Thursday, April 30, 2015

Upcoming Webinar: "Advanced Branding Concepts"

Hi everyone!

I'm very excited to share with you that in less than two weeks, on Wednesday May 13th, 2015, I'll be giving a webinar through the Private Practice Section of the American Physical Therapy Association.

You can register for this webinar linked below, titled:

There are going to be some very exciting topics starting with some foundational marketing and branding principles, extending to management levers, and perhaps most excitingly, I'll be sharing with you several marketing metrics to measure the financial returns on your branding initiatives.

Oh, and there's that added bonus of our time together counting as CEUs.

See you there!

5 Lessons after 5 Years of Marriage

So, I've been meaning to post this one for a while... particularly since I wrote this back in March. In any case, better late than never!

As many of you know, Christina and I celebrated our 5th wedding anniversary in March. For lack of better words, it was magical. We're stronger, happier, and more in love now than when we first got married. And, it's funny that many times in life, circumstances arise to which you find yourself an "expert" of certain areas in life to one who asks advice. While I don't claim any true expertise in marriage and family counseling, I do believe that the success in our marriage has found itself rooted in a committed congruence of intellectual, emotional, and spiritual constructs. Therefore, to those who are interested, I'd like to humbly share with you...

5 Lessons after 5 Years of Marriage

1. 100/100
This is perhaps one of the first pieces of advice we suggest to anyone who comes to us with relationship questions. Early on, we established that ours would not be a 50/50 relationship. Anything that is 50/50 easily deteriorates because it relies upon human performance. And as humans, we are far from perfect. If 50/50 represents the total 100% in a relationship, then that relationship can easily be chronically functioning at less than 100% during a vast majority of the tine. However, if a couple is 100/100, each dedicated to being and owning 100% of the relationship, then the relationship truly has 200% of total potential to fill 100% of need. In the very common circumstance when someone is having an off day, they may be only holding 50% of relational waters. The other person needs to maintain their strength... even if is only at 90%, the relationship is still functioning at 140%/100%. Strong. Healthy. Whole. Consummate. 100/100 is an "all in" concept; there is no divvying of responsibilities. The relationship is everyone's responsibility in its entirety. Just because one person isn't having the best day doesn't enable the other to similarly let things go. That is how and why 50/50 deteriorates so very quickly and wears upon the relationship. Yet, in a 100/100, all in approach, the relationship is always at 100% because two people are filling those needs rather than two people, each filling only half the needs in any relationship, hoping to make the 100% fill line for both. 

2. We can both win
Once, at a fun little double date dinner with good friends, we were talking... couple to couple, sharing the lessons we've learned as those newly married. I chimed up and said, Christina & I learned that we can both win in our marriage. The response from the other party was a sharp gasp, "No....!" Head shaking. Such a thing is impossible! If there is a winner, there must be a loser. However, this wasn't our approach. We learned that in any argument within the marriage, we can certainly both win when we offer each other victories based on different playing fields. My wife may be playing golf. I may be playing baseball. She needs to sink her hole and I need to hit a home run. They are two very different games, nevertheless, being played on the similar terrain of dirt and grass. Therefore, it is important to keep in perspective the goals (even when conflicting) likely are only seemingly so. That it is the method of approach which is the quarrel, not necissarily the end goal. Sometimes, the end goal we claim to have such fervor for is actually only a means to an end we have yet to discover. Here is another way to put it (paraphrased and linked for you): It's a marriage. You can either both win, or both lose. Choose to win, for each other.

3. Gossip!
No, no... it's not what you think. But, it's funny just to say it in print. Really, the word I'm looking for is hypothetical conversations. Christina & I constantly discuss hypotheticals. We take our vantage point against that of any circumstance, real, storied, or imagined, and go through what our thought process would be, what our goals would be, what our action plan would be, etc. We do this when we watch TV, movies, hear about news stories, see it in real life at the store, whatever it may be... we take it and talk about it. And, we do it all the time. We do this because the more we talk about hypotheticals, the more our mind frames are exposed to each other. And, since nothing is at stake, we also start to suggest solutions. Time after time, our solutions become organically far more in tune with each other. Over time, it is hard to find hypotheticals that we are not on the same page because we're always talking about them. When finally the hypothetical discussion becomes a reality, we already have an action plan in place. We are already familiar with each other's frame of minds, and, more importantly each other's expectations. When we jump into action, nothing is truly a surprise. We've already talked it out. It's just a matter of tackling the situation and nailing it.

4. The other comes first.
Beholding the highest of the beloved; filtering the world through a "they come first" mindset is a pillar of strength in any relationship. It's easy to be selfish as humans. In fact, it is innate. However, when you filter the world through the needs and preferences of your partner, life becomes truly interesting. This is, in kind, a type of 100/100 action in play. You're already going to be thinking for yourself, no matter how hard you try to be selfless. How much better, when your spouse is thinking for you and you for them, all the while your natural instinct covers the basics for yourself? It is as if two people are being as kind and considerate as possible to you at any and all times. Marriage isn't about you; it's about the person you've pledged your life to.

5. Role Play!
No.... it's not what you think either. There's a phrase I heard long ago that stuck with me, "Different, not unequal. Unique, not inferior." In any relationship, each person plays a different role given any specific circumstance. Each role is not lesser or inferior to the next. It is simply different, unique. For those of you who are uber nerds like myself, think about a Role Playing Game (RPG). In an RPG, everyone has a different role. Typically, characters are classified by the function they serve. In many games, there exists a "tank" classification whose purpose is to absorb damage and take the brunt of any battle. There also exists a "healer/medic" classification whose purpose is to up keep the health of the "tank." For Christina and myself, I am the tank, she is the healer. Ironic, since I'm the PT. LOL! But, in all seriousness, I'm known to have more stamina, endurance, and overall durability compared to Christina. However, I can't just go about the battles in life on my own. I need her support to do it. Without her, I'd just be battle damaged into oblivion. As is per our roles, this means I also can't just go out independently and fight battles when there is conflict around her. I must constantly be mindful, circling back to shield her as tanks shield infantry in real life. Again, neither of these roles are superior to another. They are merely different, serving a different purpose, mutually aimed towards the same goal of success. Without a tank, a healer can't be protected and the fight is over in mere seconds. Without a healer, a tank will inevitably run out of gas and die out. Both are necessary for success. Now, this is quite the hyperbole of an example; but, I mention it to serve a very important purpose of wisdom. In the marriage relationship, roles need to be clear and agreed upon. Some roles are chosen; other roles are simply natural. The best situation is created when the natural roles are filled by those naturally strong in it, and, the chosen roles are done so for the benefit of the beloved, that they may be blessed by your service. When the greatest goal of your role is to bless the one you love - AND - this is mutual... life becomes a truly beautiful thing.

Well, that's it! I hope you enjoyed this relationship oriented blog post. Until next time!!

Thursday, April 23, 2015

The Success Dilemma In Healthcare (Part 2)

Continued from The Success Dilemma In Healthcare (Part 1), this post offers solutions to the situation analysis made available in Part 1. Just in case you missed it, follow the link above. Otherwise, here's a quick refresher:
  1. Being honest with ourselves, "healthcare" as we know it has become a monster of our own doing.
  2. The use of care extenders is nothing novel; at the base of it, this is just a "strategy" of cheaper labor. You get for what you pay for; quality always suffers when downsizing and substituting.
  3. The gatekeeper model has failed. WE have failed. Consumers seek value; not information or rationing of products and services.
  4. Unity is paramount to success in healthcare.
  5. Value Based Healthcare is the solution to breaking out of the Success Dilemma.
The Success Dilemma In Healthcare (Part 2)

3(b). What's my solution?

I propose that Value Based Healthcare requires two things before it can truly come to fruition.
  1. As healthcare as an industry can no longer sustain fee-for-service reimbursement and hourly-based pay, we need to restructure the financial workings and supply chain effects so that VALUE is the currency at hand. To do this, we will very likely need to see a relative blunting of compensation for the continuum of healthcare providers based on contributed value.
  2. Physicians can no longer serve as arbiter and absolute authority of the care team. Instead, the CONSUMER must take this role; responsible for their own health, both personally (as it is, of course their health), financially (as a consumer), and systemically (as a return customer). Content experts will take point of care for each case while an entire network of providers provide integral care throughout the life span of the patient.
Proposition #1 will probably cause the most upheaval if not outright angst against the very idea. But, just bear with me. We are discussing a re-evaluation of how we use our resources and how we can be more responsible about it. Again, I refer to the prior mention: Is it realistically worth ANYONE's time for a physician to sit down in person and educate a patient about how an antibiotic won't cure a flu when other processes can be laid in place for the same qualitative effect with better quantitative measures?

Does it sound better or worse that the physician will bill a $100-200 dollars for that 4 minute visit?

It sounds awful! So, instead of fee-for-service paradigm, I would propose and reasonable surmise that value based compensation will cause a blunting effect since those 4 minutes are not likely very valuable. The following is a table and graphs of the value based blunting effect and is only a theoretical estimate based on financials that healthcare can become sustainable in the long run (beyond the bickering of extenders and best practice).

Why do I even DARE to suggest this? Aren't I afraid the AMA and other healthcare godfathers will come after me? Nope... Because, the recent literature in health sciences have shown us that many of the interventions we've touted aren't actually causing the effect we had hoped. Bluntly put, there are many unnecessary surgeries, interventions, drug prescriptions and the like which are truly affecting the broad spectrum of population based health outcomes. And, guess who is most vocal about this? PHYSICIANS! The ones who became medical doctors because it was a calling, not an earning. They are thought leading, sacrificing their own pocketbooks for the betterment of us all -- and, kudos to them!

But, back on the main issue at hand, consumers don't value visits. They value timely access, effective intervention, and long lasting outcomes. They value the CNA when no one else can help them clean themselves in the hospital. They value the PT when no one else will listen about their chronic pain. They value the social worker when they've lost all hope on how to pay for their bills. THAT is what the healthcare consumer values.

As such, we need the professionals who are the content experts to be directly accessible to the consumers such that they don't go through some gatekeeper, wait in line and a funnel system which only serves as temporal-crowd-control-barriers to their good health. Moreover, so much resource in time, repeat visits, repeat tests, and "failed conservative care" are used to "justify" "medical necessity" of big name drugs, surgeries, equipment, etc. that would quite likely never have been wasted would be averted if the content expert was directly consulted in the first place.

This proposal means that the healthcare supply chain needs itself to change; it can no longer be linear. It must be agile and multidimensional; it must be a well tuned, collaborative, data focused, tech driven, consumer oriented cooperative that ALL internal stakeholders value consumer outcomes above their own billed hours. Under a value based system, fee-for-service disappears, and therefore, much of the conflict of interest of a "follow up visit" or the "mechanic's dilemma" disappears. It also means the initial blunting is just that, initial.

This is just a mock-up of what could be; those who contribute more value get paid more for their value. Those that don't... don't. The system would have to iteratively re-evaluate what is and isn't valuable, and, how much value it actually is worth -- the system, driven by the healthcare consumer.

Imagine that, get paid for the worth of what you do.

This proposal also means academic institutions and professional organizations will need to also get honest with themselves as well; what is the real value (or cost to student) of education, and therefore, what is the best mode of said education? Questions a little beyond my scope of expertise at the moment.

This value based system will have a blunting effect carrying over as a value based compensation for healthcare providers, from the CNA all the way "up to" the neuro surgeon. After all, it is no long service people want, it is VALUE.

Now, I made all this reference about CSR and social responsibility as a whole. Therefore, let me run this through some CSR frameworks and an ethical screen to demonstrate that it fits the mold, and therefore, is a recommendation worthy to be considered as a prototype solution.

3(c). CSR and Socially Responsible Healthcare

Going beyond direct access and into the forays of a truly collaborative community of healthcare providers who are paid by value added versus service rendered, this is my CSR analysis. It also serves to explain Proposition #2 in the section 3(b) above.

Carroll's 4 part definition of being CSR is this:
  • Be economically/financially responsible (create value, earn money).
  • Be legal (obey the laws, play within the rules).
  • Be ethical (be moral, act socially respectable & responsible).
  • Be a good corporate citizen (philanthropy, paying it forward, giving back).
Considering this, AND, the image below depicting prevalence of health concerns (a BIG shoutout to Jerry, Sturdy, and the whole team at SF Physical Therapy):

I hope we can agree that a value based, collaborative system with direct channels to content experts is FAR superior to a gatekeeper and justification mechanism. Instead, if ALL providers were empowered by society (laws and all) to practice at the top of their credentials, so much would be solved in this regard. I have a physician/medical director to thank for this part of this idea from way back when (but, he has yet given me okay to name him publically. No worries, his thoughts have already been recognized at official ranks of national policy concerns and will be published soon and therefore I respect his privacy) -- nevertheless, there has been a name given this functional model to which I credit him once he feels ready.

This solution is not leader based; it is network based. A network of healthcare providers lead by mutual interests of the consumer's best health. It has nothing to do with who gets what piece of the pie. It has nothing to do with who is billing for what. It has to do with who is contributing, and, to what value is that contribution represents in the lives of our consumers.

Testing for social responsibility (pass/no pass):
  • Be economically/financially responsible: Value based, agile network model will allow for consumers to lead with their market demand and their dollars for an entire collaboration of healthcare providers to optimize resource use per outcome. Pass.
  • Be legal: Instead of finding loopholes for extenders, billing creatively and what not, this agile model will already connect a direct line for a basic health concerns to NP/PA/PT, etc. In cases such as an emergent concern, it goes directly to an urgent care/emergency physician. For musculoskeletal concerns, a physical therapist. Therefore, best candidate within the network of providers to best address the concern is operationally (and legally) highlighted as the case lead in a specific circumstance of patient concern. Pass.
  • Be ethical (be moral, act socially respectable & responsible). This value based, agile network model also provides care accessible in an on demand/ASAP basis. This is excellent because society wants their health concerns addressed NOW. Not after a 6 week health scare. Not after going through several hoops of failed conservative measures. They want their concerns to be treated as such; CONCERNS! Pass.
  • Be a good corporate citizen (philanthropy, paying it forward, giving back). While the value based, agile network model may not directly contribute funds back to society, what it will do is set up society to adopt a culture of health. This is something Western culture has desperately struggled against. Pursuit of best health seems to be an arduous task. This model will allow for PTs, OTs, RNs, dieticians.nutritionists, social works, counselors and like-minded professionals to keep consumers aware, accountable, and active in their own health. Pass.
Since the conditions of social responsibility are sufficed, let's make sure a micro-version of an Ethics Screen is also passed for extra measure. By the way, I challenge you to try fitting any one of our current models (or suggested models) through the Ethics Screen (via Carroll). It will likely fail.

An Ethics Screen
  • Conventional Approach
    • Is this the best representation of healthcare as an organization of sorts?
      • Conventional Model: Fails. Why back our consumers up and make them assume a holding pattern in the supply chain?
      • Agile Model: There is no holding pattern in this model and the supply chain is networked so that consumers are served as directly as possible. PASS.
    • Is this the best representation of societal concerns?
      • Conventional Model: With all the political and social upheaval on affordable healthcare and what not, I'd say this is a definite fail. Things are not working at present (circa 2015).
      • Agile Model: Society is familiar with agile access to products and services. Look at Amazon, Google, Ebay, etc. People KNOW where to get the answers. They go there directly. Healthcare has been trying to safeguard its secrets; it's infantile since all of our "secrets" are already out there. Consumers that don't know who they need are victims of our selfishness. Consumers who know who they need are frustrated by the conventional model. Agile network access to healthcare = PASS.
  • Principles Approach (Just to save blog space and you're reading time, I'll hold off on this section to compare and such... all to say: Yes, the Value Based, Agile Network model passes).
    • Does this model have utilitarian benefits?
    • Does this model have virtue?
    • Is this model caring?
    • Is this model following the Golden Rule?
  • Ethics Tests Approach
    • Does this model suffice Common Sense?
      • Duh! This model is practically the model for every other industry. This is a Pass.
    • Is this model a representation of "One's Best Self?"
      • I think the Agile Model is definitely a representation of healthcare's best self; having content experts directly connected to patient concerns while the network of providers assume consultative and collaborative roles to the lead of the content expert is a GREAT way of expressing our best self. Musculoskeletal concern? Why not a physical therapist take lead, internist & pharmacists consult regarding any medication concerns, have pain psychology and social work hover as support? I can't give a reason, why not! Pass.
    • Does this model pass the "Gag Test?"
      • To this, I'll just say that many of the "extender" conversations I've heard does NOT pass the Gag Test. If it makes you gag even a little, it's a fail.


In my humble opinion, healthcare is at a crossroads where: We can all win; and, we can all win together. Or... we can all lose, one by one until it's all tragically and agonizingly gone.

We caused this problem together. Times got tough, so we billed more (creatively), downsized, used cheaper labor, etc. We found ways to make people wait, or stay away, to our benefit. Or, we got them to come back regularly, to our benefit. We created our own bottlenecks, gatekeepers, and circular referral processes. Payers started noticing what we were doing, so they kept decreasing what they were willing to pay because obviously we were trying to increase what we were going to fairly get.

Around and around this went until we come to now: a breaking point.

The conventional model as we know it has failed. We need to STOP redesigning the horse and buggy and we need to start crafting the horseless carriage.

I've covered organizational, cultural, professional, financial, and societal perspectives on this problem... this Success Dilemma in Healthcare.

I humbly present my recommendation as proposed, for healthcare to adopt a Value Based Agile Network model. This keeps people healthy and directly connects them to the expert of best position when a concern comes up, all the while being supported by the entire community of healthcare professionals in a collaborative network.

It capitalizes on what our society is doing best, right now: TECHNOLOGY.

And, it returns healthcare back to the core of it's identity: HUMANITY.

This model acknowledges that information is everywhere... the rationing, distribution, and social monopolization of health information/services is no longer seen as fair nor acceptable. Therefore, this model provides healthcare in a fashion which society deems responsible.

The appropriately lower margins of costs driven by "value based provider compensation" makes the burden of healthcare more evenly dispersed across the continuum providers and the consumers. Moreover, it is sustainable.

Rather than an interventive, reactive pattern to which so often, things come up typically too little, too late (like running around with a garden hose, hoping it will reach all the hotspots of a fire)... the Agile Network model serves the consumer on both an on demand basis as well as via an integral approach, taking many snapshots of a patient's health over small bits of time to assure there are no alarming trends towards disease, dysfunction, or disability.

The Value Based Network Model has the greatest scope of reach with the highest levels of credenced practice for all providers in the network. Moreover, it directly connects consumers for early intervention, serves as a preventive and proactive measure, and is highly educative to its consumers such that consumers benefit through the lifespan of their health needs versus a dissociated event-by-event basis.

Most importantly, the Value Based Network Model breaks out of the Success Dilemma. Instead of beating the same horse to move the same buggy, we finally broach the subject of designing and implementing a horseless carriage.

Ironically enough, Henry Ford did not invent the automobile, neither did he come up with the idea of an assembly line; he made cars accessible and affordable for consumers. That is spirit of success behind the horseless carriage.

My answer to the Success Dilemma in Healthcare?

Let us unify and disrupt ourselves; together, forge a better, stronger, and sustainable future to turn this social burden into a societal value.

The Success Dilemma In Healthcare (Part 1)

There has been a LOT of clamoring in social media about licensed healthcare providers and their licensed and/or unlicensed care extenders; believe you me, it's not just the physical therapy world that has been talking about this. Care extension has been at the center of a rather heated, uncomfortable, and disuniting talk for MANY healthcare circles including that of physicians, PAs, NPs, RNs, LVNs, CNAs, rad techs, diet techs, nutritionists..... need I go on?

So, after reviewing the true spirit of the discussions, debates, yellings, and social media japs as of late, I've come across this post (which has been in sitting in my blog queue for some time) and realized.... THIS is the center of our problem.

PS. Yeah... this may be a tiny bit of a rant; but I do offer real solutions with plenty of background.

PPS. I've split this post up into Parts 1 & 2. Part 1 as the situation analysis & Part 2 as the solution. Enjoy!

The Success Dilemma In Healthcare

In once sentence, here is our problem: "We're still trying to make a better horse and buggy when we should actually be working on a horseless carriage."

A reference to the oft quoted to Henry Ford, though perhaps not so accurately attributed in this case.

I feel as an industry, and certainly an economic construct, healthcare as we know it has topped out. It has been spinning its wheels in its own Success Dilemma; the vicious repetition of what worked in the past in hopes it continues to work for the future. This particular dilemma is not unique to any one industry. It happened to the horse and buggy when replaced with the horseless carriage. It happened to radios when they went from tube to transistors. It happened to Blockbuster when it got paved over by digital streaming, NetFlix, and the like. It happened and will continue to happen when sticking to whatever once made success, ultimately creates the rigidity that causes its failure.

As for healthcare, let's all be honest for just one moment.

Just even for a moment...

EVERYONE is talking about care extenders. And, why? It isn't for the greater good. It isn't for better efficiency or even the brainstorming of "innovative" care models.

Because, again, we're being honest right now, right? This talk has been around since commerce has been around: "If someone can do something for cheaper..."

I'll come right out & say it even if no one else will: IT'S ABOUT THE MONEY!

Extenders are cheaper by the hour than for whomever's care they extend; therefore, by being less costly upon a business based on human labor and time, it makes the margins better to substitute as such. Yet, We've TRIED this already. What has happened? Healthcare is STILL way too expensive and beyond sustainable for any local, regional, or national economy. And, it is unsustainable for all areas of practice.

The problem is SYSTEMIC. And guess what? Our consumers are absolutely sick (ha ha) of our internal bickerings -- they want applicable solutions TO THEM, not you clinic, business, firm, or organization.

Yet still, what have we all been yammering about? Finding new ways, crafting new laws, enabling new policies, and trying to sway professional opinions amongst our colleagues in such a way that doing things "differently" in the name of cost savings or what have you is then a good thing. Now, there are times when it is certainly necessary. When the automatic blood pressure cuff came out, did you really need a physician or nurse to do duplicate this manually as a health screening? NO! This  and many more types of care elements in this vein exists throughout the continuum of healthcare.

However, this isn't where our problem is. This, again, is a Success Dilemma. We're trying to do the same thing over and over again (definition of insanity); because it has once worked, it has been working, and we can only expect it to work again.

The problem is, everyone is doing it. Everywhere, in health systems, healthcare companies, private practice, for profit multi-center firms... everyone is focusing on better margins. As margins have been falling with lower earnings (due to various factors, including declining reimbursement rates), dismal growth is being reported; that's a bad thing when considering the shareholders. Since firms don't want investors to start dumping their shares, the knee jerk reaction for any company when costs are squashing margins comes to play. Reimbursements went down, so what did we do?

We billed more and paid our people less. When that didn't work, we downsized. When that didn't work, we started using cheaper labor that could hopefully substitute for quantity and quality. We hoped all of our management decision wouldn't affect quality, or, that no one would notice. We hoped that as our little management tricks served to inflate our earnings, improve margins, and hopefully restore growth, that quality care would not suffer. But, it didn't work and it doesn't work. Quality ALWAYS suffers.

And, this is where we fail... this is where the Success Dilemma destroys us. So, what's the answer? Well, it's nothing organic nor is it new. Nope. It's absolutely intentional. When success fails, disruption occurs.

Industry disruptions have historically happened when characteristics of products (or services) offer inherently novel combinations of traits which allow people to go about their day in a way never done before. I need to stress here that it isn't about performance features; making something fast faster isn't disruptive per se -- this just makes all the other competitor shift their understanding of the status quo (ie. "Henry Ford's" faster horse + faster buggy vs. horseless carriage).

Disruptive innovation creates entirely new markets because of the RESULTS of their products; entirely new ways of thinking; entirely new lifestyles; and entirely new sets of human behaviors.

If what you're trying to do is same thing but faster and/or more efficiently, it isn't anything innovative at all. It certainly isn't "different." If you go down this road long enough, you'll find the same "solution" humanity has always found when things can't go any faster.... you take SHORTCUTS.

So, what's my recommendation, you ask?

1. First, I suggest we take a look at what healthcare was and has become. During its inception, healthcare was really the practice of healing arts when it came to the human experience. Be it physician or surgeon (yes, they were considered different in a time before), sage, shaman, healer, priest, witch, whatever... the human experience looked to experts for their knowledge as well as their information and understanding of the human body. As science began to take hold for the human experience, societies started to notice certain reliabilities and consistencies and gravitated to what was termed as the practice of "medicine."

Nevertheless, the skill sets involved all circulated around one thing: Information. As various perspectives on the human experience and health evolved, healthcare eventually became a business model with many disciplines to create a care team, typically headed up by a chief physician and governed by an administrator.

As costs started to present themselves insurmountable, we tried different things. A gatekeeper model, a maintenance model, preferred provider, wellness... you name it. The problem is, the whole time we were still rationing and distributing knowledge in the form of access to care, prescription of pharmaceuticals, and scheduling of procedures. We failed addressed the one thing that could help us.


Since information is practically free now, it is no longer valuable as it stands alone. And, while certainly, the information isn't always accurate as framed on any given website due to generalization or what not, consumers don't care. They already have their information, what they are now seeking is value. As such, my first recommendation is that we get honest with ourselves, our consumers, and all of our stakeholders.

Healthcare has spun out of control in so far that it is no longer a viable business model in and of itself. And trust me, that is HARD for me to say. I spent a lot of time, blood, sweat, tears, and money getting my degrees and training to be licensed to do what I do. I pay good money to maintain my license to have the privilege to provide care for others.

Still, it isn't enough. Honesty declares that the monster we've helped create by ALL the current practices we have participated in... has failed.

We, have failed.

2. Arriving here, my second recommendation becomes a little more obvious. Healthcare is a social burden. As such, solutions must be forged together. All this talk about extenders, cost savings, and blah blah blah... it only divides us. It never unites us.

Unity is what we need. Unity within the professions; unity amongst the professions.

This is part of the big picture I've been talking about.

The solution I recommend has to do with social responsibility as form of economic sustainability and competitive strategy. I base this off of what I'm observing in the grumblings, debates, and opinions in the healthcare marketplace at large. I also base this on the many business studies that have proven a properly leveraged corporate social responsibility (CSR) as that which adds significant value, and sustainable value at that, for consumers. As such, I think it is fair to say: Healthcare is facing a crisis in social responsibility.

The IRON LAW of Social Responsibility:
The iron law of responsibility says that in the long run, those who do not use power in ways that society considers responsible will tend to lose it.

So I ask you, are our healthcare systems using its power responsibly? I would offer the answer is "No." If we were, we wouldn't be in this pickle. We wouldn't be arguing amongst ourselves while all of our consumers, shareholders, and stakeholders are at our throats in one form or another.

So again, my second recommendation is UNITY. We can't do this if we're divided. We can't solve this if we're bickering over the most minute of things which do NOT cause to help the big picture. This means that each profession needs to humble themselves and stop thinking about their supply side perspectives. Sure, physicians do more than prescribe. Sure, pharmacists do more than dispense. Sure, nurses do more than attend. Sure, rehab therapists do more than massage or exercise. Sure, technicians of all sorts do more than press buttons, wave wands, or take blood. Yes. Yes. Sure. Sure. All of it is correct.

But, the fact of the matter is this, all this bickering is going to take the power away from both provider and consumer... and place it completely into a third arbitrary party. At that point, no one gets a say. Don't think so? Just ask those struggling with new contracts; it is so. And, it is terrifying.

3(a). As such, this is my third recommendation: pursue Value Based Healthcare. What?! This isn't anything new, you say? Well... it isn't. People have talked about it. But, people have never AGREED on it. There are 101 definitions to what value based healthcare is and should look like.

This is what I'd like to suggest: Let's examine value from the perspective of the healthcare consumer.

A quote (likely a paraphrase) from one of my business professors goes something like this: "What companies need to do is to develop products by understanding circumstances in which they are used by customers... " It is here that I believe value can be found for how we can provide healthcare.

We, all of us, as internal stakeholders and a community of healthcare professionals need to look at our consumers and external stakeholders and ask ourselves what their circumstances are to which the need arises that they demand (want/need) healthcare services. For it is in those circumstances we find the first seeds of value.

Therefore, I will share again my taken formula for value in healthcare:

As such, let's work from the bottom up. Healthcare consumers want two things: (1) to stay as healthy as possible for as long as possible, and, (2) when health concerns inevitably arise, to have immediate access to expertise and care.

With this in mind, I ask the rhetorical: Is a 4 minute office visit by a physician educating you that you have a flu and don't need antibiotics valuable to its cost? Or, is it better that a message be sent by a patient, screened by a provider, and response given through a digital patient portal?

Is making that same 4 minute office visit to discuss your back pain really all that valuable? Especially when the result is "do these nonspecific print out stretches," take "these pills," and "come see me in 4-6 weeks if you don't feel better" truly valuable?

Even worse, when after those 6 weeks, you get referred to a physical therapist only to wait for another week or two to get scheduled? Or, would it have been better to register a digital health concern of a musculoskeletal nature and get immediately referred to your physical therapist?

The way things have always been is not driving a Value Based Healthcare System. It is neither good business, nor is it socially responsible. So I continue this vein to ask you the following:

How it is even remotely socially responsible that I regularly hear customers complain...
  • a doctor's visit wasn't worth a copay or time
  • that a PTA did more than the PT ever did
  • when an aide provided ultrasound (and it was billed for)
  • that the CNA is the "real" nurse
  • when the OT seemed to just be following what the PT was saying
  • any ungodly wait time for healthcare services
  • that an MRI was used to both fear monger and justify medical necessity for a surgery (and PT was never consulted)
  • a PT "walks a patient" (noncardiac) for 1000ft and doesn't d/c services in a hospital
  • patients get the imaging run around until they receive a referral to a physical therapist months later
  • prescription drugs are ordered brand name and not generic when possible
  • I mean... the list goes ON!.... FOREVER
The answer is obvious: It isn't. It isn't responsible. It isn't ethical. It isn't right.

The situation is clearing wrong. It is no where near functional, efficient, good for providers, good for consumers, nor right for society. Value Based Healthcare sounds like a great idea; but, does it have any backing? Does the framework even have theoretical grounds for building? What about the "evidence?"

Please continue reading and find my solution for breaking out of the Success Dilemma in Healthcare... AND, an entirely new paradigm of healthcare here at:

The Success Dilemma In Healthcare (Part 2)

Wednesday, April 22, 2015

5 Tips For Finding A Mentor

Finding a good mentor (or even several) gives you invaluable advantages in your journey towards establishing, developing, and growing a career. I can certainly attribute some very critical circumstances to which I relied upon a mentor's words of wisdom to choose the best paths which lead me to where I am today. There, I present to you....

5 Tips For Finding A Mentor

1. Personality
When finding a mentor, make sure they have a good personality. After all, you'll be interacting with this person for quite some time in the coming future. They need to be personable, compatible, and respectable in your eye. They'll likely have many encouraging things to say to you, and, if they're a good one, they'll have some chastising and constructive criticism as well.

2. Keeps you in check
Speaking of which, one of the most important things a mentor can do for you is to prune and sharpen your dreams. Much like a diamond cutter makes the rough that much more valuable with each strike, your mentor must carefully and purposely prune you into the gem from behind the rough. This can include reining you back in when your head is way beyond the clouds -- like, in outer space. They also know how to smack you out of your depressio-doldrums as well. In essence, they keep your outlook balanced and keep you honest with yourself.

3. Attentive and accessible
A good mentor needs to be quickly accessible and very attentive to the many things you won't be saying. They can read between the lines, through your poker face, and into your heart-of-heart-of-intentions... even the ones YOU don't even know you have. They are quick to respond to your questions and can do so with compassion as well as understanding. After all, they were once where you were.

4. Willing to check up on you
Sometimes, mentees forget to check in with their mentors. A good mentor will remember you; recall that its been a couple months of radio silence. For whatever reason, I've found that this is commonly the time when mentees need their mentors most. As such, if you see a prospective mentor who has a habit of checking in on people, remembering them even after months if not years past, you've found a good one.

5. Willing give you the ugly, ugly truth.
When it's all said and done, you're moving onto the next phase of life, your mentor needs to be willing to give you the ugly, ugly truth. Stage by stage in our lives, we tend to see things with a certain lense of naivety. However, with this innocence exists the wonderful thing of hope. However, hope must be tempered with reality as carbon is tempered with iron to make steel. When hopes and realities align, great things happen. Sometimes, the ugly truth is what is required to harden the steel, create a definitive edge, and purpose an instrument to a great cause.

This last one certainly happened to me; my mentor promoted me outside of his very organization with his sharing of the ugly, ugly truth. You know what? I'm better for it, and, it's a testament to his mentorship that he was willing to lose me for my own betterment.

So I ask you, have you found someone?

Do they have all these qualities? Well... Ask them out! ..... As a mentor, of course ;)

(I know you were thinking it.)

That's it for now. Until next time!

Monday, April 20, 2015

5 Tips For Finding "Clinch" Rotations

So.....! Clinch means really awesome??? You kids and your new words... #FeelingOld. Alright! Let it never be said I don't rise to random and rather serendipitous challenges!

Here are.........!!!!

5 Tips For Finding a "Clinch" Rotation

1. Network Early, Network Often.
I can't say it enough, "It's not what you know, it's who you know." I said so as lately as this post and probably all the posts in the career paths label. Yet, what I mean by network is that I encourage you to seek out those who may be able to offer you a favorable introduction to a highly competitive clinical rotation. Think on it: a rotation at NYU Medical, Harvard, Stanford, UCLA, Michigan, Johns Hopkins... just to name a few. It'd be pretty cool, huh? Therefore, it is best to make contact with people early, establish a relationship with them, become likable to them, turn up the charm, and make the connection both relatable and regular. How, you ask? It can be as simple as cold calling a facility. Call up that world class hospital you've been thinking about, ask for the PT department, request to be forwarded to the PT student coordinator.

Do this a year in advance since most likely, all the spots this year are already filled and start networking. You could also leverage social media and make contact that way. There's always your friendly PT Pub Night. Oh, yes! CSM is always a welcome way to make an approach, establish contact, and hope to continue the connection in a meaningful way until the rotation is settled. All those booths with people waiting to be talked to? Yup! That's your in. Oh, one last networking opportunity is via alumni. For this, many times networking is through social media or just serendipity. In any case, CIs from the same program typically love to take on students from their alma mater -- it's a great opportunity to pass the torch and gossip about the professors... I mean, speak... only.... professionally..... always.

2. Don't Be Afraid To Move
Some of the best clinical experiences are far, far away.
Yes, I know... it is expensive. Yes, I know... it can be annoying to move. And, yes... I know, it's just an overall pain. But, guess what? It is temporary. Quite short term, in fact. And, being that some of the best rotations require just a bit more umph in mobility, it's likely that only the local students will take interest. This is a good thing since many times, CIs will get bored of the same students from the same program... they just may want a little mix-it-up and that's where you can come in. But really, the REAL reason not to be afraid to move is that when you come out with your DPT, you will want to be able to put on your resume that you did a 12 week rotation at NYU Medical's Cardiac Rehab program. NOT, that you landed a super convenient rotation close to home that no one knows about. Besides, you BETTER believe you'll get a job in any acute care hospital after that world famous rotation (more on this in tip #4).

3. Seek Out Teaching Facilities
Be it clinics, hospitals, university affiliates...etc. such facilities tend to offer students the most well rounded and comprehensive learning experiences for any given clinical rotation. Hospitals as such, usually offer students to observe surgery and will have them rotate through the breadth of the campus. Another advantage of seeking out teaching facilities is that the CI population is quite likely to have a natural way of teaching with a passion for grooming up and coming students. It truly comes across with a quality difference when rotating in a for-profit-SNF experience versus an outpatient "sports medicine" wing attached to a teaching university's medical campus. Trust me, it's worth looking into.

4. Seek Out Big Names and Big Brands
The true competitive advantage that any given clinical rotation offers isn't the experience per se. Certainly, if your CI is an OCS, SCS, FAAOMPT, and 20 other credentials, is a great communicator, savvy mentor, amazing clinician, and is also an empowering teacher.... Then, yup, you stuck gold! But, the likelihood of this being the case on the draw isn't so high. Surely, if you network early, you can up your chances. BUT! If you were to rotate at one of the larger brands as mentioned above, it becomes no question as to the quality of your training (be it the case or not). The bottom line for many hiring managers is this: "Can I trust this person?" When you are able to state that you rotated at one of the nation's largest and most venerable medical campuses, it becomes much to your favor in the job market as the strength of the brand you rotated with now becomes attached to that of your own.

5. Get To Know Your People
DCE...ACCE...CCCE...CIs???? What ARE those? Well, this link will tell you and so will I. The DCE/ACCE is typically the same person who arranges and matches available rotations to the students in the DPT programs. The CCCE is the site coordinator who receives the students from DPT programs to which the CI (clinical instructor) will supervise every move the student will hence make. Getting to know your DCE is of paramount importance; because, if they like you well enough, they may very well labor to set you up with a choice rotation. Now, don't squander this. Don't choose some conveniently located rotation close to home; choose something that will challenge you and will up your overall value as a future job market applicant.

Sooooooo..... That's it! Those are my tips for finding a "clinch" rotation. Haha, it was definitely a lot of fun spinning this post together. Please keep the ideas coming; requests are always warmly welcome.

Until Next Time!

PS. Click here to see the original post "5 Tips For Finding a Clinical Internships." 

5 Tips For Finding Clinical Internships

While different than another coming post with the title of finding "clinch" rotations, this post circulates on finding rotations when the competition is tough, versus the other post which is finding the most choice rotation you can get your hands on. This post will circulate on what to look out for, what opportunities to capitalize on, and, which rotations you may wish to avoid. Certainly, there will be some overlap in content since the topic at hand is so similar. Yet, in any and all cases, I hope you find this post valuable and helpful in your journey.

Here are............!!

5 Tips For Finding Clinical Internships

1. Big name, big brand, big resume builder.
Look lets face it, we're in a consumer's society where branding matters. When you rotate with a place of national if not international acclaim, you then will be blessed with that affiliation. There is also a big advantage in seeking these venues out. They are BIG with lots of rooms and armies of clinicians where the likelihood of you landing a clinical internship will be quite high. The brand value added, a definite plus ;)

2. The setting is important.
Clinical exposure is a big deal and makes you more marketable as a prospective employee. Try not to double up on the same setting, but rather, spread out your breadth of exposure. This is also helpful in simply landing ANY setting since there are many opportunities out there typically untapped for student rotations. You just have to ask, have your DPT program's DCE help facilitate, and the likelihood of getting a rotation just went up!

3. Favor rotations where people are able to teach.
Private practice is great; however, it can be tight operations with a high pressure on productivity. The same goes for SNFs and for profit home health. As such, teaching and learning in such settings tends to be rushed and sometimes even haphazard. When compared to big organizations that love to teach, it becomes night and day. Lots of larger organizations tend to not be on the cutting edge, at it were. However, it won't really matter as what you need most out of these rotations is: (A) to have one, and, (B) to have quality exposure to a healthcare industry setting.

4. Reach out via social media.
It's happened before and it will happen again! Social media has been a great way to bridge opportunities for both clinicians, affiliation sites, and students alike. I've been a part of such dynamics in the past and it is actually quite rewarding to use something like Twitter to connect people together for the benefit of a deserving and learned student. It's good stuff.

5. Consider areas where no one else is going.
Similar to the words of Tip #2, sometimes choosing a setting where no one is going is a good way to get a rotation. Going in the opposite direction to where everyone else is going allows you a bit more freedom. The trade off is that you may have to physically move to the rotation locale or you may have to settle for a less than favorable setting. But hey, when comparing being held back due to lack of a rotation versus having one.... having one is better than none.

It's actually a rare thing for DPT students to be held back because of unavailable rotations. What IS common, however, is that students are biting their nails... waiting for that rotation to finally get pushed through the proper channels. Personally, I hate living on that nervous ledge. I rather have things better planned out. So while this post circulated around the situations of IF you were struggling in finding a rotation... the follow up post will be centered on how to secure a choice rotation.

Stay tuned!!

UPDATED: Here's the follow up! 5 Tips for Finding "Clinch" Rotations.

Sunday, April 12, 2015

5 Things I Wish I Knew BEFORE School

A most common and fun question to answer when I get interviewed goes something along the lines of this: "What do you wish you knew before......" Dedicated to all you wonderful people who were willing to interview me for one reason or another... and, continuing on this running theme of student and career oriented posts...

HERE ARE............!!!

5 Things I Wish I Knew BEFORE School

1. Earn your stripes, earn them early.
This is relevant to high school, college, graduate school,.. basically anything during and surrounding emerging adulthood. We've all heard that phrase, "Start 'em early!" In many ways, I agree... within reason of course. I tell many people that I mentor as a life coach (of sorts), "Make your claim to fame, and, move on." What I mean by this, is that earlier you start in pursuit of an ideal, the quicker you are likely to achieve it and/or something else truly significant along the way.

We've finally emerged into a point in humanity where schooling only means so much. As it stood earlier in the 20th century, schooling actually gave competitive and functional advantages to those who earned degrees. However, the world is now saturated with graduates at all levels. Information is no longer useful; ability is. Therefore, start on something. Pursue with the intent of perfection.

It is like what my Brazilian Jiu Jitsu instructor likes to remind me of: The next belt promotion isn't the goal, BLACK BELT is the goal. In life, there are no shortcuts and there are no breaks. The only way to get better in life is to do it; school no longer offers the shortcuts we wished and hoped were still available. The earlier to earn your stripes, the higher up you will be in the areas of life you aim to be.

2. Work hard. Grind harder. Fight even harder. Win.
I've said it soooo many times before: As a corollary to "It's not what you know, it's who you know"... I remind those I mentor, "It's not what you do, it's HOW you do it."

The only way to get better at something is drilling it, practicing it, perfecting it, and dedicating your life's energy toward it. If you work harder than those around you; if you're at the grind with more effort that those around you; if you put out that much more than those competing against you in the fight... You. Will. Win.

Work ethic is the fuel of success. The rest, is made of wise choices, fortuitous circumstances, and catching the ball when it comes. 

3. Earn everything, because you deserve nothing.
One of the things that truly irks me about an emerging cultural element in our society is entitlement. UGH! Even writing that word out makes me a little ill.

This kind of has its own relations to my first thing I wish I knew "Earn your stripes." So often, especially among youngsters, there's this attitude that so long as I do something, I deserve it. NOT THE CASE IN LIFE. What is the case in life is that you must EARN IT. A degree, a certificate, a participation trophy... none of those things makes one deserving of ANYTHING. It is the earning, the achieving, the laboring, and the suffering endured that truly makes someone deserving of anything at all... and even then, they didn't deserve it... they EARNED it.

Once you graduate, you've only earned your degree; you must earn everything else.

4. Knowing is second to the ability to apply it.
So much of our educational system is based on knowing. So little has to do with applying. I remember this hilarious discussion with a pharmacist years ago when I was learning undergraduate chemistry. Immediately, she rattled off all these useful chemical interactions and how you could do certain things to make one drug into another. When she found out I was learning numbers in chemistry, she just about lost it: "That's not chemistry! That's theory."

What I really wish I knew before school was that anything I learned NEEDED applicational platforms otherwise, the knowledge was no more valuable than the words on the page that I gleaned it from.

5. Relationships are everything.
There is far too much emphasis on all the other aspects of life when it comes to schooling. You take a look around, and no matter the level of education (save perhaps graduate business programs), no one ever stresses the importance of networking relationships.

When you finally hope to put your schooling to economic use (ie getting a job), no one will care what you know. The truth is, EVERYONE knows what you know because everyone went to school. However, just like I mentioned above: "It's not what you know, it's WHO you know."

This old adage reigns true today, perhaps even more so than our recent past. So, I can only stress to you (as I mentioned on my Resume Tips post), make sure you connect with people early on in your learning so that when you need to truly cash in on those connections, they are there for you and willingly so!

By the way, I find it in no curiosity on these statements:
  • It's not what you know, it's who you know.
  • It's not what you do, its how you do it.
That the words "WHO" and "HOW" are but a difference of arrangement.

That's all folks. Until Next Time!

Monday, April 6, 2015

5 Tips For Salary Negotiations

I've been noticing a lot more talk about salaries and compensation packages on social media as of late. After getting involved in a small conversation myself, it inspired me to write up a blog post on exactly this topic. Note, some of this perspective may be off by just a few years since my days as a rehab director. Nevertheless, the concepts and business constructs remain valid.

I hope you enjoy yet another student and career oriented post...!!!

5 Tips For Salary Negotiations

1. Start with a strong point of reference.
This may seem almost silly to advise; but, you'd be surprised how many times I was approached (unsolicited, mind you), with someone looking for a job saying "Oh yeah... here I am and I'll work for THIS amount." That amount, being something like 20-25% above my highest paid staff (not to mention even more than that, my own).

Doing your own market research on what competitive compensation packages are for your region is the first action of respect when you're approaching the table for negotiations. While you can certainly use websites like Glassdoor (which is actually fairly accurate), asking around for primary sources is the best. Nevertheless, anything is helpful -- just get an idea where the median compensation is per dollar and then extrapolate the totality of possible compensation packages. Check out this Cyber PT guest post for more info, and, this post on related interview tips in the same vein.

All this to say, be very mindful about the range your dollar signs can go. Most hiring managers, regardless of their titles, are typically paid only 5% above the average pay grade. There's a lot of red tape, unwanted overtime, and headaches that come with that 5%; RESPECT THAT FACT as you approach the table.

2. Know the business structure.
Knowing the business structure is an exercise in deciphering a department and/or firm's supply chain. This is really important to understand because while Tip #1 lets you know a good base of reference for negotiating a number, Tip #2 tells you the actual wiggle room you have while negotiating. While some places can't give you anything above what they initially offer (via company policy), some places just won't. It's not always up to the hiring manager.

Therefore, there exists several key factors to consider; the area, the location, and WHY they need to hire. Also, if and when (because you should) tour the facility to which you are a prospective candidate, take a peek and ask around as to what the turnover has been like. This will give you a huge clue as to why they are hiring and what the wiggle room per dollar actually is.

A department filled with senior staff; veterans of the department for 10+ years are very expensive to retain. They've received 10 years worths of merits and successive raises; it is likely they will want to hire you to lower their cost per minute. If the department is basically all new staff, what you are likely looking at is a shuffling period for the department or company; there is definitely wiggle room in this case.

Also, take a look at what the temp staffing is like. They need to fill a position, that's why you are there; however, they also need to have that position in the supply chain currently manned otherwise they are losing out on precious revenue and botching their customer service. So, take a look at how expensive the local registry (outside agency staffing) is, how much per diem they may be using, and whatever travel staff might be present. These are huge hints as to what they are spending to keep the department floating.

The middle point between how high you can ask for versus how much money they are wasting on temp staff represent the wiggle room between what they can offer and what you can ask for.

3. Consider the entire compensation package.
Some hiring managers may look at you like you're crazy when you want more money. These managers typically represent organizations that just don't find compensation in cash as the "big" part of pay; they compensate you on benefits. Now, don't take that kind of reaction personally. THEY know that their company gives them amazing benefits. To them, the benefits far outweighs the pay cut in cash. But, you don't know that about their company... not yet, at least.

This is where I tell you to fully evaluate any compensation package before you negotiate. This is also where I tell you that typically, unless you have mad connections or hackabilities, it is unlikely you'll have full access to the details of any given compensation package to where you can make counter offers right off the bat.

Take the offer home. Ask for a day or two to consider it, nothing more. You don't want to be wasting their time, nor yours. Examine the compensation package carefully. ALWAYS consider the entire compensation package; retirement accounts, pensions, matched contributions, health benefits, PTO, con ed dollars, mentoring, fringe benefits, work-life-balance, opportunity for upward mobility, etc.

I've mentioned in the past that some packages take from your direct dollars so they can have some present value of their own to grow the company. In exchange, their contribution matching towards retirement accounts is something truly insane. I've seen companies basically help you accrue upwards of $10k plus a year in retirement funds for the pay cut. So, just make sure you understand the details.

If this is your first job out of school, it's no time to be picky. Most of you already know my stance on what to do as a new grad. However, if this is your 2nd job or otherwise, it's time to get a little bit choosy and hustle depending on the situation.

4. Value Added, Cost Alleviated.
You're probably thinking, "Alright already! I get it. When do we get to the negotiation part?" Well, any smart negotiation needs to map out all the tools and pathways they have. That is why the first three tips are so important. Without those, you can't possibly utilize Tip #4.

The soul behind negotiating salaries is most basely this:
They are trying to rip you off, and, you are trying to get more of what you're worth.

Sorry, that's the truth of the matter. Where the middle ground is found is when the marginal cost of adding you to the department does not exceed the alleviating any temporary staffing costs and/or lost revenue because of your absence. The more value you add and the more cost you can convince them you'll alleviate, the more wiggle room you have to push the upper bound. Sometimes you can demonstrate how you've already proven your productivity is far greater than par. I've mentioned this in my post about writing resumes. You could also use any formal exposure to whatever additional training to your advantage. Example: Home health companies are always clawing for PTs already trained in OASIS. Competency in various EHR interfaces is also a welcome plus.

Just remember, Value = Benefit / Cost. How much benefit can you bring to this department, company, and/or organization for the cost of compensating you for your time, work, and presence? This is a key element in leveraging and justifying whatever upper bounds you wish to press for.

5. The Counter Offer (aka "Who's turns is it, again?")
Whenever negotiating, it is crucially important to know who's turn it is. Meaning, who has the control of the conversation. Now while in most situations, it is more common that the employer has the locus of control and they'll pass the control to you once they make their offer. Nevertheless, there are plenty of situations (to which I've been a part of) where the prospective candidate is actually in control! Just make sure when you make your move that it is actually your turn to speak. 

Now, you're probably wondering when a prospective candidate actually has the upper hand. Well, it happens when the costs of holding a position unfilled has been deemed unsustainable; basically, when the position has been opened for a long time and the market is just really shallow. Trust, me it has happened many times before and will continue to. You just have to have the right timing to strike that iron while it is hot.

So then, when "they" have the control and it becomes your turn, this is what you do:
  • Asking respectfully with words like: perhaps, consider, possibly, etc... Offer what they want , for what they are willing to give.
    • Typically, this means productivity.
    • However, it can also mean work schedule flexibility (ie weekends, 4x 10 hour days... even a 12 on a weekend to help with supply chain challenges)
    • It can also be managerial support; with operations being ever so tight in healthcare, it could very well be that the manager is struggling to contain the angst of their own department. Support from YOU could be a welcome thing. Caution, this could put you at odds with the staff at large. But, it is a negotiation strategy if you really want something.
  • IN RETURN, you then have some room to ask for things they are willing to give you. Surely, this could be another dollar an hour (maybe even 2 or 3). Make sure you quantify this; every $1/hr is $2000/year. Convince them you are both worth this and why they would want you to benefit from this.
    • Example: If feel this would better reflect the value I can contribute (aka what they want); and, would help financially in my circumstances (as a new grad) to which I can fully dedicate myself to this department and to you (the manager).
    • Good managers know that it can cost upwards of $20k in 2-3 months to fully train a new employee. They do NOT want to waste such resources on turnover. The bad managers... well, you wouldn't want to work under them anyway.
    • What this does is it locks in their need with their willingness to give. You're able to give them what they want. And, they don't want to lose that. Since you asked so respectfully, they like your attitude. Liking you is the most important part of any hiring process. Therefore, since they like you, they will want to find ways to help you. They rather not that you hire in, find all sorts of random other places to work per diem for better dollars, and then eventually get offered a full time position there.
    • So just remember, with the most likeable and respectful approach, offer them what they want for what you've gathered they are willing to give you whether in dollars, in benefits, in scheduling (4x 10s, weekend rotations in/out, whatever), sign on bonuses, extra CEU dollars, etc.
However! If the stars are aligned and it is YOUR turn as it is, this is what you do:
  • Asking with even more respect and grace than you would the first situation (as to demonstrate goodwill)...  Offer what they need, for what they are able to give you.
    • Now, I underlined need & able because I've had counter offers from people I genuinely liked; but, the offers were so unrealistic and borderline disrespectful that when I bumped the request up to the powers at be, they got shot down with brutality.
    • So, as stated in Tip #4, most of the time any hiring department wants value added and costs alleviated. Offer them this. Again, many times this is productivity. Other times, its the cost of poor scheduling conflicts due to seniority. Yet, other times, its unwillingness to see certain types of patients for reasons of familiarity, comfortability, competency, whatever it may be.
    • In such a situation, a hiring manager is so pressured to fill both the need of your presence in a position AND the additional value added need being filled, that they are going to do everything they can to convince their own bosses to give you the extra dime and reel you in. I've been there, personally, in such a situation. It's an interesting dynamic and the negotiations can be quite nerve wracking all the way up and down the chain of command. But, the way the hiring manager hustles on your behalf can really make for a wonderful working relationship going forward - it's actually quite touching!
  • IN RETURN, you can now ask for more specific increases in the compensation package that you are desiring.
    • Make sure that you are very clear and REASONABLE about what you're asking for. Avoid insulting the manager and the other staff by asking for a dollar amount far beyond what is actually fair, be it the pay grade or a sign on bonus.
    • Also, be sure that what you ask for is specifically communicated in relation to the need you are willing to offer to fill.
    • Example: If a department is wasting all sorts of dollars for weekend per diem staff, offer to work a relatively robust rotation of the weekend (if they don't already have that in play, or, if their rotations are out of control). In such a case, this is cost containment therefore you can ask for a bit of the cost being contained as part of your pay. You could probably seed in something like: "I'm sure you know that as a new grad, finances can be quite challenging. I like this place. I want to work here and I want to work for you. Could we perhaps, consider a rebuffed weekend rotation for me. For this, perhaps the powers at be would be willing to consider giving me 10 hour days so that I can be more of a work horse on the weekend while increasing my compensation by $X/hr. Just remember that "X" amount must be a reasonable recovery of the marginal value added per marginal cost alleviated.
Some Closing Thoughts
Negotiating your salary is always a game. Sometimes you make it; other times you break it. Sometimes what you ask for is a deal breaker. Other times, it a reluctance. Whatever the case, it is always a gamble. Just remember, the job market is still an element of business. It's JUST business -- it is nothing personal so treat it as such. Therefore, make sure you approach it this way. Surely, be likeable and charming, but also be sure to understand that these days, hiring managers are attracted to humble, thankful, and gracious applicants. Whatever you negotiate, it must benefit them as much as it benefits you. If you can convince them of this, they will surely do whatever they can to make the situation mutually profitable.

Saturday, April 4, 2015

5 Ways Twitter Changed My Life

As part of my efforts in both advocacy and mentorship, I've found that Twitter has been the most effective social media platform. Now, this is an experience in and for myself -- not to say that other outlets such as Facebook, G+, Linked In, etc. are not better or worse. It's simply that I've found that Twitter works for me. And, we tend to favor things we're good at. In any case, I can't advocate enough that both students and young professionals of all walks and of all industries find their way to Twitter that they may benefit as I have.

Here are...!

5 Ways Twitter Changed My Life

1. Connectivity
Perhaps the biggest benefit I've experienced via Twitter has been connectivity. A broader reach, a stronger platform, and, a more visible personage has been the wonderful results of how Twitter has changed my life. There are many months that I've seen my organic Twitter circles help me reach easily in the millions of unique connectivities in just 7-10s of any given campaign, initiative, or effort of awareness. When Twitter is used naturally (without gimmicky follow-backs and such), it truly becomes a social connection. And, as such, people learn about you, grow to know you with their trust thusly earned. As such, they are willing to lend a helping hand to deserving causes and intents. Twitter has exponentially elevated my connectivity.

2. Community
The Twitter community is something truly interesting. Everyone goes about it their own way; through lists, following apps, hashtags, etc. Nevertheless, people develop a community based on mutual interest, shared values, common goals, and a passion to make better the lives around us. The Twitter community is strong; perhaps stronger than any other social media platform. It is stronger, as I see it, because there are no privacy settings to hide behind. Twitter is largely public. And, it is an outlet for voices; for ideas. A community of ideas can lead to an outbreak of action; it can, it has, and it will continue to. Twitter has grown the community to which I belong.

3. Collaborativity
As if it were such a word... the opportunities to collaborate have been never more accessible than via Twitter. The etiquette of many other methods of communication tend to be more stringent, formal, and closed. It is seen as invasive if unanticipated or uninvited solicitations arrive via email, Facebook messaging, etc. Yet, with Twitter... our words and our ideas are open. Thus, such also is our invitations to more closely connect with each other and work with each other. Twitter has given me more opportunities to collaborate than I've ever experienced before.

4. Calling
I've noticed that through my interactions using Twitter, I've found new and expanded purpose... a calling really. It first expressed itself in the realm of exercise and wellness. Then, it came through the promotion of advocacy issues. Finally, it has matured to the realm of student mentorship and business/management consulting. It is easy to have the blinders on too tight; to be too focused on the issues at hand and be blind to all the glorious opportunities available. Twitter allowed me a far broader scope of examination to the areas which I could serve others... the calling to which I could answer. Twitter has the ability to inspire a new calling.

5. Continued Learning
I've heard it said before that Twitter is the world's best community college. I tend to agree! The plethora of new views, novel considerations, radical methods of approach, controversial mindsets, conflicting but constructive interactions... all of which, many times, leads to finding mutual solutions. Such is the benefit of continued learning in the context of Twitter. There have been personages, video channels, blogs, and Tweet chats that I've been exposed to and have taken part of that have completely blown my mind. Such opportunities to learn that I can assure you after 2 bouts of graduate school and 1 bout of undergraduate work that such experiences do not occur in formal education. And, as I've heard so many times from others (to which I've seen as well), such learnings through Twitter are often times far more influential. Twitter has opened my eyes to continued learning in ways never seen through formal didactics.

Some Closing Thoughts
And, so! These are but five ways Twitter has changed my life. Perhaps even 2 or 3 years ago, such a post may have been considered fickle, shallow, even self serving. But truly, Twitter is a unique platform of communication, and of, information exchange. There is an elemental rawness, even nakedness of expression, that makes us interact in a way which perhaps is more real.... than is real.

Certainly there are those who may be considered "trolls." That's what the block function is for. As to the rest of those many wonderful individuals to whom you can connect, commune, collaborate, find a calling with, and continue to learn from... such are the ways Twitter can change your life.

I hope you give it a chance.

Wednesday, April 1, 2015

Developing A Marketing Plan

One of the true joys of this blog is the interactions I get to have with you. One of the interactions I love the most is answering your questions. To this, we have Zack Duhamel to thank for today's post.
Developing A Marketing Plan

There are perhaps an infinite amount of approaches to how experts feel one should develop any given marketing plan for any given service and/or product. The discussion can be broken down by emerging or incumbent products (to which for the sake of this post, we'll include services), emerging or existing markets, sustaining or disruptive innovations, and-on-and-on it can go.

Personally, when I'm thinking through the steps in developing a marketing plan, I tend to want to start with the question "Why?" Why do I need a marketing plan? The purpose is severely important. It is too easy to be blinded as a supplier, "I need plan because I have a product." But, does the consumer need that product, or even, your product? Maybe, and, maybe not. Nevertheless, if one is trying to develop a plan (new or updating the old), it is prudent to at least mentally approach it with a fresh start.

And, while a good marketing plan has many feedback loops, for the sake of this blog let's begin with a three part framework in developing a marketing plan from scratch.

Part 1: The Pains & Gains
This idea is best known from the canvas model; it adapts the jobs to be done approach with the concept of a value proposition. In essence, starting here determines if there is even a market for your product. It's a good place to start; sometimes there is no need for a marketing plan because no market actually exists for you. A good example to think on is this:

Does your product fill a need or reduce a cost? If so, you have just created a customer.

To the customer: What need (job) requires filling? What about filling that need is the most cumbersome for them - their pains? And, what about filling that need do they wish for the most - their gains? Harvard business professor Theodore Levitt is famous for saying, "Nobody wants a 1/4 inch drill—what they want is a 1/4 inch hole.”

Then you must answer, does your product kill pains and make gains for the prospective consumer? If so, you have the foundations of your marketing plan.

Part 2: What Is Your Marketing Mix?
After establishing the fact you do indeed have a market for your product, and, that your product does present a unique value, now we have something to talk about. Your marketing mix.

Most marketers consider the marketing mix as the "4 Ps"
  • Product
  • Price
  • Placement
  • Promotion
Some schools of thought have also included a 5th "P" in the form of Profit. The nice thing about this 3 part framework I'm offering you is that Part 1 *is* your first P, your product. To know that you actually have a product is important! I can't tell you how many times I've seen businesses simply produce something and call it a product when its not really marketable. That's not a product; it's a hobby. In any case, following the 4 Ps, we need to talk about price.

Oh, real quick: Depending on the school of thought, these 4 Ps can occur various orders; but, the idea is the same. You must clearly define each. Personally, I find price to be next after product, for the reason that most consumers are quite price sensitive. Defining the price gives you an internal feedback loop on your value proposition. I've found a commonly accepted definition of value as:

Value = Benefit / Price aka "bang per buck."

I've also seen equations like: Value = Outcome / Cost. But, really, it's all the same.

Value = (Gains made + Pains killed) / Price of product.

Right? All the same. It's a matter of perspective. So check your price. Where would it be that you could make your product the most valuable to them? It's not always the lowest price; lowering your price many times lowers the amount of benefit your product can offer as you may not be able to afford high quality products with such low returns -- so think on that.

Then, we must think of placement. Many marketers also call this "positioning" to some extent. Where will you be placing your product for sales? Online? Retail? Direct sales? B2B? Will it be sold on the top shelf? Middle? In bulk? How will it be made available for consumers? Will you do a product launch or small market tests? Etc. etc. etc.

Finally, you must think of promotions. How will you promote your product? Will you have parallel promotions? Freebies? How will you advertise? Will you engage in guerilla marketing? What's your plan in generating awareness and demand? What about co-branding? Endorsements? Maybe in person sales and demonstrations? All the various ways you have to make your product more interesting and raise share of mind in the general consumers must be considered for this step to be successful. Most importantly, the mental framework of this step must be from the perspective of the consumer.

Finally, a blip about profits. Marketers and business strategists (for myself, I identify as a marketing strategist since I generally am involved less in sales and more in the planning, execution, and supply chain side of business)... are regularly guilty of being too theoretical; requiring financiers and accountants to pull them back into reality. Or, making less than happy friction against supply chain and operations managers who have to deal with the day-to-day results of their ivory tower shenanigans. THEREFORE, it is always important to refresh your screen and examine the 4Ps established against the reality: IS YOUR MARKETING MIX PROFITABLE?


Part 3: Plot Your Strategic Approach
One of the biggest (and most difficult) responsibilities of any marketer is the screening for future opportunities and threats. Nearly every strategic theorist and marketing guru will hold a different method of approach. Some say go where the demand will be. Others say, go to where the money is. Yet still, another school of thought may be to quell threats and stay ahead of your own strengths.

Regardless of how you decide to plot your strategic approach, you MUST include a regular screening of the future market projections. You can use any framework really: SWOT, Porter's 5 Forces, Blue Ocean Strategy... just to name a few.

Personally, I'm a big fan of the SWOT analysis because it serves as such a great reality check. And, it also loops back to Part 2 which then bounces back to Part 1. SWOT also allows you to analyze your competition to which then you can attack their weaknesses, follow fast and swoop in on their opportunities, and even split their resources such that they must address their threats, minimizing their ability to attend to current strengths. It's a powerful tool if done correctly, systematically, and with the right gauge of reference points.

Perhaps the most important part of Part 3 is the feedback toward Part 2 and Part 1. Just as Part 1 fed-forward to Part 2, Part 2 helps define where you're going with Part 3. But, Part 3 then returns back to Part 1 to answer the question: "Is my plan sustainable?" Will it work out in the long run? If so, push that same thought forward to Part 2 and update your marketing mix. Feed that data into Part 3 again and ensure you're still on course for long term gains. And, of course, continue the loop back to Part 1 to ensure that your product is still marketable - BECAUSE - once it's not, you need to either change your product, change your marketing mix, or change your strategic approach entirely.

So you can see, even just the development of a marketing plan is FOUR DIMENSIONAL! The execution, now there's a chess game to be played.

Some Closing Thoughts:
And so, this is my three part framework for developing a marketing plan. And, I call it "development" because a good marketing plan is never complete. It needs to be constantly updated, refreshed, and made relevant to the ever changing market environment. Also, it is JUST the beginning as there are sooooo many other frameworks and strategies of approach for success. These are just the first steps in making sure the foundations of any marketing plan you slate out is done so on solid ground.

I hope you've enjoyed this episodic Q&A blog. Again, thanks to Zack for bringing up the topic. I hope you all have found it beneficial to your practice, business, organizations, and sense of personal edification.

Until Next Time,

PS. Any and all questions for future blog posts are warmly welcome. Talk soon!