PTO 147 | Care Plan


Treating patients isn’t just about getting them through the doorYou and your team also need to make sure their plan of care is completed. Our host, Nathan Shields, flies solo today as he talks all about making sure no patient falls through the cracks. Nathan discusses how to plan and execute a weekly walkthrough to make sure all active patients are attended to. We also hear about the benefits this brings, not just to the patients, but to your health care providers as well.  


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Nathan's Coaching Moment: The One Meeting That Has To Be Done Weekly 

I want to share with you something that Ive been working on quite a bit with my coaching clients. Something that we use to address issues regarding retention, situations in which maybe theres a busy season or youre expecting a busy season, but youre not as busy as you think you should be or just those situations when you might be thinking, “Whatever happened to that guy? Whatever happened to that girl? She came in a couple of weeks ago for her knee and now shes not here anymore. Worst of all“We had a ton of new patients and our total visits arent going up significantly this week. It seems like people have dropped off. 

That issue came up routinely for us in our clinics. There was one thing in particular that we did that helped it out and that was called the weekly walkthrough. You might be doing your version. You might even call it something different and thats great. Id love for you to share with the other owners what youre doing. Share with me and Ill let other people knowespecially if its a good idea. The issue generally comes up that patients are falling through the cracks. Youve got poor retention effortsor were not doing anything retention-wise to keep patients in the books. Theyre canceling, not rescheduling, and going on vacation and then not returning for physical therapy, you name it. 

The statistic that we want to improve with this particular action is increasing our percentage of completed plans of care. Click To Tweet

Ultimately, that leads to poor outcomes for the patients, lost patients, and revenue. That poor outcome for the patient eventually leads to a poor reputation for you because now theyre not getting the results that they want. Hopefully, but routinely, it gets back to the physician, That physical therapy clinic didnt work for me. We need to move on. That ends up being a loss of referrals for you, not in terms of the physicians, but also, theyre not going to refer to their family and friends. What is one thing at least that we did on a routine basis to help with these issues? That was called the weekly walkthrough. This is where it was simple. We got an Excel spreadsheetlisted all of the active patients and their future appointments with notes available to list any communication efforts that weve made. First onlist of active patients, next few columns the appointments that they had scheduled coming forward, and then lastly, any communication efforts that were made. 

Each patient on the list was addressed, whether theyre scheduled or not. What is their status? What are the communication efforts? If you can take it to the next level, the frequency in which they are scheduled at an appropriate level for their appropriate plan of care. Lastlywe would talk about who was formally discharged and informally discharged from that list. Formal discharge was obviously who agreed with the physical therapist that theyre not coming anymore. They popped the champagnegot the coffee mug and t-shirts, they high-fivecelebrity walkthrough, and lead them out the door. They were formally discharged versus those who simply arent returning your calls. Those are the informal discharges. Well talk about the important statistic to track that. 

Ultimately this walkthrough is focused on patient retention and that patient retention leading to happy and engaged patients meeting their goalsThe statistic that were going to try to improve with this is the percentage of completed plans of care. Thats the statistic I was talking about with the discharges. That percentage of completed plans of care is notoriously poor for our profession. Depending on who you listen tothat could be 10% to 20% of all patients that come through our doors are actually completing their full plans of care and meeting their goals, which is horrific. Its lost money, lost revenue, and poor reputations, you name it. Itall that stuff. 

The statistic that we want to improve with this particular action is increasing our percentage of completed plans of care. Another byproduct of it could be increasing the frequency per week that we see those patients. Inherently, if were only seeing them one time a week in a typical orthopedic clinic, theyre probably not getting well and not meeting their goals. Theyve got to come 2 to times a weekso you want to address that as well. What can the results be from the weekly walkthrough? The results are increased total visits, which leads to increased revenue, increased bottom lineprofits, and the patients ultimately are getting better. Theyre following through with their plans of care. The weekly walkthrough is a must and we called it the weekly walkthrough because we literally walk through each chart back in the day of each patient in our file folder in the file cabinet. Were old school. That was how it was back in the day. Now your EMRs can print out some of those sheets. Some of them arent very trustworthydepending on your EMR. It might be better for the front desk person to literally print all of the active patients and keep that active patient list going. Thatthe kicker. 

Heres the secret. This is the front desks responsibility. This is not your responsibility. Your responsibility is to make sure that this meeting happenssame day, same timeevery week. Ensure that it happens and that all the active patients are addressed. The responsibility to keep that active patient list up-to-date and fully communicated is the front deskresponsibility. They should be living in that form throughout the week, knowing where all the active patients are and exactly what efforts have been made to get those patients on the schedules. 

Ultimately in an ideal situation, I, as the leader, would come into the meeting. The front desk would hand me the Excel spreadsheet with all the patients listedall their scheduled appointments. If they dont have any scheduled appointments in the near future, especially the next weeknotes are made as to what their communication efforts have been and where that patient is. Maybe theyre on vacation or something thats happened that they cant come in. Everything is listed and they report to me exactly what is happening with all of our active patients. 

PTO 147 | Care Plan
Care Plan: The responsibility to keep that active patient list up-to-date and fully communicated is the front desk’s responsibility. They should be living in that form throughout the week, knowing where all the active patients are and exactly what efforts have been made to get those patients on the schedules.


Recognize this is the front desk responsibility and it needs to be reported up to you. That is their job to ensure that all the patients are on the schedule and make sure all their patients who are scheduled come in. That’s why one of their main products is arrival rate, but make sure that all the patients who are on the schedule to actually come in for their visits and ultimatelyfill the schedules of the providers. That’s their job. Make sure that this one meeting happens and what will you benefit from it? You’ll see an increase in total visits. Youll see an increase in revenues, increase in patients plans of care being completed. Happy patients that are engaged in referring friends and family and doctors who are happy that the patients are getting better and thuswilling to send you more patients. This one thing can help you with all of those byproducts and increase all of those statistics, making you a happier owner. Recognize that the secret to it all is that youre not in charge of it. 

Yes, initially youll have to do some training. Youll have to show them what to do and how to do it, but then eventuallythey have to take ownership. This is their responsibility. They are supposed to lead out in this meeting and show you exactly whats happening with all the active patients that are coming through your doors, so they are not falling through the cracks and not getting better. The weekly walkthrough, I highly recommend it. It has to be done on a routine basis and if you do so, things will improve in your clinic. Thats my moment for the day. 


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PTO 120 | Patient Retention And Referrals

No matter how good you are at physical therapy, there is one thing that will turn your patients into raving fans or active detractors, and that is the service they receive from your team. Customer service is probably something most owners would consider an inherent plus in their clinics, but how often do they take the time to train, role-play, and focus on improving the customer experience? If it's not continually improving, we'll assume that it's gradually declining. Dr. Kelly Henry joins Nathan Shields to bring his insight as an executive coach to the podcast to discuss the keys to ensuring a great customer experience, and the benefits of intentionally working on it to multiply your profits.


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The Key To Patient Retention And Referrals With Kelly Henry, DC

In this episode, I have Dr. Kelly Henry, a chiropractor who's living in Texas. He had grown a successful chiropractic business for many years. He's now an executive coach. I'm excited to have him on the program to talk a little bit about customer service and its importance in our practices and what it can do for us. First of all, Dr. Kelly Henry, thanks for coming on. I appreciate it.

Thank you, Nathan. I appreciate the opportunity. Thanks for having me.

You might be the first chiropractor I've ever had on the show, but there's a lot that we share in terms of the business aspect of our practices. It's great to have you on. I know you've been working with some physical therapists in your coaching business. Tell us a little bit first about where you came from and what got you to the point that you are now.

My story is maybe similar to a lot of other chiropractors and physical therapists. I got out of school and I thought I knew everything. I thought I knew how to run a business. I thought that I open the doors and I was going to be tremendously successful. Things turned out otherwise. I got out of school at Dallas Parker Chiropractic College. I moved to Phoenix with my wife and with our one daughter. Fortunately, I got into practice with several other chiropractors. We each had our own practices. If you know Phoenix, as far as a physical therapist, it has a chiropractor in about every corner of the streets. There is a lot of competition. I was very naive and I did not do well at all. There is not much money at all.

Fortunately, the doctors I was with in that particular clinic, there were a couple of older doctors that had been in practice for 15, 20 years. I gained a ton of knowledge from them, not necessarily experience. I hardly make any money. It’s very frustrating times. Looking back, it was tough but I appreciate what I have now because of what I went through then. I was there for roughly a year. I got a call from a chiropractor that I had met in New Mexico where my wife was from. He was retiring and wanting to know if I wanted to buy him out.

I was fortunate enough to come up with some financing and do some things to be able to buy him out. I moved to New Mexico. I did okay. I was doing better than Phoenix, which is not saying much, but it still wasn't to my expectations of what I needed. I struggled on for a few years and finally got with a coach and that's when my career took off. I was able to get a great coach and coaching system to implement as far as the management side in my office. I steadily grew from there. I outgrew that coach. I was with another coaching and consulting firm. They helped me get to another level and I outgrew them, and it kept going on and on.

Finally, I got with another coach and blew up from there. After about 10, 15 years of that, I developed my own systems taking pieces of all the coaching that I had and ran that. I had two locations so I was able to grow my office. I had a satellite location with another chiropractor. I was able to sell those all out in 2018 and then turned my attention to executive coaching and coaching of chiropractors and other industries in the ways of customer service. That was the bedrock of how I was able to grow my businesses on the foundation of great customer service that helped me to retain patients. It’s what the key was.

Your story isn't all that different from most physical therapists that we talked to. We don't get a lot of business education in PT school and I figure it's the same in chiropractic. Once we get some of that technical knowledge in terms of how to run a business, and that's what I'm sure you got from your coaches, that's when things tend to turn. That's one of the keys to the success of the PT owners that I’ve interviewed that are successful. It takes some time for them to hit rock bottom or start getting burned out before they finally turn to a coach and someone who might know more before they start to see improvement. Part of the show here is to tell them, "Don't wait until then.”

Based on a Harvard Business Review study, improving the customer experience can increase your PROFITS between 25-90%! Click To Tweet

You're going to save yourself a ton of time and money if you'll swallow your pride and work with somebody that might know what they're doing to help you grow your business quicker. It's funny you say that because a lot of times I'm very leery of working with docs that are out of school for only 1 to 2 years. What I say is they don't know enough to know what they don't know, to know that they might need a coach. As you said, they hit rock bottom, life and business slap them in the face to say, “You don't know what you're doing that they say, ‘I do need some coaching.’”

What's cool about your coaching is yours is niching down. I'm sure you could do business coaching in general, but you're niching down and focusing on the providers and the owners that you work with on customer service. That focus on customer service will translate into greater patient retention and referrals from family and friends. Tell us a little bit about that and maybe expound upon your focus a little bit if you can.

You nailed it on the head there. The focus is on customer service. From a chiropractic standpoint, my ultimate goal was to serve my patients and to help them get healthier. I know that's what physical therapists do too. They are there to serve their patients, help rehab and get them healthier. We can do that through our service and the mechanics of that. The problem is when our customer service doesn't align with our service attitude and trying to help our patients get healthier, I don't care how good a chiropractor you are, the best adjuster, and do phenomenal on that side, if the customer service is bad, if your staff treat your patients bad, they're going to leave you

I assume the same thing would happen with a physical therapist. My concern is let's quit having that happen. Let's improve the service side of things. I mentioned to you that my philosophy of coaching is doing these simple and easy action items. They seemed so stupid easy but they make a huge impact on the patient's perception of the service, being valued, feeling valued and important as they walk into a clinic. On top of that, you give great service through the mechanics of physical therapy and the rehab that you do. When you mesh those two together, that patient's like, “I love that office. I feel physically better.”

Psychologically, they’re like, “I love going in there because they make me feel like I'm the most important patient in the world.” Subconsciously, they're like, “I'm going to tell my friends. I'm going to tell my family. I'm going to get others to go in there so they will feel physically good. They're going to be treated like a rockstar when they walk in that office.” That's my purpose and my passion behind niching down to customer service to meld all that together, to help those businesses grow. I know we have good products from the side of physical therapy that's a great service and a needed service. Let's get that customer service in there to enhance it and grow these businesses so patients can get healthier.

I'll never forget. I had an interview with the founder of a software program called Keet Health. We were talking about marketing and what you can do for patient engagement, retention and whatnot. I'll never forget and it's hard to figure this out exactly, but he believed that we could triple our marketing efforts if we simply focused on customer service more. Provide a great service from the initial contact, that initial phone call all the way through collecting the balance down to $0. If we focused on customer service throughout the life cycle, we could triple our marketing efforts. That makes me think, “All that time I'm spending on marketing could be focused on customer service instead and get some of the same results if not better.”

There are a couple of stats that I like to use along those lines. One is it's 5 to 25 times more expensive to market to acquire new patients than it is to keep the current patient. There's a ton of money going out to external marketing, which is needed. The problem is you need to do something to the internal market to keep those patients. That's where the customer service comes in. The other stat that I love to use and this is from Harvard Business School. They did a study that a 5% increase in patient retention or customer retention through customer service can lead to 25% to 95% increase in profits. The reason that can happen is because as you’re increasing retention, you're keeping those customers and patients, they're referring more. You don't have to throw as much money into external marketing. That goes to your bottom line. That's what can increase that profit margin for you. I preach that all the time. I would completely agree, triple, quadruple and five times the profit, I can see that happening. I've worked with some clinics and it's pushing there.

We talked a little bit and it seems fairly similar between chiropractors and physical therapists in that, you get drop-offs like we do. They tend to occur somewhere in the 3 to 5 visit range where they haven't fully bought in and they lose the enthusiasm. They fizzle out and they're gone. If you can simply keep more of those people through their full plan of care to see the results, that might go straight down to the bottom line because your expenses don't necessarily increase, but keep those people involved, keep them engaged. What are some of those things that you talk about to help providers focus on customer service with their patients?

There are several things, although I want to touch on why physical therapists and certainly chiropractors lose patients after a couple of visits. This is outside of customer service that I've found that's common is they don't communicate the seriousness of a patient's condition correctly. We touched on that a little bit where they don't give them the overall picture that, “If you don't take care of this now and do it correctly, it may not bother you in a couple of months. Fast forward, 5, 10, 15 years down the road, this could become a major issue that could keep you from golfing or taking care of your grandkids or whatever the case may be.”

PTO 120 | Patient Retention And Referrals
Patient Retention And Referrals: You can save a ton of time and money if you swallow your pride and work with somebody that knows what they're doing to help you grow your business quicker.

The chiropractors and physical therapists tend to get too near-sighted and not communicate the longer-term effects. That's one thing outside that certainly will help. From a customer service standpoint, the patient comes in and from a chiropractic standpoint, they're hurting. They want some help. They need some relief and those types of things. Chiropractors are good with that, initially. If they do x-rays and be able to say, “Here's what's going on. Let's get you adjusted.” The patient is going to come in and get a little pain relief, but things aren’t communicated well and the ball has dropped as far as customer service. If they don't feel like they're valued or important like, “We're here to take care of you, get you out of pain and get you healthier. We're here to serve you first,” those patients are not going to stay very long. A couple of adjustments, they get a little relief and they're like, “I'm out of there. That office could care less if I'm there or not anyways.” They're gone.

You said it on our phone call that the patients will take their injury only as seriously as the provider does. If the provider comes up and says, “Figure it out with the front desk. Schedule one time a week, two times a week, maybe three times a week or whatever you can do. You guys figure it out and then we'll see you next time you come, and we'll do some good stuff for you.” It’s a laissez-faire, “I don’t care.” They're not saying “I don't care,” but the attitude comes across like, “I don't care. Just show up and we'll get you better.” You'll lose some confidence in that regard as a patient. The patient is sitting there thinking, “Do I have a problem? If you're not taking it seriously, then I guess it's not a big problem. Why am I spending my copay dollars on this one if it's not a big deal and you're taking it lightly?” I love what you said that they'll take it only as seriously as the providers do.

They'll default to that. I can tell a patient, “You're going to die tomorrow,” but if there's a disconnect, “This is what's going on,” and God forbid, I've never had that happen. I'm just using this as example. The seriousness of it, if I don't communicate that or even if I do communicate it and I have a disconnect, “Give us a call in a couple of weeks and we’ll see how you're doing.” That causes that confusion and they're like, “I'll see if I remember in a couple of weeks to let you know if I need to come back in.” If the doctor, the physical therapist, and the chiropractor don’t take it seriously, the patient certainly won't. You lost credibility and you lost patients following through on what they need to.

That goes even back to what we were talking about on some of the small things you can do. They’re at the front desk as they're having these interchanges, especially the first time they walked through the door. You can lose a lot of patients right there. No matter how good a provider you are, that front desk person has nothing to do with the physical therapy care that you provide. If they lose them there, it doesn't matter what care you provide. They're so valuable. Sometimes we put an ad out for someone that's $8, $10, $12 an hour and hope for the best and not focus on that. Whereas that could be a huge detriment to your business. The ones that are great are great and those clinics do well.

I used to tell my staff, but I tell my clients now, you could have the greatest chiropractor in the world, but if the staff is terrible, you're going to have maybe at best an average business and it probably won't even be that good. You could have an average chiropractor that's decent, but if you have a tremendous staff that does great with customer service, you're going to have a tremendous office. It's that valuable.

What are you telling some of these teams to do in order to focus on customer service? Are there exercises you take them through or are there tips and trainings that you recommend?

I train them on a lot of different factors. There are a lot of different pieces to great customer service. There are five that I focus on with most offices, clinics and clients because they provide the greatest bang for your buck. You could look at this and this and it had marginal gains. Through my research through my clinics or my clients, I've never been down to five pieces of the puzzle that if a clinic, a PT, a chiropractor will focus on these areas, it increases the perception of customer service in that clinic for the patients. That's what you want to do because customer and patient perception is everything. The patient is going to perceive customer service by how you make them feel.

If you're doing everything to make them feel valued, then you're going to have pretty good customer service for the patient. The five areas that I focused on, one is positive mental attitude, positive aspects of the office, and keeping that positive mind frame from the owner, the PT, the staff and all the way through. It's hard to provide great customer service if everybody's walking around that's ticked off with a negative attitude. You may say the right things, but the attitude comes through. It's not going to be as effective.

Doing simple and easy action items seem stupid, but they make a huge impact on the patient's perception of the service. Click To Tweet

Do you find that teams often take on the personality traits or the attitude of the leader, the owner, the main provider on the team?

They do and that’s why I want to train the owner, the PT, the chiropractor or whoever is at the top first. If I go down to work with the team members, I can get them all riled up and have them functioning at a certain level of customer service. If it's not at the top and working down, it's going to be undermined and it will not be as effective. They do take on that attitude from the top down. Whoever is on the top is, it's going to work its way down for good or bad.

You tend to see that especially in doctor's offices. You're like, “Not that the temperature is cold, but it feels cold in here with my interactions with the people.” I meet the doctor and I think, “That's why.” Sometimes you can get that front desk person who rises above it and has an attitude that no matter what the environment is around them, it can be of high excitement and high tone that you don't see a lot of that. They usually match the other people in the office.

If you do hire one with that great attitude, they start rolling it back down and match it too. We always want to start from the top and work down and make sure everybody's on the same page.

Number one is a positive mindset.

The second one is creating a team atmosphere for the whole employee interaction.

This isn't necessarily customer-related. This is more you and the team.

It’s you and the team, but it goes to the customer in the sense that you can't have great customer service if you're treating your employees bad. Happy employee equals happy patients. There's got to be that dynamic. I'll point fingers at myself. There are several years in my practice where I had this mentality that my office staff and my employees were a liability. My job is to nitpick every little wrong thing they were doing to correct that all the time. All that did was foster more wrongdoing, bitterness and irritation. It was very difficult to create a positive atmosphere and great customer service.

One of my coaches finally called me on it and said, “You need to quit doing that. You need to pick out and start focusing on the good they're doing, which is far more than the negative they’re doing.” Foster this team atmosphere that the front desk may not be doing anything as far as an adjustment or diagnosing, but they're helping the physiology of the patient when they walk in by treating them like they're important and like they're valued. Setting them at ease and calming them down, which helped me on the back end taking care of their physical health. I bought into that. Every employee, maybe some had office manager title or some were new and they were filing paperwork, but they all played a part in the success of the business. However big or little they may seem, but they all played a part in how successful the business was because of how they interact with the patient and make sure those patients felt like they were important.

PTO 120 | Patient Retention And Referrals
Patient Retention And Referrals: It doesn’t matter how good a chiropractor you are; if the customer service is bad, if your staff treat your patients badly, they're going to leave you.

Also, because they were happy. That’s number two. We've got a positive mindset and a team atmosphere.

The third thing is to create a friendly atmosphere and there are a lot of aspects to that. Customer service begins and ends with a friendly atmosphere. From the second that patient walks in, “It’s good to see you, Nathan. We're glad you're here. We're going to take care of you in a couple of minutes. Have a seat. If there's anything you need, let us know.” When you’re through the process of getting your treatment and then as you're leaving, “Nathan, we’re glad you came in. Let's get you scheduled for your next visit. You take care. If you need something, let us know. We appreciate you.” I call that bookending. Be overly friendly on the front side and be overly friendly on the backside. The patient leaves that perception like, “They love me here. This is great. I love coming into this office.”

My mission statement or my customer service mission statement in my clinics and this is what I teach my clients is to be the best part of the patient's day. You don't know what that patient's going through on a day-to-day basis. They're in pain. Their dog died. They're late for work. Their kid is sick. They're having trouble at work or whatever the case may be. There are a lot of problems in life. When they come into my office, I want them to be able to forget about those problems. I want them to feel like they are a rockstar, superstar, and the most important person in the universe when they walk into my office. Make it the best part of their day so when they leave, they're rippling that out to the people they interact with when they leave.

Sometimes we forget as providers, coming to physical therapy 2, 3 times a week for up to an hour at a time is a disruption to normal life. They sacrifice a lot. That sacred time for them, whether that’s taking away from work or taking away from family or even some spare time that they don't have a lot of. They sacrifice a lot to come often throughout the week and for weeks at a time to care for themselves. It's important for us to recognize that and thus provide a great atmosphere like you're talking about for them to be a part of. Otherwise, I can see where they fall out quickly if they're not getting recognized when they show up and as they leave. If it's not happy, if it's not fun or if it's not engaged, if no one asks them a whole lot on the way in or the way out, why bother sacrificing my time for that?

You feel like a number instead of a rockstar or a person, “It’s probably good. My shoulder feels a little bit better. I got to take care of other things.”

We all have that. There are plenty of other things we could be doing. That's number three.

Number four is being faster and more efficient as a business as a whole. There are a lot of aspects of that too. From a physical therapy type situation, the physical therapist has to spend a lot more time with their patients, 45 minutes to an hour. You can't expedite that necessarily. You got to have that quality time, but you could be faster with setting appointments, maybe having extended office hours, and make it more convenient for a patient to do business with you. Being faster at expediting when they're done with their session, they’re paying to leave, being faster and expediting new patients to get them in. Being faster with getting insurance inquiries back to them and returning phone calls. There's a whole lot of aspects there. We live in a microwave society. That's not going to change. We know we want everything then. We have to be conscious of that and do everything we can to make it quicker, more efficient, and less obstacles in the way for them to do business with us. That makes a huge difference.

There's something to be said for going to a place and they have my paperwork already for me versus, “You're here now. Let me print out the paperwork for a minute. Take a seat and I'll bring it.” You’re like, “No, I have it already for me.”

Customer and patient perception is everything. The patient is going to perceive customer service by how you make them feel. Click To Tweet

You walk in and you go, “Nathan, you're the new patient. It’s great to see you. Here's your paperwork. There are three pages here. Fill that out quickly. We're going to get you in and out of here as quickly as we possibly can.” That tells the patient that you have their best interests at heart. You are conscious of their time. Everybody's time is valuable. You're telling them, “We're glad you're here. We're conscious of your time. We're glad you chose us. This is how we're going to help you because we're going to be quicker in taking care of you.”

Looking ahead on the calendar and seeing, “So and so is coming,” and maybe not just the front desk, but even as providers. We say, “What do I want to do with this patient?” Maybe look in their past chart and say what happened in the past. To bring that up to them and say, “In the past, we did this with you, how did you respond?” Instead of them saying, “We tried that before” and maybe they won't even say it to you. They might say, “You guys are trying the same thing over and over again. You haven't even asked if it's working.” That's what you're talking about. It’s being prepared and looking forward. Treating each patient as someone who is infinitely valuable and treat them accordingly.

It's amazing what a difference it'll make in the patient's mind when you take those little steps to do that for them. Not treat them like a number and run them through because you're trying to meet a certain financial level for the month. It's okay to do that. First and foremost, it has to be on serving the patient.

What is the last step?

Number five is I call it fixing problems or service recovery. Every office drops the ball somehow some way. To be able to recover from that in a specific manner makes a huge impression in the patient's mind. A consumer that had a problem and the business took care of that problem in an efficient manner to their satisfaction, they have more loyalty to that business than the consumer or the patient that didn't have any problem at all that but they didn’t experience great service. It'll add to that extra level of loyalty that those patients or the consumers will have because of the problem and the way it was handled.

The nice thing about customer service, when you have great customer service, you're going to have less problems. You don't have as many to take care of. Even if it's glaringly the patient's fault, you still have to treat it like your problem because it is your problem. If you take care of it right, you create that extra value with that patient or that customer, and they become your strongest advocate. I saw that many times in my career. In my chiropractic office, those patients that we took care of those issues, they were phenomenal. They were referral machines after we went above and beyond what they thought we should. It's a great thing. Now, you shouldn't try to create problems to create that extra value. That's not the point here. The point is to have a system to take care of those problems efficiently and do it in a great manner. It benefits you tremendously.

To that point, are there some tips that you recommend people use if a patient is upset or comes in with a concern, how they address it appropriately, any advice you can share?

Three main things, one is to address it immediately. We talked about being fast and doing things in an efficient manner. You want to address the problem immediately in the sense that, “I'm sorry, there's a problem.” Go to resolve it as quickly as possible. The other thing is to apologize immediately too. If it's the clinic's fault, if it's an employee's fault, you're going to apologize. You want to do that and take responsibility for it. I also coach and recommend that you apologize, even if it's the patient's fault. You apologize in the sense that you'll say, “I am sorry, you're going through this. I'm sorry, this is happening. Let's make this right for you.” You're not necessarily taking the blame for it, but you're still putting that patient that customer at ease by saying, “We recognize it’s a problem. We're sorry you’re going through this. We're going to take care of it.” Those two things are huge.

The other thing is don't play the blame game. If it's the patient's fault, you shouldn't have done that. Don't play that because all you're doing is creating anger. You're fueling the fire. Nobody's going to win, it’s what will happens. The patient's going to be upset. They're going to leave. You're going to lose a valuable patient, possible referral source, and profits coming into your office and your clinic. You got to be careful there. Apologize, do things immediately, and do not play the blame game.

PTO 120 | Patient Retention And Referrals
Patient Retention And Referrals: You could have an average chiropractor that's decent, but if you have a tremendous staff that does great with customer service, you're going to have a tremendous office.

We want to do that. We want to find out who's to blame for this so that we can point the right finger at the right person. It's so much easier when you say, “No blame, no pointing fingers. We're in this situation, how do we simply resolve it?” It allows the emotions to stay out of it. That's for sure.

That's the main thing. You want to keep the emotion out of it. When emotion gets high, reason gets low and that's where everything blows up. Be very conscious of that.

Any other little tips along the way that you share with people? Wear your hat the right way or sit the right way, anything like that that you can tell people. These little things if you think about them, they can improve customer service.

There are two things that are so stupidly easy that whenever I tell people this, they're like, “We already do that. That sounds good, but it can't be that effective,” but it is. My coaching philosophy is doing the simple things consistently, that's where you're going to get major results. These two things that I want to share are very simple. The first thing is to put a smile on your face. Every employee, every day, the practitioner, everybody has a smile. What I tell my clients is a smile should be part of the uniform of every employee. If they wear scrubs or if they put a name tag on, a smile goes along with that. Smiling is the universal welcome. It immediately puts people at ease when they see a smiling face. It calms them down and it lets them know, “We're here for you.” Smiling seems so ridiculous, but it's not. It's very effective.

The other thing is I call it manners matter, but it's using three phrases, please, thank you, and you're welcome. Everybody goes, “We know that.” They may know that, but in this day and age, it's lost a lot. I recommend using those three phrases in every form of communication too, face to face, on the phone, text, and email because those are a big part of most clinics' communication sources too. They show respect for the other individual.

I like that you also included emails and texts in that because think about confirmation calls. I don't recall a lot of please and thank yous. I'm glad you included that.

It takes the edge off. It's showing a little bit of respect to that person. You're trying to drive perception. If I'm sending a text, “I want to verify your appointments. We appreciate you. Thanks for being a patient,” or something like that. How easy is that? If it's an automated text, it’s like, “They're glad I'm a patient.” Those three phrases are so simple to use. It's so simple not to use it as well. That added an extra edge of, “I appreciate you, your valuable to me, your valuable to this office. You're important to this office. We're going to respect you with that language, to verify and to show you that's what we mean.”

This sparked a thought in my head. You talked about you bring these things up to them like you should be doing these things, smiling, please, thank you, you're welcome. People will say, “We do that.” Have you ever used any secret shopper exercise or anything like that? Maybe you call the front desk to see what words they're using, what verbiage they have, and what tone it is? Have you done that before? I'd assume most of the time the owners are surprised of what they hear.

Happy employees equal happy patients. Click To Tweet

They are. Nine times out of ten, it's not as good as they think it is. That's the funny thing about customer service as a whole. Most businesses think they provide great customer service and they have certain aspects of good customer service. Maybe they do a little of this and a little this. As a whole, the perception of the patient or the customer is they don't have that great customer service. What a lot of businesses do and this is very common and I did it as well, is you'll have a new patient come in, you treat them once or twice. That's the honeymoon phase. Everything is all hunky-dory and roses.

You send them a, “Do a quick Google review for us.” They'll give you five stars every time. Give it another 2, 3, 4 or 5 weeks and see if that patient is still in your office for one thing. If they are, let's see how they're going to review the office at that point. Is this still going to be a five-star? To me, that's not a legitimate Google review, if it's the first couple of visits. As I was saying about chiropractors, the first couple of years in practice, they don't know enough to know what they don't know. It’s same with patient's first impressions, "They treated me pretty good. I'll give them a five-star review. I don't want to say anything bad about them.” Once they get a little bit of understanding, most of the time, it's not quite as good as what they'd like it to be.

The newness fades a little bit. Maybe it's not a five-star review anymore. Maybe it's closer to 4, 3.5. I noticed these things over and over again that you guys don't do.

It’s probably the first couple of times, but it keeps happening over and over.

In that regard, do you also recommend doing surveys with the patients’ NPS, Net Promoter Scores and that kind of stuff?

There are three metrics that I promote with my clients. You want to get a patient score survey and understand where they are. What I recommend is a 1 to 10, if a patient says 8 or below, then you need to contact them and see what is going on. Why are we an 8 or lower? What's our problem? What do you see as an issue? How can we improve? The second survey is an employee survey. Question them, would you recommend your friend coming to work here at this clinic, this office, this location?

You need to do this in a way where it's not going to be if they say no, that it's going to be a problem. You understand why they wouldn't because happy employees equate to happy customers. If the employees aren't happy, customers are not going to be happy. It's going to cause a problem and disconnect. You got to be careful with that. The third metric is profit and cashflow. There are a lot of KPIs that you can work through. These three came from Jack Welch, the CEO of GE. Those are the metrics he used. If they’re good enough for him, they're good enough for me.

If he can do amazing things with GE back in the day, then I can do the same thing for my clinic. They're great. The patient survey one is obvious, but I love the employee survey. When it comes to the cashflow and bottom line, that's the bottom line if people are liking you or not.

PTO 120 | Patient Retention And Referrals
Patient Retention And Referrals: It's hard to provide great customer service if everybody's walking around that's ticked off with a negative attitude.

The purpose of the business is to get a patient or get a customer. You need to keep that customer and then make a profit. A lot of businesses, they understand to get a customer. They do very little to keep the customer and then they try to make a profit, which to some degree they can, but they are missing the whole aspect in the middle of keep that customer, which expands the profits. That should be the focus. My passion is to help businesses do a better job with that.

Thanks so much for sharing your time. Is there anything else you want to add before we sign off?

No, we've covered a great deal. I appreciate your leading questions and help me to open up some of this stuff. I've loved our conversation.

You've provided a ton of value. If people wanted to reach out to you individually, how do they do that?

There are several different ways. You can go to my website, By all means, email me at If you have any questions would like to contact me and maybe set up a chat, I'd love to do that. If you like to text or call me by all means, I'm open to having patients or potential leads and clients call me. My cell phone number is (575) 706-3304. I'd be more than happy to talk about what we do. My coaching is a little different. I call myself a multiplier and my goal is to help multiply getting patients. If it's PTs or chiropractors or customers, multiply profits, growth, employee engagement and multiply all these things that we've talked about.

We do that from the inside out. We look at the internal things and change the dynamic. It’s not to change the business completely. Let's just enhance certain things that are going to create the greatest results. The 80/20 rule, let's look at this 20% set of things that are going to give you 80% of the results and see what happens. That's my coaching philosophy. My coaching programs are customizable. I have different time periods, 3, 6, 9 months, depending on if some would like to spend more time with me, weekly calls or monthly calls or biweekly, whatever the case may be. There are some customizable pieces to my coaching to make it affordable to the different price points and different budgets of the clients I work with.

Hopefully, some people reach out and get some more information from you, but thanks for all the information that you provided. It was a great help for many owners.

I appreciate the time. Thanks so much, Nathan. I enjoyed it.

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About Kelly Henry

PTO 120 | Patient Retention And ReferralsFor 20+ years, award winning chiropractor Dr. Kelly Henry helped patients achieve and live healthier lives.

With the foundation of exceptional customer service and streamlined business procedures, Dr. Henry grew his business into the top producing chiropractic clinics in the nation with multiple locations and doctors.

After retiring from private practice in 2018, Dr. Henry has dedicated himself to consulting and coaching business owners on how to create incredible growth and profits using the processes and procedures he used to create phenomenal success in his offices.


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