"Practice Impossible" Leadership Skills for a Thriving Clinic

We recently became interested in the television program Restaurant Impossible, a Food Network show hosted by Robert Irvine, a noted chef and restaurateur. The premise of the show is to help failing restaurants by giving them a complete makeover. The makeover is carried out by Chef Irvine, a builder and an interior designer. The catch is the makeover has to be completed in 48 hours on a budget of only $10,000.

If you follow the program for a short time, you will quickly see that the chef focuses on five factors of the restaurant business regardless of the size and type of restaurant. The five factors are: leadership, the staff, the menu, the décor and marketing. You will also realize that the methods he uses are applicable not only to the restaurant business but to any business and this is why we like the show. The chef uses many of the same business principles we have used in running successful practices and in consulting for other chiropractors. We have to note however, that our delivery would be a little softer than Chef Irvine.

This series of articles will work through these business principles from our chiropractic perspective. In part one, we focus on leadership. In the television series, most of the restaurants are locally owned, with the owner typically serving as the "manager" as well. The scenario every time is that the restaurant is losing money, the staff is upset and the customers are either dissatisfied or have left. As the chef digs in, he commonly finds the manager cannot answer many basic questions about his own restaurant. He does not know basic business statistics like: which dishes sell the best, which dishes produce the most profit, what he has in inventory or total overhead.

When it comes to the staff, he has provided minimal training, requires long hours, provides low pay and has shown very little leadership. If it is a family business, the staff suffers even more. The owners are often at odds with each other and the staff doesn't really know who's in charge as one owner says this and the other says that. A problem here is the owner is in the position of manager by default. He owns the restaurant and, consequently, he is in charge. However, this does not mean he is a leader. When Chef Irvine points this fact out the owner/manager is usually surprised and defensive and they often seem sorry they asked for help.

The hardest transition for these restaurants is usually the transformation of the owner/manager but this is also the most important. It is the same for a troubled practice. Owning a practice does not make a doctor a leader. Owning and leading are not equivalent. In his book, The E-Myth Revisited, Michael Gerber reviews this reality by saying that just because someone is a great technician does not indicate they will be a great business owner. There are key fundamentals that every business owner must know to be successful that are above and beyond technical or trade skills. Yes, owning the practice places the doctor in charge and makes him the decision maker. But, does the doctor manage well and earn the respect of the staff and patients? Are the decisions he makes appropriate, trustworthy and productive?

Does the doctor set an example, keep his word, admit fault, manage his time, manage money, notice trends, adapt to change, innovate, set goals, prioritize and market? Does the doctor have the ability to hire, communicate, motivate, educate, compensate, reward, draw boundaries, discipline or fire employees? In our experience, we find there are some specific qualities that a good leader must focus on in order to be successful in his or her chiropractic clinic. Though the list could be significantly longer, we have limited it to three qualities for review in this forum. They are: lead by example, have goals and a plan of action documented to achieve them and, grow your people and give continual feedback.

Lead by Example

In most settings, employees will follow your lead. Have you ever been to a service business and been mistreated by the staff only to realize later the manager was just like them? Conversely, have you ever noticed when you go into a business where everyone is singing and happy and the manager seems to be the biggest instigator? It's because everyone looks to their leader to emulate. Therefore, the first step in leading an office is to act exactly as you wish your staff to act. For example, the ability to keep one's word, admit fault and give credit are important characteristics of a true leader. These are many of the qualities that make a leader human. If these characteristics are present, the leader can have a strong professional relationship with the staff. Is that you?

Another example is time management. It is one of the leadership qualities most important in leading by example. The doctor must show up to work, meetings, etc. on time. It is hypocritical to expect punctuality of employees when you are not punctual. The doctor must also be punctual in the office. He must see patients in a timely manner. If the doctor expects the patients to show up and be on time, he must operate on time. The number one complaint against doctors for decades has been waiting time. In many offices, where waiting is a problem, the doctor's lack of time management is the primary issue. We often say that a staff will care as much as you do. Therefore, you must show them you care through your actions.

[pb]Goals and a Documented Plan of Action

The most notable authority on goals is Zig Zigler. He mentions repeatedly in his book, See You at the Top, it is impossible to get where you are going if you don't know where that is. And you significantly increase your chances of achieving them by writing your goals down and creating a specific plan of action to reach them. This may include things like gaining more education, hiring people with specific knowledge or talents, or identifying specific people you need to know in order to reach your goals. However, without defining specifically what you want, the chances of obtaining your goals reduce significantly.

Assess your practice. Obtain an accurate assessment of your current status and then set goals for where you will be in one year. Knowing where you are starting from helps you set more realistic and obtainable goals. Once you have your goals, break them into steps and prioritize them. Work on the hardest and most important steps first. Work on them day-by-day, week-by-week, and month-by-month. As Jim Parker use to say, "plan your work and then work your plan." Most people would agree that leaders generally know where they are going. But leaders are also very aware of where they have been and where they are at the present time. Knowing where you have been, where you are now and where you want to go are all vital in goal setting. If you are not conscious of where you have been, you may end up creating a new version of the past. Knowing where you are now means knowing your practice statistics. Going where you want to go relies on knowing where you are starting from. If you search the internet for directions to a specific destination, you cannot obtain the directions without providing the address of the starting point.

Grow Your People

While you are setting your plan in motion, assess your staff. Assessing their performance will help you assess your skills as a leader. Did you hire well? Were you accurate in reading the people you hired? Are they performing as expected? If not, did you train them correctly? Anyone who has been successful has had help. In Jim Collin's book, Built to Last, he states that every successful company had to, "get the right people on the bus and find the right seat for them on it." Too often, in a chiropractic clinic, we tend to hire people we like and then try to figure out what they are good at. Unfortunately, generally speaking, that does not work.

Initially, you need to define the roles in the office and create job descriptions for those roles because then it is easier to hire personalities to fit those roles. After you have found the right person, then it is time to "invest" in those people. The philosophy we try to follow is to do three things with everyone in our company: help them grow professionally, help them grow personally, and help them grow financially with increased incentives. Without all three, your people can burnout.

As you are growing your people, continual feedback is very important and it has to be specific and continuous. Most issues arise in work relationships because of disconnect between employer and employee. The employee is told to be helpful to a patient. However, do the doctor and staff have the same definition for being "helpful?" You, as the leader, must define what being helpful really means. Then, continued feedback must be given through periodic performance evaluations to ensure their activities match your definitions. Some other questions you may want to ask yourself are: Have you motivated, compensated and rewarded your staff appropriately? Do you have clearly established boundaries for your employees? Have you hired friends, relatives or patients that are not truly qualified? Employee hiring, training, motivation and discipline are some of the hardest skills to master for the doctor. They require study, a few hard knocks and patience as they evolve over time. The second article in this series focuses on staff, so stay tuned.

Final Thoughts on Leadership

Do you command or earn respect? There is a huge difference between the two. The doctor who cannot lead well will have to command respect. He will only obtain respect through threats, intimidation, bullying or discipline. He is the boss and can fire an employee if he wants. Employees only learn to respect the power of position and not the doctor as a person/leader. The doctor who leads well will earn respect. He does the things necessary to grow and manage the practice for the benefit of his patients, his employees and himself. He earns a position of respect and power in the minds of his employees through his actions and accomplishments. Leadership was addressed first in our series because it is the hardest business factor for the doctor to evaluate and change. Sometimes we meet the enemy, and it is us.

Assessing your leadership skills requires being introspective and honest with yourself. The points raised in this article are only a few of what you might need to master leadership in your practice. You must have the willingness to admit and improve upon your own mistakes. You must have the determination to study leadership and improve your skills. Work through this first. Then, continue to read this series and work through the four remaining factors. It will improve your practice; and, you have more than 48 hours to do it.