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I've got Tom Dalonzo-Baker of Total Motion Release and Total Motion Release Seminars. You may have seen his ads or his courses. I'm excited to bring him on because he not only talks about how he developed Total Motion Release but how he took the systemization, the process that he used to create Total Motion Release and that new technique within his company and use those processes to overhaul his front desk operations and billing operations. He took such a simple process. You'll read it in his story, the simple process of tweaking and changing those things in his treatment and use the same process to overhaul everything else within this company. He's been successful in the continuing education space. Tom also owned and operated four PT clinics in North Carolina and sold his last one to his staff in January 2017. Maybe we'll have to have him back for that interview to see how you can exit by selling your clinics to your staff. I thought it's a great podcast and a lot that you can take from it.
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I'm excited to bring on Tom Dalonzo-Baker of Total Motion Release Seminars. Thanks for joining me, Tom.
Thanks for having me on, Nathan. I appreciate it.
I’m really excited to bring you on. I started making lists of the people that I wanted to interview and your name was on there. I'm glad I finally got to get you on here.
This is going to be fun.
We love hearing wisdom wherever it comes from. Tell everybody a little bit about your story, maybe the rise of Total Motion Release and some of the genesis for that, but how you got to where you're at. You're not just the Founder of total motion release, you also own physical therapy practices. That's why I'm excited to bring you on because you were able to do both.
I was a teacher before I was a PT and I was a business guy before that. I have a business degree, a teaching degree and a PT degree. They used to say, “When are you ever going to do anything with this stuff?” I said “It's all going to match together. I own the business, I teach and I do PT with it.” The PT part of it started in 1999, so I've been doing this for twenty years. Right out of school, I knew I wanted to own clinic. I worked for somebody two or three months and they sucked. I was like, “This is crazy.” I walked into a new fitness center and I said, “I know you have a closet. Can I at least start in that closet?” This guy was nice and he shook my hand. Thank goodness because the next day a big company came in and asked to be involved, but he said, “I shook your hand and I’m a man of my word.” I started in a closet in a big wellness center in 1999. From there, I had a clinic all the way up until 2017. I sold it to my staff in January of 2017. I have my company with seminars and we do Total Motion Release. We do a pediatric TMR course and I've done that out to the clinician since 2005.
The TMR concept started as you were treating patients and getting some benefit from your usage of manual therapy. I'm assuming you went to a number of courses as you were developing, you're out of school when you opened your clinic. You're doing a lot of work around to get these patients better.
In 2002 is when TMR came about, but as soon as I got out of school, I started taking six to ten courses a year. The truth of the matter was I went through PT school and I went through volunteering for PT. I said, “Is this really all there is?” I was bored with what it looked like. I said “I'm going to have to go out there and see other stuff. I've got to see what's on the fringe. I've got to get out there and educate. They’re living out of myself.” That's where I became really fascinated with manual techniques and started there. In my mind, the penultimate place to be was to be a kick-butt manual therapist. That changed to a degree, but nothing going to change before I got there.
You started working with your manual techniques and started seeing some results I'm assuming.
I had 30 or 40 courses under my belt in three to four years, but something occurred to me in 2002, 2003 that started the Total Motion Release. What I want to do is I want to address somewhat from the owner perspective how what was developed and created allowed me to eventually step away from my clinic and do the seminars as I pretty much ran my clinic from home. It became that powerful, but I had to put systems into place. I started with the physical therapist because they were the people that seem to stay with me the longest. If I could convert them and get them to understand this system that I've put into place from a treatment perspective, it helped all the way down the line from the patients to the therapist, to me, then we could all train the exact same way.
Tell us about that, especially those of us who are in the audience, if you're young or you're looking to expand. What you're really looking for is to get everybody on the same page so that it does not disruptive when someone goes to a different therapist because of scheduling issues or whatnot. You want to expand your influence. People are coming back to see you because of what you do, the owner, the founder.
3 Simple Rules for Systemization: Keep doing what works, Tweak it if it's not improving, or Change Everything Click To TweetYou’ve got to step away and you go, “My doctors want their patients to go to me. How do I deal with that?” Then you step away from the clinic as an owner and you think that therapists think that for me, I thought that they thought that I was back at home twiddling my thumbs. I was actually trying to create systems so that I could see things being done and I will make sure we're being efficient. I was a small clinic. I was always small as far as that goes. I had to squeeze as much as I could out of everything. I'm going to take a step back a little bit. I'm going to talk about the creation of TMR and then how I took that and went forward into a process that we could all use. Without the history, you probably won't completely know what it is. The first thing I'm going to say, everything I'm talking about here is on the website TotalMotionRelease.com. It takes you through the steps. It literally on the homepage says, “Step one, watch what does. Step two, here's how it works. Step three, here's how long it last. Step four, years of training that you can do if you need to.” What you'll hear is some of it.
The history isn't on there and I'll tell you about it. I was a manual therapist. I got out of school thinking that's the best thing that I can do for my patients. I got to a point that it seemed every time I learned something new and I got good and expert at it is that I was getting more and more complex patients and there are always 10% or 20% who weren’t getting better in that. It felt like my fault. I had to go learn something else. After a while, I was like, “There's not much more I can take. I know I'm not an expert at all of it, but is it always going to fall on me?” I realized that I was doing all the work. The patient wasn't. It was something about it from my teaching days. I love teaching because when they left me, they knew how to do math and algebra. There was a light bulb that went off that I was missing that passion for it. I didn't even know that.
I had a patient who knew me well. He’d taken all my stuff. He'd been with me from the beginning. He said, “Tom, how good are you at fixing a patient?” Puff up my chest and I saw a top 10% with all the courses I've taken because I used to take six to ten courses, but he didn't bat an eye. He knew me. He knew what my history was. He knew sitting in front of me what I provided, and he said, “Tom, how good are your patients in fixing themselves?” I said, “That's a whole different ball game. That's what I want. Can I really do that? Can I make it to my patients can fix themselves?” Right then, my trajectory, my entire career change, but don't think that right there I started creating TMR and all this technique. Things had been leading up to it.
We had an insurance company that cut our payments from $110 to $120 a visit down to $74. We used to do an hour long. We used to only be a therapist and then we had to do every half an hour. This was happening, but at the same time within during all these courses I was taking, I was watching things going, “This can't be. What's going on here?” For example, I took MacKenzie and strain-counterstrain back to back weekends. When I did McKenzie, they fixed the guy with a herniated disc with symptoms down to their knee with the extension. Next weekend, strain-counterstain, I was fortunate enough that the patient that they have had a herniated disc with symptoms down to their knee, it was even on the correct side. It was on the right side and they fixed him with flection. There we go back to the argument of flections from 50 years ago. You’re going to use an extension. I witnessed something. We’re either lengthening or shortening tissue, that's all we're doing.
I didn't know that necessarily that time, but what I began doing is I began testing left side versus right side on people. Why? Strain-counterstrain, Lawrence Jones who developed it used to say, “If somebody crooked make them more crookeder,” which means if they're leaned over to the right, lean them further to the right, but they would always do it by laying them on the table. We position them and hold them there for 90 seconds. I couldn't figure it out, but what about people that come in standing straight and looking normal? I loved his tagline, but I also taken all of John Barnes’ Myofascial Release stuff, follow the body, look where it's going. Do more of that. Follow the flow of the body and flow with it. I had those concepts in my head and I couldn't figure out if it's crooked or make it more crookeder, if they came in crooked I knew what to do, but if they didn't.
One day this lady came in with back pain. She wanted to dance on her daughter's wedding. She's 68 years old. I assessed her in four different types of evaluations. She had three rotations in her spine. She couldn't get out of a chair without gently touching it and getting up. She couldn't bend over. Her back hurts so bad she couldn't get down to her knees, sliding her hands down her thighs. I asked her before I started, I said, “Is there anything else I need to know?” and she said, “Yes. For the last three years, I haven't been able to take a step leading with my right leg up a step. I've always had to leave with my left. Left and bring up the right.” I put a nine-inch step down by the wall and I said, “Show me.” Sure enough, left was easy. The right one she should put up on the step, but she couldn't activate getting up on the step. It looked almost she had a stroke or something, but she didn't, she was a fine lady. I was like, “This is crazy.”
I was off to the side and for that moment in time I go, “She's crooked.” There's the crooked, her left worse, her right doesn't. Could this be the thing? I go, “Come on” but she's been using her left. If it's going to work, that's crazy. I said to her, “Try something for me. Will you do three sets of fifteen on your good side?” She did. She went and re-stepped up on the right after she got done. What did it so fast, she almost hit the wall. We laughed, and she goes, “What was that?” I had no clue. I said, “Can we do something?” I checked you not knowing about this step thing. I checked you with four different types of evaluations. Can we check to see what happened the rest of that stuff? Her arm improved 60%. All three of the twist in her spine was gone. She could get out of the chair without using her hands and she could slide down her fingertips to her calves. We're on to something. I didn't know it. She goes, “What was that?” I said “I don't know, but we're going to be very scientific here. You're only going to do your step up.”
She came back the next time and she didn't need any more treatment. I said, “Wait a second” Now, I already looked in left, right, and I had a patient three sessions and she had a boot on. She had three months of pain and she'd been to awesome therapist that I knew very well. I said to her, “I learned something. It's not new. It's been percolating.” I said, “You've been to an amazing therapist. She's done your hips, she's done your whole left leg, but can we do the rest of your body?” We went and we tested the rest of her body and her biggest restriction was her shoulder. We went and treated the good sided shoulder, and her left foot. We made her walk beforehand, she couldn't without the boot. We made her walk after the boot. After doing that and she was walking fine. She was seeing two or three times. I was like, “I think I can get this so the rest of my people can do it.” I don't know whether you are like the boss. When I hired people, I had VIP’s or certain people come in, I had to have.
When I had somebody good, I had to push them off to that person and maybe I'd hope that they do well. If I had a new person and I’m not sure. I was like, “Maybe this is the thing.” What I did is I then took this and what I realized was we sucked as a profession doing the scientific method. What do I mean by the testing, treating and post-testing? Many of you will say, you do it? Do you do something, one thing for two sets and then recheck everything? What we found out was if you would recheck after two sets of whatever you are doing, you would begin finding out what was working and what wasn't. That thing is if we were doing shoulders and we're doing a joint mode, and we did it for two sets, we would do it and then we'd look back and go, “Did it work?” We rechecked shoulder flection. Are they better or they are not?
What we realized, all this crookedness thing was is instead of going into restriction, we said, “Why don't we go into ease when we do a joint mode?” We would do two sets of into ease, and we'd compare in the ease and the restriction. It always seems to work better for seven out of nine times. We got bored of the shoulder and we go up to the neck and we were given permission because nerves run down it. We start testing the neck into ease and restriction and ease would go better. Where we got bored with that and we'd go to the other side of the body and then we went into the hips. From the right shoulder, we'd go into the legs and we'd start using all the extremities. What we learned was a process then that began that looked like this. We have a form that pretty much you can use for any technique and you can go, “Here's what my score is.” Instead of one to ten, we use 1 to 100, and you literally can say, “I have a shoulder abduction issue.” I’m going to call it an 80. That’s pretty high.
I'm going to do this technique, which we're going to use the other technique on the other side, and we're going to do two sets of fifteen reps, and then rechecks afterwards what we did. With this set, we laid out an entire diagram of this form and we started using it. We began learning that, “This form was making it.” We only needed two techniques to fix the person because we learned ways to tweak it to make it better. With this one form, I all of a sudden could put every one of my therapists, whether they are doing Total Motion Release or whether they were doing manual therapy and simply say to them, “I want you guys to do in the restriction like you normally do and I want you to go in to ease. I want you to keep playing around with different areas of the body until we all of a sudden come up with these patterns.” That’s where Total Motion Release was formed.
The thing that rings to me as you're talking about this is you were very intentional about the things that you're doing to the point where you keep talking about we. It's not I, the head guy, the owner, but we. You got the whole team involved and they bought in to the point where you had such alignment in your care that Tom Dalonzo-Baker's knowledge was part of the whole team, and it was a collective knowledge. It wasn't yours anymore. They were buying into it. The ability to equally care for, expand your care and influence starts multiplying I assume. Is that what you saw?
We're all thinking the same thoughts. We're doing the same things. It didn't matter what technique necessarily. We eventually all came over to Total Motion Release because we found patient-generated motion fix more things at once than therapists generated motion. Before that time, you're exactly right. We're all doing the things together. We all had the same concept that we’re trying to explore. I remember we would do one month, we'd say, “Go explore these motions.” We come back the month and say, “We're eliminating these and now we're going to use these.” We went from fifteen exercises down to six. We would check those six exercises. What would happen if instead of those patient-generated motions, if we actually moved them for that, and we always found that patient-generated is better. We created forms together and then every person that came in from a patient standpoint, we realized we were repeating ourselves so much.
We took what we’re repeating, we shot videos for it, and then what we had is this massive training program, not only did we could do on our patients, but any person, any clinician that walked in was being trained the exact same way. I very quickly had people that I knew. The big thing for us was when our patients had to go from one therapist to the next. They didn't have time and they had to change therapists. Totally different quality of care. They weren't being taught. They weren't educated, all of a sudden they were. Instantaneously, they were having the same quality of care. They could even see the therapist and our PT’s are even trained to do the exact same understanding and knowledge. The flow was so much easier and better. It made it so that I could step away and begin looking more into marketing. First, I went into my billing and my front desk and I systematize those because I understood how to systematize it from a standpoint of the therapist first.
Get the care and quality kicked-butt, then step back because what we did is we created a form that it can be used for any technique, but then we created three rules. If it works, what should you do? Do more of it. That’s rule number one. Number two is if there's little change, it plateaus or it fatigues, what should you do? Tweak it, I didn’t create new tweaks. You can increase or decrease speed, increase or decrease resistance and increase or decrease the time. We can also visualize. We could do a different body position, things that you already used. Rule number three changed everything. Rule number three is one part that TMR gave to our profession that wasn't out there. After watching a lot of experts and also being a math guy, rule three says if something increases, a pain changes location, a new pain comes on or something funky happens. Here's what you do. Notice what we gave, we have these three rules, if it gets better, if it gets worse or it gets unchanged, I'm going to give you three rules to follow.
I give that control over to the patient, I give that control over it and my therapist, so everybody can even check each other. Rule number three is if it increases like that. The first time it happens, it might've been a fluke, do it again the exact same way, 60% of the time it was a fluke. They're holding their breath, they’re doing something, they weren't knowing what was coming up and they're a little more anxious. 60% of the time it'll go right back to where it's supposed to do. The other time is if it increases a second time in a row, if you were doing restriction, go into ease. If you're going to ease, go into restriction. If you're doing the right side, do the left side. That changed the entire concept to be used for any, every technique and it gave the power over to the patient. You give the power to the therapist and those three rules can be used for marketing, front desk care, billing. Because of the three rules, no matter what, they’re the products of the university that you put an ad out there and it stops working, it works, keep flowing more of them out.
If it stops working and it was working, you got to tweak something. If it was made worse, you've got to go back and look at certain parts and see what you were doing that you took out. I always say, “If you're trying to lose weight and you're eating a bunch of bonbons at night, you got to do the opposite. Stop eating.” “I’m eating bonbons. I need to go eat something at night,” the truth is you started something, you've got to stop it. That's the opposite. The opposite of restriction is ease. Opposite of doing it is not doing it. We began using this structure of that entire concept throughout our clinic, not just in therapy.
It’s so simple. I love your three rules, whatever's working, keep going with it. If it's not so much plateauing, then tweak it a little bit. When you say change everything, I'm thinking to do the opposite of whatever that is and what cool is that you agreed with that. You aligned all your providers with those rules, with the treatment pattern. You also handed that over to the patient and for them to remember the three rules is easy and they can really care for themselves.
This is the biggest point. I call it the wellness pyramid. They say when a patient walks in you share with them that, “You're going to go to a phase that you're hurting, that's because why you come to us right away. You're going to go through where we relieve your pain in one to four visits.” You can say, “I get to go.” The pyramid block above that is increasing the range of motion and strength. We need to increase your range of motion, strength and make sure the pain doesn't come on while you increase activity. Above that brick on the pyramid is increase your activities of daily living and get you go back to normal. That's the pyramid we've been following in our profession. That's the ultimate place where you want to get them. That's the top of the pyramid and it's no longer that. Let me tell you the other two blocks above that we challenge ourselves too is providing a skill set that they can fix themselves.
Maybe they get all back to normal, but we want them to know that how to do it again if they have another issue. That puts them back in their own ballpark. It's self-generated, it’s self-taught, and it’s the ability to fix themselves. Our patients are so good that when they leave us that many of them will report back, “I went home. I showed my wife, my cousin, or whatever I had. A shoulder they couldn’t lift, I showed them to go to the other side. I showed them to lift up the leg and got better.” On top is the ability to show somebody else how to fix themselves. You don't have that anywhere else. If you're doing therapist generated motion as higher up the pyramid as you can get is activities a day to live and you’re getting back to normal. Recognize where do you want to be as a therapist? How high up the pyramid do you want to go?
Again, if you want to be a great manual therapist, that’s one where you want to stop, it's fine. How high up do you want your patients to go? The question becomes how high up do you want them? A question you asked them, if in two hours your pain comes back, do you want to know how to fix that? You want to come back in and pay another $50 copayment because the longer you're out of pain, the longer you’re in comfort, the more healing success. All this stuff I'm talking about, I'm talking about from a therapist’s perspective and a patient perspective. We take that exact same thought process though and integrate into the front desk. I can go into more of the front desk things we change and the standards we put into place to make things work.
I hope you do but I think it's easy to recognize how, once you can get those systems in place and you can have them think for themselves and not coming, “Tom, so-and-so council. What do you want me to tell him?” You're working up the pyramid and they should be fixing that themselves.
If something works, do more of it. If it stops working, you got to tweak something. Click To TweetWhat rule is that? It’s rule two because they're not coming or maybe they canceled a couple of times and that's rule number three and we need to do something.
The patterns for fixing issues, the patterns for implementing structure. You ultimately want to get to that fifth level, where the front desk person is teaching the next person how things get done.
We’re trying to be fluent in the same language. We’re also trying to challenge that language to get us to the next, which are standards. We create standards and we're always challenging our standards.
Give us an example of what you did with the front desk. I talked to a friend that's one of his biggest bugaboos is the front desk and he's working with Dee Bills to shore that up.
You can’t quite get it in. I've never met until I met Dee Bills, where I had never met somebody like myself that had the front desk figured out. Smaller claims, I said, “What seemed to be happening is the patient were maybe scheduling one or two visits at a time, taking so much of mine front desk time.” They'd sit and chat, then the front desk had so much stuff to do. They felt very anxious at the end of the day because they didn't get the job done. If you talked to a front desk person, they've got more place in the fire than anybody else. They’re spinning so many plates. When that happened, I made my front desk work from home virtually. I got Tim Ferriss’ The 4-Hour Workweek. We needed virtual assistance. [I did some really cool stuff that way. When I figured this out, I was like, “I think our front desk will work from home.” Everybody's like, “No, you can’t do that.” I’m not here just to talk about that, but I want to hear the power of because we were able to do that, what we did was here's the spreadsheet. I made a spreadsheet that I call the front desk to ask for it.
One of the things that I've been trained in an enormous amount of leadership training, I know you've had Shaun Kirk on here and went to measurable solution stuff. We talk about policies and procedures and the books get made, but it's not in a daily routine. I needed a place for me working from home that I could look at it and I could know exactly whether we're doing good or bad. I’ve never seen anything like it before. It's a simple spreadsheet. I made my people do duplicate entries. I know they had to put in the EMR, but what they did was on this spreadsheet, they put the person's name, they then had to put down their phone numbers, home, cell and work, and then the following columns were some of the most important. We put down the number of visits scheduled. We then put down the number of times per week they should be seen like three times a week for four weeks. Then next to that we put Monday, Tuesday, Wednesday, Thursday, Friday and number one and when their appointment was and zero if they cancel. If you can picture that.
I know exactly when every one of my active patients is scheduled and I also didn't know the number of times they should be there during the week. If I see a three and there are only two slots and I'm the front desk, they know I'd better be calling them because on the spreadsheet they can sort it and show everybody who is minus one visit or minus two visits. When they saw that, it was like, “I made their job easier.” The one thing is I was looking for patterns. The spreadsheets and dashboards are created to find patterns. In an EMR, if I walked into the clinic and I said, “I need to know if these ten patients or these 60 patients we have are active.” They would have to physically go look up every one of them. We even tried to work with some EMRs to see if they could change and create this for us, and it just didn't happen. It was easy on a spreadsheet. Remember, I'm trying to get an active working policy and procedure thing that is being part of the structure every single day, acting procedure manual. It's a living thing. Now they've got it down, they can sort it but now the thing was the follow-up that I needed to see.
We're also looking for patterns. I also had a thing that said Monday, Tuesday, Wednesday, Thursday, Friday and that was for the contact they made with those patients. I called that voicemail and that's what they'd say, they'd VM, but how do you know their voicemail, their cell, their home and work? Did they give him a text? Did they give him an email? We just have their names, their phone numbers and emails because we realized we should have emails on there. We began asking a lot more for their cell phones because the majority of the time now everybody pretty much has cell phones. We only have given numbers. Then what it did is by me being able to have that spreadsheet to say, “You've got a pattern here, you're just putting voicemail, but I have no clue where you left the voicemail. I have no clue whether you did a text or an email.”
What it did was the front desk got to cover their own asses by the more things they wrote, they were covering it. They had a comment section because life happens and you can make a comment about this is what's happened with the patient, they’re two weeks off and/or this and that's going on or they're sick. We could look back, that patient seems to be coming in sick three or four times. They're not like the other person who’s coming in sick. Very quickly then with this dashboard, they learned what I wanted, “I need to check all this stuff up.” They learned that to also see that, “We're trying to get people scheduled on their evaluation and we've got a bunch of five visits, two visits, three visits, four visits.” It's the biggest thing that's keeping us from having visits. We just fixed that and we had 92% of our patients in schedule, twelve visits on their evaluation. Remember, my front desk work from home. Figure that one out. How many of you see your patients twice a week or your therapist think twice a week is enough? You learned it should be three times a week. You play this dashboard long enough, and what you have is your own data. Look at the people.
At the end of the spreadsheet, our standards that we have equate to what completion is. With that completion, we know where the person’s at and how good the therapist is to her with the front desk. What we found was we would take those who completed with the highest percentage. We just look at what was the pattern in the people who finished and got the best done the most? What we did is we sort every three times a week and looked at their discharge stuff. We sorted everybody came twice a week. Those who came three times a week, they average around 92% improvement. Those who came twice a week, average between 67% and 82% improvement. Those who came one time a week or only came four or five visits, their average improvement is 33%, which was across the board you'll find. We will be able to get rid of our own preconceived notions just by tracking and observing data. It was sitting right in front of us.
You have the data to show your therapist as they come on board, “This is the system. This is how it works.” Whatever it takes, you need to get the patient in three times a week and they can talk to the patient accordingly and say, “You're going to get better if you come three times a week. Here's the data, we can prove it.”
Our pattern generated information are not based on what these researches are. I don't mind research, but your research should be what you're doing daily. It’s your clinical research that's happening. That is so much more profound because you said, you can go out there to research articles and argue any of your points.
You can say, “Maybe you can go to the other guy down the street, but here at our clinic, this is how we treat and patients get better 92% of the time when they come three times a week.” That's really powerful for a therapist to have that in their pocket.
We got to a point where we should start doing four and five and see what that does and whether we decreased the amount of time they have to be here for two weeks. If you’re going ten to twelve visits and we say over three to four weeks, why don't we cram them into two weeks if they can and see if that makes them feel better fast? We never get to that point.
That was going to be my question. Did you ever do that? You’ve got to try that. What was that completion after all just to clarify?
It's got a little story in it too. Let me just phrase it. You see how the rules that we have for the patients and for the therapists, and those same rules are used for the front desk and our billing and we've got this dashboard that's an active living thing. We are all speaking the same language from the entire patient experience. The only thing that we don't know, which started back at the beginning, is what is completion? That drives everything. Think about it like this. I’ll do a presentation and I'll say to people, “What percent of your patients do you think complete their treatment?” Almost everybody will say 70% or more. Unless they actually track it and they know it. I said, “Awesome.” If I went into a clinic, I'm sitting here with all these owners, and this is what you guys said, “What do you think your patients will say to your therapist?” They pretty much say the same thing. What equals a completion? People would throw stuff out. If I went back to your clinic, would they all say the same thing what a completion is? If I had all ten of your therapists or seven of them and they didn't know, we probably wouldn't at all. We don't know what a completion is.
Everybody would say something different. I said, “How can we have this going on and not have arguments and friction within our own culture because we don't even know what the standards are that we're going for? When I realized in my clinic this simplicity we did and it too was a living thing that we continue to change and challenge ourselves.” What's the minimal amount of improvement did they have to have in order to be discharged? We decided 75%. They have TMR that they'll know how to continue to fix themselves. You guys as a team and we did this as a team, you need to do it as an owner to think about what you want and then put it out to your team. We said, “75%.” What's the minimum number of visits it takes for a completion? Some would begin the argument. We said, “Just put it so that we can say this is a completion or not. It's not going to weigh. If your person finishes in six, and we're going to call it not completion, even though they got 90% better.” I know that sounds crazy, but if we're all working in the same system, we're all going to be penalized or rewarded the same way. You get away from that. What is their post-op? They get into all these extraneous things that almost stopped the discussion.
On general, what do we want to say? I think what we said was eight because we were averaging four or five because we’re like, “We're doing so good with four or five,” and we’re like, “Let's see if that's good or bad.” We said eight and then we said, “How about goals?” How are we going to know how many goals we’ll do? We did something called Progressive Goals. Progressive Goals are like they can't do a step and you say, “We're going to get them to a four-inch step, to an eight-inch, to twelve-inch, in a big goal of stepping up on a chair.” Every one of our goals were written that way so that we could then say, “We want them to get their goals three quarters of the way there, to the eight-inch or twelve-inch step.” We also would do go to metric measurements if needed. Then we would say, “They had to show up for the discharge visit.” That was a communication thing. They didn’t show up for the discharge visitors communication that wasn't happening, letting them know how important it was to have the discharge visit.
People in their head think it's not important. From there we said, “We don't want to cheat.” If my bonus is equated to this thing or you're looking at me to be a good therapist, I'm going to think about how do I get the easy way or if he's doing something that's making him elevated and me not elevated, then I’ve got to do this stuff. This is real life. We said, “What do we do about this?” That’s where Progressive Goals came in. We had four steps that we lean towards. That's where we said it's got to be eight visits or nothing. It's got to be at least 75% or nothing. They're considered non-complete. Last part was the front desk had to be able to tell by looking through the chart whether it's completed or not completed. That makes organization and neatness become powerful within your chart. We look at our charts and we sucked. What we did when we had that, we made everybody go pull ten charts and decide how many percent was completed, and we had 34%. In six weeks, we changed it to 85%.
It's an example of what gets measured, improves.
Our goals for us with TMR, we just say we have to get them to grade eight, because there’s a system within the TMR, lesson eight. At first, let’s just get everybody to lesson two, and then we improved it to lesson six and then with lesson eight and now it's lesson eight plus two other sessions. We're at eleven to fourteen visits because we want to get them to the top of the pyramid of fixing themselves and allow them to be able to fix somebody else. Now, everybody knows the standards from the front desk down. Everybody knows about the discharge visits. Everybody knows about goals or where the TMR part is. We can't get to the standards. We can't get to eight visits without everybody's effect. We can't get to 75% without everybody working together. The patient has to be there.
You've done so much working together with your providers, with your front desk and then coordinating between them all. Did you have a meeting rhythm? I'm thinking some others are going to sit there and say, “I don't have the time.” Where did you find the time to get these people to talk to each other? Was it a once a week thing? How did you organize those meetings?
If you're trying to lose weight and you're eating a bunch of bonbons at night, you got to do the opposite - stop eating. Click To TweetIf you were to say, “Where do I start?” I say you start with the front desk dashboard, number one. They need to get them trained in TMR, so they all speak in the same therapy language, and then you do the front desk. The front desk dashboard changes everything. We have weekly meetings, but I try not to overwhelm. I just say, “Where are we on this project? Yours is a front desk project. Each group had their project. This did not happen overnight. In my mind, everything to be looked at as a two-year project. That makes you take a deep breath and then set things in the quarters. I'd like to go to weeks, but it just seemed it was too overwhelming. We meet each week just to check in on it.
You want to hold people accountable and make sure things are moving in the right direction. I'm glad that you said two years because even myself, I felt, “Okay.” I'm getting anxious. I don't even own a clinic anymore, but I want to implement things and I can imagine the audience thinking the same thing, “How do I get this dashboard into play and how does this work?” It takes time and there's got to be some coordination and you’ve got to take it in small steps. You’re not going to come up with a dashboard by tomorrow. You work together with your front desk and you gradually implement things and it happens over time. As you do that, then that flywheel starts spinning slowly until it really catches on.
You don't even know that you're being a novice at the dashboard. Let me give you the idea of that dashboard. You bring the dashboard in. The first thing is they're going to whine and complain and they rightfully so that I have to do duplicate entries. You say, “I know, trust me that as soon you're going to be able to sort this and you'll be able to come in on a daily basis and say, ‘That's all I have to complete because I've already got the rest of this stuff completed. These are the names.’ It will save you time.” They begin and you realize, “They've done it. Their comments are just coming from one place. Now I know what they're doing and I can say, “What have you thought about this?” and I go, “No, I haven't. That makes all the sense in the world.”
In about three months, I remember my front desk person coming up and say, “Tom, I know I hate it and I drag my feet, and I was probably me this longer than I had to be, but I'm really glad you made me do this.” Same with my billing person because anybody who owed us money from 30 days-plus. If you have your own billing system, you need to be doing it, and if you have somebody outside of it, you need to have all your active accounts and it's done a certain way too. Initially, a week or two, you should have the spreadsheet out. With the TMR, you've got a weekend course or you've got 30 days to take the course to get the feel of it. Then you gradually start saying, “What can we do here?” As an owner, I would go in on Monday and Wednesday and I just look at the thing and observe. You are looking to observe things.
You've got to find time as the owner to do that. You can't be treating 60 hours a week. This helps because you can look you said at a dashboard and figure things out, but you've really got to be taking the time to step away and really manage and lead the practice.
The one part of all the training I've ever had, and you can ask anybody, it becomes supervision. You've got lots of kids. I’ve got lots of kids. I can't expect the chores of my children to get done unless I'm supervising it and I want to do it in the least amount of time possible. My kids send me videos of their rooms completed. I'm away on a trip and they still send me videos of their rooms completed because they know when they get on the weekends, and I said electronics is like crack cocaine. What I made my staff do was they would do screenshot videos of their front desk dashboard and send it to me so I could watch it on my convenience. My other departments, same thing, they would do it. It sounds maybe I'm a perfectionist. I like the 80/20 rule.
I'm not looking for perfection. I want to go in and slap their hands and give him a high-five for doing all this cool stuff, and then you sit down and say, “What patterns are we seeing?” We’ve got a lot of people sick. What can we do? What dialogue can we use about sick people? Are they really sick? Are they not? We don't have a lot of people to scheduling now. What's going on? What can we do? What we were doing before? That dashboard does that wondered. If I go into my therapist and my patients, we can all talk the same language of the TMR. The TMR is shortening and lengthening tissue, therapists-generated or patient generated. We're all there sitting. I've never seen something culturally that is put something through the entire system like the living dashboards and then a system like the concept of TMR. We had an exercise base TMR, and we also have a manual.
It’s impressive how you really implemented systems throughout your organization that are simple. They're not complex but they can tell you so much just by simply following the patterns and doing the minimal work. Maybe in some ways, it duplicates work. It can tell you a huge story and then you as the leader don't have to start figuring out, “Whose problem is this and who went wrong and where did it go wrong?” You have the objective data right in front of you and that makes things so much easier.
You’re being preventative. There’s a problem, let's go back and look at the data. That's what I kept doing and I was like, “We would go and we have stats and we have grass and stuff.” We say, “The grass coming down, what should we do?” We didn't know and we didn't know how to supervise it. I was like, “This is driving me crazy.” That was going on for seven years. I had seven years of trying to put things together before this stupid thing of a dashboard came about. The stupid thing about shortening and lengthening tissue came about. Literally, here's our beginning score, here's what we treat them with, here's our post score. We're going to do another two sets and here's the score. The simplicity of our form is so basic. It's like I played basketball. We shot, we dribble and we pass. I wanted the very basic stuff down. We have their names, their phone numbers and times that they're with us, and then the Monday, Tuesday, Wednesday, Thursday, Friday when they're supposed to be, whether they're here or not, and then we have Monday, Tuesday, Wednesday, Thursday, Friday for follow-ups. That's really simple. We take that and just say, “Can you text them? Can you email them? That makes all the sense in the world, and now we can sort that.”
I've thought of a concept that Jim Collins brought up and that was fire bullets and then cannonballs. Just do little tweaks and then when you find some success, then you can do maybe a little something bigger and then fire little tweaks again.
Because I don't even know what it's going to look like. The front desk thing, I didn't know what it’s going to look like. We go limited rose at certain times and we added them and we thought this was important back, but it was always the more basic, we kept it the easier. It’s gone into other people that I've helped out clinics and it will change things literally overnight. Give them a couple of hours to write everybody's names down and stuff like that, but once they had gotten it down and they keep track of it, it's an easy thing.
Is your front desk still virtual?
Theirs is.
We talked about what Telehealth stuff and ownership and the plantation and you even brought up selling your practice to your employees. I'd love to hear more about that someday. Are you open if people wanted to reach out to you? is there a way they can get a hold of you or TMR Seminars?
My passion is really the seminars. However, if I had a group of owners that said, “I'd love your front desk, I’d love to do it.” I'd love to help people out because there's one part that I'd love to do is actually going through every other week and being the person that actually helps your front desk implement that spreadsheet, help your therapist implement TMR. I'm really busy, but that sounds really good too. On my website, TotalMotionRelease.com, you can find my cell phone number and my email. The biggest thing I'm going to tell you to do though is you’ve got to start with the seminars. After that, you catch up with me the rest of the stuff and we can get people.
Thanks for being so available. Not a lot of people as busy as you share their cell numbers, so that's very nice of you to provide that.
When we get on, we even have Voxer. It's a walkie talkie app. The minute that you've taken a course of mine, you're connected to me and ten more. I had people say, “Tom, I have problem with the patients.” This is what I do. I don't have patients 8:00 until 7:00. I get the freedom of doing things and having an open schedule.
Thanks again for taking your time. I appreciate it, Tom.
Nathan, I appreciate you. Thanks for doing what you do.
Thank you.
Hi. I am Tom Dalonzo-Baker and have been a PT for over 20 years. Was a teacher and businessman prior to this. I live in Raleigh, NC with my 6 kids (5-18 yrs old) and my awesome wife.
