Despite the impressive results physical therapists deliver in their procedures, the realm of social media marketing is still foreign to them. Most of them commit so many mistakes when connecting with patients, leading to poor retention, higher self-discharge rates, and overall decreased clinic productivity. Nathan Shields aims to help his colleagues level up their online marketing game by sitting down with the Founder of GoGoDone, Heather Chavin. Heather shares her experiences in helping physical therapists improve their marketing tactics by using email marketing to better connect with patients even through home exercise programs, creating and leveraging landing pages, and taking advantage of the huge influence of customer testimonials.

---

Listen to the podcast here:

Common Mistakes PT's Make In Social Media And Email - And How To Fix Them With Heather Chavin, MA

Using Email And Social Media More Effectively

My guest is Heather Chavin. Heather, thanks for joining us. I appreciate it.

I’m thrilled to be here. Thank you, Nathan.

Heather did an article in Impact Magazine and I thought it was valuable information for us in terms of marketing and maybe thinking about how to use different aspects of marketing differently if you will. I wanted to bring Heather on and explain some of that to us because she's worked with a number of physical therapists in the past. Although she's not a physical therapist herself but has a ton of experience as the Founder and CEO of GoGoDone. She is a productivity coach and does contract social media marketing. We could use a lot of insight from someone outside of our profession. I don't know about you, Heather, but we're not notoriously known for our marketing skills in the physical therapy business. We could do a lot better.

I’m well aware of that.

I'm excited to have you on. I should note that you're also a member of the PPS Administrators Network. It’s cool that you've worked with physical therapists in the past. You know a little bit about us and where we're coming from, our faults are and what you would recommend we do instead. Thank you for coming on. I appreciate it. Tell us a little bit about your experience in the PT world and how it worked with marketing and your experience with physical therapy in the past.

I started with a continuing education organization, specifically for physical therapists in manual therapy. I ran the gamut and that's where I started to meet my first actual PTs and drew a lot of PT owned practices, small independent clinics, and clinic chains. I worked there and it was my first foray into the PT industry. From there, I worked for a clinic chain and I worked with Outcomes with an Outcomes product. If you get somebody who's not a PT, you're thinking, “How do you feel about technology?” They put me in those roles, which were good for me. I worked both with outcomes with sales and marketing around those in both organizations. I'm doing some contract work and getting that social media machine up and running and humming all for PTs or continuing education organizations geared towards therapists.

The article specifically called A New, Better Way to Use Your Patient Emails talks about how we can leverage the email addresses that we have on file to improve our engagement, especially patient retention. Talk to us a little bit about that. Start from a beginner's perspective for some of those who aren't using those emails at all to do these things. What would you recommend? How would we best utilize those email addresses for those purposes?

Starting from the human perspective, which is an area that PTs need to revisit when they think about the home exercise program. This article was specifically about patient retention, and in a previous life as a mental health therapist, having worked with behavior change, having worked with marketing, having worked with PTs, and having worked with technology. You take one look at this, a PT with a home exercise program would come from this medical model and you think you're giving them a prescription and that is not the case. How many times have we been told to exercise more? How many of us succeed with that. That's always a terrible example for PTs who tend to exercise more than anybody else on the planet. If it was easy, we wouldn't have an obesity problem.

We're looking at behavior change, which is challenging. Even the field of mental health is good at getting you to want to be different but, what are the steps to take to be different? There's great research out there if you want to look, especially around environmental design and willpower. Willpower will always run out. One of my favorite books is called Willpower Doesn't Work by Benjamin Hardy. It’s focused on environmental design. A PT could read that book, get the gist of it and create an email sequence depending on their writing skills but they could work with another staff person in their office to create an email sequence that helps communicate some of these principles.

PTO 127 | Social Media
Willpower Doesn't Work: Discover the Hidden Keys to Success

There are a couple of principles that are the most important. I love the paradigm of shifting from a prescription to an experiment when it comes to a home exercise program. Number one, a prescription is I'm in charge, I'm the expert, you are the receiver and you’re unengaged. This is not shared decision making. This is not the patient involved at all. This is me on high telling you what to do. Maybe we do it or maybe we don't. We probably don't. We're hurting, “Why don't I take a Percocet instead?” They don't come back. When you move to an experimental model, the patient must be involved. They're the one doing the experiment. You're advising them on the experiment.

The most important thing that is involved in this experimental model is that failure is part of an experiment. When the patient goes home, they don't do their exercises every day. It's super easy. It's an easy request. They don’t feel like a total jerk and they're not afraid to come in full of shame and admit it or they come in and lie. Every PT has this story where it's like, “I did a strength test.” They say stuff and then they do a strength test and I'm like, “They didn't do anything.” Why aren’t we talking to each other? You're not making it safe for them to tell you.

We have this out-of-date model because we think they're non-compliant. Why don't they care? You've asked them to do something astronomical. They're already stressed out. I don't know anybody who isn't. If they're seeing you, they're in pain. Maybe they've had their body cut open and that could be a knee replacement or whatever it is. There's so much going on and you're asking them for this astronomical thing. You shift it into a shared decision making friendly model, which is this experimental model. You're going to try something. Some of it's going to work. Some of it's not going to work. Maybe all of it doesn't work. I need you to tell me. You're putting them in charge of their own health, which we know for the long-term is more important. All those good things naturally come. Run it as an experiment. Let them know they're trying things. Let them know failure is expected. This is a lot to say. This is where the emails come in.

You say, “We're going to try something. These are some exercises that worked for others in the past. They may or may not work for you.” Is that what you're talking about, that conversation? Instead of saying, “Here are your exercises.”

It’s like, “It’s important that you strengthen your glutes. Here are some ways we can do that.” Let's start with shared decision making, “Here are some ways we can do that. Do any of these sounds like something you could do regularly at home, three times a week, seven times a week, two times a day?” You're the practitioner. You know where you want them to get. Which one of these sounds like the best one to try first? We're going to put this on your sheet. We're going to put it on your printout, however, you send them their information for their home exercise program. You put it out there and say, “It's hard to change a habit. We're going to put you in our email system. You're going to get some information on this. We're going to do these email follow-ups,” which is what that whole article was about. It’s giving them a little email coach that goes with them and saying, “Try this. We're not going to hit the nail on the head on the first go. We're going to need to experiment with what's going to work and what's not going to work.”

You could go into all the behavioral change stuff. Pre-decide anything you can so they don't have to make a decision at the moment. You could do implementation intentions for where they think they're going to fall. What's the most likely thing to get in the way? “My two-year-old has a tantrum every morning?” When your two-year-old has a tantrum every morning, what are you going to do? I'm going to ask my partner to take point on the days that I'm supposed to do my exercises and then I'll take the off days. What's going to happen when the two-year-old has a tantrum? They’re going to do that. All these little strategies, tactics and all of those things, you can get it from the books and you can get it from reflecting on it as an experiment to what you might do. Put those in an email campaign as reinforcement.

Anything you say to somebody in the clinic, on their first visit or their second visit, you're the power person. You're in your place of power, your clinic. I'm here, I'm the expert and I have all the power. The other person is scared and uncomfortable and is looking at social cues for how to not look like a jerk. They're trying to be cool. It's like a cocktail party. It’s like, “How do I behave here? This is a new environment for me.” There’s no retention. It’s the reason why we give it to them on paper or email them their home exercise.

Make sure that you tell them once, in person, with love and that connection. We're building trust and follow it up with those emails that say, “It's okay to fail. We expect it. You're supposed to. We need this information. Please tell me when you come back in. Here are some strategies, the pre-planning on how you're going to respond to the difficult things.” All these little pieces that they can get. Email is the most accessible but if you're good with your iPhone or your Android and you want to put a little video together, I would recommend that modalities. Some people will prefer one over the other. They can click on a two-minute video that says, “This is what an implementation intention is.” Repetition is okay throughout the sequence. The most important paradigm shift is not a prescription, an experiment. We collaborate together on an experiment that must work for you and it's okay to fail. We're supposed to. That's what experiments are.

I love that conversation that you have right off the bat. If physical therapists are going to implement this in their practice, they need to probably start role-playing it with the other providers or the technicians or the front desk. They get comfortable with what you're talking about and recognizing that the people aren't coming from a place of certainty but they're trying to figure out their place in your clinic as you're having that conversation. You want to make them feel as comfortable as possible.

Failure is such a loaded word, even though it's the best way to learn and move forward. Click To Tweet

That's why that repetition is important because half of their brain is like, “Am I doing the right thing? Am I safe?” It's a new circumstance. The cognitive load is like, “How am I doing in this new environment? Am I doing the right thing?”

What I also like about having that conversation is projecting forward. What could be the hurdles to being successful with this home exercise program? At the moment, they're going to sit there and say, “I can do these three times a day. That's no problem. They only take two minutes. It’s no big deal.” Inevitably, three days later, they're like, “I forgot to do any of those.” Projecting forward and saying, “What is it going to take for you to remember to do these every day? Do you have reminders on your phone?” This is where you get in the article specifically, it was like, “Expect some emails from us that are going to help you.”

You can imagine that simply telling them about this email drip campaign is going to increase the likelihood of them opening it up, to begin with. Also, be a supportive coach when you're not there to guide them through their home exercise programs and what to expect, the possibility that they might fail, and what to do when they do. If you're having concerns, note them down. Let them know that this is what's happening and this is what could happen. we're going to support you along the way in the form of this email drip campaign that you laid out.

Teach them and coach them along.

You laid out seven days' worth of template campaign. Tell us a little bit about that.

It is step-by-step starting with making sure that they understand. It’s like, “It's okay to fail.” Communicate what's working and what's not. I don't use the word fail. What works and what doesn't work? Failure is such a loaded word even though it's the best way to learn and move forward. To do that, give them a little bit of information and encourage them to open up and have that open conversation with their physical therapist. A lot of times, that's the sticky point. Nobody wants to come in and say, “I didn't do it.”

When I worked for the Outcomes company, there's this phenomenon I found in the data everywhere. There were maybe 1 or 2 clinics that were an exception and it's in the patient satisfaction. They had multiple questions but two questions in particular. One was your NPS, your Net Promoter Score, which I'm sure your readers know. How likely are you to recommend this clinic to friends, family, colleagues? Off the charts, PTs are the best in the world at NPS. The next question is, how satisfied are you with your progress during treatment? Fifteen to twenty points lower across the board, across clinics, across the country, across size, across hospital outpatient, everywhere. I don't know this for sure because we don't have the data around it. This company didn’t have the data. We didn't get to dig into that.

From my experience in mental health and behavioral health, it's because they're not doing their home program which they see is their fault and not your fault, “My PT is great. They have all the answers and they love me. I'm the jerk who can't do two exercises six times a week. What's wrong with me?” They put the blame on themselves. They can share the blame but if your job is wellness, which the PT industry is moving towards, behavioral health is a huge part of that. If you find somebody who has a disorder, that's for mental health. If you find a human being trying to make a wellness change, if you want to be in wellness, that's now under your belt. I challenge PTs everywhere in any rehab, it can be PTAs, it could be your aides, and somebody in there needs to be getting on this information because the patients aren't happy. PT, as an industry, freaked out about how many people we could be helping who could use PT but we cannot retain the people we have.

The other statistic that floored me was the self-discharge rate. It’s 60% of people self-discharge, half of them early on and the other half towards the end. We're not keeping the patients that come in. Don't tell me about the 95%. Why don't we work on that 5% that are in our door and not satisfied and not getting better or not as much as they could? There's this huge gap. You don’t have to learn a ton. Learn some of those basics about behavioral health. You guys are doing it. You do it every day. Learn a little bit and implement it. Your patients will teach you far more than any book can. Read Benjamin Hardy to get you launched and then start doing it. You guys are doers. Go out there and do it. You're brilliant. You'll find the patterns. You'll analyze it all. You'll figure out what works and move forward with it. You have to start thinking that basic behavioral health is part of wellness and I need to learn it.

PTO 127 | Social Media
Social Media: Basic behavioral health is part of wellness.

 

That's great information. I'm with you. It’s because those patients fall off quickly, they're not getting the results that we expect and the results they could get. It turns into, “Physical therapy didn't work for me.” That gets pushed out into the environment and everyone around them. We don't get the patients and the referrals that we should be getting and the message doesn't come across that physical therapy works in general. It’s important.

This fits in marketing. Those patients you stay with for 10 or 11 visits and drift off because you don't do an official discharge. There's so much that people have at their fingertips and don't use and the official discharge is one of the big ones. Speaking of environmental design, if I know this is the last time I'm going to see a patient, it's going to cue a series of behaviors. If I think I may or may not see the patient, it's not going to cue those behaviors. What behaviors are cue? Telling them they did a good job, telling them they're successful, celebrating like crazy, taking their picture and putting it on your wall of success, asking for a testimonial. All these marketing, word of mouth activities get cued at an official discharge and not to mention the message, “You got better.” We have this, like, “Am I better? We're not ending but maybe I make another appointment or maybe I don't.”

The message is, “You are 100% better. If you have a flare-up, you come talk to me. If you decide you're not better, and then come talk to me.” They’re oftentimes discharging patients before they get their full gain because they're already on the path. You're like, “You got this. You don't need me anymore. I'm going to discharge you. You're going to keep getting better over the next couple of months. If you have a flare-up, call me.” Get to that endpoint. Do your marketing asks and you send a message, “PT works. You got better.” They're not even getting that message. They're ending with like, “I'm better. I'm going to maybe make another appointment if I'm not better, which I'm not sure.” It’s like, “How is the patient?”

I had someone on and he talked about how they implemented in their clinics a policy that was part of the new patient intake paperwork that said, “In order for you to discharge, you have to show up in person.” You can't call and say, “I'm done with physical therapy.” They have the choice not to come in. Our form of policy and what the front office and what the provider would say is if they call in and say, “I'm good with physical therapy.” Remind them, “Our policy is that if you're going to self-discharge, we have to see you in person so that we can get that final report and all the measurements to the doctor and finalize your case and see exactly where we finished up.”

That goes back to whatever we can do to formalize that process and not miss out on the things that you're talking about. Don't let them self-discharge because that cues many things to wrap that up and say, “It works. We made this progress. Here is the objective measurement to show you as much and you're subjectively better. Here's your gift. Here's your mug, your t-shirt.” All that stuff. It's important to have that discharge. What's the rate that you came across? I hear it's about 15% of our profession that complete their full plan of care.

Somewhere between 15% and 20%.

That's hundreds of thousands of dollars that are lost right there.

Think about the missed appointment. Think about your poor administrative staff, “I'm keeping these fifteen files open because they might come back.”

There’s so much lost productivity. The cool thing you talked about in your article is, “Day one is to positively reinforce their decision to engage in therapy. Day two, list common barriers and possible solutions to those barriers. This could be a single paragraph. Day three, positively reinforce their continued engagement even if it's reading their emails and giving them suggestions of what to do if they're struggling. Day four, provide another set of suggestions and short success stories for more social proof. Five, acknowledge the drip. That newness is wearing off and life is getting in the way. Give them tips for staying consistent. Day six, encourage reflection on what's worked and what has been challenging. Day seven, congratulate them on making it for a whole week and remind them that even if they haven't completed all the exercises, they've learned something about themselves.” These can be pre-written into an automatic drip campaign.

Post something on your page and nobody would ever see it. Tag someone and then people would care. Click To Tweet

You're not typing these one at a time.

They simply go and do a drip campaign and there's plenty of software programs that can do this automatically for you.

A tip on that if you can, use personalization. Use their first name or maybe Mr. or Ms. or if they have a preference on that route. Depending on how it's set up, sometimes you can do condition-specific or body parts specific or pain. You might have some campaigns that are specific if you're specializing. If you're specializing in pelvic health, make a special one for your pelvic health patients and funnel them through that because they'll have some different considerations. Anytime you're specializing in an area I would make a special campaign for those and make that personalization a little bit different.

You recommend that this not be the only drip campaign. As soon as discharge hits, there's another drip campaign that's going to go out maybe a month or two afterward. Tell us about that.

I would make sure that because you're collecting emails, you need to stay in conversation with your patients. After they've left, I would do maybe a couple of emails to help facilitate word of mouth. People get obsessed with the knee and they're like, “You do shoulders too.” That message needs to come out there as well. You can give them another thing and you give them a reminder that you guys are there when they have questions. They don't even have to make an appointment. Maybe they can make a phone call. Make yourself accessible. You can also ask for a testimonial if they haven't done a testimonial.

Google reviews at about this time as well.

Email because you got links and they can go straight there. Keep that in mind. It’s not extensive after they're discharged but a couple of touches. I would say most generic rehab clinics who are in ortho patients would be emailing my entire list, potentially segmented into this type and that type depending on what's going on or what kinds of patients you want to have in. Maybe quarterly putting something out there. It can be small and simple. PPS, Private Practice Section, has some great freebie stuff that you can use. They let you use it if you're a member. They’ll give you an article. PT First has a lot of stuff. You want to make sure it's of high value to the patients. They're doing great stuff there. You put it in a newsletter. It's a no brainer. You put a tickler on your calendar or assign it to somebody like, “Check this every two months. Get it ready for the third month and go.” You want a little bit.

If you're branching into wellness, you need to look at more frequency because they could come in for a massage anytime. They should be coming to your Pilates classes on a weekly basis. You're looking at a different cadence. The bulk of the clinics that I worked with were ortho patients. They weren't following up. They weren't saying, “Six months later.” You can if you have that level of sophistication. You could take all your lower back pain patients and put them in one bucket and make sure there's a more focused campaign. It can get complicated. Even with a simple email system, a simple newsletter, one to everyone, make sure it's short and sweet and has something of value, which PPS can provide, something personal. If somebody is pregnant and had their baby or what you dressed up like for Halloween is a popular one and stuff like that. It says, “We’re normal, safe, friendly human beings. We love you.”

A patient success story would be a great thing to put in there, especially on the target market. If you're going after acute lower back pain, put in an acute lower back pain patient success story there. Anybody who has been near anybody or is somebody who has experienced lower back pain says, “Yeah.” They forward the email, they can give you a call or what have you. Knowing what your target market or markets are and making sure there’s a success story there. It’s three little bits. They don't take a lot to do. It's a cool picture from your clinic. It's a thing you took from PPS and put a nice picture on and a success story from a patient, which hopefully you're collecting on a regular basis or quarterly. It’s not rocket science.

PTO 127 | Social Media
Social Media: Only 15% of physical therapy patients actually complete their full plan of care.

 

If you take a day, you could set those up for the entire year. It doesn't have to take a lot of time.

I don't know if you want to make everybody dress up for Halloween and not on Halloween.

You could have the template in place. You could have the content all ready to go. All it is a matter of, “When that time comes that is supposed to go out, I need to insert this picture there and that picture there and a testimonial here.” I like the recommendation that you're sending testimonials to past patients. I hadn't considered that before.

They need to come back at some point. We have long lives. If you're going to have your clinic open for a long time, they'll need to come back for something. You saw them for the knee and they forget you did shoulders and their mom has a problem with their shoulder. In psych terms, it’s called priming. You prime them with this information so that when it happens and they cross that information in real life, they come back to you. Once I've sent you an article about acute lower back pain, you might not see anything for two weeks.

If I've sent that email to you and two weeks later it occurs to you, it'll be a little tickle in the brain because I have primed you with that lower back pain success story. I put it in a story format with somebody's face in there and you got emotionally connected to it and you felt good for them and you're like, “I rocked it at PT too. I should be a success story,” which hopefully they are. They're more likely to bring that up. That's why you want to make sure you feature your target market. If your payor mix is too heavy on Medicare, don't be putting the Medicare success story in there. You want to put the person with Blue Cross, Blue Shield, or whatever it is you want. Feature those so that's on everybody's mind as they're moving through life.

You've worked with many physical therapists in the past, in different capacities. What are some of the issues that routinely pop up that bug you about a physical therapist and their marketing efforts?

There are two things, in particular, that are huge missed opportunities that I see everywhere. Number one, not knowing what to post on social media or posting random stuff on social media and not having a focused campaign or an idea of what your social media is. People are good at posting on their own Facebooks and their own Instagrams and all of that. It's different when it's business. You need to be thinking with your business mind. What's this channel for? What do I want to say and who do I want to say it to?

You don't probably want to cater to your Medicare patients or Medicaid or whatever is. You look at your payor mix. You look at your target market. You look and see who you want the most of. If you're going after workers comp, what do you post on your Facebook? Does it have anything to do with workers comp? It's like, “I post whatever is easy and convenient so I can check this thing off my overloaded to-do list.” The number one thing that any clinic can do is figure out who your target market or markets are and get testimonials. A lot of people do testimonials but your testimonial must be a picture or video. I highly recommend one of the care providers is in the picture, even if it's an aide but especially if it's the PT.

You must tag the patient. Make sure you get your legal in order. You have to have a process. Partner with your administrative staff and with all of your staff. This is a staff anything. What is our process for collecting a testimonial? Who asks when, where, and what? The PTs will have to get to official discharge, which will be an important part of this. Probably, the aide is going to do some, which care team looks like. Who's going to talk to who? The front office staff is going to have the release and they're going to make sure that the release is signed properly. Not only for pictures or videos if that's the case. They're going to gather the written testimony if there's a written testimony. They're going to help them write that written testimonial because the patient is like, “I don’t know what to say. It was great. Thanks, Bob.” It will prompt them. Make sure that they get permission to tag them on the social media outlet that you're posting to.

To build great content, always know who you are writing for. Click To Tweet

Everybody should have Facebook, it's the biggest number still. Instagram is growing, it's growing in younger markets. Who's your target market? Where are they at? Everybody should be on Facebook based on the numbers and based on the PTs that I've seen. They know how to post there. You could post there and tag the patient and then it shows up in the patient's feed. Guess what? All their friends see it and their mom, aunt, niece sees it, and whoever else sees it. Instead of a post on your page, which nobody ever sees because the algorithm is mean and it won't show your stuff to anyone unless you pay it. You tag somebody and then people care. You have to get that. It has to be a picture. Otherwise, it's a tiny text and nobody is insignificant on social media. Get your picture or video and you tag that person. You should tag the therapist and the aide and whoever else.

As many people as possible.

All the relevant people. If that's all you use your Facebook for, it's a radical improvement from what I've seen across the board. Also, put the Halloween pictures up, Susie's new baby, Bob shaved his beard. Give it a personality. Those testimonials with tagged patients to the core on which you build your social media.

I love that you shared that. One simple thing is to tag the patients and your staff. How else are you going to promote these? No one's going to your group page. You tag the people and that promotes it to all their friends and then all their friends. Adding a picture or a video gets higher open rates.

If you can have the PT comment on it and say, “Jane was the best patient ever. I'm excited for her to run her first 5K next month.” Make her a hero. Make the patient the hero and make the PT care enough. It’s like, “How nice is that? There's somebody in her court pushing her.” It’s like, “I want to go to that PT.”

For people to get a release if they don't have that social media release form, can you get one pulled off of Google?

I'm not a lawyer. I'm probably going to defer that question. That would be my first move, Google it and be like, “What's on there?”

You didn't say that.

That's what I would do for myself. It’s not because I know what’s the right thing to do.

PTO 127 | Social Media
Social Media: Any clinic must figure out who their target market is and then gather success stories in the form of testimonials.

 

That's one of your pet peeves. It’s like, “People aren't posting relevant stuff on social media and tagging with pictures and video testimonials.” Number one, if you're not doing any social media, at least do that. What’s number two?

I don't know why somebody would go to PT school because they like people and bodies and face-to-face interaction and then think they can be a writer. You guys are not writers. A small subsection, if they would like to be writers, are probably writers or could be writers. If I say to you, after a long day, all your patients, you're not even done with your case notes and I'm like, “Write me a blog article.” You're like, “Are you kidding? Do I have to be on the computer?” No. I'm going to go home to my kid. I'm going to go train for my marathon. I'm going to do whatever. PTs do not want to be writers. It's a nice fantasy that if you could wave a wand and be a great writer, you might do. It is a tough skill. There are billions of people out there already doing it well.

Here's what you do instead. If you're in the wellness industry, you probably need a blog. If you're PTs doing generic ortho patients, instead of a blog, you have a couple of landing pages. A landing page is a static page on your website, although make it a little less static. It's not like I have to do something every week or every month. It's one beautiful page that you put extra time and energy into because you're doing the one.

Let's go back to that target market acute lower back pain. I have one page on my site that specializes in getting great knowledge that I want in the patient's brain on acute lower back pain. You'll have a little bit of the stuff in there. Within two weeks, you want to be talking to us, “Here's what happens here.” All your genius. You don’t even have to write it. Somebody in your office is probably a better writer than you. Write it collaboratively or go to Upwork or Fiverr and they can have your crappy writing. That's okay. Crappy writing is great. Crappy first draft and send that to them and they'll do all the nerdy grammar stuff and the headings and subheadings and the search engine optimization stuff. They know how to structure it.

If somebody knows something about headings, subheadings, search engine optimization and grammar, they'll do it all pretty and they'll throw some pictures on there. Getting your own pictures of your own people in your own office would be best. Put that together and have a great acute lower back pain-landing page. Every so often, you’ve got to go back and refresh it. You're probably reading the research or something's come out and you go out and you put a tweak in there and not a rewrite. Whoever is managing your social media site can link to that page and they can link to that page all the time. You don't want to do it five times a day, every day. You could do it once a week or you could do it every third week or something like that. They could take a piece of wisdom from that article and put it out there. You can have it on your page instead of blogging. If you're going to put all the time and energy into making an issue about it, social media is a great way to do that.

After you have your testimonial situation in order and you've got that system set up, the next thing you want to do is a great landing page for one of your target markets and then have whoever's doing social media on whatever cadence you feel is appropriate for you. I wouldn't go more frequently than once a week. Once a month might be pretty good if you're having multiple target markets. You could maybe do two. On Twitter, you can do as many as you want. Twitter is all about frequency and recency. For your Facebook, put a piece of that out there.

If it's a short landing page, you don't want to put a duplicate copy out there. With a longer landing page with different sections, you could do something and then you can cycle back through. There's an 80/20 principle that applies to content. You should spend 20% of your time making the content and 80% of the time promoting it. The PT doesn't have to do the promoting. When you think of a piece of content, how much time has been spent promoting it, and how much time has been spent creating it? Bait that great landing page and promote. You can promote it on social media. Maybe you put an excerpt from it in a newsletter.

Look at who you're talking to and what you want to say to them and how you're reaching them. Once you have that, then you do your second landing page. Have a collection of landing pages. Once you have enough, you put them in a little pull-down menu in your bar so that you're not cluttering your navbar in your website. You have a little pull-down and specialties or something like that. You can have these more detailed pages. Once you have half a dozen landing pages, then you could do 2 or 3 times a week. You're cycling through and taking different sections. You can do somewhat duplicate content if it's six months to a year later. You could put the same part of that article six months from now. Refresh the pictures occasionally, whatever. Look at it as a nice piece of patient education that needs refreshing maybe every six months or a year. If you get a student come in, send them that page. Tell them, “What research have you been reading? What am I missing?”

“How do we need to update this? What would you change about it?” When I learned about landing pages in the past, it's usually related to a Facebook Ad or a Google Ad or something like that. People come in and go to the landing page and you capture their information. Are you talking about the same thing here, you could have that capturing information at the bottom?

Let go of the things that are not working well and learn from them. Click To Tweet

Yeah. I should get a little more specific about that. First of all, every page on your website should have a call to action that should bring people further into your sphere, whatever that looks like. You might want to capture an email if you're doing regular update emails. You might want them to make a phone call, “Call us if you have lower back pain questions.” Free consultation if you do a free consultation on the phone, whatever it is. Those are a call to action. The reason I say landing page, even if it's mostly geared towards patient information with that call to action at the bottom, is when you're doing your website and putting it together. It's a static page. I want people to think of it not as, “I'm going to do the blog and the blog is going to have six posts on it.” It's not a blog. You could make it a generic static page on your website. Landing pages take away the top nav and all of that. Make it a static page, it doesn't have to be an official landing page to try to get you to download.

eBook or something like that.

It doesn't have to be that. It's a static page, which you'll update, but it's not the sequential blog. Don't turn on your blog. Do these pages that are patient information. If you want to make it a lead magnet to be able to get somebody's email, you’ve got to have a lead for that. If I'm bringing somebody to my site for acute lower back pain and my call to action is to make a phone call, if you don't put the call to action to be the email, that's not going to solve their problem. It needs to be the phone call to help me with my lower back pain. If you have a regular series going out about lower back pain, then you can collect the email and then put that drip campaign that I talked about for the patients. You could do a series there.

If somebody is signing up for an email for that acute lower back pain, the clock's ticking. You want to be talking to them right away, “If you have acute lower back pain, please call me right now. Here are some things to know about getting an intervention right now.” Maybe it's chronic. Maybe you have a great resource. If you don't have an email set up, don't capture their email because they came to you for lower back pain. You wanted them to call you and to connect. You don’t have to be an official landing page as long as you know it's not turning on your blog. It's a nice page that stays there.

We got to do better on our social media posts, tagging patients, putting it out there frequently with pictures and testimonials. We got to set up some landing pages for our websites and refer people. You don't have a landing page just to have a landing page. You start using that as a vehicle to get people to go to the landing page again. We got to the two issues that you have with physical therapists and their marketing. Is there anything else that you got to cover, that you got to get off your chest to a PT owner audience?

Those are my biggest soapboxes are behavior change and that experimental model and that patient retention. We think of marketing as a new patient. Retain your patient. Provide what you're supposed to provide. You know how smart you are. You need them to benefit from all of that. They need to grow as well. You have that usage of social media and your newsletter and your landing pages and all of that. Remember the 80/20. Make a little bit of great content and don't stop talking about it.

I love that 80/20 principle thrown in there because I worry so much about the content and once I have the content, I promote it once or twice and then I'm done. Your focus is to make content. Take it down into bite-sized pieces, find ways to promote after that, spend more energy doing that, and then generating the content.

You want to track your analytics if you can. I don't want to bring up too many numbers or freak too many people out. There are some simple ways to track analytics. There's a company called Databox.com and they do these dashboards. You can hook them up to your social media and be like, “Which posts are the most popular?” You can look at the performance of your post over time. You might have some dads out there. Nobody cares. It's too nerdy. It’s like, “All the PTs are reading it and none of my patients are reading it. I went too nerdy on this.”

Some of them you let quietly sunset but you'll have some that are more popular than others. Those ones, you update them and put, “For 2021,” in the title or those different things. It’s called evergreen content. To your best stuff, you can let stuff that's not doing well go away and learn from it. The stuff that is doing well, that's your core evergreen content. You can promote that. Continually update it so it's nice and fresh and your call to action is appropriate. Promote the heck out of it for potentially years to come.

PTO 127 | Social Media
Social Media: Even though you can gather a lot of referrals through social media, physical referrals cannot be given up yet.

 

Seth Godin is one of my marketing gurus. He talks all the time about his blog and he says, “His most popular blog posts are never his most recent ones. They're the ones that are coming up in search engine searches and being read again and again.” Seven years old or something. You're an expert at the edge of your field. Many beginners are searching. They don't need to be at that top 10%. They're like, “Please get me from 20% to 30%. Please get me from 30% to 40%.” As physical therapists, you're dealing with patients who maybe aren't even living in their bodies, people that are disconnected. They don't know the first thing about it. You don't have to have the smartest thing out there.

When I talk about building great content, it's great content for who you're speaking to. You got to know who you're writing it for. You're writing it for your patients. You can reference the research at the bottom, in the footnote. If you're that one nerd out of the 1,000 people who read this, I got you covered. That doesn't go up top. It's the stories and the love and the human connection and what a PT relationship is like with a patient and all of those great things. They're starting probably from square one, maybe square two. You don't have to have the most up-to-date research and all that. As much as it's relevant, a fourteen-day piece would be an important up-to-date research piece to have. You got to think about who you're talking to and they don't need that top 10%. You're getting them. You're getting their training wheels off. That's the goal.

Do you recommend that maybe before you post on social media you run it by your grandma or something like that, somebody who needs the bare minimum information?

Consumers' feedback, absolutely. For the first couple on social media, if you're concerned about it, the nice thing about social media is you can do it again and again and it disappears. Don't put too many high stakes on that. Your landing page should go by grandma, mom, whoever the target market is. The more you can do that, the better. Doing social media posts is not a bad idea. Here's your ROI. Is this bringing money into the clinic? Should I spend an hour doing it? A landing page, absolutely. Social media posts, you'll learn from the interaction. Because they go out to the world, they should be able to give you feedback. If you're not good at reading your Google Analytics, then it's harder to get that information from your landing page.

It's imperative nowadays. The way we marketed at the end of 2019, now we're at the end of 2020, early 2021, even later, if people are reading this down the road, it's different. Much of the staple was to go to the doctor's office and generate that relationship so you can get referrals. We can't physically go into doctors' offices because of COVID concerns. There is a huge focus on generating new patient referrals through social media. It's forcing the physical therapists' hands, in most owners' cases. We're a couple of decades behind when it comes to this stuff. It makes us come up to speed and it's imperative to get information from experts like you on exactly how to do that.

Not to rain on my own parade, at least from what I've seen, the number of referrals that you can generate from word of mouth on social media, you can't give up physician referrals yet. It’s not there yet. PT as an industry needs to do better and be more visible to churn out. This is why I'm like, “Don't have a blog. Have a landing page.” What's your social media testimonial machine? Do the bare minimum and then build on what works. Unless you're a specialized industry, we need some time for it to be a real huge revenue generator.

If people want to reach out to you, are you available? Are you willing to share your contact information if they want some more info?

HeatherChavin@Gmail.com is a great way to get to me. If you're interested in productivity, GoGoDone.com would be all that information there. There's an admin email address there for that route.

Thank you for sharing your wisdom. I appreciate you being on. Especially considering the specific expertise, you have a physical therapist. What you shared with us was valuable beyond measure. I appreciate you helping us out.

You bet. My pleasure. You guys do such good work in the world. I want more.

We need to get the message out. We got to do it the right way, start tagging patients. Thanks, Heather. I appreciate it.

Important Links:

About Heather Chavin

Heather is the Founder and CEO of GoGoDone Virtual Coworking Community, helping remote workers stay connected and highly productive. Before this, she was the Business Partnerships Manager at CareConnections Outcomes System for two years and Director of Business Development at the North American Institute of Orthopaedic Manual Therapy for nine years. Before entering the rehabilitation field, she worked as a mental health counselor and educator. Her master’s degree is in Counseling Psychology from Lewis & Clark College in 2002.

Love the show? Subscribe, rate, review, and share!

Join the Physical Therapy Owners Club today:

PTO 126 | Certified Athletic Trainers

It’s not something you hear of every day, but many physical therapists collaborate with certified athletic trainers (ATCs) inside their clinics. Jim Stoker, PT is back on the show with Nathan Shields to share with us his secret for a more effective utilization of ATCs.  From his 25+ years of experience working with ATCs in the past, he has found a way to use them in a way that is collaborative and a shared benefit to the community, and allows PT owners to not bear the financial burden. Taking a big step further from traditional collaborative paradigms, Jim co-created Play Safe, a nonprofit that accepts charitable contributions, employs the athletic trainer and then contracts and provides that athletic trainer to the high school.

---

Listen to the podcast here:

Utilizing ATCs More Effectively, With Jim Stoker, PT

I've got a returning guest, Jim Stoker. He is an Advisor at 8150 Advisors, a physical therapist, and also a past partner of Clemson Sports Medicine and Rehabilitation. I'm excited to bring him on this episode because he's going to talk about a part of physical therapy that I've never talked about before in the years of doing the show with anybody. That is the utilization of athletic trainers in physical therapy clinics. I've got a little experience with it. We used one athletic trainer years ago, and it's a great experience. I know there are plenty of physical therapists out there that might have athletic trainers on staff or are interested in going that path. Jim comes with a lot of experience in that. He's developed a foundation to facilitate that. I'll let him get into that. Jim, thanks for coming on again.

Thank you, Nathan. I appreciate that very much. My experience in outpatient orthopedic physical therapy is rooted in sports medicine. I mentioned in our last conversation, one of my partners Skip Hunter, but my other former partner, Neil Richardson, they started our clinics many years ago with a foundation in sports medicine. Some physical therapy owners may recall that there was a day in time many years ago, where you had a relationship with an athletic trainer that dropped by some high schools. It was an outreach to the community. It connected you with some physicians' community. It was a nice thing to do. The whole reason those scenarios exist, if you drill down to why that started and why there remains a challenge now, in South Carolina and in our neighboring states, but typically taxpayer funds are not allocated from the state budgets to secondary schools, to high schools, and to employ certified athletic trainers.

There are some examples of school districts creating their own line item and allocating revenue to hire an athletic trainer for a school, but typically, taxpayer funds from the state level do not flow down to secondary schools to hire a trainer which I think is crazy. We have huge athletic programs like football. We know the risk of concussions. We know all those risks, but to provide the facilities, the equipment, everything that goes into an athletic department, and then neglect the healthcare that should accompany and provide a safe, healthy for children to participate. That frames the why behind Play Safe. Why does Play Safe exist?

It's a community issue. To give you a little bit of the cliff notes story. The old scenario of one trainer stopping by schools quickly evolved to everyone understanding that every school needs an athletic trainer. It came to the point where one entity being Clemson Sports Medicine, or whoever in your own community, you can't afford it. It becomes a donation to the community. Marketing is outreach, but it gets to a point where he can't afford it. I, in conjunction with a number of local physicians, decided to come up with another solution where it’s like it's too important to simply not do it to care about too much.

A lot of physical therapists might be in that same boat where they've got athletic trainers on staff. The backend proposition is that some of those injured athletes are going to come to you for physical therapy, but that's a sizable investment in people, monies, and time that those athletic trainers to have to spend with the teams. It's a significant outlay for an independent physical therapy owner to that kind of stuff because it's not coming from the school districts. That can be difficult to handle. I love that you guys took it a step further with this organization.

Any business owner, a physical therapist that has been involved with sports medicine, if you've hired an athletic trainer, you’ll get a couple of athletes a year. There is no way in any scenario that I've been involved in years of outpatient orthopedic and sports medicine do you ever have a direct correlation of revenue coming in that's going to pay for your expense of athletic training. It does not happen. There is an element of philanthropic donation to the community of marketing. Our region grew to the need and to the point where we could not afford it. We joined with a couple of local physicians that care about sports medicine, who understand how important it is for the children.

We honestly decided that this is a community problem and responsibility they don't know about. We need to create a community solution, so we did. We created a nonprofit federally tax-exempt 501(c)(3) called Play Safe. It serves as a vehicle that concerned community members that care about the health and safety of their children playing high school athletics can contribute. Play Safe accepts charitable contributions, employs the athletic trainer, and then contracts and provides that athletic trainer to the high school. It's a self-sustaining program.

The physical therapy clinic can contribute an appropriate terrible amount to our organization so can the doctor's office and in the hospital, but you could also use that organization, Play Safe, as an educational tool to educate the community. Also, educate the moms and dads that, “The trainer that's been standing there for many years, he's not funded by your taxpayer dollars. It is by the generosity of John Smith, PT that has done that for years.” You can then educate the community and you can grow the grassroots support and provide a sustainable structure.

If I'm a pet owner in Arizona where my clinics were and I wanted to take advantage of this, maybe I have athletic trainers on staff and I would like to transition over to this, can I do it with PlaySafe.org and become part of that organization?

Logistically, across many state lines would be challenging, but you can. Play Safe, being a federal tax, we are in two states now. We're in South Carolina and Georgia. There are an opportunity and a mechanism by which to do it across state lines.

If the physical therapist then simply wanted to do it themselves, you're saying that it's possible. They can create that 501(c)(3), make it a tax-exempt entity, and then solicit donations from various people in the community to support this athletic trainer. You're still managing that per se. What does that level of management as you're managing that 501(c)(3) on behalf of that athletic trainer?

Play Safe has agreements and contracts with 23 high schools. We have 31 athletic trainers on staff, and it's always changing. We have one athletic trainer supervisor named Jasen Powell. We have an HR staff entropy who is a retired athletic director herself, who cares deeply about high school sports. We have a bookkeeper, accountant, executive director whose role is growth and development, raise funds, develop relationships, and spread the word. We're in South Carolina and Georgia now. We've been approached by certain regions and we go have the conversation and explained to them how it works. We bring all the stakeholders to the table and say, “This is how much it's going to cost year over year to support this system.” Honestly, the stakeholders get together and say, “What can you do?” Everyone pledges. You have the funds pledged to provide the service and off you go. You have to have the funds in place. Play Safe is not a foundation that has a big bank role that they can come in and just plug and play. It's a proactive community solution that is housed and serves their own community.

What would you tell me as that Arizona physical therapist who sees that as an opportunity to benefit the community? Where should I start? It's establishing the 510(c)(3), but where do I go from there?

Number one, they can contact me. They can get shoot me an email at Jim.Stoker@PlaySafeSC.org. You can go to our website, which is www.PlaySafeUSA.org. There are so many different moving parts and so many nuances with each community. The easiest way is to have a conversation.

The true benefit is that it becomes a community effort and not just the physical therapy clinics’ effort and burden necessarily. You get everybody playing together. You're working in a situation where you are peer-to-peer with a physician rather than asking for referrals. You're trying to get these guys on board and then what can we do for the community? It's also something that you could do. Do you find yourself also working with other physical therapy clinics in the community? This isn't you hiring and it's your athletic trainer on your payroll. This is the community's athletic trainer and we can do this together with other physical therapy clinics as well.

PTO 126 | Certified Athletic Trainers
Certified Athletic Trainers: Play Safe serves as a vehicle that concerned community members that care about the health and safety of their children playing high school athletics can contribute. It's a self-sustaining program.

It has taken time. Play Safe was founded in 2011. Years later, we have physical therapy clinics that contribute to physician's offices both orthopedists and primary care hospitals. There's a general sense that you have a locally based nonprofit hospital, part of their mission is to serve the community. It's a natural fit, but at the same time, you use Play Safe as an organization to promote. Don't be afraid to promote the people that provide a fantastic service to your community. You have a central entity that can promote and thank the organizations. Being a high school is a tremendous amount of visibility to the community. We have construction, engineering firms, car dealerships, and accounting firms that all contribute to Play Safe to training. They can grow beyond the medical community.

It's important to recognize that if a physical therapist hasn't gone down the path of having an athletic trainer for the purposes of providing support to the local high school, it's not altogether a huge return on investment. It's usually a philanthropic effort. This is a way to still achieve that purpose that you're wanting to achieve and provide a valuable service to the high school athletes without taking the financial punch.

It's a constant challenge to educate. Concerned moms and dads in high schools turnover every year, but the athletic trainer has to be part of the organization. It takes a consistent and educational effort. There isn't also an educational mission to Play Safe because we do collect injury reports and data. We believe that there is a larger responsibility to contribute to a body of knowledge about sports medicine injuries. It is fairly rudimentary. We're not perfect. There are places that Play Safe can improve for sure, but we do track injuries. We believe there's a responsibility to collect some of that data and as best as we can to try to contribute to that body of knowledge.

You've grown it to a point where you have 31 athletic trainers on indirectly now, but it sounds like it's very doable for the singular practitioner or clinic owner to support 1 or 2 high schools in a valuable way. It doesn't sound like it might be all that difficult.

Looking back, probably not. It takes work on the front end. You have to build the coalition, the collaborative group that cares and that is committed. It has been a rewarding way to connect and further strengthen your network. People that care, you're working towards a common goal across professions, and in many times across industries. There's a lot of work on the front end.

What's cool is if you are thinking about how this might benefit your clinic, many times, we do want to provide this benefit to the community, but something that might be refreshing if it were me is, I'm talking to physicians even hospital administrators, and other in the community, not from a point of, “Send me your business.” It is not from a position where I want something from them, but simply educating and more so inviting, like, “Here's this separate third party, the athletic trainers and our high school athletes that I'm trying to help. Maybe if we work in this collaborative way can help this third party.” It's nice to have that conversation more so than the typical, “Can you send me a referral?” type of thing.

It's a mechanism to build relationships. It is a common ground to develop relationships and to achieve a common goal. Physical therapy owners know that it is important to establish and foster relationships in your community, be it through your referral network or your chamber of commerce, but it's a commonality that will help develop relationships for sure.

You already shared your email information. What was the website again?

The website is www.PlaySafeUSA.org.

Please share your email address again.

It's Jim.Stoker@PlaySafeSC.com.

I invite physical therapists that are interested in athletic trainers, employing them and creating an 510(c)(3) to reach out to you. Thank you for being available in that regard.

It is a pleasure. Thank you. It's a challenge, but it is a lot of fun.

Thanks for joining me again, Jim and I invite everybody, if you want to learn more about Jim, I did another episode with him where we talked about establishing goals, especially we're talking about goals to look back on, reassess and also for the future. He provides a ton of great information and wisdom. Thank you for being part of both of these episodes, Jim. I appreciate it.

It's my pleasure. It was a lot of fun. Thank you, Nathan.

Important Links:

About Jim Stoker

PTO 126 | Certified Athletic TrainersJim has over 25 years of management and leadership experience in the healthcare industry and is passionate about helping owners reach their full potential. Jim specializes in strategic growth and clinic optimization of key performance indicators and clinic metrics achieved by creating an engaged employee culture of teamwork, excellence, accountability, and leadership development.
His experience includes Partner and SVP of Clemson Sports Medicine and Rehabilitation, where he and his partners grew their practice from 3 to 30 clinics culminating in a successful sale in 2016. Jim also served as VP of South Carolina Operations with ATI Physical Therapy, President of The South Carolina Chapter of APTA. He also co-founded and serves on the Board of PlaySafe, a non-profit organization that provides Certified Athletic Training and Sports Medicine to secondary schools.
Jim holds a MA and BA in Exercise Science from Furman University, a BS in Physical Therapy from the Medical University of South Carolina, and he is currently pursuing a DPT from the University of Montana. Jim resides in Easley, SC with his wife Eleanor, 2 children, 3 dogs and their parrot.

Love the show? Subscribe, rate, review, and share!

Join the Physical Therapy Owners Club today:

PTO 125 | PT Marketing Basics

Steve Line, PT has spent plenty of time and $$ on all of the different marketing tactics over the years, and has made his share of mistakes along the way. Based on his experiences he shares his insight on the basics of marketing and the need to understand the different audiences and messages that are needed for a successful marketing strategy. What worked five years ago doesn't work now.  In fact, the marketing strategy that worked in 2019 definitely isn't as successful in 2020.  Thus, it's important to get back to basics and reassess our audiences and message. Join in as he discusses all of these on the show with Nathan Shields.

---

Listen to the podcast here:

The Basics Of Marketing - The Buckets, Budgets And More With Steve Line, PT

I have Steve Line, a physical therapist, owner and President of Columbus Physical Therapy out of Nebraska. I got Steve on because he wrote an article in Impact Magazine about marketing and covered some basics that are important to visit and revisit over and over again. I've done so with my clients after reading his article and discussing some of the basics that he mentioned. Steve, I appreciate you coming on. Thank you.  

I appreciate the opportunity, Nathan. This is a great show. I've enjoyed your previous episodes.

Tell the audience a little bit about you, where you come from, what brought you to where you are, a little bit of your professional experience and where you're at now.

I have been a therapist and an owner for many years. I wasn't a staff therapist very long and then I was thrown into the fire. I grew up in Kansas as a kid and went to Nebraska to PT school and everything. I've been in Columbus, Nebraska since 1998. What brought me to this point was I've always wanted to be an owner. I had the first love of Biology and the part of Physical Therapy that the patient care part that drew us all to it but there was always part of you that wanted to be an owner to lead the operation. I had a particular interest in customer service. A lot of that was grounded in some of the part-time jobs I had as a child. Through high school, I worked at a grocery store then I got to college and got more jobs that were customer service oriented. I was in a grocery store bartending, various things that had to do with dealing with the public. I could see the parallels and the weaving of this thread of, “We're all the same,” but it doesn't matter if it's a patient or if it's any consumer, we need to reach them at that level.

You've been a business owner for many years now so congratulations. Do you have one clinic or have you grown to multiple clinics by this time?

We've got three locations.

In your article, you talked about some of the basics. I was intrigued by the title itself, it's called Marketing Like an Engineer. I know where you're going with that after reading the article but let's start with some of the basics. You talked about marketing buckets to start off with. I think when PT owners look at marketing, they look at everything. Marketing is marketing but it's important to recognize that there are some distinct areas that you want to focus on and allocate monies and have completely different action items in those different buckets than you would with the other buckets. Lay it out to us. What did you define as the four buckets there?  

It's reverse engineering. At the end of the day, we want to have patients. What makes up the new patients that come into our practice? Time and time again, I measured it over a lot of years and kept coming up with these same four general areas. This isn't anything that I created on my own because now that I've talked with other clinic owners, they're coming up with the same stuff. It's common knowledge to some degree but we haven't talked about it. The four buckets starting out former patients or your patients in general. Those are the people that you're working with. Those should be your most loyal fans, the people that return to you, that is the most valuable of all of them.

I know I'm speaking to any therapist that is big into quality care and those issues certainly are patient bucket is number one. You want to put as much emphasis on energy. A lot of it is an investment of emotion and relationship into these people. You don't have to necessarily spend a lot of money to invest in that level of marketing. It's probably the cheapest of all the marketing buckets. You do a great job whether you build a relationship with them, give them great service and send them out the door with a great taste in their mouth or the experience that they had with you. It doesn't take a whole lot to get them back into your doors if they had a problem again. We got to stay in touch with them. That's one of the things we do there.

You're talking about not current patients but also past patients. That is huge. That's outside of the local community. That's your largest pool of potential there. As you said, it doesn't take as much money. There are other things that cost significantly more but it could get you more bang for the buck as you spend more time fully. With the current patients that are in your clinic, there are ways that you can improve engagement and their experience like you alluded to win them over. There's a huge pool of multiples that have been to you in the past that know, like and trust you that can put some added energy into them as well that can repeat returns.

Get on the reactivation but that's the first main bucket. I tend to count the next three as patient referrals being a branch off of patients. If you can have your loyal, raving fans then if you can get them to send friends and family, not only bring themselves back in but bring someone with them. Now, you've expanded the ROI of that particular bucket and then moving on to physician referrals or professional referrals. Not necessarily be physicians alone but any professional that can send you a referral like, “I know this group. They do a great job. I recommend you go there.” The final bucket is your general public. Now, you're casting the net out into capturing people with different messages across all of those buckets.

Look at money as energy and push it toward the things that are going to keep your venture going. Click To Tweet

Correct me if I'm wrong but from my experience, the amount of money you have to allocate to those different buckets increases with the way we've progressed thus far. Patients and past patients are relatively cheap. Getting patient referrals again shouldn't cost you a lot. Maybe a little bit of incentive might be in play for patients and past patients to bring family and friends over. Maybe spend a little bit more to get in front of the physicians. Maybe it's a newsletter, an occasional gift, lunch or something like that. You have to be mindful but it does take a little bit more and to reach out to the community, you got to spend a lot of money to net out.

A lot of that money comes into the various avenues and platforms you have to use to reach them. You have to do every door direct mail, however, you're putting on an event some of these things can get costly and in a hurry. Not to deter anybody from like, “I don't want to mess with that bucket.” I'm going to leave that bucket alone. The general public bucket can expand and explode your clinic but you have to do it correctly. I've learned a lot from Chad Madden, Shaun Kirk and a lot of different people that train in marketing systems. Having that specific message and knowing who you're targeting particularly is critical.

I want to get into that but before we do, since we're talking about budgets, I love the story that you shared about the marketing budget that got out of whack in your early years. If you want, you can go ahead and share that but let's talk a little bit about budgets and what people might need to allocate for marketing because as I'm talking to some of my coaching clients, they'll ask, “I want to do this thing or the other. What do you think?” I said, “How much money do you have to spend?” That's what everyone is going to ask you. A marketing expert is going to say, “How much are you spending?” That is a deer in the headlight question for every PT owner I've come across. They're like, “I don't know, how much should I spend?” They don't know. Talk to us a little bit about some marketing budgets.  

It isn't just marketing budgets. The same question could be posed if I wanted to get into a new location and I have a new lease, I want to build a building or whatever, it's like, “How much do you have to spend? How much is the clinic going to cost you? Is it going to be beyond what is feasible within your operation?” I've stood on the shoulders of many great mentors like all of us have and learned how to allocate it on a formulated basis so that no matter what, every dollar that comes in or X amount of cents, gets given out to labor, payroll cost, benefits, marketing, rent and utilities.

After a while, you start seeing some similarities on that to how much percent is appropriate. Give or take, in some regions, you're going to have to pay a little more to get a therapist so your labor cost goes up a little bit. Marketing in general, we always try to keep it generally around that 10%. We have gone in our start-up clinics when we're trying to get out there and push it off the ground and get it to launch 14% to 15% but it doesn't stay there. Once we start growing, you'd get those patients within, as long as you've got a good customer service and a reactivation system in place, you're staying in touch and keep a relationship there. You then can start lowering those costs overall and get it down to 10% and start reactivating the cheaper but the lower hanging fruit in marketing and that's your form of patients.

That's a surprise to some physical therapists because if they were to do the calculations, they'd find their marketing spend in the past has been somewhere in the 1% to 3% or less range but if they want to achieve the goals that they want to achieve, they got to recognize that they should allocate somewhere in the 5% to 10% range and more if they're starting up something new. That can be a hard pill to swallow for some physical therapists thinking, “I need to spend that much.” Maybe you don't. If you're happy where you're at and you're not necessarily focused on growth, maybe you need to be closer to the 2% to 5% range to maintain and continue going forward. If you have any illusions for growth, you're going to need to expect to pay more in marketing and that's where you start. How much do you have to spend? A lot of times, it depends on how you're going to spend it.

I try to look at all of it. It's an investment. I use the term ROI a lot around the clinic and everybody on the leadership team knows what I'm talking about but it's like, “I would like to do X, Y and Z program or campaign. I want to try this. What do you think?” I'm like, “I don't know. What's it going to get you? I don't know. I just want to try it.” I’m like, “We need to spend a little time and project out and think about, not, ‘We don't know,’ none of us have a crystal ball but we should have a pretty close estimation of where we're going to land, what we're targeting to understand how to get that.” When we're talking costs, 10% is an investment not only to grow your practice but keep your practice stable and keep it where it is because competition never stops and costs never stop growing and reimbursement never stops decreasing. You get caught between those three and you're squeezed. You need to always be pushing funds and energy, look at money and resources as energy, push it toward the things that are going to continue you and keep your venture going. That's probably another way of how to look at it if they're freaked out about the growth part.

That goes to like, “After I know what my budget is, how do I allocate that money?” That's where you were leading the discussion. Let's come back to that. It's like, “Who's your demographic?” If you don't know who your target audience is then you're not going to know where to allocate your marketing monies because you want to be where they're living.

You want to know your community and that takes time. Nobody pops into a town and knows everything about it but you want to learn what's your median range of ages? What is the household income level? What type of community is this? Is it white-collar or blue-collar? Is it farming, agriculture or manufacturing? Is it all tech? It could be all of it mixed into one. You need to know if you're targeting particular people of influence. Have they been well-educated? It's the same thing that political pollsters use. They are trying to identify who is that avatar within the community, that individual, that face, that nameless person because that generally reaches across to all of them.

We have a manufacturing, a heavy community in our first location. Our second is all agrarian, an agriculture is driven which is a smaller community. The third community that we have is a practice in is a combination of all. It is manufacturing, it got some retail, it got some white-collar related people there and it got a little bit of a mix. On the physicians, we have to target them differently too. We keep going. It's a piecemealing of all these buckets figuring out.

In each bucket, the message is going to be completely different but when you're looking at your avatar in the community bucket, what comes to mind for me is a podcast that I listened to is Paul Gough’s earlier podcasts. He's in England and people have the choice to go to the state-sponsored clinics but he's not part of that program. People have to pay cash to come to see him. His target market when it comes to marketing is the 55-year-old female kids or older. They have a little bit more income because they're upper-middle-class. Simply that alone can influence your marketing message. You're talking to females. How are you going to talk to females? How are you going to talk to older women who have a bit more money that can pay cash out of pocket versus going to the state-sponsored clinic?

PTO 125 | PT Marketing Basics
PT Marketing Basics: If you want to achieve your goals, they should allocate 5-10% on marketing and even more if you're starting up something new.

That alone is we'll generate a different message than the message that you're going to create for your past patients. There's a different message if you're going to focus on orthopedic physicians versus internal medicine. Honing that message to your target audience doesn't exclude the rest of the audience that you're reaching out to but it will capture their attention more so and bring you the type of patients that you want to see.  

It's as simple as this. When you are talking to a friend or a family member, you've known them your whole life, your level of understanding of that person is so much greater. You can talk pretty generically and more loosely and then hone in on specifically what they're interested in. Case in point, you have patients that are into baking, crocheting, hunting, fishing, football or welding or whatever it is and you learn those things. You can't keep records on everything but you do need to have some sort of semblance of, “This is what this guy or this girl was into,” then when you're sending out some personal related messages or the phone call systems that we do, “How are your grandkids doing? The last time we talked X, Y and Z.”

There is no better way to connect. You can't do that when you're talking to somebody you've never met before. Right in there are the basics of the message change. You're trying to target, what is important to them and what means something to them? In our particular case and a lot of cases, we're looking at middle-aged females, like you said and they're the family, consumer decision-makers. They decide when grocery day is and what they're going to buy for groceries. They decide where their kids are going to go to school. They're going to decide for certain where their health care is going to be done. That is who you're targeting.

That's good to know because although your interest might be in high school athletes, you got to recognize that they don't carry the purse strings. It's the parents that they got that. The majority of the time, it's the mother that you've got to influence.

Always target the decision-maker.

I interviewed Angie McGilvrey down in Florida. They've got a number of practices and we were talking about social media advertising. She's been very successful with that. She posts regularly on the different social media channels but her target audience is going to be the female athlete who’s probably in CrossFit and their 20s or 30s. She's got it mapped out. She knows who her avatar is down exactly. She tailors that social media message to those people and thus, has been successful with her social media campaigns. Know that message and know who you want to work with. Angie used to take all comers and the majority of it is in Florida and Medicare. Since they had a reset, which happened to be a hurricane a number of years ago, they decided to change their message to focus on the patients that they wanted to see. Now, the demographics of their patients are completely different because they tailor the message.  

We've never felt that we could wholesale, go and choose one group like the 30 to 40 female athlete or what have you. We still target all comers. We do it differently through different strategies to try to get them all. We're in a low populated area so we have to squeeze as much as we can out of what's available though.

Are you a little bit more rural?  

We are.

You got to be the country doctor, essentially. They're not bringing you their animals.

Haven't yet anyway.

Never assume that everybody knows what you do. Nobody thinks about physical therapy, ever. Click To Tweet

That can be some of the more difficult marketing that you do when you're reaching out to the public.

It is. In that article I wrote, I used some references from Dan Kennedy in marketing and they get the Marketing Results Triangle, taking, targeting and tying in together the message, the market and the media for the group that you're going after. Once upon a time, you could say social media, internet, email, all those things and don't work for Medicare people but that's not true anymore. As grandmas are all on Facebook now, you can now open up some of those avenues that once were viewed as well, you can only reach them with newspaper ads and mail. What worked many years ago now is moving and evolving and you have to keep moving with that.

We're at the end of 2020 and what worked at the end of 2019, now post-pandemic is different. You've got to recognize, if you don't have any energy, time and money put into the direct to community marketing bucket then you're going to be in a lot of trouble because that physician bucket is shrinking because maybe not in your community but I know in some of the larger metropolises they can't go in and see doctors anymore.

I don't want to say it's completely gone, but the only way we can ever reach those guys is we tried to do everything systematically so it isn't just licking and sticking. We try it once and see how it goes but making sure that our notes always read a certain way, particularly to the doctor because we know what they all generally want. They don't want three-page notes sent to them on progress. They want them as simple and short as possible. I still see at times therapists on the bigger ones. We are already missing them if you want to try to influence them. That's one piece but then always making sure that we do a quick phone call, “So-and-so is coming over to see you. We want to make sure that there's a note that's already been faxed. Have a great day.” It's trying to provide customer service to them as well. The last thing is we do an in-between progress call having our therapist make a call to the doc's office saying, “I want to touch base to let you know how so-and-so is doing. That is all. Thank you.” That's all the way you can make those touches when you can't see them face to face. They don’t want you in there and I don't want to be in there.

When you consider the direct to community type of marketing, that's new territory for many owners. Either they haven't used social media, don't know how to use social media or they haven't used mass market mailers, media posts, the radio, TV or anything like that. The post-pandemic forced their hands if they want to make some connections and growth. They might say, “I don't know what to do.” Start with, who are you marketing to? If you're thinking about the decision-maker is being the housewife, the majority of the time then where are they living? That might guide you to where you need to be in social media.  

That's an easy one from a mailing standpoint. You can do a target grid search on every door, direct mail, if you want to hit X amount people in certain age groups and so on and so forth, you can get that down to a fine point. Our mailers, once upon a time, wasn't an effective marketing campaign but it dropped off a lot as far as our effectiveness with it. Particularly if you're marketing the same old, “Come in for a free consult,” some sort of a new tripwire that connects them. That works well with us still but if you're sending something that says, “Do you have back pain? Call us today,” you're better off using some other strategy than that. It's going to be costly.

The one thing that therapists always make the mistake with is we assume everybody knows what we do. Everybody's thinking of physical therapy every day of their life. Nobody is thinking about physical therapy ever. Let me break everyone's bubble now with that. I learned that early on and that was probably a saving grace for me. I focused on, “These are consumers, these aren't patients.” That may ruffle some feathers with some PTs but if you start changing that mindset and knowing that that individual is being competed with by General Motors, by their utility bill, by their kid's college tuition, by all these other things that are drawing their time and money and energy, you're going to go in there and say, “If you've got back pain, call us today because we give great quality care,” you're not going to reach them. You have to do something more targeted to get them to reach out and call. One of the things that Chad Madden did is using a digital product, eBooks, things of that nature like, “If you have a low back pain, come and get your free low back pain workbook, learn how to treat yourself.” That speaks to some people. Things that bring them out and get them reaching to you. You're trying to attract people to you.

The important thing to recognize and you've alluded to it essentially, is that you do something and then you've got to assess the effectiveness of it. That's why you're changing the message on your direct mailers every so often. Recognizing that, “We sent out these three mailers. We've spent three months on social media,” which seems to be about the time it takes to gain some traction on some of these. Maybe you can share your experience.

It takes time.

People think that if I send out the social media posts, things should be ringing off the hook like, “I've increased my Google Ad spend for the past three weeks. Why aren’t we getting more new patients?” It takes time. At that point, that’s important to figure out exactly what was the ROI or the Return On Investment.  

Whatever you do, if you're doing social media for three months, make sure that we're measuring. Is it working? Make some adjustments as necessary. Marketing is conversational. You're talking with someone and you keep saying the same thing over and over to them. They're going to be like, “Something's wrong with this guy. I'm not reaching them. They're not connecting with me.” Your conversation has to adjust to whoever you're talking to in-person. Marketing is going to change in whoever you're talking to out there. The things that they want to hear is what you want to try to reach them with. As you know, there are only many things, what are the results and the benefits and then try to overcome those barriers of, “How much time is it going to take? How hard is it going to be? How much is it going to cost?” Those are the pieces of sales that you'll have to work on to overcome when people do finally reach for you.

PTO 125 | PT Marketing Basics
PT Marketing Basics: Start with identifying who you are marketing to. It will guide you to where you need to be in social media.

It's interesting, as more people have been doing social media posts and some of my clients have noted so much of the focus of the content can be like, “Here are some stretches for low back pain. Here's the anatomy of a shoulder that you need to consider,” and I'm not convinced that's what gets people engaged. Honestly, one of my patients said, “I get more engagement from posting a beautiful sunset than I do from any of that other how-to stuff in social media.” I'm like, “I probably wouldn't click on any of those things either and might give a thumbs up to a nice sunset too.” We got to consider that not everyone wants to know your how-tos and what- fors.

They don't want to know that. They want to know, “I have a problem. What are you going to do for it?” If they have shoulder pain or back pain that’s been bothering them for a long time, at some point, you send the right message out, “Are you sick and tired of this back pain?” That's different than we treat back pain as not emotional. It's factual. There's no feeling from it. Marketing has to derive a feeling. It has to create any emotion because that’s what motivates us to move, to go do something. You have to target that. Knowing where most individuals are at in their feelings about their problem, makes a big difference in how you tailor your message to them.

If you're in a running community and those are the people that you want to see are the roles, you're not talking to them about sitting at a desk and how that causes neck pain. You got to target the message appropriately and give it some time to take traction. I'm not convinced that it’s a home run out there to get new patients in the door but it's a repetitive single in the baseball analogy that usually gets some tractions.

It's always a small ball. It is the things of how much marketing have I done over the years and all the while, my marketing was great, my front desk personnel was terrible? You got people ringing in but unless you're taking the phone call, you're trusting that individual to hook them and say, “Come on in. Are you having pain? You need to go see your doctor first.” That is what we know. That works against your general public marketing. When you want the general public to reach to you and then when they do, you say, “Go somewhere else.” That’s wrong. It isn't just marketing. It's knowing how to handle all the other components that come with it.

It's customer service, at that point. That's what you were talking to at the beginning. I remember talking to one of the founders of Keet Health. If you can focus and improve the customer experience, that will triple your marketing efforts because those people will think about that, especially in the different buckets. It's going to improve the patient compliance and they're coming back if you can improve the customer experience. It's going to more likely help them refer family and friends to come to as well so it's going to help that bucket. If you focus on the customer experience, patients are going to go back to the physicians in that bucket and say, “I love this place and you ought to send all your patients there.” On the backend, if you're reaching out to the community and they have a poor experience on that initial call, you just wasted your marketing dollar at that point. It is so much that it comes back to customer service and the effectiveness of our marketing can be submarined if the customer service isn't there.  

It's got to be credible. If you say that you deliver the feel-good experience, which is what our brand name is. Our tagline on everything is the feel-good experience. Meaning, we do focus on not only making them feel good physically but emotionally, spiritually, making that connection with them, giving them a great experience all the way through. When they do call in and say, “You got to go somewhere else first,” and treat them like, “You've been here before,” we related to whatever then you've blown it. You got to make sure that that is incredible all the way through that you perform and behave as your marketing is.

Trusting somebody to do that naturally is a fault.  

You got to train it in.

They don't say whatever comes off the top of their head that they think sounds good, you have a script for them like, “This is what you say when a new patient comes in. This is what you say if they walk in the door versus if they say, ‘I heard about you on the radio or I got this flyer in the mail,’ and then you say, ‘Great,’ then you say this.” That's trained over and over and its role played. That training can be taken into many different sections of the customer experience. It's not just front desk training, that's training that can occur at any point in the customer service experience, providers, technicians and billers. You name it.

You're leading off into my last project here. I've been working on a book. I created a system many years ago and I'm getting around to putting together an actual book for it. It’s called the Feel-Good Experience: How to Grow Your Practice with Five-Star Customer Service. It covers all of the psychology of the human being, our needs, wants, the certainties and the things that we're looking for, all of us. It doesn't matter who you are, where you come from, what gender, nationality or any of it. There are certain commonalities that we all are seeking. Ultimately, it's respect and communication and that level of professionalism to lead them through the process. One of the worst things that I can see over the years and I've had it happen to me personally is when I go in seeking a service or an item and someone says, “It's over there,” and they point me toward it.

To me, the difference is when that person says, “Let me go take you there and show you where it is. Let me get it for you.” That's the difference. We always want our clinics to run within that model. We have five stations or so. Front desk, we use the aids, therapists, hosts and hostesses because their first action is to bring them back. There's a whole set of steps there on how you body language that action to show them respect, honor and appreciation for them being there and bringing them back with them, being cognizant of those things. Things that they tell you, things that they maybe don't tell you, the subtle tells. If you're sitting at the poker table, you got to be able to read people. Going through clear to the end again, the front desk individuals are the last ones to get them again. They got two important parts, in and out. That's all within the book soon to be released.

Marketing has to drive a feeling. It has to create an emotion. Click To Tweet

Do you have a title for it?  

The Feel-Good Experience: How to Grow Your Practice with Five-Star Customer Service.  

When is this coming out? If someone read this episode in the future, what do you think?  

It'll be out in February or March 2021.

Congratulations on that. It all goes back to the topic of how we can improve our marketing and much of that can be fortified and even multiplied by having a good customer experience.  

You'll find out quickly if you’re not, particularly if you're at an executive level of management in your company where you're managing a lot of different sites and you're not right there watching everything. When your former patient bucket starts tanking out and you're still doing all the ingredients that you've always done that work to bring people back in and you're dropping off quickly, there's a reason they're not coming back. You definitely want to target some of those things.

You're saying that a lot of people will measure the return patient percentage of their new patients. What percentage of your patients are returning patients that have been there before? You're finding a correlation between that statistic, that number dropping and maybe a worsening of the patients.  

It's usually two different things. The first thing I'm targeting is I'm going to my marketing going, “What's fallen out? What are we not reaching out to them with?”

We're not sending emails and calls to the patients.

We're doing it all and it's all because everything is well documented in our system. I'm like, “They're not coming back then on the phone calls. What are they saying?” “They didn't want to come back or they went somewhere else.” You then start taking note of all that. They started going to other places and that's when bad things are happening. You want us to fortify former patients and get them served.

I love that you brought that up because that can be key for some people who are seeing numbers dip and give them something to look into because they might be saying, “This circumstance led to not coming back,” but you are not looking internally and saying, “Maybe they're having some poor customer experiences that they didn't have in the past or something's fallen out.”  

PTO 125 | PT Marketing Basics
PT Marketing Basics: If you focus on improving your customer experience, it will triple your marketing efforts.

Particularly if it's a lifelong person that keeps coming back and they've been back for ten years and we've had this happen, it's the most painful thing ever as an owner, when you treated that patient. When I was a therapist and you had this such tight connection that they would text you, they will call you at home and you took care of them. All of a sudden, the next time you see them, they're standoffish and then they say things like, “I went somewhere else.” It's like, “What happened? Something's not right.”

That's such valuable feedback that maybe you get that from physicians occasionally if they're honest and you have that relationship with them, or the one person in the community that came through and then decides to go back on Google and give you a one-star rating or something like that. You can simply trust and get much more out of those past patients if you stay in communication with them regarding how things are going in your clinic. That's something that you have to do as you personally step away from treating everybody, which is the most PT owners. There's so much value there, for sure.  

They're a wealth of survey knowledge, instead of hiring a survey group to do surveys, survey your past patients. That is the simplest and most cost-effective way to find out how you're doing. You've got to make sure that they're being honest. You allow them to be honest, you give them a safe place to be honest. If they say something bad, you can't lose your cool with them. You have to say, “I appreciate that,” then you can mark it and make your changes off of that.

You covered a ton of great stuff and shared a ton of wisdom. Steve, is there anything else you want to share before we start wrapping things up?  

Thanks for having me. I appreciate it. This is an absolute, tremendous opportunity. If anybody would like to contact me, they can contact my clinic number at work (402) 564-5456 or reach me by email, which is CPTSL@ColumbusPhysicalTherapy.com.

We'll look forward to your book here. Thanks for your time and sharing. Hopefully, everyone gets a ton out of it but I appreciate your time.

I appreciate it, Nathan. Thank you.

Thank you, Steve.

Important Links:

About Steve Line

Steve Line, PT,OCS,ATC is President/CEO of Columbus Physical Therapy, P.C. He founded the company in 1999, leasing office space in a strip mall in Columbus, Nebraska. Since that time, he has expanded the company to 3 locations across Northeast Nebraska, going from 1 employee to 25 and boasting a nearly 14x growth in a underpopulated rural area.
Before starting CPT, he worked as a new grad PT for another PT practice that highlighted the importance of production volume, expansion and customer service. Prior to working as a PT, he attended UNMC PT program in Omaha, NE and UNL for undergraduate studies.
Throughout high school and college years, he worked at various customer service - oriented part time occupations to help pay for schooling. It was throughout those formative years of dealing directly with the consumer in grocery and bartending that developed his intuition for “anticipating consumer needs” and eventually developed a proprietary customer service model, “The Feel Good Experience” that is used primarily in all of the company clinics.
Although, a physical therapist by training, Steve identifies more with the mindset of an entrepreneur, a leader and a teacher. He has published several articles with Impact magazine, a publication of the APTA PPS, and is currently finishing a book entitled, The Feel Good Experience: Grow Your Physical Therapy Practice With Five Star Customer Service.
Steve, married to Kristine for 21 years have 2 sons Evan and Derek, in highschool and twin daughters Alexis and Brianna in middle school.
In Steve’s spare time, he enjoys being outdoors; hunting, fishing and working on his several farms he owns in Kansas and Nebraska. He enjoys reading, and talking about “anything business, real estate or property management related.”
Steve is available for questions and consultations regarding business coaching and operations and can be reached at cptsl@columbusphysicaltherapy.com.

Love the show? Subscribe, rate, review, and share!

Join the Physical Therapy Owners Club today:

PTO 124 | Workplace Culture

Business goals usually look and sound good when written on a piece of paper or hung in the office, but most of the time, they are easier said than done. By putting an effective workplace culture in place, these goals can be brought nearer to reality. Nathan Shields talks to Jim Stoker, PT, advisor for 8150 Advisors, about the importance of nurturing employee relationships, frequent company meetings, and integrating accountability in reaching every goal laid out for the success of a business. Jim also talks about going beyond the usual team-building strategies, emphasizing the one thing every leader is afraid to explore – challenging your goals and seeing if they are truly worth the shot.

---

Listen to the podcast here:

The Secrets To Inevitable Growth With Jim Stoker, PT

I've got Jim Stoker, an advisor with 8150 Advisors, and also a past partner with Clemson Sports Medicine and Rehabilitation. I came across Jim because he wrote an article in the November 2020 issue of Impact Magazine, talking about how to review past goals, adjust your expectations, and create goals for the upcoming year. It's a good time to reassess, adjust and projecting the plan for 2021. Thanks for coming on, Jim. I appreciate it.

Nathan, it's a pleasure to be here. Thank you so much for the invitation. I'm looking forward to this conversation.

I know you've got plenty of experience to draw from, and I'll reference the article as we go through a bit because he hits some great topics in terms of assessing and creating goals for the future. Tell us first a bit about yourself, your professional experience and what got you to where you are as an advisor.

I'm a physical therapist. I've been practicing for several years. I joined Clemson Sports Medicine and Rehabilitation when we had just three offices. Over the years, we grew from three offices to 30. That culminated in August of 2016. We were acquired by ATI Physical Therapy. I continued to serve with ATI Physical Therapy for South Carolina, overseeing the operation of 60 clinics for about three years. During that time, what shaped my appreciation for planning, goal setting, and even more specifically, strategic planning was a lot of my involvement with our state association, the South Carolina Physical Therapy Association. I have served as the Vice President, President, Legislative Chair, Reimbursement Chair, many roles with our PT association. In one of those roles, we completed a strategic plan a number of years ago. That was my first introduction to strategic planning and goal setting, and how that's such an important part of any organization.

PTO 124 | Workplace Culture
Workplace Culture: Looking past yourself can help determine where you are, where you want to go, and how you want to get there.

What's interesting in the way you approached it in the article is that you started by reassessing your goals from the previous year. I don't think that's a step that a lot of us take. Me as a coach, sometimes that's a step I overlook, like how did we do in this past year? We'll think generally we hit some targets and whatnot and things were great, but we focused a little bit more on the ideal scene going forward and what we want to hit. Tell us a bit about what you recommend in terms of reassessing the past. Do you spend a lot of time on that? How much energy do you put into it?

You have to be willing to be objective and self-critical to look at the past and be honest about what did we do well, but at the same time, what could we have done better? Hindsight is 2020, so there is some knowledge to be gained from looking at the past, and take an opportunity to say, “Where did we fail? Where could we have done better? What would we like to do better in the future, and how would that translate to improving value for your company or for your organization?” Many times, acknowledging your missteps can teach you where to do better in the future and what you may want to avoid.

I liked that you referenced the willingness to look at some of those KPIs and assess them against not only progress in your own company but against national benchmarks. Nowadays, you can find those benchmarks here and there. They're more easily available to the PT industry than they used to be. It's nice to say, “Our arrival rate improved. We got to where we wanted it to be.” How did it compare nationally and what should be expected? That gives you a better sense of where you truly stand.

A shameless plug for the Private Practice Section that I've been a member of for years and have benefited from the knowledge of that group and the network that provides. The Private Practice Section published some benchmarking studies. We didn't have those several years ago, but many times it can be difficult to look beyond the thought that patients love me and like me. Unfortunately, there's more to business success than patients like me, and they recommend me to their friends. It’s having a standard but appreciating there are significant regional differences within those national standards. Something as simple as revenue per visit, then the KPI that people look at. If you delve into that, we understand there's a significant variance in the geographic price index that determines the Medicare fee schedule. There are some variations you have to appreciate per region. You can drill down to your practice setting in your region and compare it to some of that normative data. It is a beneficial exercise.

The personal goals of the owners directly impact the goals of the business. Click To Tweet

I came across an article that yes, it's a worthy exercise to consider why we got the numbers that we got. Sometimes our perspective can be a little bit tinted, but more importantly than looking forward is, how do we improve? How do we get to another level? How do we correct some of the missteps that we made prior and move forward in that direction? That starts a different conversation rather than looking backward and saying, “Why?” Yes, that's a worthy exercise. There was this, that, and the other, but “how” then generate some more forward-thinking. That was the takeaway message from the article that I was reading. It was focused on how and what we need to do going forward to those changes. As you're looking from the past, how do you then shift to looking towards the future as an advisor?

Looking past you essentially helps you determine where you are. You're focusing on where do we want to go and how are we going to get there? How do you bridge the gap? One of my colleagues at 8150 Advisors is Steve Stalzer. We were both passionate about our belief in the benefits of strategic planning. Strategic planning can look and feel different for many different organizations. If you're a one-person practice, if you're a large practice, or if you're a hospital department, there are a lot of different moving parts. The basic framework of strategic planning provides the necessary steps to objectively address the questions you outlined. You start with the strengths and weaknesses of your own organization.

This whole process requires honesty and the ability to be self-critical. You identify your own strengths and weaknesses. Where are we good? Where are we not good? Where can we improve? You then expand that strategic planning process to an internal plan, internal assessment, and then external. Most people can have the ability to control and influence their internal environment, much more than you can your external environment. There has to be a willingness to commit to the plan. Once you decide, these are the obstacles. What is it going to take to overcome these obstacles? That's where you use the strategic planning process to drill down to initiatives and action items that are going to take to address each obstacle to move you towards the goals you want to achieve.

As you're doing something like this, and you're referencing the SWOT analysis, do you start with that ideal scene first like what I want my clinic to look like and some of the numbers I want to see at the end of 2021? Do you do a SWOT analysis before that or does it matter?

It does matter. I mentioned to Steve, years ago, I was one of those individuals that felt a mission statement and a vision statement was mostly fluff. It was something that looked good on a piece of paper and it felt good. It wasn't until years later that I completed this type of process with our state association, and then went for our own company that I did appreciate how important mission and vision statement is. It does drive your goal setting. You start with your mission and vision statement and then determine what our overarching goals are. Do we want to expand our clinics from 1 to 3 in the next year? Do we want to go from 3 to 5? Is it a goal-setting just for your clinic? It improves aspects of that clinic. Is it a business goal or revenue bottom line? Do you have a philanthropic goal of community engagement?

A lot of people only think of business, which is important, but there are other worthy goals that may not be directly tied to your bottom line. I like to think of it as start with an agreed-upon mission and vision statement that helps you drive your overarching goals, and then you drill down. You start the big picture and drill down to the details through the specific goals. What are the specific KPI goals that allow us to achieve the overarching goals? What obstacles are in place, what initiatives, tasks, and specific action items do we need to take to achieve those goals? It was going from the big picture to small detail.

I love that you brought up that it's more than the clinical stuff because we're talking to individual and independent business owners here. In my experience, and maybe you've come across this as an advisor, I've had clients come to me and say, “What should my next steps be? Where should I go next?” I can't answer that for them. Much of these things originate from what the owner or the partners in that owners want to achieve. You have to be clear and figure that out first because not all of it is about clinical growth, financial goals, you name it. Some of it is maybe you don't want to treat 40 hours a week anymore, or you want to go to part-time treating or not treating at all. You want the freedom to explore a hobby, or there's a household revenue goal that you have for your household, and your business needs to create 100% of that, 75% or whatever. Some of these overarching goals stem from our personal and household goals that we need to be a bit clearer on as well.

When you have partners in a business, the more partners you have, the more potential obstacles. You have different personalities and characteristics, and those can potentially lead to different goals. One of the things that were a challenge for us that we do ask when engaging a client that has more than one owner is, is the leadership aligned with her goals? Many times, they're not. Without question, the personal goals of the owners directly impact the goals of the business. Business goal achievement is directly tied to an owner's personal goals. You do need to have that question. You need to have an agreement among the leadership of what are the goals together. You can't have two people pulling in two different directions. Many times, you have that down South here in the Bible Belt, we call that the Come to Jesus meeting place. You've got to get the leadership and ownership on the same page in agreement with, “This is our goals. This is where we're headed.” If you don't have alignment at the top, you're going to struggle to have alignment moving forward with the rest of the team.

That even goes so far as alignment with your spouse or significant other that might be a significant part of the business because there are some spouses that are a part of the business.

We recommend if a spouse is legally part of the business, potentially not officially part of the business. Input from all influencing factors is important.

What I thought was interesting in your article that I hadn't considered so much, as you look at these goals for the upcoming future, you go so far as to consider the ROI of change. Tell me a bit about that and your thought processes regarding the ROI of change and going past more than the goal setting, but what it's going to take to achieve that goal and considering if that goal is worth it.

As you go through the planning process, something might look nice, fun and pretty on paper, and it might feel good. You might determine as you drill down to the individual tasks and action items that are required to achieve that goal. You may find out it is going to take a Herculean effort to move the needle a bit. When we talk about the return on investment as you vet the various goals, you'll want to turn and say, “How much a difference is that going to make?” I’ll give you a specific example. If a particular company looks at a common KPI of visits per day, I don't think you can meet a physical therapist in outpatient work that doesn't talk about how many people do you see a day.

PTO 124 | Workplace Culture
Workplace Culture: A lot of planning success begins with the culture that you have.

If we move the average visits per day from 10 to 10.4 or 10.5, is it clinically relevant? Are we able to maintain the commitment to quality that we always have? You answer all those questions, and they say, “Yes. It's doable. It's reasonable. It's a goal.” What's the monetary return on that? You can objectively put a dollar amount. From January 1 to December 31st, if we're able to achieve a 0.5 increase, or maybe there’s a percentage increase, you know your revenue per visit and your expenses, and you put that number on top of it. You know exactly how much value you're creating for your entire company and your organization.

That makes me think about some clients who might say, “I want to double my gross revenues this year.” That's nice and good, but it is also important to recognize doubling your gross revenues means doubling your number of visits. Do you have the capacity to do that? Do you have the square footage? Do you recognize the staffing that it's going to take to double your revenue? Do you have it in your marketing budget to increase your marketing spend to get double the new patients? There are other things you can do to improve the efficiency and productivity of your clinic that can get you a bit more business, 10% to 20% better if you short things up. You're talking about a large investment. It's worthy to consider an exercise in which you're looking at not just the goal but also what it takes to get there. Is it feasible? Is it realistic? Do you have the capacity to do that?

That's the process we vet with clients about. If someone suggested that goal, “I want to double my gross revenue,” we're going to ask the difficult questions of, “Is gross revenue the best goal that measures value for a company? Is it net revenue?” If you focus on net revenue, you're acknowledging both sides of the business equation of income and expense. You drill down to where that can come from. How much of it are internal efficiencies through visits, appropriate charging, clinical efficiency, front office efficiency? Are we losing revenue because of authorizations or denials on treatment? Those are efficiencies you can create internally. How much is going to come from internal factors that we can control? How much potentially needs to come externally? How many more new patients are we going to have to generate? Do we have physical space? Do we have the staff? Can we recruit the staff? How long does it take to recruit and hire and bring someone on board? That would be an example of a large overarching goal that would have many sub-goals that would come for different aspects of the company to try to achieve.

I love the drill down to maybe focus a bit more on net revenues. See how that affects your business a bit better. I love the way that you redirect a little bit there. I also liked how you talked about how does that change occurs with the team that you currently have because then you further go on to talking about change management. Many of us as entrepreneurs have grandiose ideas and visions, “We're going to hit the arrival rate. We're going to improve it. It's going to be a 95% arrival rate this year. Let's go. Here it is, team. We're going to push.” A month later, “What did we talk about last month?” There's a lot of energy and spark at the beginning. How do we get a change in management to occur?

You described the mistake I've made more times than I care to admit. It’s multi-factorial. There are many moving parts. I do believe that so much of your planning success begins with the culture that you have. There’s so much at the end overall industries about how culture is important in an organization. At one point in time when I was more black and white, science-based, and right out of school and focused on clinical aspects. I didn't appreciate that as much as I do now. I learned that the hard way. To truly have a culture that will accept change, accept challenges, and focus on goals and improvement is paramount to the success of any plan.

That's part of the looking back process that you start initially. You answer the difficult questions about what culture is in place now. That involves communication style, frequency of meetings, are you a top-down culture? Do the owners decree, “This is how it's going to be. Do it my way. This is how we do it?” Do you have a culture of engaging your staff and your leaders, and empowering them to be part of the problem-solvers and decision-makers? You have to understand the environment in which you are going to implement the plan. That’s part of determining what obstacles are in place, not just physical obstacles, but environmental obstacles, and how does the team function?

Culture fosters the ability to work towards a common goal. Click To Tweet

I'm glad that you took it in that direction. Was it Peter Drucker or was it Brené Brown that said, “Culture eats strategy for breakfast?”

That was Mr. Drucker.

She quoted it though in her book, Daring Greatly. You could have many plans and ideas, but if your team isn't willing and isn't prepared in a place of reception from what you're bringing down from the mountain per se, then it's going to fall flat. If someone is reading this and they're like, “I don't know if I have that kind of team,” or “I need to work on my culture,” would you recommend they start improving their culture first before hitting some of these KPIs?

I do because it will be part of the entire plan. If an owner believes that and they acknowledged that that is an obstacle, we're going to help them create initiatives and action items to overcome that obstacle that is going to be occurring in concert with your other goals and your other action items. It boils down to leadership development. Developing leaders and identifying the champions may not be owners. That's going to differ greatly between the size of the organizations. If you have one clinic, that's three FTEs versus one clinic that's ten FTEs, versus 3, 5 to 10 clinics. You're identifying those champions that are going to help foster change. You need to begin with one level of leadership training, maybe it's two levels of leadership training.

When you were following the leadership training, you're investing in your team. You're communicating with your team. During that process, they become part of the team. That is building the culture. They are appreciative of the development in themselves. They see that there's more to this process than simply showing up at 8:00, seeing ten patients and going home. You’re part of the bigger picture. As you include them in the process, you provide transparent communication. They begin to appreciate the bigger picture, and then now being able to implement goals that impact the larger picture, which is the organization is much easier to achieve.

I talk to clients about leadership development. The limitations of the clinic are the limitations of the owner. If they are unwilling to delegate, train and develop these leaders, then the clinic will expand to the limits of that owner's time and capabilities, and also will mimic the weaknesses and strengths of that owner. Whereas you can be a much more well-rounded business. You can expand and grow if you expand that leadership team. When I bring that up to owners when I'm on a conference call, I get the deer in the headlights sensation because they don't know where to start. I don't know what you'd tell your clients, but I'm telling them to do what you did. If there are books that were influential for you, invite them to read some of those books and discuss what you learned.

If there was a consultant or a group or a training program that you went through personally for management training, invest in particular team members to take that same training or follow your path. You don't have to recreate the wheel. I'm sure there are companies out there that can provide management training for you. If you want to start from scratch, do some of the same things you did, and then give them morsels of leadership when it comes to leading out on a team meeting. If there's a charity that you want to endorse, let them start the toy drive or the canned food drive. Get that going and get everyone involved instead of you doing yourself as the owner. Those are opportunities for leadership and growth that you're talking about and can help with the culture.

I'm a firm believer that step one is getting to know your team. All those great examples that you mentioned may not apply to clinician number one versus clinician number two. Joe Brown is going to have a different skillset, characteristics, and value system than Jill Smith. In order to understand how to communicate and how to connect with your entire team, you need to understand and get to know the team members. I'm an old broken-down athlete myself. I'm an old basketball athlete with two old knee surgeries back in the ‘80s. Thank goodness they don't do those procedures anymore.

When I'm talking with folks, I equate to being a coach of a team. There are team members that responded to grabbing your face mask and physically challenging someone, versus your teammates that they more respond to put your arm around them, support them, ask them what they need and be more of a friend. It's one example that many people relate to having play sports throughout the years. Your various team members are going to communicate differently. They're going to absorb knowledge differently, and they're going to respond to challenge differently. Learning how to address and communicate with each team member will help you build that culture. That also develops trust because as you're getting to know your staff, you're developing trust.

I was talking to another client about creating culture. It's something that owners might think comes naturally, thus there's nothing special about it. As he's developing and writing out policy and procedure, I told him, “It's as important to be intentional and write out policy and procedure to generate your culture.” That sparked something in him. When we think about culture, we might think it happens naturally because it comes from us who are the leaders, and we generate the initial culture. If we want a certain culture, there are things that we can do intentionally with our clinics to generate more “culture.” You mentioned meetings on a regular basis, how those go, what you highlight, and how you address and communicate.

What I was talking about with him is he enjoyed a lot of crosstalk in the clinic between providers and patients, and patients with other patients. What are some of those things you can do to generate crosstalk? Whether that's a TV in the clinic, watch certain game shows or a sporting event, or a whiteboard that has a nice saying or a trivia. Some of those things can be intentional to generate culture. I'm assuming you would agree that it's almost as important to have things that do generate that culture in the clinic, as it is to make sure people are wearing their name tags and coming in on time.

I'll give a lot of credit to one of my former partners and mentor Skip Hunter. Skip Hunter was a PT and athletic trainer, one of the more fun individuals that you'll ever meet. He said from day one when I started as a staff therapist, "The most important piece of equipment we had in the physical therapy gym was the radio." Having the radio on the created conversation. It created much of the culture that you described. It creates an environment that is inviting that's professional but relaxed. That was the culture that we chose. That might not be the appropriate culture for everyone. Everyone has to choose theirs. We were in an orthopedic sports medicine environment that did encourage communication and cross-talking between clinicians and patients.

One example of how we encourage that, we felt it was important and best for the patient that they get to know other team members on day one. It's important for our clinic to be available to the patient at their most convenient time. If they have a stringent schedule and they need to be there at 4:30, we all know how popular that 4:00, 5:00 appointment is. I can't see everybody at that one time. On day one of the evaluation, before that patient leaves the clinic, I'm going to put my arm around them and we'll introduce them to at least two if not three of my team members. I tell them their name, have them wave and introduce them. I'm going to talk up my team members. I have known this person for 10 years, 5 years, they are one of the best shoulder specialists you can have. We worked together much. When the opportunity arises that is in the patient's best interest that they need to see a team member, it is a seamless transition. It creates that team environment and culture in the clinic. That's one example of something that we emphasize that I felt helped greatly.

PTO 124 | Workplace Culture
Workplace Culture: If there are books that were influential for you, invite your team members to read some of them and discuss what you have learned.

This conversation has gone in a different direction than I thought it would go. I thought we were going to talk about some KPIs, what the important ones are, and how we need to do that, but we ended up talking about culture and the importance of it, and I'm glad we did.

That's the mechanism that allows you to pursue the goals that you set, the KPIs. To jump back to our initial topic, the planning process allows you to drill down to the KPIs that you believe are most meaningful and are going to have the greatest impact on your organization. At the same time, it also helps you stay focused and know when to say “no.” You can't do everything all the time. If everyone on the team has agreed that these are the goals, these are the KPIs we're focused on, and we're not going to get sidetracked with the latest and greatest idea over here. This is what we're focused on, and this is where we're going to work towards in that alignment. The culture that we enjoy talking about fosters the ability to work towards those common goals.

As you have a team and a culture like that, then you can say, “We're doing our patients a disservice because only 20% of our new patients are completing their full plans of care.” The team is going to recognize. You talked about why that's an important statistic that we need to measure and how it affects our patients in our business. You get their buy-in and a sense of urgency, and then you work together. You can generate a plan as the owner, but as you start talking about it and get their feedback and input. We talked about how we're going to measure this and see for making growth and progress towards our goals.

When you have that culture that tends to stay in place and setting up some structure from the ownership side and being intentional about, “We're going to measure it at this stage. We're going to measure it the next month. We're going to address it at this meeting. We're going to see how we're doing, and we're going to have this conversation.” Having that structured implementation and a strategic plan on a solid culture keeps those statistics in front of mind, then you can see some real progress and change.

We enjoy talking about culture. In general, when you talk about culture, you start with the fun part and about the fun aspect of culture. There's a significant business professional aspect to culture. That's accountability. Accountability has to be part of your culture. Your entire staff needs to be aware of expectations beyond the only time and your patients like you. The expectations of every third Tuesday of the month, we're having a staff meeting and we're going to review the prior month. Every Monday at 12:30, we're going to have a fifteen-minute huddle to review our KPIs from the previous week. We do that every week. That's what we do. That's part of our culture. We're open and honest about, “My KPI of arrival rates slipped last week. Why in the world did it do that? What I could have done differently?” That conversation quickly expands to, “How can we as a team help each other manage?”

I had this conversation all the time. If you've worked in a clinic, your schedule never happens the way it looks at 8:00 in the morning. You get your schedule, and you see it's nice, and however often you schedule it, be it every hour, every 30 minutes, every 45 minutes, whatever you do, it never happens the way it looks. Things go haywire, people show up late or they cancel. That's where that culture of teamwork helps you achieve efficiencies that help drive those goals. The professional business aspects of culture boil down to accountability and the frequency and follow up. Everybody has these great either end of your meetings or beginning of your meetings, “This what we'll do next year.” A month later, everybody’s forgotten about it. The problem is you have to engrain accountability into your culture, so it does stay top of mind.

Meetings are a huge part of that. There are many clients that I talked to that don't have regular meetings with their team and with their leadership team to expand it out, or even with their billers. They should have meetings with their billers. It's in those meetings that you have the opportunity to maintain traction towards the goals and you take that. What we're talking about is a year-end projection, and you break it down by months and like, “How did we do in the past month? What are we going to do this next month to improve that? This is where we are, guys.” That meeting rhythm is important to the growth and acceleration and progress of the company. I love that you shared that. When we think about culture, sometimes it's about the fields, the atmosphere, the parties and how we engage with people, but there is a business culture that's also a sub-part of culture. That business culture involves regular team meetings, one-on-one meetings, and how we act and perform and how we hold accountable. I love that you brought that part of it.

That made me think of one of the obstacles. It's common that many times impedes the ability to have frequent meetings is accessibility and visibility to your KPIs. One thing we talk about with offices is, what's your visibility? How can you extract information from your system? Can you drill down to the individual clinician? How frequently can you calculate the arrival rate? Can you calculate visits per day for a clinician? It is common in any team and industry, if you put a handful of teams of individuals together and there's a team, you're going to have high performers. You're going to have middle of the road, and you're going to have those folks that you have to bring along. That directly impacts how you coach and what you do.

For example, you have a clinic and you believe they're a little bit low on arrival rate. “We can do better.” If you address that clinic as a team, say, they're five clinicians. You're addressing the team and challenge them, “This is what we need to do.” If you never drill down and see the details behind that number, you may see that you have three that are 98% knocking it out and they love it. There's one person that may be at 82% or 80% bringing down that number a bit. You're spinning your wheels because your high performers believe you are lumping them into the problem when they're not. Visibility to the KPIs and to the numbers, and correctly identifying where the opportunity is, and then addressing the opportunity as a challenge, but also thanking your high performers. Don't lump your high performers into the problem or the challenge. Thank them and then incorporate them into how they can impact, influence, and potentially lead the other folks that need some support.

A culture that will accept change and challenge is paramount to the success of any plan. Click To Tweet

I love talking to owners about their accessibility to numbers, and can they get the statistics that they need. Many EMRs aren't that capable, unfortunately. Some of them are behind the curve, but to get that down to an individual practitioner level is huge. You could be cracking the whip on your whole team like, “We're trying to get to 92% arrival rate and we're stuck at 90%. What's going on?” The high performers are like, “I don't know. What more do you want me to do.” You shouldn't be cracking the whip on the team but drilling down to that individual provider. It's equally important that they are capable of being able to track and find their own individual numbers so that they can see what their scorecard is. There might be only 1, 2 or 3 KPIs that you assess some of your providers on, but getting them to know the system well enough that they can see their own numbers can be labeled, so they can see how well they're performing.

Accessibility and visibility, and then understanding which ones. Not to get lost in the big picture because you can be overwhelmed with too much. That's where the focus of what we are working on is important. Something that gave me another thought is that you use the word intentional. One of the more common obstacles that I experienced and that I hear from many owners is the inability and the unwillingness to sacrifice treatment time or clinical time to designated time to work on the business. If you're expecting accountability, the frequency of the meetings with your staff, the owner has to set that standard. They need to schedule time weekly, be it 1 or 2 hours, be it in the afternoon, whatever it may be that’s appropriate for that size of the organization. It needs to be scheduled, uninterrupted, and standardized. What am I doing with this time? Where do I start? Where do I finish? What am I going to focus on? The shotgun approach. I have learned from my mistakes many times. Life became easier when I followed that mantra and learned from many other people.

Do you find that it's hard to convince some owners to take away productive time and hours from the clinic to have a meeting? I do. I'm wondering what you do to change their minds or convince them otherwise. What do you say?

That goes back to calculating your return on investment. If you're saying, “If we move these visits per day,” or whatever KPI is, this percentage point over the period of time, the cumulative effect of doing that compared to one visit once a day and you compare the time. You do the math. Easily, you see if you improve a KPI over the course of the team. You compare those two. It’s easy to see the benefit of creating long-term efficiencies versus squeezing that one patient in that one day.

I have to challenge the clients to do some of the meetings first. They understand the reasons why they're doing it because it's going to benefit them and it's going to get the team moving in the right direction. It's not until after a few meetings and their team members are saying, “I don't know what we did. How did we get by for ten years without having weekly meetings? How did we survive as a company?” They finally start noticing that things are getting done, things are improving, and numbers are improving. We're able to do things that we've never done before they finally recognized the value of some of those meetings.

It takes time and commitment. It's not a sprint, it's a marathon. That's also what creates long-term success. It's not a quick fix or a Band-Aid. You have to get over the hurdle of feeling like you've plateaued, and you have to stay the course. That's where you're going to appreciate the growth and the improvement over time. Many people get a little fatigued, “We're not making progress. We're still pushing.” It’s the commitment, accountability, and consistency over time that makes a long-term impact. Ultimately, it’s going to create value.

Those consistent little actions are eventually going to get us to that goal and that ideal scene that we want at the end of the year, but we have to stay the course and stay consistent. That's where those regular meetings, holding people and the team accountable, over time, we'll eventually see bigger goals being achieved. We've covered a ton of stuff. Jim, is there anything else that you want to add as we start wrapping things up?

I could go on forever. I enjoy the topic. We've proven that one topic leads to another. Many different aspects are intertwined. Bringing it back to the core of strategic planning, just as our conversation flow to many topics, that could also happen with an organization. You can get off track with chasing different topics and different goals. A strategic plan helps you focus on what you have decided is most important in this period of time for our organization. It helps you provide focus.

PTO 124 | Workplace Culture
Workplace Culture: To understand how to communicate with your entire team, you need to know your team members.

If people want to get in touch with you, how can they do that?

My email is Jim@8150Advisors.com.

A simple Band-Aid fix cannot attain long-term success.A simple Band-Aid fix cannot attain long-term success. Click To Tweet

I'm going to do another interview with you. We're going to talk about something else that you're passionate about and you've had a lot of success with, and that is the utilization of athletic trainers and coordination with physical therapy clinics.

A little bit because we’re sports medicine in orthopedic clinics for so long. We've had experience with athletic trainers. I was a co-founder of a nonprofit organization entitled PlaySafe. We did that because taxpayer funds, state allocated funds for public schools are not allocated to public schools to hire athletic trainers. We tried to come up with a better way and a more sustainable way to help fund and provide athletic trainers beyond one entity, a PT clinic, a doctor's office or a hospital hiring them all. It’s an interesting topic and it's a passion of mine as well.

We'll wrap this episode up and use that as a little teaser for those interested or who have athletic trainers on staff and how they can utilize the program you guys have started. Nonetheless, thanks for sharing your wisdom and being a part of this.

It’s my pleasure. It was a lot of fun. Thank you, Nathan.

Thank you.

Important Links:

About Jim Stoker

PTO 124 | Workplace Culture

Jim has over 25 years of management and leadership experience in the healthcare industry and is passionate about helping owners reach their full potential. Jim specializes in strategic growth and clinic optimization of key performance indicators and clinic metrics achieved by creating an engaged employee culture of teamwork,
excellence, accountability, and leadership
development.
His experience includes Partner and SVP of Clemson Sports Medicine and Rehabilitation, where he and his partners grew their practice from 3 to 30 clinics culminating in a successful sale in 2016. Jim also served as VP of South Carolina Operations with ATI Physical Therapy, President of The South Carolina Chapter of APTA. He also co-founded and serves on the Board of PlaySafe, a non-profit organization that provides Certified Athletic Training and Sports Medicine to secondary schools.
 
Jim holds a MA and BA in Exercise Science from Furman University, a BS in Physical Therapy from the Medical University of South Carolina, and he is currently pursuing a DPT from the University of Montana. Jim resides in Easley, SC with his wife Eleanor, 2 children, 3 dogs and their parrot.

Love the show? Subscribe, rate, review, and share!

Join the Physical Therapy Owners Club today:

 

PTO 122 | Sustained Growth And Success

Brandon Buehler, PT is routinely asked, "What is the secret to your success, especially in a difficult PT market like California?” To that question, he responds that he keeps his focus on truly living their practice’s purpose and values, and infuses those into discussions and staff meetings. He joins Nathan Shields to explain how this enabled them to establish a team culture that has grown from within to establish seven clinics in southern California. Brandon admits it takes a lot of hard work, but the added effort to establish solid and living purpose and values is what makes it fun and fulfilling.

---

Listen to the podcast here:

The Secret Sauce For Sustained Growth And Success With Brandon Buehler, PT

I've got a guest on that I've wanted to have for a long time. He's part of the network that Will and I were a part of as we grew our clinics over time. He was in a group with other people on my show that I've had before like Vinod and Blaine. I still haven't had the girls on from Magnolia, Amy and Lisa but these were all people that we looked up to. Brandon Buehler, who is the President and Founder of Coury & Buehler Physical Therapy in California. He’s one of those people I'm excited to have on. Finally, after a couple of years of doing the show, I've got him on. Brandon, thanks for joining me. I appreciate it.

It’s my pleasure. Thank you so much for inviting me.

I'm excited to bring you on because you guys have been successful especially in a difficult area of the country in California. I think when we knew you back in the day, you had maybe 2, 3 clinics and now you guys are up to seven. You've been successful in your model and I've always looked up to you guys because you've always been well-founded. That's a lot of what I want to talk about with you because I know that's the basis of your success. Before we get into a lot of that, do you mind sharing with us a little bit about how you guys got to where you are? A little bit of the story of Coury & Buehler Physical Therapy and what's made you guys successful?

I'll show you a little bit about how I got into physical therapy and then how that led into the birth of Coury & Buehler Physical Therapy. My route to becoming a physical therapist was a circuitous one. Initially, I had no idea what I wanted to do. I went to UCI and it was an engineering major. I was good at math and science so I figured engineering sounds right. I started in that and I did well. I enjoyed it but towards the end of my first year in college, I got in a bad car accident and suffered a bad back injury. I had pain for months and when I saw multiple doctors and MRI. I was referred to different specialists and medications thrown at me like crazy.

It wasn't getting better. I'm like, “This is crazy.” A friend of mine said, “Have you tried physical therapy?” I said, “What is physical therapy?” I had no idea what it was. I went to physical therapy and within one week, I was already starting to feel better. Within three weeks, I said, “This is what I want to do with my life. I can be an engineer of the body instead of an engineer for other things.” That's led me down the path. That's one of the reasons that I'm passionate about our profession. We can help people naturally that we don't have to be spun in this web for months or years of pain until they find me getting physical therapy as we hear it all the time.

A patient had five years of headaches within about a month of treatment with us, the headaches gone and tears rolling down her eyes. She asked me a common question we hear from a lot of people, “Why didn't I get it earlier?” That's a good question. It is something that us, as a physical therapy community need to solve. Why few people getting into us? Why are they seeing specialists, MRI, surgery and medication only to often fail that and then come to us?

We fall short in that regard. The marketing efforts of physical therapists over the years have been so focused on, “Talk to the doctor and get that referral from the physician,” that we've failed as a profession to market what we do to the communities at large. Even nowadays, I've been a therapist for many years, the question continues to come up like, “What makes you different than a chiropractor? Are you a massage therapist? What do you guys do?” Many people don't know and that's a failure on our part.

One of the sad aspects of our profession is we all feel like we're competitors. It's a crazy thing. In my world, we see such a small percentage of our community. We're always worried more about our competitor down the street doing the fact that 99% of the people in the community aren't getting into either one of us. We work to band together. We couldn't handle the business we have, instead our patients are going to a chiro or getting MRIs, medication, surgery and seeing specialists. It is something we can work on. What you're doing, Nathan, is you're working on that. You're trying to bring people together and through consulting, networking and these types of podcasts. Other people who've been here like me are sharing some similar ideas.

That's a lot of what the pandemic has led owners to do is to not focus on physicians because that physician pipeline essentially got cut off in a lot of places. How are we marketing now to get those referrals in the door, to get those patients in the door and see them because people are still getting injured, whether we have lockdown or shutdowns? It doesn't matter. They still need physical therapy. A lot of my shows have been about how to use social media, how to do the direct to consumer marketing route and spread our message so that we don't necessarily rely on physicians to also get it out to the people that physical therapy is available to them.

PTO 122 | Sustained Growth And Success
If we combined our efforts and promoted our profession, that alone would have a dramatic influence on all of our business.

Imagine if our profession, all of us, whether they're next door or the next city over, if we combined our efforts and promoted our profession. That alone would have a dramatic influence on all of our business. The concept of rising tide would in full effect on that. That’s my story about becoming a physical therapist in terms of how Coury & Buehler Physical Therapy started. My founding partner Rich Coury, we met as I was doing internships at a place and we became instant friends. He was maybe a couple of years ahead of me. We weren't far apart in age. We clicked and connected as friends. I finished up there and started working somewhere else and he was working somewhere. We would hang out a lot.

We would grab drinks or lunch. He came over and hang out with my wife and me. We were friends, but we also were both passionate about the profession. We would spend many evenings talking and dreaming about, “What if physical therapy could do this? What would it be like if the place we worked at providing this type of care? Is this constant dreaming envisioning of the ultimate physical therapy company? What would the dream vision of a physical therapy company look like?” We talked and talked. I remember one night my wife saying, “Are you guys going to keep talking about this or are going to maybe follow up on these dreams? You seem like you have the passion about it.”

Rich and I met one day and said, “This is the time. We have this vision. The physical therapy model that we think is better and will provide better outcomes and results for patients. Let's do it. What do we have to lose, my house? That's about it. Let's move forward.” It's been a fun ride. Since then we've grown since day one and that was about many years ago. During the first couple of years, we found that to be a challenging time but we grew quickly early on I think just because of our good looks and our charisma with treating.

We hit this wall where we're kept. We felt like we're limited in what we could do. We didn't know what to do and how to get to the next step. That's where we started luckily to meant that we needed help. At that point, we got some consulting. We started networking with incredible physical therapists like yourself, Will, Vinod, Lisa and Beth and all these great therapists. Getting help from different people, talking and reading books, taking on the posture from that day forward of being a learner in terms of not as a physical therapist, but as a business owner and practice owner who wants to improve the profession.

That's something that I've always loved about you is that you've always come from a place of so much wisdom. I've read books that you've recommended to me during the course of conversation. I don't even know if you remember that you've recommended books to me, but you've been someone who's always been looking for more information. You are a learner trying to absorb as much as possible to improve yourself, not just professionally, but also personally. That's kudos to you and it goes to the typical pattern of a successful physical therapy owner that I've seen in 99.5% or 100% of the successful PT owners I interview. They recognize that they need help.

We didn't learn any business things in physical therapy school essentially, so we need to get some business acumen. Networking is huge in that regard and helping you know that, “I'm not in this boat alone. There are other people who have done some successful actions that they're willing to share.” The networking alone can be a huge aspect of it. There are always books that can give you inspiration, insight, and that stuff. I'm reading one called Grit by Angela Duckworth.

It's an awesome book. I haven't read about the topic that we're going to discuss but in the course of our discussions prior to this interview, you told me that other owners and younger owners might come to you and say on occasion, “What do you guys do? What makes you successful?” I thought it was great that you came back to we really live our purpose and our values. That's where I want to take this because we've discussed this on the show before not you and I, but other guests about how to establish a purpose. How to establish values and exercises you can take your teams through and how important it is? I know that you guys live that stuff. You guys reference back to it. You use your purpose and values as a filtration system for the choices and directions that you go to and your physical therapy ownership. Tell me a little bit about that. What was the Genesis of finding your purpose and values? Then we can get into, what are you doing to keep it alive and well?

I appreciate you bringing this up because this is something I'm passionate about. It is funny. We have people come up to us often either calling us in PT network meetings or wherever like, “What is your secret sauce or what tricks you got? What are you doing?” Everyone thinks we have some magic thing that we're hiding behind the scenes for our success. Everyone's looking for that one answer. What's that one book that turned it for us or that one marketing guru we're following? We all want that in life. We want the pill that'll make us lose weight. We want the one exercise that'll give us big biceps.

We all know that it's much more than that. It's more complicated than that, but the reality is my answer to everyone is that it's our commitment to our purpose and values. I know it can sound commonplace for people to say that or to throw that out there. For our company, it's been true. I told you about the story of how Rich and I started the company and his dream, but a lot of our dreaming and visioning is starting to talk about our purpose, vision and values. Back then, we had no business training. We were young therapists. We didn't know what it meant to create a purpose statement and core values, but we were smart enough to know that those things mattered.

In a small business that experiences ups and downs, having a stable and lived purpose and values is like a lighthouse in a storm. Click To Tweet

We started talking a bit about it. We didn't necessarily use the word purpose and values, but we would talk about what we wanted to be about. We talked about how we wanted the company to operate and the type of people we wanted. We started in those early days formulating our purpose and values and the same concepts from day one before we started the company. I was telling people, I started the company about 1.5 years before the company started. It started with Rich and me talking about it and dreaming, visioning and creating these fundamentals. Once the company started after one year or so, we decided to get real fancy and write the things down we talked about. Put it on the wall.

It's a piece of paper. It was a rudimentary version of what we came up with. Those things evolved a bit as we started to find out more. When you're at a company, it's like you go from being a teenager to an adult. Your company evolves and develops. Over time, our values did not change, they matured. What happened maybe about many years ago is our company growing. We also have grown a leadership team, which is phenomenal. We decided to sit down as a leadership team and to relook in a new union of time. We call it our vision statements, purpose, values and BHAG.

We spent a whole day, maybe two days offsite, just looking at that. What we did is we didn't add to it, we simplified it. We looked at every single one and said, “This is too complex. Let's be real with who we are, our purpose and values. Those two are great, but that's not us. Maybe we liked it, we agree with it, but let's focus on what we know we will die for.” We went from maybe 8 or 9 to 6 core values. We refined some of our other statements that we have what we call team creed. We have our BHAG. We have a care statement. We took what we've always had, and we refined it. That's become the foundation. If you want to know what our process for success, it would be those things.

What I want to highlight is you thought it's important that you guys took two full days, one would be enough for me, to focus on this.

Two full days after already having stuff in. We've already met years formulating and refining it. We decided to take two days to refine it on the stage for the next many years to reach our BHAG.

Purpose and values shouldn't necessarily be changed all that much. Maybe they get altered a little bit. As you said, you mature and you change a little bit because life and business environment change over time but you took things and simplified it that sparked a memory in our ownership. We recognize that we spent too many hours in meetings. We simplified and became more efficient in that regard. The same thing, we had these values, but we didn't have any definitions behind them. We took the time to come down to some concise phrases that weren't more than a sentence that describes those values to be more concise and clear about what they meant to the company.

Even though we all had our own individual definitions, we felt it necessary to define what those values meant in our company. What that look like? How does that show up? We also had some other things. We had cultural values as well, that was separate from our core values. The fact that you took much time and were that specific and intentional about it, could you say after doing something like that many years ago, it provided more clarity and maybe even a better foundation, a jumping-off point for continued expansion and growth?

We've always focused on them and made them part of our organization. At that point, it was another turning point in the company where we decided to more fully commit to our purpose and values than ever. At that point, we got more committed to making sure that every part of the organization was ran based on those values or reflect those values. We committed to instilling that more in the company and found other creative ways to make those alive in our organization.

Let's get a little bit deeper into this specific. What are some of the action items you take to have your purpose and value lived through each individual in the clink? How does it get from the owners and distilled down into the everyday actions that even someone at the front desk? If you use technicians to get down to the technician, what are some of those things that keep it alive and don't collect dust on the show?

PTO 122 | Sustained Growth And Success
Sustained Growth And Success: Your company evolves and develops over time. Your values evolve a bit as you start to find out more.

One thing is interesting is you hear a lot of people talk about, “I've done that. I got that.” Most of my friends not in physical therapy, I try to connect with a lot of my friends who have businesses outside of our industry. I love learning from people outside of our industry, but I find the majority of people I know who have done this, it's something they put on the wall. It's like, “We got it in the break room or it's in a policy manual,” which means everyone read at once and then forgot about it. It's a mistake a lot of us make. Purpose, values and vision statements, those only have an effect on the company if they are ingrained in the fabric of the company.

We talk a lot about Pinocchio at some point became human because he got a soul. We talk about our company is not human until it has its purpose and values breathed into it. Another way to say it is that the personality of our company is based on our purpose and value statements. It's the person that's who we are as a company. We have to be lived and breathed. There are multiple ways we do that. Starting with, first of all, recruiting and hiring. The first entry point of the company starts with measuring every single purpose to our purpose and our values. We use some statements that even our recruitment ads about our company because we want to try to track people who are attracted to that. When we do our interviews, the first questions are all against our core values and our core competencies for that position. Right off the bat, we're asking questions based on each of our values because we try not to take generalizations or trying to get specifics on how they maybe align with the value of teamwork.

You can say you do, but tell me how and what that means to you and describe it. Based on the initial screening interview, you can get an idea if someone aligns with their values and if they don't, it doesn't mean they're bad or were bad. This is who we are. We sell maturity and growth to do, but we know who we are. We know the type of people we need to bring on. Our companies not for everybody without a doubt. We know who we're for. We are for a certain type of people who align with us and the people who do aligned with our values or our track, they do well in our company. The first thing we do is we hire based on that.

We did the same thing. We've listed our values. This is our purpose. This is how we do things in our company. It's interesting as you do more interviews, I don't know if you're still doing a lot of the interviews, but as we were doing the interviews, you watch body language. As you're starting to talk about values and the people who are bought in start leaning forward a little bit more and they light up a little bit. The people who aren't bought in, you could tell in their body language. They don't care as much. I agree. It starts there. You start discussing those at the forefront and so that they recognize that these are important to us and you can find those people that work well with you. It's easier to do as you do more and more of those interviews.

What's hard in our clinic or with my coaching clients is we'll talk about purpose and values at the beginning. I think a lot of companies go through this and that the owners get this bright idea that, “We're going to establish purpose and values.” Two to three months down the road, it was like, “Did we talk about that one time? I forgot.” It has some initial momentum and then falls off. I know you guys do more about that and you're going to share a little bit more with us. I just want to interject a little bit, but go ahead.

Once we hire someone based on our purpose and values and someone we think is aligned to that. The first thing they do is go through a training course on that. It takes them several hours. They could read the purpose and values, but we created a several multi-hour course that takes into the reach component and goes in-depth on what that looks like. We even have some fun video examples. We'll read. We're trying to impress that into them. It's one thing to say teamwork, but what does that mean? What does that look like? We try to press that into them and then have them answer questions. Not just like ABC, but some essays. They got to think about it and write it down because we want people to process these things.

That's the next thing. They go through that and during their onboarding, we're making sure that they understand and agree with it. There have been times where maybe we brought someone on and then during the training we realized, “I don't think they're a good fit. We're finding maybe they don't align with these values.” That's the initial thing we do. During their onboarding, the first few months, their managers are continually watching and making sure this person is the best fit. They continue to match this person to who we want to our purpose. This person agrees with our purpose, this person agrees on these values. Can they live at our team creed? If they don't, they're not bad. We're not bad. It's like, “You are probably not a good fit. This is who we know we need and I don't think you align best with this. You'd better in a different setting.”

Those are some of the easiest firings, aren't they? When you do a value-based firing like those actions that you're doing or performing aren't living up to this value. You're not exemplifying teamwork when you act in this manner. If professionalism was one of your values, it's not professional and we can't tolerate people who come in late consistently. That goes against professionalism. We're going to have to let you go. You're not a bad person. We don't tolerate people who don't align with the values.

Most of our hiring are more based on values these days. Those are the big things. Beyond that though, the question is how do you make it a day-to-day part of the organization? It’s because it has to be and if not, it'll become that type of thing where like, “What did we want to talk about? Isn't it on the wall in the break room?” There are multiple ways we do this and different things we experiment, try and have fun with. I'll go through some of the different ideas. One, we have a display. It's displayed everywhere. It's on our website. We don't hide it. It's in every one of our clinics. It’s somewhere were patients could see it. It's in different admin areas or breaks rooms. It's displayed to remind people. During our weekly meetings, we try to focus on a different value each week that we were cycling through them to continue to drill through. Maybe every couple of months, they're getting back through the cycle.

The secret sauce to our success? It's our commitment to our purpose and values. Click To Tweet

You're talking about and maybe, “Have a short couple minute discussion about a particular value.”

A real quick and maybe a minute or two. This is the night of the week. You talked about it. Maybe share a win based on it. Maybe we'll take a couple of minutes and camp on that and have a quick discussion about it or bring up a patient experience on that and things like that. We do a weekly email from one of the founders, Rich or I. Every email we always try to highlight or one of the values of the week and talk a little bit about that or maybe share a story about that trying to interject that into it. Our HR manager sends out a weekly value of the week award winner. Another great way to promote either a purpose, one of the values or one of our vision statements. Somebody who's living out one of those aspects. They're getting recognized and sharing a fun story about them. It's a sneaky way to remind people of that value because we'll get your coworker to live this out. Remember, it's one of our core values and that's part of our purpose.

We did the same thing. We didn't do it anything weekly like that, but at our annual parties, we would have a value award for a particular employee and highlight some of the things they did over the course of that year that exemplified that value. I'm sure your HR person is doing that same thing but on a weekly basis. This person exemplified blank because they did blank, that exemplifies this value. I think that's great. That recognition brings that to people's minds, especially the receiver of the award.

Our leadership team met and we are starting to finalize our awards for our annual Christmas party. One of the big aspects of our awards is our value awards and we give out awards based on each value. I worked on that and coming close. That's another way to do it. Those are some of the main ways we do that. Each manager during reviews or the reviews are off that's part of the route integrated into the review process as well. We're always finding fun ways to interject that in or sometimes we'll send out a random story or video to remind people of something.

We did the same thing with our reviews. It was not only value-based recruiting and hiring and value-based firing and value-based reviews. In our reviews, to get a little bit more specific, we would have the person that we're reviewing fill out essentially the same sheet that the supervisor would fill out. That was here are the values. What did you do in the past year, six months or whatever the timeframe was to exemplify those values and maybe even give yourself a score or maybe on some other things? The person who was being reviewed would say, “These are some of the things that I did.” The supervisor would say, “These are some of the things that I've seen you do and how can you improve on some of those values, live those even better and more fully in the company.” I love that you brought that up. It reminded me that you take values into recruiting, hiring, firing and exemplify on a regular basis, but also bring it into things that might have pertained to a salary increase or a promotion. You want to promote those people and you want to give salary increases to people who live out those values.

One of the best byproducts of this is culture it helps create. We're very protective of our culture. You probably have read Good to Great by Jim Collins. There's one part of his book that stuck out to me. It's one of the most memorable quotes from a business book I've read. He talks about your goal is to have your values infused into your company. He says, “Your culture is so strong. You have a cult-like culture.” Anyone who joins the organization either gets swept up into these values or they stand out like a sore thumb and get injected like a virus.

I'm like, “That's a powerful analogy or description of what it should look like.” You can create such a strong culture in your company based on your values and your purpose where people who joined the team get swept up in it or they stand out. There's no in-between. The people who stand out, it's like that group pressure where you better join and get out. We're not perfect at that, but we see that at times. When we're doing well, you see that and it’s a good place to be. Culture is everything. Your team depends on having been working in a great place, a place they love and believe in. No one wants the drama. No one wants the other stuff.

It takes some years and some intentional effort to get to that point but I know that over time we can develop that culture, such that people have finally gotten to the point where the purpose where they're waking up knowing how they're going to fulfill that purpose that day. Not that they're waking up and going to a job and punching the clock. It elevates things to another level for the people that buy-in once you establish a strong culture like that. These are people that will stay with you through thick and thin, work hard and maybe even for less than where they would get other places because they buy into exactly what you are fulfilling in them and as a company. It creates so much strength.

COVID is a tough time for people. You see everyone handling it differently. Now more than ever, our teams need a North Star, a guiding light. They need to have something to look to. There are a lot of confusion and chaos in our offices. There are frustrations. Everyone's a little bit have difficulties outside of here. There's this challenge and reminding, “I know things are harder. I know we have more in tribulation in our offices, but this is who we are. Focus on this.” We’re headed towards that goal. We just get to look up. I know this stuff stinks, but remember, this is what we're about. We're about changing people's lives. The other stuff settles down a little bit, it’s like, “Compared to that, this stuff's not as important.” People are sick or different things going on because of COVID, but if we can continue to focus on a purpose, it helps people be aligned.

PTO 122 | Sustained Growth And Success
Sustained Growth And Success: Our purpose, values, and vision statements only have an effect on the company if they are ingrained in the fabric of the company.

Has that been a stable thing for you as you've gone through the COVID experience these several months? You have seven clinics and you're a successful guy, but you got bruised, battered and hit like every other PT on are out there. Did you find yourself reflecting back to the purpose and values and may be either shifting them a little bit or relying on them more in order to get through it?

As a company, we decided to close down for three weeks. We decided to mostly because we wanted to regroup. We wanted to decide as a leadership team on how do we run the company? What do we do? We want to provide care but in the safest manner. We took time, but Rich and I were back in day one. We came back to the office and felt like it had to be here. The very first thing we started talking about is, “Let's remember what we're about.” We can sit here, cry, complain and get frustrated. There are all these things we could talk about, but we know what our purpose is. We know what we need to do and let's focus on that.

Sometimes we talk about our purpose being like a lighthouse. You're in a storm and lost at sea, which direction do you go in? You see the lighthouse, you’re like, “I know where to go.” There are many times in our company history for ourselves and our team that that's been the case. It’s like, “We know where the lighthouse is. Let's go in that direction.” We were all bummed out. Seeing our company closed down brought tears to my eyes, but that didn't last very long. Within minutes I'm like, “I'm not going to cry about it. I'm going to focus on what we need to do because I know the purposes. That purpose includes what we need to do for patients and our team.” We started moving forward.

I can imagine that your weekly newsletters over this period of time in 2020 have had to focus more on the bigger picture perspective, why we're doing this? These are the decisions that we're making and this is why and how it relates to where we're going. Did you find that you had to reflect back on that a lot?

Yes.

Especially with the decisions that you were making, were there some things that you changed in your workplace due to the pandemic? Maybe you let some people go or you changed some things around on how you treat but still, you bounce those things and filtered them through the purpose and values.

We did have to make some changes. The biggest change was changing our treatment model to have less people in the office at one time. Administratively spacing people out. We have a lot of moms, we had to support them. Some couldn't come back to work yet. Some needed to work from home. Shifting things around. We're often comparing things and decisions against the purpose, but this is a time where we at it continually do that and remind ourselves of this is what we're about. This is not best for the business, but this is who we are as a company. This is our hardest decision based on revenue, but this is who we are as a company. We need to make this decision.

When you first established your purpose and as you've refined it over time, I wonder how you defined it. As I'm working with my coaching clients and I asked them their purpose which has something to do with, we provide great physical therapy care to the residents of blank. I want to tell them, “That's what you do. That's your job as a person and as a company,” but it's more about the why. I'm wondering if that's how you've thought about your purpose over time and came upon it. It was like, “You do physical therapy, but for what purpose?” It goes back to a higher purpose which I talked about with a 30-minute key and that is helping people live pain-free. If that was your higher purpose or support the surrounding community so they're healthier. How you go about doing it is you provide physical therapy. How do you define purpose and how it helped you clarify what your purpose was?

We're on the same page. We have always seen purposes as the most important question. The purpose for us is the, “Why.” That is the first and foremost, question decision that any business makes to help make all the decisions under that. You see a lot of businesses in our industry and not in our industry, start a business and they haven't made this decision and they're making these decisions. The problem is these decisions can be right or wrong. If they're not, they don't know they don't figure out the why. When we came up with a purpose, that was the thing we were talking about, like, “Why do we exist? Why are we here? Why are we doing what we're doing?”

Those are the overarching type of theme. What we also decided is we felt like our purpose needed to transcend our industry. I feel like your purpose is in your industry. It’s not as bad. Our purpose is to help people out of pain and that’s awesome but we felt like, “Maybe our purpose should be bigger than that,” because it takes us out of the industry and is more important in our industry. Our purpose is to enhance the lives of people in our community. Our focus is helping our patients get out of pain, this includes our team and the people around that you work with even vendors. Vendors come in to enhance our lives. Whoever we're dealing with. The neighbors in our building, let's enhance their lives. It gives us a little bit of a different perspective on what we do overall.

The personality of our company is based on our purpose and value statements. Click To Tweet

As people start defining their purpose, it becomes less about the physical therapy they provide and what they can do for other people's lives and broadens the influence to not just the patients. As business owners, we want our team members to feel a certain way, to have a certain experience and experience a certain culture. We want to be the ones that establish that culture to better their lives as if we were working on a patient one-on-one. We want to enhance their lives and we want to enhance the patient's lives and thus affect the community in multiples. As you establish that purpose, it becomes less about the physical therapy itself and the care that you provide, not less about that, but to also include the workers, the people who are supporting you and the people that you interact with in helping the vendors, the workers at the physician's offices to include everybody that you come in contact with. It expands to more and more people.

Everyone in the team and what our position is can be part of that purpose. It's bigger than just helping patients in pain. Enhancing lives may look different for each person in our company but we can all be a part of that.

Were there some books that were influential to you in regard to purpose? You mentioned Good to Great but were there others that guided you along in that regard?

All of the Jim Collins books touch on that. Simon Sinek’s Start With Why and the Scaling Up book as well. There are others, but those helped formulate some of our thinking.

Is there anything else you want to share in regards to the purpose and how you guys live it and breathe it in Coury & Buehler?

It affects and influences most of our decisions. In terms of how we run the company on a day to day basis. Big decisions we're making in terms of a standard to measure our company with. Rich and I, when we meet, sometimes we check each other on this. We'll be talking about things and be like, “Remember this is our value. Does that align with that? We talked about this, we know what we're about.” We check each other all the time. If we didn't have that, we'd be making dumb decisions.

One of the things I'm most proud of is our company is, it's not Rich and I, we have a team of partners. That came out of Rich and I, when we were going through our purpose and values realizing that there are a couple of values that compelled us to expand the ownership team. We had some incredible physical therapists that we felt like based on what our purpose, our values and some of the things that we want our culture that we needed to provide that opportunity for them. That stemmed out of the purpose and values that we’re going through.

That's the easiest route to expansion is to find those people in your company that you've not only vetted but figured out they align with you. There's a great Jim Collins phrase, “You find those people who are truly aligned with you.” It's to expand when you have those people on your team and open up other clinics, grow or provide them leadership opportunities. It makes growth so much easier and fulfilling.

It's fun to see them grow and reach their dreams.

PTO 122 | Sustained Growth And Success
Sustained Growth And Success: The people who align with your values will do well in your company.

You provide that foundation from which they can build off. It's not there unless you have those purpose and values and have them well-stated because they've been with your company for a period of time. They align with you through all the decisions that you've made with them over time. To help them expand and start up a satellite clinic and get the next clinic going. They're simply living those purposes and values. You don't have to train that up all over again. They continue the cycle all over again. That makes it so much easier.

We've never brought someone from outside for a higher position. Everyone starts in a position. Anyone in management or above has grown up in the company. They are moved up in our system.

Thanks for your time, Brandon. It was great to have you on, you've got a wealth of knowledge and wisdom. I finally got you on the show so you could share that.

Thanks for having me.

Do you have any contact information you can share or a website people can go to check out your clinics?

My email is BBuehler@CBPhysicalTheraphy.com. My cell is (714) 345-0426.

You've grown a ton. It's impressive. You've always been someone that we looked up to. I'm glad that we could tap into some of your wisdom. Good luck with everything. 2020 has been a tough one but I know you guys are in a great position to withstand it and grow going forward.

I appreciate what you're doing for our profession. I love your podcast. I love that you're helping coach and consult for other physical therapists because our profession needs that. Kudos to you for what you're doing for our profession and for all the help you're providing for physical therapy private practices out there.

That's nice of you. I appreciate that. Coming from you, that's a huge compliment. Thanks.

Important Links:

About Brandon Buehler

PTO 122 | Sustained Growth And SuccessBrandon decided to become a physical therapist after being involved in a car accident and had to go through months of treatment in order to return to playing soccer in college. After experiencing how physical therapy helped him return to his normal activities, Brandon decided that this was the career that he wanted to pursue. He has a passion for helping people return to their sport or daily activity without pain or limitations.
Brandon has extensive training in orthopedics and manual therapy through the Institute of Physical Art. He places high value in continuing education and training at CBPT. Brandon emphasizes the importance of quality and personalized care with one-on-one treatment for every patient.
Brandon is also the co-founder of POISE (Prevention of Injury and Sports Enhancement), Richard Coury, MPT, assisting athletes in preventing injuries, helping them in full recovery to their sport and improving performance on the field or short.
In his spare time Brandon enjoys spending time with his wife and kids, running, working out, hiking kayaking & paddleboarding.

He enjoys spending time with his close friends, especially enjoying a meal from his barbeque.

As a native Philadelphia, Brandon is always on the way to pizza.

Love the show? Subscribe, rate, review, and share!

Join the Physical Therapy Owners Club today:

PTO 123 | Druid Hills Physical Therapy

 

Over the past three months, Dr. Avi Zinn, PT, the owner of Druid Hills Physical Therapy, has made some big moves. He’s hired a new PT, signed on for another year of consulting, and switched his coach. He also continued to refine his processes with a new Prompt EMR and a new billing company. Thus, he has continued to grow his practice and has not had to step back into treating or be physically present in his clinic for a full day since March. Much of his hard work to establish systems and work on his business for the past couple of years is paying off for him, basically setting him to be a top-ranked PT in Atlanta, Georgia. Listen in as he shares these improvements with Nathan Shields.

---

Listen to the podcast here:

Reality Episode #4 With Dr. Avi Zinn, PT

This is Reality Episode 4 with Avi Zinn. We've followed Avi here in 2019. We followed you because you are a newer owner. We first got in touch because you were looking for some consulting help. If you want to hear about his story and whatnot, you can go back to the first episode. You decided to go with a consulting company. You've been with them since 2019. You have seen great growth in yourself as an owner and also in your clinic. We want to come up to speed.

In the last episode, we talked about how you got through COVID and how you're coming out. You’re optimistic about how things were going in general. Atlanta had opened up from lockdowns. You were projecting to continue to grow and bring on another PT. I’m excited for you in that regard. Bring us up to speed. What's been happening? We can talk about some of the trials that you might've had and some successes you've had as an owner over this period of time?

A lot of stuff has been going on since the last time. The biggest thing I listened back to our previous episode and I was talking about hiring on a new PT. The majority of what I was focusing on around that time was trying to figure out when the right time was to bring the new PT on because it was during COVID. It was hard to decide when things were going to feel like we're back to normal and clearly, we're not back to normal. We decided to go ahead and make the decision. Finding the right person is always challenging. It took a while, but I was able to find the right fit and we were able to get her started in the middle of September 2020.

Let’s talk about a few of the details if you don't mind. You were trying to figure out when was the “right time” to bring them on. What were some of the numbers you were looking at? What were some of the thoughts that were going through your head to make you decide to finally do it?

As a coach, you would not necessarily think I went in the perfect way. I didn't fully look at all my numbers to see that we were at a good utilization percentage or this and that. I got a sense by looking at the schedule and feeling that we were full. The world started opening up, we were getting more people wanting to come in, so it felt like we were busy and we need to hire on.

I assume you were seeing a jump up to a different level of new patient numbers or a consistent high total visit numbers.

It’s more total visits and new patients have always been about the same and that's also an indication of needing a new PT. When you get new patients but you're not getting more total visits. It’s because the PTs are discharging or too early. Some patients are falling off because we're too busy trying to get the new people when we can be focusing on the ones we have.

You got a sense that with the new number of new patients that you had, you weren't being as efficient as you could and getting them in for the 2 to 3 times per week or giving them a level of attention to the patients. Sometimes patients don't feel comfortable when the clinic is completely full. There is no table to do your exercises or they have to wait for that. You lose a little bit of patient engagement. You got some of those senses.

It was a few of those. Because of COVID, we've spaced out our clinics. We only do one patient at a time and there's not a space issue with that, but the therapist schedules were getting full. The patient engagement was more like we were letting people drop off and not having room for people and retaining them.

What were your concerns financially about bringing on someone? That's always an issue when I'm talking to newer owners. It’s like, “I've got to bring on this salary and the benefits for this PT. How is that going to impact me?” Had you worked that out or were you feeling uncomfortable?

I was feeling comfortable basing it on what it seemed like the influx of new patients and we were getting full. There were concerns with any time bringing on someone new. You’ve got to fill their schedule, spend a month or two trying to fill them up and you're still paying them. Luckily, I was able to find someone who agreed to start at part-time for the first month and then at the end of the first month, we transitioned her to full-time. What happened was even after the 1st or 2nd week, I had already asked her to increase her hours because we had enough patients. She was interested and she was happy to increase her hours.

That’s one of the benefits considering the situation that our industry is in. There are a number of PTs that are looking. I don't think that was the case in 2019. I don't know how many PTs would have been okay with starting part-time and then ramping up as they go. There’s an opportunity now for owners to bring on people slowly to build up their caseload that wasn't quite there a few years ago.

PTO 123 | Druid Hills Physical Therapy
Druid Hills Physical Therapy: When you get new patients but not more total visits, it’s because the PTs are discharging too early. We're too busy trying to get new patients when we can focus on the ones we have.

 

It allowed me to choose someone who I felt was a good candidate because there are a lot more people out there looking for jobs. I was able to find someone. I knew I had a little time so I didn't hire because I needed to fill a spot right away. We did get a little busy waiting to bring that person on, but I knew that I wanted to find the right person. That was what a lot of the work I was doing with the coaches. I've got my original coaching group, the Lighthouse Leaders, which is what we've been talking about most of the episodes.

Additionally, we talked about in the last episode where I hired Will Humphreys’ billing team. He also does coaching with me as well. I've got two coaches. I’ve got the coaching group and Will. A lot of what we've been focusing on is the mission, purpose, vision and values. Bringing on this new PT, I was able to make sure that she was aligned with our purpose and our vision. Making sure that she was the right fit for our team and not hiring someone because I need someone to be a PT in the clinic.

Was that a different process for you than what you've used in the past?

It was. Will helped me write some of the ads. He’s good. What did we write in the ad was about joining a team that is committed to values and purpose. Do you want to be a part of a team? Phrasing it that way. It gets better candidates because they are attracted to those specific things. I hadn't done it that way in the past.

Did you find that you got better candidates and people that were more engaged?

What’s interesting is that in March 2020, I was about to hire someone on. It didn't end up happening because of COVID and everything. Even with that candidate, she seemed like a good candidate. I was about to hire her, but it was something different when we spoke about the vision, purpose, future, growth and goals whether or not the other one wasn't the right person or not. It's hard to say it didn't happen anyways but this time, it felt different.

As you went through the hiring process, could you tell the candidates that weren't aligned or not engaged when you talked about values and whatnot? Did it help the filter system a little bit?

It made sense why I was doing that. There was one guy who clearly needed a job, which is fine. I don't blame him but all he was focusing on was specifics of like, “I want to work and I want to get paid.” Not anything more than that. That’s not what you want to say in your interview. Even though I was prompting him to talk about some of these things, he didn't align with or didn't buy into it.

If people are uncomfortable in that position when you talk about values, if their body language changes or they pay some lip service to it but you see something different in their job shadow, that tells a lot. When you put them up against the values, hold them to it and have them verbalize things related to your values, then it's almost like they self-select because they can't use the words if they're not aligned with the values. It comes across junky. You can always tell they're not comfortable. That helps a lot when you're going through that hiring phase being clear about those values and having those discussions.

You get a sense that they're authentic, sincere and it's someone that will be a good fit for your team because you can tell that they want to be a part of a team.

Not to spend too much time on this section, but it's awesome that you went through that experience. The part-time part of it is cool as well that she was coming on part-time for a couple of weeks. If it didn't work out over a 2 to 3-week period, you got some support but you're not fully committed so you have an easy out if they're not living up to what you expected.

For the reason of allowing me to ramp up with a lot less pressure.

Congratulations on the hire. Did you simply post something on Indeed and work through that?

You can sense that someone is going to be a good fit for your team because you can tell that they really want to be in it. Click To Tweet

Yes.

You’ve got the benefit of being in Atlanta, but you also have the benefit right now of so many PTs looking for work compared to past years. I'm sure you had so many to choose from.

The PT I hired moved from Houston. She's making a change. She and her sister wanted to both move to Atlanta.

There are a lot of PTs out there doing that.

People are moving from what's going on. You hear about a mass exodus from New York and people moving out of there. People are changing their lifestyles now because of what's going on.

I've heard about it with a client in Cheyenne. I've heard about it with some friends in Ketchikan, Alaska. People are uprooting from Chicago, New York, New Jersey, you name it, to give themselves an opportunity to reset so it's a good time to find those people.

With her moving from Houston, it was super helpful to have Will and his team as our billing company because not only has it been great having them as the billing company. The first main reason is I'm not doing the billing anymore. They do a great job. They have all their systems for keeping track of the billing, claims, deposits, EOB and all the stuff that they should be doing. They also do verification and credentialing. Since she came from out-of-state and she had only worked in a hospital system, her credentialing and all that stuff was way more robust. It was a bigger process to have to completely get her credentialed with Medicare and then all the other insurances. It was a lot of work that I’m glad that I did not have to do.

It's so beneficial to have someone do all that credentialing stuff for you because if you fill out the form wrong or check the wrong box then it can delay that credentialing process so much longer. You'd rather pay somebody to deal with those headaches. Tell us a little bit about also the consulting. You’re still with the same consulting company. You signed up again after being with them, but you're changing individual coaches. Talk to us a little bit about that.

I signed up for group membership or whatever you call it to be part of the consulting group. The year came up and it was time to decide how to move forward. The group has a new lead coach that is not a PT. He’s got a much different background. He’s a CPA and has a lot of experience with business consulting but not specifically in the PT arena. It was appealing to me to get a different perspective from someone outside of the PT realm to see what it could be like.

There's an opportunity there to get a different perspective and not work with someone who might be simply accepting of your reasonings, your thought processes and you haven't worked with him yet. Going forward, he's able to challenge you a little bit on some of those fixed ideas that you have.

It could be. The coach I had in 2019 was great, valuable and we got a lot accomplished. Having this new one to challenge me is exactly what I am looking for. To challenge me, dive into some of the financials and look at our numbers a little differently. In the first year of coaching, I had a lot to focus on other things whereas all the numbers are important. There was a lot of focus on our systems and a lot of things that were not so data-driven. This could be a cool switch with the new one.

That’s not uncommon. Will and I had at least 4 or 5 different coaches over the course of the number of years that we worked together especially if you delve into it a little bit. The CEOs that are out there that have coaches, they'll change coaches every few years to get a different voice and a different perspective. They also have strengths in different areas that you can build off of. Not to say that they're necessarily improving in the coach that they're using each time, but they're simply getting a different voice. Something that speaks to the owners or the CEO’s weaknesses a little bit more. I can see the benefit of that.

PTO 123 | Druid Hills Physical Therapy
Druid Hills Physical Therapy: The company had PTs make videos of introducing themselves talking about their philosophies to be put on the website and use as promotional stuff.

 

I can relate to that in two instances with the previous coach. Chris and Will in two separate occasions both talked about mission and purpose. Even though we're talking about the same thing, the way Will talks about it versus the way Chris talks about it is different. You disattach onto the language that they use differently and relate it to an experience or a construct that you have in your head. It allows you to think and approach it differently. It could be as simple as that. Hearing the same thing but hearing it differently.

As long as people are getting some coaching, that's my greatest concern. I've had coaches that were PTs and most of my coaches were not PTs or in the industry. There are people that have reached out to me to get some input and advice and some of them work with PTs and some of them don't. That’s fine, as long as you're getting some support, guidance and business training, stuff that we didn't get in physical therapy school.

As long as you're simply getting it, that's the first step and then moving on from there to make sure you have the proper systems in place. You're working on the right things at that stage in your business. We’ll have to keep track with you on how the new coach goes going forward. Tell us a little bit about what you've been working on outside of the hiring process. You've got the coach. You switched over to billing with Will as of last time we spoke. It sounds like things are going well in that regard and the other things that you've been working on.

Outside of hiring on the new PT, the billing company and we switched over to EMR so we’re still working with Prompt and they're getting better. They're developing their software and they're coming up with cool things. Every update, they have cool new features. One of the big pushes that we've been doing since Corona is social media presence. We had a little extra time but we didn't have a social media presence.

We’re posting more on Facebook, Instagram, creating blogs, video content and sending out MailChimp newsletter. One thing that we did was have the PTs make videos of introducing themselves talking about their philosophies to be put on the website and use as promotional stuff. To also send out to people so when they sign up for an appointment, schedule their first visit, it includes a video or a link to their webpage and say, “Meet your PT.” They can meet them before even getting into the clinic.

That was an idea that Jerry Durham talks about in some of his podcasts. I didn't exactly come up with that on myself. Including it in the email to introduce before people coming in. Along that same lines of social media is something that we've been talking a lot about in the coaching group, the Lighthouse Leaders, is relationship marketing. It's not the same thing as social media but in a way, a lot of our referrals have been from Google Ads and we do a lot of paid advertising.

I haven't focused so much on making relationships with people in the community. Not just doctors but also trainers, massage therapists, athletic trainers, running groups, or yoga instructor, whatever. I put that in the same category as our social media because we're reaching out to people and we're trying to be connected with more people in our community. We’re trying to widen our audience, try to figure out who our target audience is. We're a generalist orthopedic outpatient clinic. It's hard to say who our target audience is. That’s also one of the things that we have been working on. It’s the social media and trying to reach out to our community a lot more.

How often are you posting social media content? How often are you sending out newsletters via MailChimp?

We’re doing monthly newsletters. We’re posting only once a week. We should be doing more. We’re getting it off the ground. We’re trying to broaden our audience and try to figure out how to get more people to either like our page or follow us so that we can reach out to more people when we post stuff. I don't know too much about the social media stuff as far as using it for not personal stuff but as a business, how to get out there and reach your audience. We're trying to do it and see what happens.

I did a podcast with Angie McGilvrey. She's a master at it. They had a hurricane in Florida, which shut them down and it gave them an opportunity to say, “How do we want to reset our business?” Coming from someone who was not on Facebook at all, no social media presence or whatsoever decided to focus on a certain target audience and do more consistent social media posting, engagement and that stuff. They started like you. Once a week, they'd post something to a particular audience that they wanted to attract. A few years later, they've got a part-time videographer that comes in and they're spending a few hours each week. Three of them are doing different social media things. They’re posting 1 to 2 items a day. It starts where you're at. Putting someone in charge of that so it’s not you all the time and then focusing on, “Who are we speaking to? What do we want to say?”

The interesting thing is, and I don't know if you've seen this as well, but as I talked to my clients, they say, “Sometimes I post stuff on how to do certain exercises, muscles they need to be concerned about, and activities they need to avoid. I'll post something about a dog and the level of engagement goes up to 200%.” Sometimes, it's not always about them wanting to know what you know and you espousing all of your wisdom. Sometimes, it's about staying engaged and posting a picture of a nice sunset once in a while.

We haven't tried it yet but we will.

The cool thing about social media is you throw stuff out there, see what sticks, see what starts connecting, and simply start doing more of that because you find out quickly who's engaged and who's not.

With the right systems and processes already in place, you don’t have to figure everything out every single time. Click To Tweet

You can see if there are 20 likes or 100 likes and go from there.

Have you had any HR hiccups that you've had to deal with? Not that you have to get into details but that things seem to be running smoothly for you.

Things have been smooth. No real issues or HR stuff. We've done HR stuff as far as developing a better employee handbook and some of the SOPs. In regards to the SOPs, our front desk has been with us since 2019. She got accepted to OT school, which she's most likely starting her program in January 2021. Before COVID, one of my PTs were transitioning to the clinical director. We put that on hold, but we're still talking about it and doing some of that stuff. Not officially but me, the front desk and the PT have been trying to develop a strong, solid SOP for the front desk so when we do get someone to fill her position, our systems are going to be much more developed and more efficient.

It should be seamless if we can hire in time that we can have her come in and even sit with the front desk for a few weeks before she leaves, that would be even better. We're working on that type of HR stuff but nothing like disciplinary things like, “Thank God, my team is great.” Part of it is luck and following the advice of the coaches and all this stuff. It’s working on your team, setting up everything in a way, meeting with your team, and making sure that everything is running smoothly and not being a micromanaging boss but also letting the team run the place and all the stuff.

The smart thing that you've done since you started was to recognize that you needed to spend time writing up systems and how things were done. That’s a grind and you're still working that at higher levels but now is when it starts bearing fruit. As you said, the team can run things and you don't have to micromanage. This is where you're working through that hiring process with your coach and Will, and establishing your mission, vision, values. It's the same filtration system for those candidates at the front desk as it was for the PT. You can have the same conversations, you can get into a flow of how that interview process goes, and also gain some experience in being able to quickly weed out those that won't be a good fit.

This is all working in your favor. The fact that you were working on SOPs for a long time. Your systems are getting into place. You've got someone who's at the front desk who thankfully gave you plenty of time, and notice as to knowing when she's going to take off so that you can start preparing well ahead of time. If the next person can come in and shadow your person to be successful and you have two people there working at the front desk for a short period or as long as you like, you're going to be set up well in that transition and hardly see a drop-off.

I hope it works as smoothly as you said. That would be great.

It all goes back to the work that you started doing a couple of years ago in putting together your systems and processes. It’s starting to bear fruit. I'm assuming where you're at, are you treating it all now? What does your weekly schedule look like?

I haven't treated since COVID, since March 15th, 2020 or whatever. I've been out of treating and I've been out billing since April or May 2020 or whatever. It’s been great because it has allowed me to focus on all these things and get some of these systems in place. Before that, I was always working on them here and there, but I've had time to sit down, write them up, get things going, get feedback from the team. Even get their advice on how we should do things and get things set in stone so we can use them efficiently.

You've been an owner for a few years. It took me 12 or 13 years to get to where you are to finally step aside and work on my business, so congratulations on that. What are the next steps for you, Avi? You've been through the process considering the mission-vision values. Part of the vision portion is setting up some goals, longer-term or even shorter-term. What are some of the things you're looking forward to in the next year or two?

I've still got plenty of work to do on the systems and everything. What I do acknowledge is that even in the year of having the coaching, I'm still not dialed into all my numbers. That's also one of the hopes of this other coach, he's got a CPA background and he might have a better sense of financials and stuff. I want to focus more on our numbers, be more data-driven. It goes back to the SOPs, but it goes almost to some of the stuff we were talking about in the last episode as far as leadership team. I've been in the process of implementing where the team reports their stats to me or to the clinic director and then the clinic director reports it to me so that we're all taking responsibility for our own numbers.

Looking at the numbers and being able to project and grow from those. I do have numbers and look at them, it’s just I don't have a strong grasp on them. Looking at the numbers of September and October 2020, October was our biggest month ever, which has 100 more visits than last month or at least. We hired our new PT. You would hope that at some point, but her schedule filled up quickly which was cool. In addition to it being the biggest month, our utilization was good for her first month.

It was at 75% utilization too. That’s a big accomplishment and that goes back to having all these systems in place so we’re not losing our patients. We’re aware of their plan of cares, cancellations, and making sure that the front desk sets them up for success by setting up their expectations before they're coming in and dialing in on all those things. Moving forward, now that those systems are at least in place, they could be refined and improved. It allows me to start looking at the numbers, projecting, and using that for some continued growth.

PTO 123 | Druid Hills Physical Therapy
Druid Hills Physical Therapy: As a boss, you have to make sure that things are running smoothly, but not to the point of micromanaging. You have to let your team run the place.

 

How many providers do you have at this time?

We've got three providers.

You’re starting to get into that phase where you start developing a leadership team. You’ve already started that process by pointing out who your next clinic director is. Considering what that leadership training process looks like in your clinic and start developing those leaders to do exactly what you said to start looking at statistics, numbers, working off of the numbers as to what to do going forward, and also tracking those numbers to see if they're meeting your goals and expectations. Developing a leadership team, getting a handle on the numbers are great things to focus on in a little bit for you as a leader. Are you considering further expansion in the course of 2021?

Yes, but it all depends on the pandemic thing. It’s hard because we have a space for more people if we didn't have to distance. In our clinic, we rearranged it so we could fit three PTs comfortably. They're all in separate areas of the clinic. That’s how we want to do it. I'm sure there are clinics that are not as distant and we can squeeze another one in, but that's how we feel comfortable with our clinics. As far as expanding, we could get another provider and fill the other hours. We're open from 7:00 to 7:00 or something like that.

For me, it's hard to make any real plans for that until some of this stuff calms down. I can see that if all of these systems continued to function and not only function how they are now but even better and improve, that growth will only be a matter of having the space, hiring the people, and getting the patients as far as growth goes big. I can't imagine it's that simple but if we have all these systems in place which we're developing, I can see how it's going to be easier each time we grow because there's going to be a process for everything that comes up and it's not going to be like, “I'm going to have to deal with everything.” We don't have to figure it out every single time. There will already be a process and it will be smooth when something comes up.

Congratulations on the new hire. Congratulations on the successful EMR and billing transition. You've gone through some great stuff and coming out of the pandemic well. We spoke about the last time, to gain more patients for this new provider, you do a lot of work with Google Ads. I assume you simply increase your Google Ad spend, revamped a couple of things and you're continuing to grow.

I will say that we are seeing more and more referrals, not necessarily from more doctors, but internal return patients, word of mouth, so that’s been cool to see also. We are playing around with the ads, boosting the budget, and all that stuff, but we are noticing that the longer we've been around, the more reviews we have. People are starting to notice us and know that we're here. People are referring their friends and family. At some point, we won't have to rely on the paid advertising and we can get patients by word of mouth and by being a part of the community.

I don't know exactly what year of ownership that is, but there is a point where your return patients start making up a significant portion of your clientele. You still have to market and get fresh blood coming in. Once you focus on starting that internal referral program and pushing patients to refer family and friends who are injured or need some help, that can be a huge boom to your new patients. It takes a few years to build up that base level, but you're starting to engage with them as well with the newsletters and the social media postings. These are people that already know, like, and love you. It’s best to tap into that number of people which could be in the hundreds and thousands over time. Tap into them and it could bear fruit.

That’s the hope. That’s what we're doing with the social media. We're trying to engage with the newsletter, people that have been into our clinical before so they've all been here. We're trying to keep in touch with them, let them know what's going on, introducing them to the new PT. We've been also creating some eBooks which have been fun. Giving out links to the eBooks. Providing value to the community and not necessarily looking for anything in return. The goal isn’t to get people to make an appointment from that newsletter, which would be great, but it's more of keeping in touch with the community. Hopefully, that will keep us on their minds. If they know someone, they'll remember to tell them that they had a good experience with us and that could create another referral.

Congratulations on the growth thus far. You're doing great especially at ownership. You’re making progress and to be where you're at is enviable for a lot of owners. Congratulations, you're making steps in the right direction.

Thanks, Nathan. It's definitely fun.

Thanks, Avi.

Important Links:

About Avi Zinn, PT, DPT, OCS - Leading Atlanta Physical Therapist

PTO 123 | Druid Hills Physical TherapyDr. Avi Zinn has practiced physical therapy in many settings prior to opening his own clinic in Atlanta: outpatient orthopedic clinics, hospitals, rehabilitation centers, and in people’s homes. He is an expert in treating all different types of pain and injury, and in developing treatment plans that bring people back to their most functional selves as quickly as possible.  Avi’s main mission in opening Druid Hills PT is to utilize the experience he has gained in the field to provide high-quality, personalized care to each and every one of his patients.

Avi has his doctorate in physical therapy from Touro College, and is a Certified Orthopedic Clinical Specialist.  He lives with his wife and three children in the Toco Hills area.

Love the show? Subscribe, rate, review, and share!
Join the Physical Therapy Owners Club today:

PTO 122 | Sustained Growth And Success

Brandon Buehler, PT is routinely asked, "What is the secret to your success, especially in a difficult PT market like California?” To that question, he responds that he keeps his focus on truly living their practice’s purpose and values, and infuses those into discussions and staff meetings. He joins Nathan Shields to explain how this enabled them to establish a team culture that has grown from within to establish seven clinics in southern California. Brandon admits it takes a lot of hard work, but the added effort to establish solid and living purpose and values is what makes it fun and fulfilling.

---

Listen to the podcast here:

The Secret Sauce For Sustained Growth And Success With Brandon Buehler, PT

I've got a guest on that I've wanted to have for a long time. He's part of the network that Will and I were a part of as we grew our clinics over time. He was in a group with other people on my show that I've had before like Vinod and Blaine. I still haven't had the girls on from Magnolia, Amy and Lisa but these were all people that we looked up to. Brandon Buehler, who is the President and Founder of Coury & Buehler Physical Therapy in California. He’s one of those people I'm excited to have on. Finally, after a couple of years of doing the show, I've got him on. Brandon, thanks for joining me. I appreciate it.

It’s my pleasure. Thank you so much for inviting me.

I'm excited to bring you on because you guys have been successful especially in a difficult area of the country in California. I think when we knew you back in the day, you had maybe 2, 3 clinics and now you guys are up to seven. You've been successful in your model and I've always looked up to you guys because you've always been well-founded. That's a lot of what I want to talk about with you because I know that's the basis of your success. Before we get into a lot of that, do you mind sharing with us a little bit about how you guys got to where you are? A little bit of the story of Coury & Buehler Physical Therapy and what's made you guys successful?

I'll show you a little bit about how I got into physical therapy and then how that led into the birth of Coury & Buehler Physical Therapy. My route to becoming a physical therapist was a circuitous one. Initially, I had no idea what I wanted to do. I went to UCI and it was an engineering major. I was good at math and science so I figured engineering sounds right. I started in that and I did well. I enjoyed it but towards the end of my first year in college, I got in a bad car accident and suffered a bad back injury. I had pain for months and when I saw multiple doctors and MRI. I was referred to different specialists and medications thrown at me like crazy.

It wasn't getting better. I'm like, “This is crazy.” A friend of mine said, “Have you tried physical therapy?” I said, “What is physical therapy?” I had no idea what it was. I went to physical therapy and within one week, I was already starting to feel better. Within three weeks, I said, “This is what I want to do with my life. I can be an engineer of the body instead of an engineer for other things.” That's led me down the path. That's one of the reasons that I'm passionate about our profession. We can help people naturally that we don't have to be spun in this web for months or years of pain until they find me getting physical therapy as we hear it all the time.

A patient had five years of headaches within about a month of treatment with us, the headaches gone and tears rolling down her eyes. She asked me a common question we hear from a lot of people, “Why didn't I get it earlier?” That's a good question. It is something that us, as a physical therapy community need to solve. Why few people getting into us? Why are they seeing specialists, MRI, surgery and medication only to often fail that and then come to us?

We fall short in that regard. The marketing efforts of physical therapists over the years have been so focused on, “Talk to the doctor and get that referral from the physician,” that we've failed as a profession to market what we do to the communities at large. Even nowadays, I've been a therapist for many years, the question continues to come up like, “What makes you different than a chiropractor? Are you a massage therapist? What do you guys do?” Many people don't know and that's a failure on our part.

One of the sad aspects of our profession is we all feel like we're competitors. It's a crazy thing. In my world, we see such a small percentage of our community. We're always worried more about our competitor down the street doing the fact that 99% of the people in the community aren't getting into either one of us. We work to band together. We couldn't handle the business we have, instead our patients are going to a chiro or getting MRIs, medication, surgery and seeing specialists. It is something we can work on. What you're doing, Nathan, is you're working on that. You're trying to bring people together and through consulting, networking and these types of podcasts. Other people who've been here like me are sharing some similar ideas.

That's a lot of what the pandemic has led owners to do is to not focus on physicians because that physician pipeline essentially got cut off in a lot of places. How are we marketing now to get those referrals in the door, to get those patients in the door and see them because people are still getting injured, whether we have lockdown or shutdowns? It doesn't matter. They still need physical therapy. A lot of my shows have been about how to use social media, how to do the direct to consumer marketing route and spread our message so that we don't necessarily rely on physicians to also get it out to the people that physical therapy is available to them.

PTO 122 | Sustained Growth And Success
If we combined our efforts and promoted our profession, that alone would have a dramatic influence on all of our business.

Imagine if our profession, all of us, whether they're next door or the next city over, if we combined our efforts and promoted our profession. That alone would have a dramatic influence on all of our business. The concept of rising tide would in full effect on that. That’s my story about becoming a physical therapist in terms of how Coury & Buehler Physical Therapy started. My founding partner Rich Coury, we met as I was doing internships at a place and we became instant friends. He was maybe a couple of years ahead of me. We weren't far apart in age. We clicked and connected as friends. I finished up there and started working somewhere else and he was working somewhere. We would hang out a lot.

We would grab drinks or lunch. He came over and hang out with my wife and me. We were friends, but we also were both passionate about the profession. We would spend many evenings talking and dreaming about, “What if physical therapy could do this? What would it be like if the place we worked at providing this type of care? Is this constant dreaming envisioning of the ultimate physical therapy company? What would the dream vision of a physical therapy company look like?” We talked and talked. I remember one night my wife saying, “Are you guys going to keep talking about this or are going to maybe follow up on these dreams? You seem like you have the passion about it.”

Rich and I met one day and said, “This is the time. We have this vision. The physical therapy model that we think is better and will provide better outcomes and results for patients. Let's do it. What do we have to lose, my house? That's about it. Let's move forward.” It's been a fun ride. Since then we've grown since day one and that was about many years ago. During the first couple of years, we found that to be a challenging time but we grew quickly early on I think just because of our good looks and our charisma with treating.

We hit this wall where we're kept. We felt like we're limited in what we could do. We didn't know what to do and how to get to the next step. That's where we started luckily to meant that we needed help. At that point, we got some consulting. We started networking with incredible physical therapists like yourself, Will, Vinod, Lisa and Beth and all these great therapists. Getting help from different people, talking and reading books, taking on the posture from that day forward of being a learner in terms of not as a physical therapist, but as a business owner and practice owner who wants to improve the profession.

That's something that I've always loved about you is that you've always come from a place of so much wisdom. I've read books that you've recommended to me during the course of conversation. I don't even know if you remember that you've recommended books to me, but you've been someone who's always been looking for more information. You are a learner trying to absorb as much as possible to improve yourself, not just professionally, but also personally. That's kudos to you and it goes to the typical pattern of a successful physical therapy owner that I've seen in 99.5% or 100% of the successful PT owners I interview. They recognize that they need help.

We didn't learn any business things in physical therapy school essentially, so we need to get some business acumen. Networking is huge in that regard and helping you know that, “I'm not in this boat alone. There are other people who have done some successful actions that they're willing to share.” The networking alone can be a huge aspect of it. There are always books that can give you inspiration, insight, and that stuff. I'm reading one called Grit by Angela Duckworth.

It's an awesome book. I haven't read about the topic that we're going to discuss but in the course of our discussions prior to this interview, you told me that other owners and younger owners might come to you and say on occasion, “What do you guys do? What makes you successful?” I thought it was great that you came back to we really live our purpose and our values. That's where I want to take this because we've discussed this on the show before not you and I, but other guests about how to establish a purpose. How to establish values and exercises you can take your teams through and how important it is? I know that you guys live that stuff. You guys reference back to it. You use your purpose and values as a filtration system for the choices and directions that you go to and your physical therapy ownership. Tell me a little bit about that. What was the Genesis of finding your purpose and values? Then we can get into, what are you doing to keep it alive and well?

I appreciate you bringing this up because this is something I'm passionate about. It is funny. We have people come up to us often either calling us in PT network meetings or wherever like, “What is your secret sauce or what tricks you got? What are you doing?” Everyone thinks we have some magic thing that we're hiding behind the scenes for our success. Everyone's looking for that one answer. What's that one book that turned it for us or that one marketing guru we're following? We all want that in life. We want the pill that'll make us lose weight. We want the one exercise that'll give us big biceps.

We all know that it's much more than that. It's more complicated than that, but the reality is my answer to everyone is that it's our commitment to our purpose and values. I know it can sound commonplace for people to say that or to throw that out there. For our company, it's been true. I told you about the story of how Rich and I started the company and his dream, but a lot of our dreaming and visioning is starting to talk about our purpose, vision and values. Back then, we had no business training. We were young therapists. We didn't know what it meant to create a purpose statement and core values, but we were smart enough to know that those things mattered.

In a small business that experiences ups and downs, having a stable and lived purpose and values is like a lighthouse in a storm. Click To Tweet

We started talking a bit about it. We didn't necessarily use the word purpose and values, but we would talk about what we wanted to be about. We talked about how we wanted the company to operate and the type of people we wanted. We started in those early days formulating our purpose and values and the same concepts from day one before we started the company. I was telling people, I started the company about 1.5 years before the company started. It started with Rich and me talking about it and dreaming, visioning and creating these fundamentals. Once the company started after one year or so, we decided to get real fancy and write the things down we talked about. Put it on the wall.

It's a piece of paper. It was a rudimentary version of what we came up with. Those things evolved a bit as we started to find out more. When you're at a company, it's like you go from being a teenager to an adult. Your company evolves and develops. Over time, our values did not change, they matured. What happened maybe about many years ago is our company growing. We also have grown a leadership team, which is phenomenal. We decided to sit down as a leadership team and to relook in a new union of time. We call it our vision statements, purpose, values and BHAG.

We spent a whole day, maybe two days offsite, just looking at that. What we did is we didn't add to it, we simplified it. We looked at every single one and said, “This is too complex. Let's be real with who we are, our purpose and values. Those two are great, but that's not us. Maybe we liked it, we agree with it, but let's focus on what we know we will die for.” We went from maybe 8 or 9 to 6 core values. We refined some of our other statements that we have what we call team creed. We have our BHAG. We have a care statement. We took what we've always had, and we refined it. That's become the foundation. If you want to know what our process for success, it would be those things.

What I want to highlight is you thought it's important that you guys took two full days, one would be enough for me, to focus on this.

Two full days after already having stuff in. We've already met years formulating and refining it. We decided to take two days to refine it on the stage for the next many years to reach our BHAG.

Purpose and values shouldn't necessarily be changed all that much. Maybe they get altered a little bit. As you said, you mature and you change a little bit because life and business environment change over time but you took things and simplified it that sparked a memory in our ownership. We recognize that we spent too many hours in meetings. We simplified and became more efficient in that regard. The same thing, we had these values, but we didn't have any definitions behind them. We took the time to come down to some concise phrases that weren't more than a sentence that describes those values to be more concise and clear about what they meant to the company.

Even though we all had our own individual definitions, we felt it necessary to define what those values meant in our company. What that look like? How does that show up? We also had some other things. We had cultural values as well, that was separate from our core values. The fact that you took much time and were that specific and intentional about it, could you say after doing something like that many years ago, it provided more clarity and maybe even a better foundation, a jumping-off point for continued expansion and growth?

We've always focused on them and made them part of our organization. At that point, it was another turning point in the company where we decided to more fully commit to our purpose and values than ever. At that point, we got more committed to making sure that every part of the organization was ran based on those values or reflect those values. We committed to instilling that more in the company and found other creative ways to make those alive in our organization.

Let's get a little bit deeper into this specific. What are some of the action items you take to have your purpose and value lived through each individual in the clink? How does it get from the owners and distilled down into the everyday actions that even someone at the front desk? If you use technicians to get down to the technician, what are some of those things that keep it alive and don't collect dust on the show?

PTO 122 | Sustained Growth And Success
Sustained Growth And Success: Your company evolves and develops over time. Your values evolve a bit as you start to find out more.

One thing is interesting is you hear a lot of people talk about, “I've done that. I got that.” Most of my friends not in physical therapy, I try to connect with a lot of my friends who have businesses outside of our industry. I love learning from people outside of our industry, but I find the majority of people I know who have done this, it's something they put on the wall. It's like, “We got it in the break room or it's in a policy manual,” which means everyone read at once and then forgot about it. It's a mistake a lot of us make. Purpose, values and vision statements, those only have an effect on the company if they are ingrained in the fabric of the company.

We talk a lot about Pinocchio at some point became human because he got a soul. We talk about our company is not human until it has its purpose and values breathed into it. Another way to say it is that the personality of our company is based on our purpose and value statements. It's the person that's who we are as a company. We have to be lived and breathed. There are multiple ways we do that. Starting with, first of all, recruiting and hiring. The first entry point of the company starts with measuring every single purpose to our purpose and our values. We use some statements that even our recruitment ads about our company because we want to try to track people who are attracted to that. When we do our interviews, the first questions are all against our core values and our core competencies for that position. Right off the bat, we're asking questions based on each of our values because we try not to take generalizations or trying to get specifics on how they maybe align with the value of teamwork.

You can say you do, but tell me how and what that means to you and describe it. Based on the initial screening interview, you can get an idea if someone aligns with their values and if they don't, it doesn't mean they're bad or were bad. This is who we are. We sell maturity and growth to do, but we know who we are. We know the type of people we need to bring on. Our companies not for everybody without a doubt. We know who we're for. We are for a certain type of people who align with us and the people who do aligned with our values or our track, they do well in our company. The first thing we do is we hire based on that.

We did the same thing. We've listed our values. This is our purpose. This is how we do things in our company. It's interesting as you do more interviews, I don't know if you're still doing a lot of the interviews, but as we were doing the interviews, you watch body language. As you're starting to talk about values and the people who are bought in start leaning forward a little bit more and they light up a little bit. The people who aren't bought in, you could tell in their body language. They don't care as much. I agree. It starts there. You start discussing those at the forefront and so that they recognize that these are important to us and you can find those people that work well with you. It's easier to do as you do more and more of those interviews.

What's hard in our clinic or with my coaching clients is we'll talk about purpose and values at the beginning. I think a lot of companies go through this and that the owners get this bright idea that, “We're going to establish purpose and values.” Two to three months down the road, it was like, “Did we talk about that one time? I forgot.” It has some initial momentum and then falls off. I know you guys do more about that and you're going to share a little bit more with us. I just want to interject a little bit, but go ahead.

Once we hire someone based on our purpose and values and someone we think is aligned to that. The first thing they do is go through a training course on that. It takes them several hours. They could read the purpose and values, but we created a several multi-hour course that takes into the reach component and goes in-depth on what that looks like. We even have some fun video examples. We'll read. We're trying to impress that into them. It's one thing to say teamwork, but what does that mean? What does that look like? We try to press that into them and then have them answer questions. Not just like ABC, but some essays. They got to think about it and write it down because we want people to process these things.

That's the next thing. They go through that and during their onboarding, we're making sure that they understand and agree with it. There have been times where maybe we brought someone on and then during the training we realized, “I don't think they're a good fit. We're finding maybe they don't align with these values.” That's the initial thing we do. During their onboarding, the first few months, their managers are continually watching and making sure this person is the best fit. They continue to match this person to who we want to our purpose. This person agrees with our purpose, this person agrees on these values. Can they live at our team creed? If they don't, they're not bad. We're not bad. It's like, “You are probably not a good fit. This is who we know we need and I don't think you align best with this. You'd better in a different setting.”

Those are some of the easiest firings, aren't they? When you do a value-based firing like those actions that you're doing or performing aren't living up to this value. You're not exemplifying teamwork when you act in this manner. If professionalism was one of your values, it's not professional and we can't tolerate people who come in late consistently. That goes against professionalism. We're going to have to let you go. You're not a bad person. We don't tolerate people who don't align with the values.

Most of our hiring are more based on values these days. Those are the big things. Beyond that though, the question is how do you make it a day-to-day part of the organization? It’s because it has to be and if not, it'll become that type of thing where like, “What did we want to talk about? Isn't it on the wall in the break room?” There are multiple ways we do this and different things we experiment, try and have fun with. I'll go through some of the different ideas. One, we have a display. It's displayed everywhere. It's on our website. We don't hide it. It's in every one of our clinics. It’s somewhere were patients could see it. It's in different admin areas or breaks rooms. It's displayed to remind people. During our weekly meetings, we try to focus on a different value each week that we were cycling through them to continue to drill through. Maybe every couple of months, they're getting back through the cycle.

The secret sauce to our success? It's our commitment to our purpose and values. Click To Tweet

You're talking about and maybe, “Have a short couple minute discussion about a particular value.”

A real quick and maybe a minute or two. This is the night of the week. You talked about it. Maybe share a win based on it. Maybe we'll take a couple of minutes and camp on that and have a quick discussion about it or bring up a patient experience on that and things like that. We do a weekly email from one of the founders, Rich or I. Every email we always try to highlight or one of the values of the week and talk a little bit about that or maybe share a story about that trying to interject that into it. Our HR manager sends out a weekly value of the week award winner. Another great way to promote either a purpose, one of the values or one of our vision statements. Somebody who's living out one of those aspects. They're getting recognized and sharing a fun story about them. It's a sneaky way to remind people of that value because we'll get your coworker to live this out. Remember, it's one of our core values and that's part of our purpose.

We did the same thing. We didn't do it anything weekly like that, but at our annual parties, we would have a value award for a particular employee and highlight some of the things they did over the course of that year that exemplified that value. I'm sure your HR person is doing that same thing but on a weekly basis. This person exemplified blank because they did blank, that exemplifies this value. I think that's great. That recognition brings that to people's minds, especially the receiver of the award.

Our leadership team met and we are starting to finalize our awards for our annual Christmas party. One of the big aspects of our awards is our value awards and we give out awards based on each value. I worked on that and coming close. That's another way to do it. Those are some of the main ways we do that. Each manager during reviews or the reviews are off that's part of the route integrated into the review process as well. We're always finding fun ways to interject that in or sometimes we'll send out a random story or video to remind people of something.

We did the same thing with our reviews. It was not only value-based recruiting and hiring and value-based firing and value-based reviews. In our reviews, to get a little bit more specific, we would have the person that we're reviewing fill out essentially the same sheet that the supervisor would fill out. That was here are the values. What did you do in the past year, six months or whatever the timeframe was to exemplify those values and maybe even give yourself a score or maybe on some other things? The person who was being reviewed would say, “These are some of the things that I did.” The supervisor would say, “These are some of the things that I've seen you do and how can you improve on some of those values, live those even better and more fully in the company.” I love that you brought that up. It reminded me that you take values into recruiting, hiring, firing and exemplify on a regular basis, but also bring it into things that might have pertained to a salary increase or a promotion. You want to promote those people and you want to give salary increases to people who live out those values.

One of the best byproducts of this is culture it helps create. We're very protective of our culture. You probably have read Good to Great by Jim Collins. There's one part of his book that stuck out to me. It's one of the most memorable quotes from a business book I've read. He talks about your goal is to have your values infused into your company. He says, “Your culture is so strong. You have a cult-like culture.” Anyone who joins the organization either gets swept up into these values or they stand out like a sore thumb and get injected like a virus.

I'm like, “That's a powerful analogy or description of what it should look like.” You can create such a strong culture in your company based on your values and your purpose where people who joined the team get swept up in it or they stand out. There's no in-between. The people who stand out, it's like that group pressure where you better join and get out. We're not perfect at that, but we see that at times. When we're doing well, you see that and it’s a good place to be. Culture is everything. Your team depends on having been working in a great place, a place they love and believe in. No one wants the drama. No one wants the other stuff.

It takes some years and some intentional effort to get to that point but I know that over time we can develop that culture, such that people have finally gotten to the point where the purpose where they're waking up knowing how they're going to fulfill that purpose that day. Not that they're waking up and going to a job and punching the clock. It elevates things to another level for the people that buy-in once you establish a strong culture like that. These are people that will stay with you through thick and thin, work hard and maybe even for less than where they would get other places because they buy into exactly what you are fulfilling in them and as a company. It creates so much strength.

COVID is a tough time for people. You see everyone handling it differently. Now more than ever, our teams need a North Star, a guiding light. They need to have something to look to. There are a lot of confusion and chaos in our offices. There are frustrations. Everyone's a little bit have difficulties outside of here. There's this challenge and reminding, “I know things are harder. I know we have more in tribulation in our offices, but this is who we are. Focus on this.” We’re headed towards that goal. We just get to look up. I know this stuff stinks, but remember, this is what we're about. We're about changing people's lives. The other stuff settles down a little bit, it’s like, “Compared to that, this stuff's not as important.” People are sick or different things going on because of COVID, but if we can continue to focus on a purpose, it helps people be aligned.

PTO 122 | Sustained Growth And Success
Sustained Growth And Success: Our purpose, values, and vision statements only have an effect on the company if they are ingrained in the fabric of the company.

Has that been a stable thing for you as you've gone through the COVID experience these several months? You have seven clinics and you're a successful guy, but you got bruised, battered and hit like every other PT on are out there. Did you find yourself reflecting back to the purpose and values and may be either shifting them a little bit or relying on them more in order to get through it?

As a company, we decided to close down for three weeks. We decided to mostly because we wanted to regroup. We wanted to decide as a leadership team on how do we run the company? What do we do? We want to provide care but in the safest manner. We took time, but Rich and I were back in day one. We came back to the office and felt like it had to be here. The very first thing we started talking about is, “Let's remember what we're about.” We can sit here, cry, complain and get frustrated. There are all these things we could talk about, but we know what our purpose is. We know what we need to do and let's focus on that.

Sometimes we talk about our purpose being like a lighthouse. You're in a storm and lost at sea, which direction do you go in? You see the lighthouse, you’re like, “I know where to go.” There are many times in our company history for ourselves and our team that that's been the case. It’s like, “We know where the lighthouse is. Let's go in that direction.” We were all bummed out. Seeing our company closed down brought tears to my eyes, but that didn't last very long. Within minutes I'm like, “I'm not going to cry about it. I'm going to focus on what we need to do because I know the purposes. That purpose includes what we need to do for patients and our team.” We started moving forward.

I can imagine that your weekly newsletters over this period of time in 2020 have had to focus more on the bigger picture perspective, why we're doing this? These are the decisions that we're making and this is why and how it relates to where we're going. Did you find that you had to reflect back on that a lot?

Yes.

Especially with the decisions that you were making, were there some things that you changed in your workplace due to the pandemic? Maybe you let some people go or you changed some things around on how you treat but still, you bounce those things and filtered them through the purpose and values.

We did have to make some changes. The biggest change was changing our treatment model to have less people in the office at one time. Administratively spacing people out. We have a lot of moms, we had to support them. Some couldn't come back to work yet. Some needed to work from home. Shifting things around. We're often comparing things and decisions against the purpose, but this is a time where we at it continually do that and remind ourselves of this is what we're about. This is not best for the business, but this is who we are as a company. This is our hardest decision based on revenue, but this is who we are as a company. We need to make this decision.

When you first established your purpose and as you've refined it over time, I wonder how you defined it. As I'm working with my coaching clients and I asked them their purpose which has something to do with, we provide great physical therapy care to the residents of blank. I want to tell them, “That's what you do. That's your job as a person and as a company,” but it's more about the why. I'm wondering if that's how you've thought about your purpose over time and came upon it. It was like, “You do physical therapy, but for what purpose?” It goes back to a higher purpose which I talked about with a 30-minute key and that is helping people live pain-free. If that was your higher purpose or support the surrounding community so they're healthier. How you go about doing it is you provide physical therapy. How do you define purpose and how it helped you clarify what your purpose was?

We're on the same page. We have always seen purposes as the most important question. The purpose for us is the, “Why.” That is the first and foremost, question decision that any business makes to help make all the decisions under that. You see a lot of businesses in our industry and not in our industry, start a business and they haven't made this decision and they're making these decisions. The problem is these decisions can be right or wrong. If they're not, they don't know they don't figure out the why. When we came up with a purpose, that was the thing we were talking about, like, “Why do we exist? Why are we here? Why are we doing what we're doing?”

Those are the overarching type of theme. What we also decided is we felt like our purpose needed to transcend our industry. I feel like your purpose is in your industry. It’s not as bad. Our purpose is to help people out of pain and that’s awesome but we felt like, “Maybe our purpose should be bigger than that,” because it takes us out of the industry and is more important in our industry. Our purpose is to enhance the lives of people in our community. Our focus is helping our patients get out of pain, this includes our team and the people around that you work with even vendors. Vendors come in to enhance our lives. Whoever we're dealing with. The neighbors in our building, let's enhance their lives. It gives us a little bit of a different perspective on what we do overall.

The personality of our company is based on our purpose and value statements. Click To Tweet

As people start defining their purpose, it becomes less about the physical therapy they provide and what they can do for other people's lives and broadens the influence to not just the patients. As business owners, we want our team members to feel a certain way, to have a certain experience and experience a certain culture. We want to be the ones that establish that culture to better their lives as if we were working on a patient one-on-one. We want to enhance their lives and we want to enhance the patient's lives and thus affect the community in multiples. As you establish that purpose, it becomes less about the physical therapy itself and the care that you provide, not less about that, but to also include the workers, the people who are supporting you and the people that you interact with in helping the vendors, the workers at the physician's offices to include everybody that you come in contact with. It expands to more and more people.

Everyone in the team and what our position is can be part of that purpose. It's bigger than just helping patients in pain. Enhancing lives may look different for each person in our company but we can all be a part of that.

Were there some books that were influential to you in regard to purpose? You mentioned Good to Great but were there others that guided you along in that regard?

All of the Jim Collins books touch on that. Simon Sinek’s Start With Why and the Scaling Up book as well. There are others, but those helped formulate some of our thinking.

Is there anything else you want to share in regards to the purpose and how you guys live it and breathe it in Coury & Buehler?

It affects and influences most of our decisions. In terms of how we run the company on a day to day basis. Big decisions we're making in terms of a standard to measure our company with. Rich and I, when we meet, sometimes we check each other on this. We'll be talking about things and be like, “Remember this is our value. Does that align with that? We talked about this, we know what we're about.” We check each other all the time. If we didn't have that, we'd be making dumb decisions.

One of the things I'm most proud of is our company is, it's not Rich and I, we have a team of partners. That came out of Rich and I, when we were going through our purpose and values realizing that there are a couple of values that compelled us to expand the ownership team. We had some incredible physical therapists that we felt like based on what our purpose, our values and some of the things that we want our culture that we needed to provide that opportunity for them. That stemmed out of the purpose and values that we’re going through.

That's the easiest route to expansion is to find those people in your company that you've not only vetted but figured out they align with you. There's a great Jim Collins phrase, “You find those people who are truly aligned with you.” It's to expand when you have those people on your team and open up other clinics, grow or provide them leadership opportunities. It makes growth so much easier and fulfilling.

It's fun to see them grow and reach their dreams.

PTO 122 | Sustained Growth And Success
Sustained Growth And Success: The people who align with your values will do well in your company.

You provide that foundation from which they can build off. It's not there unless you have those purpose and values and have them well-stated because they've been with your company for a period of time. They align with you through all the decisions that you've made with them over time. To help them expand and start up a satellite clinic and get the next clinic going. They're simply living those purposes and values. You don't have to train that up all over again. They continue the cycle all over again. That makes it so much easier.

We've never brought someone from outside for a higher position. Everyone starts in a position. Anyone in management or above has grown up in the company. They are moved up in our system.

Thanks for your time, Brandon. It was great to have you on, you've got a wealth of knowledge and wisdom. I finally got you on the show so you could share that.

Thanks for having me.

Do you have any contact information you can share or a website people can go to check out your clinics?

My email is BBuehler@CBPhysicalTheraphy.com. My cell is (714) 345-0426.

You've grown a ton. It's impressive. You've always been someone that we looked up to. I'm glad that we could tap into some of your wisdom. Good luck with everything. 2020 has been a tough one but I know you guys are in a great position to withstand it and grow going forward.

I appreciate what you're doing for our profession. I love your podcast. I love that you're helping coach and consult for other physical therapists because our profession needs that. Kudos to you for what you're doing for our profession and for all the help you're providing for physical therapy private practices out there.

That's nice of you. I appreciate that. Coming from you, that's a huge compliment. Thanks.

Important Links:

About Brandon Buehler

PTO 122 | Sustained Growth And SuccessBrandon decided to become a physical therapist after being involved in a car accident and had to go through months of treatment in order to return to playing soccer in college. After experiencing how physical therapy helped him return to his normal activities, Brandon decided that this was the career that he wanted to pursue. He has a passion for helping people return to their sport or daily activity without pain or limitations.
Brandon has extensive training in orthopedics and manual therapy through the Institute of Physical Art. He places high value in continuing education and training at CBPT. Brandon emphasizes the importance of quality and personalized care with one-on-one treatment for every patient.
Brandon is also the co-founder of POISE (Prevention of Injury and Sports Enhancement), Richard Coury, MPT, assisting athletes in preventing injuries, helping them in full recovery to their sport and improving performance on the field or short.
In his spare time Brandon enjoys spending time with his wife and kids, running, working out, hiking kayaking & paddleboarding.

He enjoys spending time with his close friends, especially enjoying a meal from his barbeque.

As a native Philadelphia, Brandon is always on the way to pizza.

Love the show? Subscribe, rate, review, and share!

Join the Physical Therapy Owners Club today:

PTO 120 | Patient Retention And Referrals

No matter how good you are at physical therapy, there is one thing that will turn your patients into raving fans or active detractors, and that is the service they receive from your team. Customer service is probably something most owners would consider an inherent plus in their clinics, but how often do they take the time to train, role-play, and focus on improving the customer experience? If it's not continually improving, we'll assume that it's gradually declining. Dr. Kelly Henry joins Nathan Shields to bring his insight as an executive coach to the podcast to discuss the keys to ensuring a great customer experience, and the benefits of intentionally working on it to multiply your profits.

---

Listen to the podcast here:

The Key To Patient Retention And Referrals With Kelly Henry, DC

In this episode, I have Dr. Kelly Henry, a chiropractor who's living in Texas. He had grown a successful chiropractic business for many years. He's now an executive coach. I'm excited to have him on the program to talk a little bit about customer service and its importance in our practices and what it can do for us. First of all, Dr. Kelly Henry, thanks for coming on. I appreciate it.

Thank you, Nathan. I appreciate the opportunity. Thanks for having me.

You might be the first chiropractor I've ever had on the show, but there's a lot that we share in terms of the business aspect of our practices. It's great to have you on. I know you've been working with some physical therapists in your coaching business. Tell us a little bit first about where you came from and what got you to the point that you are now.

My story is maybe similar to a lot of other chiropractors and physical therapists. I got out of school and I thought I knew everything. I thought I knew how to run a business. I thought that I open the doors and I was going to be tremendously successful. Things turned out otherwise. I got out of school at Dallas Parker Chiropractic College. I moved to Phoenix with my wife and with our one daughter. Fortunately, I got into practice with several other chiropractors. We each had our own practices. If you know Phoenix, as far as a physical therapist, it has a chiropractor in about every corner of the streets. There is a lot of competition. I was very naive and I did not do well at all. There is not much money at all.

Fortunately, the doctors I was with in that particular clinic, there were a couple of older doctors that had been in practice for 15, 20 years. I gained a ton of knowledge from them, not necessarily experience. I hardly make any money. It’s very frustrating times. Looking back, it was tough but I appreciate what I have now because of what I went through then. I was there for roughly a year. I got a call from a chiropractor that I had met in New Mexico where my wife was from. He was retiring and wanting to know if I wanted to buy him out.

I was fortunate enough to come up with some financing and do some things to be able to buy him out. I moved to New Mexico. I did okay. I was doing better than Phoenix, which is not saying much, but it still wasn't to my expectations of what I needed. I struggled on for a few years and finally got with a coach and that's when my career took off. I was able to get a great coach and coaching system to implement as far as the management side in my office. I steadily grew from there. I outgrew that coach. I was with another coaching and consulting firm. They helped me get to another level and I outgrew them, and it kept going on and on.

Finally, I got with another coach and blew up from there. After about 10, 15 years of that, I developed my own systems taking pieces of all the coaching that I had and ran that. I had two locations so I was able to grow my office. I had a satellite location with another chiropractor. I was able to sell those all out in 2018 and then turned my attention to executive coaching and coaching of chiropractors and other industries in the ways of customer service. That was the bedrock of how I was able to grow my businesses on the foundation of great customer service that helped me to retain patients. It’s what the key was.

Your story isn't all that different from most physical therapists that we talked to. We don't get a lot of business education in PT school and I figure it's the same in chiropractic. Once we get some of that technical knowledge in terms of how to run a business, and that's what I'm sure you got from your coaches, that's when things tend to turn. That's one of the keys to the success of the PT owners that I’ve interviewed that are successful. It takes some time for them to hit rock bottom or start getting burned out before they finally turn to a coach and someone who might know more before they start to see improvement. Part of the show here is to tell them, "Don't wait until then.”

Based on a Harvard Business Review study, improving the customer experience can increase your PROFITS between 25-90%! Click To Tweet

You're going to save yourself a ton of time and money if you'll swallow your pride and work with somebody that might know what they're doing to help you grow your business quicker. It's funny you say that because a lot of times I'm very leery of working with docs that are out of school for only 1 to 2 years. What I say is they don't know enough to know what they don't know, to know that they might need a coach. As you said, they hit rock bottom, life and business slap them in the face to say, “You don't know what you're doing that they say, ‘I do need some coaching.’”

What's cool about your coaching is yours is niching down. I'm sure you could do business coaching in general, but you're niching down and focusing on the providers and the owners that you work with on customer service. That focus on customer service will translate into greater patient retention and referrals from family and friends. Tell us a little bit about that and maybe expound upon your focus a little bit if you can.

You nailed it on the head there. The focus is on customer service. From a chiropractic standpoint, my ultimate goal was to serve my patients and to help them get healthier. I know that's what physical therapists do too. They are there to serve their patients, help rehab and get them healthier. We can do that through our service and the mechanics of that. The problem is when our customer service doesn't align with our service attitude and trying to help our patients get healthier, I don't care how good a chiropractor you are, the best adjuster, and do phenomenal on that side, if the customer service is bad, if your staff treat your patients bad, they're going to leave you

I assume the same thing would happen with a physical therapist. My concern is let's quit having that happen. Let's improve the service side of things. I mentioned to you that my philosophy of coaching is doing these simple and easy action items. They seemed so stupid easy but they make a huge impact on the patient's perception of the service, being valued, feeling valued and important as they walk into a clinic. On top of that, you give great service through the mechanics of physical therapy and the rehab that you do. When you mesh those two together, that patient's like, “I love that office. I feel physically better.”

Psychologically, they’re like, “I love going in there because they make me feel like I'm the most important patient in the world.” Subconsciously, they're like, “I'm going to tell my friends. I'm going to tell my family. I'm going to get others to go in there so they will feel physically good. They're going to be treated like a rockstar when they walk in that office.” That's my purpose and my passion behind niching down to customer service to meld all that together, to help those businesses grow. I know we have good products from the side of physical therapy that's a great service and a needed service. Let's get that customer service in there to enhance it and grow these businesses so patients can get healthier.

I'll never forget. I had an interview with the founder of a software program called Keet Health. We were talking about marketing and what you can do for patient engagement, retention and whatnot. I'll never forget and it's hard to figure this out exactly, but he believed that we could triple our marketing efforts if we simply focused on customer service more. Provide a great service from the initial contact, that initial phone call all the way through collecting the balance down to $0. If we focused on customer service throughout the life cycle, we could triple our marketing efforts. That makes me think, “All that time I'm spending on marketing could be focused on customer service instead and get some of the same results if not better.”

There are a couple of stats that I like to use along those lines. One is it's 5 to 25 times more expensive to market to acquire new patients than it is to keep the current patient. There's a ton of money going out to external marketing, which is needed. The problem is you need to do something to the internal market to keep those patients. That's where the customer service comes in. The other stat that I love to use and this is from Harvard Business School. They did a study that a 5% increase in patient retention or customer retention through customer service can lead to 25% to 95% increase in profits. The reason that can happen is because as you’re increasing retention, you're keeping those customers and patients, they're referring more. You don't have to throw as much money into external marketing. That goes to your bottom line. That's what can increase that profit margin for you. I preach that all the time. I would completely agree, triple, quadruple and five times the profit, I can see that happening. I've worked with some clinics and it's pushing there.

We talked a little bit and it seems fairly similar between chiropractors and physical therapists in that, you get drop-offs like we do. They tend to occur somewhere in the 3 to 5 visit range where they haven't fully bought in and they lose the enthusiasm. They fizzle out and they're gone. If you can simply keep more of those people through their full plan of care to see the results, that might go straight down to the bottom line because your expenses don't necessarily increase, but keep those people involved, keep them engaged. What are some of those things that you talk about to help providers focus on customer service with their patients?

There are several things, although I want to touch on why physical therapists and certainly chiropractors lose patients after a couple of visits. This is outside of customer service that I've found that's common is they don't communicate the seriousness of a patient's condition correctly. We touched on that a little bit where they don't give them the overall picture that, “If you don't take care of this now and do it correctly, it may not bother you in a couple of months. Fast forward, 5, 10, 15 years down the road, this could become a major issue that could keep you from golfing or taking care of your grandkids or whatever the case may be.”

PTO 120 | Patient Retention And Referrals
Patient Retention And Referrals: You can save a ton of time and money if you swallow your pride and work with somebody that knows what they're doing to help you grow your business quicker.

The chiropractors and physical therapists tend to get too near-sighted and not communicate the longer-term effects. That's one thing outside that certainly will help. From a customer service standpoint, the patient comes in and from a chiropractic standpoint, they're hurting. They want some help. They need some relief and those types of things. Chiropractors are good with that, initially. If they do x-rays and be able to say, “Here's what's going on. Let's get you adjusted.” The patient is going to come in and get a little pain relief, but things aren’t communicated well and the ball has dropped as far as customer service. If they don't feel like they're valued or important like, “We're here to take care of you, get you out of pain and get you healthier. We're here to serve you first,” those patients are not going to stay very long. A couple of adjustments, they get a little relief and they're like, “I'm out of there. That office could care less if I'm there or not anyways.” They're gone.

You said it on our phone call that the patients will take their injury only as seriously as the provider does. If the provider comes up and says, “Figure it out with the front desk. Schedule one time a week, two times a week, maybe three times a week or whatever you can do. You guys figure it out and then we'll see you next time you come, and we'll do some good stuff for you.” It’s a laissez-faire, “I don’t care.” They're not saying “I don't care,” but the attitude comes across like, “I don't care. Just show up and we'll get you better.” You'll lose some confidence in that regard as a patient. The patient is sitting there thinking, “Do I have a problem? If you're not taking it seriously, then I guess it's not a big problem. Why am I spending my copay dollars on this one if it's not a big deal and you're taking it lightly?” I love what you said that they'll take it only as seriously as the providers do.

They'll default to that. I can tell a patient, “You're going to die tomorrow,” but if there's a disconnect, “This is what's going on,” and God forbid, I've never had that happen. I'm just using this as example. The seriousness of it, if I don't communicate that or even if I do communicate it and I have a disconnect, “Give us a call in a couple of weeks and we’ll see how you're doing.” That causes that confusion and they're like, “I'll see if I remember in a couple of weeks to let you know if I need to come back in.” If the doctor, the physical therapist, and the chiropractor don’t take it seriously, the patient certainly won't. You lost credibility and you lost patients following through on what they need to.

That goes even back to what we were talking about on some of the small things you can do. They’re at the front desk as they're having these interchanges, especially the first time they walked through the door. You can lose a lot of patients right there. No matter how good a provider you are, that front desk person has nothing to do with the physical therapy care that you provide. If they lose them there, it doesn't matter what care you provide. They're so valuable. Sometimes we put an ad out for someone that's $8, $10, $12 an hour and hope for the best and not focus on that. Whereas that could be a huge detriment to your business. The ones that are great are great and those clinics do well.

I used to tell my staff, but I tell my clients now, you could have the greatest chiropractor in the world, but if the staff is terrible, you're going to have maybe at best an average business and it probably won't even be that good. You could have an average chiropractor that's decent, but if you have a tremendous staff that does great with customer service, you're going to have a tremendous office. It's that valuable.

What are you telling some of these teams to do in order to focus on customer service? Are there exercises you take them through or are there tips and trainings that you recommend?

I train them on a lot of different factors. There are a lot of different pieces to great customer service. There are five that I focus on with most offices, clinics and clients because they provide the greatest bang for your buck. You could look at this and this and it had marginal gains. Through my research through my clinics or my clients, I've never been down to five pieces of the puzzle that if a clinic, a PT, a chiropractor will focus on these areas, it increases the perception of customer service in that clinic for the patients. That's what you want to do because customer and patient perception is everything. The patient is going to perceive customer service by how you make them feel.

If you're doing everything to make them feel valued, then you're going to have pretty good customer service for the patient. The five areas that I focused on, one is positive mental attitude, positive aspects of the office, and keeping that positive mind frame from the owner, the PT, the staff and all the way through. It's hard to provide great customer service if everybody's walking around that's ticked off with a negative attitude. You may say the right things, but the attitude comes through. It's not going to be as effective.

Doing simple and easy action items seem stupid, but they make a huge impact on the patient's perception of the service. Click To Tweet

Do you find that teams often take on the personality traits or the attitude of the leader, the owner, the main provider on the team?

They do and that’s why I want to train the owner, the PT, the chiropractor or whoever is at the top first. If I go down to work with the team members, I can get them all riled up and have them functioning at a certain level of customer service. If it's not at the top and working down, it's going to be undermined and it will not be as effective. They do take on that attitude from the top down. Whoever is on the top is, it's going to work its way down for good or bad.

You tend to see that especially in doctor's offices. You're like, “Not that the temperature is cold, but it feels cold in here with my interactions with the people.” I meet the doctor and I think, “That's why.” Sometimes you can get that front desk person who rises above it and has an attitude that no matter what the environment is around them, it can be of high excitement and high tone that you don't see a lot of that. They usually match the other people in the office.

If you do hire one with that great attitude, they start rolling it back down and match it too. We always want to start from the top and work down and make sure everybody's on the same page.

Number one is a positive mindset.

The second one is creating a team atmosphere for the whole employee interaction.

This isn't necessarily customer-related. This is more you and the team.

It’s you and the team, but it goes to the customer in the sense that you can't have great customer service if you're treating your employees bad. Happy employee equals happy patients. There's got to be that dynamic. I'll point fingers at myself. There are several years in my practice where I had this mentality that my office staff and my employees were a liability. My job is to nitpick every little wrong thing they were doing to correct that all the time. All that did was foster more wrongdoing, bitterness and irritation. It was very difficult to create a positive atmosphere and great customer service.

One of my coaches finally called me on it and said, “You need to quit doing that. You need to pick out and start focusing on the good they're doing, which is far more than the negative they’re doing.” Foster this team atmosphere that the front desk may not be doing anything as far as an adjustment or diagnosing, but they're helping the physiology of the patient when they walk in by treating them like they're important and like they're valued. Setting them at ease and calming them down, which helped me on the back end taking care of their physical health. I bought into that. Every employee, maybe some had office manager title or some were new and they were filing paperwork, but they all played a part in the success of the business. However big or little they may seem, but they all played a part in how successful the business was because of how they interact with the patient and make sure those patients felt like they were important.

PTO 120 | Patient Retention And Referrals
Patient Retention And Referrals: It doesn’t matter how good a chiropractor you are; if the customer service is bad, if your staff treat your patients badly, they're going to leave you.

Also, because they were happy. That’s number two. We've got a positive mindset and a team atmosphere.

The third thing is to create a friendly atmosphere and there are a lot of aspects to that. Customer service begins and ends with a friendly atmosphere. From the second that patient walks in, “It’s good to see you, Nathan. We're glad you're here. We're going to take care of you in a couple of minutes. Have a seat. If there's anything you need, let us know.” When you’re through the process of getting your treatment and then as you're leaving, “Nathan, we’re glad you came in. Let's get you scheduled for your next visit. You take care. If you need something, let us know. We appreciate you.” I call that bookending. Be overly friendly on the front side and be overly friendly on the backside. The patient leaves that perception like, “They love me here. This is great. I love coming into this office.”

My mission statement or my customer service mission statement in my clinics and this is what I teach my clients is to be the best part of the patient's day. You don't know what that patient's going through on a day-to-day basis. They're in pain. Their dog died. They're late for work. Their kid is sick. They're having trouble at work or whatever the case may be. There are a lot of problems in life. When they come into my office, I want them to be able to forget about those problems. I want them to feel like they are a rockstar, superstar, and the most important person in the universe when they walk into my office. Make it the best part of their day so when they leave, they're rippling that out to the people they interact with when they leave.

Sometimes we forget as providers, coming to physical therapy 2, 3 times a week for up to an hour at a time is a disruption to normal life. They sacrifice a lot. That sacred time for them, whether that’s taking away from work or taking away from family or even some spare time that they don't have a lot of. They sacrifice a lot to come often throughout the week and for weeks at a time to care for themselves. It's important for us to recognize that and thus provide a great atmosphere like you're talking about for them to be a part of. Otherwise, I can see where they fall out quickly if they're not getting recognized when they show up and as they leave. If it's not happy, if it's not fun or if it's not engaged, if no one asks them a whole lot on the way in or the way out, why bother sacrificing my time for that?

You feel like a number instead of a rockstar or a person, “It’s probably good. My shoulder feels a little bit better. I got to take care of other things.”

We all have that. There are plenty of other things we could be doing. That's number three.

Number four is being faster and more efficient as a business as a whole. There are a lot of aspects of that too. From a physical therapy type situation, the physical therapist has to spend a lot more time with their patients, 45 minutes to an hour. You can't expedite that necessarily. You got to have that quality time, but you could be faster with setting appointments, maybe having extended office hours, and make it more convenient for a patient to do business with you. Being faster at expediting when they're done with their session, they’re paying to leave, being faster and expediting new patients to get them in. Being faster with getting insurance inquiries back to them and returning phone calls. There's a whole lot of aspects there. We live in a microwave society. That's not going to change. We know we want everything then. We have to be conscious of that and do everything we can to make it quicker, more efficient, and less obstacles in the way for them to do business with us. That makes a huge difference.

There's something to be said for going to a place and they have my paperwork already for me versus, “You're here now. Let me print out the paperwork for a minute. Take a seat and I'll bring it.” You’re like, “No, I have it already for me.”

Customer and patient perception is everything. The patient is going to perceive customer service by how you make them feel. Click To Tweet

You walk in and you go, “Nathan, you're the new patient. It’s great to see you. Here's your paperwork. There are three pages here. Fill that out quickly. We're going to get you in and out of here as quickly as we possibly can.” That tells the patient that you have their best interests at heart. You are conscious of their time. Everybody's time is valuable. You're telling them, “We're glad you're here. We're conscious of your time. We're glad you chose us. This is how we're going to help you because we're going to be quicker in taking care of you.”

Looking ahead on the calendar and seeing, “So and so is coming,” and maybe not just the front desk, but even as providers. We say, “What do I want to do with this patient?” Maybe look in their past chart and say what happened in the past. To bring that up to them and say, “In the past, we did this with you, how did you respond?” Instead of them saying, “We tried that before” and maybe they won't even say it to you. They might say, “You guys are trying the same thing over and over again. You haven't even asked if it's working.” That's what you're talking about. It’s being prepared and looking forward. Treating each patient as someone who is infinitely valuable and treat them accordingly.

It's amazing what a difference it'll make in the patient's mind when you take those little steps to do that for them. Not treat them like a number and run them through because you're trying to meet a certain financial level for the month. It's okay to do that. First and foremost, it has to be on serving the patient.

What is the last step?

Number five is I call it fixing problems or service recovery. Every office drops the ball somehow some way. To be able to recover from that in a specific manner makes a huge impression in the patient's mind. A consumer that had a problem and the business took care of that problem in an efficient manner to their satisfaction, they have more loyalty to that business than the consumer or the patient that didn't have any problem at all that but they didn’t experience great service. It'll add to that extra level of loyalty that those patients or the consumers will have because of the problem and the way it was handled.

The nice thing about customer service, when you have great customer service, you're going to have less problems. You don't have as many to take care of. Even if it's glaringly the patient's fault, you still have to treat it like your problem because it is your problem. If you take care of it right, you create that extra value with that patient or that customer, and they become your strongest advocate. I saw that many times in my career. In my chiropractic office, those patients that we took care of those issues, they were phenomenal. They were referral machines after we went above and beyond what they thought we should. It's a great thing. Now, you shouldn't try to create problems to create that extra value. That's not the point here. The point is to have a system to take care of those problems efficiently and do it in a great manner. It benefits you tremendously.

To that point, are there some tips that you recommend people use if a patient is upset or comes in with a concern, how they address it appropriately, any advice you can share?

Three main things, one is to address it immediately. We talked about being fast and doing things in an efficient manner. You want to address the problem immediately in the sense that, “I'm sorry, there's a problem.” Go to resolve it as quickly as possible. The other thing is to apologize immediately too. If it's the clinic's fault, if it's an employee's fault, you're going to apologize. You want to do that and take responsibility for it. I also coach and recommend that you apologize, even if it's the patient's fault. You apologize in the sense that you'll say, “I am sorry, you're going through this. I'm sorry, this is happening. Let's make this right for you.” You're not necessarily taking the blame for it, but you're still putting that patient that customer at ease by saying, “We recognize it’s a problem. We're sorry you’re going through this. We're going to take care of it.” Those two things are huge.

The other thing is don't play the blame game. If it's the patient's fault, you shouldn't have done that. Don't play that because all you're doing is creating anger. You're fueling the fire. Nobody's going to win, it’s what will happens. The patient's going to be upset. They're going to leave. You're going to lose a valuable patient, possible referral source, and profits coming into your office and your clinic. You got to be careful there. Apologize, do things immediately, and do not play the blame game.

PTO 120 | Patient Retention And Referrals
Patient Retention And Referrals: You could have an average chiropractor that's decent, but if you have a tremendous staff that does great with customer service, you're going to have a tremendous office.

We want to do that. We want to find out who's to blame for this so that we can point the right finger at the right person. It's so much easier when you say, “No blame, no pointing fingers. We're in this situation, how do we simply resolve it?” It allows the emotions to stay out of it. That's for sure.

That's the main thing. You want to keep the emotion out of it. When emotion gets high, reason gets low and that's where everything blows up. Be very conscious of that.

Any other little tips along the way that you share with people? Wear your hat the right way or sit the right way, anything like that that you can tell people. These little things if you think about them, they can improve customer service.

There are two things that are so stupidly easy that whenever I tell people this, they're like, “We already do that. That sounds good, but it can't be that effective,” but it is. My coaching philosophy is doing the simple things consistently, that's where you're going to get major results. These two things that I want to share are very simple. The first thing is to put a smile on your face. Every employee, every day, the practitioner, everybody has a smile. What I tell my clients is a smile should be part of the uniform of every employee. If they wear scrubs or if they put a name tag on, a smile goes along with that. Smiling is the universal welcome. It immediately puts people at ease when they see a smiling face. It calms them down and it lets them know, “We're here for you.” Smiling seems so ridiculous, but it's not. It's very effective.

The other thing is I call it manners matter, but it's using three phrases, please, thank you, and you're welcome. Everybody goes, “We know that.” They may know that, but in this day and age, it's lost a lot. I recommend using those three phrases in every form of communication too, face to face, on the phone, text, and email because those are a big part of most clinics' communication sources too. They show respect for the other individual.

I like that you also included emails and texts in that because think about confirmation calls. I don't recall a lot of please and thank yous. I'm glad you included that.

It takes the edge off. It's showing a little bit of respect to that person. You're trying to drive perception. If I'm sending a text, “I want to verify your appointments. We appreciate you. Thanks for being a patient,” or something like that. How easy is that? If it's an automated text, it’s like, “They're glad I'm a patient.” Those three phrases are so simple to use. It's so simple not to use it as well. That added an extra edge of, “I appreciate you, your valuable to me, your valuable to this office. You're important to this office. We're going to respect you with that language, to verify and to show you that's what we mean.”

This sparked a thought in my head. You talked about you bring these things up to them like you should be doing these things, smiling, please, thank you, you're welcome. People will say, “We do that.” Have you ever used any secret shopper exercise or anything like that? Maybe you call the front desk to see what words they're using, what verbiage they have, and what tone it is? Have you done that before? I'd assume most of the time the owners are surprised of what they hear.

Happy employees equal happy patients. Click To Tweet

They are. Nine times out of ten, it's not as good as they think it is. That's the funny thing about customer service as a whole. Most businesses think they provide great customer service and they have certain aspects of good customer service. Maybe they do a little of this and a little this. As a whole, the perception of the patient or the customer is they don't have that great customer service. What a lot of businesses do and this is very common and I did it as well, is you'll have a new patient come in, you treat them once or twice. That's the honeymoon phase. Everything is all hunky-dory and roses.

You send them a, “Do a quick Google review for us.” They'll give you five stars every time. Give it another 2, 3, 4 or 5 weeks and see if that patient is still in your office for one thing. If they are, let's see how they're going to review the office at that point. Is this still going to be a five-star? To me, that's not a legitimate Google review, if it's the first couple of visits. As I was saying about chiropractors, the first couple of years in practice, they don't know enough to know what they don't know. It’s same with patient's first impressions, "They treated me pretty good. I'll give them a five-star review. I don't want to say anything bad about them.” Once they get a little bit of understanding, most of the time, it's not quite as good as what they'd like it to be.

The newness fades a little bit. Maybe it's not a five-star review anymore. Maybe it's closer to 4, 3.5. I noticed these things over and over again that you guys don't do.

It’s probably the first couple of times, but it keeps happening over and over.

In that regard, do you also recommend doing surveys with the patients’ NPS, Net Promoter Scores and that kind of stuff?

There are three metrics that I promote with my clients. You want to get a patient score survey and understand where they are. What I recommend is a 1 to 10, if a patient says 8 or below, then you need to contact them and see what is going on. Why are we an 8 or lower? What's our problem? What do you see as an issue? How can we improve? The second survey is an employee survey. Question them, would you recommend your friend coming to work here at this clinic, this office, this location?

You need to do this in a way where it's not going to be if they say no, that it's going to be a problem. You understand why they wouldn't because happy employees equate to happy customers. If the employees aren't happy, customers are not going to be happy. It's going to cause a problem and disconnect. You got to be careful with that. The third metric is profit and cashflow. There are a lot of KPIs that you can work through. These three came from Jack Welch, the CEO of GE. Those are the metrics he used. If they’re good enough for him, they're good enough for me.

If he can do amazing things with GE back in the day, then I can do the same thing for my clinic. They're great. The patient survey one is obvious, but I love the employee survey. When it comes to the cashflow and bottom line, that's the bottom line if people are liking you or not.

PTO 120 | Patient Retention And Referrals
Patient Retention And Referrals: It's hard to provide great customer service if everybody's walking around that's ticked off with a negative attitude.

The purpose of the business is to get a patient or get a customer. You need to keep that customer and then make a profit. A lot of businesses, they understand to get a customer. They do very little to keep the customer and then they try to make a profit, which to some degree they can, but they are missing the whole aspect in the middle of keep that customer, which expands the profits. That should be the focus. My passion is to help businesses do a better job with that.

Thanks so much for sharing your time. Is there anything else you want to add before we sign off?

No, we've covered a great deal. I appreciate your leading questions and help me to open up some of this stuff. I've loved our conversation.

You've provided a ton of value. If people wanted to reach out to you individually, how do they do that?

There are several different ways. You can go to my website, DrKellyHenry.com. By all means, email me at DrKel@DrKellyHenry.com. If you have any questions would like to contact me and maybe set up a chat, I'd love to do that. If you like to text or call me by all means, I'm open to having patients or potential leads and clients call me. My cell phone number is (575) 706-3304. I'd be more than happy to talk about what we do. My coaching is a little different. I call myself a multiplier and my goal is to help multiply getting patients. If it's PTs or chiropractors or customers, multiply profits, growth, employee engagement and multiply all these things that we've talked about.

We do that from the inside out. We look at the internal things and change the dynamic. It’s not to change the business completely. Let's just enhance certain things that are going to create the greatest results. The 80/20 rule, let's look at this 20% set of things that are going to give you 80% of the results and see what happens. That's my coaching philosophy. My coaching programs are customizable. I have different time periods, 3, 6, 9 months, depending on if some would like to spend more time with me, weekly calls or monthly calls or biweekly, whatever the case may be. There are some customizable pieces to my coaching to make it affordable to the different price points and different budgets of the clients I work with.

Hopefully, some people reach out and get some more information from you, but thanks for all the information that you provided. It was a great help for many owners.

I appreciate the time. Thanks so much, Nathan. I enjoyed it.

Important Links:

About Kelly Henry

PTO 120 | Patient Retention And ReferralsFor 20+ years, award winning chiropractor Dr. Kelly Henry helped patients achieve and live healthier lives.

With the foundation of exceptional customer service and streamlined business procedures, Dr. Henry grew his business into the top producing chiropractic clinics in the nation with multiple locations and doctors.

After retiring from private practice in 2018, Dr. Henry has dedicated himself to consulting and coaching business owners on how to create incredible growth and profits using the processes and procedures he used to create phenomenal success in his offices.

Love the show? Subscribe, rate, review, and share!

Join the Physical Therapy Owners Club today:
© PTO Club 2018 - 2019
linkedin facebook pinterest youtube rss twitter instagram facebook-blank rss-blank linkedin-blank pinterest youtube twitter instagram