Strategy – more than a plan

Is a business plan enough?

Business plans are important tools for any owner, and in my role as a QIP practice surveyor I have seen many such plans – some brilliant and some in need of work. Not a lot of work, as most are pretty close to the mark and just need firmer time frames and outcome measures. But none of them was a strategic document. None projected a longer term vision of the business or demonstrated a purposeful system of achieving it. 

Strategy

It has been said that strategy is more than a list of goals and actions to achieve them – more than a plan. Strategy is more deeply rooted in the DNA of the business, the owner and the organisation. It is the combination of behavioural patterns, customer management, competitive advantage and the philosophy of adding and delivering value.

Well, so say the academics in the field of strategy. Like Mintzberg who listed no fewer than ten ‘schools’ of strategy, or Sun Tzu (‘The Art of War’) whose work has been commandeered by business coaches and consultants often with good effect. And of course Michael Porter, a more recent guru who insists that strategy is focused on a unique mix of offerings that enhance competitive advantage.

If you would like to develop a strategy for your business that provides direction and perspective in turn generating a purposeful business plan, HR plan, marketing plan, earning plan and exit plan you will need two things. Firstly, an open mind toward how to analyse, structure and drive your business; and secondly, a day with me to guide you through the process.

Developing a strategic plan is not simple, nor is it absolutely necessary to have a narrow strategic focus. In fact, the best strategies are often flexible, responsive and able to adapt to changing circumstances. Too rigid a strategy can be counterproductive when the internal or external business environment shifts unexpectedly. 

That said, it is still useful to have a point on the horizon on which to navigate your progress.

Some can develop their own strategy in-house, using the collective knowledge and wisdom of the team. Others go outside and engage consultants or advisors to steer them. More often there is a blend of these two methods. The end result is the measure of success. Not the actual plan that is constructed, but the achievement of the milestones inherent in the plan that show you are making strategic progress.

Take a moment now to envision your ideal business in around five or so years. In your mind take a walk through and see the layout, talk to your team members and maybe your new business partner, get a feel of the culture of the organisation and the marketing signals given out by the quality of fittings, people and service. Write it down, distill the essence of the outcome you want, including your role, time commitment and investment in this business. Afterwards you can back track on the key elements and what needs to be in place in three years to enable the five year plan. Then what needs to be in place in one year, six months, next week. These steps are your key performance indicators of strategic success or need for adjustment.

How can I help?

Two of my workshops include strategic planning. One is an introduction as part of a multi-stream day. The second is a full day devoted to developing a strategic plan for your business.

Remarkable Practice

Three topics across a one day workshop: strategy, marketing and leadership. We look at fee setting strategies and other important starting points before moving onto the other two streams. Ideal for newcomers to private practice or those looking for a boost to their business enthusiasm.  Check the event list at www.redsok.com for when this event is next scheduled.

Remarkable Strategy

The aim for you at the end of this workshop is to have a strategic plan to enable your business to outperform in terms of market share and profitability.

My strategy is for you to leave the workshop with:

  • A clear understanding of how strategy arches over every business decision you make, service you deliver and product that you make.
  • Knowledge of where your specific competitive advantage lies and how to maximise it.
  • Ideas galore to transfer to your business plan to ensure your strategic intent is reflected in your activities and outcome measures.
  • Examples of implementing strategy in your finance, HR, team building and leadership activities.
  • Finally, a renewed enthusiasm for your business and your ability to actively manage it to success.

Is all that possible in one day? Probably not, but you have to start somewhere.

Check the list of events at www.redsok.com to see where and when Remarkable Strategy is next hosted.

The Numbers That Count – what happens next?

EOFY – End of Financial Year – a time for checking how your practice is traveling. The one time per year (for most of us) when we take an interest in the financial numbers of our business.

No longer a physical transfer, we deliver the electronic shoe box of invoices, bank statements, receipts, petty cash vouchers to our accountant where the alchemy occurs and columns of figures are produced which will mystically reveal our financial situation.

Well sort of.

Typically the financial reports will include a profit and loss statement, a balance sheet and a cash flow statement. These will form the basis for your company and personal taxation reports. Sadly they won’t tell you much about your financial future or the likely state of your business in three, six or twelve months.

The balance sheet will tell you about your debts and assets including cash holdings. The profit and loss will tell you how you arrived at this position, and the cash flow statement will inform you as whether you can afford to service your debts and finance your business growth. Or not. Mind you, most of as are only interested in the final number – how much tax is due and where can we find the cash we have allegedly accumulated to pay it.

These reports are historical in nature and necessary for financial compliance. However other numbers will be more useful for business planning and stability.

There are some numbers hidden in your business data that may be more accurate lead indicators of future business growth than these financial compliance reports. You probably already record these numbers but may not be giving them the credit they deserve. And thus not allocating resources toward developing them.

For about five years I tried to measure as many variables in my physio practice as possible (much to the frustration of my long suffering staff). I measured attendance figures, referral patterns, satisfaction scores, cash flows, conversion rates, re-booking rates, medical record compliance, appointment saturation rates, work in progress indices plus many, many more. And then I looked for links, congruence and patterns. I analysed the raw scores and then indexed various scores against each other to search for hidden relationships. This search had a few goals but one was to identify key numbers that would predict ongoing work levels and thus cash flow and business growth.

I wish I could tell you I found a complex equation that I have trade marked and will sell you. But is was much simpler than that. And being a good bloke I am happy to save you five years of analysis and tell you the two of the critical numbers that best predicted how busy our clinic would be in the next three months or so. Not a long lead time, but it was a start.

Two simple numbers, easy to find, that correlated positively with appointment saturation rate and cash flow several months later.

It must be pointed out that for one of these numbers to operate as a lead indicator there is a condition to be met: the current number of treatments per episode of care must not decrease. Or if you are not in that type of industry, the current spend per customer encounter must not decrease.

So the two numbers:  here is the big reveal –

Firstly – the breadth of referrers. The more sources of new client/customer/patient referral on a consistent basis the more likely new work will continue to arrive. For most of us word of mouth referrals from satisfied clients is the best source and thus it is a constant for all practices and disregarded. But what about all the other sources of referrals? Not just medical but all sources. The more of these that are active the better your business is insulated from variations in any one or two of them. In other words, the less reliant you are on any single source. To qualify as a referrer the source must contribute at least two new clients per month.

Secondly – the number of new episodes of care commenced each week. These can be either new clients or previous clients returning for a different or recurring problem. This number depends on the number of clinicians in the clinic and you need to determine it for your own situation. As an example, when I had four physio and one massage therapy providers this number was 26 new episodes per week. Fewer than this number for a couple of weeks would result in a down turn in work about five or six weeks later. Knowing this gave me few weeks to crank up our internal marketing, ensure letters to referrers were up to date, put out a topical e-newsletter, review our return rates, remind staff of their KPIs in this area, schedule time off for me or one of the other physios in four weeks or so, or some other intervention that might arrest the decay or utilise the down-time.

These are just two of several really valuable numbers to monitor in your business. I share others in my various Practitioner Business Academy workshops but for the moment you have enough to work with.

All the best in your prosperity,

A/Prof. Craig Allingham APAM, MBA
Director, Practitioner Business Academy

The Dangerous New Person on the Team

You’ve done it. You have seen the need for more talent in your team. You have taken the bold step of advertising or letting people know you are hiring. You have screened, interviewed, interviewed again, worried, calculated, negotiated a remuneration package and agreed on a start date. All done.

Except for the ticking time bomb that is the new hire.

For the past few weeks you have been focusing on your candidate. Now you are focused on the orientation process and setting up the workplace for the new person. Admin are sorting the payroll and appointment lists, other clinicians are making space in the office and fridge and some are having to reschedule their hours to fit around the hew hire.

Day One: orientation, light work load, problem solving and hovering by you (rightly) with all the attention on the new arrival. Introducing them to clients, referrers, work mates, baristas and other essential components of the business.  You monitor and provide feedback on a daily basis helping them get used to the way things are done around here. They feel special, important and vital to the enterprise.

Meanwhile your troops on the ground are curious, concerned and perhaps a little worried. They may welcome the additional help but it might also challenge their professional and personal comfort.

Change is generally uncomfortable, especially a change over which we have little influence. I remember being a young physio in a hospital department when a new hire arrived full of confidence, skills, post-grad training and I realised my place in the pecking order was up for resetting. It all worked out easily as the new physio was happy to acknowledge my ‘seniority’ and share her knowledge freely. But it doesn’t always work like this. I have seen situations where the new hire imposes his or her presence on the new workplace with little regard for other clinicians or admin staff, perhaps as an overcompensation for their own apprehension (in which case it can be down-trained) or just a personality trait reinforced by their recent success of getting the new job (harder to reconcile).

While you are busy with on-boarding the new hire, your existing staff are looking for signals of their status in the new line up. As many of them are human all it takes is some mindfulness on your part to include them in the bedding down process and reassure them publicly of their ongoing value.

  • As you introduce existing staff to the new hire, reinforce their importance and unique contribution to the clinic. Don’t be vague, be very specific regarding their special skills whether they be phone conversions, ability to sell products, consistent rebooking of clients, go-to person for difficult cases or whatever.
  • When finding physical or diary space for the new hire, try not to displace anyone else without them being part of the decision.
  • I find it useful to have a new clinician to spend an hour or so watching and listening at the reception desk to learn how complex and demanding this work-space is and also how things are done around here.
  • Utilise relevant skills in existing staff when on-boarding the new hire. Share the load and show how much you trust the team you already have in place.
  • In the first staff meeting after the new hire starts, be sure to recognise other staff members for their work rather than focus only on welcoming the newbie.

Exciting times – a new staff member bringing new competencies and increased capacity. Don’t mess it up. No point welcoming one and alienating others.

Men’s Health Tip for Health Professionals

Communication

As a health professional there are two singularities when working with men that amuse and concern me. The first is their ability to understand all the good health messages (exercise, nutrition, sleep, etc) and the risks associated with non-compliance yet continue to engage in a fierce campaign of non-compliance. The second is their concept of what exactly comprises being healthy.

Taking the second one first, it seems to me that for a bloke, being healthy is simply the absence of death. As long as he can function in his life to some degree he sees himself as ‘in good health’. As demonstrated by the first response to the standard clinical interview question, ‘and how is your general health?’, to which he inevitably replies, ‘pretty good’. Only to reveal later (once rapport and confidence have been established) that he has type II diabetes, high blood pressure, sleep apnoea, two coronary bypasses, kidney disease and an unexplained tremor on movement. None of which have anything to do with health in his mind because he is still walking, breathing and working. The message for us is – don’t believe him! Dig deeper on health matters and try to get him to see how his current state is the end-game of his lifestyle decisions.

Back to the first issue on non-compliance. This is a second defense mechanism deployed by his male ego filter which may acknowledge at a cognitive level the links between lifestyle decisions and the prevalence of non-communicable diseases but seeks comfort in the fact that this only applies to other men. Every bloke believes he is outlying data – the exception, the maverick, the hero. Compliance is for those other men who are at risk, and as ‘I am not at risk I have no need to change my attitudes, thoughts and behaviours’. This is the blank canvas upon which we try to paint a treatment plan. Until the man acknowledges his risk he is not able to make vital changes. Note: acknowledges risk, not just understands it. Sometimes our job may include scaring the invincibility out of them to over-ride the ego filter defense. For example you could try this, ‘I had another client like you who did well for a while then it all went belly-up and his stroke left him totally disabled. If only he had done the exercises…….’. This line is best delivered while gazing into the distance over the client’s shoulder and gently shaking your head. Then pause, and make eye contact until he looks away.

The Huddle

American sports utilise the Huddle extensively: the action is interrupted by meetings of the participants to review and implement strategy. For example, in basketball there is the time out and in American football the quarterback calls a huddle pretty much before every play. In golf the player and caddie huddle all over the course. The business Huddle is an extension of this concept.

Key Points for Effective Huddles in the workplace:

  • Meetings are short, no more than 15 mins
  • Stand, don’t sit
  • Timing is up to you – first thing, or later in the morning when all are in. eg. 11.45am
  • Huddle is high priority
  • Everyone must speak. Who first? Vary it.
  • It is not an interrogation – it is a communication tool
  • Honesty is critical
  • Stick to facts not opinions
  • Huddle time is NOT for problem solving. Identifying yes, but not for solving
  • What to share:
  • Project updates
  • Client updates
  • Wins – celebrated
  • Roadblocks
  • Individual priorities for the day
  • What you achieved yesterday
  • Review couple of team or company metrics

 Not all these are part of every huddle, but the list provides examples to get it flowing

  • Problems identified are flagged for follow up meetings
  • Discussions are shut down – this is reporting only
  • Off site team members can join via skype – as it is NOT a discussion they can make their contribution and also hear from others

How do you know if Huddling is working for you? (Give it six months at least):

  • Your KPI metrics will improve: check them
  • Your team awareness of strategy and projects and how they fit together will improve
  • Your leadership will improve as you have a clearer grasp of all the elements
  • Stuff gets done on time, accurately and profitably

Post Holiday Desk

How did you feel arriving back to your work desk after the holiday break? Did the sight of it fill you with excitement for a clean start for 2016? Or were you confronted by the unfinished work of last year?

Client files waiting for discharge notes, letters to stakeholders, follow up calls, reports to insurers or a half completed file waiting for the most recent client encounter to be documented with all the accuracy a ten day break can generate.

I wise mentor once described to me the presence of ‘heart sink’ patients. These are the clients who when you see their name on the day list your heart sinks. I believe you can get the same lack of joy from a desk littered with unfinished and non-prioritised tasks.

To ensure you begin every year, month and week in a better frame of mind and clarity of purpose try this one sneaky trick – complete the paperwork as you work with the client. Simple but difficult, especially if your habit is to make cursory notes and fill in the details later. If you are an employee you are probably donating your private (unpaid) time to get this done. If you own the business you most certainly will be donating time that does not generate income. Neither is acceptable nor necessary.

For the details, I refer you to a post from 2010 (yes, you could have been doing it better for five years). Click here for a short read that may gain you up to an extra one hour per working day.

5 Hints for Successfully Managing People

Human Resource Management evolved from personnel departments which were previously called common sense. However the gradual  disappearance of common sense from modern life has allowed a new professional body to arise who are experts in managing humans for improved performance.

My experience working at the pointy end of sports science and medicine for twenty years brought me into contact with coaches who are masters of this dark art and other who were technically skilled in their sport but could not bring it out in their teams or athletes.

So in an effort to short cut your learning process in Human Resource (people) management here are five key points to take on board.

  1. People generally don’t or won’t manage themselves. Never assume because a person (employee, partner, contractor, patient, referrer) is intelligent, conscious and cooperative that they will manage their efforts in any way to your advantage.  You will need to provide a structure and systems to ensure their performance is contributing to your goals as well as their own.
  2. Hire attitude over talent. It is much easier to teach skills than it is to teach personality. When looking for staff be very clear on the skills you are seeking and once the base line for those has been met turn your attention to which remaining candidate possesses the right balance of values, aptitude, attitude and capacity to deliver within your organisation.
  3. People don’t leave jobs, they leave people. The most common reason for loss of quality staff (the only ones you will miss) is some conflict or discomfort in the workplace. It may be a workmate or it might be you. Recognise the problem and if you can’t change the dynamic to the advantage of both parties one of them will leave. Be very clear who you want to keep and why.
  4. Workers contribute to their maximum when they feel valued. Not when they are valued, but when they FEEL valued. If the first acknowledgement of value appears in an employees departing reference it is way too late. Shame on you. Take the greatest care not to be so busy with your own tasks and roles such that you don’t see and remark on the ordinary efforts your team puts in day after day. And if there is an extra-ordinary effort CELEBRATE it in front of everyone.
  5. Money is rarely the strongest motivator for improved performance. There is no doubt money is important as we all need to meet our obligations, but  beyond a certain level more money won’t create engaged, motivated and high performance employees. A fair compensation package will bring adequate performance, but add some of Number 4 (above) and you will see a greater return from your human resources (people).

Across all professional disciplines that I have worked with (allied health, legal, finance, personal care) the common woe is how to manage the people in their business. How to recruit, train, manage, engage and dismiss the right people to ensure the business grows and the day to day worries are reduced. This is not easy, and it is not a skill business owners are trained in. But if you are interested in improving this area of your business I believe you will get great value from my workshop on herding cats. To find out if this workshop is scheduled soon go to www.redsok.com and check out the upcoming events column.

Strategic Learning – Do You Have a PD Plan?

I recall in my early days of practicing, I pretty much did every PD course available. Which was not difficult and probably only took three or four weekends per year. My how times have changed, you could fill every weekend now if you set your mind to it.

We are spoiled for choice with a huge range of professional development opportunities advertised every month. So how do we select what is most appropriate for each of us?

Do you go for new topics? Or base your selection on the presenter? Are some topics fashionable (think dry needling or fascial planes)? Each course involves significant outlay in terms of cash, time and energy so it makes sense to select wisely.

Your workmates or employers can offer guidance based on your current role or aspirations, but it is based on their opinion of what you need or what you can bring to the workplace. But is it the right fit for you?

Strategic Learning is a practice of aligning your professional development with a longer term strategy of where you want your career to go. Or at least to give you the tools to respond to career opportunities that may arise.

To be strategic, you must first have a strategy. To have a strategy you must have some overarching idea of where you and your career are going. The old ‘where do you see yourself in five years’ type of exercise. Or ten years. This is a difficult exercise to do on your own without input and challenging from a trusted mentor or panel of advisers.

I like the option of reverse engineering a strategy by starting with the end in mind, asking ‘What would be my ideal job at the time of my retirerement?’ and back track a strategic course from that end point. Like any good strategy it can be modified and adapted as the career landscape changes.

Once you have developed your strategy you can then evaluate PD opportunities based on how they align with your path. Do they add knowledge, skills, networks, contacts or connections to advance your strategy? When you see an event advertised ask yourself these three questions:

  1.     Will this event contribute toward my long term professional pathway?
  2.     Will this event deliver skills to improve my understanding or performance in my current role?
  3.     Will this event enrich me as a person?

The event should get at least one tick, if it gets more than one it is starting to look like a good investment. Three ticks and it is a ‘must do’. If you are not certain from the advertisement you should contact the provider and seek further specific information to make a considered choice.

Still going ahead? Great, now there are two more questions –

  1.     Can I afford to attend?
  2.     Can I afford NOT to attend?

The first one relates to resources (money, time, logistics) and is a totally practical decision. The second is a more important consideration in terms of the cost of not pursuing your strategy. If you have a strategy and the event is well aligned you are retarding your plans if you don’t attend.

As a provider of professional development I have a vested interest in you as a potential client. In my experience the best teaching happens when the learner is truly engaged in the topic, the process and the long term outcomes of the knowledge exchange.

Think carefully when evaluating PD options. Understand your long term strategy not just short term needs. Plan your learning to align with where you want to arrive rather than where you starting from and you won’t go far wrong.

How do Clients Judge You?

One of the best feelings in our work is when a new patient answers the question, ‘Why have you come to see me?’ with ‘Because I was told you are the best’. This has two great benefits, firstly my ego gets a stroke (although my wife may suggest this is neither a benefit nor necessary), secondly it indicates the patient is more likely do well with my treatment because they already expect to do well.

However it begs a second question of the patient: ‘Best at what?’  A question I was never brave enough to ask for quite some time (or subconsciously avoided to preserve the ego stroke), and when I started to ask the answers were sometimes unexpected.

It appears I was ‘best’ at each of the following for various patients who then found it useful to tell others:

  • attractive staff
  • running on time
  • privacy of treatment room
  • worked at the Olympics
  • warming the ultrasound gel
  • variety of gym gadgets
  • getting a result
  • interesting memorabilia display
  • no stairs
  • explaining the treatment program
  • availability of parking
  • excellent coffee shop next door

Shock and horror!  Many of my ‘recommendations’ had absolutely nothing to do with my professional expertise or competence and everything to do with the ambience, convenience, consideration, accessibility and neighbours of the business.

It appears that patients use a different yardstick to judge (and thus recommend or pillory) health practitioners than we use to judge each other. I am impressed with colleagues who have mastery of theory, knowledge and techniques whereas patients judge us on their experience rather than ours.

Of course they do. How could they do otherwise? Our clients rarely have an understanding of the treatment evidence base or current trends in health care for specific conditions. So they judge us on what they do understand: customer service, respect, honesty, integrity, fairness, cleanliness, hygiene, eye contact, manual contact, tolerance, value and coffee.

A quick search of the literature  shows a vast array of complex assessment tools to evaluate ‘quality’ of patient care. Almost all give a strong weighting to the outcome of care – was the goal achieved? Yet patient satisfaction is not the same as patient outcome. Nor is it the same as the patient experience. It appears clients can be very satisfied despite a poor outcome provided the experience was positive, supportive and client centred.

The sensory environment has also been studied with factors such as music, aroma, air quality, furnishings and layout being assessed in relation to hospital patient outcomes. As yet the quality of studies lacks rigor (link to Cochrane Library).

The American Medical Association states that ‘patient-centered communication is key to quality care’ and not only reduces errors but also can ‘achieve better health outcomes’ (link).

In another article, Dr Oliver Kharraz identifies the relationship (likeableness) of the practitioner as a significant factor in whether the client will follow the advice provided (program adherence).

I think this is more critical for practitioners who provide a process as opposed to providing an event. Let me explain, the concept of selling goods versus services is well understood. However I believe in medical care the service can be further divided into those that are events and those that are processes.

Events include vaccinations, surgery, provision of an appliance (orthosis, plaster cast, etc), completing a procedure (dental filling or extraction, blood test, endoscopy, etc). Each of these has a clear end point and a yes or no outcome.  Did it happen or did it not?

Processes include weight loss programs, blood glucose management, neurological rehabilitation, soft tissue recovery, fitness programs, aged care and so on. These tend not to have a clear start/finish cycle but are more elastic and depend on patient adherence for desired outcomes.

Physiotherapists are process therapists. Most of our clients require more than one session as we build their programs and progress them through the recovery. Spinal manipulation for mechanical displacements (wry neck, facet subluxations) are the exception and practitioners who work solely in this area are (I suspect) judged on immediate outcomes as a result of the manipulative event.

So what is the take home message here?  Simply this, as we are a process profession, we need to make sure the process is very, very good. We cannot rely on them feeling ‘cured’ each time they attend (a great event when it happens). Our science based treatments take time and adherence to have their therapeutic effect and it is the elements of process that enable sufficient exposure to the therapist for the treatment to make a difference.

Patients will recommend you based on the process of you delivering the treatment. So take some time to evaluate the patient experience in your business – from referral to discharge. Every single, seemingly insignificant element of the patient journey is important to the patient experience. Ask them what you are doing well and what you could improve on. Put aside your professional ego and listen closely.

Is it Possible to Overservice a Private Client?

This was a question posed to me by a participant at a business workshop and my immediate response was, ‘Good Question’. This is a time honoured strategy to gain time to formulate a considered answer thus avoiding saying something like, ‘You wish,’ or ‘How do you mean?’

If a considered answer still remains elusive, the second strategy is to ask the questioner to clarify the question. Eventually however I had to respond.

Who decides if a client has been over-serviced?  The health professional or the client?  In the case where a third party is paying for the treatments, it is often that party making the call of ‘enough already’. But what about when the client is paying for their own treatment? Who decides when enough treatment is enough?

I am sure we have all had clients that proved difficult to discharge. Everytime we got close there was a relapse or new problem that necessitated extending the treatment plan. Then there are those patients with chronic, degenerative conditions that are never going to be cured. How many sessions are sufficient for a condition that is always going to need management?

And what is overservicing? Too many sessions over a short period of time? Or too many over a long period? When (if ever) do you say to a client, ‘That’s all. No more treatment for you’, even though they are prepared to pay for further sessions?

What if it wasn’t a medical service, let’s say I really love a particular restaurant or cafe and frequent it several times per week. Are they over-servicing me? Or am I simplyl meeting a need, paying a price and receiving what I consider to be fair value?

Does a cinema refuse admission if you have already seen the movie twice? Does your butcher say ‘No more, you have eaten enough meat already this week’? I don’t think so.

Are these purchases that meet needs such has hunger and relief of boredom any more or less valid than purchasing a service that fills a different need and does so at a price that represents good value?

The evidence-base theory of treatment would place this decision on the practitioner, who has the knowledge of what further benefits are likely with ongoing treatment. When the benefits dwindle, according to the evidence, we must then discontinue treatment lest we be operating fraudulently.

The customer focused practitioner would have access to the same evidence base, and upon reaching a point of diminishing returns would ask the client if they were receiving sufficient ongoing benefit to justify the ongoing cost. Perhaps the evidence isn’t measuring all the benefits that the client is perceiving, and even though the condition is no longer improving the process of treatment is meeting some other as yet unmeasured need.

Ah, if only it was that simple: if the client believes it is helping then it can’t be over servicing. Now into play comes the gray areas of fully informed consent, unequal power relationships, the concept of ‘the expert’, and self interest.

Continuing to offer treatment based on authority, fear, dependence, self-interest or mis-information is unethical and unprofessional.

Continuing to deliver treatment at the request of a fee paying client where clear professional boundaries are respected, full information about the limits of treatment are explained and acknowledged and where the client has the power to regulate and/or cease at any time can, in my mind, be optimal servicing.

At all times the benefit equation must fall on the side of the client. Repeated questioning regarding the perceived benefits of ongoing treatment, benefits that can be described in a logical, rational manner rather than emotional (I just like coming here), should ensure the level of service represents a value proposition for the client.

Alongside that process should be regular reviews where the practitioner and client document the treatment plan for the upcoming period and identify where the benefits are likely to appear.

The final test: if you can’t explain to a professional colleague why the client is attending, they probably shouldn’t be.