The Absence of Correlation

Most business owners, entrepreneurs, managers, etc. will tell you that the correlation between effort and income is absolutely necessary to keep a company financially viable.

Without the ability to forecast money received based on services rendered or products sold makes for a difficult, if not impossible, economic course to navigate.

Especially during these tough times.

Pizza Guy know exactly how much money he will bring in on any given day when he bakes and sells 50 pepperonis with extra cheese.

Ms. Manicurist knows how much take-home money to expect when she does the nails of 15 customers.

With the Honor Box, however, I am clueless.

Over the years, I have studied the stats and have computed an overall figure as to what the average patient visit yields.

But on a day-to-day basis, I am constantly taken by surprised.

For example, at the end of a crazy, busy day when I see on my sign-in sheet that I have adjusted 75 patients, I may open the Honor Box with high expectations... and find instead hardly anything inside.

Then there are "slow" days when patient volume is way down from the average and I'll open the Box and find a crazy amount of unexpected dollars.  Big money!

This absence of correlation between the number of adjustments I give and the money I take in is both a curse and a blessing.

A curse because it is extremely difficult to rely on the numbers-- to predict with any sense of certainty.  If on paper, X amount of marketing is supposed to yield Y amount of patients and Y amount of patients is supposed to generate Z amount of cash, the reality of the Honor Box and its incalculable nature makes budgeting and income projections frustrating at best, nearly impossible at worst.

However, the removal of the correlation between effort and money from my business has also been a huge blessing.  It is easier to see people as people, not as dollar signs.  It is easier to focus on quality care instead on "chasing paper".  It is easier to feel aloha instead of greed and need.

It has made me a better chiropractor.

Will the Honor Box Survive?

Times are tough.  Companies going bankrupt.  People out of work.  Stock market keeps tanking.

And a fear presses down on all of us.

We fear for our economic future.  Our kids' college education.  Our retirement.

Next month's mortgage.

So in this state, this state of pessimism and discouragement, how can I possibly expect the Honor Box to survive?  With less and less being put into the Honor Box each day, how long can I keep things going?  What about my bills, my obligations, my needs?

This is a time of testing for me.  What is it that I really stand for?  How bad am I willing to fight?  How much am I willing to risk?  Do I press on regardless, or do I conform to the easier path?

It may all explode, blow-up... and all that I have may get wiped out, but

This is not the time to quit.

So to quote the Kurgan shout-out to the Highlander, "I got something to say.  It's better to burn out than fade away!"

The Church of Chiropractic

I don't know if this is the honest truth or a false rumor. Either way, I won't mention any names.

I've been told that a certain chiropractor in Hawaii has built a prayer room in his clinic.

Sounds righteous, yeah?

Except one of the main purposes of this room, it seems, is to help close the sale.  When patients are hesitant or reluctant to commit a payment for a year's worth of chiropractic care, they are invited to enter the prayer room and ask God to reveal His will to them concerning the matter.  Because chiropractic is so important, so right, the doctor knows these patients will emerge from the room enlightened, ready to sign on the dotted line, and eager to hand over the credit card.

If they come out of the prayer room still unsure, well, maybe they just didn't pray hard enough for an answer.

All I can say about this is:

chiropractic should center around the adjustment.

Not the manipulation.

A Bit More Patience

A couple of months ago, I blogged Patients and Patience.  Didja see it?

Anyway, I was just now reading Seth Godin's blog.  If you don't know Seth, he is basically a bolo-head genius who has written some of the best books ever about marketing a business.  I've never met him, but if or when I do, I'll have choke mahalos to give the man!

But anyway, Seth's last post was about this important virtue of patience as it relates to business success.  Here's an excerpt:

I discovered a lucky secret the hard way about thirty years ago: you can outlast the other guys if you try. If you stick at stuff that bores them, it accrues. Drip, drip, drip you win.  It still takes ten years to become a success, web or no web. The frustrating part is that you see your tactics fail right away. The good news is that over time, you get the satisfaction of watching those tactics succeed right away.  The trap: Show up at a new social network, invest two hours, be really aggressive with people, make some noise and then leave in disgust.  The trap: Use all your money to build a fancy website and leave no money or patience for the hundred revisions you'll need to do.  The trap: read the tech blogs and fall in love with the bleeding-edge hip sites and lose focus on the long-term players that deliver real value.  The trap: sprint all day and run out of energy before the marathon even starts. The media wants overnight successes (so they have someone to tear down). Ignore them. Ignore the early adopter critics that never have enough to play with. Ignore your investors that want proven tactics and predictable instant results. Listen instead to your real customers, to your vision and make something for the long haul. Because that's how long it's going to take, guys.

Referrals

There are many doctors who claim to have a great system for getting referrals.  These systems may involve a certain "scripting" on how to ask a patient to bring in their friends and family, or a special brochure, or maybe even a special offer or gift.

I used to feel referrals could be harvested with the right words, the right materials, the right system in bountiful quantities.

I don't feel that way any more.

A referral is a gift.  It is not the product of a series of proper steps taken.  A doctor cannot, should not, manipulate a patient to give up the name of a friend or family member to become a new source of income.

No matter how much the doctor feels he or she can help and serve the referral, it is not right to chase after it.

When the referral does come, however, unforced-- a product of gratitude, hope, and appreciation from within the chiropractic family, it is quite a different matter.

The referral stands as a gift.

Not a result of marketing, smooth talking, or great deals...

Simply, a gift.

The Service Test

How can you as a doctor know if deep inside you are really about "serving the community?"

Simple.

When you meet with a patient for the first time, honestly determine which type of internal questions surface in your mind-- key questions that will ultimately reveal motive and dictate your attitude, focus and protocol.

Are your thoughts--

TYPE A)  "Does this patient have insurance?  Can they afford my fees?  What kind of car does he drive?  Does he have a good paying job? "

or

TYPE B)  "What does this patient want from me?  What does this patient need from me?  How can I best help this person be stronger, healthier... more joyful?"

The Value of Chiropractic

Some doctors complain that the Honor Box devalues chiropractic, as if the true value of an adjustment can only be assessed by a consistent, relevant fee (around $50, or so) collected for services rendered.

When I was struggling with my decision to implement the Honor Box, I studied carefully its "grandfather", a payment system from back in the day commonly referred to as box-on-the-wall. I was blessed at the time to stumble across an article written by Dr. Joseph Strauss.  Dr. Strauss wrote eloquently on his motivation behind the box and the experiences he has had running his practice with the box.

This piece of writing influenced my decision to start the Honor Box back in 2001 more than any other single piece of chiropractic research, philosophy or advice.

Here's the link: http://f-a-c-e.com/gpc.htm

Now in answer to the critics and their claims that the box lowers the value of chiropractic, let me quote directly from Dr. Strauss's words:

It has been suggested by Markson, Nikitow and others, that allowing the patient to set a fee or not having a fee comparable to medicine demeans and belittles the practice of chiropractic and ultimately making it less valuable in the eyes of the public. That may be true for those chiropractors because they see chiropractic, and probably everything else in life, as being valuable in terms of dollars and cents. It is simply not true, even if many people believe it. Those that believe "you get what you pay for" do not themselves apply that principle to everything. I have no idea what it costs today to have a baby in an expensive hospital. But would having that baby in the back of a New York City taxicab make it any less valuable to the parent? If people do put a value on things based upon the price then we as chiropractors should work toward changing that attitude rather than helping to perpetuate it. How much is love worth? How much is a life worth? How much is an air conditioner worth to an Eskimo? How about to a native in Equatorial Africa. Obviously, value is directly dependent upon an individual's perception of an object.

The Line

I have heard that some chiropractic practice management gurus teach their clients to think of their practice policies as "drawing a line in the sand" which they must never allow a patient to cross.  For example, starting care at 3 visits a week.  For some docs, this is an absolute.  If a patient can't comply, they're out.  Another example is bringing the spouse along for the report of findings.  No spouse, no report of findings.  I've even heard that in some offices it was a rule that all kids must be checked for subluxation or the parents under care will be dropped from the practice.

The reasoning for the line is explained clearly.  Why have a rule if the rule can be broken?  Why set a policy if it is not enforced 100% of the time?  These practice policies that the gurus teach are ultimately for the good of the patient and their family.  It is to ensure that the best chiropractic care is provided at all times.

But I wonder.  Are these lines really for the benefit of the patient?  Is a zero tolerance for a transgression of practice policy really all about giving the best care to the individual?

Or is the notion of 100% compliance-- my way or the highway-- more about the doctor's ego.

Yes, it stings when you tell the patient to start care with 3 adjustments a week and they instead insist, "I can only come in once.  Isn't that good enough?"  Yes, it does frustrate the doctor when they invite the whole family to be checked for subluxation, and it never happens.

That sting, that frustration can lower the chiropractor's energy, esteem, and motivation to be the best he or she can be.  But if the rules are so strict that when enforced the non-complying person is ousted from the practice, was the rule really about the patient or was it to protect the ego of the doctor?

Rules are important and policies must be enforced, but to me, living life without mercy or compromise is unhealthy.  And running a practice that classifies a person as either a rule-follower or a rule-breaker, and then goes about to eliminate the rule-breakers without thought of accomodation, in my opinion, is wrong.

Would you like to explore this idea further and reflect more clearly where you stand in terms of the rules you create and the rules you follow?  Read The Cider House Rules by John Irving.  They made a movie based on the book, but I think you have to read the book it in order to fully grasp Irving's underlying themes.

There will always be rules.  But all rules should defer to the higher law:

Love.

PV or $?

To all the chiropractors reading this:

Would you rather, over the course of one working week, adjust 300 patients-- collecting $10 for each adjustment or instead, choose to adjust 50 patients at $60 an adjustment?

And what if you had to live with this choice as the PV standard and set fee for the rest of your career?

What would you choose?  And why?

The Honor Box and Real Life

Yoda said it best to Luke: "Do, or do not.  There is no try."

When I decided to "do" the Honor Box back in 2001, Yoda's wisdom was at the forefront of my mind. I knew that I had to be committed to the Honor Box concept.  If I was to merely "try" it and see how it worked out, I would surely fail.  I knew that whether it drove me to bankruptcy or made me out to be the laughing stock of the Hawaii business community, I was going to run my practice this way and not give it up.  Regardless.  No matter what.

There's been hard times.  Times when I would open the box, count the money and worry about how in the world the bills would ever get paid.  There have been frustrating moments, like the time someone left me a Subway Club Card as payment.

But for the most part, I have come to believe that it is not from the pockets of my patients that the Box gets filled, but rather, from the windows of heaven.  God fills the box.

What gets filled into the Box is in direct correlation and proportion to the level of my faith.  The more I am humble, diligent and worthy, the more God bestows.

So the Honor Box is a measure and a test of my faith and I have come to accept it as such...

But how can such spiritual perspectives find congruence in the cold, hard merciless world of business?  Because when all is said and done, my practice is a business.  Not a ministry.  Not a charity.  Not a non-profit.

A business.

Real life, baby.

And when my faith falters, those times when I think how easy it would be to charge the full price to each and every patient and make what I'm "really worth"-- when my mind computes the bank I would be making if I charged full price, I find that I immediately must call on myself to repentance.  Because any prolonged examinations of "what could be" in terms of my finances in a life without the Honor Box, would quickly lead me down a road to a hell of greedy thoughts, selfishness and ultimately, deep regret.

And to regret the implementation of the Honor Box would be a prideful, scornful rejection of what is not at all a burden, but in fact, a blessing.

How many others have this blessing where the spiritual can blend so simply (not necessarily always so easily) with the daily transactions of a business?  For whatever reason, I have been given stewardship over this Honor Box and I must guard it well always.

For this is, for me, real life.