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 54 | Patient Experience


No business can level up their patients’ experience if they don’t understand the customer’s journey. The host of Healthcare DisruPTion Podcast, Jerry Durham, PT, has built a reputation in the PT industry as an outspoken expert who sees things with a different perspective. Jerry and his partner, Sturdy McKee, decided to take their physical therapy practices out-of-network before it was trendy or even a consideration for most PT owners. However, because of his view on things, he has also turned his experience and outlook into an opportunity to share what it takes to create the clinic and business that you ultimately want for your patients’ experience. As he takes us through the lifecycle of a patient and their interactions with the physical therapy clinic - from the initial call through the billing cycle - learn about the essential roles of the front desk and the ten-point checklist if you aspire to hire the right person and empower them to be successful. On the side, find out the difference between customer experience and customer journey, and understand the customer lifecycle.


Listen to the podcast here:

Improve Your Metrics And Culture By Improving The Patient Experience with Jerry Durham, PT

I've got Jerry Durham. I'm excited to bring Jerry on because he's well known in the industry. He has been an expert, a conference speaker and industry leader for a number of years. His focus is to help physical therapy practice owners to engage patients for great results. He has questioned why there isn't more emphasis placed on treating patients as individuals and focusing on truly developing the relationship with patients. You're increasing your arrival rate, decreasing no shows and cancellations and achieving greater results, all through improving that relationship between your clinic and your patients. He talks about the patient's journey. We've talked about the patient experience in the past, but I like how he explains it. He takes us through the life cycle of a patient and their interactions with the physical therapy clinic from the initial call through the billing cycle. At each touch point with the patient, each staff member has a responsibility to create a great experience with that patient. Developing that relationship will get us the numbers that we want. It will improve conversion rates and cancellation rates, improve collection rates and improve our physical therapy results.

I'm excited to bring Jerry on so he can share his wisdom. A little bit about him personally, he grew up in the Napa Valley. He played some sports and got turned on to physical therapy in that way. After physical therapy school, he worked in a number of different settings and eventually opened up his own practice. He partnered with Sturdy McKee and opened San Francisco Sport and Spine Physical Therapy. They've been in practice for several years. Halfway through that, they decided to go out of network with everything. Interestingly, it was a quick and easy decision for them. They've been successful ever since. Jerry is not only a partner in the clinics but also hosts a podcast, Healthcare DisruPTion. He's a nationally recognized expert and sought-after conference speaker, as well as a clinical instructor who travels across the United States. He's also on the nominating committee for the PPS of the APTA. He is thriving in teaching and consulting with physical therapy practice owners, whether they accept insurance or are strictly going out of network and cash-based. Let's get into the interview itself. Jerry has a ton of information to share.


I've got Jerry Durham, a physical therapist out of California. I'm excited to bring him on. I've seen his name for a long time. I've heard about him through different circles. I'm excited that he's finally on the podcast as a guest. First of all, thanks for coming on with me, Jerry. I appreciate it.

I appreciate you giving me your time too. The only thing we can't get back is our time. I promise to make it worthwhile for everybody reading and you.

Do you mind bringing us up to speed on what you do, where you've been, your experience with physical therapy in the past and what you're doing now?

It's many years in the profession. I always have to throw that out first. It's several years of my own practice of which are not public knowledge but becoming more common knowledge that I'm moving my way out of. I'm no longer in California. I moved to Philadelphia. My wife and I brought my two poodles out. We love it out here. The biggest part of the journey was opening my own practice with my partner, Sturdy McKee. We started like everybody else. We started in network practice. We did everything that everybody else was doing. To give everybody some context about where my conversation in my world comes from, ten years in with multiple clinics, we went out of network.

The only thing we can't get back is our time. Click To Tweet

I'm going to say two things, not as an ego, but to set some context. We went out of network when nobody else was. We were looking for solutions from other physical therapy practice owners and couldn't find them. We had to learn something new. That's when my business education started. We had to learn something from someone to stay and exist. One of the big tipping points in my career was when I joined EO, Entrepreneurs Organization. I joined an organization with 100 other business founders all doing $1 million at the time. There are no healthcare people in there. I learned so much about what we were doing. What we needed to do was run a business, which, prior to that, we were not running a business per se. From that day forward, it's running a business. That's how I got to where I am, which is this whole patient experience, front desk training, and understanding that we, both as PTs behind our names, are not the most important people. We're part of a team. Like any other sport on the face of the earth, when you engage the whole team, it's when everybody thrives and strives, including your patients, including your employees and including your bottom line. That's what I'm helping people now with.

Back in your story, what was the tipping point for you guys to decide to go out of network?

We weren't doing business things. We were doing a handful of things in reflection. One of them was we knew our cost per visit from day one. By knowing our cost per visit, it was simple. The conversation to go out of network took about a minute and a half. We made a huge business decision in a minute and a half because we understood that part of the business at the time. We knew that we could not continue to deliver care and lose money at the same time. Two things occurred right then and there. We decided in about a minute and a half to go out of network. The third huge tipping point for me in my career was as soon as we acknowledged that we had to go out of network, I looked at my partner and said, “We're going to have to start. We're going to have to change the way we are talking to people when they first call in because we're not going to be in the network.” That's what started this whole thing. I tell everybody, “Put the patient first. Your business will be successful.” That's how most clinics fell. Even though they claim to be patient-first, they can't prove to me they're patient-first. It's that and the whole team approach. Knowing that stuff, it's baffling.

What do you tell owners when they do come at you with that typical, “We put the patients first,” or “It's all about the employees?” What do you tell them to have them think differently?

I follow that up with a business question. We put our patients first. We put our employees first.

We're there to serve. It fulfills our purpose.

PTO 54 | Patient Experience
To Sell Is Human: The Surprising Truth About Moving Others

My follow-up question is, “What's your cost per visit?” If you don't know your cost per visit, you can't run a business and you can't put anybody first. After that, I'm going to ask them the second question, “What is your drop off rate?” Your drop off rate will prove to me how much you know about the business. It will tell me whether you know about your customers' journey. I'm a huge Herb Kelleher fan, the Founder of Southwest Airlines. Herb Kelleher is one of the first people that I ever heard said, “Your happiest customer is only as happy as your most unhappy employee.” I took that to heart. I believe that. I have a piece of flip chart paper hanging in my office. It says, “Happy employee.” Right below, it says, “Happy patient.” I have an arrow going through a complete circle. Without your employees knowing what they're working towards, they never can create a happy patient. Once they know what they're working for, they can create a happy patient, which creates a happy employee. It becomes this virtuous cycle.

What I found after studying all these successful businesses and bringing it into the physio world is every single successful business on the face of the Earth understands one thing first. They understand their customers' journey. They understand where their customers are engaged. They understand what their customers want, rarely is it what they need. Most of iPhone people, if they needed a phone, they would have bought a $35 phone. They don't need a phone. They need something else. They know what they want. They understand their touch points. Walk into an Apple store. There's a rhyme or reason on all of it. They understand the journey on the website. They understand everything about their customer, which in turn tells their employees what the focus is.

When I get in a room and I'm going to hire someone, I say, “This is our focus. Here's our customers’ journey. At the center are happy employees. Here's your role.” Once I understand my customers' journey, I can tell you the role you play. I have never interviewed a front desk person without starting out, “Your role here is to help people get better.” That's what I tell my front desk people. Your role here is to help people get better. If you don't help them and manage their expectations and bill address on the first phone call, they're never going to get better. If they do get better, it's because you managed the relationship. You took care of them on your part of the journey. In my mapped-out customer life cycle, guess who has the most touch points with the customer in the entire life cycle? It's my front desk.

I've used the term with a few of my guests here. Customer experience, can you equate that to customer journey?

These are different. We use it separately. It's important. A customer life cycle is every single touch point and interaction, your potential customer to a customer. In our world, they complete a plan of care. They leave you. It's pretty objective. You lay it out. They came to me through my website. They call here. They arrive. They meet my PT. They complete a course of care. It's simple. That's your customer life cycle. It's objective. It allows you to do a lot of things. Understanding your customer life cycle allows you to understand who owns the interaction, what objectives and goals need to be met at that interaction, what tasks it's going to take to complete and meet those objectives and goals and what information needs to pass to the next touch point. The mapping of the customer life cycle has to be first.

There are different experiences within each touch point.

Your happiest customer is only as happy as your most unhappy employee. Click To Tweet

This is the beauty in it. I had a hard time understanding this. You get to create the experience you want. Everybody says, “That's your customers' emotional journey.” I said, “I know.” The important thing is to understand what emotions you want to facilitate and which you want to get rid of. We want to facilitate trust. We want to decrease and eliminate fear, doubt, and uncertainty. At every step you're going, how are we building trust and how are we eliminating fear, doubt, and uncertainty? The experience they remember is their emotional story with your service and product. That's the difference. You must know the life cycle first.

I love that you said that you gave the front desk a purpose, which is not what you would expect the purpose of the front desk is. It is so much their job because they are a frequent touch point there. They're the face of the clinic. They're the first person they see. They're the first person they talk to. They're the person that's collecting the money. They're the person that's explaining the insurance benefits. You could be an amazing physical therapist, but if any of those four things drop out at the front desk, they might care less about the therapy that you're providing. 

Here's a great story to prove that too. Everybody's sitting on the other end and they're saying, “That sounds great. How do you measure it?” You don't know it's there until it's gone. Here's how I figured this out. The part of my story I left out and part of how I came up with this process is I answered all the new patients' incoming calls from my clinic for a year. I answered close to 1,000 new patients' incoming calls. I did the cost callbacks. I was the voice of the company. I was the one giving them their cost. The way we set it up, they would walk in and meet the face of the company. I was the voice and the entry points for the company.

Here's what I learned. I made that conversation around the purpose. I didn't answer the phone as the owner or a physical therapist. I answered it as the person scheduling you. When I made it purposeful and made it about you and your story, if we were the right fit for you and what you wanted from us, when you appeared, our no show and cancel rate went down. When you appeared, our billing and collections problems disappeared. When you appeared, our copay collection rate went up to 98%. When you appeared, you stayed and you got better. It’s completed care. Here's the other thing I learned. When you didn't arrive, you still had a great experience through your life cycle with our company, which was, however, you found us until I hung the phone call up. I have had referrals from people who call on the phone and chose not to see us because it was too expensive who later referred clients to us. I followed up. The first time this happened, I was more baffled than anybody else. I sat there and said, “I’ve got to find out why. There's no way anybody should be sending patients here.” It's all about the PT. It's all about whatever it is, the chiro, the acupuncture or the physio. That's what people want. I'm like, “I'm here to tell you otherwise.”

I called this guy back. I forgot his name, so I'll make names up. “Jim, this is Jerry over San Francisco Sport and Spine. How are you?” “I'm great, Jerry.” “Jim, I've got a question for you. You sent Steve Smith over at us, right?” He said, “Yeah.” “I have another question for you. I have no idea why. I'm wondering why you sent Steve over to us.” He said, “I sent him over because I figured a clinic that was so nice and so helpful on the phone before I even arrived. It probably has the best providers in town.” I went, “It's noted. I greatly appreciate that. You're very welcome.” That was my proof of process. All my billing, collections and complaints disappeared when we changed the first phone call.

You put all that experience, the time you spent, right into that first call. It’s the first time a person talks to the face of the clinic. All focus is on that. It’s giving them their purpose. Those two things alone are huge. Did you go to the point of even making a template of, “This is what you're going to say,” or are you willing to give them some freedom and say, “As long as you meet these standards and help them build trust and decrease fear, doubt, and uncertainty, and achieve your purpose, I don't care what you say?”

PTO 54 | Patient Experience
Start with Why: How Great Leaders Inspire Everyone to Take Action

If you come from a position that your front desk is task-oriented and their job is to get people scheduled, who cares what they say? If you're going to churn people out, everybody goes on the schedule and it doesn't matter if they're a fit, you waste their time, money and energy. You wasted the providers' time, money and energy. If you want to hire the right person and empower them to be successful, I have a ten-point checklist. The people I train and I work with know the front desk roles. They're two things. It’s to start to build a relationship that will last throughout this person's entire life cycle with your company. That could be the end of the phone call. Number two is to be a problem solver. I say, “That's your goal. That's your objectives with every phone call you answer.”

I split the front desk out. The phone call people are on the phone. The task people are doing tasks. I give them the checklist. I give them the services that they know we offer. Some people offer free discovery visits versus paid visits. I help them to understand where these separates, then I put it in their control. Here's the structure. It's almost like you give someone a poured foundation. You build the house, but here's the footprint for the house. We measure success by conversion rate. Success is easy to measure. Book that and MPS. You’re doing MPS front desk and conversion rate. It's theirs. You’ve got to hold them accountable. You need a recording tool, something where you can track the phone calls. Have some discussions with it, what's going well and what's going not. I want them to help me find the trends before they happen.

That's part of the problem solver thing. It's not problem-solving just for the patient, but problem-solving for their position as well. To get them to that point, you talked about a little bit of the training involved in that. What do you recommend your training to be? A lot of times, you put the ad on Craigslist. I'm speaking from personal experience. You go on Craigslist. You get the person who'll take $10 an hour. You say, “Here you answer the phone.” I shadow this person for a day and then, “Now you do it.” Is yours quite a bit more involved?

If you're going to hire for front desk, healthcare or admin, you put it in that group. Here's what I tell people they do. It's not like writing an email you want to be opened or a book you want people to read. The headline has to read differently. I had this discussion. I'm having trouble with finance. I said, “How about you do this?” Put it in the same place as this admin person. I said, “Go look at every other ad. It's going to list the tasks they have to do.” They're all going to read the same. Answer the phone and deliver great customer service. It's all going to be subjective. You're going to get 130 applicants. At the top of it, and probably in slightly smaller fonts so it stands out. It's the top of what I'm going to need you to do. We are looking for someone who is willing to make an investment in helping patients get better and stay healthy. I tell her, “51% of the reason for doing that is to get the right people to apply. 49% is to get people to opt out.” Instead of 100, you got 20. I would add some more stuff down below that. There would be some tricks like, “If you're happy with what you've read so far, please reply to this email I've written here. Do not reply to this.” Anybody who hits reply to the job posting gets filtered out.

I've done some of that myself. “When you send your resume, put an asterisk in the top right corner.” It's towards the bottom of the ad or something like that.

I want them reading down. I want someone who took the time. I want them to invest with Nathan, who's on the phone asking about their low back pain. We don't take his insurance. I have no idea what insurance he has. That's not the important question. I do secret callers. People schedule me. “Tell me it's going to be 150 hours. Schedule me.” They never tell me the name of my physical therapist.

Every single successful business on the face of the Earth understands one thing first, their customers' journey. Click To Tweet

We got into the front desk right off the bat because you're focused on that. You've seen a lot of benefits in training people that way. You have Everlasting Training Academy that you've started to help people in general. Tell me about the culmination of that.

I started out with a gentleman by the name of Todd Wickstrom who's got a great story. He does not come from healthcare. I met him at a mastermind that Paul Gough was running. He’s not from healthcare. He's from the startup world. He's from the management world. He's from the hiring world. Todd loved this conversation I had about the front desk, putting patients first, relationships, people revenue and all these things that are his terms. We connected after the mastermind. He had known I'd want to start a front desk course. I had all the content. He was like, “Let's do this.” He had some experience doing this. Todd and I got together and created what we call the Front Desk Certification Program. We started it. We had some good success with it.

The thing I like to credit doing the most was surveying our customers, our students, and our payers frequently. We get some good feedback every time we've done it. That has grown into what I call our Everlasting Training Academy, which is our new company. How it's evolved is we're training everybody in the business. Everybody says, “You're training everybody, but this part is just my desk.” I'm like, “There is no one part.” Everybody needs to be aware. The left tackle on a football team, when a play is called, even if the play is away from him, he may not know the routes the receivers are running, but he knows where the quarterback will be. He knows where the left guard will be. He knows where the running back's going. That's what makes a successful team. He's very skilled at his position. He is aware of the team. What we found is when the team was involved, the success was far greater. By success, I mean metrics.

I'd love to help everybody on this call, but this is not a pitch. We had someone come in who was a new front desk person assigned with a brand-new clinic manager. I found this out after class. I debrief with them. These two started to work together two weeks before our course. The owner told him, “Get in the course. I opened our third practice.” I ask them some specific questions. They both acknowledged a lot of things. The biggest take home was the front desk person said, “Think about this. This is a brand-new clinic with two people.” They were now putting four more people a week on the schedule since the course started. My head is like, “That's cool. There are four weeks in a month.” Each of these people works with roughly $1,000. I'm like, “How much should we charge you?” It was because the clinic manager and the front desk person came out aligned on what needed to be done at the front desk. The clinic manager didn't have to go back and convince the front desk of any of their role and purpose. The front desk didn't have to go back and tell the clinic manager, “This is my role and purpose.” They hit the ground running and after class.

From our experience, once the whole team knew what the other people were doing, their roles and how their roles affected them and vice versa, how what I'm doing affects them as well, that's when we started to see the creation of a greater culture or family or an environment.

I used to hate the word culture. We had people come back and say, “You helped us create our culture.” I was like, “They can't be talking to me. I don't even know what you mean.”

PTO 54 | Patient Experience
The E-Myth Revisited: Why Most Small Businesses Don't Work and What to Do About It

You never said the word.

I’ve got to say, “Please, tell me what this means.” They gave me the same answer you said. It was people coming together. “Guess where this comes from, Nathan? If we could double back all the way, it's understanding your customer's life cycle.” Until you understand your customer's life cycle, you cannot show the other members of the team what everybody is doing. When you create the customer life cycle, you can hire. This is why I say, “You can't have happy employees without happy patients and vice versa.” You're coming to interview in my clinic. I show you our customer life cycle. I show you, “This is what we're trying to create.” I show you your role as the therapist here. I show you how everybody else on the team comes together for successful client experience, not so you can get your ego stroked and make $100,000 a year. If you want your ego stroked, this is not the place to be. You show up knowing it's all about the patient. You deliver to the patient. They're happy. You're happy. The owner's happy. We're making more money. Your $100,000 becomes $150,000.

I'm shooting for an office where the front desk person and the provider are both at the same salary. Think about it. Because of understanding the revenue and how they drive a practice, we can set up incentive programs for that. My goal is to have the front desk person to make as much as the provider. I understand my business. I understand their role in the patient life cycle. The no show cancel rate, nobody owns it. Everybody owns it. It's a company metric. It's not the front desk metric. If it's a front desk metric, you told your PTs they have no control over it. If it's a simple metric, you told your front desk there's no control over it. No show cancel rate is a company-wide metric. This is the stuff I love. It's that tipping point of getting into EO, being in a room with someone with one or two extra zeros behind their name, talking about how they think they're going to miss payroll in three weeks. You're like, “We've missed payroll. We might miss payroll. Their payrolls have two extra zeros on it. My problems aren't so big anymore.” My problems weren't so big. Every company was having the same problems.

You're hitting on so many of the things that I love and that I'm learning about as I interview other successful physical therapy owners. Number one is I always recommend that you step out. If you're going to be a true leader in your company, you can't be treating patients full-time. 

If you treat all day long, you can't be a great businessperson.

You’ve got to reach out and find people like you. I've had a number of guests that are coaches, consultants. It's somebody to guide you. We're physical therapists. We're not business owners. You've got to invest in your business education as you invested in your physical therapy education. It takes time and money. You also have to network. I was an EO member in the past.

The experience your customers remember is their emotional story with your service and product. Click To Tweet

My favorite chapter was the Arizona chapter.

Those guys are awesome down there in Arizona. I was a part of the Accelerator Program, where revenues were less than $1 million. Between my partner and me, things started shifting. My partner will attest to it. He's still an EO member in Phoenix. It's when we networked with other people. They weren't other physical therapists. They were other business owners. There are plenty of networking groups within the physical therapy industry, whether it's a mastermind, PPS, peer-to-peer or that stuff. You've got to do those things to build your business acumen. You can turn around, be the leader of your group and build something that you are proud of. 

One is step up. Even mastermind groups and stuff, what's interesting when you take a look from the outside in is if you're not careful, it becomes a room of like-minded people. I get it, yet, I don't want to be in a room with like-minded people because we're only going to start to reinforce our biases and beliefs. That is probably one of the best things about EO though too, is because nobody in the forum was from the same industry. We couldn't claim, “This is what I always love.” I had this conversation. “We got to do A, B and C.” “That's not going to work for us. We're different. We're too small. We're in a rural area. We do this. We do that.” I'm like, “Are you guys treating patients?” “Yeah.” “Are those patients still people?” “Yeah.” “It's going to work. You’ve got to do it.” It's that mindset. We go get a group of PTs. This is why it's stepping out of the profession for anybody. If we look back, any great business stepped out of what they knew and found someone.

I'm growing my team around me. What I'm being cognizant about is my team doesn't need me. There is no one I'm putting on my team who needs me. This is important because I want to be able to stand up and go, “This is Nathan. This is his expertise. He's here because I need him. I believe he can serve you.” That's a lot different approach than I'm in a room full of PTs. That approach has done so well. One of the guys I remember, he owned a huge furniture moving company in Phoenix. He's one of the EO guys. These were the people I connected with. “I had nothing in common. I’ve got nothing to learn from you.” He was like, “No.”

I remember the guy. He owns Get Your Move On or something like that.

Being on the West Coast, I met a lot of the Phoenix guys.

PTO 54 | Patient Experience
Rich Dad Poor Dad: What the Rich Teach Their Kids About Money That the Poor and Middle Class Do Not!

You find a lot of physical therapists, they've built their clinic because they put up their shingle. Their name was tied to it. I had to get over this myself. Patients were coming to me and the doctors are referring to Nathan Shields. They weren't referring to Pinnacle Physical Therapy back in the day. It's hard to make that transition from referring to me, the owner and getting out of the mindset that I am the foundation of this company. It's changing from a mom and pop to an enterprise.

The next step up. I would argue truly running a business.

Otherwise, you own a job. 

I did a Facebook Live. I posted, “Do you have a job or a business?” I spoke about this. I said, “God bless you, for anybody listening. I don't want people to think I'm some snob. If you wake up every day and love what you do and you're making money on it, God bless you. If you wake up every day and you're making money on it and you're going to teach other people to do it, God bless you. If it can't thrive or strive without you, it's a job. God bless you. Be happy until the day you die, but don't go tell people you own a business. Don't do business training.” It's not my ego. Nobody's stealing customers from me. What I'm worried about is people saying, “I'll help you start a business.” I'm like, “You're not helping them start a business. You're helping them create a job.” If you own that and you tell people, “I can help you do something you love every day. You just got to stay in it every day,” it's fine. Own that. I see this every day, the guy on my corner shop. I see the same guy. His whole family is in there. That's what they do. They love it. They wouldn't have it any other way. I'm okay with it. I'm not bagging on him.

They're achieving their dreams. If that's your dream, God bless. I have to give credit where credit is due. We're talking about Michael Gerber's E-Myth Revisited, a popular entrepreneurial book. If you're starting a small business, you ought to check it out. Robert Kiyosaki talks a little bit about it in Rich Dad Poor Dad, where you become an employer to an investor and different quadrants that you work with.

Also, Cashflow Quadrant. When people ask the three books that I recommend, they're all older books. I recommend Kiyosaki's books. Everybody should read it anyway. I recommend Gerber's E-Myth, Start with Why by Simon Sinek and To Sell Is Human by Daniel Pink. Those three will get everybody at least in the mindset. None of those are doer books. They're all mindset books. If your mindset's not set, you can burn 36 hours a day doing the wrong thing. Those books had the biggest influence on me. I got to meet Simon Sinek when he first rolled that book out at an EO event. I got to sit in a room with 50 other people and Simon Sinek at an EO event. Those Kiyosaki books, I don't care if you think the story is true or not. Let that go. Cashflow Quadrant will get you in the mindset.

Step one is step up. Click To Tweet

That's all about mindset and assessing where you're at.

This is great stuff. I've been involved in PPS for a long time and stepped off the nominating committee. I have offered my assistance to over and over. My goal, I've offered, is to take a day at our PPS conference and not allow one speaker to be a PT. We just bring in outside people. I'm still pushing for that. I'd still like that. I'm speaking during the pre-con. I’m another PT presenting there, yet, I'll be presenting stuff that people won't hear anywhere else.

Are there any teasers on what the topic might be?

It's going to be all about training your team around the customer life cycle. We send providers off to new courses. We make them come back and teach all their providers what they learned. I'm like, “Where's the front desk people?” It's the front desk people in here knowing what the providers are doing.

Aren't they the salespeople for us?

Back to my pre-con for PPS, I worked collections. I had mapped out this customer life cycle. If you think about it, there's no zero in anything. I never knew where the ceiling is or where the floor is in this stuff. I want to know, “Where are the floor and the ceiling on people we send the collections? What percentage of customers should we plan on going to collections?” I took care of the collections. I called everybody who had one foot in the collection door and one foot still out. They had one last opportunity. It's understanding my patient's life cycle, understanding the experience we had created, understanding every script and every piece of paper that everybody ever saw before I called any of these customers. They're all past customers. Before I called any of them, I went back. The first thing I looked for is, “Did they have assigned financial policy?” Our financial policy is the bluntest thing you've ever read in your life. It says, “If any of this is an error, it was your insurance company's fault.” At the top of our financial policy is, “This is your cost.” We gave them a number. If they signed it, they saw it. We made them initial the part that said, “Your insurance company made a mistake.”

The Purpose of the Front Desk is to GET PATIENTS BETTER, not just get them in the door. Click To Tweet

Did they sign the financial policy? Did they complete their plan of care? Did they pay at the time of the visit? I knew all of this before I ever picked up the phone. Like that front desk person answering the phone, I started every phone call with them. “Nathan, this is Jerry. I'm the owner of San Francisco Sport and Spine Physical Therapy. I know we're having an issue with some money that is owed to us. I am calling you to see how I can help you get this resolved. I wasn't calling to collect money. I wasn't calling to threaten you.” People get protected. They get everything. I had all this information. The most empathetic I ever was with another patient whose insurance company had screwed them. I was saying, “Nathan, I get that. I was looking through your chart, so bring me up to speed. You do understand we called the insurance company. You do understand they gave me their information. You and I both know they're looking to screw people. Unfortunately, they screwed you. You pay your premiums. You showed up here. You paid every time. Your insurance company screwed you. How can I help you get your insurance company to pay me?”

Not everybody called me back. Everybody that called me back, I collected 100% of what was owed based in that conversation. I base it on a person who understood their journey and understood, “I know the insurance company screwed you. I wasn't calling to say you owe us $1,500. Your insurance company owed us that money. How can we get this done together?” Everybody knew at that point that I was on their side. They knew their insurance company messed with them. They all paid. I took them down. This is what we're going to teach. Someone started asking me, “Should I bring my front desk or my billing people to your class?” I said, “Yes. You're going to have to prep them because they're going to wonder what they're doing in the room. You should have your billing people.” I do this whole thing. I credit Ray. Out of Pittsburgh, Pennsylvania, we are doing some work together on some technology stuff on how to systematize, how to customize and how to automate some of this stuff I'm telling you about.

Ray has this great idea. You know if you're in network. You know you do billing. Everybody's going to get an EOB for about three weeks in. You know if there's a billing problem, you're going to have Jerry from billing call them. There's no better way to kill a relationship than have you be the happiest and, in two months later, you get a call from Jerry in billing at ABC Physical Therapy telling you to owe another $250. First off, you're like, “Why do I owe this money? Who are you?” Ray gave me this great idea. I train everybody to do this. You put your billing team in the video. You send me an email. It's your billing team, “Hi, I'm Jerry. Hi, I'm Becky. Hi, I'm Steve. We're the billing team here at ABC Physical Therapy. Why are you getting an email from us right now with this video? You should have received one of these. It's called an EOB. That is the biggest misnomer on the face of the Earth. We know that when you open your EOBs, you probably don't understand it. It's an explanation. If you have any questions on this document, we want you to call us. You can ask for Becky, Steve or Jerry. We will help you with that EOB.” That's it. You give them their billing phone number.

Two things occurred. You told people, “I care.” You told people, “Your insurance statements are going to start coming.” You told people you know they don't understand it. You said, “Let me be a solution for you.” My financial policy says all the mistakes of the insurance. When they call you and they don't understand their own mistakes, we will again reiterate, “Your insurance company screwed that up. Let us help you with it. Here's what you need to do.” It's going to say it too. Back to that scenario when Jerry and billing called you and you saw the video, now you know Jerry and billing are calling you to help you. “Nathan, this is Jerry Durham over at ABC Physical Therapy. I've got a bill here of yours that I'm looking at. I'm wondering if we could have a discussion about it.” I'm going to script that call-up. You already see the name and the face and you know I'm calling to help you. That is understanding your customers' life cycle in creating an experience. That could have ended disastrously. They say, “I'm so glad. I'll send that $250 over.”

What I love about it is you're thinking through the entire life cycle and not just knowing the different parts of it. You're thinking through the life cycle and, “What are they going to experience here? What's going to happen here? How can we be at the front end of that to create an experience where we can maintain communication? How can we make it better?” It's an evolving process.

It's always changing, dynamic itself.

They have to believe that and create a patient experience that increases trust and eliminates fear, doubt, and uncertainty Click To Tweet

It's intentional. This is the experience we want them to have.

Everything is intentional. Here's my favorite analogy. You're thinking of your business. You describe your business as an ecosystem. What's going to happen here fourteen days later is going to have an effect on interaction. How can I manage those downstream effects?

I love the beauty of the life cycle. Laying that out and seeing how everyone's involved and what their purpose is at each point generates a powerful cycle for you. No show rates are a team experience. Those will diminish. Conversion rates on the first calls are going to go up. Your collections are going to improve. It's as long as everyone's working together as a team and knows everybody's purpose and responsibilities. 

This my passion. If anybody needs us more than any other industry in the face of the Earth, it's healthcare. It's not because healthcare sucks in America. It's not because it's too expensive. It's because healthcare is about other people more than anything. We owe it to this person. I'm not going to get into evidence-based medicine. We owe it to this person to acknowledge him on the phone when they call in. I took you through my wife's journey to get some doctor's appointments and visits, it took her almost two weeks to get a live person on her phone to follow through with the referral and to get a scheduled appointment. Nobody deserves that. When you're told you need this follow-up and we make them two weeks, what's important? Is the follow-up important? Is your broken system more important? What's most important? It's me. This is healthcare. If people who I buy my shoes from can give me this, healthcare can give you this.

You shared a ton of great wisdom with us. We didn't even share that you're also a fellow podcaster. You've got the Healthcare DisruPTion podcast. You've got plenty of episodes to listen to. There's a whole section that you have specific to the front desk. If you want to check that out, you want to go to the Healthcare DisruPTion podcast. How can people find you? Share all your contact info. is my website. will take you to my podcast page. The top podcast is the last one. There is a front desk series that I started. There are seven episodes. If you listen through those, you will know everything you need to know about the mindset and the doing. Some of them are doing about how to create a customer experience, which we know goes back to understanding your customer life cycle and where to put the focus. I have an interview with an awesome person who has been a patient. I did a follow-up podcast on how could we have made this experience better for this person. There are a lot of references to this person's blog posts and something like that. The front desk series is the last seven episodes. My last one is one of my most opens. It's called, What is Customer Service? If you're training customer service, it means you don't understand someone's customer experience and you're putting out fires. Here's a quote to leave you with. “Customer service is reactive. Patient experience is proactive.”

If people want to look up Everlasting Training Academy, is that the same website? will tell you all about my team training and the front desk training around all this. PM me on Facebook. It's Jerry Durham on Facebook. I'll give you my phone number. It's (415) 509-3986. Text me there. Put like, “Nathan's podcast.” Say, “Jerry, I’ve got some questions about the front desk,” or “I want to know more about this.” I still have people pinging me from the first podcast I ever did and I love it.” I'm like, “This is awesome.” This is what I want to happen. When it's your time, it's your time to have this conversation. It's so much stuff. This is passion. Do you want more new patients? You've got to figure out your customer’s life cycle. Do you want more money in the bank? You've got to figure out your customer’s life cycle. Do you want to hire employees? You’ve got to figure out your customer’s life cycle. It's that simple.

Thanks for being on. You've been awesome. Thanks for sharing your wisdom.

I appreciate your time and energy. Thank you very much.

Important Links:

About Jerry Durham

PTO 54 | Patient Experience

Jerry Durham helps Physical Therapy Practice owners engage patients for great results. Following graduation from Physical Therapy school, Jerry practiced in a variety of settings, inpatient and outpatient, from small independent clinics to large hospitals and from the very beginning, Jerry questioned why there wasn’t an emphasis placed on treating patients as individuals, with unique concerns and objectives and why more effort wasn’t being made to develop true relationships with patients.
Jerry’s experiences in these settings fueled his drive to prove that you can increase arrivals, decrease no shows and cancellations and achieve great results all through the relationship between your clinic and your patients.
Jerry grew up in the beautiful Napa Valley, working in the vineyards his hardworking parents planted and otherwise assisting in a variety of small businesses his parents launched over the years. Jerry’s entrepreneurial spirit was both born and bred as he watched and learned from his parents' successes and failures.
While Jerry admired his parents' efforts, his passion lay elsewhere and he did not follow their footsteps. Jerry was active in sports during his youth and it was his high school football team trainer, a Physical Therapist, who set Jerry on the path to becoming a Physical Therapist himself.
After graduation from Physical Therapy school, Jerry was an employee of a variety of clinical settings, small and large, independent and corporate.
During this career stage, Jerry was constantly frustrated that the focus in all of these settings was on codes, and numbers and not on successful patient relationships. This lack of relationship mindset drove Jerry to start his own practice, to prove to himself that there was another way to practice, one that would place the emphasis squarely on great results for the patient.
After several years of believing there was a better way, Jerry set out to prove it by opening his first Physical Therapy practice in San Francisco. Within a year of opening, Jerry and his current business partner, Sturdy McKee merged their successful and like-minded practices into San Francisco Sport & Spine Physical Therapy expanding to multiple locations in the San Francisco Bay Area.
Jerry opened his first clinic and in less than a year, Jerry was operating a successful practice, with a full schedule building one patient relationship at a time.
Early on, Jerry learned that he wasn’t the only Physical Therapist willing to buck an established system by treating patients in a way that everyone said would lead to failure, one patient to one Physical Therapist.
Today, San Francisco Sport & Spine Physical Therapy follows that same tenants as from the very beginning, including one to one patient to Physical Therapist treatment and has never wavered from the mission that they exist to create happy patients (SFPT LINK)
How did Jerry prove what he set out to prove? That’s the question he’s asked most frequently and the reason he is now sharing his experience, learning and techniques to help all practice owners who truly want to achieve great results for their patients and build relationships for life.
Today, Jerry is the Chief Relationship Officer for his physical therapy practices, hosts the podcast Healthcare DispuPTion, is a nationally recognized expert and sought after conference speaker as well as a clinical instructor who travels across the United States teaching the next generation of practice owners.
Jerry is on the nominating committee of the Private Practice Section of the American Physical Therapy Association and is on the forefront of the movement around patient engagement leading to great outcomes and how to own and operate a thriving business whether you accept insurance or are strictly cash based, simply by cultivating great patient relationships.
Jerry is a lifelong learner, an avid reader, is ruled by his 2 poodles, has a serious fear of heights, loves all things baseball and is forever grateful that his wife encouraged him to start his own practice. Jerry is passionately working to bring true and lasting change to the healthcare industry for the betterment of all.
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