business model of targeting a broad "middle class" segment of just about any business or consumer market will soon be impossible. Realistically, there will be two groups: the "low-end, only price matters" group and the "high-end, affluent" group, with little in between.

All sales categories, from automobiles (Lexus to VW) to retail (Neiman Marcus to Wal-Mart) will be vying for customers. Every purchase will be reviewed by tomorrow's consumer with an eye on value perception and selection. Success or failure for the businesses of tomorrow (including chiropractic practices) will be predicated upon a "perceived value" in the minds (and hearts) of the consumer.

Here is the emerging difference in the way consumers think and shop. The trends of tomorrow, regardless of an economic recovery or short-term stimulus package, will simply uncover and reinforce the fact that high-income earners will continue to shop at Wal-Mart long after our current economic crisis du jour is over. Both the real and perceived value of any commodity will be understood by the end user to be the main reason for purchase. High-income earners will also continue to shop at Neiman Marcus because the "value proposition" will continue to exist at the high end of the purchasing spectrum.

The bottom line is that you will see high-income and low-income consumers buying for "value" and "price." The "vanilla" businesses in the middle that tried to serve everyone will simply cease to exist because there will be no market for their products/services. In other words, the value of the "middle" in terms of cost/benefit will not be perceived. This sophisticated discriminating attitude will be transferred to the utilization and selection of health care services, as well as to the purchase of products.

The Value of Patient-Centered Care

Doctors of chiropractic have an excellent opportunity in these anxious and economically constrained times to understand, incorporate and perhaps even exceed time-honored and well-known "consumer-driven" needs and expectations. Understanding this trend of consumer discretion in purchase selection helps us to understand and incorporate changing concepts into our practices as soon as possible. It is imperative that we do this before the trend to find patient-centered practitioners has passed us by.

When was the last time you reviewed - really reviewed - your patient-centered service model? Have you allowed your practice to get sloppy? Has success allowed you to ride the reputation you earned without replenishing it with updated services to meet today's demands and expectations? What will be meaningful to the patient-centered consumer of tomorrow is not much different than it has always been, but health care professionals have become more like the airlines of late (less service, poor attitude, increased cost, fewer amenities and fewer accommodations) than the caring doctors of yesterday. A non-service model will not survive long in health care or any other business.

Is It Time to Update Your Practice?

Let's talk about some obvious "cosmetic" changes that can be implemented in your office immediately. Many of these will not involve a lot of money, but more of a total attitude change. In business, it is a well-known fact that workers do not leave their employer; they leave their manager. Doctors whose staffs have taken on the attitude that patients are an interruption to their coffee breaks need to refocus. Forgetting that patients are anxiously awaiting a call about their test results, or espousing an office policy of, "We only call if there is something wrong," is unacceptable. Pick up the phone more often and call.

There may be a need to extend hours of service to accommodate your community needs. Wow, what a concept: hours that are convenient to your patients! The ability to communicate with your patients on "their" terms may need to be revisited. Have you asked yourself, "Could I afford to visit me?" If the answer might make you uncomfortable, perhaps you might want to revisit your fee schedule.

Here are some other ideas to consider if they're not already a part of your practice: a Web site, e-mail, a current database, a 24-hour answering service, healthy beverages and snacks in the reception room (notice I did not say "waiting room"). Perhaps a computer terminal in a small area of the office to accommodate patients who may need to send a message; a private area for personal telephone calls, or a beeper system if you are located at a mall, in order to let your patients wander around if you are running a bit behind (you might want to send them off with a gift certificate for ice cream or coffee); voice mail or text messages to patients if you are running behind so they can use the time more productively; comfortable gowns that fit and ensure privacy; nicely decorated offices with modern appearances; individualized music accommodating patient preferences (easy to find out); a help desk that really helps patients navigate through the complex maze of forms and procedures; transportation accommodation if there is a need; merchant processing for easy credit card payments; a clipping service (one of your staff) to review the paper for any patient activity that can be commented upon; at least five appreciation notes a day from your office; a children's play area; a restroom that has all the accoutrements for men and women; umbrellas to use for those who get caught in the rain. The list is endless.

You may want to consider an anonymous patient survey (conducted by a third party) to see what your patients are saying and feeling about your practice. Try calling your office or have someone call your office like the "mystery shoppers" in department stores and see what the barriers to entry in your office really are.

When was the last time you visited a colleague who has a successful practice? It might be a good time to do so and see what they are doing to prepare for these changing times. How about this idea for a fun employee staff meeting? Have a "live the patient experience for a day" and have every staff member internalize the experience. You might be amazed at what being the patient, rather than the staff, will do to change people's attitudes.

You should also evaluate your actual facility and be certain the equipment and building is top-notch. I always remember the old axiom, "Never go to a doctor whose plants in the reception room are dying." Sweating the small details of your practice facility automatically transfers to care and detail in your professional management of patients. They want the best from their doctor.

While these and a thousand other ideas are all individually small, collectively they can help create a "wow experience" for patients who have almost become immune to the sterile, sanitized, insensitive environment of today's health care system. If your office environment is different, you can rest assured it will be noticed and talked about.

Knowledge Is Power

After the cosmetic makeover, the next step will be to consider a serious re-evaluation of your own practice skills. Look in the mirror: Who are you, who are you becoming, why is it happening, and how will it change you? When is the last time you seriously undertook a continuing education program? No, I don't mean sitting in the back of the room reading USA Today; I mean taking a course in orthopedics, clinical laboratory, nutrition, understanding research methodology, low-tech rehabilitation or even technique. Ask yourself these questions: What are the names of the books and journals I read? When is the last time I read a real research or scientific article? If the answer is, "A long, long time ago," maybe you should make a New Year's resolution to subscribe to JMPT, Spine, JAMA, NEJM, AFP, FCER's DCConsult, a nutrition-focused journal, or a variety of other reliable health information resources to improve your education.

Reassess your memberships. Do you belong to your state and national association? If not, ask yourself why. Membership in your professional associations not only strengthens the profession, but also provides a source of pride and insight that creates an attitude of confidence. Think back to the last time you really did something educational or became involved in a project. The new energy you experienced transferred to your practice, whether you know it or not. Your patients see it, your staff sees it and you simply walk a bit taller.

When I talk to doctors whose practices are down, my first question to them is, "What are you not doing now that you did when your practice was booming?" The energy created by involvement is hard to describe, but its presence is undoubtedly discernible. All of this transition and renewed patient confidence will not happen overnight, but you will be surprised at the speed of detection if you have a plan for implementing a strategy for patient, personal and professional growth. Just watch the attitude changes in your staff. If you do not see a staff change, then change staff. The entire atmosphere of your office should be transferred to your patients, which will be translated to - in the parlance of public relations - a "BUZZ" about you and your office. Creating an atmosphere of caring and concern, coupled with comfort and competence, will be the winning strategy to differentiate you and build long-term relationships and trust with your patients and staff. Just remember: It all begins and ends with you.

Giving Patients What They Need

Chiropractors have an excellent opportunity to take advantage of the yearning for compassion that still exists at the core of most patients. People don't care how much you know until they know how much you care. Doctors of chiropractic who move to a patient-centered model of health care now, before any changes to the health care delivery system take place, will be way ahead of the game. They will be perceived as the "value-added" doctor worthy of patient loyalty - an economic value for the services provided. These are the kinds of doctors patients will be drawn to.

Chiropractors have always been patient advocates, patient educators and patient-friendly providers. Never before has there been such a need to refocus our practices every day to be proactive and recognized as the doctors who care; as the doctors whose office environment is friendly, supportive, inviting, accommodating, and where caring is a part of every patient encounter.

Creating the patient experience does not have to be costly, nor is it a program that can be implemented today and discarded next month. It is an attitude to be incorporated forever; a choice made by each and every practitioner about how they will meet the challenges of tomorrow's changing health care delivery system. It is a choice about how we will differentiate chiropractic care from other available health care services. Chiropractors need to position themselves as the high-touch, low-tech solution to many of the ailments suffered by patients every day. We can also be the low-cost, high-value doctors whose service, value and outcomes facilitate our success.

The gloom is only there if we allow it. Putting the serve back in service and removing the vice might be a great way to start 2009. Attitude is everything!