The horse shelter at Raza's Clinic

Our friend Raza Shah, ND has a large Mennonite patient base–so large, in fact, that he actually has a place to shelter horses while patients have their appointments. So cool.

In The Practitioner’s Journey, we wrote about how my dentist used to amaze me by thanking me in person for each referral over the past year as I sat in his chair. It made me feel great, of course, and I was sooo impressed he remembered.

The truth is, he wasn’t really remembering–he or his staff simply wrote the names of people I referred in my file. As he sat with me, he could look over and say, “Thanks for referring Lisa.” A free, simple tool to get a simple, but important task done. And like good magic, even when the trick is revealed, I’m still impressed.

Raza’s like my dentist. His gift is connecting with people, and it’s important to Raza to remember the little, personal things. The problem, of course, is that you really can’t remember them–not all, anyway. To accomplish similar magic to my dentist, his office uses sticky notes in the file to remind them of the little things that are important in the lives of their patients.

“One patient had missed a previous appointment, which was very rare. When she called to reschedule, we found out she’d missed her appointment because her horse had fallen in a ditch the night before. Carol put a sticky note in the file that the horse’s name was Tony. When she came back in, I asked, ‘How’s Tony?’” – Raza Shah, ND

Needless to say, the patient was thrilled that he asked. I love this. It’s an elegant, painless and basically free way to remember important things, and communicate them between practitioners and staff.

The sticky note, though, isn’t really what this is about. The sticky note is just the manifestation of actually caring. It’s no different than putting a note in your calendar to remind you of a friend’s surgery, or your mom’s birthday. It’s just a way to make your clients feel like their lives are important. Because…they are, aren’t they? (And, no, writing it down doesn’t mean you care less, or that it’s a gimmick. The fact that you write it down at all means you care more than most.)

Your patients might not arrive by horse. But for the price of a few sticky notes, you can still perform magic of your own and show you care.

Note: I love that patients arrive by horse. Anyone else know of out-of-the ordinary practice set ups or patients? Do share…   -Dan

Last year at our strategic planning session, which involved a big push to serve, we launched Project 52, a customer service initiative for 2009. The goal was simple: make one customer service improvement each week for a whole year.They didn’t have to be huge or expensive shifts – they just had to improve the client experience.

A year later, we’re looking at a long list of improvements. They range from warm slippers and adding additional  soundproofing between treatment rooms, to 30-minute guarantees on returning messages during business hours and softer toilet paper. I thought I’d share how we did it in a little more detail, and tell you about our new Project 52 for 2010.

How To Start Your Own Project 52

1. Create a Visual Way to Track Progress

Of course, if you’re going to make 52 improvements, it makes sense to track them. Not only can you monitor how you’re doing, but as we’ve discovered, there’s a nice side bonus of ending up with a sort of “diary” of customer service improvements over the year. It’s easy to forget just how much change you actually make in a year – it’s a pretty rewarding feeling to look at our list of enhancements.

For us, a piece of flip chart paper was the easiest, cheapest way to track our progress. Draw a grid with 52 squares and you’re done. Total time: about 2 minutes. Total cost: about two cents.

You can use a computer file if you want, or something smaller than a big flip chart. Just make sure it conforms to the next tip, which is…

2. …Post Your Tracking In a Visible Place

We have a small staff room in the clinic, so we hung our chart there. It made it top-of-mind for everyone. There was always this mild pressure to come up with a new idea. If progress slowed down, it was visible to everyone. And when we were stuck, we could…

3. …Ask for Ideas

Making 52 little changes isn’t actually that hard. Surprisingly, the hardest part can be to think them up. It’s easy to come out of the gate quickly – I had a good dozen on my mind when we started – but as things get busy, it can become challenging to think of new improvements.

Looking over our list, the vast majority didn’t come from Tara or I. They came from other people. If you get stuck, try the following:

• Ask your clients: We did a very brief survey over the course of a couple of weeks in the office. It had two questions: What do you enjoy most about your visits here? and How can we make your experience better?
• Turn on your radar for subtle “hints”: once you get tuned into this stuff, you realize that people are giving you service feedback all the time – it’s just not in the form of outright complaints. Listen for those comments that aren’t really complaints, but are indications of less than ideal service.
• Ask non-clients: great service tends to be similar across great businesses. If you ask a few friends about where they receive the best service, and why, you might find you’ll get some great ideas.
• Ask your stafff: If you have help, ask the folks on your team. They’re the people getting all the front line action and fielding most of the comments and complaints. In our case, the credit for pulling this off goes to them. Including our high-tech tracking system.

3. Collect Ideas Somewhere Safe and Visible

Some ideas aren’t implemented right away. Some you won’t use at all. What’s important, though, is to have a place to keep track of them. We taped our Project 52 list to a whiteboard so anyone could scratch down potential ideas as they occurred.

4. Don’t Worry About “Big”

In addition to service, one of our other core values is continuous improvement. Project 52 is a visible, measurable manifestation of that. But to continually improve, you need to let go of the idea of massive, sweeping improvements that hog resources. Something as small as our parking bowl improves the client experience by a tiny bit. Those tiny bits can add up to whether or not a) a client returns to your practice and b) they refer other people to you.

And this year? Our new Project 52 is called Random Acts of Wow! (Yep – we love naming stuff.) It’s similar to last year (there’s a flipchart), but with a couple of differences. This year, we’ll focus on making exceptional acts of service on an individual level. Little gifts, thoughts, calls, notes and other random acts of kindness for our patients.

To make it happen we’ve established a massive Project 52 budget of $50 per month. That can be spent at the discretion of anyone on the team. The only rule is this: you don’t have to ask, but you do have to tell. In other words, be kind, and share the stories with us via the Project 52 board.

Everyone seems pretty excited about this one. I suspect that most of the things that fill the chart won’t cost anything. Kindness, after all, is usually free.

Happy 2010 everyone. Thanks for reading, and have a wonderful year of helping and growing!

-Dan & Tara

Contrary to popular belief, you don’t need to be booked solid to have a waiting list. It’s a tool that works wonders at any point in practice.

The challenge is that waiting lists are harder to use than they seem. Here’s how you can make one work for you and your clients with no cost and minimal effort.

The Challenge

We were doing well with our scheduling strategy, but we still had a lot of holes coming from last minute scheduling changes. We don’t double-book, over-book, charge for missed appointments or use any other fixes that I feel reduce our level of service, but we really needed to do something to get the schedule filled more effectively, while still serving clients even better.

The waiting list was the answer. We just needed to use it the right way!

The Benefits

We were already using a waiting list, but it wasn’t working the way we thought it should. This time, we fixed our process for good and noticed the following in just a few days:

• Less waiting for new and existing clients
• More client visits in fewer clinic hours
• More convenient scheduling for patients
• Better daily flow for practitioners
• Greater revenue with the same or lower costs

To make that happened required five key shifts. Not difficult ones, but each is important.

Shift 1: Work Less

In the past, we’d tend to scale up available hours as things started to get busy. Once the schedule approached the 70-80% mark, it was harder for patients to get in at certain times, so we’d add a few hours here and there. It seemed sensible – after all, if there’s not much room in the schedule, you add more, right?

Wrong. This year, we took a new approach. Faced with a busy appointment book, we actually reduced our consult hours. This was the real turning point.

Reducing available time is really a way to push the adoption of a waiting list. It forces you to find a way to truly use the time that’s available in the schedule.  Why book only 75% of 30 hours when you could book 95% of 25? The deliver similar “billable time” but the latter involves a lot less time in clinic.

The result for us? We’re seeing more patients in the new reduced schedule than we did before, and providing much better service.

Shift 2: Change the Intention

In hindsight, “waiting list” isn’t the greatest phrase. I mean, who wants to be put on a list for waiting?

In the past, we might ask someone, “Can we put you on our waiting list in case there’s a cancellation?” Many would say, “No thanks.” A waiting list wasn’t really a patient-centered offering, and people weren’t interested. And for our staff, who take our clinic values very seriously, the waiting list wasn’t much fun either. For them it felt like a frustrating exercise that was all about making the clinic more financially efficient.

The solution? We changed our waiting list to a rapid care service. I know – it sounds like fluff, but it’s not. It was a fundamental shift in the purpose of the tool. Now the staff can reassure patients who can’t get in as soon as they’d like by explaining our rapid care service that will get them in sooner. Then they delight them a day later when they say, “Guess what? We’ve got a space for you.” Patients love it. It’s helpful for the staff. The practitioners love it. And the clinic is busier than ever, with fewer wasted clinic hours.

This shift is simply about service. A waiting list that is built around the intention of, “not wasting time we could be billing for,” will never work as well as one that’s built to serve.

Shift 3: Just Start

Don’t make this a big deal.  You can start your own rapid care service with a scrap of paper taped to the front desk. That’s what we did, and it worked great. Just get started, and figure it out as you go.

And don’t wait until you’re busy. The waiting list isn’t a tool for booked-solid practitioners. It’s a way to increase the speed and convenience of services in your office for everyone from the clients to the staff to you. That means no matter where you are in your practice, day one or day one thousand, you can use this tool to make life in the office easier for everyone. Even if it’s just you and a small roster of patients, get this habit in place now.

One of our early problems was making this bigger than it needed to be – that kind of thinking puts up too many roadblocks and “buts.” Just get started.

Shift 4: Get Involved

A real turning point was when I manned the front desk for a few days over the school break when we had some staff shortages because of vacation. It’s a job I used to do more in the clinic’s early days, but haven’t done much recently. It’s a great way to appreciate a) the challenges of filling a book effectively, and b)just how often a waiting list can be put to work.

You may be doing your own scheduling, and know exactly what those challenges are, but if you haven’t done the job in a while, it’s worth making a few hours to live in your staff’s shoes by answering the phone and booking appointments.

If you’re not doing your own booking, you’ll still need to be on top of gaps in the schedule. Make a point of checking the schedule regularly through the day. Help your team think of ways to fill any holes. “What about Mrs. So-and-So? She could come in.” Getting your waiting list to work is about changing habits, and that’s going to require you to be leading the charge.

Shift 5: Collect Better Information

To make this work, you’ll likely need to start learning more about your patients than you currently do – or you’ll at least have to start writing it down somewhere. Focus on these three areas:

• Best contact: To make your system work, you need more than just a way to get in touch with people. You need the fastest and most certain way to reach them. If you have a sudden opening in the schedule, you won’t be able to fill it quickly if you’re calling someone at home, but they’re at work for the next six hours. That means you need to know the best way to reach them now. Is it their cell phone? Email? Text? Work number?

• Patient preference: You waiting list needs to have some details – like what service patients are waiting for, and their preferences for times and days

• Patient flexibility: You’d be surprised how many clients have flexibility in their lives. The trick is to know who those people are. They’re the ones that are going to be a) great candidates for your waiting list, or b) the people whose appointment you can shift to accommodate someone else on the list who’s less flexible, and waiting for a specific time slot.

How you collect that info is up to you. Whoever does your bookings will develop a good sense of patient flexibility and preferences, but only if they ask in the first place. You need to be asking patients this information during the booking process. If you can’t reach flexible people in the fastest way possible, your list is going stumble before it gets out of the gate.

Small Effort, Big Benefits

Once you get this in place, you’ll find the benefits tend to spread into the schedule. When you have a great intention, and you can reach flexible clients easily, it become easy to shift the schedule to make it more efficient even when there aren’t people waiting. That frees up more blocks of scheduled time that help you get people in right away without ever having to be on the rapid care list at all.

Don’t be scared to work less to make this work. Test-drive it for a couple of weeks – you’ll be surprised not only at how efficient you can be, but how well your clients will respond.

The stats show that about two-thirds of us make New Year’s resolutions. My guess is that the majority of the other third can’t help but think at least a little bit about 2009, too. It’s natural. We’re thinking about getting organized and making fresh starts. Out with the old. In with the new. We feel the need to grow, change and just get better at what we do.

The challenge is that these are pretty big projects, and it’s easy to bite off more than your practice can chew. Instead, I like to think of one principle to focus on in the coming year. It’s a bit like herding – I need one idea that can guide all those tiny details, decisions and actions in the right direction. Each “cow” might have its own unique path and nature, but at the end of the year, I want all those bovine bits to arrive at the same place.

The guiding word for this year? SERVE.

Why Service is Everything in Practice

It’s hard to be the cheapest in this industry. Or to have the biggest selection. It’s not usually that helpful to be the fastest, either. So how do you compete?

The truth is you’re not really competing with the practitioner down the road, you’re competing with a preconceived notion about what health care is. You’re competing with ideas in the minds of prospective clients. Things like “free”, “covered by insurance” “requires an MD”, “needs a white coat”, and “happens in a hospital only”. These are ideas that pop up when someone needs care, and they stop people from choosing you.

So how do you compete, and grow? In this industry, you can best compete by providing incredible service, all the time. You grow, in other words, when you serve. It’s the word for this year, but it’s probably the word for every year.

As Gandhi said:

“A customer is the most important visitor on our premises, he is not dependent on us. We are dependent on him. He is not an interruption in our work. He is the purpose of it. He is not an outsider in our business. He is part of it. We are not doing him a favor by serving him. He is doing us a favor by giving us an opportunity to do so.”

What We’re Doing About It (and You Can, Too)

We have two pushes on for the year to help us serve better.

1. Project 52: We’ve been rolling out a big service push at our office – it started back with the parking bowl phenomenon, really, but our niche has always been high service, and I want to take it up a notch. We’ve started what we call Project 52, which is our goal to make one customer service improvement every week all year. It’s fun, it’s tangible, and everyone gets on board.
2. Random Acts of Service: Sometimes an opportunity appears to go that extra mile. We’re going to try to seize more of them. A client is an avid reader? We send them a book that will really help them. A client loves the warm slippers we provide in a treatment room? We mail them a pair. These are little things that we don’t do for everyone, but that we do when we know someone will really love it. It feels wonderful to do it, and it’s great for business.

The great thing about this stuff is that it’s inexpensive. I bet most of our Project 52 ideas will be free (so far they are) – they’ll be tiny tweaks and improvements that really aren’t hard or costly.

People Who Can Help YOU

Here’s some 2008 gratitude and some 2009 well-wishes to the people out there who are doing their best to serve YOU so you can better serve others. I think these folks are an important part of what we’re all doing to help people get better. I’d say most aren’t making millions doing this – they’re just jazzed about helping you so you can help others. You should pay them a visit. They’ll help you serve.

To all of the following, in no particular order: thanks for all you do to serve, and thanks for the great interactions we’ve had in the last year. (If I’ve missed you please let me know!!)

• Acupuncture Clinic Marketing
• The Healthcare Marketer
• Alternative Growth Streams
• CAMLAW Blog
• Chinese Medicine Notes
• Professional Practice Success
• Acupuncture Business School
• IntegrativePractitioner.com
• Advance My Practice
• Chinese Medicine Tools
• Marketing Matters
• The Healthcare Marketing Connection
• Create a Thriving Business
• Insights for Acupuncturists
• Natural Medicine Business Success
• Community Acupuncture Network
• Build Your Dream Practice
• AltMD Pro Center
• Holistic PR
• The Acupuncture Marketing Blog
• TheBodyWorker.com
• The Integrator Blog
• DC Practice Tools

To all of our regular readers and visitors, and to practitioners everywhere: Thank you, and may 2009 be as remarkable as you are.

-Dan and Tara

ExamineYourPractice.com offers comprehensive practice evaluations using “mystery shoppers”. Likely best for checking the performance of your staff, but you could always get a self-review…

Mystery Shopping – Medical Mystery Shopper – ExamineYourPractice.com

There’s also an interview with President Jodi Manfredi on SoundPratice.net:
http://www.soundpractice.net/article.cfm?id=290