It’s a Shame the Basics aren’t more Exciting

Are you the kind of person who likes to get to the exciting bits quickly?  I don’t mean fast forwarding a DVD or leaping ahead in a book to see what is coming up (or perhaps you like that too), I mean do you get bored doing the basics.  Of anything.  Whether you are learning a musical instrument, acquainting yourself with a new smart phone or building a business or career.

Most physiotherapy clients I work with as a business mentor agree that the basics are really important, and then rush to show me their latest ‘bright shiny object’ – a new piece of equipment, gadgetry or tool. Or a new technique, system or software.  Or a new person, place or whatever.  And that’s the thing: basics are important but not exciting.  Nobody seems in a great rush to boast about their new policy on personal phone use in the business, or how they check the references for potential employees, or a new procedure for handling incoming phone calls and message taking.

Not exciting, but absolutely mission critical.  The examples above may seem minor in the big scheme of things, but when they are compounded by the multiplier of frequency they can make a huge difference to your business outcome.

I am about to embark on a tour of New Zealand to present business workshops for private physiotherapy practitioners and I just know they are hungry for ‘the next big thing’: the one secret of marketing or leadership that will boost their business outcomes. Well let me tell you the one big secret I am about to tell them….FOCUS ON THE BASICS. Especially people, service and cash flow.

I recall my very first patient when I graduated as a young and enthusiasic physio in Australia.  She had recently suffered a stroke (CVA) and was wheelchair bound with a left hemiparesis.  After months of neuromuscular rehab starting on the floor mat, progressing to four point balance, then to sitting skills and finally standing from sitting she was able to learn how to walk independently.  This was the exciting part made possible by previously focusing on the basics and getting them right with repetition, coaching, practice and feedback.

The basics of business are just that: the base on which everything else is stacked – the exciting bits are the highest, most obvious and premium-priced items, but they are fragile if the basics are shaky. Not only that, but the foundations can shift or fatigue.  Regular management reviews will indicate when repairs or updating of your boring basic systems is due. Which is often more effective at boosting your business than a new ‘bright shiny object’.

Craig Allingham

How Many Hats?

My fabulous and usually tolerant wife Mary has declared ‘no more hats’.  She is referring to my proclivity to wearing, and therefore acquiring, hats. I just love hats.  I believe it is time men reclaimed the hat as a personal statement of masculine fashion.  I am talking about proper hats – trilbies, fedoras, snappy brims, wide brims, stingy brim jazz hats, even pork pie and cloth caps.  Pretty much anything except baseball type hats.

Anyway, Mary has suggested (wife speak for ‘this is really important, pay attention and no one will be harmed’) I purchase no further hats until I have another hat rack to accommodate them.  Yes, another hat rack.  I have filled the first one.  Fair enough, I thought, these hats deserve their own position and care. So no more hats unless I retire one. 

We blokes wear a lot of hats.  Not necessarily the actual hats of which I speak, but the many ‘hats’ associated with our many roles.  Husband, son, uncle, father, sports coach, employee, boss and so on.  The idea of ‘putting on a hat’ in regards of assuming a particular role to play.  The way you conduct yourself changes according to the hat you are wearing at the time.  Your Dad hat makes you a different bloke to your Sports Coach hat, or your boss hat.  Same person, different role to play.

I wonder if Mary was hinting in a cunning subliminal female way that I had too many of these other hats.  Too many roles in my life that may be diluting my effectiveness in all of them.  I have my Dad and wife hats of course, but also my professional speaking hat, my author hat, my chamber of commerce board member hat, my business coaching hat and quite a few others.  Perhaps she was suggesting (see above) that I should not take on any further roles, tasks, jobs or projects until I have cleared some space on my ‘hat rack’. 

It is very easy to add stuff to your life, to find corners of time and enthusiasm to tackle a new project or activity.  Obviously the time must come from somewhere else and your current hat collection may suffer.  Pretty good advice, really. 

So when a new opportunity to get busy, to take on a new project or activity appears or is thrust upon you – before putting on the new hat take a good hard look at the hats you already have on the rack decide if there is space on the rack.  If not, retire one hat before you put on the new one.  Then all your hats will get a chance to be worn with style and success.

Is Your Business Stable?

One of my sons, Jon, is completing a bachelor degree in circus.  True.  Swinburne University in Melbourne houses the National Institute of Circus Arts in a fabulous modern training facility.  How fabulous to be able to gain a degree in a performing art as esoteric as Circus.  

Modern circus is full of spectacular physical stunts, acts, theatre and acrobatics.  Which is exactly what young Jon (22 is apparently still young) is learning.  He has a vast repertoire of tumbles, juggles, leaps, catches (other people) and dives through hoops.  Which is what we see at his shows.  Apparently other peoples kids are also doing stuff but I can’t seem to recall them. These flashy, impressive acts are difficult because they challenge the very laws of physics and the performers constantly appear on the brink of failure.  The liklihood of falling, dropping, missing or just stuffing up is what makes the acts so watchable.  The whole business of circus is built on instability – the imminent failure that is so obvious to the audience.

Curiously, they rarely fail.  The obvious instability is underpinned by hours and hours of strength training, agility drills, stretching, skill building, rehearsals and then start again.  The preparation is the stable base that allows controlled risk taking in the name of entertainment.  But of course, the audience never sees the preparation, just the outcome.

Your business is no different from a circus.  Perhaps it even resembles one at times.  The fabulous face your business presents to the client in terms of customer service, clean facilities, quality products or services and so on is only sustainable if it is built on a stable base.  Your staff training, record keeping, inventory management, cash flow management and many other systems and procedures are the foundation on top of which your business can shine.

However, if the base has been cobbled together in a rush to get the business up and running, or maybe a good base has been undermined by staff turnover or complacency, the ‘customer facing’ aspects will be unstable. And the wobbles will be evident to your clients.  They will notice stock shortages, appointment mistakes, failures to follow up or deliver on time. And perhaps worst of all your clients will percieve you are more preoccupied with keeping the good ship afloat rather than look after the passengers. There, I think I have mixed all the metaphors I could think of.

Here is the bottom line: the basics are not the exciting bits.  The hours spent by Jon in the gym building his body and skills is the tough repetitive grind on top of which he embroiders the visible performance skills we pay to see.  Same for you – hours of unseen (and unpaid) work to build strong basics for your business to shine. Yet the whole facade of your professional expertise is anchored by sound basics and a firm base for your business and this time spent on the basics is never time wasted.

The message is obvious – if you are building a business to last, build, sell or franchise, you should spend time, money, resources and effort on getting the basics right.  Seek assistance from advisors, regulators, professional organisations and mentors to ensure your success. In fact, as part of his circus degree, Jon is studying event management, marketing, sports injury care and other business basics to prepare him for managing the back of house not just the onstage presence.

Build your business on a stable foundation and while you might not get a standing ovation like Jon, you will prosper from return business and recommendations.

Craig Allingham
Professional Development Consultant

How Passive is Passive?

Passive shouder movement is a common early rehab option for patients who have undergone recent rotator cuff repair surgery.  This treatment is to maintain joint mobility while avoiding active loading of the repaired tendon.  However recent research suggests passive may not be as passive as we thought. 

In research published by Uhl, Muir and Lawson (2010) they found that when performing passive range of motion there was still slight electrical EMG activity in the rotator cuff muscles.  They also found that the transition from passive movement to active-assisted exercises involved only ‘insignificant increases’ in EMG activity in the muscles measured. The increase in activity rose from below 10% of MVC to around 20% of MVC.  

My take on this is two-fold – firstly be very cautious with ‘passive’ range of motion exercises because there is still some active assistance being offered by the musculo-tendinous unit.  Secondly, the transition to active-assisted exercise could probably be made earlier in rehab depending on the fragility of the repair, the number of tendons repaired, the pain levels reported and the confidence of both physio and patient. 

Ref: Uhl TL, Muir TA, Lawson L. 2010. Electromyographical assessment of passive, active assistive and active shoulder rehabilitation exercises. Phys Med & Rehab Feb 2(2):132.41.

Survival of the Best Fit

Charles Darwin is often misquoted as saying evolution is the survival of the fittest.  Not quite true.  He actually said ‘It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change.’  In other words, the creatures most suited to the current environment will be advantaged and reproduce. 

The same is true in business.  In New Zealand there has been a shift in the operating environment for physiotherapsts and some other health practitioners.  The previous system where the government run accident insurance scheme provided full funding for physiotherapy consultations has now been modified and the agency only partly funds the cost of treatment.  Many practices are now having to ask clients to actually pay some of the fee, for the first time ever.  This is a huge environmental shift.  And like the dinosaurs who couldn’t adapt after the planet was struck by a huge meteor, some practices in New Zealand have also perished. 

Fundamental changes to the operating environment are not common, but change will always be in process.  Some changes will be internal to your business (people, systems, technology), some external (suppliers, tax laws, HR regulations) and some will be environmental (think global financial crisis).  Business that are strong and have systems and procedures often believe they are ‘change proof’.  Just like a dinosaur.

Being able to recognise change (even before it arrives) and adapt to better suit the new environment will ensure your business survives and thrives.  Being open to ideas, seeking new information, having a agile approach to opportunities and recognising that the old way may no longer be appropriate is a sign of competent leadership and proactive management.

 Late in 2010 I was invited to New Zealand where I had the opportunity to speak to private physiotherapy practitioners in four major cities about the changes and suggest strategies to respond to them.  Under the heading of my “Seven Deadly Sins of Business – and how to avoid them’ I shared my experience in business and the successes and stuff-ups I have generated.  Got to love those stuff-ups – a lesson in every one of them.

Small and medium business is doing it tough globally.  Even in health care we are competing for the discretionary spending of our clients.  Any money they spend on clothes, holidays, skin care, domesting cleaning staff, etc is money they wont’ be bringing through the physiotherapists’ doors.

I like to think I offered value to those attending and helped them identify the current operating environment so they can adapt more quickly and completely.  Each participant received a copy of ‘Book More Clients’ to help educate them and their staff in how to better convert, service and market to their clients in order to build a more resilient business model.

I look forward to returning to New Zealand in March 2011 with more targetted information and strategies to improve the agility, speed, efficiency and responsiveness of their businesses to the changes occurring within and around their businesses. Much of which I will also share with my online readers.

Easing the Pain of Selling

One of the most difficult concepts for health and fitness professionals is to consider themselves as ‘sales people’.  Their training and predisposition to help people achieve recovery, health or new goals is an overwhelming drive.  Selling is completely underwhelming and often seems at odds with the notion of ‘helping people’. 

After struggling with this conflict for most of my physiotherapy career I came up with a strategy that gives an opportunity for the client to initiate the enquiry.  Once over this hump the whole process simply becomes another way to help them. 

Those of you who have attended my Biz Fizz workshop will know the secret already, and I know from your feedback that it is working for you.  For the rest of you: if I could tell you a way to overcome your discomfort with selling, would you want to know it?

There you go.  You now know the secret.  It is the sentence in purple!  Simply adapt it for the situation, for example:

  • If I knew of a product that might improve your recovery would you like to know about it?
  • If I could show you a program that would allow you to achieve your fitness goals more quickly/conveniently/fun would you be interested?
  • If I could show you how the benefits of a higher membership level would improve your outcomes, would you like to know?
  • If I knew of a nutritional supplement that brings more bang for your dollar would you like to hear about it?

So there it is: a simple strategy that invites the client to seek your professional opinion on a product or service that they have given you permission to tell them about.  All you do now is tell them, answer their questions and let them make a purchasing decision based on their perception of  benefits vs costs – also known as VALUE.

One of the most difficult concepts for health and fitness professionals is to consider themselves as ‘sales people’.  Their training and predisposition to help people achieve recovery, health or new goals is an overwhelming drive.  Selling is completely underwhelming and often seems at odds with the notion of ‘helping people’. 

After struggling with this conflict for most of my physiotherapy career I came up with a strategy that gives an opportunity for the client to initiate the enquiry.  Once over this hump the whole process simply becomes another way to help them. 

Those of you who have attended my Biz Fizz workshop will know the secret already, and I know from your feedback that it is working for you.  For the rest of you: if I could tell you a way to overcome your discomfort of selling, would you want to know about it?

There you go.  You now know the secret.  It is the sentence in purple!  Simply adapt it for the situation, for example:

  • If I knew of a product that might improve your recovery would you like to know about it?
  • If I could show you a program that would allow you to achieve your fitness goals more quickly/conveniently/fun would you be interested?
  • If I could show you how the benefits of a higher membership level would improve your outcomes, would you like to know?
  • If I knew of a nutritional supplement that brings more bang for your dollar would you llike to hear about it?

So there it is: a simple strategy that invites the client to seek your professional opinion on a product or service that they have given you permission to tell them about.  All you do now is tell them, answer their questions and let them make a purchasing decision based on their perception of  benefits vs costs – also known as VALUE.

Seven Deadly Sins

While in London recently, I was asked to make a business presentation to a group of private practice physiotherapists who are part of the Physio First network.  I was happy to share with them, as I believe the stronger our profession becomes in business the better it will be for clients, employees and owners.

This opportunity allowed me to unveil a new presentation titled ‘The Seven Deadly Sins for Physiotherapy Business’.  A two hour overview of common errors, over-sights and missed opportunities with specific application to any service or health business.

The Seven Deadly Sins are-

  1. Secrecy
  2. Chaos
  3. Sciolism
  4. Neglect
  5. Naivety
  6. Sabotage
  7. Deference

I love this presentation – it allows me to dig deep or skim over each sin as determined by the needs of the audience.  It can be customised to suit the occasion.  This presenation can be a keynote for a large event, or a workshop for a small group.  It can be platform or interactive.

Anyway, the presentation went down very well in London and the feedback was overwhelmingly positive.   So much so that I used it again in New Zealand with private practitioners looking for strategies to adapt to a new operating environment.  A feature article on the Seven Deadly Sins appears in the December 2010 edition of ‘Business in Practice’ an Australian physiotherapy publication. 

If your organisation is interested in more information with a view to booking me for a workshop, please let me know.

Frozen Shoulder – Sick not Injured

 When I graduated I knew everything about treating every condition.  I was on fire!  Three days into my new career I had crisis of confidence – not only did I not know everything, I pretty much knew 10% of very little.  And this was in the days when there wasn’t much to actually know!
One thing I was pretty sure about was that if a joint was stiff it was my job to make it move.  To jiggle it, lean on it, twist it and then do all three at once.  And reassess. There are many women out there who now believe physiotherapy is a satanic pain ritual practiced by young men with more muscle than brains.  These are the women who came to see me with a Frozen Shoulder – Stage II.  Let me now apologise to them: ‘I am so sorry that I caused you immense pain in the pursuit of a five degree gain in shoulder flexion or a zillionth of a degree of external rotation’.  Why you returned for futher appointments speaks more for my postive attitude rather than any actual improvement.

Yet, they DID improve.  If I treated them long enough they all responded to my brilliant therapy skills.  Sometimes it took three or four months, sometimes a year or more.  But they all got better.

So did the clients who stopped treatment – they also got better.  Some took three or four months, others a year or more.  But they all got better.
So I rethought my approach to treating frozen shoulders (adhesive capsulitis).  This condition is thought to be an auto-immune disorder where the lining of the shoulder joint becomes acutely inflamed (capsulitis) with lots of pain, then goes haywire and starts to weld up it’s collagen fibres (adhesion) and become incredibly stiff.  These two stages (I and II) I call ‘freezing’ and ‘frozen’.  Then later the shoulder goes into stage III – thawing – and the movement starts to return without the previous pain.

Identifying a client in Stage I is difficult. Often they have been through the doctor/X-ray/Blood Test/Specialist visit cycle during which the shoulder moved into Stage II and arrived at physiotherapy ready for rehab.  Too late.  Here are a couple of ideas for identifying shoulders that may be in Stage I:

  • Pain is out of proportion to any recent trauma
  • Significant loss of external rotation first, then later elevation
  • Investigations for structural pathology are negative
  • Pain is not direction specific when testing movement or strength
  • Look for signs of immune system stress, for example recent illness or surgery (not necessarily shoulder), big life events (moving, parent or partner death/illness, family or financial troubles)
  • Over the age of 40
  • Left shoulder
  • Diabetes or it’s precursor Metabolic Syndrome
  • Female

None of these is diagnostic in it’s own right, but when they co-exist my index of suspicion zooms up and I can better navigate the optimal care plan

If you believe a shoulder is freezing, there may still be a chance to prevent it progressing to frozen.  Pain control is vital as is inflammatory control   Mild cases may respond to oral pharmacology, others may need intra-articular cortisone.  Non-stressful joint mobilising to adhesions and modification of aggravating activity will help.  As will a clear explanation to the client. A supportive physician or rheumatologist is a great partner in the care of these clients.

In fact, I find the education aspect of the treatment to be the most important.  I am careful with my words and tell them their shoulder is sick, not injured.  Patients understand ‘sickness’ has a course to run, and are more likely to ride with the slow progress if they get the difference.  You can then put the ‘sick shoulder’ into the context of their general health issues, the immune system struggling to cope and the internal battle now being waged.

For those patients in Stage II (frozen), I believe it is critical to keep them active and healthy.  The ongoing pain is distressing and combined with the lack of short term improvement can predispose to depression and anxiety.  Which doesn’t help their immune system resilience.  I try to keep them active (total body) with walking, cycling or modified aquarobics.  This is a positive approach mentally and may help prevent weight gain during this period of restricted activity.  I also try to reduce sources of inflammation (activity, stress, nutrition) and check them every four to six weeks to monitor their maintenance exercises, encourage them to stay active and patient,  and to identify when Stage III begins.  This is the stage when I can enhance their recovery with more frequent joint therapy, massage, exercise and functional activities within the limits of their inflammation threshold.

And I get the credit!

This is the secret to getting all the credit for the patient’s recovery:  make sure you are treating them when they get to Stage III.  Because whoever is treating them at this time gets ALL the credit!  Physio, Chiro, masseur, astrologer, aura therapist – it doesn’t matter because it is all in the timing!

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The Conquest of Space

Have you ever had trouble getting started on a project?  A project that you really want to do, one that gets you excited whenever you talk about it at a Chamber meeting or out to dinner with real friends, a project that pushes all your buttons: but you just can’t get it started.  This is my story…..

My project is to turn my speaking topics on productivity, longevity and fun for men (also known as men’s health) into an absolutely riveting, entertaining and useful book for men.   I intend to write the first ever book on men’s health that men actually read, and maybe even act on.  But I haven’t.  And more importantly I couldn’t work out what was stopping me. 

I finally realised it was space.  I had some, but it was the wrong type.  It was my ‘busy’ space – the desk where phones rang, emails demanded action, payments were made, meetings were arranged, business correspondence written and financial records were processed.  Whenever I sat down to start my project any attempts at creativity and planning were invaded by all this busy work.  And so was my mind: I was trying to do creative work in my admin space, but my mind would not be tricked.  It promptly switched from right side activity to left side activity and I got busy.  So there was my barrier: my external and internal spaces were neither suitable nor ready for the task at hand.

I realised progress depended on a different quality of physical space and discipline of my mental space.  So I did the unthinkable: I sought help! This goes against all the programming of the male mind and was quite a breakthrough.  I did a ‘paper flow workshop’ (Kikki K, Maroochydore) to learn how to manage all the pits of paper, bills, invoices, letters, notes, appointments, etc that come over my desk. Then amazingly, I actually implemented the plan and noticed an immediate change in the appearance of my workspace and the feel of sitting down to a clear work top instead of a clutter of horizontally filed paper where priority had been overwhelmed by arrival date. 

Next was my head space.  No convenient workshop for that one!  It required some coaching from a fellow speaker and author to help me identify what my ideal head space should be, and how to retain it against constant invasions from external and internal sources. 

Now I am ready – title done. Web domain? Done.  Chapter concepts? Done.  Outlines? Next.  But that’s me, what is the message for you?  Who cares?  I’m underway!  No, that’s a bit harsh – the questions I would like to pass on are simple: what is stopping you from your next leap to greatness?  What simple steps can you take that will allow you to achieve your next success in business or life?  And are you prepared to ask for help?  Is your workspace or headspace holding you back, because if it is and you can conquer it, the universe beyond is beckoning.

 Cheers for now,

Craig