Speechies in Business

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

David Kinnane

Speech pathologists in private practice: How to learn new skills rapidly

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By nature and necessity, speech pathologists in private practice are life-long learners. Not only do we have to stay on top of research to keep our clinical skills up to date, we have to learn finance, marketing, technology, compliance, and other business skills, too.

Learning is essential to providing quality care to clients and for running our practices. But there are so many things to learn, and so little time. So what can we do to learn new skills rapidly?

Skills and knowledge are related, but different. Both are necessary to do professional work well

Professional work combines practical skills with special knowledge. They are not the same thing:

  • In law, I graduated with good academic knowledge of the laws of evidence, but then found myself as a new grad unable to make a simple filing because I didn’t have the skill to know how to draft the filing in a form that would be acceptable by the Court. I needed my supervisor to show me how to do it, using a template and modelling.
  • In the first semester of my speech pathology degree, I memorised head and neck anatomy, but then struggled to complete my first cranial nerve exam on a real, breathing person. It took me a good 15 tries before I could smoothly coordinate the practical motor requirements of the tests with my theoretical knowledge of the cranial nerves.

As a nerd, I’ve always found it easier to start with knowledge, and then learn the practical skill. Some of my colleagues do it the other way around: throwing themselves into practical tasks and then building the necessary professional knowledge around what they do.

Both ways can work. But good speech pathologists learn quickly that, in clinical practice, you need both skills and knowledge to do a good job.

Learning a new skill isn’t the same thing as improving an existing skill

Seems obvious, right? But we sometimes forget that you need to walk before you run. Many speech pathologists I know (including me!) sometimes forget that acquiring the basic skill requires a different approach to training an existing skill. Learning to walk is hard. Going from walking to jogging is less hard; and accelerating your jog into a run is easier again.

How to learn a new skills quickly?

Josh Kaufman, in his excellent “The First 20 Hours: How to Learn Anything Fast”, recommends 10 key principles of rapid learning. Here they are, paraphrased and ‘translated’ for speech pathology practice:

1. Choose a lovable project: Rapid skill acquisition is hard. It helps if you choose a skill that is important to you and your business – a skill that will make a difference, and ideally, that you will enjoy having. For example, early on, I decided to learn how to do evidence-based voice therapy for people with Parkinson’s Disease because I found the work very rewarding. I learned how to blog properly because I love sharing knowledge. I learned how to use video editing software (like Camtasia) to make training videos for my team because I was sick of spending my time saying the same thing over and over and wanted to save time. In each case, I had a compelling reason to do the work.

2. Work on one skill at a time: Focus! In our clinic skills improvement program, for example, we focused first on deepening our knowledge of language stimulation skills for children with Autism Spectrum Disorder before we kicked off a project to improve our diagnosis and treatment of childhood apraxia of speech. In business marketing, we decided first to learn the basics of Facebook, Twitter, LinkedIn, then Instagram because my target audience was interacting on those platforms. I don’t worry too much about Snapchat at this stage. But, like Instagram, I might change my mind if it makes sense from a business perspective to do so.

3. Define your target performance level: To be good at my job, I don’t need to become a web or graphic designer, or produce award-winning documentaries. I need my work to be clear and useful. What does good enough look like to you? For new clinical skills, our base-line is competence. We won’t offer a service until we’re sure we can do it competently. In business marketing and advocacy, our base line is based on the usefulness of the information we present. Will a particular blog post give families enough evidence-based information to know what to do next or where to go for more information? This means we always proofread our work for readability, and cite our sources. It doesn’t mean that we aim for perfection. Trying to be perfect is a fool’s game, and can lead to procrastination and paralysis. 

4. Deconstruct skills into sub-skills. Most important skills can be broken into sub-skills. For example, when learning to do Cycles, we broke the program into sub-skills. We read a few of the leading peer-reviewed articles. We blogged about it (mainly to explain it in Plain English to ourselves). We broke the research down into chunks, like how to choose targets, how to do auditory bombardment, how to explain the program to parents, how to give clients feedback on attempts, how to use reinforcement and feedback, and how to ensure adequate dosage/repetitions in sessions. We then story-boarded a sample session and tried it out on each other in role-plays. We then developed resources (e.g. audio recordings and target word lists) to support efficient and consistent delivery across the practice. This approach works for business skills, too. For marketing with infographics, we first sat through a tutorial on how use the software properly (Canva), then worked out how to make a readable template, then practised summarising some of our more popular blog posts into single page bullet point lists, and finally mapped out how to get the work done on a schedule.

5. Obtain critical tools. It’s hard to practice a skill without the right equipment, and it’s easy to put things off because you don’t have the right tools. For example, in the clinic, you need evidence-based resources to assess and work on each of the Big 5 and oral language comprehension before you can practice literacy intervention. In business, having access to quality templates, procedures and management systems is essential when learning, for example, how to improve client satisfaction ratings and retention, or to reduce your failures to attend.

6. Eliminate barriers to practice. You need space, resources and time to practice new skills properly. Distractions (e.g. emails, phone calls, texts, Facebook) and emotional blocks (like fear, doubt, imposter syndrome, and embarrassment) can get in the way of learning new skills. In the clinic and in business, I block out times to work on new skills. I unplug my devices and force myself to persevere, despite my internal doubts.

7. Dedicate time to practice. You have 1,440 minutes a day to get things done. We all have work and family commitments. We all need leisure time, exercise, and sleep. But we all have time-wasting behaviours, too. I did a time audit and discovered mine were Netflix binges and reading the news on my phone. By reducing both, I found the time to learn new skills.

8. Get fast feedback. After learning about a new skill you think is important, don’t wait months to get your hands dirty. Try things out safely in the real world as soon as possible, and be prepared to make quick changes to improve your accuracy and skill level. For skills like book-keeping and social media posts, you might get instant feedback from your system or followers (sometimes a little confronting!). For new clinical skills, try to gets lots of immediate feedback on how you are doing when you are first practising the skill; then move to delayed and less frequent feedback as you master the basics and start training the skill. Experienced mentors can be a big help here. But, if you don’t have one to hand (and you should!), tools like biofeedback, or video and audio reviews of your performance can help you assess how you are doing – even if they are painful to sit through in the early days!

9. Practice in bursts, by the clock: When you’ve mastered a skill, time flies. But, during your first few attempts, time can drag. In the early stages, set a minimum block of time to work on the skill, e.g. 20 or 25 minutes. Once you start, keep going – even if it feels like you’ve been making mistake after mistake for hours. When I’m particularly hopeless at something (usually fine motor-related), I sometimes feel like the timer will never go off! Hang tough, even if you feel terrible about your poor performance and ‘urgently’ need to know all about the local footy scores or have a sudden urge to Marie Kondo your garage. Aim to distribute practice throughout the day when learning a tricky motor skill. Kaufman recommends practising new motor skills just before bedtime so that your brain can consolidate your learning during sleep. 

10. Go for massed practice and fast repetitions: you need sufficient quantity of practice and speed of trials. Once you’ve achieved acceptable ‘basic form’ in whatever skill you are learning, practice as much as you can, and as often. The faster and more often you practice, the more rapidly you will pick up the skill.

For motor skill acquisition (e.g. like touch typing or learning to use a new resource requiring manual dexterity), many of these principles will sound familiar to those of us trained in principles of motor learning.  

What about rapid learning of knowledge?

Aha! Good pick up and great question. Regular readers will note that some of Kaufman’s principles are consistent with evidence-based studying techniques, such as spaced practice, forced retrieval, and doing practice tests with the same structure as the real test.

This is one of my favourite subjects and an excellent topic for another day, don’t you think? (Watch this space!)

Bottom line

For speech pathologists in private practice, learning new skills is hard, but essential. When next preparing to learn a new skill, use the 10 principles above to practice it in the most efficient and effective way possible.

Principal source: Kaufman, J. (2013). The First 20 Hours: How to Learn Anything Fast. London, England, Penguin Books.

Image: httpss://tinyurl.com/y2pnmxx9

8 mental models speech pathologists in private practice can use to make better business decisions

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The world is complex. Speech pathologists are busy. Many of us are inundated with information. Most of us are juggling work and family commitments. Quite the recipe for procrastination, getting overwhelmed, and indecision!

Productivity tools and systems help but you need mental models

Trying to remember and prioritise lists of random things – from upcoming sessions, outstanding reports, phone calls to return, articles to read, supplies to order, bills to pay, tax statements to submit – is exhausting and stressful. Productivity tools, such as the Pomodoro technique, can help. So, too, can investing in the right systems, templates and resources. But none of those things help us to make decisions.

In private practice, we all make hundreds of decisions – big and small – every week. One way to clear away clutter, sift information, and to make decisions, is to use mental models: simple representations of reality that enable us to sort the wheat from the chaff.

You are already using mental models for clinical decisions

At University, most of us were trained to use mental models to make clinical decisions. For example, most of use elements of the ICF Framework, the Participation Model, and/or the EB3P model to plan and deliver services. As professionals, we are also required to adopt an ethics framework – whether it be Beauchamp & Childress’ biomedical framework underpinning our Code of Ethics, casuistry, or another framework altogether. In devising therapy goals, most of us use models of typical development, or evidence-based therapies that are themselves built on models of speech and language, e.g. Blanks Levels or Complexity theory.

But what about mental models to help with business decisions?

Here are 8 mental models I use to make business decisions in my practice:

1.Know your Circle of Competence: I spent a lot of my early professional years pretending I knew everything – even to myself. This left me with lots of blind spots that ultimately hampered my professional development. These days, I know what I understand, and am very honest with myself about what I don’t know. When I don’t know something clinically important, I add it to the list of things to investigate. In the context of my private practice, some of the product of this work evolved into the Banter Speech blogs and ebooks. Understanding my circle of competence helps me know when to seek help, and where to spend time and money improving my skills (and the skills of my team).

2. SCAMPER your services: As speech pathology services globalise and become more innovative, we need to think about how to deliver new services, and to deliver existing services differently. One way to think creatively about service design and delivery is to use the SCAMPER model, developed by Bob Eberle. It helps people to improve their products and services by asking the following seven key questions (originally developed by Alex Osborn):

  • Substitute: can you substitute people, components, or materials?
  • Combine: Can you combine with other functions or things?
  • Adapt: Can you adapt functions or visual appearance?
  • Modify: Can you modify the size, shape, texture, or acoustics?
  • Put to other use: Can you find other, new, combined uses?
  • Eliminate: Can you reduce, simplify, or eliminate anything you don’t need?
  • Reverse: Can you use it for the opposite effect, or invert or reverse it?

3. Apply Hanlon’s Razor to keep perspective: Private practice can be a hot bed of paranoia and second-guessing, especially when it comes to things like negative online feedback and staffing issues. Hanlon’s Razor tells us we should not assume that people are acting with malice when we have a misunderstanding, disagreement, or receive negative feedback. If we assume that all criticism is from someone “out to get us” or someone “trying it on”, we miss opportunities to consider simple solutions, such as apologies, better systems, or more education, that makes what we do better for everyone involved. People have bad days. People make mistakes. People do things without thinking them through, especially on the Internet. If we give our staff and clients the benefit of the doubt by not projecting ill-intent onto their acts, and respond constructively, we tend to feel better about our practices and ourselves (and so do our staff and clients). 

4. Exploit the magic of compounding: The process of adding interest to a fixed sum, which then earns interest on the principal and the interest added, then repeats forever, can reap enormous business rewards over time. Borrowed from the world of maths and underpinning the time value of money, compounding refers to the exponential effect that small, regular efforts can have on real world outcomes over time. In our practice, we find that working even a little bit on projects every day almost always results in better outcomes than trying to find (often non-existent) blocks of time to dedicate to projects. Breaking projects into small chunks also makes them less daunting, lowering resistance to sitting down and getting the work done.

5. Deal with the harsh realities of the Red Queen Effect: As the Red Queen says to Alice in C.S. Lewis’ Through the Looking Glass: “Now, here, you see, it takes all the running you can do, to keep in the same place”. In a competitive market for services, standing still means going backwards. Every year, we discharge clients and must attract new ones; and we may lose staff and have to replace them. To thrive, we have to first deal with the “churn” of clients and staff, before considering growth plans. If we fail to account for churn, we’ll find ourselves over-stretched and behind competitors who manage their own churn more efficiently.

6. Understand Dunbar’s Number: This is the number of individuals a primate can get to know and trust deeply, and is related to the size of the primate’s neocortex. For humans, the number is around 150 individuals (with a range of ~100-250). Dunbar himself expressed the rule informally as “the number of people you would not feel embarrassed about joining uninvited for a drink if you happened to bump into them in a bar”. Although the network effect tells us that organisations like Facebook, LinkedIn and Twitter become more valuable as more people join them, the Dunbar effect reminds us that there is a limit to the number of people with whom we can maintain stable, inter-personal relationships. It also explains why larger communities (including communities of speech pathologists) need laws, regulations, and rules of conduct to function effectively.

7. Improve team performance with the Drexler/Sibbet Team Performance Model:  This is a simple model for building a team to carry out projects. If you treat your practice as an ongoing project, Drexler/Sibbet’s model can help you think about how your team members are interacting and how the team is performing.

Source/Credit: httpss://davidsibbet.com/process-models/

8. Use your stakeholders’ “Narrative Instincts”: We are wired to tell stories. We are also wired to listen to them. If you want to help educate or persuade people to your cause, frame your facts within stories. You may have noticed me not so subtly using the tactic in this very blog!

Further reading and free resources to help you choose mental models to help make business and life decisions

One of my favourite resources for thinking about thinking is the Farnam Street Blog and their equally thought-provoking podcast. See their amazing list of mental models here. 

I also recommend the The Decision Book by Mikael Krogerus and Roman Tschappeler, which summarises 50 models for strategic thinking.

Image: httpss://tinyurl.com/yxnqx2zs

Can employers access employees’ personal phones?

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Like too many employment law issues in Australia, the answer is that: “it depends”.

The rise of the personal smart phone

  • When I was a young man, it was common for employers to issue employees with IT-approved “work” phones. Many of us had two phones: one for business, and another for personal calls.
  • These days, it seems like many (if not most) private practices no longer provide staff with phones. Instead, employees access their employers’ email and other systems through their own, personal smart phones.
  • Like most speech pathologists, on my phone, I have a mixture of business and personal information contained in emails and through various client and IT management systems accessible through apps. My employees are in the same boat.

Work information belongs to employers

  • Information employers provide to staff during the course of their employment belongs to employers.
  • Client information is, of course, confidential. Express and implied terms of employment protect employers’ ownership of that information, even if it is stored on an employee’s phone.

Read your contracts and workplace policies

  • There is no general legal right for an employer to search an employee’s phone. But employers can take steps to ensure employees are meeting their obligations under their employment contracts and workplace policies.
  • Employers can only inspect employees’ phones if:
    • they have an express right to do so under:
      • a workplace policy (e.g. an Acceptable IT Use Policy, or Investigations Policy, or Code of Conduct); and/or
    • where they instruct an employee to hand over their phone and it is a “reasonable and lawful instruction”.

Workplace investigations and privacy considerations

  • Employers will have good grounds for instructing an employee to hand over their phone for inspection if they have reasonable grounds to suspect that evidence of a breach of a workplace policy, employment contract and/or other misconduct will be found on the phone, e.g. that the employers’ intellectual property or confidential information has been stolen, or that workplace safety or anti-discrimination laws have been broken.
  • Because an employee’s phone will probably contain personal information about the employee that has nothing to do with work, employers need to think about the Privacy Act 1988 (Cth) when accessing an employee’s phone. But exemptions exist for “employee records” and also where the employer “has reason to suspect unlawful activity or misconduct of a serious nature” and “reasonably believes that the collection or use is necessary to take appropriate action”, which, together may cover most of the employment-related material of interest to the employer. (Remember that the Privacy Act applies to private practices of any size, because we are health businesses.)

The employer owns the work WiFi system

  • The employer owns the practice’s WiFi system, and so will have the right to monitor employee access to practice systems using personal devices. But care needs to be taken to comply with State and Commonwealth workplace surveillance laws. For example:
    • in NSW, employers cannot carry out surveillance of an employee’s phone/computer without prior notice in writing and a policy (see s10 of the Workplace Surveillance Act 2005 (NSW)); and
    • under Commonwealth laws, employers have to notify employees of any listening to or recordings of workplace communications, including phone calls and emails (Telecommunications (Interception and Access) Act 1979 (Cth)).
  • The Federal Court held in Griffiths v Rose [2011] FCA 30 that an employer’s monitoring of its employees use of work-provided IT equipment to ensure compliance with the employer’s code of conduct, was lawful under the Privacy Act. Logically, some lawyers think this would apply to an employee’s use of a personal device via the practice WiFi system.

Bottom line

Employers and employees should review their employment contracts and workplace policies to assess whether employers have the express right to access employees’ phones and, if so, in what circumstances. If there is a workplace investigation into an employee’s conduct, it is very common for the employee to be asked to give the employer access to his/her phone for the purposes of conducting the investigation. When an employee refuses, the key legal issue is whether the request was lawful and reasonable in the circumstances. Employees should be aware that, generally, employers own information created by employees during the course of their employment, and own workplace WiFi systems.

Disclaimer: The information in this article is for general information purposes only and is not legal advice. 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. It cannot be relied on by any person for any purpose. If this article raises any issues for your practice, you should seek independent legal advice based on the facts and circumstances of your situation.

Related articles:

Key source: De Flamingh, J. & Magness, P. (2018). The limitations of a modern day bag search. Law Society Journal, 48(76-77).

Image: httpss://tinyurl.com/y7ko9zul

Happy New Year!

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Happy New Year to all our friends, followers and fellow speech pathologists! We wish you all the best with your practices in 2019.

We’ll be uploading lots of new products this year, so feel free to check back in on a regular basis.

Hope you like our new video and feel free to contact us at hello@speechiesinbusiness.com.au if you’d like to get in touch.

Speechies in Business Speechies in Business
Speechies in Business is owned and operated by David Kinnane, a Certified Practising Speech Pathologist, lawyer, writer and speaker in private practice in Sydney, Australia. You can read more about David’s professional background, qualifications and experience here. David also co-owns and co-manages Banter Speech & Language, an independent private speech pathology clinic, and Bodkin Wood Legal & Advisory, a law firm specialising in allied health issues. David sits on Speech Pathology Australia’s Ethics Board and Professional Standards Advisory Committee and is a part-time Associate Lecturer at the University of Technology Sydney’s Graduate School of Health.

When is a casual employee really a permanent employee?

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In Australian employment law matters, the real world substance of a work relationship often trumps what the contract says.

For example, sometimes people called independent contractors in contracts are really employees. Similarly, sometimes people called casual employees in contracts are really permanent employees – a point recently made clear by the Full Court of the Federal Court of Australia (the Court) in WorkPac Pty Limited v Skene (see case citation and link below).

Casual v permanent employee: Why does it matter?

Unlike permanent employees, casual employees are not entitled to lots of benefits under the Fair Work Act 2009 (Cth) (the FW Act), including paid leave, notice of termination, redundancy pay and paid holidays. To compensate for the lack of these entitlements, casual employees are paid a “casual loading”, currently 25% of base pay for Monday-Friday hours for speech pathologists in private practice under the Health Professionals and Support Services Award (see clause 26.2).

To be a true casual employee, the employee must have no advance commitment as to the duration of their employment or the days (or hours) worked. Some indicators of casual employment include:

  • irregular work patterns;
  • uncertainty as to the period over which employment is offered;
  • discontinuity; and
  • intermittency of work and unpredictability.

Can you side-step the issue by simply defining an employee as “casual” in their contract? 

No.

Things like what the contract says, payments of casual loading, the need to submit timesheets, and the right to terminate at short notice (e.g. 1 hour) are relevant, but not of themselves decisive. Instead, what matters is the real world “objective” substance of the relationship between the employee and employer at the time. For example, there must be no long-term, firm, advance and mutual commitment to work an agreed pattern of hours.

What happens if the employer gets it wrong?

If the employee is really a permanent employee, she/he is entitled to annual leave and other entitlements under the National Employment Standards and/or the Award. In theory, employers should be able to set off any casual loading paid to the employee against these payments. But, in the Skene case, this didn’t happen because the employer had not designated a specific amount or percentage of wages to be casual loading.

Another consequence of getting it wrong is that the employer might be liable for penalties under the FW Act. The Court made it clear that ignorance of the law is no excuse, and that it’s a serious offence to mis-classify a permanent employee as a casual employee.

Bottom line

When deciding whether an employee is casual or permanent, Australian courts apply a substance over form test. Simply labelling an employee as “casual” in the employment contract and/or paying casual loading is not enough to guarantee the employee is truly casual from a legal perspective.

To mitigate the risk, employers should ensure that any casual loading paid to employees is specifically quantified in the employee’s contract and payslips. This may allow the employer to set-off that amount against any claimed entitlements. But the risk cannot be eliminated by legal drafting, as Courts will look at the true relationship between the employer and employee. Employers should therefore seek legal advice to assess the level of this risk for their businesses.

Case: WorkPac Pty Limited v Skene [2018] FCAFC 131. Full case access via the Federal Court of Australia website here.

Principal source: De Flamingh, J. & Kiley, E. (2018). Another casual conundrum: substance over form prevails (again), Law Society of NSW Journal, 72-74.

Image: httpss://tinyurl.com/ycvxcayp

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