Customer Experience In Occupational and Physical Therapies

Jerry: I have seen physical therapists actually push back and say we’re not in the service industry. And that’s unfortunate because we are, I’m just going to put it out there. We are in the service industry so we have to understand that there is service to be delivered.

Jimmy: Welcome to FOXcast OT, A podcast for clinicians made by clinicians. It’s brought to you by FOX Rehabilitation. Find out more at foxrehab.org.

Jimmy: Welcome to FOXcast OT. I’m your host physical therapist Jimmy McKay. Special guests on the show is Jerry Durham. Jerry welcome to the program. I say a patient experience expert and I always want to follow that or maybe lead with that is your a physical therapist.

Jerry: Yes I am a physical therapist which sometimes I have to remind myself.

Jimmy: If you follow Jerry on Twitter what is it. What is your handle again?

Jerry: Jerry_DurhamPT

Jimmy: How do you sum up when you’re in an Uber and someone says, “What do you do?” How do you explain to someone? Because even within the field of physical therapy I don’t think people see what you do is clearly as how you explain it.

Jerry: Great question. The shortest pitch I make is I’m bringing customer service to health care and it’s bigger than that yet. That’s going to grab 99.9% Of people to say, “Oh I get it.” Because then what happens when I say that everybody goes, “Yeah it sucks” and I’m like “cool because I’m going to change it.”

Jimmy: Also with us is Jason Hazel physical therapist. Doctor of physical therapy with the practice here at FOX Rehabilitation and explain a little bit about what you do.

Jason : Yeah. My role here with the practice, I’m the vice president of senior living partnerships. Main goal and objective is to take the partners that we currently serve and ensure both clinically and from an experience perspective we’re delivering consistently across our 16 state footprint. And then going out and find new partners and we know that from the clinical delivery of what we package and do that it’s darn good and we scream from the mountaintops. Where we think our next step from an evolutionary perspective of the practice is to continue to engage at a higher level to make sure the experience that our partner both the owner operators and the residents within the senior living communities just have a wonderful experience not only with the clinical care. But just the engagement in activity with us and I’ve been a follower of Jerry’s on Twitter for years and here about a month ago I saw him pop up with more Phillies and Eagles gear than I had ever seen and I think that guy lives right down the road now. So so Jimmy and I got on the horn and and pinged Jerry and said come over to the home office and meet a few of our folks and we feel like we’re probably kindred spirits and we think in very similar ways and I wanted to poach a little bit of his time and get him on our podcast and get the word out. I wanted Jerry to become a friend of the practice because I felt like he was where he was just on the wrong coast. So his commutes a lot shorter now.

Jerry: Oh yeah way shorter.

Jimmy: So why we why we bring in somebody who works on customer experience and a physical therapy podcast? I mean physical therapists listen to this show that work with older adults. So I guess our first thing I wanted to get into where does the client experience begin and end and who’s responsible for that? You know you never want to work in a practice where “that’s not my job.” This is your thing. You pay attention to. Where’s that experience begin and who’s who’s responsible who owns that?

Jerry: Love that. Just for context I’ve already sat through a couple talks here at FOX for about an hour and they had some great conversations and even got to meet the founder, Mr. FOX himself. And I love it because I’m going to reference something real quick that he said in this word service experience. It’s so funny. I remember. And you’ve probably seen it on Twitter. I have seen physical therapist actually push back and say we’re not in the service industry, and that’s unfortunate because we are just going to put it out there. I’m not going to argue it or discuss it now. We are in the service industry so we have to understand that there is service to be delivered. With that said I will answer your question now. The experience starts the moment they see your brand. Right. Let’s say you’re patient. So I’m going call your clients because I like that word better. Your clients might be introduced to your brand through the through the living facility right, someone there yet, That is the first touch point. So how that information is presented how it’s received everything is when that experience starts and then your potential client. Because I love when everybody says, “oh a new patient called today to schedule.” And I’m like,”did they schedule, no?” Well then they’re not a new patient, they’re a potential patient or client. Then it continues every touch point along the way as part of that experience they call the office right. They get scheduled. Someone arrives at the house. The conversation, the way the physical therapist provider, not only physical therapist, is dressed, the conversation that occurs, the things that are left behind, the equipment used, the follow up visit-everything. And then here’s my favorite thing. There is no discharge, there’s never discharge. Right? You get someone at an assisted living facility who is mainly in their space and they have lost some mobility. Now they’re on a walker-and there’s no one I know who’s excited to use a walker-and their primary goal is to get off this Walker so that they can get back in the community. And you as a physical therapist just spent four, six, eight weeks with this person building a relationship-a professional relationship-that you cannot disconnect the personal from, and you get them to achieve their goals. And you have high fives and you take a video with them outside now and you’ve given them freedom that they never thought they could have. And now you’re going to discharge them. I’m so confused. No other industry on the face of the Earth does that. Now that doesn’t mean you keep them on care. It doesn’t mean you keep billing them for something. It doesn’t mean you try to upsell them equipment. It means they stay in touch with you. What does that mean. I don’t know a phone call and e-mail something. So the relationship never ends right?

Jason : Yeah.

Jerry: Touchpoint, the relationship never ends. And then who’s in charge of each of those is important as hell. And I talked about this with Travis earlier love talking. Travis is understanding there needs to be ownership of each step and the person who owns it has the accountability. That’s my other favorite word, the patient experience has accountability built into it. And if you understand who owns this step they get to make the decisions. They’re the person who owns it that’s fine. Yet they’re accountable for the decision that was made. And I’ve seen that too much in my practice right over the years of “wait a minute what happened here? Who dropped the ball.” And then you step back and you’re yelling at people as the owner and going,”Holy crap I never made anybody responsible for this.” So, so many good things come out of mapping out this patient experience. So many good things. And back to another reason I love FOX and what they’re doing. When you go to the website it’s not all patient first, patient focused. It is. And then you start to dig deeper and I read some writings by Tim talking about it’s really about the employees. And we can call it happy employees call it what you want, yet it’s it’s about trained properly employees, a great culture built around making sure your employees are happy, which trickles down to the customer.

Jimmy: Make sure they know that they’re a part of this. You know they’re not waiting for you to see something and will tell you what to do. Right? Jobs used to say that, “hire smart people, wait for them tell us what to do.” I don’t care what position in the customer experience you’re in, you’re responsible, we need to hear that from you. Right. You’ve got to tell the story real quick. The first story that.

Jerry: I love I love that you tagged onto this because this is one of my favorites.

Jimmy: So how did you figure out some of those touch points you have practices in San Francisco. How did this one activity or one thing they did to figure some of those points out maybe where you were failing or where there were opportunities to succeed.

Jerry: So I spend and would spend the majority of my time with my front desk team and I’m doing the quotes thing with my finger. What I would do is, I would sit in our waiting room. I’d grab my cell phone pretend like I was looking down-most of the patient client customers didn’t recognize me as the owner. I was able to listen and visually see what was occurring at just about every single touch point in my company from the waiting area. So I stole the phrase from Tom Peters. He’s used to call it managing by walking around. I called it managing by sitting in your waiting area. And I’ve encouraged every practice owner ever to do this and think about this for a second because we had a waiting area that fed into an open gym that was right next to four private treatment rooms, so I could hear a first phone call. A new patient phone call carrier. I could hear a current customer calling for something. I could watch a current customer walk in engage with my front desk. I could watch a new patient walk in and engage with my front desk. I could watch a provider and listen and greet a new patient. I could watch a provider greet an existing patient. I could watch a provider come out of an evaluation of the private room and walk them to the front desk and hear that conversation. I could hear conversations of providers with current customers but that was actually where I learned the difference between why one of my top performers had the lowest noshow council rate and one of the other ones had the highest when it would appear and sound like they were doing everything exactly the same.

Jimmy: What was the difference maker?

Jerry: The difference was I always used to say that a good P.T., the best P.T., doesn’t talk, because they allow their patient to talk. So one day I’m sitting in the waiting area and I hear my best P.T measured by no counts or a completed plans of care and my lower performing P.T. were both talking the whole time and I just let it go. That day I was like whoa that there is blown out of the water because they’re both talking so I reflected on it and just said well now I need to go back and listen to the content. So I went back a few days later with the focus on the content. What I found was the lowest achieving provider was talking and when they were talking it was taking what the patient was sharing with them and flipping it into them. So they would talk about their favorite NBA team. They would flip it into their favorite NBA team. The patient would talk about their dog they’d flip it into their dog. Right? Everything. My top performer talked the whole freakin time. At the end of the 45 minutes, I knew nothing about her-zero. There was nothing about her personally. Periodically you know the patient throws some stuff and yet never spoke about herself right. She was talking the whole time and it was about you Jimmy and why you’re doing this exercise and how was it last time and this is why you’re going to do it, and this is going to build into this. And you talked about this and was a huge football fan and she’d still talk about your football team. And so that was the realization that it’s not about the quantity. It’s about the quality. And I learned that from the waiting room.

Jimmy: Who was this experience about? It’s about the patient.

Jerry: And so it was so cool because it was like the live petri dish of it all. Right? And it all coming together.

Jimmy: Recognizing it and knowing that you have a problem is the first step or as I say opportunities for improvement.

Jerry: I like that way better.

Jimmy: How would you tell someone a practitioner, an owner, anybody along that spectrum of opportunity what do they need to do first and what can they do better what can they do?

Jerry: I had this conversation with Travis, this is good, I’m glad you asked this. That patient experience I spoke about the steps in the accountabilities. The first thing to do with people is to show them the patient journey-visualize the patient journey for everybody in your company so that they can see the path, the one the patient takes, because everybody takes pretty much the same path. And then what I like to do is highlight, and I do by color coding, who is the owner of that step. Well you’re going to realize that most people are going to realize there are many many steps outside of themselves that occur for them to be successful once they see that and you understand everybody else’s role in the company. It’s easier to have just that conversation. It’s easier for me to go back and go, “Jimmy, OK now we went through the steps. Do you get those.”

Jimmy: Yeah.

Jerry: Now you understand the conversation that started on the first step and what information you need.

Jimmy: Yeah.

Jerry: Now are you getting this? Are you getting this information properly from the front desk? And then you say, “yea.” OK. There seems to be a disconnect somewhere in here, so we need to chat about it right? I don’t know what it is, yet if you understand it to that point then you and I can sit down and have a non-personal, “you’re attacking me” type conversation. OK. We know the information is getting in here. Let’s just try to figure out, is it your patients who maybe aren’t understanding the information? Do we need to change the way we’re sharing it, or are you just not sharing it? So if you understand that whole journey first and who owns the steps and what work has gone into it then it’s easier to do that.

Jimmy: Yeah.

Jerry: It clears it up. I call it a visualization of your culture. I hated the word culture up until about a year ago until I started mapping these out. So in an interview, I pushed the paper across from a front desk person, a P.T. This is what we’re doing at this company. By the way, “here’s your role.” And my goal would be there would be people opting out going “I’m just here to treat people” or “I’m just here to answer a phone.” I’d say “cool, good luck to you.” I want someone else to go. “Wow that’s really cool. I get to…” And I’m a little biased towards the front desk. So many use their example. “Wow. I’m not just here to answer the phone. I’m here to help the company be successful. I’m here to help people get better. I thought I was just applying to answer the phone.” No, your role here is far bigger than that.

Jason : First impression. Generally the first engagement a client has and if we don’t get it right there. Oh boy.

Jimmy: You’re automatically going uphill.

Jason : We set ourselves up for failure. So Jerry one of the things that I’ve seen you do in addition to just the client experience-you know putting putting that methodology together and seeing the full spectrum is- is the the art of of selling your practice. And I’m curious how did those two things tie together and what’s the tip of the iceberg for the secret sauce? How do you do it? How do you go to practice owners that are saying I don’t have enough folks coming through the front door? How do I sell better?

Jerry: I think the last part of that question is really the best part of the question. Everybody wants more new patients and I say you’re wrong. You don’t want more new patients. You want more people calling your practice who are the right fit for your practice. So everybody will nod their head yes and agree and I say “OK now let’s identify who’s the right fit for your practice.” So step number one. It’s so funny how it’s all foundational right? And speaking 130 percent from experience, we skipped the foundational stuff and think everything else is going to work out great, identifying who you want to serve in your community, and by that I would take it one step further. “Well who do I want to serve in my community, I want to serve everybody.” And I say, “OK, can’t do that.” And that’s a recipe for disaster. Look at Apple, look at Dell, look at Harley Davidson, right? People buying Harley’s aren’t looking at Honda and vice versa. Right? People looking at Apples aren’t looking at Dell’s and vice versa. So who do you want to serve in your community? “Well you know what Jerry. I believe that I can help female runners who are postpartum,” and I’m like, “now we’re on to something.” Ok awesome. Write that down. Step two, and it’s only two things yet, it’s probably not the most difficult. One of the most difficult things you’ll do in your practice. Step two is now, what are you going to serve them with? “Well I’m going to give them physical therapy.” “OK. Now where are you?” “I’m in Charlotte North Carolina.” “Quick, Google physical therapy for me would you? How many hats were there? Right? Now Google post-partum female runners who want to get healthy. Now how many hits come out? Wait a minute. That’s a lot less right?” So identify who you’re going to serve, what you’re going to serve them with, and then train everybody in your company how we’re going to train them right near you. Then the selling process becomes easier because by the way now you’re just educating. Now you’re just sharing information. Now you’re just asking a lot of questions in order to engage this person who called you right to see if ABC physical therapy is the right fit for them and then the selling process becomes so much easier.

Jason : So a lot of the confusion and subsequently failure, it sounds like, can come from not knowing who you want to serve and what you want to do as a practice.

Jerry: Yeah.

Jason : And folks just come in with this mixed bag approach of we’ll be jacks of all trades, masters of none. And because they don’t know their own identity, their subsequent clients have no idea what the identity of that practice is. So they choose to go elsewhere.

Jimmy: You aren’t even sure what you’re here to serve at that point. To use something that both you guys like, baseball, you can put me on the field but I don’t get a position on playing. Yeah I know I’m a baseball player.

Jerry: You’re inside the foul lines. Where do I go?

Jimmy: Right. Now if I don’t know that. How can I help the team be successful? Also, that’s probably why people check out a lot. I don’t know what I’m supposed to do here, I don’t know what my expectations are, so I feel weird. I feel awkward a lot so I’m going to I’m not going to do a great job and I’m probably going to be looking to get out.

Jason : Certainly one of the things Dr. FOX got right was twenty years ago. He wanted to serve older adults under an outpatient model in their home. Oh yeah. And he pinpointed an area and said that’s the individual that we’re going to target. It’s a evergrowing underserved population in our country that we said we found this model that can that can effectively serve him.

Jerry: And after talking to Travis I know you guys even go deeper than that so.

Jason : I just wanted to throw that in there.

Jerry: I Just want people to understand that it even goes deeper and you guys understand I start a lot of my talks like this. It’s, who will benefit from your service the most is the person you need to be serving. And I use the example of why did you schedule this person who doesn’t fit any of your criteria in that 9 o’clock slot on Tuesday, when you had this other person called who who checks all that criteria? Who would engage you. Who wouldn’t cancel. Who would pay on time, who do all these things and would achieve the outcomes you know they could. But you put this person in here that you shouldn’t put in there and that’s part of the cell cycle is figuring out who’s not fit.

Jimmy: Last thing we’ll bring up.

Jerry: Giants?

Jason : He’s in the town of champions now with a different sport.

Jerry: Oh oh oh oh I love it. I was pulling you know once my Niners were not going anywhere, so I was a Niner fan and then watching the Eagles and knowing and by the way for the record of which I have, Philadelphia is the best sports city in America. So I was so excited come here.

Jimmy: Dilly Dilly! If you knock it down to a couple a handful of variables and how you measure customer experience success what would they be? And as many as you’re a few as you want.

Jerry: Completed plans of care, and you guys are doing some like that as I learned from Travis, which is the only other person I’ve ever heard bring that term up – completed a plan of care.

Jason : And get rid of the word discharge. That was you. You got to one of the questions I had jotted down and sent over to Jimmy before we even got there. And it was like OK, you know my dentist my GP does not discharge me. Why as a physical therapist should I discharge my client? For us, it’s an older adult, who’s the most generally, the most medically-fragile population that we need to stay engaged with.

Jerry: “I’m just calling to check in and see how you’re doing.”

Jason : What a great customer service experience.

Jerry: By the way your follow up question, is “How are you doing today?”.

Jimmy: What’s a better word? So obviously discharge is out. I don’t love “I’m putting you on hold.”

Jerry: I call it a complete course of care.

Jimmy: OK you got it. But that sounds final, like we’re done.

Jerry: So that’s what I was going to say. So within the company, within the rooms, within the training, you are completing a course of care Jimmy. Now you come up with a script by the way, of which I do for people, of how the last visit gets managed and the terminology that gets used.

Jimmy: Because those words matter big time now, because this is the end, but we don’t want it to be the end.

Jerry: Correct. So you’re still talking about it’s great that you got through this. It’s great you got to the goals you wanted, you got on that cane. And that’s why I was here this time. So this is the conversation that’s coming out around completed course of care. I got out a discussion this week about that discharge word. The problem with discharge, is I’m finally coming to realize, is it’s more the mindset of the provider. I think you’ll love that, because and it just really hit me so so we can say, so saying completed course of care I swear is more for a provider mind set of not going.

Jason : I washed my hands, we’re done for good. I never see you again.

Jerry: So you do need to script out the words matter thing you guys have seen that were popping up everywhere and I jump on every conversation and go “can we agree words matter outside of the treatment room?”

Jason : Sure.

Jerry: Like how you answer the phone.

Jason : Yes sir.

Jerry: Right. “Can I get your insurance information.” No. “Can I find out your name. Can I hear your story. Can I you know find out what you need from us.” Oh and by the way at the end of the conversation right “how did you want to pay for this? Are you going to use insurance that you want?” You know, not oh great. Yes Jerry we can get you schedule what insurance do you have? Words matter. Discharge all these other things. They matter.

Jimmy: Love that. Web site if people want to take another look at what Jerry is doing out there is JerryDurhamPT.com, and e-mail address and contact information is all on there. I don’t know if I know another more active person on Twitter, not sure if I do.

Jason : Not always about P.T. He’ll throw a couple bourbons in there, a couple of gym photos. Livin the life, and not just talking the talk, but walking the walk, and lots of sports references for sure.

Jimmy: Also another podcast you guys are doing out there with Andrew Rothschild.

Jerry: Yeah and let me let me preface something there so it’s health care disruption, which I love, and Andrew and I started it with the mission that the disruption in health care is really just people it’s not technology. And we started with this idea of around let’s just talk about how to engage people better. And this is it’s come together so well, and the Mike Eisenhart’s which I saw you’ve had on the podcast for FOX, and people be familiar with having the Mike Eisenhart’s on there. And Mike’s not teaching anything technology-wise, treatment-wise, he is talking about a new mindset around how to manage people and that’s all we’re doing by the way, both employees and patients. And so health care disruption pretty soon is going to I’m not changing the name or anything but I’m going to roll out a whole front desk series because I have a bunch of stuff. A bunch of content and it’s all going to be about that front end engagement which I call the voice of the company because that phone call is your voice of the company.

Jimmy: Everybody rowing the boat in the same direction that matters all over the practice. Jerry, appreciate your time and your insight. For people to continue this conversation, just follow Jerry on Twitter. He’ll get to that rabbit hole that you want to get to.

Jerry: See me and my dogs eat breakfast.

Jimmy: Thanks for listening to FOXcast OT. It’s brought to you by FOX Rehabilitation. FOX clinicians work hard, love their work, and get the respect they deserve. Sound good? Then you’ll love the autonomy to work in your own style and the support you get to achieve excellence, plus freedom and flexibility to have a personal life, whether it’s your first day or you’ve been around for a while. Your contribution is acknowledged and rewarded. That’s what makes FOX a success. Happy well-trained clinicians make great health care. Are you a fit for FOX? Find out now at foxrehab.org