How to go from Build to Scale (Part 2): A Scaling Your Practice Deep Dive
Have you been wondering how to move forward in the chiropractic profession and both grow your business and your practices? Dr. Cliff is here to show you how to find your path in this profession.
Get into a conversation with two leaders in the chiropractic profession with eyes on dozens of clinics and become the best doctor, best leader and best human. Join host, Dr. Cliff and co-host, Dr. Joseph Esposito as Align Your Practice helps you understand the transitions between build and scale and what and who you need to become to move to the next level of practice for you. It is time to start maximizing your operational efficiency as well. Too often doctors and leaders are jumping from Crisis to Crisis to Crisis. Learn how to stop that and be more intentional around that.
After you have built the practice where you are the only doctor, now learn how to make your office scalable and durable by adding doctors and team to make a better experience for you and your team and your patients. Create that win win win!.
· Build in a manager to support the doctor.
· Manager is responsible for the business.
· Train the Patients, Procedures, Flow, Communication, and Team.
Download the pdf here: https://bit.ly/AlignLifeLaunchBuildScaleCommunicationPDF
About the Host:
Dr Clifford J Fisher
Dr Cliff Fisher – Owns several offices all over the US and has a coaching business Dream Leadership Institute to help people find the greatest version of themselves. He will help you get to a foundational understanding to create the business and life that align with your being.
Dr. Joseph Esposito, CEO
Dr. Joseph Esposito, D.C., C.C.N. C.N.S., C.C.S.P., D.A.B.C.N., F.A.A.I.M. C.T.N., is the Founder and Chief Executive Officer of AlignLife. As such, he is responsible for the direction of AlignLife as it expands further across a dynamic and rapidly changing health care landscape. Dr. Esposito has more than 20 years of experience in a broad range of businesses, including chiropractic, nutrition, technology and internet marketing.
Dr. Esposito has extensive post-graduate academic accomplishments, as well as 15 years of experience managing successful chiropractic clinics in multiple states. He also is founder and CEO of Aceva LLC, a service-based nutritional company providing products and services to the AlignLife clinics. As the former CFO of an internet publishing company, Dr. Esposito understands the power of leveraging the internet to impact the lives of millions of Americans.
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Align Your Practice podcast with Dr. Cliff Fisher where your best practice and life awaits you. Are you tired of running a practice on your own? We want to come alongside you with experts to help you create your dream practice in your dream life. Here is your host.Dr. Cliff Fisher:
All right, you guys, welcome back to part two of scale. And so this one, there's a lot in here. And so we're gonna dive into this next part. Joe, what were some of your takeaways from last time?Dr. Joseph Esposito:
Yeah, I think the mindset of scale being different that we have to think differently in our planning, we have to think differently on our management, on our business metrics, and our financial modeling. Those are bigger thoughts that are outside of these granular deliverables. We're going to go over today, those four that I mentioned, I think we can bring it up on a future podcast, but really the awareness of what do they need to do? And I think that's what you're going to present today. With the chart?Dr. Cliff Fisher:
Yeah, I think the charts awesome. But I think understanding that at a high level before we dive into it, because you don't understand it that high level, it's not going to be worth it, because it is work to you know, get these, each one of these things built out in a really good healthy way.Dr. Joseph Esposito:
I think the point that we had was in build, you are keenly aware of everything going on in the office, because you're the main energy. Yeah, the thing that you and I learned over decades of doing this as once you're not in that building, and you're not the main clinician, things are gonna go more towards entropy and disorganization a lot faster when your energy is not the main energy in the practice. So would you say that's, that's a big awareness point that they have to have other ways of finding, assessing the smoke before there's a fire by the right management team, the right KPIs and business metrics, right, there has to be more better ways of securing data. And the current state of the clinic, whether it be energy, morale revenue, you have to have an assessment of all of those, if you're not the main clinician.Dr. Cliff Fisher:
Yeah, I think in that, for me, that space comes to having that accountability and visibility. And it's, and if you're ever relying on a person's energy, and in that space, it'll always slow down the whole system and machine and honestly, the business like, it'll be limited by that person's capacity. Because even when I was in my office at 100%, that I still had people around me that if we were working as a system, and as a team, we were way more functional, than if it was just me trying to lead and do it's like, it's that team that really allows us to grow into who our business could be, or if that's what we want it to become. But that's how we get to scale by basically getting with our team and having a system rather than relying on any person, even if it's the leader, like the leader is in charge of casting the vision, but it can get jammed up by that leader.Dr. Joseph Esposito:
Yeah, so what you're saying is that, right now, if you're a build, and you want to scale scale being, you want either multiple doctors, or you want multiple clinics. And if you're in your office right now, in the build, which is meaning you're building the business, and you're the main player, sit back and ask yourself, are my the main energy of the business? Yes or No? Or am I the main management of the business? Yes or no? Are mine the main acquisition of data for the business? Yes or no? Are my the main morale builder in the business yesterday, and and you start realizing that all of those energy and data points of business components are built around you. You can't move to scale yet. So you have to start, like Cliff is saying has to be a team system. It can't be the you shelf. You don't I mean? So I like what you said, I think there's some meat there Cliff for if they were going to want to get into scale the next six months to a year. Those are some good questions to start asking.Dr. Cliff Fisher:
Yeah, 100% And I think just and thanks for pulling all that out of that. For me, like, I had an ego involved, like I wanted to be about me, I'm like, oh, I want to be the doctor. I remember when I brought on my first doctor. I was like, I didn't want the patients to like him more than they liked me. And like and obviously I matured over years, but it was hard and and over the years it became I just want them to have the their best experience. And their best experience shouldn't be Doctor related. It should be system related.Dr. Joseph Esposito:
Yeah, I agree with that. And I think when when we replace ourselves inside of the clinic and scale, we try to the first round of doing it with a new Your doctor is at least I tried to make the doctor do what I did look at the revenue, look at the finance, oversee the market, oversee the training and do what I did. As an owner, that's the biggest mistake, the lesson learned for me is getting management in place before the doctor, which takes over half of my job, because I'm a clinician and an owner. So the owner job details The manager took over. And then my clinical role got replaced by the doctor. So too many doctors tried to replace your whole job detail with a clinician that comes in, run the whole thing. And I My advice to you would be I would not approach it that way. I would have a manager and a doctor and split those roles a bit, versus trying to have the doctor do what you did as an owner. Does that make sense? Sir?Dr. Cliff Fisher:
Yeah, I love it. And I was trying to break down in my head, like how the process for me how I would do that. Now going back because I didn't build out my team until after I was already underwater. But if I could now as I'm building clinics, now what we do is we build in that manager first, then we bring on another doctor, so then that manager can actually be that doctor supervisor except in clinical questions.Dr. Joseph Esposito:
That's a huge point. Because if the manager is in place, and competent, and knowledgeable and knows the business before the doctor comes on, they can report to the manager, and the manager is competent and has strength inside the business. If you hire the doctor first and then try to pull in the manager that doesn't know the business, it's going to be hard to hold the authority. So I, I really liked that as a first move when you're ready to go towards scale. If all those questions I was asking before are all you you, you you you get the manager in place and start leveling up that manager before you bring on a doctor, that's really strong advice plus,Dr. Cliff Fisher:
yeah, and I really I love what Francis says, Like us as the CEO, our job is to lead the business, and then the CEO or the office manager, their job is to run the business. And so and there's a great ascension plan that we've built out inside of align life. So you know, we can walk you right through each of those steps. Because, you know, if you miss that, that and you lose an A player, that's like 10 times their salary lost out the door, in both revenue and lack of growth. And so you really like need to make sure that you're continually climbing and keeping that momentum going. And the momentum is there. Like when we're we're not hiring, right, we make the wrong hire, we, you know, you know, put the wrong person in the wrong role. Those are all those things that slow us down from in build, and we just keep getting frustrated and kind of stuck in that build, we feel like we're in the mud.Dr. Joseph Esposito:
And that's I think one of the strengths of align life is quantifying and helping a doctor quantify where they are right now, and what steps they need to take to get to the next stage of business. So we have brought up last time a link, but we'll go straight to the site flip align life opportunity.com, there's a consultation link there right on that page, align life opportunity.com, if you want to get gained some help in really quantifying where you are, what stage and what steps to get to the next stage of business, if you if you so desire, will allDr. Cliff Fisher:
add I'll have both I'll have that Lincoln in the last one. And this one that makes a lot of sense. So okay, great. So if you guys are watching this awesome, we have a sheet up that will kind of go through each one of this things that you need to do well to be in scale. So scale is anything over 300. And so for training, so scale, like the theme for me is training the patients. So we went from training the doctor to training the team to now our training the patients,Dr. Joseph Esposito:
the training, that doctor was launch. Yep, training yourself on how to even run a business as your main without you, nothing happens, right? experienced staff you have inexperienced marketing. So you're training yourself face to train the doctor, I liked that clip. The second is build and build your training your team. Yeah. Gearing up for scale, I can train your team and now you're saying scale is we're at a point we're going to train the patience and the rocket practice they talk about creating ambassadors, and this is more of like creating a level of Ambassador. Right? Absolutely.Dr. Cliff Fisher:
Because it gets too heavy. Like we you know, if patients aren't trained on following procedures, they're, they're gonna get jammed up and hold up the growth of the practice. And so once you have the doctor competent and in mastery and once you have the team and competency and mastery, then you start to move the patients and that's really how you grow these big practices because it's too heavy of a lift if you're always if the patients aren't on board.Dr. Joseph Esposito:
Make sense? Okay, so we're looking at this chart. This is about scale. You see the chart In the in the middle, and you see four different components of scale that are in each quadrant of this document. Procedures, flow, communication and team. And these are what you're saying clef are the three things in each of these components of practice that if you level up, you're going to make scale, less painful, less stressful, less friction, right? less resistance to get scale, if you level up these 12 different components. Outside of this, we talk really high level that I brought up, which was management, metrics, financial modeling, and strategic planning, which is another conversation. Yeah, he's gonna be like granular action steps that you can lift up right now, to have a better scale, right?Dr. Cliff Fisher::Dr. Joseph Esposito:
Yes. So in a line life, this is obviously handed to you on a silver platter, you have a training schedule for the year, you have a trainer, a group of trainers that are going to help instigate the awareness and the deliverable, and then you just finished the training on site. But line life will provide it for you. If you're not part of a line life, and you're doing this on your own, then you need to lay out your DC training for the year. So you want to come up with a series of training on a weekly basis, about 50 weeks a year, and you want to start laying out these trainings. What's the purpose? What's the actual training, I mean, there's work to be done here. But these are all pieces before you bring on the doctor that should be locked in step implemented, not on the fly, when you're trying to bring a doctor on it should be set in stone. And that's the beauty of a line life is these are completed cycles that have matured, right, and are ready to be delivered. So now what's, oh, I'm training, office management training. That's a different training. You're saying Right?Dr. Cliff Fisher:
Yeah, so office manager. So in that space, it this is where in Jo, we talked a little bit about it last time, but management has to be different. So the office manager has to be in charge of trainings and running the trainings. And so you're kind of walking alongside of them, helping teach them everything you've learned over the past cycles, but they're actually starting to take over trainings, they run the trainings, you still do the opening the heart, make sure that everybody's present for that. But then the office manager is the one who actually runs the trainings.Dr. Joseph Esposito:
So I think where people fall down in scale, I mentioned this in the last podcast is that when we step out as an owner, and maybe not the head clinician, we keep forgetting that we're also the owner, in addition to the head clinician, and we can't let the clinician try to take on the owners role. And the lead clinician in the office, that's where the manager comes in. So where people fall down as a hiring manager to train that, the DC and this CA's and the staff, but no one trains the manager. So let's saying is, you not only have to have a training curriculum for the doctor, but you better have a training curriculum for your your manager because they're going to be running the team. And that's where I think we see a lot of fall down is we have hire the manager and step out like Okay, I gotta manage, that's, you're gonna be working more, but it's gonna be a lot of training of the team for a year or two, before you have that freedom that you may want, right? I mean, it takes some time to level up the managerDr. Cliff Fisher:
to level up the manager and make sure you guys are on the same page. And, you know, I know inside of a line life, we you know, we have our meeting rhythms where we, you know, we have our same page meeting. And I know TRP they have that same thing where they have the same page meeting every week you get with your manager, and that's before you review, what's what we're covering. And so you're right alongside of them. You're not just like, okay, cool. You're the manager. Good luck. You're like, Here, here's what we'll do. We're going to, you know, put your arm around them Let's do this for a quarter, two quarters, Joe, like you said, one or two years, depending, you know, what's going on in your team but and who's coming in as your office manager. But I think that is the biggest misstep, I think doctors are like, cool, then they step way back versus lean, this is a space to really lean in.Dr. Joseph Esposito:
Yeah, we've spent a lot of time onboarding, that office manager, not just training after they're on boarded. But the onboarding process is vital for that manager, because they're going to be speaking your vision to the team when you're not present. They have to know your purpose, your mission, your vision, they have to emulate, understand, and really own the core values of the business, the major beliefs, like there's a lot that has to be done on the front end with the manager in training. We don't have onboarding here. But a boarding is a component of trainingDr. Cliff Fisher:
100 personnel. And then typically, the ascension, like your office manager, like I always went from within, like, they would start out as like my checkout CA, then they would move into my back office ca and then they would move into my office manager. So it was an ascension process, because those three personalities are right for that office manager. But I can't just throw somebody in because I just I want them to really be on vision on mission.Dr. Joseph Esposito:
Yeah, I think that's great if you can hire from within people that are already part of your business, but don't force that. But if you can have that IP, that intellectual property in their brain of knowledge of your business, and they worked with you, so there's massive value if they have the chops, and they're wired to be a manager, but don't force that, because if they're not management's quality, you can't just make that person a manager, like most doctors, just take any staff and now you're the manager. I think hiring from outside that had the chops, the behavior style, the experience to be a manager even paying more money, I think you'll get more value. In some instances. I know I never did that I only just hired my front desk staff just became the manager because I thought that's just what you do. Just make sure that the right the wire the right way to take that job detail.Dr. Cliff Fisher:
Yeah, I think that's probably one of the biggest mistakes a lot of doctors do is that whoever has been there the longest is the office manager versus if they're, if they're more of like that outgoing people, person they're not systems are not timing, you know, structure that they're gonna really struggle with that and you're kind of setting them up to fail.Dr. Joseph Esposito:
Yeah. So great. All right. The third one and procedures is teaching scripts, teaching the communication. So that's teaching the communication to everyone, the doctors, the CIA's, the tech CIA's, the any marketing staff manager, that were cross training, right, where we're really leveling up the communication cycle within the clinic.Dr. Cliff Fisher:
Yeah, 100%. And so. And teams start teaching also. So it's not just all again, falling on the doctor, that's your office manager, and other team members start to teach everybody else in the roles, the thing versus it all coming from the doctor, the the clinical person, like the head of clinical, this is now everybody's teaching it. And so it really starts to uplevel, your whole team. And so those are the three things in procedure. So if you have fives in all of those, I would imagine, that's the first step in being at the top end of scale.Dr. Joseph Esposito:
Awesome. So the next one flow, the, the flow has to be trained more, because you're not going to be the main clinician there. So there's going to be inefficiencies are going to pop up if we're not consistently training on flow. So first one is adjusting the exams, the adjusting flow. So that is, you know, when a patient walks in the room, are they lying down? Or are they sitting up that they have instructions, we want to make that kind of a reference position of like receiving this adjustment and respecting that time and present time consciousness with the patient. And there's a lot that goes on in the tick that conversation, that deliverable, the adjustment, there's so much there, then you have exams, those are progress exams, as a real exams, there's a science around those transitory points of a care plan, because you have to make sure that they fill out the progress exam questionnaire, so we know where their knowledge base is on the chiropractic lifestyle, right in the gaps, and we got to really own that, and then re exam at the end of the cycle. The care plan is where are we at what's next? Yeah. And then and the report, the all the different reports that we have. So that's huge. I know. Most people are going to be a two or three there if they're really honest with themselves, and we realize those transition points are huge to get stick rates to climb and compliance and PVA to go up that that one checkbox there. So you get what's next for multiple doctors Tips, What do you mean by that?Dr. Cliff Fisher:
So one of the things as you start to expand and scale, you start to have shifts for different doctors. So sometimes doctors will be the exam doc, sometimes there'll be two doctors on like, when we had six doctors, we had six adjusting rooms. So we had multiple doctors on different shifts. So that way we can be at the highest energy when we're with our patients. And so that was where we, when we talked about that, like, having each doctor have their own shift in charge of and be able to manage that.Dr. Joseph Esposito:
Okay, so you're seeing a doctor managing a shift, like there may be four doctors they are but one doctors managing that clinical. The floor in a sense,Dr. Cliff Fisher:
yeah. And they're in they're part of it like each like, because with us, we had to shift to multiple shifts, because we didn't have enough room. Okay, so we would have like, it allowed us to have bigger hours. So we'd go from seven to seven.Dr. Joseph Esposito:
Yeah, that's great. Even if you have the room, some doctors will be on a Saturday shift some doctor, I know some clinics even open a couple hours on Sunday for emergencies and get another handful of new patients or work in later time because you have multiple Doc's that you can do split ships at Yeah, that's a great point. Block Scheduling.Dr. Cliff Fisher:
And flex one are flat. Yeah. And that's just a must on all of them. So on flow, block scheduling, making sure you have exam times adjusting time, new patient times. And then I think the bigger thing and depending on who you're doing this for, but like for the CEO, the doctor, like they need to make sure they're blocking time to prep to do the planning side of it, because that's where they miss, I feel like because they just they start adding people within they're not giving time for planning and preparing. And there's kind of that king of winging where they show up and they're like, oh, yeah, this is gonna go awesome. And everybody already knows what's in my head, but they don't. And that's what the taking the time to slow down to speed up.Dr. Joseph Esposito:
So there's, in the line life, we have different verticals in the natural health space that support chiropractic. So you may have a health coach that has their own schedule, right. So now it is a little bit more to manage there, you may have a tech ca that's doing the exams outside. So you're running that X ray and exam room as an independent flow scheduling, versus the adjusting when it's a one doctor show. The one doctor is either in the exam room on the adjusting floor or taking the X ray, just one person right? Now, when you have multiple clinicians, those rooms, other independent schedule, you can have X ray, back to back to back to back, because there's four doctors and someone's running that department in a sense, yeah, it's on schedule, right? So that's a big shift for in scale verse. The doctor schedule, he's doing an exam where he's doing an x ray, he's doing adjustments. It's one column. Right? That was a big shift for me that now we have a new column. That's X ray. And I have someone running that. And how, why are we under utilizing that? Because we underutilized it? Because it was one person doing everything. Now you got four people, someone spraying their wrist? Well, you're not used to take an x ray, because he never had the time. But standard of care says that should have an examined X ray, because they fell, we should level up our quality control level up the utilization of the tools we have, let's say x ray. Now, when we have these departments laid out, and that block scheduling per clinician, does that make sense? Because I know I lost Yeah, I was given a lower standard of care, the busier I got, because I was a one man show. And when I brought people on, I didn't realize I could level up my quality of care and make more revenue at the same time.Dr. Cliff Fisher:
Yeah, we had to add another exam room because we, we couldn't schedule in that we had, we could do them with the people we had, and the X ray. But we but we also had our re exams and our progress exams and that that was taking up too much time. So then we we had set up a whole nother room for just re examine progress exams, so that we were able to maximize that. And so that's part of that, that next year, next level of block scheduling.Dr. Joseph Esposito:
Great, great, okay, let's go to communication. So Joe, Joe, IDr. Cliff Fisher:
feel like like this would be a great place to stop and then on our next episode, we'll dive into communication and team because I don't want to rush through it because that's communication and team are probably the two, you know, are so critical. So I would love for like a recap of what you got out of today and what your thoughts are and how they could level themselves up on training their patients.Dr. Joseph Esposito:
Okay, yeah, that's great. So let's close up for this. This episode, the procedure and flows we went over my recap on it is and from my experience is the gap between the office manager training and the DC training the plan. I think laying that out for the year would be crucial I think the office manager trainings where I dropped the ball, I just thought I hired them and told him to read our manual. But I didn't really spend the time realizing they were my voice now. Yeah, that was a mistake I made, I wish I would have tripled the training and time I put in the office manager 20 years ago, and I think I want to level up even faster. That's my outcomes with there, and then flow. The block scheduling a little bit differently, when it's a one doctor show versus having someone running different departments like extra an exam that we just talked about, I think that's whoever's listening to this could take a pen and a paper and start really thinking through how to level of quality of care to standard of care, and bringing more revenue by departmentalized. In that a little bit.Dr. Cliff Fisher:
Yeah, and just doing what's best for the patient. Because I think sometimes we get so busy being busy, that sometimes we don't lift her head up, we get like too close to that rock face. And we just miss like, how to, you know, like, cool, we're getting busier, and we have a bigger team, I cool, we've can now take better care of our people, you know, our team and our people.Dr. Joseph Esposito:
And that's a that's a conscious thing. Because I know some doctors are like, Why don't just want to sell, I don't want to now that you have these multiple verticals of revenue centers, let's say in a line life you have, we actually do lab testing, or we have the opportunity for weight loss. But like, I don't want to, you know, like sell more to the patient, I think it's really important, what you said is leveling up the care, what we have to always keep in mind is whatever is going to create the greatest outcome to their health is what we should recommend, period, end of story has nothing to do with revenue, you just have more opportunity to take better care when your team grows. And don't look at that as a negative look that as an opportunity, inspiration that we could better serve our clients. I think that's really important. mindset.Dr. Cliff Fisher:
Yeah, I think and you know, we always talk about training, like lives depend on it, like we need to run our business, like lives depend on it, because it does. And if we keep, like, I don't know, I think sometimes we're just, we're so worried about ourselves, we're not taking care of our team and our community. And that's really at the end of the day, what you know, builds a business and then building a smart. And that's where alive, I think we have all those tools that allow us to do that. ButDr. Joseph Esposito:
so make sure you guys, you heard the six points that we want to hopefully have a rating, you know where your gaps are. And then you can start delivering some of the tasks in order to level those up. So I'd set a goal with what we did today, maybe you had a two in training or office manager, maybe you had a, a one on one of these other components and maybe a lot of fives, so just look at the lowest hanging fruit. We don't all have to be great at everything. But we do have to level up the business and take those weak points. And even if you don't do the work, there's someone else on your team that may be the expert on let's say script training, or any of these other components. Just make sure that the business itself levels up to as close to a five in each one of these components as you can. Yeah,Dr. Cliff Fisher:
we don't have to be good at everything. We just have to be able to build a team that's good at everything.Dr. Joseph Esposito:
Exactly. Awesome. Great recap. So next time we'll go over the second two components of mastering scale in the business.Dr. Cliff Fisher:
Awesome. I'll see you guys next week. Have a awesome week.