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, By all means, email me at 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.

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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.

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PTO 50 | Patient Experience


Some businesses struggle with connecting and keeping patients, especially in the PT industry. The secret to this is always being able to create an excellent customer experience. David Self, the Director of Product Strategy for the software company, Keet Health, shares what he learned from the internet software realm and how it can be incorporated into the physical therapy business. Focusing on making the treatment experience for provider and patient more comfortable, basic, and easy, David uncovers the top hacks in achieving more exceptional results for your business and maintaining personalization without destroying efficiency. Discover how technology is positioned in the PT industry and learn why it is crucial to market your brand assets.


Listen to the podcast here:

Triple Your Marketing Efforts By Improving Your Patient Experience with David Self, PT of Keet Health

On this episode, I have David Self of Keet Health, which is a PRM that is used to improve the relationships and the interactions between physical therapists and their patients. You'll be interested to follow David's story. He recognized the dichotomy between the relationship and the experience that he had in working with some of his fitness patients versus some of the patients he was working with in his clinical internships in PT school. Thus, evolved the software program that he developed with another founder of the company. He works as the Director of Product Strategy for Keet Health.

We're focused on how Keet Health helps the customer experience for patients in their physical therapy settings. How that can help the physical therapist maintain the relationship and improve the customer experience of that patient so that they continue to be returning patients and customers of theirs. The great insight that he shares comes from not only his experience in the physical therapy realm but also the experience and things that he has learned from the internet software realm and how that can be incorporated into our physical therapy businesses. I’m excited to bring in his fresh perspective. Hopefully, it can inspire you to do more in terms of improving the customer experience in your clinics.


We have David Self of Keet Health. He is Director of Product Strategy. First of all, thanks for coming on with me David.

It’s my pleasure. I'm happy to be here.

If you don't mind sharing with everybody your professional story and I’m sure that's going to incorporate the development and growth of Keet Health. Do you mind going back and tell us a little bit about how you got to where you are?

I am a PT by trade though I’ve never actually worked at a PT practice. I’ll start from the beginning.

You’ve never been into practice? You've been business-minded the entire time.

Focus on the customer experience and your 'marketing' efforts will triple in potency Click To Tweet

I had my own while I was in school, which is a misnomer. I had it the first few years at Keet. I practiced PT and got paid for it, but I’ve never been paid.

I’m excited to hear your story.

I went to school at the University of Texas. When I was there, I worked with the basketball team. That was a great experience for me because I was heavily influenced by a PT named Gary Gray who became a close friend and mentor of mine. That's where I first got exposed to thinking about doing therapy for a living. I was going to do strength and conditioning. It’s funny because I weighed ten pounds. That’s where I got started with. Todd Wright was the strength coach there. He’s now with the 76ers. It was an amazing experience at a young age. I went from there. I went to a PT school at Texas State University right outside of Austin.

Right before I started that, I started my first business, which was called Austin Integrative Fitness. It was essentially aftercare, functional fitness therapy business. The niche was I’m going to be the smart trainer that knows how to deal with people in pain that the other people don't want to work with. I’m not actually into therapy. That was my first route in the entrepreneur game and it was successful. That was a fun thing. You can imagine being a PT student trying to market for PT practices within a square mile of that studio.

I can't imagine going to school and having business at the same time. That had to be a lot of work.

PTO 50 | Patient Experience
Patient Experience: Quality care has two components - getting great results and great customer experience.


I don't recommend it, but I was able to come out with not a lot of debt. It's primarily because of that. That part worked out. I was a founding member of the Austin Health Tech Meet Up and for those who don't know, Austin is a technology hub. I was a member there in my second year in PT school. In the first meeting, I was sitting at a table with about eight people. It was six venture capitalists and the Founder of MapMyFitness and some other big company. I introduced myself, “I’m David. I make no money. I’m into the ankle joint and that's about it.” I met a person there named Jason Bornhorst, who was doing this thing called Patient IO, which was a patient engagement startup. He was getting started. I was one of the first customers. I started introducing them to a lot of people that I knew in the fitness world, like some big box gyms.

I had a lot of connections from my time in Texas. That was my first taste of Neon technology, opportunities big. It's fun. It's exciting. That got my whistle wet if you will. My last semester of PT clinicals, I was at Texas Physical Therapy Specialists, which is now a customer of ours. I met my Cofounder at the time named Jon Read and we both collectively thought that there were so many things that we had to do as either a patient and/or a therapist that was not actually related to us spending time together and working on the recovery. I recall I had my fitness studio. I’d wake up and have a session at 6:00 in the morning, one-on-one, no documentation and no bureaucracy. I was texting patients. I was sending them YouTube videos. I was super close. I went to PT practice, which I thought would be much more advanced than that. In reality, because it's what everyone knows, it felt like I was going back in time.

I felt very disconnected. There was a particular day that I was driving home from my clinicals. I was seeing twenty patients, which like Armageddon when you're a student. I stayed on top of all my paperwork. I was like Johnny non-stop. I got out at 5:00. I was going to a happy hour at 6:00. I remember driving away from the clinic, I was at a stop light and I thought to myself, “I know half the names of the patients I saw and everything that I did was primarily to expediate the amount of documentation I have to do. I said, “I don't want to do this. I’m not making great money. I got to wear Dr. Scholl’s. It's not very motivating and I feel way more disconnected than I do in the mornings when I’m the studio. We decided to go for it. That's how we started Keet. That obviously has scaled and was successful and we were acquired by Clinicient, an EMR company in Portland. Now, I’m in the tech world.

Based on your experience, I’m sure you can see where a lot of frustration, even what you'd call burnout can occur for owners and for longtime therapists. The focus is so much less on patients and so much more on everything else, honestly.

It's spot on and it's not the provider's fault. Sometimes these days it can be a little bit their fault if they're not willing to adopt it to the new wave of healthcare delivery. By and large, it's by necessity and unfortunately, that necessity can decrease the passion of why you got in that in the first place. I’ve been at PT school for three years and about 50% of my class has either got out of PT or they went to home health. It's a big problem and it's tough.

If you can't implement it, then it's useless. Click To Tweet

Your main focus then with Keet, tell me a little bit about that. When you initially started, tell me about what your purpose was and if that's evolved over the past few years.

It certainly evolved in terms of what we ended up building and pivoting to like any startup company. Essentially Keet’s always for me had the same vision. The vision can be characterized as we wanted to try to reimagine recovery. We wanted to reimagine that primarily as a movement of being excited again, of being able to break a lot of historically, super outdated processes to the modern world. We want to rediscover that human connection in healthcare, which fundamentally was connecting the provider and the patient. The second part of that vision is that we want to be able to do that in a way that was scalable for practice owners and not just a call center for them. The margins are insanely low compared to other businesses in therapy. We didn't want to build the super cool thing, but then it was cool but there wasn't ROI to pay for it.

It's largely remained the same. We've always had two eyes focused on value-based care. We've always believed that the most fundamental level that quality care has two components. It’s getting great results, which isn't just relevant in value-based care, but in fee-for-service or any other type of payment model we ever come up with. You've got to give a great service to customers, but you can get great results and not have a great experience doing so. Particularly not have a great experience doing so beyond the walls of the clinic. Those are the two prongs of any business.

We wanted to be able to measure both of those things. You’ve got to be able to measure that you're getting great results and mention your experience. That continues to be our fundamental hypothesis that outcomes in patient engagement should never be separate from each other because they're intimately related. Most importantly, as healthcare changes to alternative payment models, they only become more and more important, those two things. That's primarily remained the same and still is what we are now.

For the person who maybe this is the first time they've ever heard about Keet, in a snapshot, what do you provide? What do you do for an individual clinician or an individual practice owner that helps obtain improved results and greater customer experience?

PTO 50 | Patient Experience
Patient Experience: When you get so wrapped up into putting out fires everyday into your to-do list, you slack on strategy and innovation.


I can talk about it in three buckets. One bucket is clinical engagement, to not get too detailed and you can visualize our Keet Patient App and then there's everything related to the patient's care. Home care plan, education, messaging and filling out their outcome measures. Generally speaking, it’s a connection to their provider when they're not there. We have a second component that is our basic automated marketing. We send out targeted emails and measure your patient’s experience via the Net Promoter Score. That doesn't require an account and that's bringing your practice in the modern age at the most, not table stakes level. We have a third component of outcomes registry. It's a qualified clinical data registry. It measures your outcomes via the engagement app if you're inside the clinic and then we report on that.

Going back to that same pillar, we're helping you get great results because we're connecting with your patients beyond the walls of the clinic. We also measure that so you can participate in other payment programs. We're making sure that we help you build a loyal following of patients. Sometimes, patient engagements become critical. It means a lot of things to a lot of different people. Sometimes it's like an excuse for marketing or email marketing. You go somewhere else and that's nowhere to be found.

It's important to sometimes transcend the label and to think about the problems that you need solve, but also how do you uniquely solve those problems there? Sometimes therapy is unique and so you can't do everything like any other business. Sometimes it's not unique and you can't do things like any other business. We've tried to focus on things that are unique because the things that aren't unique, those are commodities. It's better to use the best software for that than a “physical therapy software.” It's a pet peeve of mine when we started trying not to commoditize terms for physical therapy. The software’s such an odd tangent and we don't want to get on that.

You've recognized the benefit of not only improving results. This isn't necessarily about improving our technical skills but improving the customer experience and the interaction between the physical therapist and even the physical therapist's experience in that relationship. Developing, growing, maintaining and perpetuating the relationship between the patient and the physical therapist.

That's a huge component of what we do and we can focus on. There's obviously the other arm of the benefit of measuring your outcomes, improving your words and how that's absent sometimes in the patient experience. That's an accepted pillar, but that's all wrapped into the actual customer experience. I might sum it up even more simply and say that we're trying to scale and what you have to do with any business is a key. Any business, regardless of therapy, it's hard to scale personalization. It's in the word. Most businesses start very hand-crafted, everything hand-crafted, meaning you do it all manual. Even when Airbnb started, everything was hand-crafted. You hit a certain stage of scale where you can no longer maintain that.

You have to be clear on what you're great at. Click To Tweet

You come to this difficult challenge of, “How do I maintain personalization without destroying my efficiency?” If you’re seeing 1,000 patients a month or something, you can't text those patients every day. You can't write personalized emails every day. You can't do all that type of stuff, but you don't want to lose that part of it. You have to have systems in place to maintain your magic sauce that got you there in the first place. That's where the provider part comes in is to be able to help give great experiences to patients in a way that keeps them loyal and helps them get varied results. Also in a way that it's not just “another thing” that the therapist has to deal with or a provider has to deal with because you can never implement that. If you can't implement it, then it's useless.

As you've been through this journey the last few years, focused on the customer experience, improving that and improving the relationship between therapists and patients, what are some of the things that you've come across that helped the physical therapy owners and the physical therapist themselves improve that customer experience? Are there some tips and guidelines? What are some of the secrets you've come across?

I’m a big fan of Brian Chesky. He is the CEO of Airbnb. He had a statement, which I agree with. I’ve had some fortunate opportunities to know some early people there. Fundamentally, it's tough to get inspired by your own industry because you get capped into the group thing. I would say that the number one thing is to try to learn from consumer internet companies. They're such an amazing example for us. They're also very salient. We all have them on our phones and we all can observe it. We all go home and watch Netflix with our kids or whatever. I would say number one is thinking about the best experience that you've always had and try to learn from those people. How has that particularly influenced us? A few things that I think that we've seen been successful by providers. It goes without saying, we learned a ton from PT owners. One is access personalization is the way that it is now and the way of the future.

You have to adopt the simple truth that that's the way it is and that's the way it's going to be. Taking that example, if a bank didn't offer mobile deposit or even have an app on their phone, again, it's not about the app, it's about the personalization. Maybe you’d go out of business because consumers have a reference point now. The banks are the ones that adopted that early, even though the majority of their customer base didn't use it very much in the first couple of years. That's what it means to be on the bleeding edge of innovation. When you implement something or you want something, it doesn't have to be super high adoption rate off the bat, but you get to escape velocity from your competitors when they're trying to freak out and catch up five years later.

Do you find that it's hard for physical therapy owners to see that far in the future when it comes to technological stuff like you're talking about? You're talking about stuff in modern day, but you and I both know that the physical therapy industry is probably years behind. Is it hard to talk to them about what the next things are coming down the pipe, either because they're busy or they can't see it? Do you have a hard time coming across?

PTO 50 | Patient Experience
Patient Experience: It's impossible to reverse any mistakes you make in culture after you'd get over it.


For anyone that’s ever owned a small business or a big business, you don't have a lot of time. At the same time, you have to prioritize what matters. I do think that it's difficult for owners sometimes because you get so wrapped up into putting out fires every day in your to-do list that you can slack on strategy and innovation. You can't afford to not do it because then you'd become lackluster. The second thing is it is admittedly difficult because beforehand you didn't think so much about technology, so you've got to focus a lot more on other parts of innovation and strategy. Whether that was treatment, whether that was how you work with someone doing customer service things or barking at physicians, how your space is laid out and how to get great leases on your spots that type of thing. That's true with any business, but now we live in the information age and that has to be something that you prioritize. There's a firm in California and Andreessen Horowitz has a phrase that I love, “Software is eating the world and if you don't make it a part of your DNA,” and I don't mean software or a particular type of software. I mean the realization that it's when you went paper to computers. You're not going to back to paper and it's no different for many other technological innovations.

I think we can see some of the growth of physical therapy in that direction, whether it's through apps or software programs like yours or even Telehealth. Some of this is inevitable. We've got to learn a way to utilize it in our own practices or we're going to fall behind when people come to expect it.

That type of stuff is at the forefront of everyone's consciousness. One of the things I think is worth pointing out is primarily a posture of thinking and a posture of strategy that often includes technology, but it's not exclusive to technology. What I mean by that is when you walk into a spa, what is a spa characterized by? Aromas. Every little detail is thought through. What they say when they first see you and all that experience. That's why they have such loyal customers. Even for people that are going there when they should be going to therapy because, “I might not be getting better, but I feel so cared for. It's a great experience and in it talks to the other parts of my humanity that is my brain, my smell, my feelings and all that sort of stuff.” That's part of the reason that we make decisions. We don't do the thing that's best for us, we do it because we said so. Those are things that don't cost money. You can start thinking about that as a practice owner. Think about your music, lighting, carpet, layout and what people wear. There are so many stuffs that we can always constantly be thinking about of establishing that great experience because that's what's happening. This is how it is.

I love where you're going with that because I never thought about smells, but honestly, what does your gym smell like? It could be a big deterrent whether people want to come back two or three times a week for that.

You'd also be shocked if you ever studied the hospitality industry, the multimillion dollars they spent testing out the aromas and the people that they bring in and the studies that they do. All of those things as a consumer, you don't even think about it. It's subconscious. All of that stuff has been taken seriously. That could sum up largely. What I’m saying is that you have a choice to either make the things that you might historically use as commodities in your business. You can either choose to make them commodities or you could choose to make them brand assets. That's the difference between outstanding customer experience and a really cool.

People pay tons of money to stay at something, not because of the result, but because of the experience. Click To Tweet

A lot of time when we talk about niche practices and stuff like that, we think about how we're going to treat patients differently or how we're going to market ourselves differently. Thinking about what you were saying there, a lot of your niche can simply be the personal experience related to your brand. It could be the smell that you use. It could be the words that the front desk uses. It could be a streamlined paperwork system for new patients. It could be comfy chairs in the front office with lights and stuff like that. A lot of things can be done to become unique and niche that doesn't require you to change a lot of what you're doing on the physical therapy side. That's something that I’m thinking about as you're going through that. From my experience, I always found some of my greatest success with physical therapists who the patients enjoyed being with, not necessarily because of their technical skill, but because they enjoyed being with them.

My business partner back in the day has stories about guys who he would have work for him that were much better clinicians than he was, but patients would come back to him. He'd ask them why? They'd say, “I like working with you. I like seeing you. I like hanging out with you and find out what you're doing.” That was a testament to me that sometimes the patients aren't all about the best care. A lot of times, it's about the experience that you provide them. I like how you're talking about there are some ways we can differentiate ourselves beside becoming the back expert or becoming the ankle expert or the knee expert, even going to women's health or vestibular. Sometimes we can make the experience unique simply by improving what we already have.

A lot of that thought matrix as to what you decide to be great on and what you decide to let fall. Particularly when you're starting out, this is different as you get bigger, but if you're relatively smaller, you're still trying to hit one particular stage of scale. You always have limited resources and that includes people, time and money. You have to be clear to yourself, “This is what we're going to compete on, this is what we're going to let go.” Part of that thought matrix is that and then also taking a sober judgment of, “What's the situation around me? Is it a saturated market or is it a blue ocean? Maybe there are the people down the street that they're killing it on getting amazing outcomes. They have the smartest people, they are off our list and you respect whatever the reason is. Maybe that should have formed this, “I can compete on outcomes, but that might be harder. Maybe if I compete on experience, time or compete on anything that's not just that, maybe that's my strategy in my market or vice versa.

I think that's what we're getting at is you have to be clear on what you're great at. It's more fun to focus on and to have the experience be something that makes you different. For a long time, Walmart was not that. Their competitive strategy was they’re the cheapest. That's obviously been successful. With the factors, the consumerization of healthcare, the more choice that patients have than ever before, that I know we are fighting for attention. It's something that we don't want to neglect anymore. The good news for everyone is that once you get to a certain stage or scale, you can reasonably compete on both. Look at Airbnb or Uber, it's the most affordable, it's the best result and it's the best experience. It's not impossible, but usually it's because you're first to market. When you’re second, third, fourth to sixth in the market, you usually can't say, “I’m going to beat the person in front of me.” You’ve got to be very strategic about it.

I like what you said about as you're starting off you can become unique by differentiating your customer experience. The thing that comes to mind, I don't have any experience with it, if you do, go ahead and speak to it. I would imagine as you get bigger, it might get to a point that it will be hard to maintain that customer experience. It has to evolve at least, if you're increasing in square footage, number of team members, physical therapy providers and then multiple locations. You've got to work even harder at maintaining a customer experience for your company.

Without a doubt and it’s why companies fail. It's not unique to therapy. It's true for any business, whether you're a software company like us or you're an airline, a hotel or restaurant. When you're going from one employee to a hundred, that's where the biggest risk always happens because you have to be a culture warrior. The CEO of Workday, he's quite fond of saying that it's basically impossible to reverse any mistakes you make in culture after you get over a hundred. It's not like you can't, it's just so much harder work because there's so much tribal knowledge, habits and expectations. That's where technology can help. This is what we say a lot to our customers and it resonates a lot with people. When you're the practice owner or you’ve got two or three of four people under you, you know everything that's going on.

PTO 50 | Patient Experience
Patient Experience: It's a lot more meaningful to a patient when they have convenient access to their care.


You know what you're saying to the patient. You know how you're talking about pain. You know how you're paying attention to them. You know the results that you're getting with them. You know everything and you know those first few employees. When you have 100 therapists or even ten therapists, you can't control that. You don't know what the new grad’s saying to them. You don't know how often they're on the computer. You don't know that stuff. That is where thinking about as practice owners always think, “How do I establish the floor of the quality, the clinical care that I deliver?” Most people will mechanize that by saying, “Everyone in our practice is going to go to this particular education, this residency or this fellowship. This is what we do with new grads.” You've established that floor of clinical care, meaning that worst case scenario at least someone's not going to get killed.

At least everyone will do the treatment-based classification for back pain. They'll at least get someone there. You have to take that same approach to customer experience. You don't know if the new grad’s butchering something. If you can make sure that when the patient is beyond the walls of the clinic between visits and interacting with your brand digitally. That you're getting the message to them that you need to get at a floor level that can compensate for whatever things might be going on elsewhere. There's a real benefit to the technology because it can scale that part of your practice. You don't have to worry about that part. You can focus on coaching your staff members to ensure that you can sleep at night not having to worry about that.

That's where I see where Keet can be a backbone to creating that fundamental structure or fundamental customer experience for the patients that come into your practice. That's what you're going for.

We certainly hope so. That’s a big part of this idea to go back to our story, that's our vision. I would say one thing I’d like to comment on. There are some things that are unique to therapy and some things that are not. An easy way to think about that, if someone said, “We're an accounting software for coffee shops.” If it's a software, it doesn't matter. You'd say, “You're an accounting software?” There's nothing unique enough about a coffee shop and how they do their books. They shouldn’t think about what they could do that as the way anyone else does. They can also emphasize the same things in any other business. There are some common characteristics between a coffee shop customer and a PT customer. They come inside, they talk to someone, they paid for a service, they get the said service and they leave. You want to keep in touch with them, maybe you want to measure their experience and you want to remarket to them, that type of thing. That's the same.

What's different about therapy is that this is unique to therapy. You have this whole concept of the episode where you’re like, “Nathan is going to see me for eight visits, nine visits or ten visits.” Also, the difference is, “Nathan's locking in.” It’s like a mini-tragedy, if not a real tragedy. He has a particular goal in mind, which is his pain and his discomfort or his goal. You have to say, “That is unique about therapy.” Consequently, being a therapy customer is a lot more like being a hotel guest. I have this snapshot and that specifically on experience to blow their socks off. You're not coming here perpetually. You’re coming here as needed, as you go to a hotel as needed. You don't go to a coffee shop as you'd go perpetually. My perspective on that is that the most effective form of marketing to that patient of establishing a groundwork for remarketing later is actually the clinical experience. In other words, “Think less about marketing and more about giving a great experience and your marketing efforts will be tripled in potency.”

When you can't possibly do it by hand anymore, that's when you worry about how to scale your business. Click To Tweet

That's why we take the approach. If someone might see our apps for instance, and again, this isn't a key fit. This is a way of thinking about it. “We already have an AGP software. We use this for outcomes. We already educate our patients and people can email our therapist.” Those are commodities. They don't hurt you, but they definitely don't help you. It's a lot more meaningful to a patient when they have convenient access to their care. When you've reinforced, maybe I explained to you how pain works. By the way, I wake up in the morning and it's like, “I have a piece of education from Nathan and it's a video of him re-explaining what you already told me. I can click something to know a little more and maybe you send me a thank you note in the morning.” That is way more impactful than thinking, “Here you go, AGP to go.” I don't mean to slam those guys. I shouldn't say that, but I think you get my point in that. What your patients care about, is that when I send them a checking email six months later asking them, “Would you like to come in again?” You're building on top of the foundation that is amazing and much more potent than if you didn't do that at all.

I love the ability that you have to work with patients between visits because it's not easy to go away and make a phone call or sending a personalized email. If you can say, “How are you doing this morning? Make sure you don't do this. Make sure you do this.” Those things can go a long way for a patient and guess what they're going to do? As they see this experience that differentiates you from other healthcare providers, they're going to say, “These guys really care about me,” and share that with their friends at lunch or over coffee. “This is what my physical therapist told me to do. This is what you guys should do as well.”

The difference between getting great results and those results are making you a fan. I could stay at Motel 6 and it gets the job done. I get to sleep, I get to take a shower and everything's fine. I’m in, I’m out, that’s it. When someone says, “I’m going to go to Austin,” I’m not like, “You’ve got to go stay at Motel 6.” I don't say that just to have the job done. I went to the W Hotel here in Austin or Four Seasons or some cool boutique thing. Think about the difference that makes you. We all have those companies in our lives that some are like, “I’m going on a business trip.” “You know where you need to go? You need to go here.” Take a step back and see, “What is it that makes you say that?”

When you listen to people start raving about they need a thing, it's not like, “They had a bed. I can sleep on it.” It's about all the little details. “It was so nice and this and that. The decor was amazing. They called me to make sure every day was going well.” Here's the amazing part about that reality, then you say, “How much is it?” They’re like, “A lot of money, but it's so worth it, I’ve got to tell you.” People pay tons of money to stay at something, not because of the result, but because of the experience. Imagine when you send that person to ask you for social review, the commodity part is asking them for a social review. You don't need some type of crazy software to do that. You need to be able to help create that person’s need to begin with.

I’ve heard many podcasts where they talk about or interview Brian Chesky of Airbnb and that's all what they're all about. It’s that customer experience. Back in the day, I remember the stories about them actually visiting some of the people who were posting on Airbnb and seeing what the experience was like to go to these places.

PTO 50 | Patient Experience
Patient Experience: What gets in the way of getting inspired and feeling you’re doing meaningful work is when the ordinary things feel like mundane things and you feel like you have no purpose.


It's a great experience. There’s another podcast, it’s called Masters of Scale by Reid Hoffman and listen to the very first episode. You'll hear an amazing story, which I’m going to sum up. It's something that we should all adopt as business owners. Brian's very inspired by Walt Disney and so he was reading the biography and he was thinking, “What can we give outside of homes?” For those that know Airbnb, they have Airbnb Experiences. I’m actually doing this with my dad. I’m taking my dad on his bucket list trip to Europe and I’m booking all these Airbnb Experiences by locals, take us to the Pantheon, to the Vatican, show us the underground or new cool restaurant.

How that came up was he didn't study and go visit cool hotels. He didn't go to tourist companies. Do you know what he did? He hired someone from Pixar who had no product management experience of technology ever. He said, “Tell me how you write a great story.” The guy got up there to say, “This is the formula. There's always the super grand entrance. They think they know what they expect, then there's this moment where they re-discover themselves because they do something uncomfortable that they would've never done by themselves. They become this new person, there is something about it.” He was like, “Great. We're going to do that for one customer.”

They had a customer, go out of San Francisco by himself and said, “We're going to take your weekend, but we're not going to go with you the first time. Do whatever you want.” That's where he came back and said, “I'm pretty miserable. I’m not that enthusiastic of a guide. I went to some bars by myself. It was really expensive. I didn't know if it was okay.” They said, “Come back the next weekend and we're going to show you around.” They flew him in a private jet. They picked him up in a limo. There was a parade in the street that he was staying at the Airbnb. They welcome him in and he got an underground bike tour. He got on all these restaurants. He got announced on stage. He got on all this crazy stuff and sent him off on a private jet.

When he was leaving, the guy was crying, “It's the best weekend of my life.” What Airbnb says, “We can't scale that, but that is the ideal experience. That's what we're shooting for. What from that can we actually scale?” That is how Airbnb Experiences started. That's been a great lesson to how often do you hear that someone's in your company or you hear some great idea and the first thing you say is, “I don't know how that would work. I don't know.” It's the wrong way to do it. You don't ever start there. Start with an imagination. Whatever your reference Pixar person is, think about that. Remove all your constraints, then do that with somebody and then you will get so inspired to get out of your box and then say, “How can I fit those types of things into our business?”

What a great exercise you can do with your executive teams, even by yourself, with someone that you work with or even by yourself. On a scale of one to five-star experience ratings, what would a twelve-star experience look like for a physical therapy clinic or for a patient to come to a physical therapy clinic? It might include a parade and having them picked up by a limo from their home and whatnot. Some of those things aren't doable, they're not scalable, but of those things that make a twelve-star experience, what could we do? What could we implement? To brush that story off as, “It's cool for Airbnb.” I think it's something that we could definitely learn from if we took it back and said, “I can't do all that stuff, but of a twelve-star experience, what could we implement now? What could we implement in a month that makes the customer experience that much better?

Sometimes, prioritize that over efficiency. It’s something we get caught up in. “I don't know what’s going on with our EMR,” like all that type of stuff. Sometimes it's worth taking it on the chin as an owner for the sake of your patient, particularly when you need to compete. The biggest lesson here is that I’m a big fan in any process in your business, you do it by hand until it hurts. When you can't possibly do it by hand anymore, that's when you worry about how to scale it. Don't not do it because you don't know how it's going to scale when you open your next site locations. You’re never going to be able to take to innovate if you constantly obsess around operations.

I really appreciate you taking the time. It's been a great conversation.

It's been a blast. As you can tell, I am very inspired and passionate about it largely because we used to have a phrase early on in Keet. We got to an interesting crew of people and a lot of us are pretty big thinkers when it comes to the big questions of life. We had this phrase early on which was a vocation as an implication. What that meant is the word vocation has largely been a lost word in our culture, replaced by job or career. Vocation, historically, is a sense of calling. It's a sense of purpose as to what you're doing and it's beyond your job. It includes your job. As implication means you're implicated in the way that the world turns out and you’re implicated the way that your business turns out.

What gets in the way of getting inspired and feeling you’re doing meaningful work is when the ordinary things feel like mundane things and when you feel like you have no purpose in things. Think about it, no one likes to do the dishes or doing laundry. It always feels it's getting in their way of something. If you could somehow make that something that is inspiring to you, it would be amazing. That's what we're passionate about at Keet as people. That's what all business owners want too. You want to be able to feel every aspect of your business is something that you're excited about. If you focus on that, then it's the same thing for your customers. I appreciate you let me rail off and getting on some tangents. I think that's always the best way to get inspired. It’s the same thing with this show. You read and it's overwhelming, just start with the one thing you can do. Take it from there and go from there.

Thanks for taking the time and sharing with us. Is there any way people can reach out to you or contact Keet if they have questions?

In terms of the actual software, if you want to learn more, You can go there. In terms of me personally, my Twitter is my last name @SelfDM. My email is I will try to get back to you, to every person, but I can't guarantee how quickly. We’re always trying to make it a point that I can. I’m also on LinkedIn. When you’re at a conference or anything and you’re around, come and say hello. I love to meet and learn from everyone else. I certainly don't know everything.

Thanks for your time, David. I appreciate it.

Thanks, Nathan.

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About David Self

PTO 50 | Patient ExperienceDavid Self, PT, DPT is the Director of Product Strategy for Keet Health - a PRM for PT companies. He began his work in the healthcare industry as a strength and conditioning assistant while attending the University of Texas. He eventually opened his own fitness facility just outside of Austin, TX while also going through PT school at Texas State University. Upon graduation he and a partner founded Keet Health in order to improve the PT experience for both provider and patient, and eventually sold the company to Clinicient.


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