I get asked all the time how I went from staff clinician to doing what I do now. This series is my most complete answer to that question — six articles covering everything from career strategy to the mindset shifts that actually make the transition stick. Paid members get access to the full series.

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Let me ask you something.

When was the last time you read something that had nothing to do with healthcare?

Not a clinical journal. Not a continuing education course. Not the latest guidelines on whatever area of practice you specialize in. Something completely outside the field — a novel, a book about jazz history, a memoir about survival in the Alaskan wilderness, a biography of a businessman you’ve never heard of.

If you’re like most healthcare professionals, the honest answer is: it’s been a while. Maybe a long while. Because there’s always more to stay current on, always another development in the field to be aware of, always the nagging sense that reading something unrelated to work is a luxury you can’t quite justify.

I used to feel that way. I don’t anymore. And I think this shift in how I approach reading has been one of the more quietly important things I’ve done for my professional effectiveness.

Here’s the argument I want to make in this final article: staying current in your field is the floor, not the ceiling. It’s what everyone serious about their work is doing. The people who think differently — who bring unusual insight to familiar problems, who can see what others can’t, who find solutions by drawing on unexpected sources — almost always got there by reading and learning beyond the edges of their industry.

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I get asked all the time how I went from staff clinician to doing what I do now. This series is my most complete answer to that question — six articles covering everything from career strategy to the mindset shifts that actually make the transition stick. Paid members get access to the full series.

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I was having lunch with a lawyer friend of mine not long ago. We were talking about business — the size of our teams, the kinds of work we take on, how we decide what fits and what doesn’t.

At one point I asked if he handled a certain type of case that seemed adjacent to his main area of practice. He paused, and then said something I’ve been thinking about ever since.

“It’s like if I was a furniture maker and someone asked me to build them a deck. Sure, I’ve got the tools. I could probably do it. But if I say yes, you’re probably not going to be happy with the result, and I’m definitely not going to be happy doing the work. So I say no — even when the money’s good.”

That’s positioning. In one clean analogy.

Positioning is knowing exactly what you do, who you do it for, and what kind of value you’re uniquely equipped to provide. It’s having enough clarity about those things that you know — without having to think too hard — when to say yes and when to say no.

And here’s what most clinicians and practice owners miss: positioning isn’t just a marketing concept. It’s a career concept. It’s a decision-making framework. And the absence of it is one of the most common reasons that capable people end up either overwhelmed with the wrong work or undiscovered by the right clients, employers, and opportunities.

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I get asked all the time how I went from staff clinician to doing what I do now. This series is my most complete answer to that question — six articles covering everything from career strategy to the mindset shifts that actually make the transition stick. Paid members get access to the full series.

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I was listening to a podcast a while back — My First Million, if you’re familiar with it — and one of the hosts said something in passing that I haven’t been able to stop thinking about.

He was interviewing someone who had started multiple companies, raised significant capital, and had one of those careers that looks almost impossibly full from the outside. And the host said, almost offhand: “You’ve just bought a lot of cheap lottery tickets.”

He moved on. But I didn’t.

Because that phrase — cheap lottery tickets — is the most accurate description I’ve ever heard for how careers like mine actually get built. Not through one big bet, one transformative decision, one moment of courage. Through a long series of small, low-risk asks where the downside was almost nothing and the upside was occasionally everything.

My father gave me a version of this advice when I was navigating early career decisions. He’d ask: “What’s the worst thing that can happen?” And when I’d say, “They say no,” he’d say, “Exactly. And then what? You’re in the same spot you are now.” But if they say yes? That’s when things change.

I didn’t have a name for it then. But I’ve been buying cheap lottery tickets my entire career. And looking back, the yeses — even the occasional ones — are responsible for almost every significant leap I’ve made.

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I get asked all the time how I went from staff clinician to doing what I do now. This series is my most complete answer to that question — six articles covering everything from career strategy to the mindset shifts that actually make the transition stick. Paid members get access to the full series.

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Here’s something I hear constantly in the groups, at conferences, and in conversations with clinicians who are thinking about stepping outside the clinic:

Our skills as clinicians translate into more than just treating patients. We should be able to get these jobs.

And they’re not wrong. Clinical skills do translate. But there’s a gap between having skills that translate and actually getting the job — and that gap is almost always a communication problem, not a competency problem.

The issue isn’t that clinicians lack what it takes. It’s that most clinicians haven’t learned to speak the language of the roles they’re trying to get into. They haven’t connected the dots between what they do in the clinic and the value they’d create in a boardroom, a consulting engagement, or a leadership team.

That’s what this article is about. Not listing generic soft skills you already know you need, but getting specific about what they are, why they matter, and how to actually build them — starting from wherever you are right now.

Here are the five.

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I get asked all the time how I went from staff clinician to doing what I do now. This series is my most complete answer to that question — six articles covering everything from career strategy to the mindset shifts that actually make the transition stick. Paid members get access to the full series.

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People love a clean origin story. The kind where someone knew exactly what they wanted, made a plan, executed it step by step, and arrived exactly where they intended.

That’s not my story. And if you’re reading this, there’s a good chance it’s not yours either.

What I can offer instead is the real version — the stumbles, the pivots, the jobs that lasted six months, the opportunities that came out of nowhere, and the slow accumulation of experience that eventually added up to something. Because I’ve found that the messy version is actually more useful. It shows you what the path actually looks like from inside it, not from the highlight reel.

So here’s the career map. Not the polished LinkedIn summary. The actual thing.

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I get asked all the time how I went from staff clinician to doing what I do now. This series is my most complete answer to that question — six articles covering everything from career strategy to the mindset shifts that actually make the transition stick. Paid members get access to the full series.

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There’s a question I get asked a lot. Students ask it. Mid-career clinicians ask it. Sometimes even people who are getting close to retirement ask it. It doesn’t seem to matter where you are in your career — the question keeps coming up.

How did you go from staff clinician to doing what you’re doing now?

And here’s the honest answer: I didn’t follow a plan. I didn’t have a roadmap. I didn’t sit down at age 25 with a whiteboard and sketch out the next 15 years of my career. Most of the moves I made felt, at the time, like I was just saying yes to an interesting opportunity or chasing something that seemed cool. Sometimes it was about the money. Sometimes it was about the team. Sometimes it was just about getting out of wherever I was.

What I didn’t realize until much later — until a client conversation stopped me in my tracks — was that all of those moves, as scattered as they looked on paper, had a common thread running through all of them.

That thread changed the way I make decisions now. And I think if you take the time to find yours, it’ll change the way you make decisions too.

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*I wrote this piece in 2020, and it became the foundation for the podcast, the book, and much of my consulting and advisory work since then.

Better Outcomes: A Manifesto for a New Healthcare

Let’s get real: Healthcare is broken. You know it. I know it. Every clinician who came into this field from a desire to care for others, knows this to be undeniably true. We feel it everyday when we enter our clinics, hospitals, and practices. We feel the burden of time-based productivity metrics, utilization rates, and the expectation to behave like cogs in a giant, soul-crushing machine aimed at extracting revenue from our patients in exchange for “units” of treatment.

Day after day, millions of patients go to clinics, hospitals, and other healthcare facilities to address issues related to their physical, emotional, and mental health. More often than not, they are met with indifference or bulldozed by procedures. And that’s not surprising, when the healthcare environment pushes clinicians to the point of burnout and apathy.

Healthcare should be about one thing: PEOPLE! Yet how many clinics, organizations, or healthcare professionals live their lives by the numbers? Metrics & spreadsheets drive most of our healthcare decision makers and administrators. That leaves patients -the people we serve- lost in the mix. Patient’s feel lost, forgotten, and ignored by a system that prioritizes efficiency & productivity over their own personal experiences, priorities, or goals.

That’s probably why nearly 70% of patients never complete their course of care.

It’s time for clinicians to finally stand up and say what we’ve all been thinking for so long: enough is enough!

It’s time for healthcare organizations to commit to serving the individual needs of each unique patient that they are charged with serving.

To do this, we need a new framework, a new paradigm, a new way of looking at this noble profession of healthcare. Below are the 8 foundational commitments to create a new healthcare:

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Commitment #1: We will care for the whole person, not just a diagnosis. We will adopt a Biopsychosocial approach to healthcare, rejecting cookie-cutter treatment protocols with one-size-fits-most, plug-and-play protocols that fail to address the nuances of each individual patient.

As I have written about here, there is always more at play than the issue or diagnosis that a patient is seeing you for. We are all people, and people are affected by biological, psychological and environmental factors, each of which is unique to each individual. We can not simply rely on a diagnosis or symptoms to determine which treatment option, assessment tool, or outcome measure will be most effective for each patient. Everything from the patient’s social environment, past experience, and readiness to change impacts the issue they are now dealing with.

In the past, a biomedical model of practice placed symptoms, diagnoses, and physiological issues at the forefront of clinician’s mind. While these factors are important, they represent only a fraction of the whole person, the individual patient, sitting in front of you now. It’s time to start addressing individuals and their unique situations and factors, instead of focusing too heavily on diagnoses.

Since, we understand how physical, psychological, and social/environmental factors interact throughout a patient’s experience of a disease, injury, or illness, we understand that there are too many factors at play for rigid treatment protocols or “cookie-cutter” treatment programs.

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Commitment #2: We will prioritize improving our interpersonal skills and abilities and focus on building meaningful relationships with each patient; relationships built on trust, empathy, & caring.

It goes without saying that —at the very least— patients expect to be treated by clinicians who are professional, competent, friendly, and caring. Research also shows that patients place a great deal of weight on the clinician’s ability to communicate effectively; from explaining a diagnosis to educating the patient of self-management strategies. In fact, this research concludes that high-quality patient-therapist interactions are more important to patients than convenient clinic locations, parking, organization of care, and even in some cases the treatment outcome.

Given that information, we as clinicians and clinic owners should be trying to do anything we can to improve the interactions patients have with our staff and clinicians. This starts with the way the clinician communicates including language, word choice, body language, and active listening.

Healthcare is a personal service involving a human experience. Patients want that experience. They want to feel that their clinician understands their situation, knows how to help, and truly cares about them.

The best clinicians —those that are sought out by patients— are those who are able to make that human connection felt.

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Commitment #3: We will put people ahead of procedures and policies.

I once worked for the Department of Veterans Affairs (VA) in an outpatient clinic at a VA medical center. This environment, in particular, highlighted one of the major issues in healthcare today: we tend to prioritize policy and procedures over people. Part of that stems from our biomedical history, as well as the environment of efficiency and productivity healthcare now finds itself in. When everything is a number, a unit, or a line on a spreadsheet, it’s easy to make decisions without considering the impact they will have on the real people on the other end.

Take for example, blanket requirements or protocols (we were fond of those at the VA). If you run the numbers and determine that X% of patients with diagnosis Y successfully manage the diagnosis or recover after completing a certain treatment, it’s very easy to make the blanket policy that every patient with diagnosis Y should complete that treatment first. On paper it looks great. You can make projections and calculate recovery rates, costs, and the like. However, blindly applying that policy to every patient with diagnosis Y fails to consider the individual circumstances or factors that may make that treatment ineffective for that patient. Many patients are stuck in treatment plans that aren’t appropriate because some bureaucrat somewhere made a blanket policy about their diagnosis, and now the patient —not the bureaucrat— suffers as a result.

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Commitment #4: We will confidently communicate the value that our treatments and services provide to the patients who receive them.

For decades, clinics and clinicians have relied on being “in network” to avoid having to talk about value. And, in reality, they didn’t have to. Patients simply went where their doctors sent them. But, all that has changed. Patients are beginning to be more picky about which provider they seek out.

Rising healthcare costs —deductibles, copays, coinsurance— combined with the advent of the internet means that patients now have a choice in who they see. And they’re beginning to use it. That means we must be able to effectively communicate the value we bring to the table. We must have value discussion with our patients —having them identify their desired goals or outcomes, attaching metrics to those outcomes, and framing the cost of treatment in terms of achieving those goals.

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Commitment #5: We will prioritize patient engagement & experience.

If all you want to do is run a therapy mill or an assembly line practice, then you don’t really care about patient engagement or experience. I mean, you want them to have a good enough experience that they’ll come back for their next treatment, sure. But you don’t necessarily care about their engagement in treatment.

Clinics and clinicians that want to make an impact in their patients’ lives think differently. They prioritize patients being actively engaged in treatment. They want patients to be involved in the goal setting, treatment planning, and benchmarking. This ensures that each patient has a higher chance of achieving their desired goals and outcomes.

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Commitment #6: We will embrace transparency throughout the entire treatment process, including financial costs for our patients.

You know what sucks? When you call a clinic to set up an appointment for an evaluation or treatment that your doctor prescribed and you can’t get the answer. The answer to the questions “How much is this going to cost me?” Most of the time, clinics respond with something like, “With your insurance, your copay is $X”. And that’s not untrue. That is the copay. But everyone knows it: about three months after that appointment, you’re going to get a bill, and hopefully it’s small. Sometimes it’s a “what the hell is this!?!?” bill.

Either way, this has to stop. We need to do everything we can to be transparent with the patient about what their financial commitments will be. This may be an estimate, range, or we may even go so far as calling their insurance to get hard numbers. What is important is that we begin to pull back the curtain for our patients, to provide them with as much information as possible upfront, so they don’t get an ugly surprise afterwards.

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Commitment #7: We will forget time-based productivity metrics and find alternative ways to measure our effectiveness as clinicians and organizations.

Whether you’re a new grad or a seasoned clinician, you’ve run into the productivity paradigm; using time-based productivity as a way to “maximize revenue” or “improve efficiency” in the clinic. Healthcare organizations, hospitals, practices, and clinics run on productivity. They focus on productivity. They require productivity.

However, by focusing on time-based productivity measures, we miss what we truly should be assessing. We miss out on measuring the quality of the healthcare service being provided. This system creates an incentive structure that causes clinicians to try to “get the most out” of every patient interaction (in terms of billable units) which cuts down on documentation and administrative time. However, what is often lost in this environment is the ability to focus on individual patient needs. It’s time we all decided to begin focusing on what really matters: patient-driven outcomes, rather than treatment units & number of minutes billed.

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Commitment #8: We will lead our patients and guide them through the treatment process towards achieving their desired outcomes & goals.

Are you a licensed, experienced clinician, or a vendor? Are your services and treatment plans “off the shelf” or “one-size-fits-most”? Put another way: do you lead your patients, or do you take orders like a good waiter?

Most clinicians worth their salt will respond “Absolutely not! We develop individualized treatment plans for each patient.” And, inreality, most clinicians strive to meet that goal.

However, sometimes, clinicians find themselves being driven by their patients. They allow their patient’s desires, expectations, and views to overly influence the course of treatment. Sometimes this stems from poor communications or not addressing expectations early. Rather than deal with an unhappy patient (or negative online reviews), the clinician decides to placate the patient. The problem with this is, that it doesn’t necessarily prevent the patient from leaving bad reviews or ending up dissatisfied with treatment. In fact, these patients can be more likely to have a negative experience. By allowing them to take the leadership role, whenever it must be taken back, they become upset and frustrated. To prevent this situation, clinicians must lead patient relationships and treatment plans.

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A higher Standard

It’s time for a change. It’s time that we, as clinicians, begin to return our attention back to where it belongs: the patient, their goals and priorities, and their desired outcomes. For too long we’ve allowed third-party payers, administrators, and number-crunchers to dictate how we provide care. Driven by time-based productivity metrics, utilization, and treatment units, clinicians continue to work to the point of burnout, while their patients receive cookie-cutter run-of-the-mill assessments and treatments. Patients, disengaged from treatment, decide that there are other options out there to help them achieve their goals. Or, sometimes they simply give up all together. They drop off your schedule, cancel appointments, or even “ghost” you —never to be heard from again.

Rehab U Practice Solutions wants to change that. We are on a mission to create a world where skilled, competent, and caring clinicians serve and care for engaged patients to promote better clinical outcomes, unmatched patient satisfaction, and lasting relationships.

We envision a world where skilled, competent, and caring clinicians serve and care for engaged patients to promote better clinical outcomes, unmatched patient satisfaction, and lasting relationships.

Given the right goals, strategies, and processes, clinicians and organizations can create uniquely awesome patient experiences that lead to better relationships, better outcomes, and more referrals. After all, healthcare is about one thing: the patient! That’s where we need to focus.

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Connect with Me

• LinkedIn (Rafi Salazar)

• Work with me

• Hire me to Speak

For More:

Join Rafael E. Salazar II, MHS, OTR/L (Rafi), principal of Rehab U Practice Solutions and host of The Better Outcomes Showas he explores the possibilities of a new healthcare. Guests range from clinicians trying new techniques and treatments to executives and entrepreneurs exploring new technology, innovative service delivery methods, business models, and organizational structures. Grab a copy of the book: Better Outcomes: A Guide to Humanizing Healthcare. Or, hire Rafi to speak at your organization or event.

Are You Ready to Take Your Healthcare Business to the Next Level?

Navigating the complexities of the healthcare industry requires deep expertise, actionable insights, and a focus on sustainability. That’s exactly what we deliver. Whether you’re looking to improve patient engagement, streamline operations, or develop a winning go-to-market strategy, I help you move the needle and achieve lasting results. If you want to learn more, reach out. I’d love to talk with you about how I can help you Leverage Objective Advice & Insight, Focused Knowledge, and Industry Expertise to Move the Needle for your Healthcare Business or Organization.

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I’ve had several clinic owners, directors, and clinicians reach out and ask about how to avoid the potential dangers and pitfalls that lurk in the shift into telehealth and virtual service delivery models. One thing is certain: telehealth is not going away. It simply provides too much convenience, access, and cost reduction to simply fade into the background.

So, the question becomes, if telehealth is going to be a permanent part of healthcare delivery in the future, how do we leverage its benefits without falling victim to commoditization and amplified negative patient experiences?

Here are some preliminary thoughts on the matter.

Telehealth Done Wrong: Commoditization, Downward Pricing Pressure, and Negative Patient Experiences

The biggest risk that telehealth poses to clinics and clinicians relates to the possibility of commoditization. Simply put, if telehealth is implemented improperly, it can reduce the perceived value of the services being provided.

But let’s explore this a little more deeply. How exactly could telehealth lead to a reduced perception of value of our services by clients and patients?

Tech Issues: Zoom Fatigue, Interpersonal Communication Challenges, and Glitches

As many have written about recently, video & virtual teleconferencing may require more energy & focus than in-person interpersonal interactions. In fact, the Harvard Business Review recently published an article on “How to Combat Zoom Fatigue“. The article discusses how distractions are much more tempting and prevalent in the virtual world.

This holds true for telehealth, on behalf of the clients and the clinicians. We’ve all done it: nodded along, saying “Yeah. Hmm…sure.” while we’re on a video call while simultaneously checking our email, texting a colleague, and/or doing a quick search on our computer or over the internet for a piece of content or resource that might be helpful in that conversation. T

he only problem is that those tasks prevent you from being fully present in the conversation, from truly listening to what is being said, and from actually being able to pick up on subtle cues being left by the speaker. Now imagine that you, or your client, are engaged in this sort of multitasking during a treatment session or assessment. What gets missed? What impression does it leave the client when it’s apparent that their clinician isn’t 100% focused on them and their situation?

In addition to zoom fatigue, there’s something more out of our control in the virtual healthcare space that has the power to negatively impact patient engagement & experience: lag, tech glitches, and other factors associated with virtual communication.

As discussed previously, communication between clinician and patient/client greatly impacts patient engagement, retention and experience. Put simply: interpersonal interactions and communication between clinicians and patients can have just as great an impact as the clinician’s skills or knowledge.

That said, what happens when tech issues prevent efficient communication between patients and clinicians? As one 2014 study suggested, delays in conferencing systems shape our views of people negatively [5]. In fact, a delay of 1.2 seconds can make your patients perceive you as less friendly or focused. In other words, a technical problem (outside of your control) can cause a patient or client to attribute their negative experience to your personality or behavior.

To understand this, you need to understand a bit about speech quality assessment. Speech quality is defined as “the result of a perception and judgment process, during which the listener establishes a relationship between what he perceives (i.e., the sound event) and what he expects (i.e., the internal reference): speech quality is not absolute, but is attributed by the listener.” [3].

It’s important to note that speech quality is entirely subjective. Your patients and clients determine what is high quality and what is not. As I’ve written about here, the environment or context affects our expectations. Our expectations influence our perception. And our perception affects what we experience, how we experience it, and the thoughts, choices, or actions that result from that experience.

Understanding this, it becomes clear how video lag, freezing, & delays can negatively impact your patient’s views of your skills, your clinic, and even your ability. The presence of some tech issue negatively influences your patient’s expectations and perceptions, which ultimately affects their experience during your telehealth session.

In fact, a report published by Hewlett Packard discusses how physical gestures and even breathing is considered an integral part of the communication experience [2]. Again, lag, latency, & freezing video impacts your patient’s ability to pick up on those cues (and also prevents you from doping the same).

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Negative Patient Experiences are Magnified in the Virtual Space

As some of the research mentioned above suggests, negative patient experiences can actually be magnified in the virtual or telehealth space. Why? Because outside of the context of in-person (or in-clinic) conversation and interactions, your patients rely on their experience of the virtual space.

This includes those factors mentioned earlier as well as others that may impact their perception of the quality of services being rendered. Take something as simple as the platform you choose to provide your telehealth treatment. How user friendly is it? Even if it is user-friendly, have you provided sufficient information and education to your patients and clients about the platform prior to initiating a session? What if you don’t check and ensure that your patient is good to go on a platform before an appointment?

Think of it like this: You call the customer service line for your internet provider (we’ve all been there). The internet crashed or froze up and you need to speak with someone about getting it up and running because you can’t check in new patients, document in your EMR, or send any correspondences to patients or referring providers.

You call the number and an automated answering services greets you. “For customer service press 1.” You press 1. “For problems with internet services, press 1.” You again, press 1. “By pressing 1, you have indicated that you are experiencing some trouble with your internet connection. Is this corset?”. Through gritted teeth, you say, “Yes.” You hear, “One moment…let me do some more digging to see what the problem is.”

Now, for the next 15-20 minutes, you engage in a series of questions, answers (and sometimes repeated answers), until the automated machine finally says, “Hold on. Let me connect you to someone who can help.” Now you’re thinking, what’re heck! You just wasted 20 minutes of my life and I still don’t have internet!

Now a real person answers the phone, they ask you basically all the same questions the computer asked you over the past 20 minutes. Then they do a little IT jujitsu and you’ve got internet again (maybe they asked you to turn your router off and then back on). While you may be happy to have internet back up and running, have you had an overall positive experience?

Of course not.

I would even go so far as to say that the experience is actually worse than it could have been if you were able to sit in front of the customer service or IT tech and say “This is what’s going on. Can you fix it?” Why is that? Because humans are social creatures and we rely heavily on interpersonal communication and signals to convey information. But it also feels like a huge waste to have to go through the runaround of the automated system.

Now take that same scenario and substitute internet problems for back pain, shoulder pain, anxiety, stress, or any other issue or diagnosis you may treat in your clinic. If our patients don’t understand how to use the platform you’ve selected for telehealth, or if certain aspects of care aren’t appropriate for telehealth, you’re essentially putting your patient in the role of calling that automated machine.

They’ll get frustrated, angry, irritated, and will likely have a negative overall experience of the session. Add to that the inability to interact in-person with you, the clinician, and it can all lead to a worse experience than having a few glitches like increased wait times at your clinic.

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Passive Treatments: Effective in the Short-Term, Damaging in the Long-Term

Now, the tech issues all relate to your patient’s experience of a telehealth session. But what about the value piece? Unfortunately, even in the clinic, many organizations and providers rely on low-value, passive treatment techniques. These techniques may temporarily relieve your patient’s symptoms in the moment, but they offer very little in the way of continued management of their own health, condition, or limitations after they leave your clinic.

But let’s take a step back and define passive treatments. According to the literature, passive treatments “require the patient to be a submissive recipient of treatment.” [6]. This could include anything from manual techniques, trigger point release, ultrasound, other physical agent modalities; basically any treatment where you do something to the patient. What’s so wrong with that?

Well, the research indicates that passive treatments, if used as the primary focus of treatment, may actually reinforce your patient’s feelings of helplessness or powerlessness and put the responsibility for management of their condition in your hands, as their clinicians [6].

Now, I want to say that I’m not telling you to throw out all of the techniques you’ve learned over the course of your schooling and career. Often times, passive techniques can be a great adjunct to treatment, and can even be used to get a patient over the initial pain or discomfort of beginning treatment.

That being said, you shouldn’t rely of passive treatment techniques with your patients, as they may ultimately have negative long-term affects on your patients. And that holds true for in-person or virtual models of healthcare service delivery.

And on top of the clinical implications of relying on passive treatment techniques, there’s the impact of patient perceptions of them in the virtual space (or your ability to even provide them over the inter webs).

For example, if the patient experience in your clinic relies too heavily on those passive treatment modalities, what happens when you and your patient find yourselves in a virtual environment, where passive treatment techniques may not even be an option? As one clinic owner recently told me in a conversation, “they [the patients] just don’t see the point in paying for telehealth if they’re not going to receive any ‘hands-on’ treatment.”

He brings up a good point here: if you’re relying on passive treatment approaches, your patients will likely (and rightly) feel that there simply isn’t value in signing up for telehealth.

It also opens the door to downward pricing pressure, commoditization, and maybe even challenges with third-party payers. If what you’re offering is run-of-the-mill services, there’s nothing to differentiate your practice or clinic from the one down the street. It makes you compete on price (if you’re cash-based or out-of-network) and also gives more power to third-party payers to set lower reimbursement rates for your telehealth services.

Doing Telehealth Right: Offering High-Value, High-Impact Services

Ok, now that we’ve covered all the ways things can go wrong during a telehealth experience, let’s look at how to do it right by offering high-value care in a patient-centered (or person-centered) manner. Like it or not, telehealth is here to stay. Patients expect it now. Healthcare providers and hospital systems are noticing its benefits from a cost & access standpoint. And CMS has established a precedent for telehealth moving forward.

That being said, you can’t simply apply “standard” or in-clinic practices and procedures to the telehealth or virtual service delivery world. The change in delivery method, treatment environment & context, as well as patient & client expectations all dictate that you learn to take your highest value services & treatment techniques and adapt them for the virtual world. Let’s start with client expectations.

Client & Patient Expectations

As mentioned previously, our expectations influence our perceptions, which in turn influence what we experience and how we experience it. Many times, your clients already have expectations in their minds about how treatment should look, the types of interventions they may receive, and the results they’ll experience in your clinic.

Now, if you don’t address client expectations at the outset of a course of treatment, you risk the client becoming dissatisfied, unhappy, disengaged, and possibly even angry with the experience they have in your clinic. Regardless of whether you are seeing patients and clients in the clinic or over the interwebs, managing patient expectations should be a top priority.

Often times, patient expectations about the type of treatment they’ll receive impacts their experience in your clinic. What do I mean by that? Well, how many patients have you seen in your clinic that expect you to “do” something to/for them to relieve their symptoms?

Just give me a pill, crack my joint, massage this muscle, stretch me here… the list goes on and on.

The problem with these expectations stems from an underlying view of healthcare. As I’ve written about here, for the vast majority of medical history, we relied on a biomedical model of treatment. This model rests on the idea that injury, illness, or disease stems from biological or anatomical dysfunctions. It doesn’t take into account the social, environmental, and even psychological factors that can be at play in a patient’s specific situation.

Often times, either in-clinic or over the web, your patients may still hold many expectations and beliefs about treatment based on this biomedical model. That being said, your goal should be to provide education and communicate in a way that is both empathetic & understanding, but also reframes their expectations about treatment, outcomes, and recovery.

This often involves a discussion about the difference between active & passive treatments. The literature shows that true, high-value treatment is based on active treatments (self-management skills, mindfulness, active movement, etc.) provides better long-term clinical outcomes than passive treatments (medications, manual therapy, surgery, etc.) [6].

Especially in the virtual space, where passive treatments can’t easily be delivered or provided, you must reframe patient expectations about the value of active treatments.

Self-management

As mentioned above, self-management skills and techniques provide better long-term outcomes than passive treatments. I’m not saying there’s anything wrong with passive treatments, especially if used in a way to encourage or facilitate participation in an active treatment.

But I am suggesting that the core components of treatment plans should be based on providing patients with the skills, techniques, and strategies to manage their own health and recovery.

This focus achieves 2 goals:

1) it empowers your patient to become the driver of their own health and well-being and

2) it decreases clinician (or medical) dependence.

It fundamentally alters the relationship you have with your patients. No longer are you the person that can put heir back “into alignment” or “adjust” their neck, or “massage” their sore muscle.

Taking a self-care and self-management approach, to treatment, you become a guide and trusted resource to your patient, who is now motivated and taking control of their own health. Your patients begin looking at you as a coach or accountability partner, as well as a trusted advisor on matters related to their health (not just the diagnosis that originally brought them to your clinic).

Education

Continuing on with the theme of active vs passive treatment, and delivering high-value care via telehealth, you must consider patient education. The type of education you provide to your patients, especially in the telehealth environment should “facilitate active engagement approaches (targeted exercise therapy, physical activity, and healthy lifestyle habits) and reduce reliance on passive interventions.” [1].

If self-management, active treatment, and the like offer the highest form of value to patients, then you should educate your patients with that type of information. Especially in the telehealth environment, where a patient might not “see the point” of attending if you can’t physically stretch, touch, or feel the area of pain or dysfunction, you must address these expectations through proper education at the outset of assessment & treatment.

Encouragement, Coaching, & Empowerment

Unfortunately, many clients and patients that show up to clinics across the country tend to value short-term relief at the cost of long-term outcomes. This, again refers to the seemingly universal desire on the part of patients to receive some treatment or intervention.

This is likely due to the fact that, at least for the vast majority of the healthcare industry’s existence, clinicians and organizations have reinforced the idea that passive treatments are the standard of care [6].

Simply put: most patients that walk into your clinic expect you to do something for/to them to relieve their pain, take away their symptoms or dysfunction, etc.

That’s one reason why taking an educational, empathic, and encouraging approach to patient care plays a vital role in helping improve outcomes, engagement, and satisfaction scores.

You must address a patient’s expectations early, at the beginning. You should use education as a tool to help patients understand that your ultimate goal is to help them overcome whatever limitation, pain, or symptoms they are currently experiencing by giving them the resources, skills, and support necessary to do so on their own.

You can certainly use passive treatment modalities as an adjunct to active treatments, self management, and the like. But your patients need to understand that your role in the process is to provide the necessary encouragement, support, and assistance to empower them to take control of their own health and well-being.

You’re a coach, a mentor, a guide; not a handyman or Mr. Fix-it.

Patient Experience: Interpersonal Interactions & Building Relationships

One of the many benefits of taking this approach to healthcare service delivery becomes apparent over the course of care, and then in returning patients: real, lasting relationships with your patients and clients.

When passive treatment modalities remain the core service offering at your clinic, the interaction you have with your patients stays at a merely transactional level. The patient comes in. You do your thing. They feel better and leave. They come may or may not come back again, depending on how they’re feeling. That’s it.

Now, I always say that clinicians that get into this field typically posses great people skills. They build relationships easily, are warm, welcoming, and inviting; and their patients genuinely value the relationship they have with them.

However, this relationship often times stays in the superficial. They may open up about their shoulder pain, how it’s impacting their day-to-day living, and their hopes for recovery. They may even share about their family, social life, etc. But when the focus of the interaction is on this “pain” or “symptom”, the relationship doesn’t grow deep roots.

However, when the focus of the interaction is on empowering your patient to take the driver’s seat in their own health and well-being, the relationship blossoms. No longer are your appointments and interactions simply transactional. You now become a trusted advisor, mentor, coach, or whatever term you like.

You become the trusted guide, helping your patient achieve their ultimate goal of a full and healthy life. That means you see greater impact in your work, your patients value you more, and you build long, lasting relationships with them. They’ll not only think of you the next time their shoulder hurts, but they’ll also think of you when they have some health or lifestyle change they want to pursue.

Summary

Ultimately, you need to understand that telehealth & virtual healthcare delivery models are here to stay. The key to diving into that world lies not in the technology, or the interface, or the format —although you should try to get those squared away.

The key to implementing telehealth is to remember what your true high-value services are. Your high-value, high-impact services are your ability to encourage, guide, and empower your patients into taking the driver’s seat in their own health and well-being.

It lies in your ability to build true, lasting relationships that can be used to support your patients as they make these behavioral changes, and in helping them develop the self-management skills they’ll need to stick with them.

Telehealth might limit your ability to physically touch, assesses, and interact with your patients, but that constrain forces you to lean into the true value that you, as a clinician can provide.

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Resources:

[1] Caneiro JP, Roos EM, Barton CJ, et al. It is time to move beyond ‘body region silos’ to manage musculoskeletal pain: five actions to change clinical practice. Br J Sports Med. 2020;54(8):438‐439. doi:10.1136/bjsports-2018-100488

[2] Geelhoed, E., Parker, A., Williams, D., & Groen, M. (2009). Effects of Latency on Telepresence. HP Laboratories.

[3] Guéguin, M., Bouquin-Jeannès, R. L., Gautier-Turbin, V., Faucon, G., & Barriac, V. (2008). On the Evaluation of the Conversational Speech Quality in Telecommunications. EURASIP Journal on Advances in Signal Processing,2008(1). doi:10.1155/2008/185248

[4] Lewis J, O’Sullivan P. Is it time to reframe how we care for people with non-traumatic musculoskeletal pain?. Br J Sports Med. 2018;52(24):1543‐1544. doi:10.1136/bjsports-2018-099198

[5] Schoenenberg, K., Raake, A., & Koeppe, J. (2014). Why are you so slow? – Misattribution of transmission delay to attributes of the conversation partner at the far-end. International Journal of Human-Computer Studies, 72(5), 477-487. doi:10.1016/j.ijhcs.2014.02.004

[6] Cosio, D., & Lin, E. (2018). Role of Active Versus Passive Complementary and Integrative Health Approaches in Pain Management. Global advances in health and medicine, 7, 2164956118768492. https://doi.org/10.1177/2164956118768492

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*This article was prompted by a recent conversation I had with Paul Sing from StrataPT on the topic of AI in healthcare. Check that out here.

I’ll be honest with you: I almost didn’t write this one. Every time I sit down to talk about AI in healthcare— whether it’s on a podcast, with a consulting client, or in a staff meeting — I’m aware that whatever I say has a short shelf life. The technology moves fast. What’s true today might be table stakes in six months or completely irrelevant in twelve. For example, 6-7 months ago, most of my consulting clients were going to market with an “AI-scribe” value proposition. Now, that space is so crowded, that the same value proposition today doesn’t get the same traction. So take everything here with that caveat in mind.

That said, I think there’s real value in sharing what I’m seeing and doing right now — not as predictions, but as a ground-level view from someone who’s both running a clinic and advising healthcare technology companies on the side. I recently had a conversation on the Strata Stories podcast where I got into a lot of this, and I wanted to pull out the most useful parts and share them with you in a format that’s easier to reference.

Here’s where my head is at.

Q: What’s your read on the AI scribe space right now?

The AI scribe space is overcrowded, and a lot of companies that dove into it are now struggling to find takers. Here’s why: the low-hanging fruit was ambient documentation — record a session, turn it into a note. That made sense two or three years ago. But platforms and EHRs have since built that capability in-house, and now most practice owners aren’t shopping for a separate AI scribe tool because their EMR already does it. If you’re a startup entering the market right now with AI-scribe-first positioning, you’re fighting for a shrinking piece of a pie that the major platforms are eating up themselves.

I’m also seeing what I’d call acqui-hires — where a larger EMR company buys a smaller AI company, not really for the tech, but for the team. The marketing makes it sound like a big win, but behind the scenes it’s more like: we’ll take the engineers and fold them in. It’s not failure, but it’s not exactly a success story either. Expect to see more of that.

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Q: Where do you actually see AI adding value in a healthcare practice?

I think about it in two buckets: patient-facing and back-office.

On the patient-facing side, there’s real opportunity in making the intake and onboarding experience smoother — automated messaging, digital check-in, guided triage before a patient even sees a clinician. Done right, this doesn’t feel robotic; it just removes friction. I actually just worked with a company that developed an agentic solution to obtain consent, onboard, and provide initial clinical education to patients enrolled in chronic condition management programs. The system gets the patients onboarded, tracks the data, and then documents it for the clinician ahead of the patient’s in-person clinic time. It save the practice admin time, provides more touch points for the patients, and allows the provider to get more informed on the patient before walking into the exam room.

On the back-office side, credentialing, billing, and authorization workflows are where I think AI has the most legs right now. If you can tighten up your eligibility verification and pre-auth processes so patients aren’t getting surprise bills and you’re not drowning in denials — that’s where the ROI is. And with payers actively using AI to screen claims and find reasons to deny, you almost have no choice but to respond in kind. It’s becoming a digital arms race, and practice owners who aren’t paying attention are going to fall behind.

Q: Where are you drawing the line — areas where you won’t use AI?

Billing decisions. Full stop.

The idea of an AI system whispering in my clinician’s ear — ‘hey, you should probably bill this code instead of that code’ — makes me uncomfortable, even if the suggestion is technically correct. That’s a conversation I need to be having with my team directly. It touches compliance; it touches clinical judgment; and it touches the trust relationship between me and my clinicians. I’m not willing to outsource that to an algorithm, at least not right now.

What I am okay with is surfacing information and letting the clinician decide. If our system sees that someone entered a code that doesn’t match the documentation and flags it as a ‘hey, double-check this’ — that’s supervision, not replacement. There’s a big difference between a tool that nudges and a tool that decides. I’m building toward the former.

Without getting too technical, it’s the idea of “supervised” vs “unsupervised” AI implementation. For things involving care decisions, billing, and clinical practice, I’m squarely in the camp of using supervised AI only.

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Q: What’s your take on clinicians using AI tools on their own — without formal approval?

It’s happening. Especially in private practice where there’s less infrastructure and oversight than at a hospital system. I’ve heard from practices where clinicians are recording sessions on their personal iPhones, transcribing them, running them through ChatGPT for a summary, and copy-pasting into their EMR at the end of the day. And honestly? I get it. The impulse to save time is real.

But here’s the thing: as the practice owner, you are on the hook for that. Even if you didn’t know it was happening. So at minimum, you need a clear policy in your employee handbook that spells out how patient data can and can’t be used. We incorporated it into our HIPAA and PHI policies — patient data stays in the EHR, full stop. It doesn’t go into ChatGPT, it doesn’t go into any non-approved platform. That policy exists partly to protect patients, and partly to protect us if something ever goes sideways.

The other thing I’d say: don’t just clamp down without offering something better. If your clinicians are gravitating toward these tools, that’s a signal worth paying attention to. Figure out how to meet that need in a compliant way — because if you just lock everything down and don’t provide a solution, you’ll lose good people over it.

Q: How did you introduce AI scribing to patients at your clinic?

Very deliberately. We have a small practice, with a loyal patient base, and the last thing I wanted was for people to feel like we were experimenting on them or treating the visit like a data collection exercise.

The framing we used — and I really believe this — was about human connection. When a clinician says, ‘I’m going to hit record so I don’t have to be nose-deep in a computer while we’re talking,’ that’s not a tech pitch. That’s a promise of a better conversation. We made sure every patient had signed a consent form before we used any ambient recording. But beyond the paperwork, we thought carefully about how to communicate the why. Not ‘this makes our life easier’ — that’s true but it’s not the point. The point is: ‘This means I can actually look at you while we talk. I can be present with you.’

That message landed well. If you’re rolling out something similar, I’d encourage you to lead with the patient benefit, not the operational efficiency.

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Q: How do you stay plugged into what your team is actually doing with AI day to day?

Two things that have worked for me: showing up and asking.

I’m in the building most days, even though I’m not treating patients anymore. I do a walk-through, I watch interactions, I pay attention to what’s on screens. People will tell you one thing in a meeting; their behavior will tell you something else. You have to be present enough to see both.

We also run a bi-weekly all-hands meeting, and the tech stack is a standing agenda item. Not in a formal way — it’s not ‘AI update #14.’ It’s just part of the regular conversation: ‘Have you guys tried the new feature? What do you think? Is there something you’ve been using on your own that you want to explore together?’ Keeping it casual lowers the barrier for people to actually tell you what’s going on.

For practice owners who feel out of the loop: the answer isn’t a big town hall about AI. It’s smaller, more frequent conversations embedded in how you already operate.

Q: What does your device and data security setup look like?

Company-issued computers only. No personal devices for anything that touches patient data.

I know that sounds rigid, but my background is federal government and management consulting — my SOP brain doesn’t mess around with HIPAA exposure. The standing rule is simple: if you’re doing clinic work, you’re on a clinic computer. If you’re working from home, you’re taking a company machine and connecting through the VPN. We don’t have a formal refresh cycle — when a machine starts to go, we retire it properly (factory reset, physical destruction of the drive, the whole thing) and replace it.

I’ve seen what happens when someone accesses PHI on an unencrypted network at a coffee shop, even with the best intentions. It only takes one complaint to trigger a HIPAA enforcement action, and those are not fun. Don’t give anyone a reason to look at you.

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Q: What does the next year look like for your practice?

I think what we’re really moving toward — and I’ve been saying this for a while — is a true hybrid model of care. The ability to meet a patient where they are and give them the right kind of support at the right time. That might be a traditional PT session. It might be a digital triage tool that helps someone understand their symptoms before they ever book an appointment. It might be a remote monitoring check-in between visits.

The bigger shift I’m watching is the move away from fee-for-service and toward direct-to-employer and value-based models. Some of the platforms being built right now will eventually push patients directly toward physical therapy as a first line of care — which is great for us. But some of them will let large health systems self-refer and keep patients internal, which cuts us out. How that plays out over the next 12 to 24 months is going to reshape referral pipelines across the industry.

I’m not waiting to see which way it goes. I’m thinking now about how my practice fits into that broader landscape, and positioning accordingly.

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What’s your clinic’s strategy? How do you come up with service offerings or determine which specialty area to choose? What need are you meeting in your local healthcare market?

Believe it or not, many of us don’t get into healthcare with those questions in mind.

Many of us went into healthcare for one reason: we want to help people. Those of us who have started clinics, practices, and rehab agencies have taken the step to make a living from our calling.

What do I mean by that?

I mean that many clinicians that start their own practice aren’t necessarily “business strategists”. They have a skillset that other people (patients, referral sources, etc.) find valuable, and they’ve decided to make a living by providing those skills as a service.

Now, I talk to a lot of clinic owners and managers about “what to do”, “where to go”, and “how to grow” in their businesses before or after they’ve started them. And, truth be told, a lot of them are lost. Like I said: they went into healthcare and rehabilitation because they wanted to serve patients. They wanted to develop relationships, help patients achieve their goals, and make a real impact in their lives.

Now, they find themselves at the helm of a business venture. Unless they are solo-practitioners doing home visits or working out of a small space, they usually have other people depending on them for income. Office staff and sometimes other clinicians rely on their clinic’s success to feed their families and provide for themselves.

That can be a lot of pressure, especially if you didn’t go to “business school”. But, whether you’re comfortable with it or not, part of your role as a clinic owner or director is to develop and mange the strategy your business takes to achieve success.

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Strategy: Do I need One?

Let’s start with the basic question you may have: Do I even need to think of a strategy for my clinic? After all, especially if you’re starting out, you can probably build a referral list and start bringing in patients without having a formal “strategy”. And in truth, that’s not a bad way to start. You get some early cash flow, patient base, and “proof of concept” quickly.

The issue arises after the initial “launch” of your clinic or business. Once you start growing and begin considering hiring staff, growing your patient base, and expanding, you begin facing the questions I mentioned at the beginning of this article. You start wondering which service would be most advantageous to add to your clinic. You wonder whether you should expand into another demographic or diagnosis area.

All of these questions can be more easily answered when you’ve landed on a strategy or focus for your practice. Some folks lump this under the term “positioning”. Positioning refers to your “discipline for market” proposition. Put plainly, your positioning connects your services to the clients (or patients) you want to serve.

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What Should My Strategy Focus On?

I always tell my clients & students that your ultimate strategy should focus on boosting patient engagement & retention. In this rapidly changing healthcare landscape, patients have more options. They’re not bound to go to a certain provider of their referring doctor’s choosing. Unless your clinic offers some very specialized service, odds are that a quick Google search will show a handful —if not more— local competitors that your patients may choose to see.

So how duo you make sure that you end up being the one they choose? By ensuring that every patient that comes into your clinic has an incredible experience, not only of the treatment itself, but of the entire process of care. This means taking a look at communication, onboarding paperwork, administrative & billing processes, and much more.

And just as important is the patient engagement aspect. Everything from your marketing, messaging, and actual patient interactions in the clinic needs to be focused on developing real rapport and relationships with your patients. This makes them more engaged in treatment, confident in your services, and more likely to have a positive experience. That leads to word of mouth referrals, both to other patients and the referring physicians.

And that’s what you want.

You want a referring physician to tell their patients “there are a few options out there for X service, but I’ve been hearing a lot of good things from my other patients about ABC clinic.”

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Finding Your Strategy: 3 Steps to Service Offerings & Marketing

Part of ensuring patients have a great experience in your clinic involves ensuring that you’re attracting the right patients or clients to your clinic. How you message, market & communicate your service offerings either attracts or repulses a potential or prospective patient or client. The same goes for actually developing your service offerings.

In fact, someone recently asked me a question about developing service offerings. They essentially asked me, “Surely you don’t come up with the kind of offerings that will attract patients off the top of your head — some planning or research must take place first, right?” Here was my response:

That is correct. You don’t just come up with service offerings willy-nilly. Your service offerings must come from the overlap of three things: 1) your clinical expertise/knowledge/scope of practice, 2) market demand, and 3) your clinic or organization’s mission or purpose.

Now, I’ve written about the importance of using your organization’s purpose or mission statement as the benchmark for business & strategic decisions. This holds true for service offering development. You must also consider your clinical knowledge & scope of practice.

Obviously, if you’re a physical therapist, your service offerings won’t include ophthalmology, so I think that’s pretty clear. You need to offer services that you/your clinicians are both competent and knowledgeable about. And Finally, market demand should provide some indications when developing service offerings.

Let’s take a look at each step below:

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Step 1: Your Experience, Knowledge, & Scope

The first step in this process requires that you take an honest, evaluative, look at your clinic’s knowledge, skills, & competencies. If you’re a solo practice owner, this includes your own clinical skills, knowledge & expertise. If, like many of the practices and organizations I work with, you have multiple clinicians seeing patients and delivering services, then you’ll need a way to get your collective clinical knowledge & skills “on paper”.

To complete this step, have everyone list the areas of clinical experience & competencies they possess within each area. For example, if you run an outpatient adult physical & occupational therapy clinic, have you may have an area marked “orthopedics” and another marked “neurological”. List all of the clinical areas in which you/your staff have knowledge, skills, and competence. Next, have clinicians describe specific skills or competencies that they possess under each clinical area.

These competencies may en up being a sub-area of the clinical area. For example, a clinician may demonstrate competence in rTSA Rehabilitation. These skills may also be specific treatment techniques. For example, a clinician may indicate a specific skills in instrument assisted soft-tissue mobilization (IASTM).

You can use checkmarks, tally marks, or something similar if/when clinicians end up putting down the same clinical skill. For example, multiple clinicians in your clinic may be certified in, or demonstrate great skill with IASTM. Simply tally up the number of clinicians next to that item.

After completing this exercise, you should now possess a comprehensive list of practice areas & specific skills & treatment techniques that your clinical staff posses and in which they could provide competence, skilled services. I’ll refer to this as your clinic’s “clinical expertise”.

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Step 2: Market Demand or Need

After taking an inventory of your clinical capacity, move on to the next category: market demand. This can be determined a few different ways. The first, would be to simply brainstorm with your clinicians and staff which clinical areas or specialities comprise your current or historical caseload.

For example, perhaps you do run that outpatient adult PT/OT clinic and you see many patients following joint replacement surgery. “Joint Replacement” would then be considered an area where you have identified a need, and where you have been able to service that need in your local community.

Do this for every area or subspecialty that your clinic sees, or has seen in the past. Make a list and then determine which areas possess the largest percentage of your current (or historical) caseload. You can use your EMR (electronic medical records) to sift through past patients —I recommend looking back at least 12 months— to determine any trends or clinical areas that make up, or have made up, a significant portion of your clinical caseload. You can also pole your current & past patients about additional services they think they need, or would be interested in.

If you are just starting a clinic or organization, or you’re just stepping into an administrative or leadership role, this step may require a little more effort. If you’re stepping into a leadership role at your organization, then you can likely sift through the data available through your EMR to determine the areas that have proven to be of greatest demand.

If you’re just starting out, you’ll have to rely on the info you gathered in step one, and then do some outreach to local area referral sources and the like to determine which areas may be perceived as more in-demand or useful to those referral sources.

Take a look at the information you gather in this step. Look for patterns. Notice if there are any areas that you may have seen a lot of patient in the past that have waned, or any areas in which caseload has recently picked up. Take a look at the information and try to determine where future demand may come from.

Are there any areas that you either aren’t addressing —or only minimally addressing— that fit within your clinical expertise?

For example, maybe you’re clinical expertise lies in joint replacement rehabilitation, and a large portion of your caseload involves treating shoulder replacements. Are you treating any knee replacements? Are you providing any pre-replacement services such as educational sessions, “pre-hab”, and the like? You want to begin to use the information from this step to look for new potential opportunities for expansion, growth, etc.

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Step 3: Your Organization’s Purpose or Mission

After you’ve both identified your areas of clinical expertise & determined where the greatest potential demand lie, turn your attention to your purpose. Since you’re trying to deliver an amazing patient experience, you need to consider the type of patient or service you wish to provide and how that fits in with your clinic’s mission or purpose.

You want to remain consistent in all your marketing, messaging, and communication with both referral sources & potential patients. Your purpose should drive your business & strategic decisions.

That being said, in this step, take some time to think about what your mission, vision, values, and purpose for your organization are. If you are the owner of your clinic, this is your responsibility. You may solicit advice & input from staff members and your leadership team, but this decision ultimately lies on your shoulders.

Your mission or purpose —your “Why” as Simon Sinek calls it— should not only drive the decisions that follow, but also be basis for the way you communicate what you have to offer to those clients and or patients that you want to offer it to.

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Does it Fit With My Organization’s Purpose?

As mentioned above, settling on a purpose, mission, and/or values is the responsibility of the owner or leadership team, depending on how your clinic or organization is structured. That being said, once the purpose is set in stone, other departments, managers, and even staff members can use it to guide areas of growth, expansion, or development. I encourage you to always use your purpose or mission as a way to evaluate new ideas or developments.

Once the purpose or mission is set, then you can take the information gathered in steps 1-3 to determine potential areas for growth, expansion, or service offering development. You will then select the options that fall at the intersection of all three foundational pieces: 1) your clinic’s expertise, 2) market demand, and 3) your organization’s purpose.

Here are a few questions to help guide your decision:

• How does this opportunity align with our organization’s purpose or mission?

• Can we easily communicate how this opportunity or service offering capitalizes on our clinic’s expertise and purpose?

• Does this opportunity show potential for market demand, or has market demand already been demonstrated within this area of opportunity?

• How will we communicate this opportunity to external entities (referral sources & prospective clients) in a way that highlights our expertise & purpose/mission?

• Is this opportunity a logical extension or expansion of our current clinical expertise, market demand, and organizational purpose/mission?

• Do we possess sufficient clinical expertise to expand into this opportunity without having to spend costly resources and building additional clinical competency?

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Honing Your Strategy: An Example

I worked with an outpatient therapy clinic (PT & OT) that was trying to develop some new service offerings and expand the business. The were looking for a strategy to expand their service offerings, while capitalizing on the clinical expertise they already possessed.

Being PT/OT practitioners, their scope of practice does allow them to treat adult, adolescent, and even pediatric populations. In fact, their clinic’s caseload did seem spread across all three areas. They even tried to market themselves as “we do it all”.

However, after some digging and talking with the clinicians, it was clear that their core competencies were in adult orthopedic rehabilitation. They possessed specializations, certifications, and regularly attended conferences and continuing education seminars on that specific area of practice.

They also had strong referral relationships and a good reputation in that space (with orthopedic surgeons, primary care providers, etc.) In fact, 80% of their caseload consisted on orthopedic cases. We used “adult orthopedics” as the area of clinical expertise for step 1.

That provided some insight into market demand & need as well. There was obviously a need, as they were getting regular referrals from practices in the adult orthopedic area. Then, we took a look at what their current and past patients reported or requested. Many patients finished their formal rehabilitation program and would request “tune-up” visits or “check-ins” That pointed to a more clear market opportunity where demand may exist. On top of that, the clinic’s mission statement & purpose involved helping patients overcome limitations and live their healthiest life.

Now, there were two options on the table for the business to expand into:

1) grow and expand it’s pediatric service offerings or
2) develop a medically-based wellness & maintenance program.

Looking at the information above, and walking through the three-step process outlines previously, it was a no-brainer.

The intersection of this clinic’s 1) clinical expertise, 2) market demand/opportunity, and 3) mission/purpose all pointed to providing services for patients after they had completed their physical/orthopedic rehabilitation programs. The area they should expand into was the medically-based wellness and maintenance/exercise programs.

Now, this is just one example from the outpatient physiotherapy world, but you can follow the same process whether you work in a large healthcare organization or a small, single-clinician practice.

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Summary

Whether you’re just starting out, or leading a large healthcare organization, you must be focused on the direction & strategy of your clinic. Whether you’re a single-clinician shop, or a leader within a large healthcare organization or system, you are constantly presented with opportunities for your clinic or department.

These opportunities may appear to be great fits for your clinic and clinical expertise & bandwidth, but you should always evaluate each opportunity by comparing them with the 3 areas outlines above: 1) clinical expertise, 2) market demand/opportunity, and 3) mission/purpose of your organization.

By following the simple three-step process outlined above, you can ensure that your organization’s strategy and development aligns with your mission/purpose while also capitalizing on your clinical expertise and market demand/opportunity.

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Why do patient’s not complete their plan of care?

According to the clinics who responded to a survey I completed a few years ago, the number one reason was insurance limits and/or denials (73.3%), followed by scheduling difficulties, time commitment, cost of treatment & unrealistic expectations. (you can check out the summary of the survey here)

Now let’s set the insurance denials or limits off to the side. While you can make the argument that this whole problem would go away (and more patients would complete their course of care) if you simply went out of network or cash-based, that’s hard step to take.

On top of that, the next three reasons (time, cost, and expectations) need to be addressed before you consider leaving the insurance world behind. That’s because those three issues revolve around your ability to effectively communicate the value of the services you provide.

The Need to Communicate Value

Now, for decades, clinics and clinicians have relied on being “in network” to avoid having to talk about value. And, in reality, they didn’t have to. Patients simply went where their doctor sent them. But, as mentioned above, patients are beginning to be more picky about which provider they go to for therapy.

Rising healthcare costs (deductibles, coinsurance, etc.) combined with the access of the internet means that patients now have a choice in who they see. And they’re beginning to use it. This change means you have to be able to effectively communicate the value you bring to the table.

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Time Commitment & Scheduling Difficulties

So let’s look at the first of the factors: the Time Commitment & Scheduling Difficulties. On the surface, this may seem like a legitamate factor, and in some cases, there may actually be scheduling conflicts that prevent a patient from completing their plan of care. However, more often this not, this is a priority problem, not a true scheduling conflict.

Why is it a priority problem, because the patients don’t see coming to treatment as more valuable than whatever else they have to do. Patients are busy. They’ve got jobs, families, & other commitments. If your services aren’t seen as truly valuable, there will always be a “scheduling conflict” that keeps patients from showing up.

Unrealistic Expectations

Then there’s Unrealistic Expectations. Usually a patient has unrealistic expectations for a couple of reasons. First, they may have been given unrealistic expectations from the provider that referred them. Other times, it results from a miscommunication or lack of communciation between your clinic and the patient.

Either way, you need to address expectations with patients at the first appointment. You do this by both educating the patient on their condition/diagnosis, the prognosis, and possible treatment options & by having a value discussion with the patient. You need to explain what the treatment options are, what their anticipated results are, and then how you (or your clinic) fit into that outcome.

Addressing expectations early prevents any misunderstandings and also gives you a chance to demonstrate and explain your value.

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The Cost of Treatment

And lastly The Cost of Treatment. Whenever someone brings up price or cost as an objection or reason they can’t complete treatment, there’s often a deeper reason. Some patients have legitimate financial limitations and can’t afford treatment. In those instances, you should work with them to make sure they can still receive as much treatment as possible, given their limited resources.

Most of the time, however, cost is a smokescreen for something else. Usually, it’s value. The patient doesn’t value the treatment you provide, and therefore is not willing to pay for it. This is related to the priority problem mentioned above.

So what can you do to help these patients prioritize both the time commitment and the cost of treatment? You need to have the value discussion with them. You need to sit down with the patient and have them identify their desired goals or outcomes. Then, you need to attach objective metrics to those goals or outcomes. After that, you frame the cost of treatment as the price to achieve those outcomes or goals.

By having the value discussion with patients, you help them prioritize both coming to and paying for treatment.

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References

https://journals.sagepub.com/doi/full/10.1177/2158244018771732

https://www.managementstudyhq.com/mcclellands-theory-of-needs-power-achievement-and-affiliation.html

https://www.mindtools.com/pages/article/human-motivation-theory.htm

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Do you take a passive approach when talking with your patients about the value of your services? Are you confident when you talk with patients about the importance of participating in treatment or attending their appointments? Or do you struggle to communicate that information in a calm, confident manner?

It seems like the more I speak with clinicians, managers, and owners/directors, the more I notice a common theme: clinicians generally have a hard time communicating the value they bring to the patient engagement with confidence. In fact, it seems that many clinicians would rather rely on hanging up their diplomas, certificates, and specializations on their wall and hope their patients will see the value they have to offer.

Why is that?

I was talking with someone the other day who mentioned that, many of the clinicians he employs consistently struggle to communicate their value to patients. He seemed to think that it may be due to confidence issues, or that clinicians may not want to feel “pushy” or “salesy”.

Whatever the reason, the result is that they have a hard time acting like the clinical experts they are. They hope that their patients will simply recognize their worth and what they bring to the table. As we’ll discuss below, this is dangerous mindset.

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Say It With Confidence

So why is it important that you be able to confidently communicate you value to patients?

Well, it’s important for 2 reasons:

1) hope is not a strategy &
2) it increases your patient’s engagement and trust in you, your clinic, and your services.

As I’ve written about here, a patient’s perceptions or expectations about the clinic, the treatment offered, and even the clinician’s skills can have real and measurable impacts on everything from satisfaction rating to clinical outcomes.

Perception also impacts patient engagement, participation in, and completion of plans of care. That reason alone should motivate clinicians and clinic owners to improve patient communication. If patients don’t perceive your clinic as skilled, capable, and even confident clinicians, they may end up deciding that it’s not worth their time, energy, or money to continue treatment or services.

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Hope Is Not A Strategy

Let’s start with the first reason why you need to begin confidently communicating your expertise, skills, and value to patients. As I just said, hope is not a strategy! You can’t passively sit back and expect your patients and prospective patients to recognize your expertise.

You need to be confident in your clinical knowledge, expertise, and the value you bring to the table. Patients want to know that you know your stuff. They want to be able to place their trust and confidence in your skills, knowledge, and abilities. That means you need to be able to confidently share that with them. You need to give them a reason to trust you. That requires that you confidently step into the role you should occupy in your patient’s mind: that of the clinical expert.

You can spend some money, buy some nice frames, and hang your diplomas and certificates on the walls. That will definitely make your office or clinic look nice, and it may even provide some assurance to your patient that you posses at least enough knowledge to graduate and get a license to practice. But paper hanging on walls falls short when it comes to communicating true, practical, and valuable expertise.

You can hope that patients will see the importance of completing their plan of care; that they’ll realize the value and benefit of the services you provide. But again, you leave a lot to chance when you do that.

Your patients want to trust you. They want to believe that your services are valuable. They want to believe that your treatment can help them overcome whatever pain or dysfunction they’re experiencing. They want to believe that, but they won’t until you explicitly give them a reason to do so. Papers on the wall, and vague statements about the “importance of plan of care completion” don’t cut it.

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Increase Your Patient’s Trust & Confidence in You, Your Clinic, & Your Services

Now, whenever this topic comes up, some clinicians come to the conclusion that they must “talk” patients into completing their course of care or participating in treatment. They feel like they’re “selling” their clinic, services, or benefits. At the end of it, they simply feel like they’re convincing patients to show up for treatment, rather than educating and encouraging them to participate.

And in reality, some clinicians and clinics may actually be just talking patients into cookie-cutter treatment programs that don’t really provide true or unique value to patients. And that’s sad. It leaves clinicians and patients alike feeling dissatisfied. I’ve been in many clinics where it was apparent that the clinicians didn’t truly believe they offered value. They were simply trying to “keep their schedules full” or “encourage patient retention“. That’s not what the goal is.

The goal of confident communication is to 1) determine the underlying issue that brings this patient into our clinic today, and any other factors that may be at play —check out our course on the biopsychosocial model for more info on that— 2) communicate those precipitating factors and findings to the patient, 3) come up with a plan, in partnership with the patient, that will help the patient overcome their dysfunction or pain and meet their goals and 4) maintain open channels of communication throughout the process to ensure progress and make adjustments as needed.

Notice how nowhere in the process are the words “convince”, “talk into”, or even “manipulate” when it comes patients attending or participating in treatment. If you do steps 1 through 4 correctly, your patients will be actively engaged in treatment and will be less likely to drop off the schedule, no show, or fail to complete their course of care. They’ll also be happier and more satisfied with the treatment they receive.

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Step Into the Role of Confident Clinical Expert

So how do you confidently step into your role as a clinical expert? Well, it should be obvious, but expertise comes through competence. You need to spend enough time seeing the same situation(s) repeatedly to begin to notice patterns.

In his book, The Business of Expertise, author David C. Baker describes the importance of pattern matching to developing deep expertise in a given field. This idea holds true for rehabilitation & healthcare in general. The more you are exposed to similar clinical situations, the easier it will be for you to identify underlying factors, select treatment techniques, make treatment recommendations, and answer your patients’ questions.

Does that mean you can’t be confident until you’ve become a deep expert in a certain clinical area? Of course not. I always tell my students and clients, “You know more than your patients.” Most of the time, you’ve received more education & training on your patients’ condition or dysfunction than they have had. (Of course, there was the time I treated a PA who worked in the orthopedic/shoulder clinic that referred many patients to my clinic, but those cases are few and far between).

What patients want and expect from clinicians is honest information and a willingness to help. You will likely be able to provide valuable information & insight into their condition and treatment options. And if they ask you a question that you may not be able to answer, you simply say, “You know what? I’m not entirely sure, but I’ll find out before your next appointment.” That response alone will build an enormous amount of credibility, trust, and rapport with your patients.

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Summary

Ultimately, clinicians —not just “rehab liaisons” or rehab marketers— need to be able to effectively and confidently communicate the value that their services bring to their patients and clients.

The ability to effectively communicate that value impacts your patient’s perceptions and expectations about the care they will receive in your clinic. It can increase their level of engagement in treatment, their adherence to recommendations or home programs, and even increase levels of course of care completion. You need to be intentional about communicating your value to patients and prospective patients because it’s key to building trust, confidence, and rapport.

If you have a hard time being confident in your knowledge and expertise, remember that you often have much more information, skills, and insight about your patient’s condition than they do. You can always go deeper in your expertise, through pattern matching and study, but you likely have enough to communicate it confidently to your patients.

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I was talking with someone the other day about patient relationships, and thought that the main points may be helpful to some folks. (Here’s a link to the original LinkedIn post) I created this infographic to outline the 5 basic steps to developing strong patient relationships.

The 5 Steps to Developing Strong Patient Relationships

Here are 5 distinct stages of patient relationships:

1. Attract & Acquire

2. Establish

3. Engage

4. Amaze & Delight

5. Retain

Each stage requires a different communication strategy.

Attract & Acquire

Whether a patient is referred to your clinic by another medical provider, or if they hear about you through your marketing, your prospective patients start their relationship with you before you even see them.

You need to be proactive and intentional in your communication with patients that are in this stage of their relationship with you and your clinic.

Establish

Patients are no longer “prospects”. You don’t need to convince them to schedule that first appointment or interaction, but you do need to provide them reasons to become engaged in treatment.

At the first appointment, you or your clinician(s) took time to listen to the patient, to validate their experiences, and to answer their questions in a way that communicated empathy, understanding, and competence.

Engage

The next step is to seek input from the patient in the treatment planning process. Focusing on goals and objectives that are meaningful to the patient leads to greater engagement and experience.

Just because a patient schedules a follow-up visit (or two or three) doesn’t mean you’re out of the woods. We need to make sure that we never take our current patients for granted. We must always take steps to ensure that they’re engaged and satisfied.

Amaze & Delight

You need to make good on those promises you’ve made in your message and marketing and during the initial appointment.

Ask your patients “Are we doing everything that you expect or desire to help your recovery?” or “Is there anything we can do to better help you meet your goals?” Taking the time to ask these questions really makes an impact on patients’ perspectives of the clinic.

Retain

There are 2 types of patient retention:

1. Course of Care Retention

2. Clinic Retention

Course of Care Retention means retaining a patient through to completing their plan of care. This should be one of the few key metrics that you focus on regularly. Patients that are engaged and are having good experiences in your clinic are more likely to finish their course of care. If you notice low numbers with plan of care completion, take a closure look at patient engagement and experience.

Then there’s Clinic Retention. This means repeat patients. These patients had a great experience, felt engaged in treatment, met their goals, and completed their plan of care. Now, perhaps they have another issue. They choose to return to you clinic (because they had such a great experience the last time). Now, obviously, we hope that our patients complete their plan of care in our clinics then go on to live a long, pain-free life. But, if they’re in a position where they need services again, we want them to think of us first, right?

You NEED to track these two types of patient retention! At the end of the day, lead generation (or drumming up referrals) covers up problems with patient experience, engagement, and retention.

Putting it All Together

When a patient walks into your clinic for their first appointment, you need to make good on those promises you’ve made in your message and marketing. You need to make sure that you never take your current patients for granted. Keep them actively engaged and make them feel valued and listened to. You must take steps to ensure that they’re engaged and satisfied (and if not, figure out how to fix it).

And finally, whether it be via social media, email marketing, or phone calls, you need to have some way of both following-up with former patients and maintaining that relationship. And then, look at your metrics: Low numbers in the areas of plan of care completion, returning patients, and cancelled appointments/no-shows indicate problems in the patient relationship cycle. Understanding this cycle is the key for any clinic owner or manager to increase retention, engagement, and returning patients. It all revolves around mastering these 5 steps.

Check out the infographic below that summarizes this concept:

How does your clinic intentionally form patient relationships? Share any additional resources that you found helpful in the comments below!

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There’s a common problem in the healthcare field; especially in the physical rehabilitation and therapy space. That problem falls under the category of not enough patients. The more clinic owners and managers I talk to and work with, the more often I notice this pattern: Owners and managers see falling numbers (revenue, referrals, appointments, etc.). They feel the pressure (to make payroll or hit their departmental numbers). They become desperate for more patients. This leads them to run to the only thing they believe will help them: lead generation.

OK, in the healthcare field, we call it drumming up referrals, but it’s the same thing. As I’ve written about here, referral problems (or “not-enough-patient-problems”) may actually be patient retention problems. Unfortunately, the best marketing plan in the world fails if it doesn’t consider the patient relationship cycle.

Managing Patient Relationships

Let’s take a look at what happens when census dips, or the clinic schedule becomes light:

Managers and clinic owners see lower revenue and dips in appointment scheduling as a referral problem. “If only we could get doctor X to refer a few more patients…” or “We really need to develop relationships with some other doctors…” These phrases usually precede the implementation of some sort of new, growth-hack related, marketing plan or system. And it works…for a little while. Referrals increase. Therapists end up with full schedules again, and all seems right in the world. Then, usually 6-12 months later, it happens again. Numbers start dipping. Schedules free up, and therapists are treating less.

What happened? The marketing plan worked. You saw an increase in referrals and appointments being scheduled. You may have even considered hiring another staff therapist to handle the new workload —and to treat the number of patients surely coming down the pipe. Within the year or two, you’re looking at the same problem. But why? It all stems from not understanding, or capitalizing on, how the patient relationship cycle works.

Patient Relationships

As in most service-based fields, healthcare ultimately revolves around relationships. Relationships between patients and their clinicians can impact everything from clinical outcomes to satisfaction ratings [1]. But what is a patient-clinician relationship?

Well, as in every other human relationship, patient-clinician relationships form through social interactions between the clinician and the patient. As I’ve written about here, communication plays a large role in developing these relationships. How a clinician speaks, asks questions, and displays body language impacts the trust and confidence that a patient feels.

Often times, this relationships forms “on the fly”. Clinics and clinicians don’t intentionally try and form strong patient relationships. People that tend to choose healthcare as a career are naturally skilled with interpersonal communication and relationship-building. This means that most of the time, clinicians are able to form relatively strong and meaningful relationships with their patients. The patients, in turn, trust their clinician and can actively engage in the planning, execution, and benchmarking throughout the course of treatment.

Sometimes however, clinicians are busy. They feel rushed. They’re under pressure to meet certain productivity metrics. They fall into a rhythm of “conveyor belt” therapy. They treat patient appointments like checkboxes that need to be ticked in order to do their job, make their boss happy, and get paid. If you think about it, it’s not their fault. They’re in an environment where time-based productivity runs the show. Especially for those of us who come from the outpatient rehab world, it can feel that your whole day consists of trying to treat patients enough to get results, get your documentation done, and meet productivity. In environments like that, it becomes more important to intentionally cultivate strong patient relationships.

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Cultivating Strong Patient Relationships

So if strong patient-clinician relationships are important, how do we go about developing them? Ultimately, relationships between clinicians and patients develop in the daily & routine interactions between them. How a clinician greets a new patient, or how that clinician conducts the initial assessment or interview sets the tone for the relationship. The patient receives subtle cues from the clinician during these initial interactions: What information are they focused on? What do they care about? Are they looking more at their watch or computer screen than me? We may not be aware of it, but all of those little things can either build or detract from a strong patient relationship.

Depending on your setting, population, and area of specialty, patient relationships can be difficult to form. For example, I once worked covering some acute care caseload. I saw patients for an initial assessment, made some discharge recommendations, and then they left the hospital in the next day or two. While you can still develop good working patient-clinician relationships under those circumstances it can be challenging.

Ultimately, our aim as clinicians should be to communicate to our patients an attitude of care, empathy, and sincerity. We want our patients to know that we don’t merely see them as a number (or 4 billable units), but as a real person experiencing a real dysfunction or limitation. We want to cultivate an environment of safety, trust, and collaboration. While we need to check certain boxes and gather important information to do our job properly, we also need to be aware of the social and emotional role we as clinicians play in the healthcare process. Patient education & counseling, responding to patient emotions, and even simply providing an empathetic ear or sounding board plays just as important a role in healthcare as gathering accurate ROM, MMT, or other diagnostic data.

The Patient Relationship Cycle

Understanding the importance of cultivating strong patient-clinician relationships leads to some questions. One of these questions revolves around the cycle of patient-clinician interaction. Patients start off as new referrals or prospective patients and, through their interactions with us and our clinics, develop relationships with clinicians, staff members, and even our organization. Understanding where patients may be on this cycle helps clinics and organizations intentionally build strong relationships with their patients. Enter what I call the patient relationship cycle.

This cycle (pictured below) represents the typical lifecycle of a patient’s interaction and relationship with your clinic. It begins with a new referral —or in some cases, a piece of marketing— and ends with (hopefully) a returning patient who actively refers friends, relatives and neighbors to your clinic. Your communication and interaction with a patient should correspond to the stage that they are in.

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New Referral

Whether a patient is referred to your clinic by another medical provider, or if they hear about you through your marketing, odds are that most of your prospective patients in the area (your ideal patients) start they’re relationship with you before you even see them. Your reputation —usually conveyed by the referring provider— influences the patient’s perception of you, your clinic, and the quality of your services. Likewise, your marketing & messaging subtly communicates to your prospective clients about the same things. These patients and prospective patients begin forming an idea in their mind about you, your clinic, and your services —all without even meeting you.

When these patients show up at your clinic for an initial appointment, free consultation, or evaluation, they bring with them these perceptions and preconceived ideas. That means when patients are in this stage of their relationship with you and your clinic, you need to be proactive and intentional in your communication with them. This may mean providing referral sources with information or “talking points” about you. Sometimes, having brochures available in the offices of your major referral sources also helps. When crafting marketing messages, be sure that those messages communicate what you want to those prospective patients. This may be the value you bring to the table, social proof by way of testimonies, or the fact that you are experts in your specialization, etc.

Then, when this patient walks into your clinic for their first appointment, you need to make good on those promises you’ve made in your message and marketing. Your front-office staff should also be involved in this, as they are likely the first people your patients see, talk to, and interact with. As I’ve written about here, often times the process of care (on-boarding, new patient paperwork) influences patient engagement and experience as much as the actual care they receive.

Current Patient

Once a patient takes the step to schedule a follow-up appointment the communication and interaction changes again. These patients are no longer “prospects”. You don’t need to convince them to schedule that first appointment or interaction (you’re over that hill), but you do need to provide them reasons to become engaged in treatment. Active patient engagement & participation positively impacts both clinical outcomes and patient satisfaction scores. So how do you get a patient actively engaged in the treatment process?

Hopefully, at the first appointment, you or your clinician(s) took time to listen to the patient, to validate their experiences, and to answer their questions in a way that communicated empathy, understanding, and competence. After that, the next step is to seek input from the patient in the treatment planning process. Focusing on goals and objectives that are meaningful to the patient leads to greater engagement and experience. That may mean regular “check-in” conversations between the clinician and the patient. Sometimes, even the clinic owner or manager can take a random stroll through the clinic and waiting area and ask patients “Are we doing everything that you expect or desire to help your recovery?” or “Is there anything we can do to better help you meet your goals?” Taking the time to ask these questions really makes an impact on patients’ perspectives of the clinic.

It is also important to note that, just because a patient schedules a follow-up visit (or two or three) doesn’t mean you’re out of the woods. As our last article outlines many patients never make it out of this stage. They go from current patients to “where-did-they-go” patients. Often times, a low patient retention rate may result from a breakdown in the patient’s relationship —either with the clinician or the clinic/organization. We need to make sure that we never take our current patients for granted. We must always take steps to ensure that they’re engaged and satisfied (and if not, figure out how to fix it).

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Retained Patient

So a patient has stuck with you past the first few follow-up appointments, now what? At this point in the patient relationship, the clinic & clinician needs to focus on engagement. Up to this point, your patient was exposed to your message or reputation. They’ve interacted with your staff and clinicians. And —hopefully— they’ve participated in developing their treatment plan, desired goals, and expressed their aspirations for treatment. Now, you and your clinic needs to use that information and integrate it into that patient’s treatment and appointments.

Take the time to gauge how the patient feels about the progress of treatment, the relevance of treatment, and their progress towards their desired goals. Use that information to inform treatments appointments. It’s one thing to ask a patient about how they feel about treatment. But you take it to a whole new level when you actually act on the information and feedback the patient provides. When the patient feels valued, heard, listened to, and feels like a partner in their treatment plan, they naturally become more motivated and engaged in treatment.

That leads to course of care retention (retaining a patient through to completing their plan of care). This should be one of the few key metrics that you focus on regularly, as it shows the level of patient engagement & satisfaction with your clinic and services. Patients that are engaged and are having good experiences in your clinic are more likely to finish their course of care. If you notice low numbers with plan of care completion, take a closure look at patient engagement and experience.

Returning & Referring Patient

Aside from course of care retention, another form of retention is just as important: clinic retention. This type of retention leads to repeat patients. These patients may have come to your clinic for shoulder pain. They had a great experience, felt engaged in treatment, met their goals, and completed their plan of care. Now, perhaps they have elbow pain or hand pain. They choose to return to you clinic (because they had such a great experience the last time). Now, obviously, we hope that our patients complete their plan of care in our clinics then go on to live a long, pain-free life. But, if they’re in a position where they need services again, we want them to think of us first, right?

Another side benefit of getting a patient to this stage of the patient relationship cycle impacts business growth: word-of-mouth referrals. Often times, patients that choose to return to your clinic feel so good about the services & treatment you provide, that they tell their friends, neighbors, and relatives about your clinic. They become advocates —and in some cases, fans— of your clinicians and your clinic. If they were referred to you by another healthcare provider, they’ll go back to that provider and talk about the great experience they had in your clinic. This may influence that provider’s choice to send more referrals your way.

Often times, I notice that clinics simply hope, pray, and trust that their patients will come back to their clinic in the future. They know these patients had great experiences, realized their goals, and left happy. But they still wonder whether these patients will come back to their clinic if they need services in the future. This typically results from not having a good method for follow-up and engagement for these patients. Whether it be via social media, email marketing, or phone calls (yes, people still talk on the phone), you need to have some way of both following-up with former patients and maintaining that relationship.

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Summary

It’s easy to see falling numbers, fewer appointments, and less patients as a lead generation (or referral) problem. In some cases, you may be right. Often times, however, you need to take a look at metrics and data that speaks to patient engagement & retention. Low numbers in the areas of plan of care completion, returning patients, and cancelled appointments/no-shows indicate problems in the patient relationship cycle. Understanding this cycle is the key for any clinic owner or manager to increase retention, engagement, and returning patients.

If you go and spend thousands of dollars on marketing campaigns aimed at boosting referrals and new appointments, you will see an increase in new appointments and referrals. You’ll notice revenue increases. What you may not notice is the slow, continuous leak of patients not coming back, finishing their plans of care, or referring friends to your clinic. At the end of the day, lead generation (or drumming up referrals) covers up problems with patient experience, engagement, and retention. Basically, if you’re spending money to fill up a leaky bucket, you’ll find out that your bucket ends up empty at the end of the day.

Does your clinic understand the patient relationship cycle? Do you have plans and systems in place to engage patients at each stage of the patient relationship cycle? Share any additional resources that you found helpful in the comments below!

References

[1] Kelley, J. M., Kraft-Todd, G., Schapira, L., Kossowsky, J., & Riess, H. (2014). The influence of the patient-clinician relationship on healthcare outcomes: a systematic review and meta-analysis of randomized controlled trials. PloS one, 9(4), e94207. doi:10.1371/journal.pone.0094207

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What if I told you that there is a common problem that costs clinics tens or hundreds of thousands of dollars a year, and most of them don’t seem aware of it? What would you guess the problem is?

If you guessed a patient drop-out, or a problem with patient retention, you’d be right. It seems that many clinics, especially those that may be struggling financially, put a lot of effort into and focus a lot of attention of getting in front of referral sources to increase the numbers of patients coming into their clinic door.

They think they have a patient acquisition problem. But as I’ll argue below, they may more than likely have patient retention difficulties.

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The Big Money Problem

Did you know that approximately 14% of therapy (PT/OT) patients do not show up for their follow-up appointments?

In fact, between 20-30% will not show up to their third appointment and up to 70 percent of patients will fail to complete their full course if care [1]. That may seem like a staggering number, but it seems pretty consistent with what I’ve noticed during my time in the outpatient orthopedic rehab world.

That’s why clinics always try to pre-book (or book out) all the appointments in a patient’s plan of care. If they’re already on the books, there’s a higher chance they’ll show up to those appointments.

Even this, though seems to fall short in getting patients to complete their plan of care. (I tend to think this has to do with clinicians not understanding some important factors in behavioral change)

But why, exactly is this a problem? Because decreased patient retention costs both patients and clinics…big time.

Financial Cost to Clinics

Let’s run some quick numbers on an a small/average clinic. This clinic employs 5 clinicians, each scheduled to see 10 patients per day (50 total patients per day). Now according to GuideDoc, the average cost for a PT/OT visit is around $100.

The average course of care in the outpatient orthopedic rehab world tends to be 12 visits. That means from a group of 50 patients, the clinic expects to generate around $60,000 (50 patients x 12 visits x $100 average visit cost).

Now lets factor in what happens if the clinic experiences the patient drop off described in the above-cited article. Let’s say that 20% of patients don’t show up to their third appointment, and that another 20% drops off every 4 appointments thereafter.

Patient retention, starting with the original 50, would look something like this:

As stated earlier, typical revenue expectations for the 50 patients was $60,000. However actual revenue after patient drop out was only $41,000. That means this clinic actually experiences a $-19,000 loss for every 50 patients they treat.

So over three months (12 weeks), this clinic looses $19,000 on these 50 patients. Multiply that by 4 (to get 12 months in a year), and you get around $-76,000, and that is assuming the clinic only brings in 50 new patients every 12 weeks!

In total patient drop-out can cost average clinics around $150,000 per year (even more, if you’re running larger and/or multi-site practices!) In a world of constantly decreasing margins & reimbursement reductions, the last thing you need as a clinic owner is to be losing 6-figures a year.

Costs to Patients

It also costs patients because they often drop out of treatment before hitting their goals. They’re stopping before they’re pain free or are still experiencing limitations.

So what’s the solution? Well, obviously, we want more patients to finish their plan of care. But how, specifically, do we accomplish this?

Research shows that increased patient engagement results in higher rates of treatment compliance & completion. Patient engagement hinges on the patient experience.

Patients that have positive experiences are shown to have higher levels of engagement. So it’s all about delivering impactful patient experiences.

Summary

When it comes to marketing your therapy business, there’s a lot of talk about allowable acquisition costs, conversion rates, and lead generation. And that makes a lot of sense. I mean, you need new patients coming through your door to keep the lights on, right?

But what about the patients you’re already seeing?

These patients have raised their hand, voted with their wallets, and come in to see you.

Are you really doing the best to not only serve them, but to retain them? Patients that do not complete their plan of care cost both themselves and clinics in terms of time and money. This usually results from a substandard patient experience and lack of engagement. It’s a common fact in business that it cost much more to acquire a new customer than it does to retain current ones.

So, if your marketing plan is designed to fill your proverbial “bucket” of patients, does it make sense to spend time and money pouring those leads into a bucket with a giant hole in the bottom?

Every clinic, regardless of marketing strategy or lead generation success would benefit from focusing on improving patient retention through engagement.

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References

[1] Jack, K., McLean, S. M., Moffett, J. K., & Gardiner, E. (2010). Barriers to treatment adherence in physiotherapy outpatient clinics: a systematic review. Manual therapy, 15(3), 220–228. doi:10.1016/j.math.2009.12.004

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We’ve all experienced them in our clinics: Patients that show up for an appointment or two, then stop coming. Patients that achieve quick results, see great change in their lives, then fall back and lose all their gains.

Patients that call to schedule an appointment, then never show up. Prospective patients who call to inquire about our treatment options, then never call back.

What gives with noncompliant patients?

Well, often it seems these patients stop coming, drop off treatment, or never call back because they “don’t see the need”. They feel that they can “do this at home” or “don’t need to do therapy.” While this can be a result of poor patient experiences, an overlooked factor is that patient’s readiness to change.

Think about it. Therapy treatments require patients to make real and challenging behavioral changes. Whether the patient is receiving treatment for a rotator cuff surgery, plantar fasciitis, weight loss, or wellness, participating in treatment challenges patients to change their activities, posture, habits, etc. And those changes are hard.

As I’ll argue below, a clinician’s main role involves guiding patients through a series of behavioral changes. Understanding the principles of behavioral change can greatly impact a clinic’s ability to retain patients, help patients achieve their goals, and attract new patients.

Is it really all about change?

Behavioral change plays a role in at least three patient-facing areas of any therapy practice or clinic:

1. Acquiring new patients

2. Retaining current patients

3. Treating and helping patients achieve their goals

Let’s start with the first one: acquiring patients. Many times, outpatient therapy clinics feel that acquiring new patients depends on developing relationships with referring physician groups or workman’s comp organizations. While this does play a role in producing a steady stream of referrals for most outpatient practices, the world is changing. Today, more patients take an active role in selecting their healthcare providers.

They use sites like Health Grades to screen potential providers, read —and sometimes write— reviews, and “shop” around for their healthcare provider. Understanding the principles and stages of behavioral change helps clinics and clinicians communicate with these prospective patients, nurture relationships, and become the provider that the patient chooses when they’re ready to seek treatment.

Arguably as important —if not more— as acquiring new patients is retaining current patients. As I’ve written about here, patient retention greatly impacts a clinic’s bottom line. Retaining current patients is often much more cost-effective than acquiring new ones.

Again, initial patient experiences with staff and the clinic affect patient retention. But some negative experiences stem from staff and clinicians not understanding where a patient may be on the path towards change.

Maybe a patient books an appointment for back pain, knowing —at least in their mind— that your treatment can help. They aren’t necessarily sure that you’re the right fit, that you understand their situation, or even that they themselves are truly ready to commit to a specific clinician or treatment plan. If the clinician dives right into treatment planning and exercise prescriptions, odds are that patient walks out the door and doesn’t come back.

The last point often gets the most attention from clinical staff. The actual treating of patients and working with them towards their own goals occupies much if our time. But here, too, clinicians need to have a solid grasp of the elements and stages of behavioral change.

If you are treating patient with chronic back or knee pain, and you and the patient have both identified that weight loss will make a large impact on their daily pain, you need to be able to guide them through establishing healthy behaviors to help them reach their goals. To do that, you need to understand where they are on the “circle of change” and how to guide them through to completion.

If done right, and these patients make great progress towards their goals, these patients can become great referral sources (helping you with area 1). They will also likely continue with their course of treatment, and be more willing to come back to your clinic if/when another problem surfaces (helping you with area 2).

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Elements of Behavioral Change

Assuming you’re still on board with the idea that a main role of a clinic or healthcare organization is facilitating behavior change, a question arises: Where do you begin? You need to start by understanding the three most important elements in changing behavior [1]:

• Readiness

• Barriers

• Relapse

To successfully alter behavior, the subject must possess the resources, knowledge, and desire to make a change (readiness). Barriers (or potential barriers) need to be identified and addressed. And, to maintain that new behavior, we need to understand what factors may cause a reversion in behavior.

On the surface, that may sound a bit intimidating. There are a lot of factors at play.

Is the patient/client ready to change?
Do they understand potential barriers or speed-bumps to their change?
Are they at risk for relapse?

Luckily, understanding the stages of change helps break down each step in the change cycle. It also helps clinics and clinicians gauge where a particular patient is along the path to change, and better understand how to communicate and meet them at their particular stage.

If a clinic or clinician understands where a particular patient or prospective patient is on their change path, they find it easier to affect real, lasting change. This can be influencing positive health behaviors, or it could be getting a prospective patient to pick up the phone and make an appointment.

The Circle of Change

After understanding the elements of change, the next step involves applying that knowledge to a framework for affecting change. Enter the circle of change. Now, this idea has been used in every area from social work to public health initiatives. It’s based on the transtheoretical model of change [2]. The image below illustrates this model of affecting change.

Around the circle, lie 6 phases or stages:

• Precontemplation

• Contemplation

• Planning

• Action

• Maintenance

• Termination or Relapse

Each phase represents a specific point along the path to change. Patients and prospective patients all fall somewhere around this circle. Our job as clinicians and clinic owners is to understand where a particular patient or prospective patient sits and then communicating in the most effective way to reach that individual at that particular stage or phase.

The Transtheoretical Model

Also referred to as the Stages of Change Model, the Transtheoretical Model was developed in the late 1970s through research and study about smokers who quit on their own vs those requiring additional treatments [2]. It is not a theory, but a model that focuses on the decision-making of an individual and intentional change.

The transtheoretical model makes one major assumption: people do not make changes to behaviors quickly or decisively [2]. Instead, the transtheoretical model posits that people make changes to their behaviors —especially habitual behaviors— in a continuous, cyclical process. It breaks this process into the six stages mentioned above, and shown around the circle in the image.

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The 6 Stages of Behavioral Change

Let’s take a look at the 6 stages of change described by the transtheoretical model and the characteristics of each [2].

Precontemplation comes first. People in this stage do not intend to take any action or make any change in the immediate future (generally within the next 6 months). If a need for change exists (dysfunction, problem behaviors, etc), people in this stage often do not recognize that their behavior is problematic or has negative affects. People in this stage also tend to underestimate the benefits of changing behavior, and generally overestimate the discomfort, difficulty, or cons of making that change.

Next, comes the Contemplation stage. People in this stage now intend to make a change or take action in the immediate future (within 6 months). If there is a need for change due to problematic or negative behaviors or activities, people in this stage recognize that.

They also take more realistic view of the pros and cons of making the change, usually with an equal or balanced emphasis on both the positive and negatives. Despite this, people in this stage sometimes still feel uncertain or undecided about change.

Determination follows the contemplation stage. This stage is referred to as Preparation or Planning. People in this stage are ready to take action, usually within the next 30 days or so. They may take smaller steps towards that change, and believe that making that change will be an overall positive to their life.

Action comes next. People in this stage make the leap to alter their behavior or make a change. They intend to keep moving forward with this change. This may involve modifying the problem behavior or acquiring new habits or behaviors to replace it.

After someone changes or modifies a behavior, some sort of Maintenance must be enacted to prevent relapse. People in this stage have sustained a given change for at least 6 months. They intend to maintain this change going into the future. People in this stage work to prevent relapse or reversion to the previous behavior.

Next, two outcomes exist: Termination or Relapse. If the person falls back into previous patterns or into the same old habit, they relapse. If the behavior change is successful, the person transitions through to termination.

People who have progressed this far in the behavioral change cycle have no desire to return to old habits or behaviors. They are also sure that they will not relapse. Termination is rarely met, and most people end up staying in the maintenance stage.

It must also be noted that, as the image illustrates, people can enter and exit the circle of change at any of the stages. For example, a smoker who quit smoking, reached maintenance, then began smoking again may not necessarily need to go through precontemplation or contemplation. They may jump right into planning/determination or even action.

Processes of Change

To progress through each stage of change, people can use different strategies or processes. There are ten stages that have been identified, with some being more effective at different stages of change. Learning these processes can help clinicians develop strategies to both assist patients in making changes and in marketing to potential patients.

Below are the 10 stages [2]:

• Consciousness Raising:

  • This involves increasing awareness of the benefits of the desired change

• Dramatic Relief:

  • This involves stimulating some kind of emotional arousal or stimulation about the desired change

• Self-Reevaluation:

  • The person making the change completes some self-appraisal to determine whether the change is part of who they want to be

• Environmental Reevaluation:

  • The person observes their social connections or environment to see how their change, or lack of change, affects those around them

• Social Liberation:

  • For this process, social proof is used to show the person making the change (or considering change) that society is supportive of the change-

• Self-Liberation:

  • Through this process, the person becomes committed to change by believing that change truly is possible

• Helping Relationships:

  • Using supporting relationships with people who encourage the desired change

• Counter-Conditioning:

  • The person substitutes healthy or desired behaviors and thoughts for unhealthy behaviors and thoughts

• Reinforcement Management:

  • This involves rewarding desired behavior and reducing any perceived rewards that come from the negative or undesired behavior

• Stimulus Control:

  • The person redesigns or modifies their environment to cue and reinforce the desired behavior and remove any cues or prompts for the undesired behavior

Some of these processes or strategies work better in certain stages of change. For example, when marketing to prospective patients, it may be more effective to utilize a strategy that involves consciousness raising and/or dramatic relief. Strategies based on those two processes can influence a potential patient to make initial contact with you clinic to inquire about services, accept a free consultation, or even schedule an initial appointment.

It just takes a little bit of thinking to determine who you are trying to communicate with, where on the circle of change they are most likely to be, and then using the best strategy from the list above to motivate that person towards the desired action or behavior change.

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How Behavioral Change Affects Clinical Practice

Now, all of this information is well and good, but how can we apply it to clinical practice? To answer that, let’s revisit an idea from the beginning of this article: the main role of a clinic or clinician is to help guide a patient (or prospective patient) through a series of behavioral changes.

Whether it is educating a patient about healthy lifestyle choices, influencing a patient to complete their home exercises, modifying a work or leisure task to prevent injury, or simply convincing them to make an appointment, clinicians are in the behavioral change business.

Since clinics and clinicians are ultimately change agents, it stands to reason that a practical understanding of behavioral change exists at the clinic or organization. Individual clinicians should be trained on the principles of behavior change and how to facilitate that on behalf of their patients. This helps those clinicians have a real and meaningful impact on their patients’ lives.

Two good examples of how this understanding of behavioral change affects clinical practice are initial assessment or interviews and patient education. Taking a behavioral change approach to an initial assessment means that the clinician implements techniques like motivational interviewing that help guide a patient to identifying and committing to some change.

With patient education, clinicians need to understand what stage of change a patient is in in order to effectively both communicate the value of the services they provide and motivate that patient to make the necessary changes.

Motivational Interviewing

Here is the definition of motivational interviewing: “Motivational interviewing (MI) is a client-centered, directive therapeutic style to enhance readiness for change by helping clients explore and resolve ambivalence.” [5] At its core, motivational interviewing focuses on moving patients towards change.

It is a person-centered counseling approach that gets the patient to explore their own motivations and resistance to change. Motivational interviewing helps patients identify what they really want and explore how their current behavior or situations are either helping or hindering them in achieving those goals.

A clinic that understands the principles of behavioral change are able to use the initial appointment and interview to fully explore a patient’s desires and goals for treatment. This results in the patient feeling valued and listened to, and —more importantly— results in the patient being more actively engaged in treatment.

This means that patient is more likely to attend their appointments, adhere to home programs, and complete their plan of care. This helps the patient reach their goals and achieve the outcomes they want, and it also helps the clinic financially as well. Engaged patients generally complete their plans of care and save their clinical providers the headaches of no-shows, cancellations, and noncompliance.

Patient Education

As I’ll describe a bit further down, the clinicians play three distinct roles in the behavior change process: educating, inspiring/motivating, and reassuring. All three of these roles come into play when providing patient education. For example, as I’ve written about here, how we provide information or education to patients can affect clinical outcomes, patient experience, and engagement.

By understanding where someone is on the circle of change, what stage they are at, clinicians can better tailor the education they provide patients. For example, let’s say a patient is being seen for low back pain and the clinician identifies that weight loss would be a beneficial step in managing it.

If the clinician simply educates the patient on the affect of being overweight and how it influences back pain and then encourages the patient to lose weight, is that really effective? Will that patient be more likely to take that advice to heart? I’d say that there is probably evidence out there to show that is not the case.

What if instead, the clinician explored the factors affecting low back pain with the patient and then identified weight loss as one of the most important factors? The clinician then used motivational interviewing techniques to guide the patient to discovering their goal (to decrease back pain etc) and how their current behaviors were impeding their progress.

The patient and the clinician both brainstorm together about different strategies to help lose some weight, different exercises that can be completed, and a treatment plan that will likely help the patient achieve those goals. Is that patient more likely to follow the recommendation to lose weight? I definitely think they’d be more actively involved and engaged in reaching that goal, especially if along the way that clinician was there to help motivate and reassure the patient as obstacles and barriers presented themselves.

The Impact on Business & Growth

Now understanding this framework for change also can help clinics acquire new patients and grow their businesses. Above, I wrote that the main role of a clinic is to educate, inspire/motivate, and reassure patients. This is an idea that Blair Enns from Win Without Pitching talks about a lot on the business development (marketing/selling) side of things.

He posits that the main role of a salesperson or marketer is to educate the unaware, inspire the motivated, and reassure the intent. He says by following this framework, business can guide a prospective customer —or in our case, patient— from being unaware of their problem to purchasing a product or service. In our case, that may be booking an initial appointment or attending a wellness class or the like.

Precontemplation

So how would this work for clinicians? Well the basic principles remain the same, and they each correlate to where a patient or prospective patient may be on the circle of change. For example, a patient may be experiencing shoulder pain or limitations, but feel that it may just be old age, stiffness, etc.

This patient would be in the precontemplation stage of behavior change. They aren’t necessarily aware that there may be an underlying cause of their shoulder discomfort. A clinic that specializes in treating shoulders may create educational content (videos, blogs, etc) that detail common causes or factors that may influence shoulder pain.

They may provide online tools or resources that help guide that prospective patient from being unaware of their problem through the contemplation and planning stages of change.

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Planning & Determination

Once a prospective patient has reached the planning or determination stage, perhaps they opt in to receive a free report from that clinic’s site, or schedule a free phone consultation.

Once the patient takes this step, the clinic then must change the communication strategy. No longer do they provide this prospective patient with educational material. Now, they focus on painting a picture of what life without shoulder pain could be like. They also provide testimonials, case studies, and social proof.

The patient then moves to the action stage of change, perhaps by scheduling an initial assessment/appointment.

Action & Maintenance

Once the prospective patient takes the leap to become a patient and schedules their first appointment, the communication strategy again changes. At this first appointment, the clinic must not only provide a competent and evidence-based assessment, they must also take time to reassure the patient that continuing treatment will help them achieve their goal of a pain-free shoulder.

The reality is, once someone takes action (or decides to purchase), they immediately begin to feel doubts and/or regrets. Call it buyer’s remorse, but their mind begins to run through the many reasons why this service or treatment may not work.

If these concerns are not addressed at the first appointment, that patient may continue to dwell on them, begin to cancel appointments, and maybe even fall off the schedule altogether. A clinic that understands this is able to provide the reassurance that this patient needs when they come into that initial appointment.

From there, the clinician will likely need to move between education, inspiration, an reassurance throughout the treatment process and plan of care. Once a patient reaches one milestone, education takes place about the next. This may also involve having to motivate and reassure the patient to take that next step.

This process continues until the patient has met their goal, has returned to baseline, or has plateaued in their progress.

Summary

Clinicians are in the change business. We help guide our patients and prospective patients from a place of unawareness through to achieving their goals and improving their health and function.

This requires a deep understanding of the process of behavioral change and how it impacts patient acquisition, patient education, treatment planning, and patient retention.

Clinics that understand the process of behavioral change and are able to modify their communication and treatment strategies to meet each patient where they are on the circle of change may find improved clinical outcomes, higher patient engagement levels, and higher retention rates.

It will also help them in marketing to prospective patients and acquiring new patients.

And between improving patient retention and increasing new patient acquisition, those clinics may noticed improved financial metrics as well.

References

[1] Cherry, K. (2019, April 06). The 6 Stages of Behavior Change. Retrieved from https://www.verywellmind.com/the-stages-of-change-2794868

[2] Behavioral Change Models. (n.d.). Retrieved from http://sphweb.bumc.bu.edu/otlt/MPH-Modules/SB/BehavioralChangeTheories/BehavioralChangeTheories6.html

[3] Marcus, B. H., Banspach, S. W., Lefebvre, R. C., Rossi, J. S., Carleton, R. A., & Abrams, D. B. (1992). Using the Stages of Change Model to Increase the Adoption of Physical Activity among Community Participants. American Journal of Health Promotion, 6(6), 424-429. doi:10.4278/0890-1171-6.6.424

[4] Hettema, J., Steele, J., & Miller, W. R. (2005). Motivational Interviewing. Annual Review of Clinical Psychology, 1(1), 91-111. doi:10.1146/annurev.clinpsy.1.102803.143833

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Every now and you read something and it sparks an insight that has been just out of reach. It may be an article in a journal, a blog post, or sometimes a book in an entirely different field. As is often the case, it is in the moments when we are not actively seeking these insights that they spring up to meet us.

In this case, a book about business and finance led me to some thoughts and discoveries about building successful healthcare clinics and organizations.

I recently read Enough: True Measures of Money, Business, and Life by John C. Bogle, the founder of the Vanguard Group. Though this book covers Vanguard’s history and John Bogle’s philosophy on investing and finance, it does offer insights into problems in our current economic environment and how to build great organizations.

This got me thinking about great healthcare organizations I have seen, worked with/for, and been affiliated with. It also made me realize why those organizations stood above their counterparts.

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Great Organizations

When you think of a great organization, what comes to mind? I tend to think about a team, company, or nonprofit that is bound together by a higher purpose; a mission of some kind.

I also think of a place where staff and personnel enjoy being. Recent business books like Leader’s Eat Last by Simon Sinek or Radical Candor by Kim Scott all speak to this idea that a great organization is built around a great culture. I personally believe that a great culture is made up of two things: people & purpose.

Culture

The culture of an organization results from the purpose influencing the people. When I talk about culture of a company or clinic, I am talking about the overall environment; how it feels to work there, buy from there, etc. This feeling is a result of the organization’s people.

At a very basic level, an organization’s culture stems from emotional roots. People are emotional creatures and how we feel impacts the decisions we make, how those decisions are received by others, and other people’s response to those actions.

For this reason, I find it amusing when organizations talk about “improving the culture” by changing systems, processes, and protocols rather than addressing the “touchy-feely” piece that is the culture. Once the human —or emotional— side of the equation is sorted out, the processes and systems tend to fall into place.

Purpose

How supervisors manage, how decisions are made, and how that affects staff members steers and forms the culture. These factors should be driven by the organization’s purpose; its mission, vision, and values.

Many confuse an organization’s mission statement with its purpose. However, mission statements are often fancy business speak meant to purvey some ideal or attribute that the company thinks will make it look good to the public. These organizations typically operate from an entirely different set of principles than those reflected by the mission statement.

For example, I was recently speaking with an owner of a physical therapy and personal injury clinic in the metro Atlanta area. I wanted to get a sense of the owner’s values, reason for being in that business, and motivation to make changes at their clinic. I asked the question, “What brought you to the personal injury space?”

I expected to hear some reasons around their skills and clinical expertise and how that fit with an opportunity in the market. What they told me was, “There’s more money in personal injury than in regular outpatient.”

That is a valid reason.

I mean, we’re all in business to turn a profit, right? However, after probing a bit deeper, the only answers this clinic owner provided was about money, volume, and revenue. The mission statement for the clinic was something like “dedicated to individualized care for each patient.”

Whether this clinic owner meant to or not, he projected that the purpose driving his business decisions related only to metrics and revenue; a far cry from “individualized patient care”.

That’s not a very compelling reason that will cause employees, clinicians, or prospective patients to get excited about.

A higher purpose plays a critical role in compelling prospective patients and/or staff/employees to want to do business with us or help us succeed. But simply stating a purpose is not the same as acting from it. Statements need to be backed up by decisions and actions.

People

Great organizations center around one thing: people. The people who work for that organization and the people who buy from that organization both play a role. Directors, supervisors, and staff members make decisions that directly impacts the culture of that organizations. Those decisions should be consistent with and grounded in the purpose or mission of that organizations.

So how do you go about doing that? By focusing on the people. I think this quote by John Bogle makes the point very well:

“Tell me, please, if you can, how to value friendship, cooperation, dedication, and spirit. Categorically, the firm that ignores the intangible qualities that the human beings who are our colleagues bring to their careers will never build a great workforce or a great organization.” (Bogle, 2008)

Ultimately, the people who work in our clinics and organizations make decisions. Those decisions impact both the quality & impact of the healthcare services provided; whether that be physical therapy, occupational therapy, or some other discipline or treatment. If we want great organizations, we need to focus on culture.

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Building Great Healthcare Organizations

So how do we go about creating a great culture in our clinics and organizations?

Healthcare is about one thing: people. It’s about a person skilled in delivering treatment, serving and healing another person, who is on a unique journey to recovery. Metrics, number, and productivity demands come second to the human experience of receiving (and providing) healthcare services.

So how do you take this into account when designing the process of care? By focusing on the patient and the patient’s experience/outcomes rather than financial numbers and metrics.

To again quote Bogle:

“…the human concerns of the caregiver and the human needs of the patient have been overwhelmed by the financial interests of commerce.” (Bogle, 2008, p.125)

It’s very easy —especially when running a healthcare clinic or organization— to focus almost exclusively on the metrics & financials. However, that misplaces the focus of the organization.

Healthcare organizations exist to provide life-changing services and treatments. They exist to help their patients overcome dysfunctions & limitations. While the numbers do need to work out for us to keep the lights on, the main focus of every decision made in our clinics and organizations should be the well-being and experiences of our patients.

Process of Care

One final note on building great healthcare organizations: Great organizations are rooted in a great culture, made up of people & purpose. Those people —ideally— base their daily decisions on the purpose of that organization. Since healthcare is about people, it logically follows that great healthcare organizations focus their purpose on the patient.

That leads us to an important point: Clinics & organizations should design the process of care to allow human connection and relationship.

This may be as simple as allowing clinicians extra administrative time to spend reviewing medical records or even something as simple (and less costly) as training receptionists and office staff how to make the most out of a patient phone call.

Are we simply using a phone call to gather the data necessary to check the boxes on an assessment form, or are we using that call as an opportunity to hear/listen to that patient’s story?

Are we using that call to let the patient know that we care about them as an individual and not just how much their insurance company will pay?

How we gather data is arguably as important -if not more important- than what data we actually gather on these phone calls. That ultimately trickles down to the front-line clinicians who will treat that patient.

Summary

At the end of the day, healthcare leaders need to recognize that healthcare ultimately revolves around people: both clinicians and patients. Organizations should strive to build and promote a culture that focuses on the patients they serve and empower their staff and clinicians to make decisions in line with that objective.

That means at times, letting the metrics take a back seat to the people.

What are you doing to build a great environment in your clinic or organization? Is culture an important piece of that puzzle for you? Share any additional resources that you found helpful in the comments below!

References

[1] Bogle, J. C. (2008). Enough True Measures of Money, Business, and Life. John Wiley & Sons. Find it here.

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What’s your story? It may not seem like it, but anytime anyone asks about your work, your life, your experiences, that’s what they want to hear. People learn through stories. Stories take mundane facts and turn them into emotional feelings that have the power to motivate people to action, or just make sure they remember you.

That’s why we tend to remember speeches or presentations where the presenter relayed a story.

So what does this have to do with healthcare, clinics, and growth? That’s what we’ll look at below.

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The Power of Stories

If you do a quick google search on the power of stories, you’ll quickly get inundated with countless articles, videos, and resources. Countless research articles, studies, and data show that stories have a unique ability to create emotional responses.

Just check out this video of a Tedx Talk, where the speaker describes a situation where a researcher bought 200 items for around $120.

The researcher then had 200 people write stories about each item and posted each on one ebay.com. That initial $120 turned into $8000 dollars! The items didn’t change. They were still cheap trinkets.

What did change?

The story attached to them changed. And that was all it took for people buying the products to consider them more valuable.

Something about adding a story to those cheap trinkets influenced the buyers in such a way, as to cause them to pay more than the trinket was actually “worth” (the entire subject of value could be it’s own article or book).

How Do Stories Work?

The obvious questions that arises from this information is, “how do stories create those emotional responses?” As described in this article, even though technology has advanced by leaps and bounds, our brains remain relatively unchanged (from an evolutionary perspective). That means we still process information in the same way we have for thousands of years.

So what does that have to do with stories? Well, stories play —and have played— an important role in helping us order information, think, and create connections between ideas & situations.

Our brains naturally create schemas, mental maps, or scripts with information and situations we experience. This helps us explain how things work, make or justify decisions, understanding and teach values. It even helps us create our identities and understand our place in the world.

Part of the underlying reason for this revolves around the fact that human beings seek predictability. Stories, or narrative structure, provides a predicable and familiar way of processing information. We can tolerate great swings in emotion, anticipation, or action in stories because we know that resolution follows conflict.

Another interesting fact about stories is that they engage the right brain and reside in our imagination. Our brains process imagined information the same way as real situations.

That means stories result in real emotions, a sense of presence, and physiological/behavioral responses. Knowing this should provide some insight as to why stories can be a powerful aid in promoting and growing your healthcare organization, clinic, or business.

What is a Story?

Before we dive into using stories to promote and grow your clinic, we must first understand what a story is — and more importantly, what it is not. A story is typically structured with a beginning, middle, and end (no great insight there, right?).

Stories convey experiences, emption, and communicate some change or transformation. That is how they differ from anecdotes. Anecdotes may be emotional and they may have a beginning, middle and end.

But anecdotes don’t necessarily need to convey a transformation or change. With that in mind, let’s take a look at what makes a story a good or memorable story.

Elements of Good Stories

Since stories help us attach emotional responses to information and ideas, good stories will be emotional. The engage the listener’s emotions. Good stories are also memorable and cause the listener to care and connect with the story teller.

As Chip and Dan Heath write in Made to Stick, stories tend to be more memorable when they are simple and concrete. This drives home the point that effective stories are vehicles to communicate simple, human experiences.

Every good story contains some common elements. This means that, when you understand those elements, you can use them to create your own memorable stories. Good stories tend to involve some element or risk, or stakes.

There is something to be gained or lost in the story. They also involve some sort of personal reflection or action on the part of the story teller. This can be done by using truthful and specific situations and examples, which also adds authenticity and vulnerability to the story (making it more human).

Above all, good stories are universal. They speak to something greater than the storyteller, a higher purpose or revelation. For more on this topic, check out Robin Gelfenbien’s work. I attended a workshop she put on that was all about creating meaningful stories that was very insightful and motivating.

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How to Structure Your Stories

The way we build or structure our stories can be the difference between impact and a dud. So how do we build or structure our stories to be emotional, memorable, and impactful? The answer is to follow the common 5-part story structure. I don’t quite know who came up with this story structure, but it is so common that I’m sure you’ve heard of it (or at least recognize it once it’s described).

The 5-part story structure goes like this:

1. There is a setup or intro

2. An inciting incident occurs (something happens)

3. Some action occurs (plot, journey, etc.)

4. There is a main event (or climax)

5. Then there’s resolution.

Let’s break each down to better understand how they come together to create a compelling story:

The setup

The setup plays the role of introduction. Characters are introduced, along with the situation, environment, or context. A simple setup that introduces the main character (usually the person telling the story), the point of the story, and even lays the groundwork for an exciting incident.

The Inciting Incident

Once the setup is out of the way, we move quickly to the inciting incident. This is usually quick and moves us onto the journey or action. It usually starts with something like, “Then, one day…” The inciting incident happens quickly and leaves the lister “hooked”, wanting to learn more.

The Rising Action

The rising action plays the role of “body” or “main plot” of the story. Depending on the type of story you are building, it could be the hero’s journey, rags to riches, overcoming the monster, a story of rebirth, or a quest. This portion of the story gives all the meat of the story. It answers some questions, presents obstacles or opportunities, and leads into the main event.

During the rising action, or plot, the main character (ideally, you) makes choices, faces obstacles, and —most importantly— has to reflect and act. Sometimes, an obstacle requires personal growth, acquiring new skills or knowledge, or taking a certain action. Sometimes opportunities present themselves during the plot. This is what builds the story and makes it interesting.

The Main Event

We naturally expect the action or plot of a story to come to a point, a main event —or climax. This is where the audience discovers whether the main character is successful or not. Questions get answered. It leads into the resolution. The main event brings about a transformation, change, or realization. It could be something like a discovery about yourself or a decision you had to make.

Resolution

The resolution acts as your conclusion. In this part of the story, you tell what you became (if this is a transformation story). This is the “and they lived happily ever after” part of the story. It answers what happened after —or as a result of— the main event.

You can also use this part of the story to share any lessons learned.

For example: “And that’s why I always check references before making a hire.”

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Making the Connection (Origin Story, Higher Purpose, & Values)

Understanding the basic elements of a good story and how to structure one brings us to the big question: How do we use this information to craft a compelling story for our clinics and organizations?

The answer to that question drives to the heart of your clinic or organization. Since stories are tools of communication, you must first figure out what you want to communication and to whom.

I tend to make the general suggestion that a clinic or healthcare organization should make an effort at communicating purpose, mission, and values through story.

A good option is an origin story.

What is an Origin Story?

Think about your favorite superhero growing up. They all have a “where they come from” story. Usually, the origin story provides some insight to the hero’s past, but —more importantly— it sheds light on that hero’s superpower and mission in life.

A compelling origin story, especially for healthcare providers and organizations, should do three things:

1. Provide history or background (context)

2. Highlight the superpower or gift (expertise, talent, skills, etc.)

3. Explain the higher purpose or mission

Providing background is pretty straight forward. This is the usual history of the organizations, or bio of the clinician. The origin story should (maybe after some inciting incident) connect that clinic or clinician to some superpower. For healthcare providers and organizations, those superpowers could be clinical expertise or skills. And finally, the origin story should tie the context and superpower(s) together with the higher purpose of that organization or clinician.

What is your Higher Purpose?

Now we come to the really important part: the higher purpose. Often referred to as an organization’s “mission”, the higher purpose provides the compelling reason why anyone should care about what you or your clinic does.

This is the why that Simon Sinek writes and speaks about. Your clinic’s (or personal) Higher Purpose tells the world (and your potential patients) that you are in this thing for something greater than yourself. It is a mission worthy of calling others to come along side to join a movement.

Ideally, your origin story provides the context behind your higher purpose. For example, your origin story may be how you came choose healthcare and/or rehabilitation as a career.

It was through that experience that you discovered your higher purpose of helping others live their best life (or overcome ____ diagnosis), and the only way you could see yourself able to do that was to open up XYZ Health & Wellness Center.

How do your origin story & higher purpose connect you to your audience?

Who is your audience? It is your patients and prospective patients. It also includes referral sources and community or business partners. Your origin story & higher purpose not only need to connect with each other, but they also need to connect with those with whom you are trying to communicate.

That may mean crafting a few different versions of your origin story & higher purpose depending on the audience you are communicating with (a potential patient may be moved by something that a referral source doesn’t care about).

When crafting your origin story and connecting your higher purpose, it is important to take into account two questions:

1. What is the feeling you want your story to elicit in your audience?

2. What is the impact you want to make?

Those questions change depending on the audience. For example, for prospective patients, we want to elicit feelings that cause them to book appointments or call to inquire about our services. What are those feelings?

It could be feelings of pain (if they’re in pain), hope (that recovery is possible), or empowerment (that they can take control of their lives/future). The impact we want to make typically involves some decision, or motivation to make a decision.

That decision is usually to reach out to our clinic for a consult or to inquire about what we can do for them. For referral sources, we use different emotions and desire different impacts.

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Summary

Stories act as a great tool to communicate ideas, elicit emotional responses, and motivate people to action.

Healthcare organizations, clinics, and even individual providers should take the time to craft a compelling story that connects to some higher purpose or mission that is compelling enough to motivate all stakeholders to take action. It is important to follow a common framework for constructing stories that is simple, concrete, and emotional.

The story should follow a simple structure that we all expect of stories (a setup, incident, action, climax, and resolution). Above all, healthcare providers and organizations should tailor their stories to be most effective for the specific audience they are trying to communicate with.

Do you share your origin story with patients, potential patients, or referral sources? Have you seen increased engagement through telling stories? Share any additional resources that you found helpful in the comments below!

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Marketing is a foundational part of any business. Therapy and healthcare, especially in private practices, is no different. Yet, it seems many clinicians and clinic owners struggle to understand how to market their services. Whether you own a practice, manage a department, or are simply advocating for the services you provide, knowing about marketing helps you get your message across.

I was recently asked by the good folks over at Covalent Careers to share some insights about marketing PT & OT services. You can find the full article here. In it, I define marketing, describe the difference between marketing for large vs. small organizations, and the principles of direct-response marketing. Check out the excerpt below.

Excerpt from the Marketing Article

Read the full article here!

Where do patients come from? It may seem like a funny question to ask. But if you think about it, it’s a very important question, especially for those that either own, hope to own, or manage a rehab clinic. Clinicians often take for granted the fact that their schedules get filled with appointments every day. They show up, see their patients, and go home. But how do those schedules get filled?

The answer is that those schedules get filled because patients and referral sources heard about that clinic, department, or even clinician and decided to book an appointment or make a referral. How did they hear about the clinic or provider? Because someone, somewhere did the marketing.

It’s unfortunate, but clinicians rarely learn a lot of the business side of therapy while in school. That includes how to market and sell your particular services. For us, that would be occupational therapy, though these principles work for any clinical service.

Read the rest of the article here!

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What can a violinist, a subway station, and 1,097 passersby teach us about patient engagement and experience? Let’s take a look…

On January 12, 2007, a violinist posted up in the L’Enfant Plaza Station in the Metro DC area. It was around 08:00 am, so rush hour. For 45 minutes, he played several classical pieces on his violin, as people shuffled to and fro, heading to their offices. Almost 1,100 people passed by him that morning.

Seven (7) people stopped to listen for over a minute, and twenty seven (27) stopped to put some money in the open violin case, totaling $32 and some change. That means that the other 1,070 people simply walked on by, not seeming to notice the violinist.

Why does this matter? Because the violinist playing that morning was Joshua Bell, one of the most famous and accomplished musicians at the time (read the original story here).

What’s even more surprising, is that only one person who walked by actually recognized him. Now, this is a performer who makes thousands of dollars a night, playing to sold-out concert halls. Yet, only 27 of the people —just 2.5%— who passed by him that day in the subway station noticed, cared, or paid attention.

Let that sink in for a moment.

One of the world’s most famous musicians stops in a public train station and plays some of the most famous classical pieces of music to a crowd of people, and no one really noticed. Why?

The answer lies in context and expectations.

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Expectations Matter

Whether we realize it or not, our expectations shape our perceptions and experience of the world around us. In fact, some publish research even suggests that our expectations affect what we see (or, at least, what our brains tell us we see) [6]. To illustrate this example, take a look at the picture below:

To read more about this particular image, check out the MIT page here.

This visual illusion plays a “trick” on our brains. We see the original picture (on the left) and notice the shadow cast by the green cylinder. Given what we know about shadows and light, we expect there to be a difference between the colors of boxes A and B.

However, when the gray lines are added (in the image to the right), we notice that they are both, in fact, the same color. What does this tell us? It tells us that our expectations impact how we perceive the world around us in a very real way.

Expectations, Perceptions & the Role of Context

Our expectations, also play a role in the placebo effect. Some researchers even refer to this as expectancy effects. These effects have been studied by clinical psychologists, neuroscientists, behavioral neuroscientists, and many more. And their research shows that expectancy effects can have lasting influence and impact on cognitive processing and behavioral actions [5]. Put plainly: we experience the world and make decisions based on those experiences. What we experience and how we experience it results from our perception of the world around us. Our perception is greatly influenced by our expectations. And what has a major influence over our expectations? That’s right, the context in which we find ourselves.

In other words, the environment or context affects our expectations. Our expectations influence our perception. And our perception affects what we experience, how we experience it, and the thoughts, choices, or actions that result from that experience.

So, going back to that train station in 2007, is it any wonder most people simply walked on by one of the most famous violinists in the world as he played? In reality, the answer is no. The people traveling through the station that day didn’t expect to encounter a world-famous musician playing in the lobby that day. They didn’t expect that because they were traveling through a train station on a busy morning before work.

Their context didn’t tell their brains to expect anything out of the ordinary, and therefore, they didn’t perceive anything out of the ordinary. How many times had they travelled through that station and seen or heard some amateur musician playing the same type of music, with their case open trying to make a few bucks? Probably countless times.

So when they saw Joshua Bell playing in the same lobby, their brains told them not to expect anything spectacular, that he was probably just another amateur musician trying to pick up a few extra bucks.

This story should make you rethink the context or environment you create in your clinic, and how that may be affecting patient experience, engagement, and satisfaction. As the violinist in the subway station points out, people’s expectations impact their experience. You should try to create an environment —a context— that gives your patients the expectationthat the services you provide are valuable and effective.

The Impact of Expectations on Patient Satisfaction

As discussed above, patient expectations can have a real impact on their experience in a clinic. In fact, clinical research has shown that an initial appointment/consultation can alter a patient’s expectations for treatment, resulting in higher (or lower) satisfaction scores [1]. This gives hope that, even if a patient may have low expectations going into an initial visit, they can leave that appointment with high expectations, increased engagement, and even a higher level of satisfaction.

But how many clinicians understand a patient’s expectations? Recent research shows that many clinicians and healthcare organizations don’t fully understand a patient’s expectations [2][4]. In fact, many organizations miss important patient expectations such as being given reassurance about treatment, receiving advice about their condition or diagnosis, information about benefits/limitations of certain treatment options, and opportunities to discuss their problems with their healthcare providers [2][3]. These expectations may seem like common sense, but many healthcare providers do not address them.

These expectations can also be influenced by the environment of the clinic as well. For example, if a patient goes to check-in for their first appointment and the front desk staff seems hurried, rushed, or dismissive, that patient may expect the same type of experience from the interaction with the clinician. Since expectations influence perception, you’ll have to work hard to overcome those low expectations.

Another interesting finding from this research, which ties into context and its effect, is that previous interactions with healthcare providers or experiences in other clinics have a strong influence on patient expectations [2]. How many times have you hears something like this from a patient: “Well, the last clinic I went to…”? Whether it was an amazing experience or a negative one, that experience influenced that patient’s expectation for what your clinic or clinicians can do for them. Understanding how your patient may feel about your clinic and treatment based off of their past experiences allows you to address and correct any potentially negative expectations upfront.

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How Context Affects Patient Experience, Engagement, & Retention

We’ve got an understanding of how the context or environment can impact a person’s perceptions and experience. Now let’s discuss how you can take that understanding and apply it in your own practice, clinic or organization. The first thing to take a look at is how your clinic’s environment may be affecting patient expectations. From there, you can build, from the ground up, and intentional environment, culture, and context that molds a patients expectations toward the positive.

Context Affects Patient Expectations

As stated above, our environment or context influences our expectations. The same is true when your patients walk into your clinic. This fact means that you need to be aware of what expectations your clinic may be eliciting in your patients. Now when I say that the context or environment can influence expectations, it’s important to note everything that can be included in “context”.

Obviously, this includes the physical space itself. The physical environment, layout, and organization of your clinic impacts not only your patient’s expectations, but also impacts the overall experience they have in your facility (read more about that here).

If your clinic is dirty, cluttered, or disorganized, your patients may come to expect the same about the services you provide or the skills and competence of your clinical and administrative staff. I’ve spoken with many patients over the years who have said something along the lines of, “Well, their office is always a mess. It’s no wonder they haven’t sent over those records.”

At the very least, your clinic should be clean, well organized, and inviting to patients and prospective patients. Another reason to pay close attention to the physical environment is that expectations have been shown to influence and alter visual perception [6]. Put plainly: if your patient’s expect to see clutter, dirt, or grime, they’re actually more likely to see it in your clinic (even if it’s not really there!).

Aside from the physical environment of your clinic, what I would consider more important, is the context of interpersonal interactions. As I’ve written about here, interpersonal interactions between clinicians and patients play a large role in patient experience and engagement. And context influences whether an interaction between the clinician and the patient is positive or negative.

Take something as simple as body language as an example. I’m sure you’ve heard of “point of service documentation” before. It’s supposed to be great for improving productivity, efficiency, and speeding up the documentation process. But what are the potential costs inserting point of care documentation within the context of a patient-clinician interaction?

When I worked at the VA, I was part of a team that helped roll out an initiative that was rooted in relationship-based care. The aim of the program was to improve both employee (clinician) and patient experience and engagement during the healthcare process. Part of the project included interviews and surveys from patients about things they felt were important for a high-quality healthcare experience.

One of the most cited factors by patients we interviewed and surveyed revolved around what clinicians call point of service documentation. Patients said things like, “At XYZ clinic, you know they don’t care about you because they have their nose stuck in their computer the whole time they’re talking to you.” In many cases, inserting this type of documentation into the context of a normal patient-clinician interaction not only impacted that patient’s experience of that particular appointment, but it also had a lasting impact on what that patient expected from that clinic in the future.

Now, I’m not saying that point of service documentation is evil and you should never do it. But what I am saying is that you need to be conscious about when and how you use it during patient evaluations, assessments, and treatments. For example, it’s entirely appropriate to be taking ROM measurements of a patient’s hand or digits, and be inputing that into the computer as you’re taking measurements.

I would argue that it’s entirely inappropriate to be typing up what a patient is saying during an initial interview. During that time, the patient expects you to hear, listen, and engage with them and their story. They want you to acknowledge and validate their feelings about their diagnosis, injury, or experience. In situations like that, put the computer away and be present to your patient.

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Expectations Affect Patient Perception

The results from a recent survey that I completed on outpatient clinics showed that one of the main reasons clinic owners and managers cited for patients not completing their plan of care was “unrealistic expectations”. In fact, that’s a common excuse clinic owners, managers, and directors use to explain why patients stop showing up for therapy.

Now, usually a patient has unrealistic expectations for a couple of reasons. First, they may have been given unrealistic expectations from the provider that referred them. Other times, it results from a miscommunication or lack of communication between your clinic and the patient. Either way, you need to address expectations with patients at the first appointment.

You do this by both educating the patient on their condition/diagnosis, the prognosis, and possible treatment options & by having a value discussion with the patient. You need to explain what the treatment options are, what their anticipated results are, and then how you (or your clinic) fit into that outcome. Addressing expectations early prevents any misunderstandings and also gives you a chance to demonstrate and explain your value.

Again, a patient’s expectations affect their perceptions about treatment and results. If they come to you with incorrect expectations, you need to address it early, so that they’re more likely to have an accurate and positive perception of the treatment you provide and the outcomes they experience.

Patient Perceptions Affects Patient Experience & Engagement

Now, what happens if a patient’s expectations are unrealistic? Let’s say they are overly optimistic about the timeline and magnitude of the outcomes they’ll experience after a few sessions of treatment in your clinic. They show up for appointment one thinking that you’ll “do something” to their sore shoulder and it will feel better.

What happens when you do provide some manual therapy to their shoulder and they still have pain afterwards (or it “works” for a bit, then the pain comes back)? Maybe the patient becomes discouraged. Maybe they begin to think that “it’s not working”. Or, they think “why am I even wasting my time/money coming here?”

If you don’t take the time, at the beginning to address these expectations and provide a realistic picture of what was going to happen & what to expect, you’ll find yourself with patients that become disengaged, unhappy, and unsatisfied. If you do address expectations early, you increase the odds of patients having a positive perception of both the treatment you provide and the experience of their outcomes.

They become increasingly engaged and satisfied with the clinic, their clinician, and the services they receive. And that leads to them sticking around to complete their plan of care, and maybe even for another round of treatment.

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The Ultimate Effect: Patient Retention

Patient retention relates to both patients completing their plan of care and returning to your clinic when another issue arises. In fact, both clinic retention and course of care retention hinge on patient engagement and experience. It goes without saying, that patients who are actively engaged in treatment are more likely to complete their course of care.

What is one of the best ways to actively engage patients in treatment? By delivering an amazing experience.

Since context, expectations, and perceptions influence a patient’s experience, you need to be intentional about every part of that chain. You need to ensure the environment and context inform a patient’s expectations. If necessary, you need to educate and provide guidance to your patient’s expectations.

You need to also regularly gauge a patient’s perceptions during treatment and, if necessary, provide more information or education to guide their perceptions to ensure that they have a positive experience. When patients are having great experiences and are actively engaged, they’re more likely to complete their course of care. They’re also more likely to return to that clinic if they need those services in the future.

Summary

At the end of the day, it’s important to realize one thing: context plays a huge role in what your patients experience in your clinic. Context affects a patients expectations, which impacts their perceptions, and their perceptions impact their overall experience. Just like with the placebo affect, a patient’s expectations inform their brains of what they are (or are not) experiencing. What we experience and how we experience it results from our perception of the world around us.

Think of it like this:

1. The environment or context affects our expectations.

2. Our expectations influence our perception.

3. Our perception affects what we experience, how we experience it, and the thoughts, choices, or actions that result from that experience.

Understanding this allows you to intentionally address each link in the experience chain to make sure that your patients have the best experience possible in your clinic. That will lead to higher levels of engagement and retention. And that leads to better outcomes for your patients, and increased revenue for your clinic or organization.

Resources

[1] Berhane, A., & Enquselassie, F. (2016). Patient expectations and their satisfaction in the context of public hospitals. Patient preference and adherence, 10, 1919–1928. doi:10.2147/PPA.S109982

[2] Bowling, A., Rowe, G., Lambert, N., Waddington, M., Mahtani, K., Kenten, C., … Francis, S. (2012). The measurement of patients’ expectations for health care: a review and psychometric testing of a measure of patients’ expectations. Health Technology Assessment, 16(30). doi: 10.3310/hta16300

[3] Patient Engagement: Technical Series on Safer Primary Care. Geneva: World Health Organization; 2016. License: CC BY-NC-SA 3.0 IGO. Link

[4] Rao, J. K. (2000). Visit-Specific Expectations and Patient-Centered Outcomes: A Literature Review. Archives of Family Medicine, 9(10), 1148–1155. doi: 10.1001/archfami.9.10.1148

[5] Schwarz, K. A., Pfister, R., & Büchel, C. (2016). Rethinking Explicit Expectations: Connecting Placebos, Social Cognition, and Contextual Perception. Trends in Cognitive Sciences, 20(6), 469–480. doi: 10.1016/j.tics.2016.04.001

[6] Sterzer, P., Frith, C., & Petrovic, P. (2010). Believing is seeing: expectations alter visual awareness. Current Biology, 20(21), 1973. doi: 10.1016/j.cub.2010.10.036

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