Business Tips and Resources

Speech pathologists: how to build ethical, profitable, high quality private practices that outlast us

17 January 2017 By David Kinnane Leave a Comment

Over the break, while couch-potato gazing at the cricket, I gave some thought to long-term, sustainable business models for private speech pathology practices. Specifically, mine!

When you start out, almost anything you read about launching a small business will at some point hit you with a frightening stat or two, e.g., that 80% of small businesses fail in the first 5 years. I’m not aware of any specific stats on speech pathology practices, but I’d expect that figure to be about right.

Why?

Lots of us start out in private practice because we want the flexibility and independence of running our own show. We are confident (or confident enough!) in our technical skills as speech pathologists and think we can do things better that where we were before to help clients with their communication or swallowing needs.

But knowing how to be a great speech pathologist is not the same thing as knowing how to run a business. To run a business, you need business knowledge and systems.

Business infancy

When I started my private practice, I was pretty much my clinic, and my clinic was me. My wife and I did all the work ourselves. But as we got busier, and our case load grew in volume and complexity, the work became harder to handle. At one stage, we were working seven days a week – often 12 hours a day – to ensure we kept our therapy service quality high. But, even working 60 hours a week to ensure our clients got the best possible service, “non-client” things started to slide. We just didn’t have the time or energy to attend to all the back office stuff.

Business adolescence

Eventually, we got some help. Initially, with some of the back office tasks we despised (e.g. book-keeping), and then by hiring high-quality staff to help deliver our services. The danger with this “teenager” stage of business is ensuring your quality remains high even though you are not delivering every assessment and therapy session yourself. This was (and remains) hard for a control freak like me! But I knew that my practice would fail in the long run if I couldn’t grow it to a stage beyond my ability to do and control everything myself.

Sometimes during this phase, I felt like retreating back to the comforts of the one-person practice. But then I remembered how awful it felt to be overloaded with work, turning clients in need away as my waiting list ballooned.

Planting seeds for growth at the outset

Successful businesses think about the future. Ideally – in the long run – you want your practice to work even when you’re not there. To achieve this, you need to think like a business-person and plan how your business will develop as it grows. So I looked in the mirror and asked myself:

What do you care about the most?
Why is your practice an opportunity worth pursuing? Is it aligned with what you care about the most?
How do you want to live?
How much money do you want (or need)?
How much freedom from working at the coalface do you want?
What sets your business apart?
How will you get clients?
What type of clients will you help?
How will you deliver your services?

(If interested, you can read more about our start-up philosophy here.)

I then developed a one-page business plan with my purpose front and centre, and my break-even point highlighted in pink.

Even though I didn’t want to, I needed to think like an “entrepreneur”. Now, I know that word has some colourful connotations, and not everyone in private practice is comfortable thinking of their practice as a business. But, as I’ve said before, I think it’s perfectly possible to be both ethical and profitable. In my previous career as a finance lawyer, I observed that it was often the well-meaning, but unprofitable and ill-managed, businesses that were vulnerable to major systems failures and pressures to cut corners at the expense of their clients.

Get out of your own way!

Here’s a quote I love from Michael Gerber:

“The problem isn’t your business; it never has been. The problem is you!”

That was so true with us! We needed to realise that many of our early struggles were caused by the confusion and tension of trying to wear multiple hats at the same time. Every day, in the clinic, I was part:

(mostly) speech pathologist, focusing on improving my technical skills to help clients with the latest, evidence-based therapies;
manager, focusing on boring (but essential) business and compliance systems, organisation strategies, and finding ways of doing things more efficiently; and
entrepreneur, creating new services and products, dreaming up new ways of doing things, looking for opportunities to grow and to connect with others.

The (ongoing) problem is figuring out how much energy to devote to each role at any given time.

How to build a business that lasts

Another top tip I learned from Michael Gerber:

“Pretend that the business you own…is the prototype, or will be the prototype, for 5,000 just more like it!”

Now, as an, ahem, former McDonald’s crew member, I’m not a huge fan of the franchise model for allied health. But I loved the idea of designing my clinic to be systems-dependent rather than owner-dependent. Documenting your key systems:

forces you to write down the (sometimes conflicting) contents of your head. I discovered scores of duplicated efforts, wastage and service gaps in my systems just by writing them down;
allows others to understand and work to your standards without being micromanaged;
ensures people are accountable for their outcomes; and
increases the predictability of your service quality.

When we started our clinic, we set up systems that we hoped would grow with the business – even if they seemed ridiculously over-engineered for the client flow at first. I even signed my own Code of Conduct.

Why we had an organisation chart for two people

Even when we were (literally) a Mum-and-Dad business, we wrote down all the roles in our practice (e.g. clinical, operations, marketing, Human Resources, accounting, finance, etc.), and then assigned them – initially all to ourselves, but, as the business grew, to our staff and partners. This helped us stay clear on who was accountable for what and when, even (especially) when we were doing everything.

Human Resources: hire people who are smarter than you

When we hire someone to help us, as an employee, contractor or service provider, we test candidates against the standards we’ve set for ourselves in the position. We look to hire people who are at least as good (preferably better) than us at doing the job. We also try to make sure staff and partners understand the meaning of the work they’re doing and how it fits into our purpose and plan.

Marketing: it’s all about the clients

Our marketing plan is simple: doing our job as well as we can. We don’t rely on advertising. We focus all our efforts on solving real-life problems for people who need speech pathology. That’s why we publish free blogs, books and resources, and address frequently asked questions. That’s why we do community and school talks. We try, consistently, to help people who need speech pathology services find the answers they need.

Don’t lose sight of why your business exists

The business development process – the design of business models and systems – never ends, especially in a time of great change for speech pathologists. When we look at our medium-to-long term business goals, we see a complex, but easy-to-run, set of systems and processes that all work together to support our primary aim: helping adults and children to speak for themselves.

Principal source: Michael E. Gerber, The E-Myth Revisited: Why most small businesses don’t work and what to to about it. Kindle edition via here.

Image: https://tinyurl.com/h2tx26v

Speech pathologists: How not to get suckered in business

5 January 2017 By David Kinnane Leave a Comment

Have you ever found yourself saying yes to an important business contract or buying an expensive resource and later regretted it?

Most speech pathologists I know are pretty smart. We also tend to think the best of people.

Optimism and trust are great qualities when working with clients and their families. But they can leave us vulnerable when negotiating business contracts with people trained in human persuasion techniques. Behaviour studies show that people use predictable short cuts (or rules of thumb) when making decisions. Salespeople and others can take advantage of these pre-programmed responses at your cost.

Knowing key persuasion strategies used in business can save you from being manipulated. They can also make you a skilled persuader yourself in business negotiations with other people.

Key persuasion strategies with real world examples

Price indicates quality shortcut: People assume expensive items are high quality than cheap ones. Example: When I started my clinic, I bought lots of expensive assessment tools that, in hindsight, were not as reliable as cheaper options. Given limited time to research, price played a factor in my decisions – something I am still paying for. On Speechies in Business, we found that some of our products sold better when we increased the price! I’ve even had feedback from a person that they would have bought my Clinics Template pack but it seemed too cheap to be good!
Rule of reciprocation: People feel obliged to repay others for whatever they have provided to us. Example: Ever fallen for the “free sample” trick? A salesperson offers you a free “gift”; or a website offers you a free download. Unconsciously, you feel indebted to the provider and are more likely to buy something.
Rejection-then-retreat tactic: People match concessions in negotiations. If a seller asked you to buy a $4000 program but then retreated and offers to sell you a $40 resource product, you would be more likely to buy it than if you’d been offered the $40 product alone. Example: This is a common tactic used by resource sellers. You baulk at paying for their ridiculously expensive product, and opt for what seems like a much more affordable one instead – sometimes something you may never have bought had it not been for the expensive product.
Scarcity rule: Opportunities are seen as more valuable if their availability is limited, e.g. by time, or if you are competing with others. Examples:
- In every lease negotiation, the real estate agent will tell you how many other people are looking at the property too.
- “2 day flash sales” offered by education publishers where you end up buying stuff you don’t need.
- Professional or business webinars with tight deadlines and limited capacity. If you think about it, there’s no real reason for them to be so restricted, other than making the “product” seem more attractive and the purchase decision more urgent.
Romeo and Juliet effect: We hate losing opportunities. If something is banned or forbidden, it instantly becomes more desirable. Example: one of my colleagues in Australia seemed to become more interested in the persuasive power of testimonials and solicited reviews after these practices were banned by the advertising rules.
The commitment effect: Once we commit to something with words or actions, we will act to stay consistent with our commitment. If we are asked to assume a responsibility for doing something, we will go above and beyond to achieve it. Examples:
- Volunteering: Have you ever volunteered to get involved in a project, then found yourself doing all the work for no additional payment?
- Mentorship: Mentors are often prepared to move heaven and earth for their mentees, even at the cost of their own work.
Initiation trial effect: If we go through a lot of trouble to attain something, we tend to value it more once we have it. Example: I once paid for a very expensive, very intense professional development program. Even 6 months after completing it successfully, I found myself telling everyone how great it was and defending it staunchly from critics, even if, objectively, the program had some limitations.
Social proof principle: We often determine what to do by looking at what others are doing. This can lead to the bystander effect where no-one else acts, so we decide not to either. Example: Countless therapy fads have taken hold simply because “everyone else was doing it”. As evidence-based professionals, speech pathologists need to be very wary of this one, and demand proof of effectiveness before changing a clinical practice to follow the crowd.
Similar people effect: We are more likely to copy others in our choices when the other person is similar to ourselves. Also known as peer pressure, and a real risk in speech pathology because of our (currently) limited diversity.
Halo effect: We tend to see attractive people as smarter, kinder and more honest than unattractive people. That’s why so many salespeople are good looking. We also tend to like people who co-operate with us for a shared goal. This can play out as the “good cop, bad cop” dynamic, where we are vulnerable to the person who “shares our pain” against a common “enemy”. Again, real estate agents are good at using this one, complaining about how unreasonable the landlord is, while at the same time making sure the landlord gets everything he/she wants (at your cost).
Authority effect: People are swayed by authority and even mere symbols of authority. Examples: Fancy titles (again constrained in Australia by our advertising rules), ritzy clinics, cutting-edge websites, silver and gold embossed certificates on walls, white coats, uniforms, power suits and even stethoscopes can be used to generate authority. Looks can be misleading, though. Sometimes the best clinicians wear jeans and work from home. But how are clients to know?

Bottom line

Be on guard for these techniques when negotiating with others. If you are in business, you are probably using some of these techniques, even if you didn’t know them by name! Make sure you stay ethical. Follow the spirit and letter of your ethics codes and advertising rules. Never use persuasion techniques to the detriment of your clients.

Principal source: Cialdini, R.B., Influence: The Psychology of Persuasion. An oldie but a goodie.

Image: https://tinyurl.com/goj6hvm

Speech pathologists: how to talk about what you do for a living without being “salesy”

27 July 2016 By David Kinnane Leave a Comment

“I need a blood test”*

Lots of people have never met a speech pathologist. Some have a rough idea of what we do, often along the lines of: “Oh, you work with kids with speech impediments, right?”

Others have absolutely no idea. And fair enough. There are loads of professions I know little or nothing about.

One of our key professional duties is to advocate for people with communication and swallowing needs. But it’s hard to advocate for some groups of clients if the public don’t know what we do or why we’re qualified to speak on issues as varied as adolescent literacy, Parkinson’s Disease, dementia care, youth justice, stroke rehabilitation, accent modification and professional communication.

Our peak bodies – like SPA and ASHA – do their best to spread the word through terrific projects like Speech Pathology Week, the 900 swallows initiative or the SPA Book of the Year Awards. But every speech pathologist has a role to play in educating the public about what we do: one of the main reasons I post so often to my clinic website.

Despite our collective efforts, I’d hazard a guess that few members of the general public understand our full scope of practice, or the many different ways we help people in different places. Shockingly, I didn’t know the full scope our practice until the second semester of my degree!

Getting the word out, ethically

One of the main themes that crops up whenever I speak to groups of speech pathologists or speech pathology students about private practice is a deep sense of ambivalence about self-promotion. And for good reason. We work with people with health needs who are vulnerable to misleading and deceptive advertising. It’s one of the main reasons the profession in Australia has such a robust Code of Ethics – Advertising policy.

But I think we can do more to explain what we do to others without trying to “sell” ourselves. And it’s a fairly simple idea, borrowed from Michael Port’s research on networking and marketing strategies for professionals:

How to explain what do you do for a living in 5 steps

The next time someone asks you what you do – at a barbeque, a kid’s birthday, a networking event, cousin’s wedding, etc. – don’t say “speech pathologist” and leave it at that. Instead, use Port’s simple 5-part formula, which I have adapted for speech pathologists as follows:

Summarise your key client groups: Who do you help most often: Infants? Toddlers? Preschoolers? School-age children? Teenagers? Young offenders? Young and middle aged adults? Older folk?
Identify two or three of the most critical problems that your clients face: In what areas of practice do you help clients? Language? Literacy? Speech? Voice? Fluency/stuttering? Feeding? Swallowing? Life-long disability/Multi-modal/AAC? Accents/intelligibility?
List some of the main ways you help people: One-to-one or group therapy? Telehealth? Parent training? Client coaching? Advocacy/education/lobbying?
Explain the number one result you want your clients to achieve.
Talk about the deeper benefits your client’s experience.

One of the great things I find when introducing myself this way is the genuine interest many people have in what I do. Rather than just a customary exchange of titles before moving onto the next topic (usually property prices in Sydney), it starts a conversation.

Examples

This is how I apply the formula to explain what I do:

I help children and adults…
who have difficulties with their speech, language, literacy, stuttering, voice, and/or accent…
with evidence-based, tailored therapy in my clinic, via Skype, or through online courses,
to pursue their goals and to make the most of their abilities and potential,
to get the most out of life.

Here’s an example for a paediatric speech pathologist focusing on traditional speech and language services:

I help infants, toddlers, preschoolers and children;
who have difficulties with their speech, language (including social use of language), and/or literacy;
to improve their language, intelligibility and literacy through home, (pre)school and clinic visits, parent training, and home programs;
to communicate with confidence, be understood and to participate more fully at home, in extra-curricula activities and at (pre)school.

Here’s another example for a speech pathologist working in a rehabilitation setting:

I help young adults and adults;
who have had a traumatic brain injury or stroke causing language, speech and/or swallowing difficulties;
with evidence-based treatments and carer training based on principles of motor learning and neuroplasticity in a multidisciplinary rehabilitation setting;
to recover maximum communication skills and to learn compensatory strategies for areas of on-going difficulty;
to regain independence and to go back to work.

Not just for introductions

The great thing about doing this simple exercise is the clarity it brings to what we do. I use my 5-part introduction not only to explain what I do to non-speech pathologists, but as a key part of my “mission statement”, business plan, strategy and even branding for my clinic. Once a year (or so!) I reapply the formula, taking into account new target clients, training and new competencies, and proposed service delivery changes for the coming year.

Bottom line

To advocate for, and to market, speech pathology services, we need professional credibility. For credibility, we need the public and potential clients to recognise our expertise, experience and authority across our scope of practice. Explaining who we help, how we help, and the outcomes we deliver for clients is critical for both public advocacy and private practice success. Port’s 5-part formula is a simple way to articulate what we do for a living to people outside the profession.

Related articles:

29 tips to Turn Pro and improve your private practice – Part 1, Part 2, Part 3.
22 lessons I’ve learned from a private practice pioneer in allied health
5 steps I took to comply with Speech Pathology Australia’s advertising rules

Principal source: Port, M. & Wallace, J. (2013). Book Yourself Solid Illustrated. John Wiley & Sons, New Jersey, USA.

Image: https://tinyurl.com/zweegrq

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* True story. This happened to our operations manager a couple of weeks ago:

Ring ring.

Gentleman: “I want to book in a blood test.”

Banter Speech: “Sorry? I’ve think you’ve got the wrong -”

Gentleman: “Can I come in later today? I need a blood test urgently. My doctor said I needed to go to…”

Banter Speech, finally twigging: “Oh, sorry. We’re not that kind of pathologist! Let me see if I can find a local pathology lab to help you out.”

Speech pathologists: 5 best practice ways to improve your advice to clients

16 July 2016 By David Kinnane Leave a Comment

In one capacity or another, I’ve been a professional advisor for almost 20 years. Although advice-giving is a core part of what speech pathologists do, few of us are trained formally in how to do it well.

Bad professional advice can lead clients to make flawed decisions. It can also strain relationships and tarnish your reputation.

It’s sometimes assumed that advice-giving skills emerge organically, with experience and through a painful process of trial and error. But giving good advice is a skill. And, as with most skills, you can get better at it with the right knowledge, systems and practice.

So where should we look for the right knowledge?

Recently, Harvard Business School Professors David Garvin and Joshua Margolis reviewed the research about advice-giving in business and developed a framework of best practices. Applying their guidelines to speech pathology practice, here are 5 evidence-based ways to improve the quality of your professional advice:

1. Before you start, check you’re the right person for the job

Ask yourself: do you have the time, expertise and experience to help? Are there alternative and/or additional sources of guidance to advise the client comprehensively given his/her needs? Do you have a conflict? Would a second (or third) opinion help the client make a decision?

2. Develop a shared understanding with your client

(a) Set the scene: allow clients enough time to explain their challenges, ensure privacy and choose a place free from distractions like buzzing phones or the next appointment.

(b) Listen actively and without prejudice – resist the urge to jump in with your preliminary view.

(d) Agree on the scope of advice sought. Is it:

(i) one-off advice for a single decision (e.g. “Do I have a clinical issue?”, “Should I be treated now, or later?”);

(ii) counselling on how to approach a complex situation (e.g. “How do I prioritise my child’s many communications needs?“);

(iii) coaching to enhance skills (e.g. identity mapping to generate and pursue meaningful, client-centred goals); or

(iv) mentoring to provide guidance to aid long-term success (e.g. acting as a sounding board for an adult who stutters or an accent modification client facing specific challenges at work, e.g. with an important presentation).

Don’t overstep boundaries or give unsolicited advice – especially advice that is outside your scope of practice.

3. Craft alternatives

Make it clear to the client that you are an adviser – not the decision-maker. If possible, help the client generate several, evidence-based, viable choices. Spell out the rationale, principles, assumptions and evidence behind each of the options and your advice. Be prepared to challenge assumptions if the facts or situation changes (or if the client changes his or her mind).

4. Help the client make the decision

Ensure all options are evaluated, including the risks and benefits of no treatment. Communicate clearly and in Plain English. Make sure the client understands your advice. Don’t jump straight to a conclusion, e.g. that a child is a “speech” or “language” kid or assume that your client will choose the treatment you consider to be the most logical or evidence-based. Pause frequently for client/family reactions. Make sure the client knows you are available for further clarification and elaboration if and when needed (i.e. that they don’t need to make a decision on the spot, and can think about other options, risks and benefits and come back with questions or concerns).

5. Help put your client’s decision into action

Reaffirm and support the client in making an informed decision, even if the decision is ultimately not your preferred first choice. Document it. Again, convey your availability for additional guidance and support to help the client to pursue his/her goals, including during treatment.

Bottom line

Speech pathologists advise clients in several ways, from face-to-face and tele-health consultations, assessment reports, management plans, home programs, email and SMS responses to queries, therapy and training activities, outcome measurement, discharge recommendations and referrals to other health professionals. Giving professional advice competently requires us to look at our competence and impartiality, the scope of advice sought and our role in giving it, the technical content of our advice, and the process through which we evaluate different options and give our advice. Skilled advising requires creativity and collaboration with clients. We need to understand clients’ problems fully to generate evidence-based, client-centred solutions over the whole term of the professional relationship. Garvin and Margolis’ framework for advising is a useful tool to do this methodically.

Principal reference: Garvin, D.A., & Margolis, J.D. (2015). The Art of Giving and Receiving Advice, Harvard Business Review, January-February, 61.

Image: https://tinyurl.com/jjd4e2c

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.

Performance Appraisals for Speech Pathologists

30 June 2016 By David Kinnane Leave a Comment

With the end of the financial year upon us, many of us are in the process of conducting performance appraisals for our employed speech pathologists. Unfortunately, many of us are hampered by the lack of a speech pathologist-specific template that is adaptable for all levels of experience – from new grads to senior clinicians – and management styles.

By popular demand and on the request of our fellow speechies, we’re created an up-to-date template designed specifically for speech pathologists in private practice who want to appraise their staff collaboratively. Main features of our performance appraisal template:

consistent with the Fair Work Australia requirements;
aligned with our current range, areas and scope of practice as defined in the Competency-Based Occupational Standards for Speech Pathologists in Australia;
employees fill out first, so you can prepare for the appraisal meeting properly;
designed to generate SMART reflections and performance goals for each employee for the next 12 months, including your expected and measurable increases in their core activities (e.g. assessment, reporting and treatment), additional activities (e.g. advocacy, education, clinical research and quality improvement projects), professional development and competency, generally;
fully editable Word document: add whatever you want, subtract what you don’t need!
easily integrated with SPA’s Professional Self-Regulation (PSR) requirements. File with proof of SPA membership and PSR compliance statement.

Click here for our Speech Pathologist Performance Appraisal Agreement template.

Looked around but can’t find what you’re after? Drop us an email requesting a template, policy or procedure, and – as with this one – we’ll hop right onto it!