#VOTPt

Customer Service

3 Steps to Improving Your Listening Now

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Preaching the virtues of listening is a double-edged sword.  It is one of the most important skills on can possess and translatable across language and culture.  At the same time, listening is a virtual unicorn in our fast-paced, multi-tasking society.  Let’s get practical with 3 steps to improving your listening now.

  1. Quiet Your Environment

This should be pretty straight forward, but I can’t tell you how often I’ve personally observed important customer conversations happening in the middle of a busy office.  Of course, these conversations happened with the best of intentions – organic and spontaneous in nature, the customer asks a question and the clinician responds in the moment leaving the conversation at the surface level without digging deeper.  Confession: I’ve been the clinician in this scenario

Exercise: As a matter of practice, take the time to routinely (weekly or every other week) to check in with your customers in a quiet space free from other noise and interruption.

  1. Quiet Your Mind

Controlling environmental noise is one thing, quieting the noise in your own mind is an entirely different beast.  The sheer number of demands in a day – other customers, documentation, needs of staff/colleagues, needs of your home – is often overwhelming and always growing.  While society has extolled the virtues of multi-tasking, our relationships, including clinical & customer relationships have deteriorated.  I’m not claiming causation, but the correlation cannot be denied.

Exercise: Practice your listening skills.  #1) Aim for 2-3 minutes of complete silence listening to every breath you take.  #2) In the coffee shop (or any public space), close your eyes and try to identify by sound, how many different conversations are happening around you.  You’re working to parse sound & channels.

  1. Make Your Goal: “That’s Right.”

You are excited to help and serve your customer.  That is a good thing.  In that excitement, though, we often subconsciously try to anticipate customer questions and answer them.  We do this at the expense of asking questions and seeking clarity.

Exercise: When your customer is done relaying their story, start with the words, “Let me make sure I’m hearing you correctly.”  Briefly summarize what you heard.  Wait.  You’re waiting for the customer to independently say, “That’s right.”  Be careful not to add the leading question, “Is that right?” to the end of your summary.  This creates the potential for agreement rather than affirmation.  The tiny psychological step that takes place with your customer independently assesses and confirms your summary turns into a giant leap of empowerment ending with that customer being heard, possibly for the first time in a healthcare setting.

Practice these three simple exercises and be sure to let me know how it goes for you.  Keep in touch through the comments below, our facebook page (www.facebook.com/thevoiceofthepatient) or through Twitter (@DReedPT or @ZachRStearns).

Your Motivation

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Why do you do what you do? Why are you making the choices that you’re making? Why are you reading this right now? Why am I choosing to spend my time writing a blog post?

The answers are evasive at best and unique to the individual. Getting a little messy never scared me away, though.
The field of economics addresses motivation to action in terms of utility. Utility, here, is defined as the measurement as “useful-ness” that a consumer obtains from any good. Whether that useful-ness is realized in terms of money, education or learning, or just a good feeling, we do what we do because we recognize utility in that action at that time.

So the questions bend a bit here. Where do you see utility? Is it in giving or receiving? I believe that there’s a way, with a little effort, that business can be sustained in genuine service to others.

We’re here to support you in your service to your communities.

Get Better Results Now.

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Give a hoot.  Actually assign value to what the person in front of you is saying.

If I were to stop here and you were to implement this alone, I can guarantee that your results – in nearly any area of your life – would immediately change for the better.  For validation purposes, here’s what happens next:

1.      You get a strange look as if you were from another planet. 

This is especially true when changing your approach with people who know you well.  “This isn’t how he normally behaves.  What’s wrong with him?  Is he dying?”

2.      Your customer’s guarded position melts and you gain better depth of information. 

If you don’t know the person in front of you well (i.e. it’s a stranger), you may actually skip #1 and start right here.  When a person knows that you actually care about what they’re saying, that they’re not just a number or a widget on the assembly line,  they will open up.  They will give you the depth of information you need to actually help their specific problem(s).  But we’re not focused on solving their problem just yet.  We’re still listening here.  Valuing what the person in front of us is saying is the ONLY thing happening at this point.

3.      Your strategy to solve the problem with which you’re presented is tailored to the individual setting you up for success. 

This one is pretty straight forward.  Better information in yields better results.  When your customer feels valued, there is understanding that you are invested in them on a person-to-person level.  Some may call what’s happening “gaining buy-in.”  We like to call it: Establishing Therapeutic Alliance.  It is the foundation for enormous results.   

4.      Your customer says something like, “I’ve never had an experience like that before,” or “This is so much better than the last _______ I went to.”

This is the point where you tell them, “Thanks, I learned it all from The Voice of the Patient.”

Enjoy.

Voice of the Profession or Voice of the Patient

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It is truly an awesome spectacle to see the dedicated and vocal professionals covering all bases of social media today.  Even better is the traction that patient-centered care has garnered. The idea that more than 3 people (my wife, Zach Stearns, and Dustin Jones) downloaded and even listened to the first few episodes of the VOTPt podcast is pretty fantastic.  If you haven’t listened yet, check out this episode with Emil Berengut and be blown away.  With this growing chorus of professional advocacy, it’s critical the patient remain that singular voice around which we all center our growth, practice, and advocacy efforts.

As I write, I’m on a plane headed to Washington DC for a weekend of FSBPT meetings (okay, maybe a little less exhilaration than CSM generates) reflecting on the important differences between state APPTA chapters and state licensure boards.  While the professional organizations challenge the status quo, advance baseline knowledge, grow the profession, and are generally the more “sexy” of the two sibling groups, licensure boards are charged simply yet profoundly with the responsibility of protecting the public from harm while receiving care.  Professional regulatory bodies hold and advance the profession’s “bottom line” or, as I like to think of it, playing defense to the professional organizations’ offense.  The voice of the patient is so important in regulation of practice that at least 1 unlicensed and independent public member is included on each state board (important arguments have been made to include more – slow process to change practice acts).

My purpose here is to question and challenge the factors currently influencing your professional trajectory.  Maybe more accurately, to challenge you (and remind myself) to continuously question these factors.

  • How does this CE course allow me to better address patients’ needs (expressed or unexpressed)?
  • Does my employer (actual or potential) allow me to respond the voice of my patients?
    • An important consideration in becoming your own employer too.
  • Does my practice setting (current or potential) provide the best gateway for me to serve and deliver real impact to the benefit of the patient?
    • Would also apply to promotion or change in role.
  • What does the voice of the patient (the voice of your own patients) say in response to this professional decision (in the clinic or for your career)?

Some Final Thoughts

Professional organizations and regulatory bodies are not opposing forces.  Rather, two components in the effort to elevate the standard of care.  Get involved with your state board and volunteer with national bodies like the FSBPT.  Stay involved with your professional organization.  Keep the patient the center of all of it.

The Voices of the Patients

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Im calling on clinical folks to listen, not only to the voices of their patients, but also to one another.
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Since January 20th (some could argue since November 9, still others would argue since January 20th 2008… and the argument devolves from there), the discourse in mainstream & social media seems to have plummeted.  We’re no longer talking about “the common good.”  Rather, I’m seeing and reading an almost scary fascination with painting any who oppose a particular viewpoint as evil incarnate.  As one side raises the intensity, the other sees and raises in kind (or unkind as it were).  Quite simply, we’ve corporately stopped listening to anyone’s voice who opposes our own.

Drown out in the sea of arguing are the voices who can’t, don’t or just won’t shout others’ down.  These voices want to be heard also.  For these, convictions are no less strong and needs no less emergent.  The recognition that each is a valued part of a stronger whole which is better together than separate is our bond.

But what does this have to do with The Voice of the Patient?  It’s not a political blog… is it (angry face emoji)?

In the on-going national debate on healthcare, we agree on the destination: Achieving optimal health for the individual –> the community –> society as a whole.  We may disagree on the path.  A now old-fashioned concept that we might thing about dusting off here is “compromise.”  We used to be able to introduce an idea and it wasn’t a personal affront.

As clinically minded people, outside of the whirlwind of politics, we’re entirely focused on our patients’ care and will go to bat for them at any cost.  I’m calling on clinical folks (PTs like me, MDs, DOs, RNs, DCs, etc…) to listen to the voice of their patient.  I’m also calling on us to listen to one another with the exact same intention – “I respect you as a person.  Though I may not care for your opinion, I will not assign this dislike to you as a person.”  In practicing and living this way, I know we can make so much more progress toward the goal above.

The truly grievous part is that we, as individuals and as a country, have the means and opportunity to come together, serve one another, and be stronger in the end.

Don’t Beat Patients with the Science Stick

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Let’s start with a few basic principles:

  1. Do no harm.  Ever.
  2. Providing care with an evidentiary basis is absolutely preferred above the alternative.
  3. Healthcare can no longer be only a series of passive modalities (physical, medicinal, etc.. included).
  4. In the case of an exception to principles #2 and/or #3, principle #1 CANNOT be violated.  Ever.

For the science-y types, please understand that I agree with your assertion that we must continually question our own and one another’s treatment approaches reducing dependence on modalities that have been tested and shown to have minimal to no clinical effect.  Likewise, we must be open to our practices being challenged.  Feelings properly checked, let’s get after it.

The rule of thumb I use in the clinic is this: I cannot charge a client for a service they could otherwise get by purchasing a product through Amazon.com and applying themselves.  Ultrasound and TENS are good examples.  This is not skilled care.  My skill is in the application of anatomy/physiology, tissue healing, biomechanics, etc… to the neuro-musculo-skeletal systems.  I will charge (plenty) for that.  It’s my opportunity to help my patients see that value and want to pay for my services.

Sure, there are certainly shady people who will continue to make a great living off of peddling passive modalities unsupported by evidence as “physical therapy.”  These patients eventually change providers and wander into our offices… expecting the same care, but different results.

The awesome, blog-reading clinician you are, have the opportunity to do something that, apparently, no other clinician has ever done with/for this poor soul.  Talk with them.  More importantly than talk, you will LISTEN.  In listening, you’ll understand they’re not asking for the junk prior PT peddlers have sold them.  But breaking out of a comfort zone is… uncomfortable.  Here’s my advice:  

Hold their hand.  Be their partner.  Earn their trust.  THEN change their expectations.

Mr. Jones:        “Ultrasound [cupping/whatever] was the only thing that helped when I was in PT before.”

You, PT:          “Studies show ultrasound [insert alternative modality here] doesn’t work.”

–> You’ve effectively slammed the door, ruined your opportunity to effect therapeutic change, and FAILED to address their core concern.  Bust out your microscope to view your chances of that patient completing the POC you’ve carefully lain out for them.

Mr. Jones:        “Ultrasound [cupping/whatever] was the only thing that helped when I was in PT before.”

You, PT:          “What were you able to do when you could walk better?  How did that change day to day life?”

“Since you’re in for the same thing, would you mind if I tried something new?  I want to help you get the relief you’re looking for and find a permanent solution for you so you can do XYZ.  Doing too many different things [you understand: independent variables] at the same time can make it difficult to tell what’s making the difference.”

“I’m open to adding [crappy passive modality] later if we still need it.”

[Consider some pain science bombs here]

–> Congratulations.  The door has been kicked open.  Work your scientifically validated magic.

Full disclosure, I have not given (or assigned anyone to give) an ultrasound in over 2 years. I’ve given fewer than a handful in the last 5 years; only after a similar conversation as above and more because I felt that there was a therapeutic “wall” in that specific patient’s mind (where pain is synthesized) convincing them that this was the ONLY treatment that would work for them. That wall could ONLY come down with a solid relationship. Most of the time that psych component can be addressed with solid, empathetic discussion and education. Other times, it needs a magic wand/ultrasound. We’re doing no harm while aiding that patient past their barrier.