On Jan. 24 1978, the New Zealand governor-general referred to a Commission of Inquiry an investigation to determine the desirability of providing for reimbursement of chiropractic benefits under the New Zealand Social Security Act and the New Zealand Accident Compensation Act. The commision's findings would impact chiropractic worldwide for decades to come.
Practice Impossible (Part 4): What is On Your "Menu"
Recently we became interested in the television program Restaurant Impossible. The Food Network show is 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 the chef, a builder and an interior designer.The catch is the makeover has to be completed in forty eight hours on a budget of only ten thousand dollars.
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 not applicable only to the restaurant business but to any business.
This is why we like the show. The chef uses many of the same business principles we have used in running successful practices and consulting for other chiropractors.
This series of articles works through these business principles from our chiropractic prospective. In our this fourth article we focus on the menu.
What's Being Served?
Most of the failing restaurants in the show have very extensive menus. They are large trifold menus with dozens of choices. When the chef first sees menus of this length, he is critical. For many of the restaurants, the long menu reveals an identity crisis or over commitment. The owners are either unsure of the type of restaurant they want to have and/or trying to be everything to everybody.
Once he has seen the menu he orders one of almost everything for tasting. This usually adds to the criticism. Being a top chef, his standards are very high.
His next task is to quiz the owner.He wants to know which dishes sell the best and are most profitable. He will also quiz the serving staff and kitchen staff about their knowledge of the menu and its selections.
What does he find? Typically the owner has no idea which items sell the best or provide the most profit. They are often stocking food for meals that are seldom ordered. Much of this food spoils before it can be used. The owner then throws out the food and reorders it. This cycle repeats over and over again.
Quizzing the serving staff reveals that most cannot describe many of the dishes on the menu because it is too long and confusing. The kitchen staff is also confused by the enormity of the menu and is frequently forced to reference recipes instead of being able to immediately begin preparing an order. Confused, frustrated employees often quit, compounding the problems of an already failing business.
Legendary football coach Vince Lombardi was once asked why he ran such a simple offense when he had some of the most talented players to ever play the game. "It's hard to be aggressive if you are confused" he said. If you look at Lombardi's winning record you will see that the word successful could be substituted for the word aggressive.
How does the chef address these problems? He shortens the menu, usually to one or two pages. The new menu contains a mixture of the restaurant's original recipes and new ones of his creation. The new menu also reflects a specific cuisine. This sets the restaurant on course for the development of a specific identity.
Once the menu is set, the serving and kitchen staff are trained and quizzed again to make sure they are ready to use the menu. Those that are not ready are usually given one more chance and released if they fail a second time.
From that point the chef moves on the other tasks of overseeing the redecorating and marketing of the restaurant.
Your Practice's "Menu"
How does this apply to the business of chiropractic? Chiropractors' menus (list of services) are often too long. This can reflect the same lack of direction and identity crisis seen in the restaurants. Just as it is hard to be a steak, sea food, taco, pizza, burger, and hotdog restaurant with ice cream stands, it is hard to be a family wellness, nutritional, sports injury, personal injury, worker's compensation, rehabilitation and fitness practice. It is hard to be everything to everybody. We live in a specialized world and nobody can be an expert in everything!
[pb]Determining which health services you will offer helps define your practice for you and your staff and helps define it for the public as well.
Like in the restaurant business, the list of services (menu) effects overhead, profit, staff and function. Most of all, it effects your focus on your overall goals.
Do you know which services are used the most in your practice? Do you know which services are most profitable? Look at old fees slips or run a report from your billing system to see.
Knowledge of top services usually reflects your true interests in practice and helps you decide what equipment is the most important.
Cut Your Losses and Fat
Chiropractors are notorious for having equipment and supplies lying around that are seldom if ever used. This clutters the office and often requires office space that is not necessary or could be used for something more important.
It is not uncommon to get some equipment that you were excited about at the time only to find that excitement faded. Now the equipment is just taking up space. But, instead of passing it along or getting rid of it, you keep it around just in case. It is like the food that spoils while you are waiting for someone to order that specific dish. Cut your losses. Sell it. Give it away. Throw it away.
In addition to knowing what services are most utilized and profitable, defining your menu also helps with staff training. Training is easier and there is less to keep up with. The likelihood of error is decreased as staff is seldom called upon to do something they are not familiar with or have never done.
A more specific example may be selling supplies versus performing an adjustment. From a business standpoint, the cost of performing a chiropractic adjustment is a fixed cost (your education and perhaps cost of your adjustment table). However, when you sell supplies, you have to purchase those items and deal with issues such as shrinkage (people stealing your items) and inventory management.
With the above examples we are not recommending reducing everything down to bare bones as much as we are recommending defining your style of practice.
However, the two go hand in hand. Some things will naturally be eliminated in the defining process.Stream lining usually means cutting the fat to some degree. If selling supplements or supports are important for your standard of care, then by all means sell them. Just know your numbers so you can make effective decisions for your practice.
In summary, whether it is in the services you provide or the marketing of those services, maintaining the KISS philosophy is vitally important. (For those of you who don't know what that is, it is: KEEP IT SIMPLE-Sweet Heart.) Don't unnecessarily complicate your practice by continually adding services, products to sell, or complicated protocols. What we do as chiropractors is amazing. Sometimes less is more and keeping your focus to a few items will grow your practice much faster.