Purpose, Principles, Policies: The 3 P’s

To succeed in Life, in Practice you must have purpose. Being a chiropractor is not a purpose, it is a job. Your purpose is your reason for being, doing. Your office should have a written statement of purpose. Everyone needs to be on the same page. An office on purpose is an office that will succeed. The purpose of these written policies and procedures is to provide a foundation for the organized and orderly functioning of the office to insure that each patient receives appropriate and thorough care.

To this end, all of my clients’ clinics’ subscribe to the Guidelines for Chiropractic Quality Assurance and Standards of Practice as detailed in the documents generally accepted by the chiropractic profession. These are readily available from your state association.

Practitioners accept the responsibility of reviewing and familiarizing themselves with the guidelines on an ongoing basis.

Ethical Principles

In my offices, of which I had six, all my staff members had to adhere to the generally accepted ethical standards that relate to interactions with patients, organizations and other practitioners. The standards focus on three main principles:

1. Beneficence: Doctor’s duty to do no harm, to heal, to serve.

2. Justice: Doctor adheres to standards of quality care and practice procedures.

3. Respect for Persons: Patients have the right to know, to privacy and to choice regarding treatment. We now call this HIPPA (Health Insurance Portability and Accountability Act).

To stay on Purpose you must overcome problems. Below is my system.

First, approach the problem with the expectant attitude that there is a logical practical solution just waiting to be found. Be relaxed, calm, confident and clear in your mind.

Second, change your language from negative to positive. Instead of the word “problem,” use the word “situation.” Problem is a negative word, while situation is a neutral word. “We have an interesting situation,” is better than, “We have a problem.” To stay on purpose is to stay focused.

The next step in Problem-Solving is to define the situation clearly.

“Exactly what is the situation?”

Then ask, “How would I like to be treated?” Sometimes stating the problem in different words makes it much easier to solve.

Next ask yourself, “What are all the possible causes of this situation?” Failure to identify the causes or reasons for the situation often causes you to have to solve it again and again. In life, like in practice, fix the cause; do not just TREAT THE SYMPTOMS.

A successful office understands the needs and the rights of the patient and respects the patient. This is why we must have Purpose of mind and policies to govern us. Let me share some of mine.

Policies govern your office and help your staff maintain purpose. Policies are the laws of the land, the mechanism that creates sanity in your office. Policies define professionalism. These should be given to each staff member and posted in an area of your office. Like in any game, it is important that your team play by the rules. Vince Lombardi once said, “The essence of the game is to WIN. Fairly, squarely, by the rules, but to WIN”

I want you to win; just do it by the rules of the game we are in: the game of Healthcare. Here are my polices.

General Policies

• Communicable Disease Reporting. Communicable disease reporting will be in accordance with individual state laws.

• Dispensing of Medications. While chiropractors do not dispense medications, some clinics may employ allopaths or osteopaths who may dispense medication and, in these cases, all dispensations will be in accordance with individual state laws and Class 4 addictive drug laws. Many DC/DC clinics do not follow all the rules. Here you must.

• Emergency Transport Policy. In cases of emergency, 911 will be dialed. In areas not serviced by 911 service, each office will develop a relationship with the local emergency service to handle emergencies.

• Independent Contractors. Only those people who can meet the requirements of being an independent contractor will be hired. Licensed massage therapists may or may not qualify for independent contractor status. Speak to your accountant; make sure they pass the government test to be an independent contractor.

• Infection Control Measures. All products used in a clinic must have prior approval, including products for massage therapy, all accepted physiotherapy units, X-rays, nutrition, etc. No clinic office is approved to use products other than those approved.

• Medical Necessity. All clinical decisions will be in accordance with accepted medical necessity underlying the specific symptoms. (Don’t be a sales person!)

• Patient Complaints. All patient complaints are to be directed to the doctor in charge of the clinic. The doctor in charge may elect to hear the complaint personally or designate another staff member to deal with the complaint.

• Practice Patterns. Files in each practice will be regularly evaluated to insure practice patterns are within the accepted guidelines of chiropractic care. The form, entitled “PRACTICE PATTERNS,” will be completed periodically on random patient files to determine practice patterns in that individual clinic.

• Protection of People against Equipment, Supplies, Blood, Etc. All clinics will adhere to the universal precautions and the statement of the Center of Disease Control and OSHA regarding safety precautions with equipment, supplies, blood draws, needles, etc. Depending on state law, some clinics will be allowed to draw blood, while other clinics will refer all blood work to an outside agency. (Optional) Do your homework, know all the laws.

• Release of Patient Records. The release of patient records requires the completion of the Patient Request for Records and signed by the patient before records can be released. Records can be released only to those people or organizations approved by the patient.

• Records Retention and Storage. Medical records will be retained and stored in accordance with state and federal laws.

• Referral of Patients. Doctors may refer patients to doctors holding specialty training, if that training is deemed to be in the best interest of the needs of the patient. In no case, may a doctor accept a referral fee, a kickback fee or payment of any kind for referring patients to another doctor.

• Research. Scientific research based on acceptable research methodology is not a specific mission. Research studies will be maintained within the organization to reveal certain information and procedures regarding the effectiveness of patient care.

• Safety Practices. Safety practices will be in accordance with assessments by underwriting insurance companies.

• Scope of Treatment. The scope of chiropractic treatment in clinics will be governed by the scope of the chiropractic law in each individual state.

• Use of Machines in Clinics. The physician(s) in each clinic will determine which personnel use specific equipment and shall be responsible for the education of the personnel and the proper use of the equipment. Handouts explaining each modality should be presented to the patient and explained during the first visit. Know state and federal laws.

• Regional Problems. All regional problems should be brought directly to the regional office in writing.

Now that you have Purpose, Principals and Policies you are on your way to winning.

Sometimes being in practice is like being at war. The concepts of military strategy have been studied and written about for more than 4,000 years, going back to the early works of General Sun-Tzu in China more than 2,000 years BC. These principles of strategy that have been developed and perfected over the centuries have direct applications and implications for strategic thinking, both personally and corporately.

These philosophies will work in your practice. The most important military principle is the Principle of the Objective. This principle requires that you decide, in advance, exactly what it is that you are trying to accomplish. What exactly is your objective? In my experience, fully 80 percent of all problems in personal and corporate life come from a lack of clarity with regard to objectives and goals.

Define your goals while maintaining your principles. The New Year is upon us. Let us go out and conquer our dreams. The starting point of career success is for you to select your Goals carefully and refuse to work with difficult or negative people.

Much of your happiness and job satisfaction depends upon your relationship with your staff and patients. If you don’t get along, make every effort to resolve that situation. If it is a patient—transfer him or her; if an employee—tell them to move on.

Choosing the right goals, the right marketing, and the right people to do it with is laying the foundation for your business success. Happy patients refer; happy staff makes for happy patients; and, thus, they REFER.

Many people ask me how they can make more money at their practices. When they tell me their goals and their visions, the problem is usually clear. Do you have ethics, principles, policies? You need to maintain sanity amidst the chaos of the healthcare system. The leaders of our profession are working in areas of the practice that others felt to be of lesser importance. EVERYTHING IN YOUR OFFICE IS IMPORTANT.

First, identify the positions in your office that are the most important for cash flow and company success: billing, front desk, collections, marketing. Find out the key skills possessed by the most respected and highest paid people in other offices. Don’t underpay your employees or they will work for your competitor who pays more. Pay fairly, squarely by the rules; but let us “win”. Let us win with Purpose and Principles and Policies; but let us “win.”

Lastly, and most importantly, never quit until you succeed.

Dr. Eric S. Kaplan, is CEO of Multidisciplinary Business Applications, Inc. (MBA), a comprehensive coaching firm with a successful, documented history of creating profitable multidisciplinary practices nationwide. For more information, call 561-626-3004.


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