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Increasing Practice Retention

General Motors doesn’t want to sell you just one car. The car manufacturer estimates that if they keep you satisfied through quality products and service, you could provide them with up to $400,000 of business over your lifetime.

September 16, 2009  By Donald Dillon

General Motors doesn’t want to sell you just one car. The car manufacturer estimates that if they keep you satisfied through quality products and service, you could provide them with up to $400,000 of business over your lifetime.

A U.S. government study estimates that it costs five times the amount of resources to gain a new customer than to keep an existing one. In the management of your practice, do your efforts draw people back to you or do they send them away?

Practice retention, the ability of a therapist to give patients reason to come back, is like building a foundation on a house – if it’s solid, the house will last many years.

Therapists may unknowingly discourage repeat business by refusing to self-examine their treatment process – that is, examining each part of how they provide care, and determining what can be improved on.


Whether they have extended health plans or not, people pay a lot of money to come see you.

They want their concerns heard, their problem clearly explained and their issues addressed.

This requires you to set excellence as a standard, not as an exception, in your day-to-day delivery of care.

What does excellence in care mean to you? What helps you to determine if a treatment was worthwhile, or
if it was not? Walt Disney stressed to his staff “Do what you do so well, people will want to come back and see you do it again.” I believe this is an excellent definition of retention … do something so well people will return to see you do it again. But providing excellence in care can be hit-and-miss unless we have criteria to determine what excellence is.

Can you remember a time when you provided an excellent treatment? What made it excellent? How did you talk to the person? How did you engage their body to assess or treat them? How did you use your body to care for yourself as well as provide good care to the person? How did you determine what type of
treatment to use? What went through your mind during the treatment? How did you interact with the person at the end of the treatment?

After many excellent and not so excellent treatments, I observed and analyzed what made a good treatment a good one, and a poor treatment a poor one. Here’s a six-point system to increase your patient retention, from their first awareness of you to reconnecting with them on a regular basis.

How does someone get their first inkling of your provisions? It’s important for you to know this because it determines what people’s outlying perception will be of you. Your signage, your brochures, your yellow pages ad, your reputation via word-of-mouth all form a person’s awareness of you. It’s very important that your primary message – the one thing you want them to remember when they think of you – is clearly and consistently projected. Awareness is the first step in your interaction with a potential patient.

The person is aware of you, and has made the commitment to see you for an appointment. This is where their perception of you expands. Your waiting room, your greeting, how your receptionist, if you have one, greets them, your treatment facilities – all this contributes to the person’s perception of what you can provide for them. They become aware of your policies, your fees, your certificates – they‘re checking out your authenticity to determine if they want to invest in your care.

In our office, we have a comprehensive one-side-of-a-page intake form that patients fill out in the waiting room. Underneath is a laminated fee schedule outlining our fees, possible initial reactions to treatment, the names and pictures of our therapists,and several other prompts that expand the person’s perception of
the services we provide. Your intake interview outlines what they can expect from you. Holding eye contact, actively listening, asking clarifying questions all demonstrate your interest in them. I once screened a potential associate by acting as “patient” in a mock intake.

She quickly scanned the intake form and encouraged me to get ready for my treatment. She didn’t take time to listen and really assess my needs before trying some intervention. My point is this – your intake process is the next step after awareness to make a positive, lasting impression.

Treatment is more than the techniques you will apply. It’s an assessment of what distortion process is at work, and setting goals with the patient to address it. It’s using verbal and kinesthetic communication. It’s honouring the person’s responsiveness and your biomechanics. It’s an opportunity to describe what you’re finding, why it  has occurred, and how your intervention can improve it.

Use treatment as an opportunity to educate – to draw awareness to patterns that may be causing harm, and methods to off-set those patterns before they become entrenched.

Re-check the findings you uncovered during the assessment process. How have things changed? What has not changed? Reinforce the changes your intervention has induced in the mind of the patient, so that they can modify attitude and behaviour to allow the changes. Plan together how the things that haven’t changed can be approached in a future treatment.

Report of Findings:
A ROF summates what you have been saying during the whole process – what you’re finding, why it has manifested as it has, and how your intervention addresses it. In our office we use a variety of teaching aids to get our points across – a muscled spine and cranium, trigger point and anatomy charts, and analogies or “word-pictures.” Incorporate visual, auditory and kinesthetic means of helping patients to understand their condition. Educated patients make better health care decisions.

Once a person has left the experience, you want to revisit with them to anchor in the effectiveness of what you have done, and check for understanding of the concepts you have provided. I believe it’s a good idea to call someone within 24 hours after your initial treatment with them. Call to check their response to treatment, and to offer guidance if they are having a reaction or need clarification on a remedial exercise you gave them.

How many times have you heard someone say “I went to XYZ therapist and I was sore for 3 days afterward!”. How many people never seek manual therapy again because the therapist did not follow up to see if the person had an unfavourable reaction?

Just an aside – make sure you have them re-perform the remedial exercise when they come to your office next time to ensure they’re doing it correctly.

Another reconnect is the use of regular mailings to keep in front of your patient base. Newsletters, birthday cards or reminder cards are all ways to stay in their perceptual field to help them remember to make therapy an important aspect of their health care. Many times I have heard the statement “I should have been in before this but…” Reconnecting helps your patients to recognize the value you provide to them.

Just ASK Them What They Think!

The best way to ensure you are meeting the needs of your patients is to Acquire Superior Knowledge. ASK Surveys are an excellent way of finding out information that may not come up in your normal interactions with patients. A short survey with range questions (ranging from unsatisfactory to excellent) can be done over a month period. Let your existing patients know you want to provide the best care, and you would appreciate them taking a few moments to respond to the survey. Survey all your new patients as well – they may provide a very different perspective than someone who’s been treated by you for some time.

You may consider printing questions on 5 by 4-inch cards and providing a shoe box with a slot cut out to ensure that people can fill the survey and return it anonymously. Here are several sample questions:

We strive for excellence in providing your manual therapy. Please help us grow
by completing the following questions as accurately as possible. Feel free to write additional comments on the back of the card.

Rating system: 1 unsatisfactory; 2 poor; 3 satisfactory; 4 good; 5 excellent

Availability: Did you get an appointment when you needed to? 1 2 3 4 5

Environment: How are the temperature, lighting, sound / noise levels? 1 2 3 4 5

How pleased are you with the therapy you’ve been receiving? 1 2 3 4 5

What do you really value, and expect from us? (feel free to use back of card)

Please list three reasons why you would refer someone to our office? (feel free to use back of card)

Thank you for helping us provide better care!

(your clinic name, your signature)

I’d recommend doing this survey every 6 to 12 months to check how well you’re meeting the needs of your patients.

There are a number of ways to give people reason to come back, including
regular self-examination of the therapy experience, keeping in contact through newsletters and cards, and surveying your patient base on a semi-annual or annual basis. If you put great effort into making a great first impression, you will save time, energy and money and your practice will grow bountifully.

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