“Whenever our numbers were down, I knew that I needed to improve communication” – Ronny Varga
Physical therapists don’t receive specific training on how to sell a plan of care, how to talk to a patient who frequently cancels or is a no-show, or how to keep a patient engaged in their care. As a long-time owner and VP of Operations for a multi-clinic facility, Ronny Varga learned that his provider team needed more training, not in becoming better clinicians, but in becoming better communicators. Ronny consistently trained his team on communication, giving them the tools they needed to improve patient compliance, significantly improving patient results and clinical productivity. In this episode, he shares some of the insights he learned and is now teaching other owners and providers.
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Want Improved Production? Start With Communication With Ronny Varga, PT Of The Clinician’s Guide
I’ve got a friend, Ronny Varga, a Physical Therapist of The Clinician’s Guide, and an expert in operations and communications coaching. Thanks, Ronny, for joining me on the show.
Thank you for having me. This is awesome.
It’s good to get in touch with you again. We met a number of years ago in passing at one of the HUD’s conferences in the past. It’s cool to see some of the stuff that you’re putting out on LinkedIn right now. I like what you’re talking about because it’s something that physical therapists in particular don’t get trained on in their schooling, and then we’re expecting productivity. One of the missing components that most clinics don’t train in is this part that we’re going to talk about, and how to help your providers get to those productivity members. Before we dive into that kind of stuff, tell us a little bit about you and where you’re coming from.
I am a physical therapist. I’ve been a physical therapist for over 22 years now. I’m originally from Montreal. I went to McGill. In the first year, I became a treatment therapist. I treated for a full year, but I realized quickly I wanted to own. The franchise I was part of basically told them I’m ready to own. I got a clinic pretty quickly from them that I was able to start from scratch.
I worked my way into expanding that clinic. I was there for about ten years. I managed and trained over 30 to 40 different clinicians and students. That’s when I realized my passion for training and coaching. I love treating, but I felt that the training and coaching part was my biggest passion. I did a lot of that, but I still had to treat it because it was my clinic.
You’re talking about training and coaching not like, “I’ll train and coach PT on this.” At the time, you were coaching other providers, right?
That’s right. I was coaching other providers. I was even coaching my own VPs. A lot of it was based on communication and different types of treatment techniques we can do. I was enforcing KPIs and all that stuff. The typical way a business should be run. We had graphs and everything. We would look at that stuff and make sure that if we did X, Y, and Z and the graph went up, we know we have to do X, Y and Z again.
I did that for about ten years and expanded twice. I realized that winter wasn’t for me. I decided to sell my clinic in Montreal. I ripped my family away from Montreal. That’s what she would say, but she’s all better now about it. We ended up moving to Florida. I didn’t want to own a clinic again. I wanted to try something different. I found a company that had two clinics that was looking for a clinical director. I jumped into that clinical directorship within about a month. I needed to figure out the differences between Montreal and US laws when it came to billing.
Once I felt comfortable, I told him I’m ready to take clinical director. Within about six months, I got promoted to VP of Operations. At that point is when the training came back in, and I was super happy to do that. I trained tons of different therapists. I took up students as well on my own. I treated less, which was great at that point. I helped him develop three more clinics. We had about five clinics.
The owner sold. I didn’t feel that I wanted to continue with that. In the end, I said to myself, “This coaching and mentoring stuff is exactly what I want.” Luckily, my wife has a good solid job. It allowed me to step back from my W-2 and allowed me to jump into this coaching and mentoring side of things, which I’ve been doing for the past few months.
Let’s cut right to it. What exactly are you coaching on at this time? Where is your focus? Where is that passion?
I was never the kind of therapist who would go and spend all this money on different techniques like Active Release stuff. I just wouldn’t do it. I ended up taking little courses here and there, figuring things out on my own, finding the best ways to treat people, and that was it. This is what I want to do. I don’t want to train people on how to treat others.
There are tons of people out there who are amazing at what they do, all the way from Active Release Technique to Mulligan. They’re all out there and they’re amazing. That’s good for them to be out there to give that to therapists. I noticed that there was not much or almost nothing out there on how to train a therapist or any clinician to communicate with patients.
The interpersonal skills you need to have from even day one of coming off of graduating to be able to know how to speak to a patient. How to make sure they understand the importance of my role as a therapist and what their role is as a patient. What they need to do to get better and get their full agreement into making sure that they are following exactly what I tell them.
There are so many things in private practice where it does not rely on your technical skill at all. I’m a prime example. I don’t think I’m the best therapist out there, but my patients came on a routine basis because I believe I developed some ability to connect and what I would call soft skills. The hard skills being the technical components, how to mobilize a joint, and how to stretch all the things I need in special tests.
The soft skills were never addressed in physical therapy school. We think maybe we’re going to learn some of that in our internships during our schooling in the last year. It is the crux of what makes a great therapist versus a good therapist. If the best therapist in the world cannot communicate the importance of what they’re doing and why they’re doing it, they’re not going to get the results because they’re not going to get the buy-in from the patients. People don’t want to be there in the first place. They don’t want to be in physical therapy.
I don’t want to hire somebody who’s got twenty different certifications but can’t speak to a patient for the life of them.
They’re not worth it. You can’t justify all the certifications they have.
I was like you. I was a great therapist because I knew how to communicate with people. It’s a superpower I have. It’s a talent I have. I’ve always had it. I like being with people. I am an introvert, believe it or not. It exhausts me by the end of the day to do what I did, but I was good at it. I was good at getting rapport and having the same understanding as the patient. I had the same understanding and the fact that they like to be next to me, the communication level was so high that they were putty in my hands. I could have told them to come eight days a week and they would have.
It’s cool that you’re talking about training team members on how to do it because this is something that as owners, we get good results because the stress of the business forced us to be better communicators. It forced us to stress the importance of physical therapy and to have these conversations with patients to come in.
Inevitably, when I’m talking to owners, their productivity numbers are the best out of the entire team if they’re treating. They usually can kill it. They can knock out patients. They can get even better results because their patients are coming more often. They’re not canceling as much. They’re fulfilling their full plan of care because they recognize the stress as the business is on them.
That stress has created a diamond in the rough. Whereas, the team PTs don’t have that kind of stress. They’re focused on being better clinicians. At some point, the level of productivity that the PT owners have developed over time is second nature. It’s hard for them to make the connection between, “Why can’t you guys meet these numbers when I can?” They don’t understand that that team has not been forced or stressed to do it, and they need training that you developed over time. Have you seen some of that as well?
Yeah. I have an owner of a mobile therapy company. I always ask what he wants to get out of all this. He said, “I want to pull myself away. I want to expand and develop, and I can’t do that if I’m treating.” I said, “Why are you still treating?” He goes, “Because I’m the best at what I do.” I said, “Why are you the best at what you do?” He goes, “This is why I own.” An owner is usually the best at what they do. He is the best at what he does communication-wise and everything. He’s finding it very hard to push that on to train to work for him.An owner is usually the best at what they do, and they are the best at what they do communication-wise and everything. Click To Tweet
They’re unable to develop those systems. What are you saying? What are you doing?
Owners might not be good trainers. They might need trainers to jump in to help with that. They might need to find one of their better therapists out there who is good at communicating and have that person train the rest of the team. Most owners aren’t good at that. They are very good at vision. “Here’s the vision. I need people now to make that vision happen.”
That’s why I developed this idea of working with clinicians individually. I haven’t gone straight to many owners because I wanted to see what’s out there and who’s interested. There are tons of therapists who are definitely interested, and tons of students who are super interested. Some of them are afraid to latch on still because they’re not treating yet.
They’re like, “If I do this now, I’m going to forget everything when I get there.” I’m like, “Not really. We’re going to develop it.” The idea is when I was a VP of Operations and I sat with the CEO, we battle-planned for the week what needs to happen. We had a loss of production the week before. Our number one was to get me onto the floor to start treating and to be out there to help others communicate.
To listen to the conversations.
Exactly. To listen and for them to listen to me. I would meet with these therapists and say, “I’m going to be treating right next to you. I want you to listen to how I am with this patient. You keep treating yours but listen to what I’m doing.” I would do that. We would open communication with the therapist the next day in a meeting. We would come up with other ideas and suddenly, our production went up.
What are the KPIs that most owners care about the most? It is patient visits. Patient visits are huge. The next one after that is your average charge. The truth is if you look at even what people are charging and you look at some of these codes, some of the higher-paid codes require better communication with your patient and education on what you’re doing, like neuromuscular education. It requires you to communicate well with your patient so that you can bill for that code. If you don’t know how to do that, that’s why people aren’t using those codes. Most clinicians are afraid of using neuromuscular education because they don’t know how to do it.
They don’t know how to educate.
They don’t, and it’s all communication. They know how to do TherEx. They can go, “Do this 1, 2, 3, 4.” They can count. That’s good. What they need to know how to do and what would benefit any KPI in any clinic is communication. “How do I get patients to come and see me more? What can I say to them, show them, and educate them on so that they will do that?”
There are some newer codes that are out now with the remote therapeutic monitoring codes that are out there that will require even more communication. You can charge now for codes simply for that phone call and checking in on them. It requires communication. Going back as you were training members of your team. No matter where they were in their life as a licensed physical therapist, did some of that training begin before they even hit the floor of your clinics?
Do you mean if we hire them at a school?
If you got a new hire that’s a physical therapist, did you do this kind of communication training before they even hit the floor?
Yeah, right away. We had a culture that we wanted to maintain. Our culture was based on good communication and being there for the patient. I developed policies on communication. What happens if a patient cancels, what do you say? Here’s a script, let’s go over that together. What happens if a patient’s doing well, what do you do? It gives you the opportunity to work on that one KPI that’s important, which is the number of success stories that you’re getting. What about the number of patient referrals? In my clinics in Montreal, most of our patients coming in were from patient referrals. It’s about 80%.
Most clinics here are under 5% patient referrals. It’s weird, “What do you mean I have to sell myself? I’m not a salesperson.” You are a salesperson. We are salespeople. Salespeople need to know how to sell. Salespeople need to know how to communicate to be able to sell. We are selling ourselves every day. I’m selling myself to you right now. You’re selling yourself to me. We are constantly selling every day something about ourselves to somebody. If we’re not good communicators, then we can’t sell what we’re supposed to be selling.
As you ask the questions as part of your training, I’m thinking, these are some of the questions that owners could ask themselves. An owner is treating and they got great productivity numbers. They’re like, “My cancel rate is the best out of the entire team. My patients come to see me all the time. I’m getting good results.” I ask them, “What are you doing to get these good results?” It’s oblivious to them because it’s second nature. They don’t know what’s special about what they’re doing.
I remember back in the day when I first had some coaching, my coach recommended and I blew it off and never did it. Now, I’m thinking I should have done that. She said, “You need to record your initial evaluation to see what you are saying and what you are doing to get buy-in from the patients. Show that to other providers so you can see what they’re not doing, and they can see what you are doing.”
There is an opportunity there for owners as they’re listening to this conversation and thinking, “How do I get my team to have better communication so that I get those better KPIs?” Maybe you’ve already trained some owners in doing this, but what I got from your example of training on your team is you could say, “What are you saying to your patients when they cancel?” What you’re saying to them could over time become a script that you train on. You can train those people who are coming on to do the same things.
You can ask that question over and over again. If someone has fallen off and hasn’t shown back up, what is that conversation? What are you seeing at the initial evaluation to stress the importance of coming to physical therapy? How are you training on that? Now you’re developing systems if you ask the owner how you do these things, and then try to replicate it and duplicate that.
I have a needs assessment typically that I send off to owners when they’re asking me to help scale their company. For the financial side of things, you need to get a financial guru. You want to work on taxes and stuff like that. That’s not me. What I’m going to do is the production side and the operation side. You might be here right now and you think that’s great. Yes, it is because you might still be in there. If you want to get out and we work on a communication system of some sort, we can bring it up higher. I believe that scripting is important. I could write my own script and give it to you, and you can use that script. What I had done in the past in training clinicians is I had them write the script themselves.
They need to have their own words
A hundred percent. At times they’re like, “This is weird. I’m reading a script to you. It’s like we’re sitting on a stage here ready to do a play.” This might not sound great but I’ve always said this, and I stick by it. “We are therapists. We are clinicians. We are here to help people fix themselves. If we don’t know 100% of what’s happening with this patient, we better act like we do.”
That’s a big part of what we do. If I had a doctor come and see me and he goes, “I have no clue what’s going on here. Let me go ask somebody.” I’ve heard therapists do that and say, “Let me get the VP. I’m not sure what’s going on here. Let me see.” I come in there and I’m trying to save the day for them. The point is you have a lot going on. We will work on things step by step, but the first thing I know we have to do is X, Y and Z. That’s what we’re going to do today and this is why we’re going to do it.
Overnight, they can go into their books and figure out what the hell is going on and then the next day, be knowledgeable. We’re not going to know everything. This is all part of the conversations that we need to have with these clinicians because I feel a lot of their downfalls come from the lack of communication skills that they have.
I’ve bumped into therapists on LinkedIn that are saying, “I don’t need what you have. I’m great at what I do.” I’m like, “Good. That’s excellent.” I leave it there because it’s not up to me to go and talk to them, but there are definitely lots of people out there. When my wife saw me put this all together, she was like, “Really?” I’m like, “Really, what?” She’s like, “There are people who really want this?” I’m like, “There are people who really need this.” She’s like, “You’re telling me there are clinicians who don’t know how to communicate?” I’m like, “Yeah.”
“You’ve never been to those doctors before?”
I’ve been to tons of PTs in the past when I wasn’t a PT. They were all about their manual therapy, “This is a great three that we’re going to do on your back. You just lie there. If you feel anything, let me know.” A lot of clinicians are in that stage still.
I love the fact that in part of your training, you had scripted stuff. You went over it and you role-played it. We got into a habit of role-playing all the time in our team meetings. Initially, our teams didn’t like it. I don’t think they ever grew to essentially like role-playing, but they recognized the benefits of it and how important it was because of exactly what we’re talking about. If you go to a continuing education course on a shoulder, you’re going to have plenty of time to work on mobilization, palpating the anatomy, studying anatomy, and getting comfortable during that weekend course, and then take it into Monday’s shoulder patients.
When we’re talking about this communication stuff, where is that safe space to practice these words, fumble with them, and find the right wording so that you feel comfortable and confident in the wording that you’re using? That role-playing and the time that it takes to train and work with a provider is essential before they get in front of a patient and try to sell their plan of care.
It’s got to be done weekly. We set aside an hour a week. Let’s say in one clinic, we had eighteen clinicians. Setting an hour a week aside for each clinician was a lot of production lost, but it was worth it because it gained more production down the line for us. We had better percent arrival rates, less no-shows, less drops, and patients got better results.
What I always recommend to any owner is you’ve got to get the time out there to help to train your staff. Their techniques are their techniques, but you got to train them on the systems you have in. You got to train them on how to improve their KPIs. The number one thing that employees want to have in order to retain them is knowledge of how to succeed in their roles.
This is where what I bring will help gain and boost that confidence for them because now suddenly, they know how to talk to a patient. They know how to get a referral. They know how to keep a patient from canceling. They have the tools necessary that they should have had coming out of school. They have all the special tests in the world but they can’t explain to a patient properly why they’re doing it and how they’re doing it. We all know that when there are question marks taken out of somebody’s head about what’s going on, they’ll feel better pretty quickly.
It’s like the touch itself. You don’t have to be an amazing therapist. If you know how to do a little soft tissue release and how to get them to do some cool and fun exercises, you could be an amazing therapist. You don’t need to have every single certification out there. There are going to be therapists that look at me funny and say, “That’s not true.” I’m like, “Good for you. That’s fine.
On my end, I didn’t have to do that.” I probably had about a 95% arrival every time that I stepped on the floor. That’s because people knew that I was there to help them, how I was there to help them, and what they needed to do to be helped. I turned tons of patients away when they weren’t there to help themselves. There’s one thing I wanted to mention when you were talking about you being in a team of your own. Some people were taking well to the training and some people were not. I say this to owners all the time, “You’re going to be as strong as your weakest link.”
If you have therapists there that are not sticking to the culture and if your culture is a training-boosting skilled culture where you’re just there to help get therapists better at what they do, and these therapists aren’t hooking onto that, they might not be who you want in your clinic. They might be the negative matter you’re going to have about all this stuff. There are tons of those kinds of people out there. I’ve seen it. I’ve talked to some of them. I’ve coached them trying to get them better. In the end, I let them go.
They won’t take it on.
No. The number one thing that spreads fast is negativity. I was a huge believer that there’s no need for negativity anywhere. If there is any, I need to know about it so I can squash it. Having people involved in training, you will find all that. If you don’t have any meetings with the staff or you don’t do any training with the staff, and you’re not involved with your staff, you will never see any of that. You will see your numbers go down because of that negativity.
I love what you talked about what employees want. Your team wants to know what success looks like and how to get there. Those are two things that most therapists, especially young owners, don’t provide their therapists. What success looks like should be discussed before the hire even happens in terms of, “This is what your productivity levels are expected to be. This is how we will know that this arrangement is successful, you’re going to meet this kind of production and I’m going to give you this kind of salary with these benefits. This is a successful win-win for both of us.”
We hire without setting those productivity expectations, so they don’t know what success looks like. In our heads, we might be thinking, “These guys are sitting around a lot,” but you don’t know exactly how successful you are because maybe you’re not tracking KPIs. Even if you are tracking KPIs, you’re not holding the line, holding accountable, and expressing and communicating the expectation.
What does success look like? Number two is, “These are the tools I will train you on in order to be successful in my clinic.” Even if they have provided, “This is what success looks like,” it means you’re going to hit at least 60 visits a week, whatever number you want. You’re going to bill this amount of money and do this continuing education. You express that, but then we throw the other KPIs out there, “Our cancel rate needs to be higher. What are we going to do?” Many times, they shrug their shoulders and say, “What can I do if Susan’s son gets sick?”
That’s my favorite.
That happens all the time.
“She’s 90 years old. She’s tired. She doesn’t want to come in.” I’m like, “Okay.”
They throw their hands up in the air, but that’s not necessarily their job. They were never trained on it. For them to come up with it intuitively, there is a small fraction percentage of the population that’s able to do that. They’re typically the owners.
Typically the owners or people who have been in other professions before being PTs, maybe in sales and stuff like that, and have that go-getter attitude.
They have that ability. You need to show them what success is or tell them, “This is what success looks like.” Also, be willing to say, “These are the tools that I’m going to train you on so that you can be successful.” Give your team those two things, what success looks like in whatever position it is, and “These are the tools you’ll need to get there,” which is a handbook, and then some one-on-one training. It takes a lot of grind.
It’s not a lot to supply to somebody.
If you can provide those two things, then your team can be successful and do so on their own.
I like calling that the Be-Do-Have model. You start with the have, “This is what I want to have at the end of the day.” It could be patients who are feeling better and who love me so much that they’re going to refer people to me. Let’s even say it’s people who know they’re getting better. That’s a whole other story than people who are getting better.
Sometimes patients don’t know they’re getting better. That’s a whole other communication story to get a therapist to make a patient realize they’re getting better because most of the time, they think they’re not. That’s a huge part of what I do training on. The Have model is knowing what you want. The Do is like you said, “Here are the tools. This is what you need.” The biggest part of it is the Be. That therapist needs to want to be that person who can do that.
Sometimes you can teach a little bit of that to somebody because they need to get a little kick in the butt for that. Sometimes they don’t but it’s the accountability, the want, and the urge to be able to do well for a company. Typically, that’s why we give a bonus. That’s why we shout out people’s names in meetings, “John, you did amazing.” All those things will get that person the way they want to be for the company.
That Be-Do-Have model is huge. Usually, in my training with owners, I create hats for these positions that they have. The hat for a therapist, there’s the Be-Do-Have in there. We list all these policies that they have to be aware of, how we’re going to train them in, and the number with the big KPI or the number one KPI that they have to work on. Let’s say, the patient visits by the end of the week, and all of the small little KPIs under that, that help them get to that one KPI. None of that will ever work if these clinicians do not know how to communicate properly with their patients.
What we’re saying essentially is if you don’t have the training for that communication to support them, then it’s not going to happen.
It’s not because the owners don’t want to do it. They just either don’t have the time or don’t know how.
Not to pull back the curtain all the way, but if an owner came to you and said, “How do I start training my team?” Number one, you’re going to say, “Set aside time on a regular basis.” What does that content entail?
If they have the content or not, that’s the big part. I have this one owner I’m working with. He has nothing. I asked him if he has any KPIs that he looks at to track the performance of individuals in the company. He said, “I know my income at the end of the month.”
“I look at my bank account every day.”
He doesn’t even like doing that. I get that. A lot of owners are in it too much and they get scared to go into other areas of the company that they don’t know much about. That was me at the beginning. I didn’t know about anything. I made tons of mistakes at the beginning. I didn’t track anything. Once I started tracking something, the numbers went up, just one little thing that I started tracking.
Start tracking KPIs.
First of all, set your KPIs up. What do you want at the end of the day for each of your therapists to hit? It will then give them a weekly target. If you have patient visits, one of your KPIs that they’re going to have to work on is percent arrival. “I have to make sure my percent arrival is very high so I have a high number of visits by the end of the week. How do I do that?” Here are three policies on how you can do it. One of them is you have to write a script for yourself and we have to train it. That’s what I would be telling them.
Also, how to present that script to the patient.
First, they work this with the trainer. There’s passing and failing these things. If you’re still failing at it, you got to find a way to make it better and work with them. It’s like anything else. We’re paying these therapists to not just treat but to create rapport with patients and to make sure they’re coming to their visits all the time. We’re not just paying them to do manual therapy on them and that’s it. That’s the first step on anything with an owner.
It speaks to the larger problem with physical therapy in general as an industry. Maybe I’m getting my number wrong but it’s close to this. The percentage of patients that complete their full plan of care in the physical therapy industry is 15%. It’s absurdly low. I think it all stems back to this one thing that we’re talking about here, and it’s communication. We are unable to express and confidently sell our value as a profession to the patients that come before us on a regular basis.
That is where I’m heading now with what I’m doing in everything that we’ve discussed. In the next probably 4 to 6 months, I’m developing an online workshop for people. Any therapist can take it. It doesn’t matter. They can take it. They can do it on their own time. They buy into it. It is not expensive. It’s going to be something that’s going to be beneficial for them.
What it’s going to entail without giving it all away is one thing. It’s a story. We are all connected as human beings by stories. As long as the story has an impact on us, we are going to want to listen to it. We have to teach our clinicians how to tell a story. We have to jump into the story of the patient and where they’re at. That patient is in a story where there’s emotional pain and physical pain. We need to know how it’s affecting them. We need to get the emotion out of the patient.We are all connected as human beings by stories. As long as the story makes has an impact on us, we will want to listen to it. Click To Tweet
It’s not going to be a hard thing for somebody who doesn’t know how to communicate well to take a workshop of mind down the line and understand, “This is just a story. I have to sit in here and figure out a story that this patient is going through. I have to make that patient the hero of the story and I have to be their guide.” It’s like Star Wars. It’s the same thing with Luke Skywalker and Yoda. Luke Skywalker wanted something but he was lazy about it. The guide came in and the guide called him to action and said, “This is what you need to do, go do it.” Eventually, he got what he wanted. He was able to succeed in his plan.
We need to always make sure that those patients are able to do that too. They need to also know what will happen if they don’t succeed. I can’t even tell you how many times I’ve spoken to a patient. I’m not there to be their friend. I’m there to be their guide. I’ve told them tons of times, “Where do you think you’re going to be in two months if you don’t get better right now? You’re having trouble walking. Do you think you’re going to want to be in a wheelchair two months from now? Do you think it’s fair for you to want to be in a wheelchair two months from now? What do you think it’s going to do about other people around you? People are going to have to push you now. They’re going to have to go out of their way.”
It’s how you get this patient part of the story. This is where I’m heading because I can go through teaching people how to ask them for the referral, and how to call them up on the phone and script it. The truth is if the patient is not involved in the story as well, they’re not going to want to be a part of this. I got into a bit of real estate investing too. A big part of it is I’m working with people who are going through pre-foreclosures. That’s a lot of pain for people. Their number one reason is usually financial or illness. It’s super sad.
As a PT, I’ve got this amazing empathy for these people. I try and get them out of whatever I need to do to get them out of that so they don’t get into bankruptcy or they don’t end up killing themselves. Believe me, those people are going crazy with the way the market is. They can’t even afford their mortgage anymore. As a PT, I was able to do this. I’m training real estate investors on how to talk to sellers because it’s the same thing. It’s about a story and where the pain point is. We’re the guide and they’re the hero. We’re trying to get them to sell their house the way we think they should sell it so they don’t get in trouble.
Believe me, it’s the same thing and I just had that epiphany now. At the end of it all, I’m not just here to talk about communication with owners. It’s a new form of communication. We always do this, “Let me tell you a story. Nathan, I got something I want to tell you. Are you ready?” I tell you the story and you’re like, “That’s cool.” We’re now suddenly communicating. I didn’t have to work on that. I just told you a story. If we can develop this communication into a bit of a storytelling type of thing, it doesn’t have to be like, “Once upon a time.”
It has to be where the patient is the hero of the story.
They’re the hero and where you’re at. Talk to the patient. I’m going to have ways of them asking specific questions that will get the patient more involved in understanding what they have. Where is the emotional difficulty here? Where is the barrier? We then guide them. Too many therapists nowadays are coming out as the hero. They are the hero.
That’s why they get all the credentials. “This is what we do. This is what we can do for you. I’m the master of blank.”
“Come on, Ms. Smith. I’m the one who helped you. You did well too, but if it wasn’t for the manual therapy I did, you wouldn’t be better.” When I hear stuff like that, it makes me sick inside because it’s the patient that needs to be put up on that pedestal. They’re the ones that will get themselves better. That’s a big part of where I’m going to head with all this stuff.
That’s what I see in some of the successful clinics that I’ve talked to. Friends of mine have that percentage of completed plan of care as a KPI that they want to significantly improve in early 2023. What they’ve done in the past is exactly what you’re talking about. They weren’t using the hero guide concept that you’re talking about, but they train their therapist to be more of the guide.
At the initial evaluation, they were clear, “Where do you want to go with this? Here’s your vision. This is the end of your story.” Along the way, they would say, “We’re 25% of the way there. You wanted to be able to walk 300 feet. You walked 50 feet. We’re getting somewhere. We need to keep doing these things. You had a little setback? This is how we’re going to handle it.”
Where a lot of providers fall short is they don’t set the vision at the initial evaluation. They don’t tell the patients where they are along the course of care. Patients are wandering aimlessly essentially going to therapy because their therapist told them, not exactly knowing, “When am I done? Am I 50% of the way?”
Then those patients dropped.
They’re like, “I think I’m better.” The therapist is like, “You’re not even close.” You never set those metrics up, to begin with, and shared the vision.
The metrics need to be set up by the patient. It’s not the therapist. I’m not here to tell you where you need to be. You need to tell me where you want to be. It’s like anything else in any relationship. My wife and I have an understanding of what’s expected of each of us. That’s why we do so well. Relationships that don’t do well are when those expectations weren’t brought out, weren’t communicated on, or weren’t agreed upon.A therapist is not here to tell you where you need to be. You need to tell them where you want to be. Click To Tweet
This is why those stats or percent of successfully completed plans of care or however we say it are not great. It’s because we don’t even know when that is. We had that stat too. We dropped it. It was too hard to track. Our therapists were not able to let us know. I would go to a therapist and say, “They discharged. Was that a complete plan of care?” “They were better but she wanted to go.” I’m like, “What is that?”
To me, it’s a discharge. We discharged the patient, but was it successful? I don’t know. Why? It’s because they didn’t even get a success story in. We ended up trying to set up like, “This is what a successful plan looks like. Somebody who’s been discharged successfully, who has a follow-up appointment, and who has a success story.” We took a picture with them and we started putting that out there.
It still doesn’t mean the patient came out feeling exactly the way they wanted to feel at the end of all this, which is a very hard thing for us to track. With more communication skill building, that would be a lot easier to track. This whole idea of the storytelling, where they are now, and where they want to be at the end. You’re the hero. I’m just guiding you. You’re the one making this happen. I just need to know that you’re all in because I can help you. I’ve helped tons of people.
I listened to this and it’s like you need to have some continuing education course. I’m glad to hear that you’re doing some webinars. If you got some continuing education credits, then that’s great. Also, I need to hear you talking at some conferences, whether that’s CSM or PPS.
It’s hard to do those because there’s no, “Show us proof.” There isn’t like, “Have you written an article on this?” No. This is communication. I try to get into a couple of them but they’re like, “We need to see some materials or written articles.” It’s a boring article to write. This is not something I want to write. I want to show you. When my workshop is done, I think I’ll have a little bit more of something that I can do that with. I would definitely love to get in front of anybody I can to discuss the importance of this.
When I was training to get involved with this like branding myself and all that, one of the big things was making sure this is a need. It’s a hard thing to make sure it’s a need. I know it is because I’ve seen it firsthand. I don’t have therapists coming up to me saying, “I couldn’t talk to that patient. I didn’t know what to say.” It’s typically, “They had a bad back. They bent over. I didn’t know which treatment to do.” That’s what they’re focusing on the most. I get that because that’s the way school has pushed us to focus.
The owners aren’t thinking that either. They’re not thinking, “You know what we need here? We need better communication.”
Every time we needed to up our KPIs in the clinic I was in as a VP of Operations, my number one thing in the battle plan was to increase communication. What that meant is more one-on-one meetings and more training. It wasn’t even just clinicians. I trained the admin who is taking the phones. They’re the first line of defense. Most people don’t even train them. They’re like, “You can’t make it? Okay, thanks a lot. Have a good day.” What about rescheduling them or getting the therapist on the phone? Why are they not on the schedule later today? These are all things that I did as well. It’s going to be a big part of what I’m going to keep pushing.
The last thing I’m wondering is how you get something like this into the PT school curriculum. I know you’ve thought about it.
Being the VP of Operations, I worked with all my clinical directors. All the clinical directors I had came from amazing schools like NOVA and all that. I came from McGill, so I have no connections here to any schools. There are a lot of different clinical directors I worked with that have connections with the department, the PT program developers, and things like that. I have a few people on LinkedIn I became friends with and sent them some information. I’m going to be making some cold calls and seeing what’s needed. I’m in real estate now, so I’m doing cold calls all day. I’m used to it.
I know you’re willing to work with owners and the clinicians on their teams. Are you willing to also go on-site and help owners?
A hundred percent. If it’s far away, as long as they pay for my flight, I’ll get there. No problem. Lately, I’ve been doing everything through Zoom and through creating shared documents that they can look at and edit. I don’t know all their policies, so I create policies that they want me to create.
How do people get in touch with you, Ronny?
I’ll give my cell phone number. I like talking to people on the phone. It’s (561) 665-1311. My website is RonnyVarga.com. There is a little part right at the beginning that I have a free 14-Day Patient Communication Challenge that they can sign up for. If you stay long enough or try to veer away from my site, a screen will pop up saying, “Please sign up again,” just to make sure you sign up. You can sign up like that. What it is is a daily email that they get with actionable tips for fourteen days on different communication skills that they can use that day with their patients.
It’s videos. It’s not like, “Do this step one.” It’s actual videos. You see my pretty face on there.
There’s something to be said for owners who bring in an “expert” to do the training versus the owners who are trying to do it themselves. There’s something about having a third party that is somewhat more peer-to-peer doing the training than the owners themselves. There’s a lot of value to that.
The truth is CEOs should not be doing a lot of the training except on their VPs. It’s the VPs who should be doing the training on their clinical directors. We got to start empowering the clinical directors to do more of the training with their staff. That’s not what’s happening a lot out there. Most clinical directors are just there to make sure things are running fine. If there’s an issue, go see the clinical director. They’re not giving the clinical director enough time to go one-on-one with their own staff and make them successful. That’s one of the things I also recommend typically.
Thanks for taking the time. I appreciate it, Ronny.
This was awesome. I love it.
We’ll stay in touch. Thank you.
About Ronny Varga
Ronny Varga is has been a Physical therapist for over 20 years with senior-level executive experience in managing high-level operations in clinical centers and leading and training staff to ensure the correct implementation of policies and procedures.
He has a proven record of effectively leading and growing PT companies and effectively leading teams to produce to their potential.
He is passionate about coaching and leading people to achieve sustained growth in organizations. He’s had the chance to lead a team of 30+ clinicians and admin staff as the owner of his own PT clinic back in Canada. He also worked for 7+ years as the VP of Operations in South Florida and led up to 5 clinical directors and their employees and collaborated on the creation and implementation of KPI-based policies and systems. In addition, he collaborated with the HR department and helped take newly hired clinicians and admin through their hiring cycle.
Most recently, he founded a consultancy focused on providing specialized recruitment services for clinicians and coaching services to improve communication between clinicians and patients.
He is also a full-time Real Estate Investor, super duper dad, a very trained husband, dog lover, and educator.
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