151: The Pivot in Chiropractic

The Pivot in Chiropractic

Hi everybody. Welcome to the KC ChiroPulse podcast brought to you by Kats Consultants, helping doctors keep their pulse on success.

I'm your host, Dr. Michael Perusich. I'm joined by my co host, Dr. Troy Fox.

Troy, you just got back from vacation. You look a little tan.

Yeah, I, uh, We've got a little sun. Um, that is kind of where the pivot came from. We've talked about the pivot in practice a lot of times, but I had a major pivot moment, um, a week and a half ago.

So I got ready to go on vacation. Friday afternoon, came around, going to fly out about three o'clock on Saturday morning. I was going to Key West. and you were maybe gonna come visit me, us. I was gonna come visit. Yeah. And Bridget was trying to check us in. Nothing was working. So all of a sudden she realizes our trip is planned for the wrong week.

And, you know, we had moved roughly 280 patients. So probably wasn't, probably wasn't going to work to switch it again. So he texts me because I'm on the golf course, which where else would I be? Right. I'm on the golf course. And she texts me and says, you better give me a tech, give me a call when you leave the golf course.

So I called her and she says, Oh my gosh, our travel agent had a snafu scheduled us for the wrong week to go to Key West. And. It was one of those deals where all of a sudden your heart kind of sinks cause you're thinking, Oh no, maybe I'm not going to get my vacation. But I said, all right, let me think about it on the way home.

I'll be back in about 10, 15 minutes. And so I'm driving home and I'm thinking we can make this work. We just, we just need to pivot. We need to come up with a new plan. So we get back and call the travel agent and said, I know you probably can't get us to Key West this like tomorrow. Um, and you probably can't get flights.

No. I said, Can you get us to Mexico by Sunday? Oh, absolutely. No problem. 15 minutes later, we were scheduled and went to Mexico. Now here's, here's the great part. Sometimes there's a little sunshine at the end of the rainbow with a pivot, right? Yep. But this was a sunshine at the end of the rainbow. It was cloudy and rainy in Key West all week.

It was beautiful and sunny in Mexico the whole time I was there, except for the morning that we left to come home. So, the pivot worked. And quite frankly, I think a lot of times in practice, we forget to pivot. We get paralyzed when something doesn't go the way that we expect that it should. And we get caught like a deer in the headlights because we're not prepared.

Now, I wasn't prepared for this pivot. Trust me, this, I've never went, huh, I wonder what would happen if we planned a vacation the wrong week. So this was kind of a last minute deal. But from a standpoint of in our practice, we have an opportunity to prepare for some of those situations in advance to be ready to pivot.

And I think it's an important thing that we do in our practice. Because you're going to have patients that come in that maybe don't fit the, the, the, the, the round hole that you put them in there a square peg that day, because they come in for an adjustment and they walk through the door and they literally end up in your adjusting room and go, by the way, doc, I fell yesterday and I, I, my shoulders all screwed up.

Can you take a look at it? Yep. And you don't have time scheduled for that. What are you going to do? Right. So now all of a sudden you got to pivot. You got to decide, do we work around this? Do we talk to this patient? And do we say, well, you know, unfortunately we don't have the time to look at that right now because we're in adjusting hours right now, but I would be more than happy to get you set up in a time slot so we can take all the time that we need to do a full exam on you.

How do you handle those situations? So the pivot is very important because it can dictate not only. Your attitude and how fun practice is for you, because quite frankly, it should be fun for us to go to work every day and we're doing what we love. Oh my gosh. We're doing what we love, but it also dictates the patient's attitude.

If the, if the pivot is handled correctly, they go with it and they love it. And they realize that you have their best interest at heart. If it's handled inappropriately. You might end up losing a patient over it because they're upset because you couldn't bend your schedule and meet their desires because they have no idea why you're not meeting their schedule.

Yeah. And those pivots happen all the time and how you handle it. Really shows a couple of things. It shows number one, how well developed you and your team are. If you've, if you've fought through a lot of these things, and I'm not saying you can think through everything, but if you practice, what happens if somebody comes in with, you know, a major hip issue, for example.

And in reality, it's the shoulder like you had the pivot still the same, the conditions different, but the pivots the same. So it's, it speaks to how well developed you and your team are as far as practicing these kinds of things. But it also speaks to your professionalism because that's what the patient sees.

And if the patient sees, you just kind of fall apart and you don't know what to do. And you're calling somebody and you're telling the patient, you know, no, or making excuses. And then you lose your professionalism. When you lose your professionalism, you lose your doctor authority. And you'll lose the patient's confidence.

So we have to be able to pivot in times like that. Oh my gosh, I mean, we could probably talk for three hours on how many different pivots we've had in practice before. But, you know, I can think of one in particular. It was an emergency pivot. We had a patient that walked in the front door, elderly woman, and, uh, she walked up to the front desk, checked in, turned to go sit in one of the chairs in the, in the waiting room.

And as she turned, she spiral fractured her femur, fell to pieces, literally on the lobby floor. However, my team knew how to handle it. One of my team members immediately went, got everybody out of the waiting room and brought them to the back and escort them down a back hall to where they could get to their cars.

We asked them to just. Please be respectful and go ahead and leave. We'd practiced it. One of my other staff immediately went and got me, told me what happened. I'm with a patient. They escorted the patient out. I went over, checked on the woman, told my staff to call 9 1 1. So we had practiced this. So all this happened in like a minute.

Now, had we not practiced it, had we not been developed and trained and ready for that pivot, That pivot wouldn't have looked like that. That poor patient would have laid there on the floor for a while. We'd have been running around helter skelter. Probably patients in the waiting room would have been trying to help.

The reality is, we looked like we were really professional. We looked like an emergency room. Like we really knew what we were doing. We weren't rattled by it. Right. You when we talk about, I know we talk about this all the time we talk about training and development, but you need to add these pivot ideas in there.

What happens if a patient comes in as an emergency? What happens if a patient comes in and they're complaining of headaches and so forth and only to find out that two hours ago in football practice, they wound up with a grade two concussion, you know, what do we do when these crazy things walk in the door?

And docs, if you're not seeing crazy things, if you're not seeing things that you need to pivot on, You're not paying attention. And these are great things for you to look at with, and we talk about this a lot as well, staff meetings and morning and afternoon huddles. Yep. So you can discuss scenarios and staff meetings.

And then there are times when a scenario happens that you've never seen before. And it's a great time in a morning huddle or an afternoon huddle to discuss it quickly. Before you go into the next day, if this type of situation happens again, we handle it exactly like we did the other day. Great job guys, or we don't handle it quite the same.

We did this and this really well. I would add this in next time. And it's just something you can throw into your huddle real quick, um, because every day there's something different. The huddle for me is a catch all, you know, when I go into my huddle, I may, Huh? I may talk about a tight spot on our schedule, or I may talk about how we handled a patient situation the day before or that morning or whatever, just so we can kind of cover it.

And then we'll probably cover it a little more in depth in our next staff meeting. That's where the real meat comes out. Because in staff meetings, we have time that we're all sitting around. Uh, with each other and then we can actually we can actually kind of, you know, really break things down eviscerated as it may be and and put it back together and figure out what works best for you.

So staff meetings, you know, they're super important. And I see a lot of cases where people go. Well, I've only got. You know, two people to work for me. We, we talk about everything in advance. We still have staff meetings. I have a very small staff and we still have staff meetings on the regular because it's important.

Not only do we talk about things that happen in the clinic, but the other training things that need to be discussed from a standpoint of staff. So they can be support for you as the doctor. So I think, I think training is very important when it comes to the pivot, because if you train well together, it's just like in a football game.

Not everything goes to plan. You know, I watched, uh, I watched, I watched the KU - K-State game not too long ago. And I thought K State was just going to blow KU out of the water and KU came in with this incredible running game and you could tell maybe K State kind of expected it, but they had no answer for it in the first half of the game.

They had to pivot. And we see that a lot in football games where teams come back out after the half and they've made either personnel changes or changes in coverage to handle that. They, they probably display the pivot better than anybody else I've ever seen. And as a team, we can operate in the same way.

You may not get it right the first time, but gosh, darn it. You can get it right the second time. You can plan for it. Right. And you know, and it's little things, you know, Think of the part of the country that you're in. Do you deal with tornadoes? Do you deal with, uh, potential heavy snowfalls or ice storms, those kind of things?

You know, how can the weather affect your practice? I can remember a couple of times where, um, we had an unexpected tornado warning and we had patients in the clinic. What do you do? Do you just run around like a chicken with your head cut off trying to figure out where to hide or do you protect the patients first?

Do you have a plan of action and have you practiced it? What if somebody has a heart attack in your office? Um, you know, that happened to us. Somebody had a massive heart attack in the office. Well, luckily we knew CPR. We had an AED and we knew to call 911 immediately. You know, have you practiced it? You know, we had rehearsed things like that.

We'd rehearsed fire drills and everybody knew where the fire extinguisher extinguished. Those things that put out fires, everybody knew where they were, but he, but he, but he, that's all folks. Yeah. Um, everybody knew where the exits are and how to get patients out of the building in case of those kinds of things.

So, you know, There are so many different pivots that happen in practice. Here's another one. What if the compliance rules change? We had a major compliance rule change a couple years ago. No surprises act and we have to give certain patients a good faith estimate. We still see doctors that aren't doing those, you know, why?

Because they haven't pivoted to incorporate it as a new procedure into their practice yet. So, these pivots can not only protect your practice, but they can bring you professionalism, they can bring you doctor authority, they can really make you look good in front of patients, in front of the community, depending on what it is.

Um, so we have to learn how to make these pivots work in our favor. Yeah, I think it's, it's one of those things where a well prepared staff and doctor make you, make you look from a standpoint of, of professionalism, they make you look like the best option there is out there from a standpoint of going, I don't even know where I went with that.

I lost it about halfway through, but basically you look, you look like such a professional that everybody wants to come see you. Um, it's, it's amazing. And I hear this from patients not to toot my staff's horn, but I'm going to toot their horn a little bit. I have patients come in that go, we're coming to see you because of what we've heard out in the community about how professional you are, uh, the type of care that you give your staff is incredible, you know, they hear all these wonderful things and we're not, you know, one of these offices that has 8, 000 Google reviews.

We're a lot of word of mouth, small town, small, you know, we're in a small town. Uh, the Yelper view is what everybody else in town says about you. It doesn't have to make it to the internet. These folks will tell their friends and they're going to tell them whether they should or should not come and see you.

And when patients are walking through the door saying you do a fantastic job, you know, that you are pivoting appropriately at the right times and that you've got a plan in place, you're about everything. And I think you just hit the nail on the head. Do you have a plan in place for everything? Are you ready for what can happen on any given day?

This is where one place is where your huddles come into play and you, you mentioned this, but when you have your huddles and if you're not having huddles, you need to have huddles because these are really important when you get together in the morning or at the beginning of a day apart for even just five minutes and you going through the patient list, who's coming in today.

That's one little thing that makes you more prepared. And it could be a pivot of nothing else of, Hey, Barb's coming in today. Barb likes to talk. How are we going to shift enough to doc disengage from the patient so we can keep him on time? You know, it's those little things, you know, that's another kind of pivot.

Use those huddles, use those staff meetings to practice these kind of things. And you guys hear me say this a lot. There's such a difference between teaching and training. We can say to everybody, Hey, if there's a fire, get out of the building. When the fire happens, if a fire happens, and you hope it doesn't.

If fire happens, will they still react? Will they remember what to do or will they panic? And we all know what happens when people panic and we can panic over, you know, somebody coming in with an acute shoulder that we didn't expect somebody spiral fracturing their femur in the middle of your waiting room or a tornado coming through town.

We don't want to panic. We want to make sure that we respond to all those things appropriately and in a business professional like manner, because that's what gets out in the community. And you want everybody to realize that, Hey, that chiropractic clinic is the place to go for everything because they know what they're doing.

And it's the difference between teaching and training. Teaching is giving somebody a piece of paper and saying, read this and remember it. Like school that's teaching. That's why they call them teachers. And I'm not saying anything against teachers. My wife was a teacher. So I love teachers But there's a difference between teaching and training and going back to your football team obviously the KU players had practiced all week probably some new plays and things that K State hadn't seen and They really drilled down on how that performance was going to happen.

They prepared all week long K State hadn't, K State's the one that had to make the pivot, but K U made the pivot earlier in the week. So you, you want to get ahead of the pivots as much as you can. That's the trick. It's to be thinking of many, as many scenarios as you possibly can. And again, you won't think of them all of all of them.

Yeah. I want to, I want to close this out today with a key that you can use a tip you can use in your practice. Cause this is a pretty broad topic. And so it's like, okay, they're talking about pivot. How does this apply to my practice? You'll probably sit down later after you listen to this and come up with some things that you need to work on.

But here's the one tip I'm going to give you, you referred back to this, uh, just a few moments ago, Dr. Paroosh. It's that huddle in the morning when you talk about your patients. We do this morning and afternoon. We look at our schedule. We figure out where our tight spots are at. This patient requires a little extra time.

These folks right here are, you know, pretty quick to jump on the table. They're always in a hurry to get adjusted and hit the road. And so we kind of know where the flow is and what it looks like. One of the most important things that you can do during the day is have the whole staff on the same page when it's, when it comes to working with patients, you wonder how practices grow.

There's a little tip for you. It's a, it's just a little nuance that happens during the day, but every single session, every single day, we get together and we huddle and we talk about these things because that's how we get better and that's how we become more efficient for our patients. So our patients don't feel like one that they're waiting on us.

And number two, they feel like we're well prepared for them. When they walk in the door, I've got staff sometimes meeting people at the front door. Hey, Susie come on back with me. We're going to go ahead and get you set up over here. Doctor's going to be in with you in just a minute. Why don't you go ahead and take your shoes off and get ready?

Because I know that you want a Dr. Fox to work on your feet today to adjust your feet. And so, you know, you have a patient like that, that maybe has an extra, uh, request that you're going to work on. Well, we can prepare for that and be ready to go. So use that time in the morning when you're talking with staff, you'll be amazed if you guys run through the schedule real quick and just take a look at it.

I think you'll find that you have more room in your schedule and you run more efficiently during the day, which will make you and your staff happier. I'm going to read you one little line out of the Oxford Dictionary. It's the definition of practice. Perform an activity or exercise or a skill repeatedly or regularly in order to improve or maintain one's proficiency.

That's what practice is about. It's about being prepared for the pivots that are going to happen on a daily basis by practicing, rehearsing, performing over and over till you master, master the skill.

Awesome. Good topic. Perfect. Dr. Fox. Yeah.

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