As physical therapists, we’re observant. We closely examine movements, attentively listen to patient complaints, and expertly read between the lines. Unfortunately, though, we don’t always give that level of attention to the non-clinical stuff. Because while we’re expert empathizers, we’re not the strongest scrutinizers. And when it comes to business, you need to scrupulously scrutinize.

I worked as a physical therapist for more than 15 years, and I spent a good portion of that time as a clinic director for a 3-location practice. In that time, I learned a lot about the importance of scrutiny—of working on my business rather than in it. Here are my top three lessons learned:

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1. Give people reasons for change; share results to validate efforts.

We had rock-solid patient satisfaction ratings, and yet, our cancellation and no-show rates were not so hot (hovering around 87%). So, we added a checkout step—which required patients to stop by the front desk before leaving—to our patient visit workflow. This gave our administrative team the opportunity to review future appointments, book additional sessions if needed, and distribute reminder cards to patients. In addition to deploying these no-show-deterring tactics, staff were able to capture missed copayments, receive payment for any supplies, and collect patient satisfaction surveys.

Sounds like a no-brainer part of daily clinic operations, right? Unfortunately, change is hard, and we experienced resistance. The staff didn’t want to walk patients to the checkout counter, because it required extra time. We had to do a lot of coaching and explain precisely why the checkout step was necessary and what goals we were trying to achieve. Slowly but surely, our therapists got used to this step and started following through on it consistently. And boy, did we see improvement. Not only did our cancellation and no-show rates decrease, but our collections rate also improved.

Those improvements didn’t last long, though, because eventually, our therapists began shirking on their role in the checkout process: walking their patients to the counter. Why? Because while we as leaders saw that it was working, we weren’t sharing those results—that proof of success—with the rest of the team. And when it comes to change management, inclusion is everything. So, if you institute change in your practice—and you rally your team behind that change—make sure you include them in the wins. It validates their efforts, justifies your change, and fosters continuity.

2. Make everyone a marketer.

After last year’s Ascend business summit, we surveyed attendees, and they shared that one aspect of business they want way more training on is marketing. I felt the same way during my tenure as clinic director. A lot of PTs think the solution to their marketing woes is to hire a marketing person. We did that; we hired someone to go out and promote our clinic. That person’s main job was to acquire new referral sources and nurture top existing ones. While we saw some results from those efforts, we recognized pretty quickly that we achieved better results when our therapists built relationships with referral sources rather than a marketer with no clinical background. Plus, it allowed our therapists to establish that personal connection and understand the intricacies of that physician’s preferences. Furthermore, it gave our therapists a sense of accountability and ownership of their own schedules. For example, if I wanted to see more ACL reconstruction patients, then I needed to work to get those on my schedule.  

Then, we discovered email marketing software, which enabled us to automate a lot of our outreach efforts and empower our therapists to solicit referrals from their patients. Now, our clinics were part of a larger corporation, so we had a headquarters assisting us with content development, which helped tremendously. But between our therapists’ efforts to network with referring providers and encourage their patients to refer friends and family and our overall clinic effort to leverage the power of email outreach, we really didn’t need a marketing person. But, what about the person who handled our email marketing? We actually were able to keep that job “in the family”: one of our tech-savvy senior billers happily volunteered to manage our contact list and build and send our marketing emails. Lesson learned here: You don’t need a marketing person to do marketing, but you do need your entire team to believe in marketing and rally behind your efforts. If our therapists hadn’t been on board with relationship marketing—and if we hadn’t had a biller willing to run our software—then we probably would’ve kept plugging along with our status quo system. And chances are, we wouldn’t have seen the uptick in referrals that we did. Nowadays, clinics of all sizes can streamline the email outreach process even more—and use it to create an even bigger impact—by leveraging patient relationship management (PRM) software like WebPT Reach. These tools help practices not only stay in touch with current and former patients, but also identify happy, loyal patients and then automatically reach out to them to request online reviews—thus bolstering a particular practice's online reputation and presence.  

3. Never discount the value of a proper plan.

I oversaw multiple sports medicine clinics, so we had several athletic trainers on staff. One time, we had what we thought was a brilliant idea: contract with local high schools to supply onsite athletic trainers. When the trainers weren’t in the schools, they’d work in the clinic. The contract stipends would offset the costs of trainers’ higher salaries, and the trainers would drive student athletes into our clinics to receive additional care. Essentially, we’d develop a feeder program for high school sports teams. Sounds smart, right?

We thought so. But a while after we rolled out the program, we dug into the numbers. As it turned out, the number of referrals we obtained in comparison to the cost of our trainers’ salaries just didn’t add up; in fact, we were actually losing money. But, when we took a closer look at the high schools that were generating new referrals—that is, the schools in which the feeder program appeared to be working—we discovered that those trainers were making a real effort to market themselves and our clinics. They were working to drive students into our practice, whereas some of their colleagues were merely showing up to sports practices and providing treatment.

Just like with our checkout process, we had to do a lot of staff training and goal-sharing to set expectations and get everyone on the same page. Eventually, we got the machine working, but we lost money in the process. Lesson learned: We failed to effectively plan our idea: there were no initial goals, no outlined risks, no identified financial runway. In any business, it seems there’s never a shortage of ideas, but a well thought-out plan is far more valuable. Now, I’m not advocating hyper analysis, because analysis paralysis is just as dangerous as execution without forethought. My point here is that—when it comes to your business—you must properly prepare before executing an idea. There will always be unforeseen bumps in the road, but planning helps pinpoint potential disasters before they strike. More importantly, planning helps you verify that your idea is actually a good one; then, if and when you execute it, you can quickly validate your efforts.

In business, maintaining objectivity—identifying key performance indicators and using metrics to inform decisions—is key. That can be a tough pill to swallow in health care. Remember, we’re empathizers, and it can seem cold and callous to think purely in terms of numbers. But, we’re talking about business here. Care may be full of intangibles, and yes, it hard to quantify everything we do clinically (cue my outcomes soapbox).

In business, though, numbers matter; the data matters. Intangibles and anecdotes are great, but they don’t keep the lights on. It’s imperative that we, as business owners, treat our clinics like businesses; we must take off our empathizer caps and use our observant nature more judiciously. So, take a good, hard, objective look at your business. Start scrubbing with scrutiny. You won’t believe the number of ah-ha moments hidden beneath the surface.


What have you all learned from your mistakes? Share in the comments below.

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