Thursday, July 30, 2009

Why They Come...

Regardless of what your professional health related profession might be, it is likely that there are just four reasons why your patients/clients come to you.

1. It hurts when I...
2. I can't do...
3. I'm afraid that...
4. I want to be able to...

Sure, there are of course signs and symptoms, a diagnosis, contraindications, precautions, complications, and compensations. But, when it comes to a decision to seek professional help concerning matters of health, the client's greatest interest is in quality of life and doing the things they enjoy or aspire to do - some for the first time, some for the last time, and some for the meantime.

They find pain and limited capacity getting in the way of living life. They find there are things they use to be able to do that no longer come easily or perhaps not at all.

They express fear in losing ability, independence, freedom. They express fear of impairment, disability, and death.

They express hope of achieving new opportunities.

Life is in the doing. Life is in all of the "ings" ...walking, running, jumping, eating, playing, hugging; the list goes on... Ultimately, that is why they come.

Life is all about function. Its about hope, and purpose and movement and achievement. It's about holding on to what one has, increasing the opportunity for more, and sharing those things with others they care about.

That's why they come. They come to be recognized. They come to be understood. They come for a measure of wholeness. They come for living life.

That's why they come.


(c) copyright 2009
Performance Builders
Sunday, July 26, 2009


"Advice is like snow; the softer it falls, the longer it dwells upon, and deeper it sinks into the mind." - Samuel Taylor Coleridge
Thursday, July 23, 2009

Right Size

I've had a few interesting conversations with Clients this week around business and the economy. Fundamentally, all three discussions came down to the same point... Each of them said in their own way, "I've been in practice for some time now and am struggling to make ends meet. What should I do? Where do I start?

Each had cash flow problems and practice wasn't much fun any more.

Interestingly I received the same reply from all three owners when I asked what their profit margin was?" Each reply was simple and to the point, "I don't know." There was more than a small twitch of uncomfortableness in each of their responses. Interestingly all three had been in business for some time and each had an accountant... Even more revealing was their response when I asked what their intended profitability was. Again, each said they didn't know.

So how does one address issues of cash flow when they don't know their profitability? They don't! Thus the problem...

Whether one is an owner or an employee, profitability matters - its either a matter of return on investment for you and your family, or its a matter of job security for you and your family. Either way it matters!

Every business with revenue has an opportunity to make a profit regardless of the amount of revenue that is coming in. But, only if one knows their profit or loss, and where the money is going before they get their share. Its a simple matter of right sizing expenses for the revenue that is coming in. Doing so means tough decisions but it also means profitability.

So here's today's question whether you are an owner, manager, employee, or independent contractor, "What is your profitability?" You can't afford to not know! And, "What could it be?" "What portion of your family's reward are you leaving on the table every year, every month, every day?" "How much will you lose over the course of your career?" How do you change the situation quickly?

Every business is challenged by cash flow and profitability at one time or another. There is no shame in that. Business owners with a financial background face such issues head-on. Clinical practice owners tend to avoid such discussions and such honesty and candor. Remember, the first responsibility of a leader is to define reality. "What is your reality?" "Are you working harder?" "Are you worrying more?" "Do you have a plan to change your reality? Do you need help?

Its all about right sizing your business based on reality and opportunity... based on revenue and expense. Your reality is not fixed. It can begin to change overnight with the simple power of a decision! What is your decision... status-quo or greater prosperity? That is your first decision...

Let me know if I can be of help...


(c) Copyright 2009
Performance Builders
Tuesday, July 21, 2009


"Your future is based on the level of consciousness you hold as you make the choices that build it." - Alan Cohen
Sunday, July 19, 2009


I'm frequently called to work with business owners on matters pertaining to the selection of business partners and negotiating terms with them.

I had an interesting conversation recently with two practice owners. Both were considering potential business partners for their respective practices. Neither had fully considered the criteria for what would make a good, or even acceptable business partner.

Of course we discussed core issues of compatibility - purpose, vision, values, culture, communications, etc. Then there were matters of work style, skill sets, risk taking, decision making, commitment, loyalty, entrepreneurism, motivation, and persistence. There were also matters of what value prospective partners would bring to the practice - strategic, relational, and financial.

After some conversation it was apparent that neither of them were considering viable partners.
Both had been just days away from making what certainly would have proven to be very bad decisions.

Due diligence is crucial, as is the intuition that comes only with experience in such matters. Like marriage, the "divorce" rate among partners is high - very high. None last forever, but some are predictably dead right out of the starting gates.

One can not afford to allow the selection of partners to be a casual or sentimental process.

Partner considerations make employee hire selections appear insignificant by comparison. Partners bring with them either the seeds for success or failure. Those seeds are planted the moment the partnership is executed. Too often the seeds are those of weeds.

Proceed cautiously. Work diligently. Choose wisely!


(c) Copyright 2009
Performance Builders
Saturday, July 18, 2009


“With the eyes of the mind he gazed upon those things which nature has denied to human sight.” - Ovid
Tuesday, July 14, 2009

Certain Uncertainty

The national debate continues on the topic of universal health insurance or some variation of it. It remains uncertain what the outcome will be precisely, but a few things appear nearly certain - demand for and utilization of services can be expected to to increase as the baby boomers move toward retirement and age related functional impairments set it, and reimbursement will continue to erode.

I also suspect the PT labor shortage is likely to continue. It will be driven by the reality of the financial gap associated with 7 years of expense for a DPT and constrained clinical earning potential. The need for business savvy as well and clinical expertise will become ever more appearent.

These factors set up a scenario where reimbursement erosion coupled with labor expense escalation will put increasing pressure on practice profitability and thus viability. In such a scenario some practices will do reasonably well, others will not. The 50% of practices that currently operate at or below average profitability will suffer - not all will survive. Most of those practices don't realize what they are missing or what they are risking. Most do recognize however that they are working harder, worrying more, getting less reward, and finding frustration in the process.

Practice change is eminent. It's coming fast and its undeniable. The only uncertainty is how individual practices will respond. The future will not be fixed by national associations. The future will be determined one owner and one practice at at time. Its time to be proactive - time to get one's practice in order - strategically, operationally, and financially. The clock is ticking. Playing catchup is a loosing strategy as is compacency and denial. There are no special considerations for those who are not paying attention to what is going on around them. Ignoring reality is a fatal decision for practice owners and those they employ and serve.

Do you have your priorities in place? Do you have a plan? Are you working that plan? Is it working?

Have you guaranteed your practices profitability and viability in times of uncertainty? Do you know where to start? If you do get started. If you don't get help. These are urgent times.


(c) copyright 2009
Performance Builders
Sunday, July 12, 2009


"The better answer goes to those who ask the better question." Bob Wiersma
Thursday, July 9, 2009

What All Great Practices Do...

All Great Practices are competent in relationships.
All Great Practices treat people with respect and dignity.
All Great Practices build trust and deliver value.
All Great Practices communicate accurately and transparently.
All Great Practices confront reality.
All Great Practices ask why?
All Great Practices debate openly about what is right and best.
All Great Practices speak publicly with one voice.
All Great Practices make timely decisions.
All Great Practices make commitments and live by them.
All Great Practices set high goals and care that they achieve them.
All Great Practices value accountability.
All Great Practices are good stewards of their resources.
All Great Practices make money.
All Great Practices take risks.
All Great Practices learn from their mistakes.
All Great Practices take pride in what they do.
All Great Practices celebrate achievement.
All Great Practices have fun and don't take themselves too seriously.
All Great Practices reward contribution.
All Great Practices take pride in the facilities and hospitality they offer.
All Great Practices are servants to clients and each other.
All Great Practices excel in performance.
All Great Practices measure performance.
All Great Practices give people opportunities to grow & contribute based on knowledge & talent.
All Great Practices give back to the community.


(c) copyright 2009
Performance Builders
Tuesday, July 7, 2009


"Don't be put off by people who know what is not possible. Do what needs to be done, and check to see if it was impossible only after you are done." - Paul Hawken
Sunday, July 5, 2009

Performance Matters - Idea #28

The first responsibility of a leader is to define reality and the last is to say thank you. In between the leader is a servant of those who follow. (para-phrased from Max DePree)

It is the leader's privilege to position others for imminent and certain success. ...To play to people's strengths. ...To enable other to do more of what they do best. ...To help others expand their repertoire of what they do well, and to provide support for those things that followers don't do well.

The leader's role is to provide support and to create a nurturing, productive, effective, and sustainable culture. That is no easy task. It is not something that happens in an environment of self centeredness or neglect. It is not something that happens in business cultures deficient in trust, honest debate, commitment, accountability, and results.

Leaders need to provide vision, establish priorities, provide resources, dialog, accountability, discipline, recognition, and rewards. Leaders need to demonstrate vulnerability and integrity.

Whether there is success or failure, it is the leaders responsibility.

The measure of a leader is not in the number of followers they have, but in the number of successful leaders they produce.

Lead well.


(c) copyright 2009
Performance Builders
Friday, July 3, 2009


"Do not be fooled by waiting for the ending. Sometimes the middle is more important." - Alan Cohen
Thursday, July 2, 2009

Performance Matters - Idea #27

Hire good people who you have confidence in. Take the time to get to know them personally as well as professionally. Meet their family. Do something recreational/social. Put a challenge to them to see how they respond under pressure. Check their references - probe! Put them through leadership and work style assessment tools to discover their natural tendencies. Interview multiple times. Include team members in the interviews. Get consensus.

Avoid filling positions with “a body” – it will always be a disappointment and will always harm the organization eventually. Harm comes in many forms - financial, lost reputation, eroded morale, lost opportunity, damaged relationships, loss of trust, wasted time... the list goes on.

Pick good people who share your cultural values, work ethic, and practice philosophy. If people aren't working out after hiring do yourself and them a favor and terminate them - do so graciously and generously, don't burn bridges, but part company - the sooner the better. No one bats a 1000 when it comes to hires. Give your self permission to make an occasional mistake in hiring but not the permission to make a second mistake by not firing.

If people truly are an organizations greatest resource make sure the people you hire and retain are the greatest resource.


(c) copyright 2009
Performance Builders
Wednesday, July 1, 2009


"Do not seek to follow in the footsteps of the wise. Seek what they sought." - Matsuo Basho