Ben Lynch: G'day, good people. Welcome to the Grow Your Clinic podcast by Clinic Mastery. Here's what's coming up inside of this episode. This episode will be right up your Allie if you're looking to fill your appointment books. We're diving into the patient visit average over their journey of care. And trust me, you want to hear Jack's take on how to get your practitioners on board with client retention. Plus stick around for when we discuss how to avoid over-servicing and making it sound like you're just about the money. Patient visit average. It's also one of those maybe borderline controversial stats. You just want to over-service patients. You're all about the money.

Hannah Dunn: It's not been a number that we necessarily have to look at with our NDIS clients, but I think that's going to change and shift when we look at block funding.

Jack O'Brien: How do you know you're over-servicing? If we're servicing patients with no progress, then that's a concern.

Hannah Dunn: What I'm trying to avoid and what I never want to happen is for a family to come back to us in three years' time and say, why didn't you tell me that this is something that I should have been working on?

Jack O'Brien: Yeah, this is the single biggest mindset shift that I think clinic owners can invest in for their recent graduates. And this will ruffle a few feathers, so bear with me.

Ben Lynch: Before we dive in, today's episode is brought to you by AllieClinics.com. If you're the kind of clinic owner who loves to feel organized and stay ahead of the chaos, you'll love Allie. Think of it as your digital clone. It's the single source of truth for all your clinic's policies, systems, and training. Test it for free at AllieClinics.com. In other news, applications are now open to work with us one-on-one at Clinic Mastery. If you want support to grow your clinic and bring your vision to life, just email hello@clinicmastery.com with the subject line podcast, and we'll line up a time to chat. All right, let's get into the episode. It is episode 358. My name is Ben Lynch. I'm again joined by Hannah Dunn, Director of Darts and OT Service in Melbourne, and Jack O'Brien, former physio. And host of the Summit, J-O-B, that's the recent claim to fame or Handyman because you're making some office changes as we're just talking about.

Jack O'Brien: Well, you know, I've made some office changes for those who are watching along on YouTube. Welcome to my newest studio. But yes, thank you, Summit host. Grow Your Clinic Summit is locked in. And so, if you're a clinic owner, this is a members-only event that we are opening to the public who are curious. about how Clinic Mastery works. Come and join us, Adelaide, March 2027. Email me, jack@clinicmastery.com. There's an application process just to make sure you're a good fit for the room. We can hook you up, March 2027, jack@clinicmastery.com is the email address. Superb.

Ben Lynch: My wife has already taken and claimed the Keep Cup that we had at the end of the summit So I'm back to the Yeti, but she thought that was a nice little trick or what do you call it? Gift bag item. So let's see what we can do in Adelaide. It'll probably be something related to wine and Hague's chocolate. I hope so. I mean, there's so many things you could do here. Farmer's Union iced coffee. There's lots of good things in Adelaide. Coopers? Well, Coopers. Yes. Iconic Coopers. Well, let's talk about patient visit average. For a lot of clinic owners in the MSK world, physios, pods, EPs, osteos, they will talk about patient visit average a lot. They'll focus on it. They'll track it. Allie does a brilliant job at being able to visualize this and see whether it's improving. I'm interested very much, Hannah, in your perspective on this in a moment when it comes to, in particular, Peds clinics or clinics that have been on the NDIS, typically it hasn't come up as much anecdotally in my conversations, but we're going to connect a few D.O.T.S to marketing, patient outcomes. Those things are true no matter your clinic background. But it's also one of those maybe borderline controversial stats. Because naturally when you bring it up with team members, they say some version of, oh, you just want to over-service patients. You're all about the money. This has nothing to do with care. It's about getting them back in the door. And I want to add some nuance to it here in this conversation about how clinic owners could think about it. perhaps more importantly, how they could position it with their team members so they're on board with it, and how it actually could dovetail into their CPD and talking about clinical pathways for certain conditions. Anyway, Let's get maybe some reference points on the table initially, J-O-P, around what is patient visit average? What does it actually mean? Just articulate some of the calculation and how we might think about this as a stat before we talk about its relevance clinically.

Jack O'Brien: Yeah, in statistical terms, it's the mean. And so patient visit average is the average number of times a patient will come and visit your clinic. And so specifically in, let's say, an acute or musculoskeletal context, it might be somewhere in the realm of four to 14 times, and particularly per episode of care. Then when we look at maybe clinics or therapies or approaches that deal with patients on more of a lifetime approach, You're thinking more on an annual basis. What is the PVA of a particular participant or client in your clinic? So if you're seeing a patient about fortnightly across the course of a year, that PVA would be caught 25 round figures.

Ben Lynch: Nice. So Hannah, does that align with how you think about it and how you've used this stat or do you just not consider this at all, especially in the clientele that you're seeing with the NDIS?

Hannah Dunn: Yeah, I think there's a saying around success breeds laziness. And so I think it is one of those times where in an NDIS world, we do have a long lifespan of a client with us in our service. And so it's not been a number that we necessarily have to look at with our NDIS clients. But I think that's going to change and shift when we look at block funding. And also for our Medicare clients, what we look at with that patient visit average is, yeah, they might get five sessions on a Medicare plan, but what I really try to focus on with our team and what you're talking about with the nuances around the language is, we may not be able to fit the service into five sessions or we may need slightly less than five sessions. We shouldn't be dictated by the funding on what we're offering to our clients and so that is where that patient visit average or those numbers come into play in those sort of clinics.

Ben Lynch: It's a great point you bring up. Two points in fact just to connect some of that tissue is Often people say, we want to look at the visit average by funding source. But even to your point there, it's like, well, perhaps we're changing the way we treat people based on their funding source. Now, of course, we need to consider some of these things about meeting the patients where they're at and their ability to fund and attend the recommended care plans. But that perhaps presents a really important point around not starting with that, but starting with the best care plan initially based on your diagnosis, your history, what you've done to get the patient the outcome they're ultimately coming for. So you bring up a really good point around how should we think about this based on the client's problem. So just before I mentioned condition pathways, people call it different things, clinical pathways, clinical protocols, whatever it might be. But I remember Andrew Zachariah talking about, in their CPD sessions, they'll sit down as a team and they'll talk through a specific condition type or group of conditions. So, JB, you mentioned, say, in a musculoskeletal sense, an acute ankle sprain that comes through the door. And they'll talk through what do we believe or understand through the evidence as best practice? How should this person undergo therapy? And what does that typically look like? Because everyone's different, but typically look like? over the first few weeks, from their initial assessment through six to eight visits. And we know that would be the visit average for someone of that condition type. And so they've sort of blended this into their CPD when they're looking at certain conditions to say what would be the typical journey. And therefore, patient visit average is a way to simply track, well, on average, are those patients going through that type of care plan? Hannah, how do you think about it? How do you approach it when it comes to the clinical protocols or condition pathways that you talk about at the clinic?

Hannah Dunn: I think we're really thinking about like parent capacity as well when we're working with our families and with the financial capacity that you were talking to before about meeting clients where they're at. But I think ultimately what we're expecting is that clients who come to us are generally quite young, that they're sort of maybe two or three years old and that we, have some trigger points in which we would expect that we wouldn't discharge clients. So things like if someone is transitioning from year six to year seven, we would not be discharging them in term three of year six. That's a massive transition in which if we've been working with them for a long time, then that is a client that we would expect to have X number of sessions to at least get them through term one of year seven, for example. Or if we've got a child going from kinder to prep, like those big transition points are where we're really looking at. These are the clients that should not be getting discharged. It might not be how many sessions have they had since they've come on board, but how many sessions do they have around this trigger point of a transition period.

Jack O'Brien: Well, what you're describing there is like phases of care, right? And it might not be necessarily sequential of phase one, phase two, maybe in acute context, it's acute, subacute, chronic. But really you're talking, what is the phase of life or the phase of therapy that this particular participant or patient requires? And interestingly, I find that cohorts or early career therapists, let's say, are not very well versed in a phasic approach to treatments. You know, often they're really good at assessments and maybe differential diagnoses and mapping out the first phase of care, but then they're really clutching at straws when it comes to how do I progress or what do I do once I hit a particular milestone or what do I do when a patient, in your case, as you described Hannah, gets to a certain phase of their care, then they're kind of left floundering and this is the opportunity for clinic owners.

Hannah Dunn: Yes. And so interesting that you mentioned those new graduates because I was only having this conversation with someone I was coaching the other day that it is so common that we would see people getting discharged way earlier than when one of our more experienced clinicians would be discharging them. And so ensuring, because on our focus sheet, one of the questions is, who have you discharged or who do you plan on discharging? And then we sort of have a bit of a quick conversation about the whys and what they were achieving because we were finding that our new grads were like, oh, they're like so great and they're doing so well that we've discharged. And we're like, but what about this area? What about this area? And so we've actually created like a discharge checklist to ensure that people are checking off what, that there's no other areas. Because when we talk to parents, they often don't know what they don't know. And so it's important that we're checking off these areas because when we have those conversations, sometimes it is like, oh, actually, now that you mention it.

Ben Lynch: So Hannah, then talk us through that checklist slash conversation with the younger therapist. How does it go? Because Definitely in the younger years, there is that sense of, well, I don't want to over-service them. That comes up a lot. And it sounds almost like when you're pointing out these are some other areas that we could support the patient or participant. these are some other areas we could add value to them, but it's maybe not the thing that they're presenting with or saying, I need help with this, or this is the reason I'm booking in, or this is the current goal that I have, that we're just trying to get them back into the clinic to kind of keep them going. How do you address that with coaching the younger therapists?

Hannah Dunn: Yes. What I don't, what I'm trying to avoid and what I never want to happen is for a family to come back to us in three years time and say, why didn't you tell me? Why didn't you tell me that this is something that I should have been working on? And so we position ourselves where we are confident that we can never have a parent come back to us and say, I didn't know that other kids were able to do this. Or particularly when it's a first child, parents often think, oh, this is normal. they don't realise how much they're compensating for that child or how much they're doing. And sometimes it's about putting in the context of, we're at the start of four-year-old kinder, there's been no toilet training, they're nowhere near being ready, mum thinks there's 12 months. And we just want to give them some information to say, while there might be 12 months, that's actually not a lot of time. to get toilet training happening, confident and into a new, be able to transition it to a new setting as well. And so when they, when you break that down and understand it, the parents are absolutely free to say, you know what, we're very happy to work on this on our own. And we say, great, go and do that. And when, if, and when you need us, we are here. For some kids, they don't need us. For others, they're like, it's come forefront of mine now, and I'm actually seeing the challenges.

Ben Lynch: So J.O.B., how have you handled in the past talking about discharging? Because that is one of the key things, especially for young therapists, they're almost like trigger happy, like they want to discharge the patient. Maybe to some degree, it feels like closure that they've, quote, got the outcome with the patient. Yeah, they're like, oh, good, we're done. And I think that speaks to getting outcomes with clients, which we'll come to in a moment. This is incredibly important, it seems, Hannah, as the NDIS space shifts. So I want to touch on that with you. JB, just talk us through the discharge side of things, even in your own experience with younger therapists.

Jack O'Brien: Yeah, this is the single biggest mindset shift that I think clinic owners can invest in for their recent graduates. And this will ruffle a few feathers, so bear with me. Do we have a fundamental belief that every time I interact with another person in a consult context, I can help them? I believe, and I think every therapist should believe, that every interaction that they have can add value and can help someone be better. Maybe that looks like more movement, more strength, more flexibility, more function, optimizing their health. There is not one single human being that is optimally healthy and functional. And so whether someone has just stepped out of surgery in the early stage of their career, of their early stage of their rehab, or they are an elite athlete, or a highly capable young adult, whatever the case is, we as therapists must believe that there is something we can do to help people. You don't want to throw your hands up in the air and say, I got nothing. I can't help. That's false. We went to uni for how many years, invested how many dollars in our professional ongoing development. We can help people. With that belief, that mindset, maybe it's reasonable to never discharge a patient. You can send all the hate mail to ben at clinicmastery.com on that one.

Ben Lynch: So, so if I am trying to read between the lines here as well, to a degree, does that mean it's actually about trying to understand what is the next meaningful goal for that client and then how we can help? I don't think you're saying. Just keep throwing the whole utility belt that you've got of different therapy interventions at them or different education. You're actually trying to find out, okay, well, maybe the first goal was just get me out of this pain or help me walk again if I go back because I know feet to some degree. It's a bit foggy now. It's been years. Don't judge me. Anyway. But it's like, oh, initially I just want to be able to walk comfortably or be able to put on the shoe. And then it's like, oh, no, but I was actually training for the marathon or actually I want to be able to run or I'm about to start this new season of sport or insert whatever. And a good therapist is constantly trying to understand what goals do you have? What are meaningful outcomes you have in your life that I could support you on with education or intervention, as you call it? Is that what you're referencing, JB?

Jack O'Brien: It is. I think here is where a lot of practitioners get stuck is we think physically and we get to the end of a phase of care and then we're not sure where to next. And so what it really probably looks like is a reassessment. And so again, good practice is to assess at the start, add an intervention, reassess. And at that reassessment, we're not only looking at the impact of our intervention, but where are the ongoing opportunities for intervention or for partnership or whatever language you want to wrap around it? But how can we find opportunities to continue to progress? Because classically, a problem solved is another set of problems created or at least identified. And so we as therapists need to have a comprehensive enough toolbox or utility belt to be able to identify issues with our clients And then opportunities for us to intervene and help them.

Ben Lynch: Hannah, it seems as though in particular, there's a lot of emphasis in the changing landscape of the NDIS on outcomes and sort of proving that what you're doing is generating outcomes, perhaps to a more blunter point, It's been, well, the participants have had this funding and they've just progressed through years of therapy, but is there any proof that they've made progress? Yeah. So coming back to these outcomes and being clear, you've already been doing this for a while, but how do you think about tracking? Because, Jack, you bring up a good point about reassessing progress. How do you think about it? How do you talk about it with your therapists?

Hannah Dunn: Yeah, so we have a rhythm in which we reassess clients. We sort of say that it's every six months that we're doing a reassessment with our clients, but we do have flexibility in that because I think that's where, what we're saying, where we don't want everyone to feel like it's one size fits all and that we're just doing it for the sake of revenue generating to have indirect time to write up the report. It's to ensure, and also with the assessment tools, it's dependent on when the reassessment times are. A lot of them are 12 to 24 months apart. And so what we really want to be able to see with the NDIS is what outcomes we're expecting to have and why we have evidence to say. So it's no longer good enough to say we're an incredible team and you know, we've got all these great resources. Now it's about like, when we see children with these sorts of conditions, this is the outcome, this is how we assess, this is the timeline. And so it's really about that evidence-based outcomes. So we do have to get more strategic in the way in which we're assessing and what we're assessing, rather than just having a chat to parents and going off the discussion there. we need to be doing a lot more observations. And Jack, when we talk about those early career therapists, as well as I think even experienced therapists who get a little bit stuck in the mindset of seeing really complex kids and then see a kid who's not so complex and feel like their radars off on what is maybe their peers are doing, is we get our therapists out to the schools, we get them into the community, and then when they go out, I say to them, don't just look at your kid's handwriting, pull out the book from the kid next to theirs, the locker next to theirs as well, have a look at what is actually happening across four or five other kids, so you get a bit of a baseline of what is expected, and then you can really assess how your child's going, because ultimately you're going to see that they're the kid who never finishes the work, the kid who doesn't complete sentences, when really in the clinic we see them doing a really good job when there aren't the other demands, and that's the sort of stuff that we need to be able to communicate through in therapy, we don't want to just see kids in the clinic and get them to a point where they're able to write a page worth of information, because that's when someone might discharge and say, yeah, we've done it, we've achieved the goal. But what we want to see is a transfer of that skill into their natural environment where we're adding all those other demands. And can they still achieve what they achieved in the clinic in that other setting? And I think that is what is missed with those clinics who don't go into the community as regularly as we do. And so that is what we need to be showing NDIS. And that's what all the information is saying, that it has to be in the natural environments.

Jack O'Brien: I think really what you're saying there, Hannah, is that we have this therapy room bias. And maybe we've seen a patient or a participant progress from X to Y, but really we need to get them to Z. And whether the case is in a classroom, as you're describing, or I'm thinking about a musculoskeletal context, I'm a physio, it's like, well, when you help someone go from three sets of 10 with the yellow TheraBand to the blue TheraBand, you're like, oh, yes, they've made it. Like, hang on, are you kidding? On what planet is a blue TheraBand enough resistance for someone who wants to return to tennis or swimming or carrying the groceries? It's like, come on, give me a spell. Let's start to think about the real world and think about how, in a console context, we can continue to progress the strength and function of our clients.

Ben Lynch: Understanding those meaningful goals, right? Client experience, it comes back to it, doesn't it? And so much of the emphasis here is actually the ability to elicit those in your consults, in your conversations, right?

Jack O'Brien: Right. I think patients start to get a little bit frustrated when, you know, they, I mean, we've seen this, we've got young kids at home and anyone with young kids would know this. It's like when mum is discharged from a hospital and they say, you can go home, but don't pick up anything heavier than three kilos. It's like, What planet are you on? My child weighs more than three kilos and I'm carrying them for 19 hours a day as I breastfeed. So we've got to remind ourselves that in the clinic, we can really push our patients to mimic the real world if we're just If three sets of 10 with a blue TheraBand is the extent of our care, no, no, we need to help our patients be picking up and deadlifting 20, 50, 100 kilos based on their job. We need them, like Hannah says, being able to complete a full page of handwriting with other distractions and other cognitive load at play. There's so much complexity that we as therapists leave on the table.

Ben Lynch: It sounds like as part of your approach to coaching and mentoring and by extension your team's approach. is this auditing of notes or treatment plans and actually show me the treatment plan. Just fill me in and even correct some of my language there, how you talk about it and think about it. And I want to connect the D.O.T.S here between patient visit average, a stat that is a bit of a proxy for us to know how well one therapist compared to another therapist is at nurturing a client through the journey of care. It's classic when you have those side by side, you might see one therapist's average is like 10 and the other is 5. We want to understand why is that the case, but this is perhaps the little signal to go deeper and part of this here is you going deeper. So what practically does that look like? You're pulling up the caseload, show me the case notes, show me the treatment plan, just talk us through how you actually get to the bottom of it.

Hannah Dunn: Yes, so that's exactly what we're doing. We have a sign-off period for our new graduates, so they have to continually show us all the things that they're sending to the parents until we feel like it's at a level that we're confident that it's ready to go. But then also, we do a six-monthly review check, and then if there's clients that aren't booked in for that six-monthly review, there's a conversation about why. Why isn't that family booked in? And it may be because, you know, mum's been in hospital and we've been out to the school and we've been engaging with the teacher and so therefore the goals are passed on and we've reassessed recently. Or maybe there was a big change and so we've already reassessed three months ago. And so we want to make sure that that rhythm is there. But then also we have different themes in our mentoring in that, you know, quarter one might be around initial appointment notes. It's not that we're putting this out a year in advance to our team so they can get it all ready. It's just as a mentor group, there's three of us who do the mentoring for the whole team. We just talk about what are the things that are letting us down at the moment and where can we find those gaps to sort of fill it in. And because we have a no judgment, this is all to help you and all to support you, We create that vulnerability where people aren't too worried, but it does create a system in which people know that we will be spot checking files. And so you want to be honest about the fact that you're not on top of things. And so that is the way in which I think creating a culture where you know that you might have things checked at any minute, not from a judgment perspective, because it sounds terrible when I say it out loud like that, but it works.

Ben Lynch: My question is, how do you do that without people feeling like they're being micromanaged and them going, you know, big brothers looking over my shoulder kind of thing at everything I'm doing? What are some of the things that you've said or introduced that make your team receptive to that? I'm sure there's a lot that you've done over time to move the needle. It's not like, yeah, we just had this one conversation, it was perfectly worded. Just help us understand a little bit more about how you've created that culture where people are okay for that.

Hannah Dunn: Yes. We talk about it being, um, that, you know, we're always learning, we're always growing. And so even if these are awesome notes, there's still things we could be doing better always. And so we take, we approach it from a learning perspective, but we also approach it from a protective perspective in that we don't want you doing this at home. So if we find there's, you know, 30 notes that are out of date, we want to work with you on a strategy because we've let you down somewhere. Like there's a lot of. Like we take a lot of responsibility in if you're not doing, you're not able to get it done, what haven't we done to support you to get that done? And so I think all of those things help. And we also, it's also a good learning for us to be able to see what are the differences? What, what are we learning from what you're doing that we can actually give to everyone? And so they see those examples coming through where we'll be like, oh, Georgia did this incredible job of the way she structured this, or Bree has got a really good brain for reorganizing the templates and getting those tables in the right way, and a way that just makes sense and breaks the language down. And so it's almost exciting for them to be like, highlighted in the way in which they're doing something and then be able to share that across the team to make everyone's job easier. So approaching it from a like, what's the why? The why is to make your job easier for us to get consistency and for us to support you to ensure that you're not working outside of hours.

Ben Lynch: It's a great way to frame it and to reiterate it right over time. This is why we're doing it this way. I think we talk a lot about here, if you ask any therapist, why do you do what you do? It's some version of, I love helping people live a better quality of life. And I think, naturally, the follow-up is, well, how would you know you're doing that? Like, what are some markers of, quote, success or progress that you are getting better? And a lot of therapists will say some degree of, like, your reputation, whether you use those words or not, that, you know, my clients you are satisfied and happy and they sort of give that reinforcement and review. That my peers within the team also see me as someone that is keeping high professional standards and that those people referring in as well continue to refer because I'm reasonably effective with my clients. And so then it's kind of like, well, then how would we know that you're actually doing that? What are some of the ways that you could pick up on that? And being able to track client outcomes, here's what they came in for, we've reassessed and they've achieved that meaningful goal, is such a great way to do it. The other is sort of completion of treatment plans. They're kind of connected, but to that point of discharge, J.O.B., I like the challenging thought. But if someone's been discharged, hopefully for the right reasons in that they've achieved their goal, their meaningful goal that they came to you with. And so, these can be measured in a number of different ways. I think patient visit average is one version of that. If you've got a therapist with a patient visit average of 2 or 3, it's more than likely that they're not getting that continuity with the patient. Maybe their rebooking rate's quite low. It's in the 60 to 70%. It means that they're not good at enrolling clients into the care plan that's ahead of them and that they're seeing it through or maybe they're just getting drop-off massively after a couple of visits. So, I think all of these are helpful to anchoring back to the ultimate, why do you do what you do? I think the more we can keep refreshing that connection and that anchor, It helps it be less of a slap on the wrist. You're not getting patients back to just fill the books and boost, you know, the finances of the clinic. So I really love how you're coming at it from always learning, always growing and extreme ownership that if you're not doing it, we've let you down.

Hannah Dunn: Yes, absolutely.

Ben Lynch: Here's the thing, Ben.

Jack O'Brien: There's a really quick gate for us all to check. And are we doing what we do for the right reasons? That's a very binary yes or no answer. And if you as a clinic owner and a practitioner can confidently say, I have good intent, I'm not here to over-service, I'm here to adequately service, I'm here to help. If you can satisfy that gate, then let's move on. Now maybe we all have this bias towards avoiding over-servicing and that's a healthy thing that there's a protective client-centric element to that. But if we can quickly move on from that gate of, I'm not doing this for nefarious reasons, I genuinely want to help people. That's where we can start to look at the metrics. And that's where tools like Allie become super useful because it's actually not one metric in isolation. It's looking at a number of the CEIs or KPIs in combination. And even to your point just then, Ben, I was on a podcast yesterday, a guest on a podcast with Barry from ClinIscribe, and he said, what's your number one KPI? I said, Baz, it doesn't exist. What matters is being able to look at rebooking, cancellation, and PVA all in combination. And when I'm coaching clinic owners through how to set up their Allie, and at this point, hundreds of clinic owners, the best clinic owners are utilizing Allie to dashboard their data, we want to be able to see rebooking rate, cancellation rate, and PVA next to each other. And here's why. Rebooking rate is a reflection of, are we providing next steps for our patients? How many of our patients have a next step in the diary? That's one thing. Cancellation rate is a reflection of, does that intention in the diary manifest with someone following through and coming into the clinic? Because if you've got a 95% rebooking rate but a 45% cancellation rate, patients are saying they'll come back. but they're actually saying they're not. And vice versa, you could have a 60% rebooking rate, which is way too low, and a 4% cancellation rate. And that tells me that when you put patients in the diary, they show up, but you lack a vision for their healthcare and we're not scheduling them into their diary. And then, of course, PVA being the third piece of how well are we nurturing clients across their lifetime. seeing opportunities once we've found solutions, finding other opportunities. It's actually those three KPIs in Allie, stacked alongside, compared internally with that practitioner and externally amongst their peers. This is what sets apart elite clinic owners from foundering clinic owners, truly.

Hannah Dunn: Yes. I just like on that point where you were talking about like prioritizing their health and getting them booked in the diary, just that, that is such a big point that we really work with our team around in regards to it. Clients don't come back when they don't understand what they're missing out next time. We have to communicate why, what is going to happen in that next session so that when it comes up and they've got a conflict that they're saying, no, I cannot miss out on fine tuning this.

Jack O'Brien: And this is where we say that cancellations are in large part the practitioner's responsibility. Now, can you control whether that child gets gastro or that patient gets stuck in traffic? Of course not. You can't control everything. But you can control how compellingly you've been able to communicate with a patient the significance of their next session, what's going to happen and why it matters. And if a patient's cancelling because they don't understand the significance of their next session, Practitioner, that's on you and that's an opportunity for you to improve your communication skills and be a more relatable therapist, build more trust and rapport with your patients.

Ben Lynch: So I don't know if you've ever had this conversation, but we love getting stuck into the details of things here. And it's interesting when a practitioner brings up or a therapist brings up over-servicing to just double click. and say, tell me a little bit more about what you mean by over-servicing, and how would we know if we're over-servicing someone? And to go through the list, I'm interested if you guys have had this experience or what your take is on this, and then to do the opposite. What would under-servicing look like and how would we know if we're doing that? Just to seek to understand the lens, the perspective that they have on this, because We're not here prescribing every patient that comes in has a minimum of X amount of visits. That's not what's going on, right? We're looking at each condition saying typically we would see this play out over X amount of visits. That would be the average. So I'm interested, Hannah, have you ever had to navigate this with your therapist or a version of defining what they mean by underservice, overservice, or it just doesn't come up in your world?

Hannah Dunn: It doesn't really come up in our world. We actually have the opposite trouble where we actually want to discharge families and families are anxious to leave because they've been so dependent on the help and support over a number of years, which is a really lucky place to be. But yeah, we're definitely not having conversations with our therapists about them feeling like they're, well, that is when we feel like we are over-servicing and when we want to get out. And so we do have conversations around how do we ensure we're not over-servicing when a family doesn't want to leave. But in regards to us sort of pushing that service more, it's probably not a conversation that we're having a lot of.

Ben Lynch: Well, let's go there because there's plenty of folks listening in that are in a similar boat to you. And then I'll come to you, JB, because I want to unpack this, especially for our MSK audience. So Hannah, how do you think about that? You know, you spoke of the checklist. I'm assuming that's kind of very practically what you want therapists to go through at that point in time without maybe going through the whole checklist.

SPEAKER_02: Yes.

Ben Lynch: Maybe just help us understand the thinking behind it. Or are there a couple of like key cues that people would use therapists at that point in time?

Hannah Dunn: It's a wait list that they are so nervous about having to go back on to if they were to need help again. And that's been historically the way that OT has been in paediatrics. And so it's just about creating systems where they're reassured that they will not be back on the bottom of the wait list. If they need to come back, that will absolutely fit them in and support their care.

Ben Lynch: Okay, so it's more so from the family side than it is the therapist. You find therapists are like, okay, we're pretty clear on when and how to discharge, but it's communicating to families, hey, you're not going to go to the bottom of a wait list once you've been discharged and then it's hard to get back in. Okay.

Hannah Dunn: Yes. Yeah.

Jack O'Brien: Is the opportunity there, Hannah, for practitioners or practice owners to think about how we make therapy more sustainable? Maybe we transition from twice a week to weekly or twice a week to fortnightly and it creates more opportunities for us to make sure that family has adequate support and care. Yes. And it creates room for the clinic to support more families also.

Hannah Dunn: Yes. It's one of the only times we do monthly or six weekly is when we're exiting a client out. Great.

Ben Lynch: So, J.O.B., to come back to the over-service, under-service conversation. Talk me through how you see it and also how you've approached it with therapists and clinic owners in particular who get this resistance. It's very real. And they're trying to fill their books understandably to cover their costs. They're also trying to provide really great care to their clients. So how do you support a clinic owner and by extension a therapist understanding where the line might be around over-service and under-service?

Jack O'Brien: I realise it can come across a little direct or brash, maybe controversial at times. I just want to make sure clinic owners realise that's not our intent. We're not here to be shock jocks or anything of that nature. Totally appreciate that it's a nuanced conversation and particularly we're talking to grown up clinic owners here. But in the clinic sometimes, a clinic owner to a practitioner conversation is more nuanced, more subtle, requires more compassion, and is a number of conversations strung together over time, particularly if it's an ideological challenge. Because sometimes what can happen is maybe a practitioner has drunk the Kool-Aid from some influencer on Instagram, Or they've read down a particular line of research that has a strong confirmation bias, let's say. And so where it's an ideological mindset shift, This becomes more of a leadership and communication challenge than it does a clinical philosophy approach. So we need to be mindful of how do we help someone appreciate another perspective? How do we change someone's mind? That doesn't happen overnight. No practitioner likes being forced to change their mind. So it's a subtle exploration of ideas in collaboration rather than us telling. But I really love practically, Ben, some of your questions of like, how do you know you're over-servicing? And really the answer to that should be, well, are we not making progress? If we're servicing patients, not that our healthcare is services, but if we're servicing a patient with no progress, then that's a concern. Now, I realize there are contexts where we might deliver therapy, maybe not make progress, but we're halting reverse progress. That is, of course, significant and worth considering, particularly in a chronic or congenital condition. So if we are still able to make progress, is that over-servicing? No. If a patient is well-equipped, well-informed, well-educated, and our recommendations are coming from a place of care, and a patient chooses to participate in their own healthcare. Is that over-servicing? Or is that just patient-centered care that they've opted into knowing full well the education information that they need to have to make an informed decision?

Ben Lynch: I wonder, we're obviously thinking through the more extreme case here of that therapist. I get you. I see what you're putting down, J.O.B. I know the person you're talking about. They might say, well, we're about, if it's truly patient-centered, then it's patient-led. And so if the patient doesn't sort of prompt to come back in or say, I'll come back in and we say, you know, see how you go and let us know if you need help. I'm truly giving that patient autonomy and agency in their healthcare to make the call where they need to come back in.

Jack O'Brien: And I really respect and appreciate that perspective. And I think we want to make sure if it's patient-led that that patient is well informed. If I have a problem that I'm going to a surgeon for and the surgeon says, well, you're in charge here, I'll say, with all due respect, doctor, you're in charge, you're the one with the scalpel and the anaesthetic, and I need you to do what's in my best interests. And so this isn't one or the other, and I think that myopic view of it's either patient-led or it's not doesn't help anyone, it doesn't serve anyone. What does help is a collaborative view that is patient-centered but clinician-informed and we make decisions as a team together. You, clinician, have spent years and tens of thousands of dollars to be an expert, you know, maybe you're not allowed to call yourself that on your little business card, but you're an expert and a specialist because of your education. And your patient's education, again with all due respect, is probably limited to five minutes or with chat GPT in the car park. And so who should lead that conversation? CHAT GPT in the car park or the clinician who has, you know, four, five, six years of university level education?

Hannah Dunn: Yes. And life gets so busy. Like we know what it's like in our clinics. And it's a bit like if we said, well, let's just let our team come to us if they've got a challenge. Like, guys, I'm here anytime you need. They're never going to come to you because they're going to be busy. They're seeing patients or clients. Whereas when we create that space of mentoring and we see them once a fortnight, they might come in and go, yeah, things have been pretty stable, but you know, actually there's just this one or two things that I'll bring up. It sounds similar in what you're talking about, Jack, in the sense that when we book that review in and we say to a client, come in and let me know how it's going, then they're going to come in and say, yeah, actually it's only 75% better. I'm wanting that 25. Whereas if we say, let us know, whenever, they're never coming back. We're never going to, our life just gets so busy. And how often do we hear, oh, I got an email from the physio and it actually triggered me to think, yeah, actually I've been meaning to go back for X, Y and Z time.

Jack O'Brien: Patients are asking for us to help them and we have a duty of care to lean into that. To withhold care is to induce harm.

Ben Lynch: So much of this conversation is around exploring just that, your mental model for care, right? Isn't it? You look at some folks in the, I love the myodetox, future-proof your body. Pogophysio as well in terms of the finish line is just two examples that have done really well at sort of articulating that. But there's a philosophy that backs and intertwines with the evidence and how they apply it, yeah, because there's no one way to do therapy. Everyone uses their experience and their philosophy to find a way forward. Maybe from a other perspective that if you've got a really resistant team member that perhaps this is not the place for them to work and that's okay. We want to find a clinic that's perhaps better suited to their philosophy of how they want to practice their care. That's reasonable.

Jack O'Brien: I think that's a really important distinction that we want to attract people who see the world through our lens. And that's okay that there's multiple lenses. There might not be one right way, but there are many wrong ways or less right ways. And so you as a clinic need to define what that is. To put in a different context, there are many ways to fly a plane. But I want to fly on a plane where the pilot is flying calmly and avoiding turbulence and is taking off and landing very gently. And if that takes a little bit longer or costs a few more dollars, that's okay, because I don't want a bumpy take-off or to be tossed around the cabin in turbulence. The same is true for surgeons. The same is true for chefs. There's many ways to cook scrambled eggs, but I want to go to the scrambled eggs that is the perfect balance, yeah? There's enough body and enough form and there's enough source. So, there's many ways, but there is- Keep giving us some more metaphors. This is good. I'm going to pick with Pilates and surgeons. That'll do. Why don't you go with coffee? Landscapers, baristas, there's a lot here. There's many ways to be right, but what's your way and what's the way that your clinicians approach things? Because that's the- and if we zoom out, Hannah and Ben, Over the next couple of years, what's going to make clinics distinct from other clinics is the operating model, the playlists that your practitioners, the playbooks that are consistently rolled out so that when I go to DOTS, I'm going to experience the DOTS way. And that will look a little bit different, like one degree different from therapist to therapist, but overwhelmingly, I'll be able to say, yep, that's the DOTS way, or that's the clinic way. And so as practice owners, we must be thinking about how we document and roll out these playbooks across our team, house them in Allie, and then install them through our mentoring.

Ben Lynch: I want to – we've focused quite a bit here on the therapist conversation, which is a tricky one and a meaningful one for clinic owners, right? Especially when – okay, materially, if you do get better enrolment of clients in their care journeys and they stick around, they don't drop out of care. you can meaningfully, one, improve their lives, two, fill the books of those team members without perhaps needing more new clients as an example. But just to connect a few D.O.T.S, I love the how does this client journey, this focus on getting outcomes with clients, measuring it in a number of different ways, notably PVA, the theme of this conversation, patient visit average. How does it also relate to other areas in the business? One that I love there, J.O.B., is around recruitment of therapists. We have seen a number of clinics where they've taken the time to document and articulate their philosophy of care, their approach to things. They do attract therapists that are like-minded, that relate to that. How much easier is the mentoring, CPD training, progression of that therapist If they're already on board, right? So it's a worthy thing actually to take the time to document this, put out what you want to attract, not in sort of a manifest way, but quite literally on your join our team careers page. Though it might also play in that realm of things, quantum attraction. Anyway, the other side of this was JB around marketing. When we understand the visit average of our clients, we can also understand perhaps the lifetime value of a client. You know, how much will they invest in their healthcare, which can then help us understand perhaps some range of what we could invest sustainably to attract the next client. And so it actually helps us with some of the marketing budget. Do you want to just expand on that side of things? Now we look at a bit more of a commercial angle.

Jack O'Brien: When a clinic owner is asked, how much are you willing to spend to acquire a new client? Classically, the answer is, I don't know. That's okay. That's where most clinic owners are, but here's where you need to get to as a clinic owner. You need to understand the economics of what is a client going to spend at your practice over time. Of course, patients aren't just money. They're way more than money, but they're no less than their dollars. What will a client invest in their care over time? knowing that number allows you to deduce how much you are willing to spend to acquire them. And so the economic formula here is CAC to LTV ratio. What is the client acquisition cost as a ratio or percentage of the lifetime value, CAC to LTV. So you need to understand lifetime value, which is a function of PVA.

Ben Lynch: We've talked in different episodes about those ratios and how much you might be willing to spend. For instance, if you're starting a new clinic in a new location, you might spend a higher amount initially to really drive and fill your books. There might be seasons where it's quite stable and that's a lower amount. Check out previous episodes for it, but just to nuance that point. Yeah, right.

Jack O'Brien: I think this is where having a coach really matters because you can go to ChatGPT and ask it, what should my marketing budget be? It doesn't get it, right? If it spits out that you could spend $100 to acquire a new client, but you don't understand that your client lifetime value is only $400, you are going to go broke really, really quickly and Zuckerberg is going to get rich off your spend. I don't think anyone here wants that, right? And so you need the guidance of a coach to help you understand who is your ideal client, what types of funding mechanisms are we accessing and how do we break this down, what is the phase of growth of your clinic and what is your cash reserves and how much are you willing to invest and what is the return on ad spend and all these metrics really do matter over time. But vice versa, if you're in a PEDS NDIS space and we'll talk classic NDIS, maybe not changing NDIS, but if a participant might be worth $10,000, even $20,000 to your practice over their lifetime, then your acquisition cost can comfortably be $1,000 or $2,000. That's a meaningful adjustment to how we go about marketing. Now, if we need to forecast and what that looks like in a dynamic NDIS environment, you need to really reassess whose advice are you taking and how are we going to attract ideal clients in a commercially sustainable way.

Ben Lynch: One just notable thought before we wrap here, J.O.B., was around patient visit average and not needing more new clients. Obviously, we've talked about how PVA can help you understand part of your marketing budget. It's a reference point, a starting position. You recently did a webinar, a workshop around filling your books, and perhaps the distinction was you don't need to spend as much on new clients or new client attraction if perhaps you took quote, you know, better care of the current clients that you serve, you know, more broadly, that those clients had quality treatment plans and actually saw them through. Did I miss anything there? But I thought it kind of dovetailed nicely into this conversation around links that want to grow that default to, I need more new clients.

Jack O'Brien: Understanding your numbers and how they all interact absolutely matters. And so if we talk in a musculoskeletal type context, going from a PVA of 8 to a PVA of 10. So helping our clients just twice more. And maybe that's the end stage or phase of care. you will grow your clinic by 25% from 8 to 10. No more new clients, no more therapists because they've probably got untapped utilization or poorly structured diaries. You can grow 25% in revenue. Most of that's going to be profit just by helping your team be able to care for a patient instead of 8 visits for 10 visits. The same is true potentially in a school-based context and if we can help patients through the school holidays rather than just default to the limiting belief that families don't want care through school holidays, check that belief on yourself. But there's 2, 4, 6, 12 weeks of a 52-week year. That's 22.5% of your year you're leaving on the table. By helping our participants and students, children through school holidays, you can grow your clinic by 22, 25%. And then what that means is we can potentially look at reducing our new client requirement from 100 new clients a month to 80 new clients a month in an MSK context. Because we don't need 100 clients to keep our books full. We only need 80 new clients to keep our books full by seeing them 10 times each in that example. Therefore, you can reduce your marketing spend by 20% and increase your revenue by 25%. We're looking at a profit adjustment there in the realm of 40% to 50% increase in your profit because it's a multiplying permutation at that point for all the mathematical statistical nerds. These are compounding stats. Shave some cost, which is not necessarily cost, but you can reduce your investment and grow your revenue, which compounds down to the bottom line.

Hannah Dunn: And I think when we're talking about those NDIS clients, it's the indirect time, the missed opportunities to like, not just the direct client care, which can really increase your profitability.

Jack O'Brien: If we can add an additional one hour a week, right? If we can take our billable time or impact hours from five hours to six hours a day, that's 20% of your week. It makes a massive impact on the clinic's sustainability, but also that practitioner's ability to be remunerated and hit some of their income goals by creating more impact, they receive more remuneration over time.

Ben Lynch: I love it. It's a very commercial way to end, but just to go back to the very beginning of this conversation where we're talking about creating great client experiences, getting the meaningful outcomes that they deserve, and finding ways to do that better over time, and also understand how well we're doing it currently by using some stats like patient visit average. Really awesome to unpack this and I think more and more we're going to go down the line of understanding how we document, capture and then use the client outcomes in therapy because that is becoming increasingly pertinent to do and do well, I think, obviously in the NDIS space, but I think it's just true of any third-party funder. They are funding the therapy. They want to see it's leading to outcomes. That makes the most amount of sense, right? So we're going to continue down this same moving forward. Hannah, Jack, thank you for your contributions. You can head over to clinicmastery.com forward slash podcast for the show notes here and all previous episodes. We'll see you on another episode very soon.