Trainers, Chiropractors, and Scope of Practice. OH MY!

When we start to feel the need to muscle up for term protection, defending scope of practice, etc... it all comes from a good place -- that the public consumer needs to be FULLY AWARE of what they are buying and who they are actually buying it from.

Still... we don't want to come across like this guy:

"This guy hates charity." - Monster's University

Positive media will always beat out negative media as it pertains to change. Sure, negative media gets more "press"... (contradiction in terms)... or, rather, is likely to get more attention. However, it may not actually get any action.

So, how do we do this? How do we go about protecting ourselves, our customers, and the consumer at large without looking like we're trying to nitpick, or even worse, come across like we're bullying other professions. Here are my suggestions:

1. Forge Strategic Alliances.

For every profession, there exists a continuum of excellence from totally amazing to "shouldn't even be in this profession." We see it all over healthcare, we see it in other professions, and certainly in personal trainers, chiropractors, etc.

Instead of saying the proverbial, "Get off my turf!" I suggest we approach the best of the trainers, chiros, acupuncturists, massage therapists... anyone who would otherwise seem to be a "threat" and make THEM our champions. After all, kind words mean a LOT more coming from someone who may be perceived as a rival. Some of the most successful cash and out of network physical therapists I know create alliances with those that would otherwise be stereotypically considered "the enemy."

It should speak volumes that such personalities are THAT successful because their mindset is not on the scarcity of resources; but, on a growth mindset that there isn't a piece of the pie to be had... rather, to make the pie bigger!

2. Get Public!

How many chiropractors, massage therapists, and TENs representatives do you see at your county fair, farmer's market, or local health fair? And... how many PTs? #PointMade

Truly, if we even wish to hope to have some semblance of professional brand awareness amongst our consumer base, we need to at the very least GET PUBLIC. GET VISIBLE. GET OUT THERE. We can't blame consumers for going to the most visible brands for substitutable expertise and solutions. We only have ourselves to blame on that one.

Therefore, what must be done is for physical therapists to capture every opportunity out there to get publicly visible. This means social media, health fairs, conferences, county fairs, conventions, community events, schools, sponsorships, ads, local news, the local paper... you name it! Anywhere there are people, ears, or eyeballs... PHYSICAL THERAPISTS SHOULD BE THERE. That... is the only way we can point the arrow to the practitioner of choice regarding physical health, the movement system, pain, rehabilitation, etc.

3. Approach Everything via Consumer Concern.

It's all about protecting the consumer. Just like we want accurate food labels, we want accurate labels on exercise, fitness, wellness, and healthcare.

This is where we can approach from a legal standpoint of false advertisement, misrepresentation, etc. We don't need to publicly blast people for doing (knowing or unknowingly) what is against the law, or at the very least, is inaccurate or unethical in terms of advertisement. What we can do, is come at this from the angle of concern for the consumers. After all, no one wants someone post-op to get hurt because they went to the wrong person, right? After all, no one wants someone who has a healthcare concern to be cared for by someone who is unlicensed, right? After all... it's all about making sure the public is protected, knows their options, and are free to make their best choice as consumers.

Coming at it from the lens of social responsibility is a powerful focus and gets a lot of positive attention, even regarding uncomfortable topics at hand which require hard changes.

Some Closing Thoughts 

As PTs, we definitely need to advocate for our consumers, protect our profession, and defend our scope of practice. We can do so with strong allies on all sides, rather than by pointing fingers at misdeed. We can do so by being a beacon of hope and constructive thought in the eye of the public. We can do so by demonstrating genuine concern for the consumer, over our own "turf," "scope," or "gain."

It is through such angles of approach that we gain favor in the public eye -- that we constantly aim for the betterment of all through transparent mindsets of mutual growth and societal benefit at large.

#PrimaryCarePT

About a year ago, I stated my thoughts "A Case For The Primary Care Physiotherapist."

Just recently, I had two dental care experiences which were vastly different from each other. While there's much to say -- and -- I *will* say, regarding the customer experience factor... there is far more significant discussion available regarding integrating a primary care PT element into healthcare. And, even some cursory discussion regarding a PT insurance much as medical, dental, vision, etc... so, why not "physical?"

After all... who is REALLY doing the "physical" examinations?

Any way... without further ado... here is my vlog on...!

#PrimaryCarePT

As always, thank you for being with me! I'm eager to hear your thoughts. Be sure to tweet me @DrBenFung or feel free to leave a comment below or in the YouTube video itself!

Best,

-Ben

PS. If you want to read more on such related thoughts, you can find them here:

• The Physical Therapist of TOMORROW
• My classic post, "Future Thoughts for Private Practice PT."
• And, even Part 1 - Part 2 - and, Part 3 of, 2015 Version of Future Thoughts.
• Annnnnd...my 2016 Prediction at UpDoc Media!

Vertical Balance: A New Look At Work-Life-Balance

Following a Periscope by Dr. Jeff Moore on balance and entrepreneurialism, I went to thinking about how I'm achieving balance. I realized for years, I had it wrong. I was balancing life as one balances things on a plate. Hence, the sayings like, "My plate is full." However, I think that a new way of looking at balance is vertically. Originally, I sad like the leaning tower of Pisa. A better way of seeing it, is like the game Jenga.

Here's my video blab on achieving work-life-balance by doing it vertically.

Physical Therapy Attitude Check: Do you own or do you work?

Physical Therapists tend to go to their daily jobs as workers. And, yet, there is all this complaint about being undervalued, under appreciated, being at the bottom of the totem pole, etc.  Ironically, this attitude is actually the root of the problem.

If you "work for," you will always care less.

If you "take ownership," then you will always care more. And, we need people to care more.

My First BPPV Case

This blog post is vlog really. It starts with my first BPPV case as a new grad. What's most entertaining is how this lead to me being the primary vestibular clinician in the department and how that lead down a whole 'nother road in Emergency Department PT and catching those strokes that like to evade the all powerful MRI. Yep... this one is alllll clinical ;) #backtomyroots

My First BPPV Case

Talking Patients, Talking Patience

@DrBenFung Would enjoy a blog post on the conversations that shape the patients mind sets in these 2 areas. Theoretical or real scenarios!

— Ryan Michael Smith (@RyanSmith_ATC) May 26, 2015

I've found that "how" you do things in life is infinitely more important than "what" you do. When it comes to patient-provider dynamics, you could not find more truth in the matter.

Talking Patients, Talking Patience

As we know, the recent literature regarding clinical outcomes pertinent to the management of pain leads us to consider a treatment model as part of the "biopsychosocial" model. Now, while even mentioning this can get some interesting (and, by interesting, I mean vitriolic) dialog amongst colleagues, the end of the matter is this:

The best outcome occurs when a patient trusts their clinician, in effect, leading to less fear and a positive outlook upon any given pain or ailment. The following is my personal style of approach along with some past example(s) of how I like to redirect, guide, and empower my patients through my interactions in their lives.

Some highlight tips:

1. Make sure they feel like they are the ONLY one you are concerned about.
2. Take seat. A psychologist once shared with me a study that sitting down makes people feel like you care more -- and -- have spent more time with them.
3. Offer examples of past horror stories which are now success stories; relate it back to the patient in front of you.
4. Speak softly... they are already anxious as it is. You don't need to be commanding, you need to be understanding.
5. Science is inhumane; patients don't want to know you're right. They want to know you care.

All in all, we need to recognize that there exists a continuum of cognitive morphology; a range. and a confidence interval of potential change. If we accept this as clinicians, we can move on together -- with our patients as providers of their best health. And, when we do this, the journey is forged together in mutual trust, which quite honestly, is what patients desire most from their healthcare experience.

5 Clinical Turn Off Convos

We've ALL been there before. Someone is talking in the background and you're beginning to register what is actually going on. Sadly, it had to be you... it had to be you that was closest to this situation that was about to unfold. You are ALREADY beginning to feel uncomfortable. The topic isn't any good. The conversation is getting worse...

Here are....!

5 Clinical Turn-Off Convos

1. The *insert degree here* debate. Be it DPT, DNP, DO, DC, MD, PharmD, PsyD, OD, DDS, whatever.... bleh. Even pharmacists at Ralph's have their name tag as Dr. So and So. We're all highly trained, educated, and ready to contribute. So... let's contribute together!

2. The *insert care extender here* debate. PTA, COTA, PA, NP, LVN, RNA, CNA... etc.

3. The *insert profession* Bashing Session, The only reason this occurs? INSECURITY!

4. Inpatient vs. Outpatient conversation... and don't forget... *whatever it is you forgot*

5. The Clinical Model's Debate. Sadly, this is highly philosophical and rarely is the actual conversation rooted in science, evidence, or even logic at its best. It's a battle of ideologies rather than of common sense.

Healthcare, the Mechanic's Dilemma, and the Tragedy of the Commons

Hi everyone! Welcome to my first combined blog and vlog episode. In this, and the next four vlog episodes, we'll be sharing some time together where sadly, I'll be wearing the exact same shirt since I recorded as many thoughts as I could during the time of my son's nap. He'll be joining us in Episode 4. It'll be fun ;)

In any case, thank you all in advance for the support in starting this video blog add on. I've decided to keep things casual. I, personally, used #casversation (casual conversation) in a happenstance since I don't plan on editing anything really. To which, I'm working on a hashtag. Brooke McIntosh already started using the #drbenfung hashtag... ugh, LOL! It's just weird for your name to become a hashtag (if that's what the people want, I'm all for it). But.... yeah. If you can come up with a good hashtag for my vlog so I can answer questions, address concerns, talk about the stuff you want to hear about... just let me know!

So, without further ado!

Healthcare, the Mechanics Dilemma, and the Tragedy of the Commons

• The Mechanic's Dilemma occurs when a mechanic is paid by the service and not by the long term results of how well your car runs. As such, a mechanic tends to worry about doing too good of a job, that business will suffer in the short run.
• This relates to healthcare as most providers are paid by each service but NOT by the long term health results of their patients.
• The Tragedy of the Commons is a popular allegory taught in business school and environmental studies to cover the disastrous effects on common resources when people don't work together; without a cooperative force, the entire land is decimated with all natural resources depleted.
• The Solution:  Judge and pay healthcare providers by the long term results of their patient populations. Forge a unity between provider, patient, and payers such that the interest and greatest value of generation is done so considering the greatest long term value in concert in promoting sustainability.

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:

"Advanced Branding Concepts for Physical Therapy"

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!

-Ben

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.

WRAPPING THIS MONSTROUS BLOG POST UP!

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?

PT v PTA v extenders v techs v aides v other professionals.... just might be #MissingTheBigPicture in #healthcare. Formulating poss blog.
— Ben Fung DPT/MBA(c) (@DrBenFung) April 22, 2015

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.

Value.

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)

The Power of Presentation

Bias is everywhere. In fact, it is biologically locked into our human psyche. Now before you go on thinking this is a political rant or whatever, it isn't. Besides, when have I EVER actually gone political on you, right? Never.

What this is about is yet another experience of being a healthcare consumer and how it relates to something called the Halo Effect. I've mentioned this more than once before; in effect, if you look the part, people will think higher of you to play the part.

So here's a personal-professional-all-around-transcendent thought process on....

The Power of Presentation

A couple weeks ago, the time finally came around for me to take my son to his very first dental appointment. I'm sure you've noticed in some of my linguo here on this blog... I don't exactly have fond sentiments towards dentistry. In fact, avoidant fear is perhaps a better descriptor. To my wife's entire credit, she did all the shopping around between social media, Yelp, and a few other resources, found the most highly recommended and rated practice within a reasonable drive. It looked great online and the reviews were really quite amazing.

So, we gave it a go!

Two words.

BLOWN AWAY.

You walked through the front door and it literally looked like a playhouse. The colors were bright, unoffending, and looked more like Chuck E Cheese than it did a dental office or any other healthcare clinic for that matter.

We entered and to the right were three playstations with 24 inch screens all set up and ready to go, games running, controllers waiting. The game options were Lego Star Wars, the game from the movie Up, and the Toy Story game. I had to do everything I could to avoid my own temptation to play. Turn left and you saw what probably was a 46 inch flat screen TV, mounted high up away from explorative little hands. On the screen was the Lego Movie.

There wasn't that smell of a dentist's office neither were there the sounds of drills, spittoons, and water hoses. It sounded like a place where kids would have fun. If my son wasn't going to go play, I certainly was! When we were called in, every treatment room was actually themed for play minus the adolescent rooms which were more traditional in the dentistry image. The rooms were themed for a certain age bracket and type of play.

The private room we went into had a small table, toddler seats, and a big box of toys. The playroom was the treatment room and it was incredible.

As it was specifically a pediatric dental practice, the entire place was specifically made to feel like a playground and it was AMAZING. The service was very fast. We were told what was to be expected at the front door, by the assistant, and then by the doctor. 

Given similar price points and elements of convenience, a top-shelf looking place is always going to outshine the bargain deal. There is always a power of presentation given the fact that the business of healthcare is the service of people.

Why Am I Sharing This Story?

I share this life experience with you because I struggle in my recollections to how well physical therapy tends to be presented. Many PT departments have small backrooms, storage wells, and otherwise "the dungeon" type locations for offices. While most private practices certainly invest in their presentation, I find that larger organizations tend to be a bit in wanting.

I find this unfortunate because the larger organizations tend to serve a proportionately larger segment of our consumer base. If the dungeon is all that we have to offer, how much better could our services truly be in terms of expected quality?

In marketing, brand image nearly always outweighs brand identity because it is the consumer's mind we need to convince in buying our brand.

If this post does anything, I hope it emboldens those of you working within larger organizations (including students rotating in said settings) to perhaps bring up a humble discussion; maybe the powers at be would be willing to invest in presentations properly representative to the power of our clinical and valued added offerings.

The Physical Therapist of TOMORROW

I'd like to talk about a little experience I had recently. Having changed health insurance carriers, I was instructed to have an establishing appointment with my primary care physician which primarily included an interview and a "physical." I was actually quite excited to see what the primary care physician's physical examination had evolved into since it had been literally YEARS since I had received a "complete physical." Much to my disappointment, the most physical thing I had to do was lay down and sit up on the examination table for abdominal palpation. Auscultation occurred, visual observation of my skin, blood pressure and temperature was taken.... however, no range of motion testing, no manual muscle testing, no gait analysis, no assessment of functional movement... all this despite an industry branding of a "complete physical." As if the results of this physical was a complete analysis of one's health, inferring the promise or at least projection of longevity, good health, and absence of disease should the "physical" return normal values.

It became more of a let down when I was told that the industry movement was towards proactive healthcare through means of exercise, clean eating, and a general sense of healthy living. But, how could such a physical evaluate a patient's needs, abilities, impairments, and risk factors in regards to exercise and healthy living?

In any case, while I was supremely happy with my physician, I was a little bummed out as a consumer. There was nothing truly physical about the "physical" I just had. The most valuable information I would eventually walk away with was going to be my lab values -- however, there really isn't much compelling evidence that the labs would determine, predict, or even be successfully utilized to prevent health, injury, or illness.

My impression is that this physical is a little formality performed because physician physicals have always been done this way. In my humble opinion, anything that has always been done a certain way without justification, standing up to academic challenge, or refined from the crucible of competition requires severe revisitation.

After a few tweets venting my professional frustration based on my position taken here:

• Future Thoughts for Private Practice Physical Therapy (2014) - Expressing the case for a tier one musculoskeletal healthcare provider embodied by a primary care physical therapist
• And expanded here: The Case for the Primary Care Physiotherapist.

I received some social response. And, finally, this tweet came about:

@PittPT Planning a blog on this!
— Dr. Ben Fung (@DrBenFung) January 19, 2015

And, it lead to this collaborative post to which I'm very proud to say is the first post on this blog with guest authorship!

Taking it away for the rest of this blog (with my most sincere thanks and appreciation for his thoughts) will be Chris Bise representing Pitt Physical Therapy on how they are training, preparing, and empowering the physical therapists today for the strategic environment of tomorrow!

The Physical Therapist of Tomorrow

It’s been a few weeks since @PittPT and myself engaged in this conversation. Since that time, CSM and a number of Twitter engagements have only reinforced my thought that the time for the “Musculoskeletal Primary Care Professional” is now. In my opinion, this goal is mission critical for the health of the profession.

The experience that Ben had with his PCP, unfortunately, is not isolated. Countless patients and professionals relate stories of doctor / patient interaction that consisted of little or no “physical” interaction. The physical examination has been swapped for diagnostic studies. Even physicians recognize the loss of the physical exam is concerning. Dr. Lisa Sanders (House MD consultant and NYT author) is quoted as saying “The physical exam will die completely or it will be resuscitated.”

Our vision and mission here at the University of Pittsburgh is the education of the modern physical therapist. The mantra here starts with “practice at the top of your license” and ends with “don’t send me patients, let me manage them.” Those two statements encompass what we feel are the essential elements of physical therapy practice. Let’s start with the first:

“Practice at the top of your license.”

This has long been the vision of many of the leaders here at the University of Pittsburgh. Our curriculum is designed around the independent musculoskeletal practitioner, operating without a referral (unrestricted direct access), managing the full range of musculoskeletal conditions. Thus, mastery of the physical exam is the first step in the journey to become a musculoskeletal expert. With this mastery comes an expectation that the knowledge gained will be applied. Many students in their transition to “new grad” are subjected to environments where they are expected to work under the supervision of a physician or have a diagnosis handed to them. The physical exam, or at least the screening elements, begin to fall to the side and become skills lost to those physical therapists. Practice patterns change, and in some cases critical thinking declines. At this point many will rationalize this decline with “I don’t have direct access in my practice environment.” I would posit that direct access, though a tangible element of outpatient practice, is in every practice environment available to the physical therapist. At CSM this year Karen Litzy, Dr.Kyle Ridgeway & Ann Wendel participated in a panel on this subject. They proposed that physical therapists practice with a “direct access mindset” across the entire range of practice environments. Some may see this as broadening our scope of practice. This isn’t an increase in our scope; rather, it is a call to assume ownership of the title “musculoskeletal expert.” Direct access isn’t an issue for only the outpatient therapist, but for the profession as a whole if we are to evolve from technicians to managers. We are musculoskeletal experts and physicians, nurses and other medical professionals know too look for the closest physical therapist when they need help.

“Don’t send me patients, let me manage them”

The role of the therapist has long been one of dependence on the physician for referrals and thus for employment. This arrangement clearly undervalues the education of the physical therapist, but as a profession, we’ve accepted this as the status quo. As physician sponsored studies here, here, and here recognize that PCPs are undereducated when it comes to musculoskeletal medicine, the proposed solution has been more physician education, and/or extender (PA/NP) specialization. Instead of increasing the burden on the physician or providing additional education to extenders I’d propose that there is a ready, well educated, musculoskeletal expert ready to fill this role. Enter the modern physical therapist.

The modern physical therapist no longer simply treats patients, he/she manages them. The modern physical therapist is part of the diagnostic team, taking the lead on all musculoskeletal problems or impairments. This occurs “across the practice continuum” and lets the therapist lead when it comes to access, diagnosis, dose, frequency, intervention. But we need to embrace different practice environments and see the physical therapist as a portal of entry into the healthcare system. Our relationships with physicians (and other therapists for that matter) needs to become lateral rather than up and down. In a perfect world, we would actually increase referrals to physicians for non-musculoskeletal problems. We know early access to Physical Therapy (here, here) reduces cost and utilization, and that physical therapists are effective differential diagnosticians for musculoskeletal conditions. With this knowledge, the next practice environment should be the office of the PCP.

My vision for the future of physical therapy involves the earliest possible access to PT. You call your PCP and tell them you have knee pain, back pain (insert musculoskeletal complaint here). Your first stop after the waiting room is the PT who makes sure you’re appropriate for treatment and either treats you that day, gives you an HEP and schedules a follow-up. With conditions that require extended care, the patient is referred to the appropriate PT provider. I can hear the critics already complaining about follow up and visits, but I can play the same game. Seriously, when was the last time your ankle sprain needed more than 1 visit and a follow-up to make sure he’s progressing? This would require a significant paradigm shift for some, but gone would be the days of inappropriate referrals. Now, in regards to musculoskeletal conditions, the PT is responsible for getting the right provider, in the right place, at the right time.

We can’t continue to subsist on the beneficence of physicians, and I’m pretty sure this isn’t the relationship they want. We need to own what we do best, musculoskeletal evaluation and treatment. The path to a sustained reality is one of ownership and responsibility of the “direct access mindset”. It’s not acute care, neuro and outpatient, it’s “neuromusculoskeletal care”, and physical therapists are the best at prescribing it.

The Physical Therapist's Brand Promise

Do we have one?

Open question to my PT & physical rehab folks: "What is our brand promise?" Interested in your thoughts! #branding #DPTstudent #brandPT

— Ben Fung DPT/MBA(c) (@DrBenFung) January 28, 2015

While I may be paraphrasing, here are some of the responses in no particular order:

• We listen.
• We start with you.
• Move. Improve. Achieve.
• Movement.
• (Mine was) - Feel awesome!
• Physical restoration.

About the brand promise: A Brand Promise is VERY different from the brand itself. The brand promise is the resultant of the brand experience. While the brand is more of a construct of the imagination; the brand promise is how a consumer feels about the brand service or product experience. In essence, "Did they do what they said they would do for me?"

As a principle, the more we deliver on the brand promise, the stronger our brand image and thus the stronger our brand positioning in the marketplace. On the theoretical level, our brand promise is the promised action/result of our brand identity. The brand image is the summative reception the consumer has of our brand. Brand promise links the brand identity to the brand image; the closer they are and the stronger they are linked, the stronger the brand equity itself.

So then, my thoughts went to, "What can we ACTUALLY deliver?"

• We can certainly deliver on "we listen."
• "Movement." Can we deliver on this? I feel many times we fail. What is perhaps worse, sometimes our consumers doesn't even care about movement. They have other things in mind.
• My lofty idea of "Feel Awesome!" ... it definitely has its constraints, no doubt.
• Physical restoration we can definitely deliver on. But, we also can deliver on much more!
• "We start with you" resonates with "we listen." And, I like them both! VERY savvy in the world of customer service.
• I like "Move. Improve. Achieve." It's more of a slogan than a brand promise, however.

It's really tough coming up with a solid brand promise. It's even more tough when a profession's brand identity is so scattered. It is paramountly worse when our brand image is more scattered than our identity!

In our current market environment, "We listen." is a very powerful statement. This can sustain and even improve our market position during this time when healthcare exists as an economic wobble-shuffle. It is actually one of the most attractive brand promises to the end-user and direct consumer. The 3rd party payer would love it too if listening meant more "favorable" utilization rates -- to which, I believe there is certainly some evidence in it.

There was another offering I was saving until now, "We get to the root of the problem." This is another power statement since many healthcare consumers are seriously fed up with duct tape approaches. They want providers to address the source issues behind their health concerns. 

As for my pipe dream idea of "Feel awesome!" This requires we have a generally standard approach as PTs in customer service, professional branding, and our commitment to best outcomes -- making our consumers feel better by doing it faster and making it last longer than any other competing options out there.

And, to be clear, it's not other PT options -- I'm referring to any other option outside of PT because our unified position and focused range of approach procures a strong confidence interval in customer experience at the emotional, intellectual, and physical levels -- on the outcome measure THEY (the consumers) care about. That's why I like the idea of "feeling" as a base for a brand promise; so very many consumer choices are based on feeling, not reasoning.

The problem is every clinic does business differently; we are losing the power of differentiation this way. Not differentiating amongst ourselves, differentiating ourselves from others. The truth is, we are TOO scattered within ourselves. It's like saying one mechanic could be way different from another mechanic the same way PTs are different.

I ask you, do you look forward to seeing your mechanic? NO! And, we don't want people to reluctantly and latently come to us in their times of need. We want them to look forward to seeing their PT -- that they can't wait because its the best choice for their health they could ever make!

So I ask, am I wrong to say that we, as Physical Therapists, want to be the 1st choice provider for musculoskeletal health? For the outpatient segment, I think this rings very true. Part of the reason I posed the original question was to delineate the hard fact that inpatient vs. outpatient PTs offer very different brand promises. Without segmentation here, we will never present a strong brand... not per setting and not as a whole. Therefore, it makes sense taking charge of the segment we have the most control over: Outpatient Private Practice.

In strategic marketing, the task is all about surveying the market environment for opportunities and threats. Our opportunities as outpatient/private practice PTs is through the roof! In healthcare's state of wobble, the threats really are more internal than external; our infighting hurts more than other people encroaching on our "turf."

I keep asking myself:

• What can we unify with?
• What is the single most common service experience we deliver on CONSISTENTLY?

I don't have all the answers. I certainly have some ideas. The thing is, it requires some strong direction to pursue. They revolve around a united, signature experience in our outpatient private practice segment. It finds a linchpin in a commitment to getting people better, faster, and keeping them healthy for life. The strategy holds on the minimization of cost burdens and the elevation of economic welfare for all of our stakeholders in concert. Sure, it may hurt in the short term. But, I can promise you if history and business research holds any water, it will absolutely pay off in the long run.

Not not all will agree on the ideas. In fact, I'm certain that what I share us offensive to some. I sense this is the case because most of the legitimate business solutions to stamping a collective brand promise centralizes on something that we as PTs apparently avoid with all our might...

Unity.

We hate unity. We may say we like it, but look at our actions! We trump our diversity, our specializations, and our uniqueness as our individual core competencies. While that certainly is valuable at a clinical level, it is NOT at an industry level. It doesn't help our profession at large when consumers can't have a common image in mind when they hear the words "Physical Therapist." 

A few weeks back there was talk about establishing brand pillars - and - I LOVE this idea!

While it's all brainstorming at this point, I encourage you to focus your thoughts on the following:

• What can ALL outpatient PTs promise and deliver on consistently?
• What can we make a signature moment for private practice PTs as an industry?
• What brand promise is most valuable to the consumer?
• And, what promises are most valuable to the consumer of tomorrow?

I feel strongly that the intersection of those four questions will summit a brand promise that will shine powerfully in the healthcare market of the future. It starts here. And, there will be many revisions in the future -- that's the business of marketing! And so, I'll be doing lots of mental grinding on this one for a while. I hope you'll join me in the task.

Talk soon! Safe travels to CSM! I wish I could be there with you, so tweet a bunch!

Warm Regards,

-Ben

Engaging Consumers with a Visible Brand

I'm very happy to share with you a guest blog I wrote for StriveLabs™, a firm on the cutting edge of patient-provider platform engagement for musculoskeletal disease.

I encourage you to check out their site and enjoy this guest post to which I had a LOT of fun writing:

Engaging Consumers with a Visible Brand

Define Marketing!

The American Marketing Association defines marketing as:

"Marketing is the activity, set of institutions, and processes for creating, communicating, delivering, and exchanging offerings that have value for customers, clients, partners, and society at large. (Approved July 2013)"

The All-Knowing-Wikipedia lists marketing as:

"Marketing is the process of communicating the value of a product or service to customers, for the purpose of selling that product or service."

What Is Marketing?

First, I want to make mention that distinguishing marketing from pure advertising is of utmost importance in successfully harnessing the full scope and power of marketing. You can read some of my thoughts on this matter in specific relations to Rehab Business in this post: "Marketing vs. Advertising in Rehab Business".

So what IS marketing? There are so many definitions, angles, perspectives, goals, fortes, and points of focus - but - when you really spin it all down, there are two ways to look at marketing.

1) The study of marketing.

2) The practice of marketing.

And, while the definition of marketing is liable to change over the years, let me draw from my favorite definition of economics to provide a working template in defining "marketing": "Economics is the study of how wealth is created and distributed."

So great! SO SIMPLE! Perfect. As I tried to model my personal definition for "marketing" after this template, the problem became more complex. There existed the study of marketing as well as the ACT (or practice) of marketing. I thought about it a little further and finally came to a mix of words I liked. Here are my definitions:

Marketing (the study of): Marketing is the study of interests, intentions, and behaviors in the marketplace.

<< for the purpose of.... >>

Marketing (the practice of): Marketing is the art and science of creating consumer demand.

Through my studies and reflections, I conceived of marketing as having four actions: discerning demand, driving demand, determining future demand, and directing future demand. However, a four part definition just wasn't simple enough for me. Reflecting on the definitions I finally came to: I realized that to create demand, you must already have discerned where it has been and currently is. It is only with that data that you can drive it forward. And, having driven it forward, one can now direct it's path and easily determine it's long term trends with incremental market analyses.

All well and good, right?

But how is it DONE? The study of the marketplace is more scientific than artistic, but the practice? Well, that's the golden ticket, isn't it?

I think it is important to recognize that the four actions in the act of marketing starts as a demand side activity. It gradually becomes a supply side event. However, the ENTIRETY of marketing is ALWAYS consumer focused.

Data? Statistics? Information? Analysis? Bah! That isn't interesting to someone's emotional core. It isn't interesting to WHO THEY ARE. All that mumbo jumbo may be interesting to the party selling their stuff... but, it is the job of the supplier to effectively market their dry information into something fruitful.

I suggest one makes dry information tasty the same way chefs do. To successfully market dry information, one must massage it, marinate it, season it, sear it, and present it as a beautiful dish which is appealing to the eye, savory to the soul, and healing to the heart. (To which my wife said, when I was proof-reading this to her, "I want steak!!")

See! THAT is marketing!

In fact, I know for a fact that I'm going to be hearing about nothing but me cooking up some steak for my wifey for the perceivable future until said steak is grilled by me and consumed by her -- I have created demand, and, I know the direction it is going. Can I get a #KABOOM?!

The practice of marketing promotes a brand experience through TWO WAY interactions between consumer and company. Good marketing gets people excited about a product, service, and/or brand. It is best done in manners, tactics, strategies, and campaigns that connect with core of human experience -- it is best done in a way that connects with PEOPLE rather than information. The consumer should feel like they are part of the movement, part of club, and, "in" on the secret.

This is in stark contrast to advertising - which merely informs, makes information available, presents data, options, and events -- for lack of a better description... advertisement without marketing savvy becomes a one way informational blah from company to consumer... it lacks personability, and therefore, lacks the critical element of appealing to the prospective consumer's human experience.

In my studies of marketing content in pursuit of an MBA, I spend far more time analyzing market behaviors and their numbers than I do creating a campaign to inform the consumer. Marketing has far more to do with the position of players in the market -- it is helpful viewing each piece like a that in a game of chess. Where are the pieces now? Where do they belong? Where should they go? Where am I vulnerable? Where am I strong? Where is my competition in such regards? What might happen five moves from now? Where then should I go? And, how should I about it?

Say it again: DEFINE MARKETING!

Marketing is the study of interests, intentions, and behaviors in the marketplace for the purpose of creating consumer demand.

Of course! It is an art. And, yes, it is a science. There are a lot of numbers to crunch in true marketing practice.  You must know where to look, what to look for, how to crunch the information into something useful, and then convey it as a logical action plan. However, the expression to the consumer MUST be personal, human, deep, emotional, and genuine. Therein lies the art of marketing.

Some Closing Thoughts

It is easy to say that marketing is X, Y, and/or Z as a conversational posture that consumers should be choosing US! Not someone else...

I challenge you: who is likely part of that conversation? Probably NOT the consumer. Good marketing communicates with the consumer in their language, with their values, in best consideration of their interests. Good marketing sees the big picture as many, very important little ones.

Credit to http://www.startedbyamouse.com/

Good marketing defines itself through the value it creates, rather than the value that already exists.

Until I become older and wiser, this is how I define marketing. How about you?

Take care & Talk soon!

-Dr. Ben Fung

PS. Interested in some related readings?

Check out my Consumer Awareness series on Access to Physical Therapists. These posts are a bit over a year old so my stance on some of the topics may have changed since... nevertheless, they are oldies & goodies :) Enjoy!

Here  is Part 1 & Part 2.