Value In Practice – new workshop for health professionals

Your business is based on value. The giving of value to clients, referrers and other stakeholders, and the receiving of fair value in return.

Value In Practice is a three hour workshop looking at three aspects of Value In Practice, they are:

Valuing your service and putting an appropriate price on it.  What do you charge and why? How do you calculate your fair value and are you prepared to ask for it? You will use your data to determine what you should be charging in return for the value you provide.

Valuing your business. I am often asked to help value a physiotherapy business with a view to selling all or part of it. It is much easier for me, as I have no emotional attachment to the staff, patients, referrers or the business itself. Without the ‘baggage’ it becomes a simple mathematical exercise. We will look at a few options.

Adding value to stakeholders is vital to grow your business. Not just for clients but also for employees, referrers your community and profession. We will workshop value adding strategies to give you practical, low cost, take-home ideas to implement in your practice. Including the secret of what every new client must understand in order to guide their decision to continue with you or not.

This workshop is scheduled in Australia and overseas – Cities, dates, fees and registration links are listed below. Click through if you want to attend.

You will receive not only the three hour session, but also a course workbook, spreadsheets for ongoing business analysis and maybe a coffee.

Melbourne, May 1, 2014.  $330 course fee, starts in Greensborough at 6,30pm, finished by 9.30pm.  Click for more

Sydney, May 13, 2014. $330 course fee, starts in Camperdown at 7pm, finished by 10pm. Click for more

Marlborough, Wiltshire, UK, June 3, 2014. £50 course fee, starts at 6.30pm, finished by 9.30pm. Click for more

Dublin, Ireland, June 13, 2014. €130 course fee. Starts at 2pm, finished by 5pm (Friday). Click for more

Perth, June 21 2014. $330 course fee. Starts at 9am, finished by noon (Saturday). Click for more

Why do they leave? This is a good place to work.

I was chatting with a respected, long term physio colleague recently and he pinned me with the question, ‘How long do you expect physios to stay?’ Meaning, what is a realistic expectation for professional staff turnover? I asked him some further questions and it seemed a more common problem with recent graduates (one, two or three years out of uni) and he told me he does exit interviews.

‘What do they reveal?, I asked. He indicated some move onto formal post-graduate study which necessitates leaving the area but the others seem to feel they have exhausted their learning opportunities at the current practice. One departing employee said, ‘I feel like I have learned all I can here, and need to move on.’  One reason she can move on easily is she had no ties to bind her geographically: no partner with a job nearby, no children in school or other family nearby.

We observed that recruiting staff a little further along their life journey provides some of these anchoring factors that aid retention, perhaps up to around 5 years as opposed to the 1-2 year expectation for the more recent graduates. I guess I felt that the curiosity and mobility of youth was a fact of life, probably not limited to physiotherapy and resiled myself to it being an unalterable tenet.

However, on further reflection this may not be the case, at least in all cases. Over the first year or so of being employed by an experienced colleague there is a steady knowledge transfer from senior to junior. This tends to be intense at first and gradually tapers as the lessons are passed on. There may reach a point of equilibrium where the teacher runs out of new material and the learner has the skills and knowledge close to that of the teacher; and being hungry for more, starts to look elsewhere.

What can be done to encourage a longer tenure in such a situation? Perhaps we need to be counter-intuitive and reverse the roles somewhat, helping the learner become the teacher and the teacher open their mind to the learner.

Lovely words – what does it mean?  I distinctly recall having talented employees who could have taught me much but my ego and inflexibility blinded me to this opportunity. They were ready and able to teach, but I was unready or unwilling to learn.

Developing talent is a wasted process if 0nce developed it is not deployed where it can make the greatest contribution. In our mini-case-study, what may have eventuated if the physiotherapist who had filled her learning quota had been asked to take over the development of staff for a year or so? Including the principal. Not by re-teaching the same stuff, but by adding from her unique knowledge and experience base, by bringing in new information to the organisation, by developing leadership and development skills in her role and by being rewarded for this contribution.

Sure, she may still leave even after this extension of her role (and tenure), but she would be leaving a more enriched organisation behind and leave as a more accomplished practitioner and employee. She would also have contributed to the training of those who followed her.

As employers we often see how much we give to our teams and resent any feelings of not being repaid by output, loyalty or even simple thanks. Step back, stop giving for a while, and ask what you might receive if you realised everyone has something to teach. Have you ever asked your reception staff how they ‘read’ clients?  Asked them to explain how they manage to multitask with phones, computers, people, money, files, letters, reports and the rest? Or asked your cleaning staff how they know when they have done a good job? Or your professional staff what skills and knowledge they may have that can be adding value to the organisational goals or client outcomes? In order, these represent customer service skills, time/task management skills, self-managing team skills and self-knowledge/development skills.

The answers to such questions may surprise you (as much as being asked may surprise them!) and potentially restless staff may even stick around to see if you have learned anything from them and are prepared to put it into practice. Who knows, you may discover your eventual replacement and they may discover a career path.

 

Workplace Dynamics – organisational behaviour

Managing Organisational Behaviour

One of the great privileges of owning your own business is you get to decide who you work alongside. You have the right and responsibility to select the people with whom you will spend huge amount of your time. And every time you make a change by removing, adding or replacing a team member you are altering the dynamic mix of the whole organisation.

There is a theory (social constructionist) that states an organisation does not exist per se, but is merely a manifestation of the relationships within the structure. When the relationships are positive and productive, so is the organisation. When the relationships are soured by greed, power plays, malice, bullying or perceived inequity (just to name a few examples), the organisation is weakened.

Selecting team members is critical to achieving your organisational outcomes whether they are measured in dollars or quality of service (and these two are most often linked). Putting a new human into the existing team introduces a variable to what may have been a stable situation. A candidate’s resume and interview presentation is no predictor of the social interactions that will follow an appointment.

The question is, to what extent can organisational behaviour be managed? And secondly, what might be a useful strategy to accomplish this?

The responses are – Yes it can be managed and re-framing may be a simple strategy for your business.

Bolman and Deal (1991) expanded on Senge’s initial work of reframing organisations enabling the dynamics of a team to be viewed through more than one perspective or filter. Each of us has a preferred way of viewing the world, some of us (like me) take a structural view, others are more in tune with relationships and are often descibed as ‘a people person’. Others may operate in the political frame pursuing their own best interests,  and the fourth frame is the cultural one concerned with vision, stories and symbols. It appears that if you use your preferred frame to analyse and guide your team you may be filtering out up to three other ways in which your team members contribute or complicate the organisation. Being a structural sort of bloke, I am really good on systems, analysis, measurement, organisational charts, reporting lines, hierarchy and so on. But less attuned to office politics (power), the pull of the past (culture) and relationships (human resource frame).

Bolman & Deal’s Four Frame Model

Structural

Rules

Goals

Policy

Task allocation

Technology

Roles

 

Political

Power

Conflict

Competition

Allocation of resources

Control of agenda

Human Resource

Relationships

Needs

Skills

Empowerment

Alignment

 

Cultural

Meaning

Rituals

Stories

Heroes

Inspiration

 

To fully understand what is happening in my business I need to consciously remove my structural analysis glasses, and don each of the other three filters in turn to complete a full diagnostic of each person, unit or the entire organisation. It is not easy, and requires self-understanding and discipline on behalf of the leader.

What are the benefits of such an analysis in a small business team; what might make the effort worthwhile?  Here is a story from my own experience – I engaged a new staff member as a clinician and she was quite talented in her field. She understood our organisational hierarchy and goals (structure) but operated chiefly in the political frame where she cultivated power over other staff members and influence beyond the organisation. Relationships were tools to be used as she increased her political position and the organisational culture and vision was irrelevant.  As a clinician she was effective with her clients, but her divisive strategies were undermining the capacity of the organisation to pursue our objectives. The performance of other staff members deteriorated and the necessary cooperation between divisions became difficult then impossible.

Analysed from a purely structural frame, which suited me fine, she was doing well – meeting targets, getting good client feedback, completing records accurately, etc. But when I approached her performance review from each of the other three frames her true organisational misbehaviour became apparent. By altering some of her key performance indicators to include elements from the human resource frame and the culture frame I could then measure her true contribution. Subsequent education and counselling proved fruitless and after repeated failure to meet her KPIs I ‘freed up her future’ by letting her go. I think I heard a collective sigh from the rest of the team….

For more information, any of the writings of Bolman and Deal will be most helpful.

Healthy is the new Safety

While giving a presentation last week as part of National Men’s Health Week, it occurred to me there were parallels between safety culture in the workplace and the strategies of healthful living. I wonder if my men’s health education work would be more ‘sticky’ if I pursued this line of thought by helping men to adopt the safety cultures they are immersed in at work as a tool for managing their physical and mental health more effectively.

For example, the concept of ‘procedural drift’, the phenomenon of  what happens when nothing happens. Detailed industrial safety protocols provide guidance to avoid injury and death, and are usually followed to the letter when commencing a new task or process.  However, with time the workers may start to take some shortcuts in the interest of perceived efficiency (or laziness), safe in the knowledge that no injury or death has befallen them. They start to drift from the procedures as written.  This can be minimised by regular safety audits and training. But humans being human, and the laws of entropy, suggest the drift will start again.

Here is an example from agriculture. A primary producer I know told me when he started working with a particular chemical he followed all the recommended safety procedures when transferring the chemical from drum to dispenser.  He gloved, masked, used a well ventilated space and had a hose handy for any spillage. With time, however, the mask, gloves and hose were gradually dispensed with as he never had any problems… until. But that is another story.

Lifting technique is another example.  Following my workshops on manual handling, it is apparent the workers think and act differently when lifting. For a while. Then they tend to drift back to their previous habits because, well, nothing felt any different with the new procedures.  Interestingly, those workers with a history of back pain or injury tended to continue the new approach longer than those who had never experienced difficulty.

So back to men’s health behaviours. Whether it is dental checkups, nutritional advice, activity guidance, relaxation or mindfulness training, any fresh information or behaviours may well gradually morph back into previous habits because there is no observable short term benefit. Think about gym memberships – the reason for enrolling persists long beyond the regular attendances because no short benefit is seen.

Health outcomes are not short term benefits. Just as health failures (heart disease, cancer, kidney failure, lung disease) are long term outcomes of poor decision making; health improvement is a long term outcome of better decision making. Procedural drift makes it very difficult to experience the long term benefits of behaviour change because of the short cuts and failure to follow the program.

Regular audits and training in the form of check ups with your health professional, information or activities to reinforce the message and the benefits and maybe even utilising a health coach to keep an eye on you and hold you accountable (the personal equivalent of an Occupational Health & Safety Officer) will improve your chances of success.

All the best,

Craig Allingham
Sports Physio and Health Educator

PS: Just as nagging from your boss won’t improve your attitude toward safety procedures, nor will nagging from your life partner improve your attitude toward better health decisions and behaviour. Just saying, that’s all.

Speaking – Lessons from the School of Hard Audiences

I heard recently of a conference at which speakers were banned from using PowerPoint.  The reason given was to give speakers an opportunity to show their skills at, well, speaking. 

I got thinking about the difference between a speaker and a presenter. They are both legitimate roles and I have filled them both.  I have given keynote addresses to large audiences both with and without PowerPoint, depending on what I was attempting to accomplish in terms of an outcome. Some outcomes were best achieved with a story, others were enhanced by images and text alongside the spoken word.

On occasions I use a flip chart or white board and produce the visual aids in real time as the journey is taken. Is this different from using a prepared slide presentation? Of course – it is more agile and interactive, yet infinitely less entertaining given my limited artistic skills. Unless, of course, participants find my primitive art amusing.

But enough about me; what about you? Does your job or some other interest occasionally or frequently involve making a presentation to colleagues?  If so, let me offer several hints that I have learned from bitter experience.

  • Never drink alcohol before your gig. Especially if you are nervous. No good ever comes of this and if things go well there will be a chance to celebrate later.
  • If you are speaking after a meal, eat lightly, slowly and thoroughly.
  • If you use visual aids, ensure they are relevant and simple to understand.
  • Let the visual aids make you look good, not overpower you or your message.
  • Be cautious using charts or tables if the audience is not accustomed to them.
  • Three strong and related threads braided to arrive at the conclusion you have pre-determined are usually sufficient.
  • Don’t open with an apology, unless it is part of  the bigger story.
  • Never apologise for poor quality visual aids – you prepared them

That is plenty to consider at first.  Some other hints relate to trying to control your autonomic nervous system: breathe, relax, move, pause, think, make eye contact with someone and smile. Simple really.

 

 

 

Management by Stealth

I may be a little slow at times, but I reckon I have finally worked it out.  My wonderful wife Mary has for some time talked of us getting some chickens to produce quality home grown eggs.  Of course, I pointed out that we don’t have a chicken run, there are foxes around, we have a cat and lots of other practical implications to owning chickens. So nothing happened.

Until three months ago when Mary’s son Daniel arrived with two live chickens as her (belated) Mother’s Day present. He also provided some feed pellets and a grand wire and timber chicken hutch measuring one metre by not much. We were suddenly set.  Except the chickens needed to be let out of the hutch to forage, scratch about and poo everywhere. Immediately on release they headed for the roadside and on one occasion, yes here it comes…. the chicken crossed the road!  Why? I Don’t care – but luckily some passers by let us know and I retrieved them and back into the hutch.

I purchased some chicken wire and spent the next two weekends building the Taj Ma-hen of chicken runs: 4 X 3 metres, fully enclosed with chicken wire (fox proof) and complete with shade cloth for the summer months. We now have two more chickens thanks to Dan’s Christmas present for Mary!  Eggs galore.

For her birthday, he arrived with seven fruit trees to plant in our orchard.  What orchard? No orchard – we have talked about it and even decided where it might go when the time comes…..  The time has come.  Today I spent hours clearing long grass, digging out rocks and planning a watering system ready to plant these trees.  Another couple of sessions and it should be ready.

I see what is happening.  There is a complicity between mother and son to push projects that in her mind have stalled by bringing on the urgency factor.  The arrival of chickens or trees necessitates the project be accelerated to a whole new time frame, with no consultation with me. Just an expectation that it will now be done.  Brilliant system. And hardly surprising that it is driven by a middle child.

But I am on to it now, so don’t get ahead of yourself Maggie (other middle child). Mind you, knowing what is going on and beating the system are two different things.

Now, I wonder how I can utilise this principle into a management strategy in business….

Prevention is OK – if within budget

I was reading a very interesting article on Medscape this week which makes the point that preventative medicine is quite likely the only healthcare area in which cost is the prime driver.

Holding preventative medicine to a cost standard is something not practiced in disease care where a cure is the prime driver irrespective of price. Hence there are many government subsidised medical procedures, pharmaceuticals, screening programs and so on of questionable evidence base or cost/benefit value but are based in the disease care model so are less questioned.

Any suggestion of a preventative program is immediately costed and if not meeting budget targets, discarded. This may be a bit strong, but you get the idea.

I am reminded of a meeting I attended at the local private hospital some ten years ago where the Director was outlining their increase in medical specialists based at their brand spanking new specialist centre attached to the hospital. ‘Four cardiologists, two orthopaedic surgeons, two ENT, three physicians…’ and on he went proudly.

Later I sidled up and asked how many preventative medicine specialists they had recruited? He look at me incredulous and said ‘None, of course – they keep people out of hospital. We want doctors who admit patients.’ The business model of private hospitals is based on people getting ill or injured, and while they can’t actually promote this, they can certainly pave the way to their admission desk.

It makes you think.

Operational Breakdown

I recently picked up a brochure on relationship breakdown (planning to pass it to a mate who is going through some tough times) and took a moment to read it.

There was a list of  ’10 Sure Ways to Breakdown’ and I realised much of the list applies to managing people in the workplace.  So, borrowing from Shirley Cornish in Maroochydore, I offer the:

7 Sure Ways to Mismanage Your Staff

  1. Think ‘It’s my way, or no way’
  2. Blame or criticise the other
  3. Be intolerant or inflexible
  4. Behave in a hurtful manner
  5. React before you think
  6. Dismiss or oppose the others viewpoint
  7. Give up

These 7 items are pretty obvious when you read them now while your emotions and ego are in check.  Avoiding them in the heat of battle when dealing with situations or pe0ple is indicative of a strong leader. Managing others always begins with managing ourselves, this list might help you identify where to focus your improvements.

Health – Taking It For Granted

Once again I am reminded of how our personal productivity is determined by our energy and health status.  Just prior to boarding a long haul international flight home recently, I got an upper respiratory tract infection.  Almost forty hours of transit (complete with two delays) is not a tonic for recovery.  Once home I deteriorated further and it has taken another ten days to start to feel well again. 

During this time I tried to continue some level of productivity but both the quality and quantity were very ordinary.  Household chores, gardening duties, errands and shopping for food were all just too difficult.  Let alone any activity requiring brain power.  Sleep was poor quality and appetite was likewise.  The only plus was managing to lose about 2kg in body weight, but not a healthy strategy to achieve this.

Two take home messages for self:

  1. be more proactive in health management when my immune system is under threat due to stress (travel, sleep deprivation, poor nutrition, whatever);
  2. be more reactive in terms of recovery strategies (turn off computer and emails, give permission to sleep more, don’t deplete energy reserves and accept any help and advice from those around you).

Message for all of us:

  • make sure your personal productivity goals have inbuilt contingency or reserve capacity in case of illness or some other factor. Packing you schedule with expectations and tasks will result in a cascade of complications when things don’t go so well, let alone being one of the reasons you get crook in the first place!

Now, must make a recurring diary note to self about this idea as when you are well it just seems logical that you will continue to be well – a default state we tend to take for granted until fate intervenes.

Do Patients ‘Shop’ online?

When I first contemplated a website for my physiotherapy clinic around 6 or 7 years ago, I was yet to be convinced my potential clients would locate me using an impersonal, electronic, new-fangled gadget.   Much has changed, including my opinion.  Your web page is now the most powerful window into your business for current and future clients.  Let alone referrers and potential employees!

The website for a physio practice is a combined yellow pages ad, practice brochure (indicating hours, people, services, etc), geographical locator, health information site and shop front.  Or at least it could and should be all those things if you want to maximise the value to your business.

Perhaps the most important contribution of your web presence is the contribution to your brand.  The online image should be an authentic reinforcement of the brand of your practice.  Not the logo – the brand.  Those elements of your business that leave clients with a  feeling or emotion associated with doing business with you.  Feelings like ‘professional’, ‘ethical’, ‘trustworthy’, ‘safe’, ‘approachable’, ‘fun’, ‘friendly’ and so on.  If you business brand leaves clients feeling ‘neglected’, ‘unvalued’ or ‘doubtful’ you should probably work on those problems long before investing in a website.

Another valuable contribution is the reducing the fear of ‘the unknown’ for people who have heard of you or better still been recommended to see you but who may be anxious or apprehensive about seeing a physio for the first time.  Your web site can do much to allay their fears and replacing uncertainty with useful information (how they can pay, where they can park, what to wear) and confidence in your professional brand.

So, what should a physio practice website be made up of?  How complex should it be and what role should it play in your business? This will differ from practice to practice, but I believe one element is common to all – get some professional help with design, composition and content.  Being a fabulous physio doesn’t make you a top class web designer or techie.  Trust me, I tried and failed miserably until I put my ego to the side and let a professional take the lead.  Not only with my old clinic website, but also with my current business sites (www.redsok.com for example).

Possible contributions from your web site to business success include accurate descriptions of your team and the services they offer.  A chance to sell them as experts long before the client actually comes in the door.  Creating an expectation of quality is a good start.  You might include health information pages on common problems you treat, or an online store for the products you sell (clients can pre-purchase and simply pick up, or ask you to post it to them).  What ever you decide to include here is the golden rule: do it well and do it soon.  Become the site of choice for physiotherapy in your area and show your brand to the world. 

If you have a web helper already and are happy with them – stay on board.  If not, or if you are yet to start looking, can I suggest the company that helped us completely rejig our website, online store (international workshops and products), newsletter systems and database building.  A small and agile company with extensive design and construction experience in large corporate websites as well as small boutique clients.  Located in Hobart this company served us so well here in Queensland we actually transferred our whole site hosting to them from a much bigger national company who basically took us for granted.

DataFirst IT Services is run by Tim Allingham and we are working together now to provide a more complete service for physiotherapy clients who want a web site that is an extension of their clinical expertise and professionalism.  If you want to know more, click through to DataFirst IT and check out the ‘Site Options for Physios’ tab.