I had some interesting responses to my last post where my main point was that most chiropractic practices need systems to propel them forward to the next level and to overcome the obstacle of being “stuck” in practice.

Most readers admitted to being guilty as charged for their lack of systems.  Several wondered if I had a good system for detecting psycho employees (If I did, that invention would land me the Nobel Peace Prize for single best resource to lower world blood pressure. But alas, no I don’t.)

One humorous DC teased and asked if my Chiropractic Office Protocol Book contained a “bathroom break” protocol apparently for his toilet-happy CA (Answer: NO.  Tell her to ease up on the Magnesium).

All kidding aside, several readers did voice concern that they believed that they had made honest efforts at implementing systems and still no results.  Without being able to analyze their systems in detail, there are two common reason that even the best systems, procedures and protocols can still fail.

So, that’s what I’d like to discuss today with you: how to avoid system failure.

Failure 101 Part A: No Consistency From The Boss

The first and perhaps most common reason for system failure is lack of consistency.  Typically, this points back to the doctor who is either (a) the chief offender and rule breaker or (b) a lousy enforcer of the rules.

For example: many docs will begrudgingly admit that they are incredibly spotty at performing re-exams. Upon closer inspection, I usually find that the doctor setup a time frame initially that the re-exam was to occur but when that point came, he or she blew it off.  Staff tried to remind the doctor, but the exam was blown off anyway.  After multiple instances of the same thing occurring, the staff eventually quit reminding the doc.  They quit attempting to even schedule patients for re-exams to avoid looking dumb when they mention it to the patient but the doc fails to perform one.

End result: The doctor / chief offender has derailed the re-examination procedure with his lack of consistency. In time, re-exams fizzle away (along with the necessary patient care, compliance and potential income).

Failure 101 Part B: No Consistency or Enforcement


There is a subset of lack of consistency and that is a lack of enforcement; both result in failure.

For example, sometimes the offender is not the doctor but the staff.  Perhaps, the staff are required to verify insurance benefits before the patient arrives or give a reminder call to all new patients.  Whatever the task, the staff don’t perform.  But instead of the staff receiving a reminder, warning, discipline or spanking (not recommended, but certainly would communicate the point), the doctor just shrugs it off.  Or the doctor waits until the practice numbers start to fade and then baboom!  The doctor goes nuts and begins his reign of terror and strict enforcement of all rules.

End Result: The sheepish doctor who enforces nothing obviously gets nowhere near the results he would like.  And the explosive doctor creates a staff that secretly hate him or fear the next outburst or both.  But he also doesn’t get the results he wants except perhaps during brief tirades.

Anyway you slice it, the consistent application of your procedures, policies and protocols is necessary for success and progress to the next level.  You, your practice and your staff would be much better off doing a few things well (that you can manage consistently) than trying to set overly ambitious “rules,” requirements or goals that you can’t really manage and monitor.

Failure 101 Part C: Total System Failure


And sometimes, everything falls apart.  You have systems no consistently applied and with no enforcement running in both directions, literally passing the buck back and forth from staff to doctor.

Worse, while you think such a mess is only visible to those on the inside, think again.  Witness the NY Times article of January 7, 2011 advising patients who want to score discounts on care to talk to the doctor. In other words, bypass the front desk who may (on a good day) actually be subject to clinic policies.  Instead, the good doctor consulted for the article advises patients to go to the softie: that’s you and me, brother and sister.

What the article recounts, in gory detail, is how patients can try to negotiate any and all fees, navigating successfully to hit you in the wallet where you are weakest: your systems and your consistency.

Don’t get me wrong. I am not saying you cannot be generous or should not strive to provide affordable care for your patients. But it should not be akin to “let’s make a deal” or subject to the negotiating prowess of your patients.  When this happens, all systems have failed you.

Failure #201 Part A: Poor Design

In Secrets of the $1250 Per Hour Practice, I talk about designing and aligning your practice for profit and passion.  Without that critical step, even the best-engineered systems will fail.  In other words, sometimes it’s possible to set up brilliant systems and procedures that are attempting to work within a flawed business model.  In those cases, systems won’t save you.

Case in point:  a few months ago the briefly famous Wall Street Burger Shoppe, home of the $175 burger, went bankrupt.  Yes, you read that right – a $175 burger!  Debuting in 2008 amidst during a high point in the recession, the WSBS made a big splash and earned a mountain of publicity for gaining the top spot for most expensive burger.  But it’s 15 minutes of fame fizzled in 2011 when owners filed for Chapter 7 citing they “couldn’t make a go of it” in reference to the 112 seat burger joint.

The reason for failure?  Probably not a lack systems, considering that the owner had previously launched 4 other notable restaurants, worked under two prominent New York chefs and has been consulting in the restaurant industry for years.  I’m sure the failure was not due to internal procedures that couldn’t get the burgers onto the tables.

Coincendentally, FastCompany magazine actually featured an article on the burger in their July 2011 issue (the same month the WSBS filed bankruptcy) and therein lies the seeds of failure.  Owner/chef Kevin O’Connell tells FastCompany:

“It started out as a joke…” and was “Created purely in an attempt to one-up the $150 double-truffle patty served at Daniel Boulud’s DB Bistro Moderne”

At the other end of the spectrum, witness the vast number of clinics all offering free exams, free x-rays or free whatevers.  Are all of these clinics bursting at the seams with business?  Doubt it.

Failure 201 Part B: Really Poor Design

In fact, these days FREE is so boring.  Thanks to Groupon-madness, Living Social and other purveyors of internet bargains, chiropractors and other businesses now have instant access to trying to outdo each other in gratuitous insanity.  In such fiercely competitive circles that are frequented by chiropractors, dentists and even plastic surgeons, the prices are getting lower and lower without the smallest thought towards profitability or even the type of patient that would be attracted to a plastic surgeon offering a breast enhancement that normally costs $5000 for a mere $79.  (Nor is there much a thought being given to the doctor that would provide the service at such rates).

My favorite big winner/loser Groupon award goes to the nutcase DC who offered: 1 free exam, 2 free xrays, (2) 1 hour massages and 2 free adjustments – all for a $29 Groupon!

In a way, these are system failures of a whole-different ilk.   When are we going to learn that competing at the bottom barrel of price does not work for our business model?  You are not selling commodities but a service.  And when you deem your service to be virtually worthless via your price, don’t come crying to me that you can’t understand why your practice is in the toilet.

Life Lesson and How to Avoid System Failures

Gimmicks don’t work.  And revenge is probably not a good business strategy either. (Daniel Bouloud was O’Connell’s former employer). And please, please don’t get in the gutter and slug it out with your neighbors on who can offer a bigger bargain.  Leave them alone.  Soon enough, their practice will wash down the drain.  But if you get in there to fight, you may go down as well.

So, as an extremely long answer to those who emailed regarding the possibility of a practice failing even with solid systems in place, the answer is yes: it is possible.  Usually due to the fact that your systems are inconsistent or poorly designed.  Or if you’re very unfortunate, both.

If you’re struggling or your practice is just not where you want it to be, take a good look inside.  You may just find one of these scenarios happening to you.  And until you fix it, your practice is in danger.