New Leaders and Old Teams

Okay, I’m a “Leader.” Now What?

At OPIE Choice and at the Fundamentals of Excellence Conference, we stress business skills and leadership. Most of the people at the conference came away with a desire to do something different, or a realization that things have to change. But thinking and talking about change are vastly different than implementing change. Most likely, the change started with you. and you have walked back into your old environment. The books and advice and easy stuff to find all seems to assume that as a leader, you get to hire the perfect team. But you don’t. You already have a team. And the relationships are there. And the history, inertia, and day-to-day work will grind you down. It is very easy to fall back into the same routine, thinking that tomorrow will be a better day to start the project.

What About Relationships?

Always keep your focus on the present and future. Your team might say things like, “You weren’t like that when you were one of us.”

Rather than getting defensive, you can respond with a statement like, “In the past we’ve relied on each other as teammates. Now, I’m going to need your help even more as your boss. I’m looking forward to seeing how we can all create a better future together. And trust me; I’ve got your back.” Or perhaps “In the past we were working in a different environment. Things have changed and I need to pay more attention to managing the business so we can all provide for our families. Now, I’m going to need your help even more as we navigate the changes. I know I can count on you to do what needs to be done. We are in this together!”

Leadership Communications

As a leader, it is vitally important that you recognize the importance of communication. This is where a ton of respect and loyalty can be won or lost. When people know that you care about them and that you understand them, they will be more inclined to trust you. And remember, sincerely (and lack thereof) is transparent, no matter how good you think you are at faking it.

Benefits of Benchmarking

Benefits of Benchmarking

Making smart comparisons of your organization’s operating ratios and other metrics to those of similar organizations can create a baseline for performance improvement. That’s why OPIE Software and the OPIE Choice Network are investing in a web-based benchmarking initiative called the “Choice Dashboards.”

Moving the organizational performance needle—or, to begin with, making the decisions that lead to better results—depends on good data input. It is vitally important that your practice is consistent in the way it inputs data into your system and that the information is accurate, too. Moving the needle, so to speak, is driven at a fundamental level by some notion of where you want to go. If you want to be the best, how will you know when you are?

To achieve that kind of understanding, measuring your own organization’s performance is essential, but meaningful comparison to other organizations can lead to additional insights. Those comparable data points are benchmarks, and they are an invaluable source of information for business professionals. With that in mind, the Choice Network has developed a web-based Dashboard tool, designed to visually represent key business operations, such as the number of revenue producing visits, referral source activity, A/R Aging and much more.

In its 1993 Benchmarking Management Guide, the American Productivity and Quality Center, a benchmarking authority, created this definition of benchmarking: “Benchmarking is the process of continuously comparing and measuring an organization with business leaders anywhere in the world to gain information which will help the organization take action to improve its performance.”

Simply put, benchmarking tells you where your organization stands within the profession—and more specifically, how you compare to peer organizations—so important decisions are sure to be fully informed.

Why Benchmark?

Benchmarking provides you with a reliable basis for comparative analysis and facilitating strategic decision making. Knowing how your organization compares with others in terms of operational performance gives you practical insight into where your organization excels and where it may be lagging

When you identify an area where your organization differs from its peers, the deviation provides an entry point for inquiry. A difference in performance measures does not necessarily mean there is an issue to be addressed, but looking at the variations helps you explore important questions. Using data in decision making supports good stewardship, whether in the ongoing management of the organization or in fulfilling fiduciary duties.

“Benchmarking isn’t just an add-on; it is a necessary tool, empowering and enabling financial administrators, advisers, and owners to answer the question ‘How do I compare?’,” says Nat Bartholomew, CPA, principal-in-charge of associations and membership organizations for CliftonLarsonAllen.

Financial teams regularly use key performance ratio statistics such as liquidity and net profitability. As businesses continue in their quest to “do more with less,” measurements of key metrics and the ability to understand how your company compares to others can help inform strategic operational decisions.

Community Intelligence

Actionable data starts with good data, and a good performance benchmarking relies heavily on the willingness of the profession to share. Of course, everything you share is de-identified and treated in accordance with HIPAA and Privacy guidelines. Data quality and accuracy improve as participation increases. A low response rate to data-collection efforts results in samples so small that the benchmarks have little real-world meaning. By participating in the benchmarking and sharing your data, you are increasing the value of the dashboards for the entire community.

O&P Care Professionals are famous for their dedication to and passion for their patients and the community we serve. Participating in the Choice Dashboards is one way to give back, contributing to the accumulation of better, more accurate data that strengthens the entire profession.



Implementing Business Performance Metrics

Business Performance Metrics


I have reached out to Choice members to find out what is important to you and you have responded!  Sixty-nine percent of you say the most important thing Choice can do is to help you understand business performance metrics.  At the end of October, I did a short piece on Key Performance Indicators and feedback for that was tremendous!  Thank you for your thoughts.  This is the first of a series of articles that will give you practical guidance into becoming a data driven, quality focused company.  These articles will introduce you to metrics and performance scorecards and tools you can use in your practice.  I trust you will find this series informative, valuable and helpful as you manage your O&P practice.
As we strive to understand and implement business performance metrics in our practices, a fundamental first step is to create a culture of excellence.  In “Good to Great,” author Jim Collins examines what differentiates “Good” companies (those with decent growth, customer service and market presence) from “Great” companies (the market leaders).  It boils down to “People.”  Good to great teams were mostly composed of people who had a good sense of balance with the rest of their lives – family, church, and so on. Of course, they had a deep commitment to their companies, but not one that blinded them to the other important things in their lives. The deep commitment comes from internalizing the mission, vision and values of the company.  When the company values and goals are also the values and goals of the people that work there, there is clarity of purpose and a strong desire to achieve the common objective.  These companies also employ some sort of “Performance Scorecard” which is a graphical representation of the progress over time toward some specified goal or goals. I will spend the next several weeks working through the concepts with you and will try to give concrete examples that you can use in your practice.  There are many models and samples for scorecards from which to choose, but for simplicity and consistency, we will use the OPIE Dashboards as our “Scorecards” in these articles. We will also use some OPIE Reports for those elements that do not have graphical representation on the Choice Dashboards.
“Performance Scorecards”
Performance scorecards are tools we use to track significant and sustainable improvements across all functions of our businesses. They are populated from metrics called key performance indicators (KPIs) which measure performance on factors considered to be critical to organizational success. Goals are established for each KPI with performance improvement achieved by closing the gaps between goals and actual performance.
In the series we will focus on the Six Pillars of Practice Success: “Strategy & Sustainability,” “Operational/Administrative,” “Clinical,” “Materials Fabrication,” “Financial” and “Patient Satisfaction.”  Each article will look at one of those topics and examine KPIs that you can use to measure your practice.  So between now and next week, take a few minutes to read this article published by the Harvard Business Review “Creating and Sustaining a Winning Culture.” the building block upon which everything we will do is based on your culture and your staff’s understanding of that culture.  
The goal of this series is to give you the tools and information you need to start implementing a data driven O&P business model on January 1, 2017. Let’s get started and be ready to ask questions!

KPIs That Really Matter

How to Find the KPIs That Really Matter


A Harvard study of 157 businesses revealed that only 23% had completed in depth analysis to set the right KPIs (
Source). Using generic or assumed KPIs can result in measuring the elements of your business that have little/no impact on your performance!


So how do you narrow it down to the “critical” KPIs? Here’s what we recommend:
1. Define your business objectives
Define the specific objective/s you want to achieve & how the achievement of those objectives will be measured. Make sure all critical functions of the business are covered:
  • Sales – “Generate $1,000,000 in sales revenue.”
  • Sustainability – “Keep ‘billable” visits at or above 20% of all visits” or “Initial Assessment visits should equal or exceed Delivery visits each month.”
  • Quality – “Maintain an overall patient satisfaction rating of 93% or better.”
  • People – “Increase employee engagement by 10%.”
Use your “gut” test to ensure you
 have a complete set of objectives.  Ask yourself, “If we achieve these outcomes would we classify ourselves as a “successful” business? If the answer is “no” – define the missing functions and/or objectives.


2. Model your business objectives
Model the input drivers that impact your objectives. For simplicity we’ll assume we have one orthotist and one prosthetist on staff.

By looking at your business operations and the data you have around your processes, you should be able to take the concept demonstrated above and map out the flow as it relates to your business.  In the example above, we have identified the critical KPIs  that we need to measure: Total Sales Revenue, Revenue by Specialty and the Number of Active Patients. 
3. Allocate KPI accountability at the right levels of the organization
As you move from left to right across the model you can identify the KPIs that need to be set & managed at each level of the business.
The CEO is accountable for total sales revenue. The Practice Manager is accountable for Revenue by Specialty. And the individual practitioner’s are responsible for their “book of business” or the number of active patients in their rotation.

By allocating KPI accountability at the right levels we can set targets that align the organization & drive achievement of the $1,000,000 sales revenue objective.

Everyone from the practitioners to the CEO is aligned on achieving the Revenue objective. Everyone clearly understands what they need to achieve, in order for the business to reach its objective.


4. Frequently review and validate your KPIs
As your business changes, improves & grows your objectives and key drivers will change. It’s critical to refresh your model on a periodic basis to ensure you’re measuring the right KPIs at all levels of the organization.

Enhancing the Patient Experience

Enhancing the Patient Experience


As payment for healthcare changes, patient experience will be an increasingly important aspect of the new payment model. While the healthcare field has focused for years on patient satisfaction, we now understand that a positive patient experience is an indicator of better outcomes. 
Engaging patients in their care extends far beyond the practitioner-patient interaction. It requires all members of the staff to connect with patients in new, different, and deeper ways. Even those staff who never see a patient impact the patient experience and have an opportunity to set the practice up for success.


What is the “Patient Experience”?


This concept is really about creating a culture of intent…intent to make sure that the entire organization is biased toward making the time the patient spends with you into an event where they feel like they are the center of attention.  How would you feel if, to celebrate a special occasion, you made a reservation at a nice restaurant,  got all dressed up, arrived on time and were told that your assigned waiter was running behind and you can’t be seated for a while? What if you were greeted when you walked in and were shown right to your table, where they restaurant had placed a little amenity acknowledging your occasion and treated you as if you were the most important people in the place?  Which experience would make you want to go back again?


As you think about your daily workflow and the procedures that are in place, is there an opportunity to create the kind of environment that would improve the patient’s experience as they move through your practice during a typical encounter? Of course we don’t want to risk safety or quality, but rather we want to smooth out the encounter moving the patient through the workflow as stress free as possible. You will create an environment that is immediately evident to patients that it is different and it is good.




Probably the most important aspect of the patient experience (except for the clinical care) is communication.  And good communication can help mitigate a clinical mistake.  Effective communicators are going to incorporate the following into their dialogue with the patients:
  • Connect to patient
  • Engage in the conversation
  • Ask the question you want answered
    • Listen for the answer
  • Explain the why
  • Explain the why not

Remember that 55% of our face-to-face communication is through body language and 38% is tone of voice.  Only 7% of our communication is through the words we use.  And if we are on the telephone, tone of voice jumps all the way up to 86% (SVMIC Risk Evaluation Data). It is important to pay attention to both your body language AND the patient’s body language as you go through the encounter.  Paying attention to the non-verbal cues can help you manage the patient encounter and improve their experience.

You can use body language to your advantage too! When you are eye level with the person to whom you are speaking, it is easier to establish rapport.  If you think about it, you will really that almost naturally, when you are speaking with a child patient, you get down on your knees or sit so that you are at their eye level. The reason is that it put the child at ease and allows you to create that connection.  If you are physically higher than the person whom you are speaking, it implies authority.  A lower position implies submission.  If you have an irate patient at the front desk, often, subconsciously, that patient might feel emboldened.  Why? Because most of the time the receptionist is seated.  If the receptionist simply stands up (in a non-threatening way) most of the time the temperamental person will back down.

Is Bigger Better?

Bigger is Not Always Better


We have observed a recent trend of health insurance plans, hospitals, medical groups and even O&P entities expanding in size. Organizations are merging, acquiring smaller entities and hiring additional professionals. They often explain their strategies as wanting to be “too big to fail,” or they believe only the largest and strongest O&P entities will thrive in the new healthcare environment of accountable care and value-based payment.

However, we see a different picture in data: that bigger might not always be better, which could surprise those who believe that a sale or merger is their only survival option. As you will see, larger practices might be able to gain economies of scale in business office operations and administration, but can lose economic advantages gained when they expand their physical footprint and duplicate services in multiple locations and facilities. Before embracing this “bigger is better” strategy, we encourage members to look at their actual practice performance to see whether there truly are economic benefits to expansion. Perhaps you will find the expertise you need is right here among your peers in the Choice Network.

The impact of size on viability is not unique to healthcare. This view is echoed in today’s local movement. Restaurateur Judy Wicks, a pioneer in the use of ingredients from local farmers, touted the benefits of being small in nearly identical terms to the healthcare business owners: “I realized that when we grow in physical size, we give up something very important-authentic relationships with the people around us and those we do business with,” she said.

If you think about the delivery of healthcare, and in particular O&P care, when it comes to the
business of providing care, your market is fairly small. You may control a city, or a region, but from a national perspective, you are still operating in a small market. The factors that influence your relevance in your market are likewise local. There may be “national” policies, but by and large the decisions about who gets the job are made at the local level. Economist Friedrich Hayek recognized the value of small, decentralized decision makers, especially as they pertain to gathering and responding to information that is also decentralized. He said: “Circumstances of time and place cannot be fully understood by central planners, and decisions based on such information should be left to the ‘man on the spot’.” Being able to communicate your value and make decisions in that small market is essential to your viability.

In the future value-based payment environment that many medical groups cite as the reason for expansion, it will be critical to have good patient outcomes and it is imperative for health care professionals to focus as much attention on managing care delivery and improving patient outcomes as they do on minimizing overhead. This is why we strongly encourage participation in the Quality Outcomes Patient Satisfaction Tool and why we will continue to add outcomes tools to help you in this arena. It’s also important to note that clinical statistics only reveal part of what happens in your practice. Some O&P practices in each size category demonstrate good economic performance, which suggests that any economic benefits derived from size are relatively small compared with the impact of good clinical and business management.

Authentic relationships in our world are built on accomplishments, but that is just the beginning.  Every care provider in every field can tell a good story about a person who is better off because of the intervention provided.  But can they back it with data?  Can you?  That is going to be your
key differentiator.  Now as you start to think about growing or selling or staying the same, you need to think about your value.  You value as a business, your value to the community, your value to the patient, your value to the healthcare system.  Then, in order to truly understand what business strategy you should pursue, it is vitally important that you understand and objectively measure your business. We talked about Patient Satisfaction and functional assessments, but patient outcomes only tell part of the story. How are you doing when it comes to running your practice? The tools made available to you though your Choice membership, specifically the Dashboards that pull data from your OPIE system, were designed to give you the “rest of the story.” When you correctly and consistently use the features and tools of the software you have, the wealth of knowledge that can be created from the data is immeasurable. That data and the resultant knowledge will help you make the next big critical decision you have make.  And that data and knowledge allow you to have very authentic discussions with the rest of professionals on the health care team.

So is bigger better? We can answer with the simple statement: Yes, for some organizations, but not for all. It might be advantageous for some practices to expand their operations, so we encourage those of you considering mergers or acquisitions to evaluate how increasing the organization’s size would affect its total operation. It’s easy to be swept up in what looks like a wave of consolidation only to find that a merger was the wrong strategy. Sometimes, all you need is a good network. According to Adam Small, the founder of Strategic Business Network, “networking is the single most powerful marketing tactic to accelerate and sustain success for any individual or organization!”  The Choice Network operates as a catalyst to ensure you meet the “right” people to include in your network and have the conversations you need to have to be recognized as an essential part of the clinical care team for the patient populations we serve. You don’t need to take drastic steps when you have options.  Once you take a look at your own performance using the metrics described above, you will be better prepared to determine the right course for your future.


Cyber Security Tips for Small Business

Ten Cyber Security Tips
for Small Businesses.


Broadband and information technology are powerful factors in small businesses reaching new markets and increasing productivity and efficiency. However, businesses need a cyber-security strategy to protect their own business, their customers, and their data from growing cyber-security threats.

Here are ten key cyber-security tips for businesses to protect themselves:

1. Train employees in security principles

Establish basic security practices and policies for employees, such as requiring strong passwords, and establish appropriate Internet use guidelines that detail penalties for violating company cyber-security policies. Establish rules of behavior describing how to handle and protect customer information and other vital data.

2. Protect information, computers and networks from cyber attacks

Keep clean machines: having the latest security software, web browser, and operating system are the best defenses against viruses, malware, and other online threats. Set antivirus software to run a scan after each update. Install other key software updates as soon as they are available.

3. Provide firewall security for your Internet connection 

A firewall is a set of related programs that prevent outsiders from accessing data on a private network. Make sure the operating system’s firewall is enabled or install free firewall software available online. If employees work from home, ensure that their home system(s) are protected by a firewall.

4. Create a mobile device action plan 

Mobile devices can create significant security and management challenges, especially if they hold confidential information or can access the corporate network. Require users to password protect their devices, encrypt their data, and install security apps to prevent criminals from stealing information while the phone is on public networks. Be sure to set reporting procedures for lost or stolen equipment.

5. Make backup copies of important business data and information 

Regularly backup the data on all computers. Critical data includes word processing documents, electronic spreadsheets, databases, financial files, human resources files, and accounts receivable/payable files. Backup data automatically if possible, or at least weekly and store the copies either offsite or in the cloud.

6. Control physical access to your computers and create user accounts for each employee 

Prevent access or use of business computers by unauthorized individuals. Laptops can be particularly easy targets for theft or can be lost, so lock them up when unattended. Make sure a separate user account is created for each employee and require strong passwords. Administrative privileges should only be given to trusted IT staff and key personnel.

7. Secure your Wi-Fi networks 

If you have a Wi-Fi network for your workplace, make sure it is secure, encrypted, and hidden. To hide your Wi-Fi network, set up your wireless access point or router so it does not broadcast the network name, known as the Service Set Identifier (SSID). Password protect access to the router.

8. Employ best practices on payment cards 

Work with banks or processors to ensure the most trusted and validated tools and anti-fraud services are being used. You may also have additional security obligations pursuant to agreements with your bank or processor. Isolate payment systems from other, less secure programs and don’t use the same computer to process payments and surf the Internet.

9. Limit employee access to data and information, limit authority to install software 

Do not provide any one employee with access to all data systems. Employees should only be given access to the specific data systems that they need for their jobs, and should not be able to install any software without permission.

10. Passwords and authentication 

Require employees to use unique passwords and change passwords every three months. Consider implementing multi-factor authentication that requires additional information beyond a password to gain entry. Check with your vendors that handle sensitive data, especially financial institutions, to see if they offer multi-factor authentication for your account.

The FCC’s Cyber-security Hub at has more information, including links to free and low-cost security tools.