Speechies in Business

Helping Speech Pathologists in private practice focus on what matters most: their clients

David Kinnane

Australian Speech Pathologists: consent to treatment for children aged 0-13 years with separated or divorced parents

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If you work with kids and provide quality, client-centred care, you really work with families. Sometimes, you’re working with Mum and Dad and the kids together. Other times, you might be working with a single parent, alternating parents, a relative (e.g. a grandparent), a guardian or another carer.

One question that crops up a lot in speech pathology forums is about what to do if you are working with a child whose parents are separated, going through divorce proceedings or divorced. This is a complex area of law and practice (particularly for children who are 14 years old or older – a topic for another day).

For children aged 0-13 years, here are some principles I use to manage the risks:

  • In most cases, the consent of either parent to provide speech pathology services to their child is sufficient. The Family Law Act 1975 (Cth) makes it clear that:
    • both parents are responsible for the welfare of their children (including healthcare) until their children turn 18;
    • there is a presumption that arrangements which involve shared responsibilities and cooperation between parents are in the best interests of children (section 61DA);
    • each parent of a child has responsibility for the child unless:
      • the court makes a parenting order to the contrary; or
      • the parents make a parenting plan that allocates parenting responsibility differently; and
    • a change in the relationship of the parents – e.g. separation, divorce, marrying or remarrying – does not affect the basic rule that each parent has responsibility for the child (section 61C).
  • If a non-parent relative attends with a child, I usually ask to see written confirmation from a parent authorising the relative to consent to assessment and treatment for the child.
  • If a guardian attends with a child, I usually ask to see evidence of the guardianship.
  • If a delegate of the guardian attends with a child, I usually ask to see evidence of the guardianship and a written delegation of the authority to consent from the guardian to the delegate.
  • In cases where I know that the parents have separated, are divorcing or are divorced, and in particular, where it is clear Court proceedings are underway, I ask the attending parent to confirm if any parenting orders have been made or are pending, or if any parenting plans have been agreed that affect the rights of the parents to make healthcare decisions for his or her child and document the response (e.g. in progress notes). Documenting the attending parent’s response to this question can be important, e.g. if you are later subpoenaed by the other parent to provide documents or to appear in Court to provide evidence.
  • If parenting orders have been made by a Court that appear to give one parent the sole right to make decisions for the child’s ‘day-to-day welfare and development’ or, more specifically, to make healthcare decisions for the child, consent from that parent must be obtained in accordance with the order. Without such consent, I will not assess or treat the child.
  • If there are no Court orders in place, and one parent consents to you treating a child and the other parent contacts you to refuse consent, I try to get the parents to talk to each other to make a decision about what they think is in the best interests of the child. I also try to inform each parent objectively about the risks and benefits of different assessment and/or treatment options (including no treatment). This usually works.
  • If the parents can’t reach an agreement on whether the child should be treated, I’m reluctant to assess or treat the child. If Court proceedings are threatened or in progress, I might hold off assessment or treatment and suggest that the parents seek legal advice on the matter in the context of their wider Court proceedings.
  • At each stage, I document all communications, keep my input factual and evidence-based, and take great care not to do or say anything to any person that could make it appear that I am “taking sides”.
  • Consistent with principles of Australian family law, my paramount concern is the welfare of the child and my key professional obligations are to the child. For example, I remain aware of my obligations as a mandatory reporter under child protection legislation in my State.

Further reading:

Disclaimer: This article does not constitute any kind of legal advice, opinion or recommendation about rights, obligations, remedies, defences, options, or strategies. You should obtain legal advice specific to your circumstances.

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Australian Speech Pathologists: Ethical Employment Practices 101

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I’m an optimist when it comes to the future of the speech pathology profession. But I’m also a realist.

A. Supply > demand = exploitation?

Although I remain bullish about the long-term prospects of the profession, I agree with many colleagues who think that the current supply of speech pathologists is out of whack with demand in Australia in some areas of practice. For speech pathologists seeking a job in a capital city, the risk of exploitation is real – particularly for new graduates in private practice. As a lawyer, I’ve seen it in some of the cases that come across my desk.

Speech pathology employers face a slew of legal risks in this market, too, particularly when dealing with some of the less clear-cut legal issues. Risks range from civil employee claims to criminal prosecutions, from financial strain to bankruptcy and loss of practising rights.

Some legal risks are unavoidable in business. Others are caused by a lack of knowledge about legal responsibilities or compliance systems to manage them. As with every profession, there are probably also some hirers out there engaged in what I would politely call “questionable practices”. (More on that later.)

B. Duty to be informed

In the current job market, knowing your legal rights as an employee is essential. On the employer side, you need to know this stuff if you want to protect your reputation and stay in business: ignorance of the law is no defence if a regulator comes knocking or you get sued.

So here are some employment law basics that everyone in private practice in Australia should know about. None of what follows is intended to be legal advice. But it is intended to alert you to some of the main issues you need to think about when hiring, or being hired as, an employed speech pathologist in private practice in Australia.

C. Key things you should know

1. Legislation

Australian employment arrangements are subject to the Fair Work Act 2009 (Cth).

2. Award

The modern national award for speech pathology employees in private practice is the Health Professionals and Support Services Award 2020 (MA000027). Read it. It takes 20 minutes. If you are a graduate:

  • you are a “Health Professional employee – level 1″ for the purposes of the Award;
  • if you have a Masters degree, you should be paid at least at pay point 4 (currently $1032.90 per week full-time); and
  • if you have a 4-year Bachelors degree, you should be paid at least at pay point 3 (currently $998.40 per week full-time).

These are the rates current as at 1 July 2020.

In addition to minimum wages, the Award covers types of employment (full time, part time, casual), ordinary hours, leave, allowances (such as travel allowance, currently $0.80 a kilometre), termination of employment, redundancy and dispute resolution.

3. Minimum employment standards

Speech pathology employment arrangements are subject to the 10 minimum National Employment Standards covering things like annual leave, long service leave and redundancy pay. Read more about these important topics via the Fair Work Ombudsman:

4. Income tax and PAYG

Employed speech pathologists earn salary and wages that are subject to income tax under the Income Tax Assessment Act of 1997 (Cth) and the Income Tax Assessment Act of 1936 (Cth). This tax is withheld from employees and “paid as you go” (PAYG) by employers on their behalf. You can read more about PAYG here.

5. Superannuation contributions

In addition to employee salaries, employers must make superannuation payments for employees under the Superannuation Guarantee (Administration) Act 1992 (Cth). Currently, these superannuation contributions are equal to 9.50% of an employee’s salary and wages. You can calculate superannuation contributions here.

6. Employment Contracts – key things to look out for and to seek advice on

Before signing up, read your draft employment contract carefully. Unfortunately, as we’ve lamented elsewhere, many of the precedent speech pathology contracts floating around are littered with serious errors. Some contain very outdated references. Some contain straight-out illegal terms.

At a minimum, make sure your contract refers to the correct Award (including pay point), the National Employment Standards and the Fair Work Act 2009 (Cth). Make sure you are being hired as a speech pathologist (seems obvious, but be wary of titles like “consultant” or “advisor”, and especially “assistant” or “support worker”).

Watch out for:

  • overly long probation periods – probation periods should not be longer than six months – and provisions that seek to claw back expenses or costs if an employee is terminated at or before the end of the probation period;
  • clauses that seek to restrict what paid work you can do for others while you are employed;
  • clauses that seek to restrict:
    • where you can work; and/or
    • what kinds or work you can do,
      if/when you leave (I’ve seen some pretty broad restraint of trade clauses out there in the market);
  • clauses that purport to restrict your ability to start your own practice if you leave;
  • minimum numbers of clients you must see every day, especially if the number is disproportionate to your experience levels to do the job ethically; and
  • clauses that purport to make your pay conditional, e.g. on the employer first getting paid by a client or third party.

Prospective employees should also be aware of their key duties to the employer, e.g. to co-operate, to use care and skill, to act with fidelity and good faith (e.g. not to steal business, make secret profits on the side, seek to entice other staff away, not to disclose confidential information to others, not to assert ownership rights over the employer’s intellectual property). A solid written employment contract will deal with many of these terms, but Courts sometimes imply these terms when the contract is silent (or not written down).

7. Sham contracting arrangements – pretending an employee is an “independent contractor”

This is a big topic and warrants a couple of articles on its own.

In short, hiring independent contractors is a common practice for speech pathologists. It’s usually cheaper for hirers because they don’t have to pay employee entitlements (like leave) or make superannuation contributions or pay PAYG tax instalments. It can also be more flexible for the workers who can work for different hirers and do different kinds of work.

Some of the independent contracting arrangements I see out in the market are, in reality, poorly disguised employment arrangements. It’s a grey area in some cases – the principles are clear, but the application can be tricky. But the legal risks of getting it wrong fall mostly on the hirer/employer. For example:

  • a disgruntled contractor may sue a business claiming he/she is an employee entitled to annual leave and other employee entitlements;
  • Fair Work Australia may fine a business for entering into a “sham” arrangement, i.e. alleging the ’employer’ attempted to disguise an employment relationship as an independent contracting arrangement to avoid responsibility for employee entitlements; and/or
  • the Australian Taxation Office (ATO) may audit and then prosecute the business (and sometimes its owners), e.g. for failing to withhold ’employee’ income and other taxes as required for employees.

If you don’t know much about this important issue, start with these resources:

If you’re still not sure, seek legal advice before signing up.

8. “Volunteers” doing speech pathology work

This another area of controversy – and one where I hold strong views. Here, I’m not talking about students on placements, which are usually classed as “Vocational Placements” for the purposes of the Fair Work Act and are thus legal.

I’m talking about speech pathology graduates and other speech pathologists being given the “opportunity” to do volunteer work for other speech pathologists, e.g. to overcome a “lack of experience” hurdle. These are sometimes very informal arrangements, with nothing in writing. Other times, they are structured as an “unpaid trial” or “unpaid internships” offering alleged perks like free training, networking opportunities and training.

Spoiler alert: I think many “volunteer arrangements” are legally questionable and should be stamped out.

The Fair Work Ombudsman makes it clear that true volunteers:

  • must not do “productive work” – this would, in my view, clearly capture providing speech pathology services for money and would probably apply to doing free screeners too if they are part of an initiative to generate business for a private practice hirer (which they almost always are);
  • should be the main beneficiaries of the arrangement; and
  • must receive a meaningful learning experience, training or skills development from the position.

Otherwise, there’s a good risk that the “volunteer” is, in reality, an employee and entitled to be paid accordingly. Again, the main legal/economic risks of getting this wrong is on the hirer, although the short-term damage of engaging in dodgy volunteer “hiring” of course hits the volunteers too, with collateral damage to the profession’s reputation.

In my view, short-term, purely observation/shadowing arrangements might be okay, provided the volunteer learns a lot and isn’t expected to do anything productive. But, if the “volunteer” is expected to engage in speech pathology-related professional work to benefit the hirer, the volunteer might have good grounds down the track to make a claim against the hirer for unpaid wages and entitlements (and interest) as an employee – especially if the volunteer comes away from the “opportunity” less than impressed or feeling exploited.

You can read more about unpaid work arrangements here. For members of Speech Pathology Australia, there is a Position Statement on Volunteering in Speech Pathology (behind the members’ wall), which binds members. But the Position Statement is arguably more permissive than employment laws, and remember that your legal obligations come first.

Bottom line

There’s lots of speech pathologists around, especially in big cities, and more competition between private practices than ever before. This makes it hard to land a job; and puts business pressure on private practices to hire efficiently. If we want to avoid a race to the bottom, we must uphold good hiring practices; and, to do that, we need to know our basic employment rights and responsibilities. I hope that this overview was a useful start for some of you pursuing this goal, though you should seek legal advice particular to your own situation before doing (or not doing) something related to any of the topics touched on above.

Just as a nation’s greatness is measured by how it treats its weakest members*, a profession’s greatness is measured by how it treats its new graduates and other vulnerable members. As a profession, we’re good at helping our clients. But we need to help each other, too. A good start is to ensure we meet – and preferably exceed – our employment law responsibilities.

*Quotation: Mahatma Gandhi.

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Received a subpoena? 12 tips for speech pathologists

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When working with kids, most of us try to provide family-centred healthcare. The upsides include better therapy and real world outcomes. But the downsides can include getting embroiled in family and other disputes, including Family Court and other litigation.

If you’re in private practice and work with kids, you should expect to receive the odd subpoena. For example, in the last 12 months, I’ve received two.

A subpoena is a writ (a court-issued command). There are two main kinds, both with fancy Latin names:

  1. Subpoena ad testificandum: these require you to attend court and give evidence as a witness in person.
  2. Subpoena duces tecum (also known as a “subpoena for the production of evidence”): these require you to attend and deliver certain documents in your possession to court.

“Sub poena” means “under penalty”, which is what happens if you fail to do what the subpoena says. In our experience, speech pathologists tend to receive subpoenas for the production of evidence more often than subpoenas to be witnesses.

So how should you handle subpoenas to produce documents?

Here are 12 tips when receiving subpoenas issued by Australian courts:

1. Don’t panic.

It’s never a good feeling to receive a subpoena. But in most cases – particularly Family Court cases – the court dispute is not about you or your service, it’s about the welfare of a client. In most cases, all you will be asked to do is to provide documents in your possession or control that relate to a client.

2. Valid subpoenas override client confidentiality.

Speech pathologists are hard-wired to protect client confidentiality – especially on sensitive matters relating to a client’s healthcare. But, as with mandatory reporting requirements, a valid subpoena overrides our ethical obligations to protect a client’s confidential information. If the subpoena appears to have been issued by a court, you should assume it’s valid and do what it says, unless you actually know it’s fake and have received independent legal advice from your lawyer that you do not need to comply. In practice, we assume all subpoenas we receive are real and valid.

3. Date stamp, read, diarise.

Record the date on which you actually received the subpoena. Read the subpoena carefully. Consider what you are required to provide and by when and, if necessary, recall files from storage. Diarise the last date on which you can submit the documents with a reminder three days before the deadline. If you don’t understand what you need to submit or think there has been a mistake (e.g. wrong date, you have no record relating to the person’s name), ring the relevant Court Registry and make enquiries (note the case number before contacting the Court Registry as you will be asked for it).

4. Keep the envelope.

Retain the subpoena and the envelope it came in. Do not throw the envelope away. Keep it with the subpoena (we always staple it to the subpoena). In the event there is disagreement about what you received, you want to be able to show everything that has been sent to you including the envelope.

5. Collate, check and copy documents.

Leave enough time to comply with the subpoena. It always takes much longer than expected to find, collate and copy all the relevant documents.  If you are in any doubt about whether particular documents fit within the scope of the subpoena, discuss with a lawyer. In our experience, subpoenas are usually very widely drafted to capture all documents relating directly or indirectly to the client in your possession or control. All documents means all documents – don’t leave documents out, even if they contain errors, are drafts or are embarrassing to you or other people. It’s not up to you to decide whether including a document is in the best interests of your client. All means all.

6. Keep a record of documents submitted.

If permitted by the subpoena, we submit copies and keep the originals on file. Generally, the subpoenaed documents will not be returned to you. If you need the documents to be returned, check with the relevant Court Registry as to how you can have them returned.

7. Submit.

If you can, personally submit the documents to the Court/Court Registry. If you can’t submit the documents personally, then leave plenty of time for the documents to be delivered prior to the deadline date and make sure the subpoena allows documents to be delivered other than by personal attendance. If you are permitted to mail the documents, send the documents by registered post or courier (unless the subpoena tells you to do it a different way). Keep a copy of the tracking number/code of the parcel and track the delivery of the parcel.

8. Where should you go?

When delivering documents to a Court/Court Registry, make sure you are in the right place. Sometimes a Court House can be in a different location from a Court Registry, e.g. the District Court Sydney at Downing Centre versus the District Court Sydney Registry at John Maddison Tower. Sometimes, the filing of general documents is handled in a different room/on a different floor from the filing of subpoenaed documents, e.g. Family Court of Australia, Parramatta Registry. If in doubt, ask the Court Security Guard or other staff.

9. Dated court receipt.

Ask for confirmation of receipt from the Court. This can take the form of an acknowledgment letter or photocopy of the front page of the subpoena with the Court’s date stamp affixed. Make sure the receipt has been dated. The last time we submitted documents to the Family Court, the Registry Clerk did not date the acknowledgment letter. Luckily we noticed before we left the Registry. This is particularly important as you may need to show that you submitted the subpoenaed documents within time.

10. File note it.

Make a file note about what you submitted, who you submitted it to, when you submitted the subpoenaed documents and how. This is useful in case the documents later go missing in the system.

11. Bank the cheque.

When you receive a subpoena, it usually comes with a small cheque to cover expenses. It’s usually not much, e.g. $25. Bank it as soon as you can. There are law firms that have a practice of cancelling subpoena cheques as soon as they receive documents, so don’t be caught out. Make sure you get compensated (in part, at least) for your photocopying costs!

12. Respond promptly to any suggestion you haven’t complied.

If you receive correspondence from the lawyers who subpoenaed documents claiming that you have not submitted the documents (and this is not uncommon given the volume of documents that a Court or Registry receives), promptly write to the firm providing a copy of the Court/Registry acknowledgment. Send the correspondence by fax, with the original correspondence following by mail or courier. Do not do it by email.

Disclaimer: This article provides some general tips associated with speech pathologists receiving subpoenas in Australia. This article is current as at the date of its publication. This article does not constitute any kind of legal advice, opinion or recommendation about rights, obligations, remedies, defences, options, or strategies.  You should obtain legal advice specific to your circumstances.

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Too many graduates, not enough jobs: are we heading for Speechpathageddon?

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“Too many universities pumping out too many graduates for not enough jobs.”

I hear this a lot. But I don’t buy it.

What people usually mean when they say things like this is that there aren’t enough traditional public hospital and government-funded community speech pathology positions for everyone. True. But it doesn’t mean we’re heading for crisis.

Muddled thinking

Many speech pathologists who lament the glut of graduate speech pathologists also talk about the desperate shortage of speech pathology services and the inability of current service providers/models to deliver them.

Does this make sense? Think about it for a minute.

Malcolm Turnbull does not rent videos

I’m an optimist and in some ways a traditionalist (and middle-aged and white and male). Despite theoretical access to Netflix, I still rent weekly DVDs (Go Civic!) and call them “videos”, to the embarrassment of my children. And I value the history and many of the traditions of the speech pathology profession.

Without wanting (in any way/ever/at all) to sound like Malcolm Turnbull, I think there has never been a more exciting time to be a speech pathologist. But we need to face some sobering facts, be open to acquiring new skills, and adjust our thinking first, if we are to stay successful.

How?

1. Feel the fear…

Privatisation, service fragmentation, increased local competition, tight margins, and information overload. Cold realities for many of us, especially – but not only – in private practice.

Globally and locally, more and more things are becoming commodities. And I’m not just talking about steel or wheat or coffee (mmm, coffee). But health-related and other white collar services, too. If you don’t believe me, spend a few minutes with Google to look at the disruption that’s taking place in the legal and accounting sectors because of globalisation, offshoring and outsourcing. And if you think it’s just the unskilled stuff that’s being outsourced to places like India, the Philippines and China, you’re wrong.

Alan Binder, Princeton economist, published a terrifying essay back in 2005 where he made the following prediction:

“In the future, and to a great extent already in the present, the key distinction for international trade will no longer be between things that can be put in a box [i.e. products] and things that can’t [i.e. services]. It will, instead, be between services that can be delivered electronically over long distances with little or no degradation in quality, and those that cannot…And there is little doubt that the fraction of services that can be delivered electronically will grow.”

Since this prediction, we’ve of course seen the beginnings of Telehealth, a slew of speech pathology blogs, product marketplaces marketing products and (so far fairly limited) electronic services to the (global) public, social media platforms, webinars and podcasts. And who know’s what’s next?

Are we really that far off from the day when we’ll need to compete for local clients against speech pathologists and similar professions in other countries offering cheaper, web-based interventions?  If you think it will never happen – that speech pathology will somehow rise above the globalisation of services – take a look at what’s already happening in the international market for internet-based accent modification and voice services. Then think objectively about whether at least some of your other face-to-face services could be provided just as effectively by a qualified professional overseas via the Internet.

2. …do it anyway

Thomas Friedman, in his bestselling 2005 book, The World is Flat, identified three broad categories of people who will be able to resist the trend for services to be automated, digitised, commoditised and outsourced. He called these folk “the untouchables”:

(a) People who are really special or specialised (even if they can’t call themselves that). People that perform functions in ways so special that they can never truly be outsourced. This small category may include the very top speech pathology researchers and clinicians. The rock stars of the profession.

(b) People who are “localised” or “anchored”. This category is much bigger and includes people who provide services that must be done in a specific location and/or because they require face-to-face, personalised contact and interaction with a client. Notably, they include some people working in high-end jobs (e.g. dentists) as well as low-end jobs (cleaners).

(c) People in traditional middle management who are able to adapt to change and take advantage of it. Friedman calls these workers the “New Middlers”.

If Friedman is right about where things are heading (and I think he is), few of us can afford to be complacent. We need to act, and we’ll have to do it outside our comfort zones.

3. Acquire new skills to thrive

Friedman argued that, to survive commodification, professionals must adapt and develop skills over and beyond the bare definition of professional competence. He identifies eight categories of professional “New Middlers”. Broadly paraphrased, and applied to speech pathology, they are:

  • Collaborators/Orchestrators: Speech pathologists who can work with diverse teams around the world. Travellers, with excellent people and networking skills. Speech pathologists with special additional expertise, e.g. in project management, research and design, marketing of health services, data sharing and storage, and/or privacy/security. People who can take a complex idea and work as part of a team to turn it into an accessible product or service for clients.
  • Great Synthesisers: People who anticipate future client needs and come up with solutions by synthesising disparate bodies of knowledge and skill-sets. A good example in speech pathology is people who can connect clinical expertise with technology skills to deliver effective remote services electronically; or bring researchers and clinicians together with medical or acoustic engineers to develop evidence-based products and services for specific populations.
  • Great Explainers: Speech pathology-related managers, researchers, writers, teacher, producers, writers, journalists and editors who are good at explaining things in Plain English. Speech pathologists who see the complexity but can explain it to a general audience simply and a lack of jargon.  People who can face the the public, governments, other speech pathologists, clients, and others, explain what the evidence says, what we can (and can’t) do, how it may benefit different people, and how much it will cost. “How to” and “go to” people. In a profession like speech pathology, with a platform powered by low-cost blogging and social media tools, great explainers may acquire global influence.
  • Great Leveragers: Speech pathologists who can design and use technology, e.g. to help other speech pathologists work more efficiently. Speech pathologists who understand client-care from first contact to discharge and spot inefficiencies in the way some things are done. People who see a problem, stop the specific problem, and then design a system to prevent the problem from happening again. People who create technology solutions to make us more productive, less isolated and, thus less likely to waste time reinventing wheels.
  • Great Adapters: Friedman calls these people “Versatilists”. They are the “Swiss-army knives” of speech pathology. People who can apply a depth of skill (like specialists) to a progressively widening scope of situations and experiences, gaining new competencies, building relationships and assuming new roles. People who constantly learn and grow professionally. People who invest in themselves, learn and then teach others. People with solid technical skills but also good insight into clients’ needs and wants. People more focused on acquiring skills than attaining prizes and letters after their names.
  • Purpose People: Friedman called this category of people “the Green People” – people who are environmentally conscious. But, in the context of speech pathology, I think my broader term is more appropriate. These are people who set up for-purpose (not-for-profit) networks, collaborations and organisations to get out and deliver services not currently met by the government or the market, perhaps in developing countries. The Trinh Foundation is an such example. Organisations outside of speech pathology include Pencils of Promise and charity: water. They achieve not just success, but also significance.
  • Passionate Personalisers: People with a pure passion for what they do, and a creative touch that no-one has ever thought of adding. Anyone who can take a traditional speech pathology role and give it something personal, authentic and special while remaining professional. This is one reason I go on about the need for more diversity in the profession (and, no, I don’t just mean more blokes).
  • Maths Lovers: Speech pathologists with a flair for numbers. People who can parse big data, create and execute algorithms, crunch numbers, interpret statistics, and analyse outcomes. People with advanced skills in algebra, data interpretation, probability, statistics, and calculus.
  • Great Localisers: You’ve probably heard the saying, “Think global, act local”. These are the speech pathologists who will take all the best global tools and tailor them to the needs of their local communities and practices. It might be speech pathologists who take the latest international research findings and adapts them for Australian clients. It might be the local speech pathologist who is able to spend more time on clinical work with reduced “failures to attend” by hiring a virtual assistant and/or using an online system to manage bookings and follow up with clients a day before their appointment. It might be simply using existing online tools like Survey Monkey and Google Docs to monitor the quality of their services and to stay in better touch with clients’ needs and expectations.  Or it might be spending more time developing management plans with clients, and less time looking for the “nuts and bolts” worksheets and other resources by using a service like Teachers Pay Teachers or Speechtivities.

These aren’t mutually exclusive. They can be mixed-and-matched. For example, a speech pathologist may run a successful clinic as a great adapter, localiser and personaliser, and also acquire an international following as an explainer. Some speech pathologists may provide traditional clinic-based services to clients and also create apps, digital products, online courses and services for clients and colleagues.

Unless you’re lucky enough to be an irreplaceable speech pathology icon, chances are your best shot at continuing success is by providing top notch, face-to-face, evidence-based, personalised, hands-on, thorough and client-centred care, focusing on serving local communities. But more of us should also think about the tremendous opportunities technologies give us to deliver our services in innovative ways to clients without access to quality local services.

Many of Friedman’s categories remind me of some of the brilliant speech pathologists in practice today. These include experienced colleagues in my local area, leading speech pathologists I don’t know but follow online on places like Twitter and LinkedIn, and academics whose work I’ve read to blog about.

Some categories play more to the strengths of some of the newer (and younger) members of our profession, including of course many of our talented graduates. I’m all for innovation and trying new things. But we need to ensure newer members of our profession get the clinical support and skills they need to find their feet and to discover their passions. More importantly, we need to be vigilant and open eyed about the realities of the “market” to ensure our new graduates are not exploited.

4. Adopt an abundance mindset

One of the best books I read in business was The Seven Habits of Highly Effective People by Stephen Covey. Despite the hype, it’s actually a terrific, practical read for anyone running a practice (or thinking of starting one).

As far as I know, Covey was the first author to cotton onto the importance of adopting an “abundance mentality”. This is simply accepting the view that there are enough resources, opportunities and clients for everyone to succeed in life. Its opposite is the depressing “scarcity mindset”, where we decide we’re in a zero-sum game, a dog-eat-dog world, in which some speech pathologists will win at the cost of others – perhaps by using deceptive tricks like testimonials and by cutting prices and professional corners. A ruthless race to the bottom.

As my suburban practice grows, I refuse to think small. But I don’t want to run a McClinic or cut professional corners, either. I want to be part of a self-confident, self-regulated profession composed of ethical, resourceful, creative, resilient, proactive, intelligent, and diverse people who are in speech pathology for the right reasons: our clients.

With the support of our professional bodies, I’m convinced we can succeed. But we’ll need to support and value each other as our world and profession changes. Especially our new graduates.

Principal sources:

(1) Friedman, T.L. (2006). The World is Flat: The Globalised World in the Twenty-First Century. Penguin Books, London.

(2) Covey, S. (2004). The Seven Habits of Highly Effective People. Simon & Schuster, New York, New York.

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Dealing with negative online reviews: evidence-based strategies for speech pathologists

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Online review sites are fairly new in speech pathology and healthcare generally. Australian examples include Whitecoat and the NDIS-inspired Care Navigator.

Negative reviews hurt

Negative reviews on sites like these – or on social media platforms like Twitter and Facebook – hurt. They may make us angry, anxious, embarrassed, sleepless – even sick. They can decimate team morale and confidence. They can tarnish reputations. They can lose us business. In extreme cases, they can even drive practices into the ground.

To compound the problem, speech pathologists are constrained by legal and ethical rules about advertising (e.g. testimonials) and client privacy. In practice, these limit our ability to respond to negative reviews, even if the reviews are exaggerated, incorrect, anonymous or even fabricated.

Review sites are here to stay

Consumers have a right to be informed about their treatment options. Despite all the risks of review sites for speech pathologists and other health professions, it’s clear regulators (and some self-regulatory bodies) in Australia see review sites as an important way of promoting consumer rights.

Speech Pathology Australia’s Advertising FAQs state that:

“advertising is not considered to include…comments made by a patient/consumer about a practice or a practitioner where the comments are made on a social media site or account or patient/consumer information sharing site or account which is not used to advertise a health service, and that site or account is not owned, operated or controlled by the practice or practitioner referred to in the comments”.

Similarly, the advertising guidelines that apply to regulated health practitioners like occupational therapists and physiotherapists in Australia state that:

“There are many opportunities for consumers or patients to express their views online that are not affected by the National Law restriction on testimonials in advertising. Patients can share views through their personal social media such as Facebook or Twitter accounts or on information sharing websites or other online mechanisms that do not involve using testimonials in advertising a regulated health service.

For example, consumer and patient information sharing websites that invite public feedback/reviews about experience of a regulated health practitioner, business and/or service are generally intended to help consumers make more informed decisions and are not considered advertising of a regulated health service.”

Although hard to forecast with certainty, it’s likely that managing online reviews will be an increasingly important part of business for speech pathologists in private practice.

What do we know about negative reviews?

We can learn from the experiences of business owners who’ve been dealing with online reviews for years: owners of restaurants and hotels. These businesses have had to deal with sometimes very harsh reviews on sites like Yelp, Urbanspoon/Zomato, Menulog, OpenTable, and TripAdvisor. A growing body of research exists about these reviews. It shows:

1. Online reviews matter.  Online reviews: (a) can attract a wide audience (Hennig-Thurau et al., 2004); (b) are perceived by consumers as credible and trustworthy (Flanagin & Metzger, 2013); and (c) play an important part in shaping client opinions and purchasing decisions (Sparks and Browning, 2010).

2. Online reviews can help improve the quality of services. In traditional management literature, customer complaints are often seen as positive because they give the business a chance to fix problems and improve services (e.g. Reynolds and Harris, 2005).

3. Reviews can also hurt you, your team, and your business. As noted above, negative reviews about your business can affect you, your reputation, your business, your employees and contractors; can affect your morale, health and finances; and may attract the attention of third parties, including government regulators and industry associations.

4. Consumers post negative reviews for lots of reasons and in different ways. Online reviews may be posted for personal, social and even commercial reasons. The trigger is usually a negative experience. The decision to post an online review depends on lots of factors, e.g. a client’s motivations, past experiences, general attitude to complaining, age, and familiarity with the Internet (e.g. Yagil, 2008). Posting reviews may provide an emotional release (e.g. to allay anger, embarrassment or disappointment, or even to provoke laughter), seek “revenge” for a perceived slight, or even the hope of economic gain (Cantallops and Salvi, 2014). Some may be heat-of-the-moment “rants”. Others may be fair descriptions of legitimate concerns. Some will be trivial. Others may allege civil wrongs (e.g. negligence) or even criminal acts. Some may be exaggerated. Others may be completely fabricated (e.g. by ex-employees with a gripe, or unethical competitors). Some are short. Others are encyclopedic. Some will be shared with one or two followers. Others may go viral. Some will be posted by named people you know. Others may be anonymous. Service quality is very much in the eye of the client, rather than the provider (e.g. Sparks, 2001).

5. Online reviews can be personal. They may name and single out individual staff (e.g. Bradley et al., 2015). They may even be discriminatory or defamatory.

So how can speech pathologists in private practice manage negative online reviews? 

Again, we can learn from the experience of hospitality businesses. As with restaurants, most speech pathology private practices are small businesses with limited time and resources to dedicate to online review management. In this context, the research identifies four broad categories of strategies employed by businesses to manage negative reviews:

(A) Preventative strategies

  • Improve your services. In theory, improving the quality of your services will reduce problems, complaints and the risk of negative reviews.
  • Conduct “real time” checks on client satisfaction to identify and, if possible, fix small problems before they become big problems (e.g. Johnston and Fern, 1999).
  • Manage client expectations about your services.

These are sensible ideas. But, owing to the intangibility of services and the variability of client perceptions, expectations and preferences, preventative strategies are never going to eliminate the risk of negative reviews entirely (e.g. Sparks, 2001).

(B) Protective strategies

The emphasis of these strategies is to shape – not prevent – complaint behaviours to minimise damage to your business.

  • Give your clients clear encouragement and guidance as to where and how to comment and complain. This can be offered orally, via a leaflet, on your website, or an email. For example, I have a feedback and complaints policy I share with all clients.
  • Include a request in your feedback and complaints policy that complaints first be presented to staff or the practice directors before being posted online.
  • Have a physical and email suggestion box for anonymous comments and complaints.
  • Provide short in-house satisfaction questionnaires and reward clients for using these, rather than going online.
  • Monitor online reviews and respond:
    • privately by email or, better yet, with a phone call or face-to-face open discussion; or
    • publicly.

In the hospitality industry, public responses are increasingly viewed as a vital reputation management strategy. Review sites like Yelp and TripAdvisor have even published guidelines on how to do it. These guidelines encourage restraint, courtesy, a focus on specific concerns and an emphasis on the business’ positive qualities.

Jay Baer, author of “Hug your Haters: How to Embrace Complaints and Keep your Customers” says that when you don’t answer a complaint it decreases customer advocacy by up to 60%: when you answer a complaint it increases advocacy by 25%. Customer advocacy – i.e. the client advocating for your service.

Complaint-handling studies (e.g. Davidow, 2003; Bitnet et al., 1990), show that effective public responses often include:

  • acknowledgement of the problem(s) raised;
  • an apology for the business’ contribution to it;
  • an explanation for its occurrence; and
  • a commitment to take appropriate preventative or remedial action.

Two important points on public responses for speech pathologists:

  • It can make sense, from a business perspective, to respond to negative reviews in a constructive way, acknowledging the client’s concerns (even if you don’t agree with them). However, it’s also important to support staff and others affected by the review, recognising that there are always at least two sides to any story (e.g. Jung & Yoon, 2014).
  • As noted above, speech pathologists must comply with their codes of ethics and legal obligations when responding publicly. This means, among other things, that speech pathologists cannot disclose any sensitive, health-related or personal information about clients or their care, which means we need to be very careful when responding in a public forum. I’ve given some thought on how best to do this.

Most review sites have moderation guidelines or terms of use that prohibit defamatory or offensive comments. For example, Whitecoat’s Moderation Guidelines and Care Navigator’s Terms of Service (see Sections 9 and 12). If you feel a review breaches those guidelines, you should alert the review site citing specific breaches and ask that the offending review be removed.

(C) Positive strategies

In hospitality, it’s common for businesses to actively encourage positive reviews from happy clients. Evidence shows that this tactic can help push negative reviews down the list and “off the page” and also result in a more balanced picture of the business (e.g. Sparks and Browning, 2011). It can also help build staff morale.

Unfortunately, actively encouraging positive reviews is not an option for speech pathologists in Australia. As with regulated health professionals, we’re not allowed to encourage testimonials or positive comments from clients for ethical reasons.

Speech pathologists can – and should – gather and share unsolicited positive feedback with staff to bolster morale. But we cannot encourage or take active steps to share this kind of feedback with the public as this would fall foul of our advertising rules.

(D) Palliative strategies

These emotion-focused strategies seek to counteract the negative emotions and stress caused by negative reviews. Examples of these strategies include things like:

  • building physical resilience – going for jogs, joining gyms, etc.;
  • enlisting support from colleagues, families and friends, including through professional networks and bodies (online and offline);
  • recognising that reviews are transient, surmountable, and often of limited consequence in themselves;
  • providing professional and emotional support to any staff affected by a review; and
  • stress management activities, e.g. yoga, meditation, etc.

Although simple and perhaps obvious, these strategies provide powerful ways to combat feelings of powerlessness and isolation, and to keep the real effects of negative reviews in perspective.

Bottom line

Online review sites are here to stay and can help members of the public to make informed choices about their healthcare. Online reviews can help speech pathologists to improve their services. But they can also inflict significant emotional and financial stress on owners and staff.

Preventative, protective, and palliative strategies, like those used in the hospitality industry, may help speech pathologists in private practice to manage negative online reviews and their effects. But we need to take care when responding publicly to ensure we act ethically and in accordance with our privacy and other legal obligations.

Principal source: Bradley, G.L., Sparks, B.A., Weber, K. (2015). The stress of anonymous online reviews: a conceptual model and research agenda. International Journal of Contemporary Hospitality Management, 27(5), 739-755.

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