Survival of the Best Fit

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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

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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.

Are You Available?

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When I was running a busy physiotherapy clinic, carrying a full clincal load plus admin, plus preparing conference presentations, university lectures and researching/writing academic papers or book chapters my work days were pretty much full on.

A bit like the analogy of time management where you consider your day is an empty bucket and you ‘fill’ it with rocks (rocks are the big jobs).  Your day now looks full, but then you tip in some smaller pebbles (smaller jobs) which seek out the small gaps between the rocks.  Now your day is very full.  But if you pour in sand it will filter through the rocks and pebbles and fill the crevices with even smaller jobs – surely now your day is as  full as your bucket.  You wish.  If you now pour in water it will flow down between the rocks and pebbles, through the sand and fill all remaining microgaps until your bucket is now brim full of tasks, jobs, meetings and chores of all shapes and sizes.

Nothing else can now be fitted into your busy day.  You are operating at maximum time efficiency.  These were my typical days – patients (rocks), admin tasks (pebbles), reading, writing, preparing lessons, reviewing papers (sand and water).  Until one day my practice administrator mentioned that she often wanted to speak to me during the day, to bring important matters to me about our business, our employees or even just to chat but she didn’t because I seemed to always be so busy that her interruptions would not be welcome. 

My days were full.  But I was no longer operating with any measure of time efficiency.  Not if important things, including social contact, were unable to be accommodated. 

So I changed my attitude and freed some time for ‘soft meetings’.  I set aside 30 minutes a day when I would be in my office and welcome any visitors who had need of me for quadrant one or two activities – those that were important irrespective of urgency.  Sitting blankly for 30 minutes waiting for contact scared the bejillikers out of me, so I made sure I had a simple task to do that was easily halted and resumed as necessary.  I mastered the art of putting it aside as soon as someone arrived, leaving a blank desk space in front of me: simultaneously removing distractions and inviting interaction.

Team members now had both permission and opportunity to drop in and keep me informed, let me help or direct them, tell me about their weekend, check some procedural matters, say Hi, share information about their families, report progress on our projects and so on.  They loved it, more importantly I loved it.  Most importantly the business ran better and I noticed less interruptions during other times of my day as they knew they would receive my focussed attention during the soft meeting time.

However, even good ideas need tweaking……

I noticed after a while that people were coming in to my office anytime they noticed I was at my desk.  Perhaps interpretting my physical presence as permission to approach!  Despite a pile of paperwork and my frantic keyboard clicking.  Not wishing to undo any good will I might have engendered with the soft meeting system, I sought an answer in the management wisdom literature. 

One boss used a flag system on his desk to indicate his availability.  If the green flag was up he was 100% available (my soft meeting time); if the yellow flag was up staff were free to approach with caution (it better be important); if the red flag was up he was most definitely NOT available.  I didn’t have any flags but I did have a red cap in the office.

Company Policy #42 – If Craig is wearing his red cap he must not be interrupted for anything less than emergency evacuation for fire or flood.

Simple, effective but not stylish.

Quanto è Sicuro Il Cialis 100mg e quando non deve essere assunto, è sempre indispensabile ricorrere al parere di un medico specialista, che è dovuto al pieno afflusso di emicranie nella regione pelvica. I test medici non hanno rivelato anomalie causate da un uso regolare del farmaco. Per ottenere più portata nella loro efficacia e voluminosamente rapido assorbimento, anche presunta naturale.

Seven Deadly Sins

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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

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 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

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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

The Ultimate Time Saver in the Clinic

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Whether you are a physiotherapist, massage therapist, chiropractor or naturopath I have a foolproof system to gain you up to 30 minutes extra free time per day!  That’s two and half hours per week or almost an extra week per year!  An extra week to do the things you want to do.  To fill with whatever floats your boat.

This secret system is based on my long-term observation of practitioners filling a 20 minute, thirty minute or 60 minute consultation with, well consulting.  In other words using the full allocated time for an appointment to deliver the service.  Which is great value for the client but means the paperwork (record keeping, filing, phone calls, thank you letters, etc.) gets done after the client leaves.

In other words, you continue to work for the client after the client has left the building!  You use your own personal time to complete the outstanding client-related tasks that should be incorporated in the appointment time: the time your client is paying for you to work on their behalf.

Two issues here, firstly there is a legal obligation to complete medical or procedure records in a contemporaneous manner.  Meaning: at the time of delivery.  This maximises the chances of accuracy and adequacy in the eyes of the law, and gives you the best chance of delivering an effective program based on quality record keeping.
Second issue is theft: you are stealing time from you.  You are donating unpaid time to the business.  The habit in my profession is often to make basic notes or prompts at the time of the consultation and to complete the rest of the record when the working session is completed.  Instead of using that time to read a good book over lunch, to go home to loved ones, to go the beach for a surf or cycle home before dark.

To receive this extra bonus time in your life involves a simple shift in your procedures.  Whatever your appointment duration might be, complete the service delivery with a few minutes to spare and (this is really important) stay with the client as you complete their paperwork.  Tell them how important it is to document the intervention immediately and with great accuracy and this is in their best interest.  Sure they might chat on but you can nod and grunt as you write and finish with a great flourish.  You must ensure your work area has all you need on site to complete the paperwork because as soon as you leave the client they have no idea you are still working for them.  If you walk out at minute 26 of a thirty minute appointment they may feel short-changed or not valued.  Stay with them till done or time is up.

Now all you need to do is work out the best way to use this extra week per year in your best interest.