How to Use Statistics to Improve Your PT Business and Increase Your Revenue with Sturdy McKee

Sturdy McKee is the CEO of San Francisco Sport and Spine Physical Therapy. He is here to talk today about how he manages his business with numbers and statistics, as well as discussing how to do this without your employees feeling like you are acting like big brother.

In This Interview You Will Learn:

  • The metrics you MUST track to manage your PT practice
  • How to affect improve your metrics when they are down, and support them when they are up
  • How to implement metrics into your practice, get your staffs buy in, and have happier and more productive employees

Interview Links:


Carl: Everybody today I’m here with Sturdy McKee CEO us San Francisco Sport and Spine Physical Therapy, I’m really excited to have you here and discuss some lessons from Sturdy about how to manage your business with numbers, without your employees feeling like you’re big brother.

What it is, what it means to manage your business with statistics, why it’s important and ways to implement it and really to talk about how you can use it to improve your business.

So without further ado, thanks for joining me Sturdy.

Sturdy: thanks Carl this is a pleasure.

Carl: cool, so really quickly… Let’s do a quick definition for people who don’t do this yet.
What does it mean to you to manage your business with statistics or manage your business with numbers and why is it important at a high level?

Sturdy: sure at a high-level it… I look at metrics and numbers from a big picture level… Coming from a medical background I think about it as a blood panel with blood tests. And if it’s a lab test, like what you see in a blood test is, [there are] ranges of acceptable levels of different things. Different levels of white blood cell counts, levels of red blood cells, etc. If something is out of range then you don’t necessarily know what’s wrong but you now know where to look. And the way I think about it, I look at it that way, and so in a business it’s very similar. I don’t necessarily know what’s happening if something is out of range, but if I’ve been able to set targets and I know what I’m looking for and I can see that a certain metric is in range… [then] I know that that’s probably operating okay and the business is healthy in that regard. If it’s not [in range] and something is out of range then I’m able to drill down and dig deeper and figure out why that might be.

Carl: got it, so what would you say to some people who just don’t track anything and they just rely on it feeling right?

Sturdy: well I think you’re running [close to the wind] doing that. A lot of business owners do it, not just in the medical field. The key indicator [they are using] is to have money in the bank account and if that’s the case things might be cruising along fine for a while, but again like the medical analogy, if something is going wrong and I’m tracking and watching and monitoring as I go, then I will know it’s going wrong before I end up in an emergency situation.
I don’t have to be quite as reactive. I can, at the very least, react much, much quicker and earlier.

Carl: yes that makes sense and that can really save you and save you a lot of headaches and time and money over time right?

Sturdy: absolutely.

Carl: so you and I know that this is important, was there ever a time where you didn’t realize this was important or did you learn the hard way or did you get some education up front to learn this?

Sturdy: A little of all of it, we learned the hard way. But it wasn’t… It was pretty early on in the business where we were starting to look at [metrics]… Actually going back all the way to the beginning we didn’t know what to look at. We were a bit lost as far as what metrics to follow, to track. I think the amount of information and the availability of that information has improved so much that simply searching and maybe talking with a friend or businessperson, [or a] coach, even briefly, can get you on track to figuring out what a few of the key performance indicators are for whatever business you are in. For us we were struggling for the first couple of years [just] trying to figure out what to do and really in a couple of conversations with people we clued-in to a couple of metrics that were beyond just gross revenue and revenue less expenses.

For us one of those [key metrics] was referral numbers and it was really the first impetus that we had to go and gather data and look at the data. And what we found out was a real turning point and spurred us on to start looking at other numbers and drilling down on other things. And the reason is that the first thing we found out was that about 50% of our total patient referrals came from 2 providers.

That scared me. Because [I realized] if something happened to one of those people, that could be a significant change to our business and might affect our survivability. So immediately what we did was we started broadening our marketing initiatives to get the word out to broaden our referral base. It was very fortunate that we did that because over the course of the next 12 months one of those providers went to Kaiser and completely removed herself from the system and our system. The other one was diagnosed with cancer and passed away, and as tragic as that was, [and as much as we miss him] we were able to survive it without a huge impact [to the business] because while all this was happening we had anticipated and were broadening our referral base so at least we weren’t also dealing with the business in a significant downturn at the same time.

Carl: but what even prompted you to look into that?

Sturdy: caused us to look at the referral numbers?

Carl: yes to even to decide, we need to figure out what numbers to look at in our business, what prompted that?

Sturdy: what prompted us to look at the referral numbers initially was just a conversation with another physical therapist. And what happened was that… When that came up we were talking about referral numbers and how you grow your business and what do you do and… I think the question was along the lines of “Are you deep or are you broad?” and at that point I knew in my gut that we were really good and had solid relationships with a few referring providers, but we didn’t have a lot of different people referring to us. Part of that was just the length of time [we had been] in the market and all that, but we hadn’t made a concerted effort to really broaden that base and when the question was asked of me it made me sit back and go “oh maybe that is important. We need to look at that”.

Then when I gathered the data and actually looked at it, it scared me! I realized that that was a significant risk and that we needed to do something.

Carl: so…

Sturdy: and that whole experience then prompted us to go into… Okay if we discovered that and were able to manage it and survive it, what else were we missing? What else do we not know that would be of use?

Carl: that’s really important, so once you learned that what…let me back up for a second and ask that question that kind of presents for a lot of people, why is this more important today than it really ever has been? Why is paying closer attention to your numbers presently more important to do than it was in the past or do you think it is?

Sturdy: I’m not sure it’s more important per se, if it is more important it is probably because of the speed. There are probably 2 reasons it’s more important, one is the speed at which any availability and reformation so competition can learn and change what they are doing faster. And if you’re not moving forward then somebody is going to pass you. The other is that in our industry the playing field has changed so much. So it’s really… There’re so many changes around the affordable care act and with the advent of accountable care organizations and legislation that’s changed and Medicare compliance issues and just a whole litany of changes and challenges, there are a lot of things that are trying to take your attention, and demand your attention and time, to deal with and by having systems in place that automate and quantify, and give you information in an efficient way, you can free up time to use towards other projects and literally that’s the part that I think is important regardless of whether it’s now or 10 years ago or 20 years from now. We only have a certain amount of time in a day and the more efficient I can be with #1 what I need to know, #2 how I acquire that information and then [#3] be able to react and anticipate and create processes where I don’t have to continually do a lot of manual work and heavy lifting to try and gather the information that I need.

If I can do that then I have freed up my time to work on what is important and the important things are that you are taking care of patients and customers and your staff and managing the customer experience, managing your business relationships and other then projects and things that will make life better for people.

Carl: Right. So for the people who haven’t started there is a lot of people who come out of school without a business education so they don’t think to keep track of these things or keep an eye on these things. If this is so important, why do you think… I guess that’s one reason right there but why do you think they don’t do it or they decide not to monitor or run their business this way?

Sturdy: I think it’s largely emotional, I think there is, #1 there is an ignorance, so if you don’t know what you don’t know then how can you anticipate or deal with that? But [#2] then it becomes emotional as well where… In the medical field is particularly we have been conditioned to compete and be the best and if I don’t know it then that’s a personal failure and with physical therapist for example they have gone through 20 years of schooling where they haven’t had too and they’ve actually in a lot of ways been discouraged from collaborating and working together on things. It is considered cheating in most environments. And I think the same thing is true of medicine and there’s very little time and very few projects devoted to working together as a team and developing those skills. And I think that creates a situation where people are little bit more reluctant to reach out, to be vulnerable, to ask questions, to say that “I don’t know”. Whereas my experience outside of medicine, in the business world, is it’s a team sport. You are not supposed to know everything. Everybody’s goal is not to be the smartest guy in the room and it’s a completely different feel and far more collaborative. I think that’s really some of the base of it… I would encourage people to go on from that kind of educational system, where they’ve actually had to be fairly self-reliant for several years, to start branching out, to start asking questions, to realize that maybe they don’t know and realize to that it might even be more efficient to not just to google stuff and try to search, but to reach out to some people that you do know in your network.

Use social media, use LinkedIn, use your telephone and just ask for help from some people. And that’s hard and that’s an new skill and it’s a different skill from what I think most of us have been conditioned to learn, believe, do for a couple of decades.

Carl: yes that’s a really good point, another thing that I hear pretty often is that people… A lot of practice owners are kind of afraid to implement this because they don’t want to upset their staff or they believe that this might cause them to feel like they are being big brother or being a micromanager, how can… What do you say to that? And how can they do that, how can this be used without that type of feeling?

Sturdy: so part… I think it again they have to take a little bit of context for some of these decisions and some of the things that I believe I’ve learned and I’m still learning along the way… There was one position one job I was in and I think it was a 3 or 4 month review where I was brought into the manager’s office and I was told that I was not hitting productivity.

The problem with that scenario was that no one had told me what the productivity standard was before that. So they were looking at numbers and metrics and going to penalized me for numbers that I didn’t know I was accountable for.
Number 2, just for my own ego, the numbers weren’t correct. I was… I just gathered the data so that just created a huge frustration for me because not only was I being measured against a number that I wasn’t aware of ahead of time but when they did show me the data and I went back and went “wait a minute. That can’t quite be right. I’m coming in early. I’m doing all this…” and I went and gathered the same numbers and showed them, it was interesting because that actually caused more of a problem because of that culture there was a little bit more of the culture of how dare you talk back and tell me I’m wrong. Needless to say I didn’t last they’re terribly long.

But what I’ve done is taken the opposite approach and it’s even published in our job listing, in our posting, what the accountabilities are. So our accountabilities are there, our core values are there and the key performance indicators for the position that we posted for are there so a person can be looking at it and at least get the big picture before they even pick up the phone or start writing an email to us.

They see what their accountabilities are and in my experience in the recruiting and hiring process, as people start to self-select out you get better candidates. You have a better understanding of “this is what I’m accountable for and I can do it”, some are little bit confused by it and you have to have more conversations around it. But that’s part of the recruiting process as part of our hiring process, as part of our onboarding process, as part of our training process. And it’s part of our ongoing management and review process and those numbers, those goalposts, don’t move. They are what they are. And my experience has been that people who work hard and are responsible and want to be held accountable and rewarded for good performance, look at that, get it, work really hard to get there, and those who are able to perform at that level in large part self-manage. And early on in the process, what we’ve learned to do is that we are very open to “look we’re going to go over this every week. If you are not getting there it’s management’s job, in my mind, to help you, to assist you, to give you those resources [you need, and] to make sure that you have the skills to be successful because it only benefits me, you and the whole team, the patients, everybody in the system. If you’re performing and doing and enabled for success, enabled to succeed in your job. And so the other side that coin, I hear what you’re saying, I do believe that there are people and employees that will push back because I’ve seen in recruiting, hiring and even after people have gone through that process and in the training and even after that, employees still occasionally being reluctant or not sure or afraid to reach out and ask for help because they’ve never experienced an environment like this before. And just from a business perspective and a professional perspective, that scares me, it bothers me. I would like to see people given the responsibility to be a professional, given the responsibility to perform but also the authority to make the decisions and to help and reach out for help. And not to believe that they are going to be penalized or get into trouble because they don’t know something. And again that comes back to that conditioning over the first 20 years of their education.

Carl: yes that makes a lot of sense and another kind of notion that I hear a lot is tracking things like productivity, if you’re tracking productivity that may mean, less time with patients or poor patient care. What do you think about that notion?

Sturdy: I think that’s entirely in the managers’ and the owners’ hands. Because if I set up an unrealistic… If I set the metrics, I’m sitting the goals, then I can design those around whatever it is I want to be achieved. So they have to be financially viable in order to keep the business operating because we are not… If we fall short we are not subsidized by the state of California or by the federal government or anybody else.
We have to dig into our own pockets and make up that shortfall. So there has to be a minimum performance standards and you have to, I believe you need to know what you can expect in the way of payment, what your expenses are and then you design your goals and your systems around what your costs are, what you want your revenue to be, what a reasonable profit is, including building a reserve so that you have a safety net, all those basic business principles. But everybody is operating under some sort of productivity standard whether they are more or less conscious of it or they are more or less deliberate about it. But ultimately if paid employees are not producing at a certain level then they are losing money and that’s not a sustainable business model.

Carl: so let’s get into some stuff that’s a little bit more tangible, in your opinion what are the key metrics to measure in a business, in a physical therapy business and how… Yeah let’s start with that?

Sturdy: so, every business has its own set of metrics that it needs to record or follow, and one of the nice things is in a lot of industries there are some pretty clear benchmarks about what some of those things are. In physical therapy the basic numbers I believe are new patients, number of visits, number of units billed, and then there’s revenue, expenses, the number of FTEs. So what we do is we don’t track, well we do track but we really look at the number of revenue producing FTEs, so I’m talking about clinical staff there. And then the number of phone calls, our incoming sales enquiries basically. And from those 7 numbers (and thanks Carl because I didn’t prepare this ahead of time so I got all 7 I think…) From those 7 numbers I think at least… Well I believe you can get most of the ratios and other data numbers that you need. So for example, when you are considering a contract, and the latest dust up here in California is the Cigna and ASH network offering [a new contract] to cap [physical therapy] at $60 a visit, if you don’t know what your cost per visit is then how do you know whether it’s a good contract or not? So I don’t want to sign a contract that’s $60 a visit if my cost per visit is $75 per visit or $85 per visit. So having the total number of visits that you are seeing in your clinic and the total expense that it takes to run your business, you’ve got a very basic number, you’re gross cost per visit, and any contract we sign or anything that we entertain needs to be higher than that. We are not going to try to make up that difference or make up that loss by seeing other insurance carriers’ insureds or people. We are going to opt out of that contract and be able to… that creates its own challenges as well. To convey value and make sure that patients are still going to come to see you and all that.
I’m firmly of the belief that I won’t take a contract at a loss. Increased volume, which is another argument I’ve heard [for taking low contracted rates] at a loss, means I’m losing money faster. And this isn’t an opinion. It does upset people but it’s real easy to just put down the objective information and solve that problem

Carl: yes that totally makes sense… So if you were to… For people who have not implemented anything like this to keep track of new patients, visits, units, revenue, expenses, FTEs and phone calls, very few people track phone calls I know. What would you suggest starting with, all of those or just some of them and how does each one of those metrics apply to each type of employee in the physical therapy business?

Sturdy: okay that’s a big question Carl…

Carl: okay I went a little bit too far but let’s start with… Let’s reel it in and start with like… Would you start with all of those?

Sturdy: let me hit a couple of them. I think it really depends… What I start with is going to be the way I make the decision around this is, what’s urgent, what’s important around me? So if I’m in the midst of being conflicted and all of my energy is being taken up by that example I just used whether I opt in or opt out of a certain network and I know what they’re offering, and I look at what I could potentially negotiate. Or maybe there’s going to be a take it or leave it thing, but I could at least make a stand and say I need this much.

I need to know what my total visit number is and what my total expenses are and then I can figure out what my cost per visit is and then go back to that them and say look I want is… Say my cost per visit is $60 then it’s going to be a break even thing for me. Do I want to work more for no money and so if I go back and say look I want to make sure that… And maybe I don’t want to tell them what the numbers are, but internally I want to make a 15% profit off of that, then I would accept $69. And I could go back to them and say I’ll take $72 and had to haggle a bit and we ended up at $69, $68 or something but I could live with that.
Personally that’s not enough for our business and our model. {our overhead is higher given our model.] But that’s how I would do that thought process. Another thing that I think is really important once you have assured yourself that you are not taking contracts or you’re bleeding money or losing money quickly is… I think it’s a little bit in contrast to what most people think.  We’ve had people and by we, I mean Jerry Durham, my business partner and I, both have had people reach out to us and talk to us about marketing and about increasing the number of new patients. We tend to ask them a few questions and what we quickly realize is most therapists start out [thinking] that the new patient number is going to solve their problems, don’t know how many visits per case they are doing. Then they also don’t want to get into a lot of discussion around what that really means. But at a really high level, my total number of visits divided by my total new patients, and maybe not once a month, but if I start spreading it out over 3 months or 4 months, I get an idea of what I am averaging per case. What I want to look at is what does that look like compared to my average plan of care? And realizing that plans of care vary a great deal, but if I know that the average number of visits, or the average plan of care is written for 11 visits, and I look at my visits per new patient and I see 6 visits, then that would indicate to me that people are not coming in and finishing their course of treatment.

I would need to look at that, as to why is that happening. Is it because they [the patients] don’t see value? Is it because it is too expensive? Is it perception? Are the therapists discussing the plan of care with them during the evaluation and getting, hearing objections and addressing those and modifying and adjusting? Basically it tells me where to look. And if I know that my average plan of care is written for 10 visits and my average patient is showing up for 9.8, then I’m going to move on to the next piece. I’m going to look at my units per visit. I’ll look at my revenue per unit or per visit. I’ll look at [something else].

Another thing to look at, as well, is are you under or over staffed? People tend to want to measure that with vacancies and wait lists on their schedule. But again that is rather reactive. If I set a productivity standard for 40, 50, or 60 visits per week and I know what my visits are. I can then, of course factoring in my paid time off and all, I can look at the number of revenue producing or clinical FTEs and I can actually back into that and figure out how many new patients a month I need to keep my staff busy and set my goals accordingly. And if I need 20 new patients a month or 50 new patients a month and I’m close to that, then maybe I do a little bit of marketing effort and go out and touch my biggest referrers and make sure that everybody is happy and that kind of thing. But if I notice I’m 20 or 30% off the mark then maybe I need to put a little bit more time and energy and effort into having an impact there.

So what I would start first really would be dependent upon where I was in my business and what needs, at least at a gut level to see a problem and look at that and see if it measures up to what I expect. If it meets my expectations and if it does, good. Move on to the next one.

Carl: so rather than give you another giant question, I’m going to be a little bit more specific this time, so let’s talk about therapists productivity and numbers to measure conditions, performance. What do you think is a good way to do that for people?

Sturdy: this one’s up for a lot of debate and discussion. What I want to [preface] preview this one with is, I believe that there is more than one way. So I think that any time someone advocates for this way or that way, we are probably not going to agree. Because even though we’ve chosen, in our business we’ve chosen one specific way to do it, I do believe there is more than one route to get to the destination. And it really depends upon what you want your practice model to be.

In our case we have physical therapists only. Our value proposition is that we’re going to spend time with people. We are going to get them better in fewer visits because we invest that time with them and the therapists are making corrections and adjustments and teaching them and engaging them [throughout their treatment]. In doing so, our business model costs more. Our margins may be lower so we charge a higher price point than some places and actually not a lot higher than quite a few, which is interesting as well, so we are able to do that and we know what our numbers are. And we’re able to run it in this model fairly efficiently and we do know what our targets are and we notice when they are not… when we are not reaching our goals. We react quickly and we make changes.
I think that if you, as a practice owner, sit down and look at the number of hours in a work week and look at the kind of model that you want to have, how many patients per hour and how many you want therapists to be seeing patients. You can then do a calculation of how many visits per week that is. You can bake in the documentation time or billing time, or outreach, or whatever else you want, and then make some decisions about what that means.

We don’t expect our therapists to be productive for every single minute of their work week. And by productive I mean, charging billable hours. We’ve built in 5 or so hours a week of documentation time, billing time, meetings and all the other things that they have to do that we know are not going to be revenue producing. That’s the calculation that people could look at. And that goes right back to the number of FTEs and the productivity and aligning those.

So if I decide, for example, that I want my therapists seeing 60 patient visits per week and with whatever aides or assistants or support or time, or what have you, and if I’m seeing 30 minute visits, 60 patient visits a week is 30 hours of direct patient care. So that would be totally doable if I’m doing half hour or 45 minute evaluations, I can factor in how many of those I need and in order to achieve that.
Then I can do the calculations on, well how many FTEs, how many revenue producing employees do I need to meet that, or how many new patients do I need to keep them busy. The other thing that is going to go into the calculation too is the number of visits per case. So if I expect 20 visits per case, 60 visits per week at that on average I need to see 3 new evaluations a week. I expect 10 visits per case then I need 6 new evaluations per week on average. And again these are all averages. There are going to be weeks where it’s half, weeks where it may be double. That’s fine, but over time it needs to smooth out or I’m doing again reacting and not planning and setting realistic goals. By the way, those are just numbers thrown out for the calculations. Those are not real targets.

Carl: so once somebody decides on what they think is right for their practice in terms of how they want to manage the productivity of their staff, if they haven’t implemented anything already… What are some ways they can introduce this and get started?

Sturdy: any time you change something like this or you try to build a culture of accountability where one hasn’t existed before, there is risk. There may be push back. There may be people who decide to lead. There may be people who are perfectly capable that just don’t like the concept of it. So knowing that ahead of time, and being able to have a discussion and a conversation and really listen to your staff and employees around what their concerns are, and being able to address those and reassure them, I think is actually a critical component of the whole thing.

It’s not, at least in my mind, that difficult to design it. But to get buy-in from your current staff, and to make sure that they are all happy with it, and know what’s expected them moving forward is probably the most… that’s the bigger challenge for me. Now the other good thing in the industry is talking to people, listening to them, hearing what might get in their way and being able to address that, and being empathetic with the whole thing is actually a skill set that most therapists have cultivated and are able to do. So, that might actually be the easier part for some folks. Getting that buy-in and getting the agreement from their staff with the understanding that, yes this is a process and we’re… also with the caveat that, this is what I’ve come up with, or what do you think? Or, how would you design it? But in the first iteration, it is the first iteration, subject to change. This may not work exactly like you think it’s going to. So, we will be revisiting this. We will be coming back to this. We will be talking about it. And we’ll be making changes as needed until we get it dialed in properly for our practice.

Carl: yes that’s a good point, I mean they do have to go in with it and it is going to be a big change so they should expect it to be a big change.

Sturdy: the owner ought too also. The owner or the manager ought to realize that this change and this transition needs to be managed like any other change. It’s not something that you can go in and announce at a staff meeting and expect everyone to, with a smiley happy face, go oh yeah great, sure, we’re on it. Therapists in my experience take time to process, they take time to… They want the time to process. They want the time to think about it. They want the time to respond, react, have and to be heard, and to make changes potentially. If you as the owner or manager don’t go into it with those expectations, that this isn’t something that we are going to announce on Tuesday and implement the followingMonday, but that we are introducing the concepts, we want to hear your feedback, we want to move forward with this, setting with them a timeline. Their expectations, re-assessments and check-ins, keeping the lines of communication open. [Do this] and I think you’re going to manage the change more effectively.

Carl: yes that makes a ton of sense I especially like involving them in it as much as they can be, they’ll feel a lot better about it that way.

Sturdy: much better. And you may find that there are things you had not anticipated, that you weren’t thinking about that you need to think about and include in the process.

Carl: yes for can you give… I just want to do 2 more things, do an example of something you notice by doing this, where you are able to… A number where it wasn’t where you want to be, you made a change, what you did and why and then what happened. So an example of some number, that wasn’t where it should be?

Sturdy: Do you want a success or failure?

Carl: let’s do both, you can start with either one, let’s start with the failure first.

Sturdy: Let’s do the same thing and with 2 different people… So I think that might actually be useful for folks. We had a therapist, this is a few years ago, actually as more years go by, it was quite a few years ago. But what we were looking at was… she’d come from a neural background and wanted to do out-patient ortho. And we normally wouldn’t have brought somebody in who didn’t have more orthopedic training, but we were familiar with the person, [she had] good thought process, good clinical skills, very good reasoning, professional, mature and we decided well, let’s take a risk. We’ll do this.
We had multiple locations and that’s relevant too because when she came in to one clinic what we started looking at was, the first few months went by, the visits per case weren’t… they weren’t matching up with her plans of care. And we have a general target and that’s what alerted us to take a look. We then looked at it… And again if you set your target, whatever it is 6 or 8 or 10, or whatever, visits per case, and you find somebody coming in with 40% below, there are a couple of different possibilities there. One is the plan of care. Are they writing it the same way you would, in the same way your most skilled clinician would? And we went in and looked at that and number one we found that she wasn’t. The plans of care didn’t really match up with what our other key performers, top performers were doing. And then patients also weren’t attending with the frequency that she had written in her plans of care. So we went through 2 things and initially there was quite a bit of resistance. Her response was that people wasn’t showing up because of the location. It was unique to this clinic and what have you. We didn’t believe that but around the same time she was also transferring to another clinic anyway coincidentally so, she went to the other location and we decided to do a little clinical mentoring, discuss plans of care, have her look at some of those things. What we ended up finding was that the same things were happening over at the new location.

To her credit when we sat down and talked with her again about this, and this was a kind of an ongoing conversation not something that we showed up one day with 3 people and said look this is what’s going to happen. We showed her her numbers. We showed her the numbers at the old location, [and] at the new location that they weren’t really different. We also pulled charts, her own charts from 6 months earlier and had her read through the evaluation and asked her if she would write the same plans of care today that she did then. When she looked at them she actually made quite a few changes, and said “No, I wouldn’t do this. I would do that.” We thought well, if that’s the case, do you think you may have still things to learn about different diagnoses and treatments, prognoses and stuff, and she agreed that yes she probably did. We put her together with a clinical mentor to go over her charts more frequently, to look at her plans of care, to bounce ideas off of, to get feedback and experience sharing. Her plans of care changed and the other thing we did with that was clinical mentor was to have them start working a lot more on communication with… between her and her patients. So actually doing some observing. Talking about how to discuss the plans of care with her patients. To make sure that they understood that this was what in her clinical expertise she believed to be the most efficient way to achieve their goal. And hear what any issues might be, including why. [Like] I am moving in 2 weeks, or I’m going to change jobs and be busy, or I can’t afford it, or whatever the objections were. But figure out ways to address those, deal with the issue as opposed to changing the plan of care. Because if we come up with what we think is truly going to be the most effective and efficient way to get the patient to achieve their goals, then that’s the last thing I want to modify. And, again to her credit she took that feedback, that information, it was a longer process, it was a bigger investment, she was able to make those changes, her “numbers” came up, but it wasn’t… I want to make the point hear that the numbers didn’t come up because she was focused on the numbers. The numbers came up because she was focused on the process and she was willing to learn. And she did the things that she needed to do each day and the numbers reflected that.

Simply focusing on “we need to get more visits” wasn’t going to achieve anything.

And then to tell you more, we’ve had the failure a couple of times where it’s essentially had and tried the same process and we’ve had people resist and be upset that they were going to be paired with somebody to teach them. Again, I think that some of this goes back to that conditioning that, I’m very smart and I know a lot and therefore I… It’s an insult to me to have to study under someone. That is something we now screen for. It’s one of our core values. We want people to strive for excellence and knowledge. We want them to learn. I believe I always have things to learn. I can learn something from every one. I learn things from my kids [all the time]. So if I can learn from them every day and every week, I can certainly learn from somebody who has 10 or 20 years of clinical experience and business experience. And maybe I don’t learn everything but there’s… they certainly… they have to know something that I don’t know and I value that.

Carl: yeah that’s great. Awesome I think that’s really a lot of great information and I don’t think we need to take that any further. Do you have any parting advice for people who are just getting into this and just getting started?

Sturdy: sure, I think the big one is that… Just to remember that courage or bravery is not the absence of fear, but being afraid and doing it anyway. I think that we too often look at it in a reluctant [way], either due to lack of experience or being afraid that we’re going to find out I’ve been doing it wrong. And I don’t want to confront that or… There are a lot of emotions that come into all of this as we learn and grow and change, and that’s okay. Ride it out. Still learn, and grow. We all have lots and lots of room to grow and learn. And despite being graciously interviewed by you, I still have lots of mistakes we’re making every day, and lots of things we need to do better. And the more able I am to get over myself and confront those things, the better off it will be for everybody.

Carl: for sure that’s… That applies in any business.

Sturdy: anybody who’s had a business knows that or has the experience too.

Carl: thanks so much and if anybody wants to reach out to you, how can they do that?

Sturdy: email, call, the easiest way to catch me is probably with Twitter. @Sturdy. I’m easy to find there.

Carl: how did you pull that off? Started early?

Sturdy: I’m an early adopter… That’s an easy way to reach me and it’s actually a fun way. I love it. I love the things I’ve learned from other people on there and the people I’ve connected with. It’s been an amazing resource, that even when I first got on I had no idea what kind of knowledge and exchange and sharing and people you meet and stuff there.

Carl: awesome thanks so much for doing this.

Sturdy: no problem! Thank you Carl. It’s fun. Actually, good questions too. You’re making me think.

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