Adventures in practice I

[Barrett Dorko]

I got my business cards yesterday so that means I’m now officially in the weeds.

Barrett L. Dorko P.T.
Clinic Director
Progressive Therapy Services
2383 South Main Street
Akron Ohio 44319
Phone: 330-785-5440
Fax: 330-785-5770

I stare at this and wonder what it might mean.

I’m to build a practice now. I’m supposed to detail the surrounding referral sources.

Like most things, I’ve found if I write about it some things will become clear to me, and I know many of those reading this will help.

Here we go.

[joebrence9]

Congrats Barrett!!!

As a fellow clinic director, the region in which I work has seen a downfall in patient visits as compared to the previous year. A few of us have formed an action committee to investigate ways in which we can capture new patients and improve our cancellation/no-show rates. I have written a stategic business plan which I am presenting to them on Wednesday, but I emailed one of my key strategies to a colleague (its built off the operator/interactor pieces by Diane/ Jason/etc.) and I think this may be of some assistance to others who are in a similiar position to myself or now Barrett. Here was my email:

"Tim,
Its Joe Brence from the Bridgeville office. So, I am working on a strategic plan for this region after talking to you. Just jotting down a bunch of ideas but what do you think about this….

I am big on the “why we do” of Keystone vs. the “how we do it” or “what we do” ---there are a lot of PT clinics that do PT but “why us”? Take Apple computers for example (the most valuable company in the country) Why are people choosing apple and not dell, gateway, ibm, etc. Apple is simply different from the moment you walk into their store---it’s its own a culture. People will stand in line for days for a new i-mac, i-phone or i-pod. How many days have people waited outside a gateway store for their new products…

Or even Starbucks. Starbucks does not have employees..they have “Baristas”..they also have a consistent culture and products.

I suggest that this region develops a consistent culture…Here’s my idea:

· All patients will no longer be “patients” of Keystone…They will be “members”
· With membership they are given a complimentary t-shirt to wear to therapy which has our logo on the front and “member” written across the back..this will create a “culture” ---I actually already give tshirts pre-tx and suggest they wear it to tx. I know its little but people love t-shirts. We (Us and the patients) are now on the same team.
· Members will get “exclusive” rights to assist in “their plan of care” and will be incentivized to refer their friends. They will document their progress so they can see change (we will develop standardize forms for them to write down their daily ROM or strength measures)
· All members will get a 1 month free gym membership after completing therapy and a discounted, affordable membership after that (as compared to the general public)
· On return visits, all members will be guaranteed an eval within 24 hours
· Maybe even develop a “membership card” and we can partner with a local pharmacy or medical supply company to advertise for them in exchange for giving 5-10% off if they present a “keystone member” card
1. It worked for Giant Eagle/GetGo

Culture is important. The feeling of support is also important. I think this "team" approach will set us apart from our competition and improve overall compliance and outcomes.

[amacs]

Hi Joe

that is interesting, however although that does appear to be a culture is it the "why"? It does seem more like packaging than the core, intrinsic, passionate expression of why you do what you do or why you exist as a company. That may be a cultural misunderstanding on my part.

regards
ANdy
(who directs nothing, presides over his dinner table and has no power beyond his autonomy and who therefore should maybe keep his mouth firmly closed)

[Barrett Dorko]

Thanks Joe,

Okay if I bring this to the clinic directors here?

[CDano]

You'll need your own T-shirts

some slogans -

Smile for Simple Contact


I do motion
e

[byronselorme]

Originally Posted by CDano

I do motion
e

I like that one!

[joebrence9]

Thanks Joe,

Okay if I bring this to the clinic directors here?

Sure!

[Diane]

This is kind of interesting, for someone like me, who has never worked as a PT in the US:
Disruptive Innovation In Physical Therapy: Part II
Physical Therapists And Their Self Image: An International Perspective
...by a PT, trained in Canada, working in the US.

[nari]

For example, the attitude of the vast majority of gatekeepers towards physical therapists is almost a God-given imposed subservience – which befits a gatekeeper model, of course. What makes this worse is that physical therapists here seem to accept this as reality.

This has been a puzzle for me over the years; that fact that this subservience seems quite acceptable to many US PTs. Perhaps there isn't much that can be done about this fact because of the health system complexities.

Nari

[PatrickL]

Nari,
My observation is that hierarchical mindset extends to the patients... Which kinda perpetuates the problem because doctors remain the first port of call in the mind of the nyc public. A typical comment from a patient in oz would be:

"I didn't bother going to the gp first, because he would just send me for physio anyway"

In NYC, patients typically say:

"so I've been to see my dr / specialist, he sent me for (insert imaging here) +/- injections. Now he wants me to try some physical therapy. i have (insert diagnosis here) and i require (insert treatment plan here).

[nari]

That's depressing to say the least.
I know some US states have autonomy in place for PTs, but it may not follow that they can choose their own program for pts.

I'm happy to stand corrected on this view, of course.

Nari

[PatrickL]

In my experience so far, the docs don't dictate how the PT treats, but the patient always arrives with specific ideas about what is wrong and what needs to be done... And it is difficult to change these views if necessary.

I think there's some kind of skeptical edge in oz that keeps most people from putting doctors (or traditonal authority figures) up on a pedestal... tall poppy syndrome? Remnants of a penal colony?

From what I've seen so far here, many have an unquestioning respect for the title of doctor and are less likely to be influenced by the opinions of non-doctor health care professionals. Title seems to carry more weight.

[nari]

Hmmm, it could well be the tall poppy syndrome.

Patients do have a lot of respect for docs, but inevitably, if they say 'oh the doc thinks it's XXXX and needs XXXX, does that sound right?' and I say 'well, no, I think it could be ZZZ and there are a number of ways to deal with that' - they inevitably say: 'you're the expert'.

I have never come across a pt in 30 years who challenges my answers; some folk are convinced they need manipulation and US, but I can convince them out of that with some ed.

Nari

[PatrickL]

Just to clarify, I meant the patients in nyc have preconceived idea of what's wrong/needed based on what I see is an unquestioning trust in doctors.

My observation in oz is that patients do not follow doctors as willfully/blindly. Not because i think people in oz are smarter but prob because culturally we are a bit more anti-authority. Funnily enough, i think physios in oz have manage to gain the trust of Joe blogs without attracting the skepticism/distrust that traditionally goes with authority figures (doctors, politicians/police/ parking ticket officer/government... "They're all in it more the money, they're not looking out for us hard working honest Aussies etc). It may be that in oz that physiotherapy enjoys a fortunate position- having the trust of the public without suffering its skepticism?

[nari]

Apologies to Barrett for unwittingly highjacking the thread.

Nari