The 20% Rule: Why Your Technical Skills Are NOT The ONLY Reason Patients Stay or Get Better With John Woolf, PT, PhD

[00:00:00] The research over the past year and a half that really kind of rocked the landscape is this, the idea that only about 20% of a treatment outcome can be attributed to the actual thing that you do to a patient. Like the actual treatment itself, only 20%, that accounts for only 20% of the total outcome.

[00:00:22] Welcome to the Private Practice Owners Club. Your hosts and coaches, Nathan Shields scaled his practice and exited for millions, while Adam Robin went from working 60 hours a week in one clinic to scaling to multiple clinics while working less than four hours per week remotely. This podcast is meant to share with you exactly how they did it and how you can build a business that supports the lifestyle that you truly desire. And don't forget to join the Private Practice Owners Club community on Facebook.

[00:00:49] Where we are obsessed with providing even more resources that help owners just like you win the game of private practice. Hello and welcome to the Private Practice Owners Club. I'm your host, Nathan Shields. And I've got a past guest coming back to us, John Woolf, who is the owner of Patient Success Systems. Did I say it right? Patient Success Systems? That's right. Right.

[00:01:17] He was a guest of ours. Oh, it was probably back in, it might've been five years ago or more last time I had you on, John, right? Yeah. Yeah. And I think we were talking about the patient experience at that time as well. But you are, you are and have been committed to the patient experience, right? And what we're talking about today, which is really interesting and you're going to share a lot of information about it and I'll relate what I can to it.

[00:01:42] But it's about how whatever we're doing with patients clinically has significantly less to do with our actual skill, the technicality of our therapy than it does other factors. And so, I mean, I just team it up like that. Where would you like to start the conversation? Yeah. Well, it's great to be back. And, you know, I think this is probably an expansion of the five year ago conversation that we started, which was, you know, the idea of patient experience.

[00:02:10] And I suspect if I was beating the same drum that I'm beating now, it was the idea that, you know, a whole lot more goes into a clinical outcome than just the treatment techniques that we do. And I had known that, I had known that because I was a private practice owner and I recognized that we had a lot of nine clinics and we had a lot of therapists.

[00:02:34] And I realized that those who were getting the best outcomes were not the same therapists that were the best technical treatment ones. If you're a private practice owner whose schedule is packed, but your bank account doesn't show it, this is going to be for you. You're paying your staff, your biller, your landlord before you even get to pay yourself.

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[00:03:30] Without working more hours or compromising the care that you want to give. Tickets are $4.97 and seats are going to be limited. Get your tickets now by using the link inside the show notes. So you can do the best, you know, these guys were, some of them were doing the best possible cervical mobilizations and manipulations, but yet they weren't keeping their schedules filled. They didn't necessarily get great reviews from their customers, from their patients.

[00:03:57] And it just led me to wonder what, you know, what is it that keeps a patient and moves a patient forward in a treatment plan to keep them engaged? And I suppose, you know, a lot of us have been thinking about this, but I got super curious. And after we sold our clinics, I just went back to school and got a PhD in psychology to try to really get into the, why does this work? You know, what's so important about a therapist that communicates well with you and connects with you well?

[00:04:23] And, you know, I just got into the, which took a deep dive into the content and, you know, learn some stuff. Yeah, I think I saw a lot of this myself and you're putting words to it that maybe I use different vocabulary over my time, but I remember distinctly hiring a clinic director at one location and his skills were questionable.

[00:04:48] And I think I knew that going into it, but I also knew that he had a personality type, an ability to connect with people that I wasn't worried about it. And I don't know why I wasn't worried about it. Like I, I probably should have been more like, dude, we need to shore up your skills here and get you set up. But he got the clinic full, right? I mean, we were starting from ground zero. So this was a new location and he got the clinic full. Patients came to see him.

[00:05:17] And let me share this one anecdote, because I think it lends to your, what your claim is. And what the studies are backing up is that he had, he eventually had a McKenzie certified therapist join his team. He saw this one patient a few times and said, Hey, you would do well with my other provider right in line with what you need. And the McKenzie protocol would do great. Send him over there. Three weeks later, the patient gets back on his schedule and he's like, Hey, how are you doing? He's like, man, I'm doing great.

[00:05:46] He's like, well, why are you on my schedule? And he's like, cause I like how you provide care. You like, he couldn't, he couldn't understand. The patient was like, well, I want to come see you. That guy has the magic hands, but I want to come see you. And so I think that lends to what you're talking about a little bit. It does. Could that therapist have gotten him to that point? Maybe, but the patient was led back to him for one reason or another. Yeah.

[00:06:13] And you probably recognized it when you trusted this guy in the position. He had it, right? He had something. And the it, what is the it that some therapists have and other therapists don't have? And that was kind of my research question. Is there something that a therapist has, the it, that others simply don't have? And sometimes you have a connectability or we call it a relatability. That's kind of innate.

[00:06:42] Innate is kind of like, you just naturally have it. And sometimes, you know, we can point people out who naturally seem to be friendly, connect, affable, a bunch of other cool psychological, you know, descriptive terms. And then other people who, in spite of the fact that they're really well hands-on trained, may or may not be as connectable. And so there's this balancing act of like, what is this thing that, what is the it that some therapists have and other therapists don't have?

[00:07:10] And if somebody doesn't have the it, like the best it, like the best connectability, can you improve that connectability? I mean, even if they don't, aren't born with it or they haven't practiced it their whole lives, can it be nevertheless improved as a result of training? Yeah. And that's what I keep thinking.

[00:07:28] I go, you know, I started to shift the fact that we needed to not just train, you know, great hands-on techniques, but we also needed to train the fact that you can be more connectable to more successfully connect with a patient in a way that creates, Nathan, what you just described is this perceived value. The value for that person wasn't the best, you know, extension exercises further back.

[00:07:55] It was the care and the connectability and the kind of the, and there are a bunch of different words you can use here, but like the camaraderie that you have when you're in a treatment environment, like someone who's there with you as you progress through a thing. I'm thinking more and more, that's really what, what patients want is this ability to connect, feel like they belong, they're cared for. That they're being heard. That they're being heard. That we're aligned.

[00:08:22] Like you understand what I'm looking to do and your treatment falls in line with that. And part of it makes me think it goes back to something as simple as, you know, if I'm going to spend a good portion of my week with you two, three times a week, separated from work, family, friends, hobbies, or even nothing, which some people would rather do than therapy. I better like you. If you're a jerk or if I don't like you, then good luck in staying engaged in that physical therapy course of care.

[00:08:52] Right. Right. And so that, that means a lot. And I think sometimes I'll judge owners, especially ones who are starting out based on their personality, frankly, I wonder how this guy's going to do. I wonder how this girl's going to do because they don't seem very affable. They don't seem very relatable to use your word. And, um, I like to see how this goes, but I have seen people who are like that, that are not as likable personality wise.

[00:09:18] And if they've been successful, it's because they've surrounded themselves with higher than normal people, people. The people around them love being with people from front desk to support teams to everyone else. They're like above average extroverts want to know what's going on. And so they have to actually, it seems like overcompensate with other personalities on the team. Yeah.

[00:09:46] I wonder the degree to which they kind of do that automatically or if there's some like true intentionality, like, you know. They recognize the fault. Yeah. Do they actually recognize the fault? And I think this is probably what you talk about regularly as a being a successful leader in a business. I mean, you really have to have some reflective capacity to kind of know where, you know, your strengths are not.

[00:10:10] And if you surround yourself with people like that or even, you know, we got to the point where, you know, we were interviewing therapists. And yeah, we wanted, they have to be capable. They really have to be good diagnosticians. Sure. Appoint treatments, creating treatment plans. But our number one variable was the degree to which they could connect.

[00:10:28] Because if you can't connect and keep that relationship, and we call it the therapeutic relationship, if you can't do that, you know, the chances that you're going to be able to successfully put all those cool manual skills in play decrease. Because the patient, like you said, they've got other important things to do in their lives. And I mean, and you use the word like to be likable. That's a pretty good descriptor. Sure.

[00:10:54] In part, because if you are spending time with someone, and I always try to teach it this way. I say, you know, imagine a patient. We can all do this. They're busy. They got a lot going on. And yeah, they have some pain. They have some things. And you finally get them to the point where they're just feeling like better, but not great. And you know that if you were to continue on a treatment plan for another, I'll just use arbitrary, two and a half more weeks or eight more visits, you could get them functioning so much better.

[00:11:23] But yet they get feeling better enough. And they're like, is it really worth going back? Or am I okay? And I'm going to say the deciding factor oftentimes is the perception that, well, I'm not just getting cool exercises, which are good and hands-on care, but I'm also experiencing something. When I go to that place, although I had to drive there, I had to park. It was a co-pay. Your co-pay. Co-pay. But the perception of the value is high enough.

[00:11:51] And if the therapist is relatable and you couple the skill with, so that relatable skill is one, but then you couple the idea, the other skill of communication that helps them understand the treatment plan and the importance of a treatment plan. And I don't like using the phraseology of selling a treatment plan. I mean, we are, you know, everybody sells. Okay, that book's out there. But, you know, at the same time, I think what we're doing is we're collaborating with a patient to create a treatment plan that they want to invest in.

[00:12:21] And then investment means the ongoing realization of the value. Right. Okay. Yeah, they're getting better. And I enjoy the process. And that's a variable that's different for each person because each person, each patient is going to have a different criteria for what's really valuable to them. Yeah, I've noticed as I've coached some clients, those who have focused on the patient experience for whatever reason, maybe they got some feedback, maybe they want to improve engagement.

[00:12:48] Maybe they're looking at some metrics to improve their business altogether. But these things will ultimately improve patient results as well. Those who have focused on the patient experience and improving the different touch points, like one client I recall, he wanted to make sure when a patient comes into the office that they're having positive experiences through all senses or as many senses as possible. Right. There needs to be good smells.

[00:13:18] The front waiting room, maybe even the treatment room needs to be aesthetically pleasing. Right. They need to be hearing nice things. Maybe there's a small waterfall in the corner or some nice music that's enjoyable and pleasant, not off-putting. Right. So trying to touch as many senses as possible to make it a pleasing experience. But then also really focusing on what is that interaction at the front desk look like? What words are we using? How much are we asking them to do? Right.

[00:13:48] How easy is the process? How simple? How fluid? How can we get them from point A to point B in a pleasant way? In a five? How can we make that patient experience a five-star experience? Right. When they did that, then frequency of visits per week improved, cancellation rates go down, people stay longer for their protocols. I've seen it in a number of clients that I've worked with. Yeah.

[00:14:14] You know, your clients are seeing it likely in the way that you're kind of guiding them into it is if you approach it from a true customer perspective, not unlike a Marriott would. And they have customers that are clearly defined with clear values, a clear value proposition for the customer. And that is to provide a five-star experience. Well, it's interesting. You know, we as clinicians in the healthcare industry, it's not necessarily one of our very top criteria.

[00:14:42] It's like how do we provide a five-star experience? And yet, when you apply that concept because you know it's important, not just for business success, and I think you know I'm kind of a nerd on the clinical outcomes spectrum as well, that it actually makes a difference in clinical outcomes. And yeah, this is where I got squirreled up in just part of my research and scholarly work is what are these mechanisms? You know, why?

[00:15:09] I totally buy into this idea that this experience is critically important, obviously. I can talk about it all day. But part of my curiosity is like, why does this work? And how does this work? Like, you know, because I love it and helping other people understand it and teaching the skills. This is fantastic. But there's still, in my mind, a curiosity. Like, why is this so important to patients? And the research recently has just, you know, it's kind of opened the floodgates to asking these questions.

[00:15:38] Where now, many of us in manual therapy are really investigating what these mechanisms are. You know, why is it so important to have this connectability? And, you know, the research over the past year and a half that really kind of rocked the landscape is this. The idea that only about 20% of a treatment outcome can be attributed to the actual thing that you do to a patient. Like, the actual treatment itself, only 20%. That accounts for only 20% of the total outcome.

[00:16:08] That's amazing. I thought so, too. I said, geez, that's a number. And, of course, you know, the methodology on some of these papers is being questioned. But that number gives everybody pause to say, wait a minute, there's a lot more going on here. Well, even if they were off a little bit. All right. Let's say you're off by 5% or 5% or 10%. Yeah, maybe it's 40, 60 or 50, 50. That still means that a majority of what you're providing technically has nothing to do with what you're doing technically.

[00:16:38] That's right. And I'd even go as far as to say, you know, the technical skill, you know, this is kind of a weird way of thinking about it. But sometimes we think of a technical skill as the perfect application of a mobilization or the application of some motor control training. That's a technical skill. Sure. But I'd go as far as to say, you know, the language that you're using is also a technical skill. Sure. And the emotion state that you show up with is also a technical skill. For sure.

[00:17:05] These are technical insofar as they're also techniques. Right. Right? Yeah. And, well, if you work on your technical skills and you know that 80% of your outcome could be, might be, is attributed to the things beyond the technical skills you use with your hands or your clinical reasoning to apply a treatment plan, it's about the relationship. We must slow this down and go, well, there's a whole lot more technical skills that I need to gain. Mm-hmm.

[00:17:35] In communication, in interpersonal emotion regulation. These are all technical terms. But there's a lot of technical terms that we use when we use and put our hands on patients. Right. I mean, well, there's a whole technology there. Let's just say it that way. The technology of getting a thing to move better or a muscle to activate better. For sure. That's great technology. Well, the technology of connecting with people to create a healing response in a therapeutic environment, there's a bunch of cool technical stuff in there.

[00:18:04] And, I mean, I could talk about that more than anyone is interested in hearing it probably. But it's wicked cool. Yeah, so I'm thinking about an owner who maybe has one of these people on their team that could benefit from learning how to not to apply their technical skills better, but the other related skills outside of what they can do with their hands and with their brain. Where would you start with them as an owner who has that kind of person?

[00:18:35] And maybe with the optimism of saying, maybe we can train this person to be better at their relatability to the patients or their connectivity to the patients. Where would you recommend an owner start with helping that person? Yeah, good question. There are very few of these kind of courses and trainings out there available.

[00:18:58] You know, if you compare those kind of skills training to your shoulder courses or your unique courses, you're like... Those are easy. Yeah, there's plenty of those. And so, you know, full disclosure, I've been teaching this stuff for a long time and so I teach this stuff. So it'd be a little too self-promoting for me to say, call me or go to my website. So I won't do that. I could say, though, also that if you're a business owner and practice owner, you know, there's the old saying of what gets measured can get managed.

[00:19:28] You can't manage what you can't measure. So one of the first questions I ask for companies that I do systems consultation with, like relationship-centered care is what I've basically been promoting. And if you're not measuring relationship, it's very difficult to manage it. And so the question I ask business owners is, well, how are you managing? How are you measuring your relationship with your customers? Okay. Right. And most people are going to say, well, we use an NPS or some equivalent, right?

[00:19:57] Which was part of my dissertation for a while and I kind of kicked it out because the validity was so difficult to actually define and the construct was a little sketchy. And does it really apply to healthcare anyway? And the answer is, I think so. It's useful. It's a starting point. It's a starting point. It's a starting point. But how do you get a little bit more granular and not asking more questions on a survey, but asking the right questions on a survey? Yeah, because an NPS score is going to be post facto.

[00:20:27] I mean, they're typically done their thing. But we're talking about how do you keep them engaged in the moment? Correct. And how do you assess how they're... How engaged they are. How a patient is doing in their perception of how it's going. Yeah. And that has to be done at the first visit and with each therapist. And it's a simple, easy set of questions that ask the degree to which the patient feels like this is a good match.

[00:20:54] And that, of course, you ask a question like that and their patient's brain is going to go, well, a good match. What does a match mean? What does a match mean? Actually, they probably couldn't even describe it, but they could feel it. I can see that. And that's almost what we're trying to explore. Okay. The degree to which a patient feels like they belong. That's a really key component in the experience of the patient. Do I belong here?

[00:21:22] And they're going to formulate the sense of belonging in the very first phone call they get from your clinic. And the very first time they walk in the door and like when your client said, the number of experiences, their full sensation of sensory experiences are going to factor into it.

[00:21:40] The very first things you say to a patient when they come in, the degree to which you match the ways in which they're telling their story and the time that you give them to tell your story. And the way that you affirm some of the emotions and the empathic cues and a bunch of other cool technical stuff. So you have to be able to measure it. And you can. We have, you know, some really scientific based surveys that are out there.

[00:22:06] And we're trying to leverage those to make them a little bit more practical for business owners to kind of go, well, how do I scale this kind of a question, these kind of questions? And we did it pretty successfully. And of course, we incentivized our front desk and all the colleagues on our team to say, you know, the incentive, the most important part of the survey based incentive is participation. So we almost don't care about how you score necessarily because what we really want is the information that we can help work and improve our team. Okay. Yeah.

[00:22:35] But we do need participation. Sure. So each therapist essentially was incentivized, a very practical incentive to get a return rate on these things at 95%. Oh, okay. I mean, we need the information. We're not going to penalize you or reward you for how you do on the information. It's the information that helps to create this potential growth that we're trying to get. Right, right, right, right. Okay. I see that. Yeah. So if you can measure it, you're already getting a sense of who.

[00:23:05] And then with the interesting part, you start correlating those outcomes to the other KPIs that you're looking at. Like what are their cancellation notions? What are their visits per plan of care? Right. What is the return rate of that patient to that therapist? Right. And the MPS is always a part of that too.

[00:23:26] And if you've got a really robust data processing engagement platform with your customers, you're also tracking the number of referrals that that patient actually made to your clinic, which also matters. Yeah. I remember one of my first coaches highly recommending, I never did it, highly recommending that I videotape my interactions with patients.

[00:23:52] That way, what comes to me naturally could start being systematized and then trained into future providers, right? Because there is a reason why most owners are successful off the bat. There's something, they have some kind of magic that they can't, maybe they can't speak to because it comes to them naturally. It's an eight.

[00:24:14] But if you were able to visualize it via a recording of some kind and then set up some kind of structure or make some notes about each one, that those kind of things could be trained into other providers. Like this is how I did this. You watch this clip of this video. This is where I feel like I'm relating to the person. This is where I'm rewarding their problem to represent. Am I clear? Are we understanding we're on the same page that this is the issue?

[00:24:43] Or am I clear as to where you really want to go with this? What are your goals? Can I restate those appropriately? Am I matching maybe tone levels? You know, are they coming in really depressed and I'm up here with cheerleader energy? That's not going to mesh well, right? Am I doing appropriately there? So there's a number of those things that you could do to, and now as you're talking about, I'm thinking about, those are ways that we could train in some of that relatability, likability.

[00:25:13] Because like I said, most of us who do have better metrics, patients are coming more frequently. We have less cancellations. And the owners tend to do really well at this because they're incentivized to do really well at this outside of their technical skills. They would do well to train it in that regard. Yeah. That is a training methodology, right? Like, hey.

[00:25:38] And if, you know, it's like sometimes we have words for what we're training. And this is partly what I've been exploring for some time now. It's like sometimes we're doing something really, really well in terms of communication, but we really don't know what we're doing. Yes. So I teach a class on this stuff, a content class, and people show up and they go, oh, I've been doing that. I said, probably. And they go, but I didn't know what it was.

[00:26:03] And as soon as you can label it, as soon as you can name it, the chances that you can teach it in a scalable fashion increases. Right. Right. It's almost like you can't, it's difficult to teach something unless you know what it is that you're teaching. I mean, all the way down to the granular level. And you said it really well, Nathan, you said, if someone's up here and the other person's down here, if the patient's down here and depressed and the other therapist comes in as a cheerleader, you have a discordance.

[00:26:31] You have this incongruency between emotion states. And this is all fancy jargon stuff. But the way we teach that is called pacing. You know, you have to do your own state management. You have to kind of figure out, well, how do I, first of all, calibrate to how that patient is? Which means I have to have my own mindfulness that there's a gap.

[00:26:51] I have to be aware of my own emotion state, which means I have to have a reflective capacity to be able to know exactly how and if and if I even want to match and meet that patient where they are. Now, that takes some resiliency in and of itself. But sometimes, like you said, you don't have that awareness of where you are unless you see it. And I like the video thing because for a lot of reasons, one way that people understand it pretty darn well is called game film. Okay. You have a game.

[00:27:21] For sure. And you remember these days, every team after a game goes back through the game film and figure, oh, hey, what'd you guys do there? What'd you do there? How'd that work? Which the intent of that is simply a process of improvement. And like you said, you can't see what you're doing when you're the person doing it. You see it from the outside. And this is now the foundation for the highest level of training. And there's two parts of training.

[00:27:49] What you're talking about is self-reflection, taking a look at how it goes. And the other is, like I just mentioned, is you have to have a language for what you're doing. Yeah. And if you don't have that, it's tricky. Yeah. And so I could see where taking that a step, that video recording a step further, saying with maybe any of your providers, part of their onboarding process is we're going to record how you're doing in those initial evaluations and some of your follow-up visits.

[00:28:15] And see how you're doing according to these things. I like that you're saying put some words to it. Are you relating? Are you restating? Are you- Synchronizing. Synchronizing. And almost like a checkbox. Like there could be a checklist. So this is how we relate. And this is how we align with our patients to get maximum engagement. And it's checking these boxes. And if you, I can see exactly what you're saying. If you have words to them, then that helps them understand, makes it more concrete, right?

[00:28:45] It's less ethereal, obtuse, or obscure. It's real. There's some mass to it if you can put the word to it, right? And I saw this again, not to share, I'm always, I'm sharing these examples, but they come to me as you're talking. I had another client, super successful clinic, many providers. And her boyfriend kept telling her, you guys need to figure out what's your secret sauce. What's your secret sauce? And she's like, I don't know. Patients keep coming to us. They love coming to us. We're overflowing with patients.

[00:29:13] And I don't know what the magic is, right? Great problem to have. And so I said, why don't you interview your patients and maybe even some of your providers and let them tell you why they keep coming back. And once she got some of that feedback, and of course, again, she wasn't aware of these things because they just come naturally to their clinic and their culture.

[00:29:36] But once she got some words as to what made her culture special and what that magic sauce was, now she can actually systematize it. This is how we keep our magic sauce. And this is, if I'm going to open up a second clinic, we're going to make sure we do things, these things. So we have the quote unquote magic sauce and now we have words to it. We can put a system behind it to make sure it's felt and continued on past me, right? Yeah, that's exactly right.

[00:30:04] And the biggest challenge of scaling, opening a new clinic, is replicating that environment and that culture. And so what you're speaking to, Nathan, really well is, I don't know, we both kind of were brought up in this idea that as a clinician, in many ways, we're clinician researchers, right? We have an N of one, we have a patient in front of us. And there we are trying to discover, do a research project, assess, make an intervention, reassess. It really is an ongoing research project. Oh, I can see that.

[00:30:33] Well, in businesses, I hope are doing the same thing. And I know you're teaching people to do this. But what you just described is kind of a brilliant approach to what's called qualitative research. And qualitative research is just that. It's not the hypothetical question where you're setting forth a hypothesis, but you're simply trying to understand the lived experiences. And in this case, the patient. And I remember a similar story where a patient walks in and she had returned.

[00:31:03] She was going, you know what? This place just feels good. And I was like, what do you mean? What does that mean? What exactly are you talking about? She goes, I don't know, but you walk in and you just get a feeling like it feels good. I will. Well, I guess that's good. I mean, of course it's good, right? I mean, you know, you want it to feel good. And of course, people generally are coming to us because they're in pain and they want a place where they feel good. But when you ask those more granular questions about, well, what specifically sense do you get?

[00:31:32] You know, what do you feel in your body when you walk in? What is, you know, some of these are the qualitative questions you ask in research. You know, give me an example of other parts in your life when you feel this. And if you ask these questions often and long enough, you're going to get a very full understanding. And this is what we do in research already. We ask these kind of questions to try to understand what are the lived experiences of our patients. For sure.

[00:31:57] Because like you said, if we can understand it well with some sense of validity, right? What they're really experiencing, not what we think they are, but, you know, there's a certain amount of rigor that goes in this kind of research. Can we apply that now? Can we actually scale it? And the answer is yes. As long as everybody top to bottom, top to bottom meaning the leadership and the line workers at all level have a full appreciation for the value of this kind of training.

[00:32:24] And like you said, and I think what we struggle from sometimes in physical therapists is that we're physical therapists. And we think that our primary offering to the client is that we're technical, physical experts. And I would say, you know, and that's often fed by this idea that it's patient-centered care, right? That it's all about trying to help somebody's knee move better.

[00:32:46] And I would say, no, it's probably more likely helping to guide a patient through an experience, part of which is to improve the function of their leg and their knee and them in their lives. But it's also kind of connect with them on this journey, which, you know, you have to be prepared and trained to be able to do.

[00:33:04] Yeah, I could see where if you would ask many therapists about a five-star experience in your clinic, the majority of what they're talking about would lend towards the technical treatment of that patient, right? If they're going to get a five-star experience, they're going to get these physical results after the fact, which are important. But what we're saying is maybe they're not as important as you really think they are. And the studies are showing that they're not, right?

[00:33:32] That the more important aspect is truly the lived experience. That's correct. The experiential aspect of the entire, as soon as they walk in the door, maybe even from the phone call, what does that entire experience look like? So it's super comprehensive and not just focused on the technical aspect of it. That's right. That's right. Very interesting. Yeah, isn't it?

[00:33:56] And then, you know, the idea that what people need, and this is, you know, I've backed up and tried to understand, well, what does the healing literature actually talk about? How do people actually get better? What's our role in this? What any healthcare provider's role? You know, this research is, it's good. It's good insofar that it's evolving rapidly. And, you know, kind of the way, one of the main mechanisms that we understand are the most important part is the relationship.

[00:34:24] And anyway, in the journey, and everybody knows what this feels like, as soon as you feel like something's not quite right, you want someone else to help. Yeah. And sometimes you don't exactly know what that something else is, but you know that you need someone else. And so what patients often struggle with is who's the right person to help guide me. And nowadays, I don't know about you, but I mean, I just, you see me in our own house. I mean, my wife has this horror stories about a doctor who just doesn't listen to her.

[00:34:53] Or the fact that, you know, they got, you know, four and a half minutes with a provider before they walk out on you. And then I'm also seeing some examples where, you know, I've watched a neurologist work with my wife. And boy, that person really slowed down and listened and asked stories. Oh, and said, oh, that must be terrible. And did some empathic tracking and some backtracking and some summarizing and all those cool technical things that I'm super familiar with. I'm like, nice job. We'll come back and see this guy. Absolutely.

[00:35:23] For sure. And it was a lady. So, I mean, I can't tell you there's any difference in that, but it was just one of those things where you just know that it's super valuable. And I would even go this far. And I use this sometimes when I'm teaching and it's like, you know, the best surgeon in the world cannot heal a cut. The best surgeon in the world can't heal a cut. Of course, the surgeon can approximate the wound. Sure. Create the conditions for healing. But the patient does the healing.

[00:35:50] And I think our job, if we're really doing it well with the best skills possible, is we're meeting patients in a place where we can help initiate and inspire a healing response in them. And that healing response in that environment, and if it's part of your mission in your business, you know that you're doing the best to inspire them to have a great result. And people notice that, you know, they just feel more empowered.

[00:36:15] And another, you know, much of the research says one of the biggest predictors that someone's going to be consistent and compliant or adherent to their home exercises is the feel is self-efficacy. Do they believe that they can do it? If we can instill this kind of stuff because we're very relatable, I think we just get better outcomes. And that's just better for the profession, right? Right. Not just our businesses, but it's also better for the entire profession. Reminds me of a book called, I believe it's called Building a Story Brand or something like that. Yeah. That's Don Miller stuff. Yeah.

[00:36:43] And the very first chapter is all about when you're marketing to people, the tendency is to set yourself up as the hero for someone who needs for the victim. But that's not what people want to hear. They are the hero of their own story and they're looking for a guide. And so the best marketers are the ones that set themselves as the expert guide for the hero, the Obi-Wan to the Luke Skywalker.

[00:37:12] So the more you set yourself up as the Obi-Wan in the story, then the more likely you'll connect with them, right? Because they want – you can't tell them that I'm going to be your hero now. They're not drawn to that. They are their hero, right? Yeah. Yeah. And some are. Some actually kind of are going, ooh, save me. And we know those kind of patients. And yet the marketing approach to that is brilliant, right? And I know Don Miller's stuff really well.

[00:37:36] And it does draw on this archetypal meta story that Joseph Campbell kind of elucidated through a bunch of stuff. It's really, really powerful. And me and a buddy just gave a talk at CSM this year on this exact topic about storytelling as being part of your clinical toolbox. Oh, cool. Do you know how to pull a story out of your toolbox and use it in a way to improve your ability to guide the patient successfully? And that metaphor, Nathan, is spot on.

[00:38:05] Like patient is the hero of their story, whether they know it or not. Honestly, this is kind of the biggest possible issues is that sometimes they don't know they're the hero of the story. Sometimes they think they're the damsel in distress and they need to be saved by a hero when, in fact, we need to position them as the person who's moving forward. And I'm partial to the Frodo and Gandalf relationship myself. I don't know. Maybe it's the white hat and the long gray beard that kind of gets me excited. I don't know what.

[00:38:34] The English accent and all. Maybe that. Yeah, exactly. Very cool. Well, look, in wrapping this up, what are you wanting to tell people? What do they need to take away from this all? Yeah. I would say that, you know, you're a practice owner and you're trying to build something brilliant. And I say brilliant because I'm a fan of physical therapists, first of all. I just think we're the profession that adds the most value. And you are supporting your environment, your business because you're training.

[00:39:03] You're providing ways for people to grow professionally and personally. And I think like those successful in business have an intent to improve the environment in which people are working. So you take care of your people and you take care of them because you, you know, maybe you provide them a content allowance or you sponsor courses in house. You want them to grow. Now, growth happens not just professionally, but also personally.

[00:39:32] And the skills that I'm interested in all of us learning and I'm interested in teaching are those that help us to not just understand what's important to patients because you have the technical skills to draw that out in a very articulate way, in a very skillful way.

[00:39:48] But also the degree to which you can connect, you know, with patients and with yourself and with your environment in a way that starts to decrease some of the burnout that we're experiencing and some of the ways in which we're disconnected from the amazing craft and service that we're providing as Gandalfs and Obi-Wans and Merlins and, you know, all the other Yodas. Yoda's a funny looking guy. Yeah. But truly, we just provide a tremendous service.

[00:40:15] And I think one of the biggest take-homes for business owners is to really focus on these skills. I mean, find a way to scale, train, learn, improve, and measure the success of this kind of investment. Yeah, definitely. And if people wanted to get in touch with you or talk to you about how to do this? Yeah, yeah. Patientsuccesssystems.com. All right. Patientsuccesssystems.com. Sounds good. All right. Well, thanks for your time today, John. Hey, my pleasure. It was good talking to you again.

[00:40:45] Man, let's not make it five years next time before. I got it. Let's do it again soon. All right. Thanks, man. All right. Cheers. Thanks. Thanks for listening to the Private Practice Owners Club. If you enjoyed this episode, would you mind doing us a huge favor and leaving a review? This helps us get the podcast out to more clinic owners to help them create greater freedom and profits so they can own their future. And visit our website, ppoclub.com to find more resources and connect with us.

[00:41:15] I'm thanks. Him. I'm here. I'm in. I'm . You can just take 11 and 42 of you.