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Journey Mapping Guides Your Practice Down the Right Path

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Reduce employee and customer friction for a more profitable business

By Jennifer Allen, PT, DPT

FRICTION IN BUSINESS

As you may remember from physics class, friction is anything that takes energy out of a system. When we experience
friction, we must add more energy to keep things moving. Imagine riding a bike on a smooth road without much resistance,
then veering off-road into sand. Sand creates excess friction, and a lot more effort is needed to keep the bike moving.
Friction can have the same effect on your business.

Every business process has some amount of inherent friction associated with it. This friction can be internal, related
to employees, or external, related to customers or patients. Friction in business can result in frustration for the
affected parties and ultimately can affect the reputation and profitability of a company.

A business example of friction may be a phone system that isn’t working correctly. Customers cannot reach the business
and become frustrated when attempting to schedule appointments. Some customers will persevere and put more energy into
reaching the business by either showing up in-person or calling repeatedly until they are able to get through to
someone. Many customers, however, will give up after one or two tries, which results in a loss for both the business and
the customer.

SATISFIED EMPLOYEES = SATISFIED PATIENTS

We know from research that patient or customer satisfaction is correlated to employee satisfaction, and business
profitability is linked to something identified as the “Service Profit Chain” model described by Heskett, Jones,
Loveman, Sasser, and Schelsinger in 1994. In this Harvard Business Review article,1 they described the links between
employee satisfaction and loyalty, customer satisfaction and loyalty, and the path to revenue growth and profit growth.
Generally speaking, happy employees are the precursor to happy customers . . . and happy customers tell us how happy
they are by spending money and time in our businesses.

Over the past two years, employee recruitment and retention have been at the forefront of our minds as business owners
and managers. The war for talent, as it has sometimes been called, is still raging, with attrition rates reaching as
high as 40% in some industries. Employees are leaving us in higher numbers than ever before.

We understand in general that happy employees make happy customers, but how do we align ourselves with our employees?
How do we reduce friction in the workplace?

How can we as business leaders begin to look at our businesses and processes to assess employee and customer
satisfaction? What actions can we take to decrease friction when it comes to employees and customers?

IDENTIFYING FRICTION AREAS THROUGH JOURNEY MAPPING

Journey mapping is a systematic and visual way to draw out vital “touch points” along the story of interactions with the
practice. Intentionally looking at these touch points allows us to identify areas where friction may be occurring.
In the physical therapy private practice business there are many customers or stakeholders we need to consider. Each
practice is unique, but most practices share these two important stakeholders in common:

  1. Employees
  2. Patients

Since patient satisfaction depends on employee satisfaction, we will discuss the employee journey first. Each practice
executes processes differently, so it’s important to understand the practice’s unique employee journey. Here are some
general examples of touch points to consider:

REMOVE FRICTION THROUGH CLEAR EXPECTATIONS

An important way to remove friction with employees is to set clear expectations along the journey.

Recruiting

Expectation setting begins with the job posting. Every message we put out begins to shape expectations of the employee
when it comes to joining our company. Carefully crafting these to identify cultural expectations and job expectations is
important, because the content will attract specific candidates.

Hiring

Initial conversations with applicants set the tone for later interactions and expectations of the employee. For example,
if, during the initial hiring procedure, the hiring manager fails to tell the potential employee that they will be
expected to do home visits in combination with their outpatient role, then that sets up the relationship for potential
friction in later stages of the journey. Expectation mismatches on either side of the equation can result in
relationship friction, frustration, and attrition.

Onboarding

This is a vital step in setting expectations between the employee and the organization. This step has been called the
most important step in employee retention, and for good reason. Like a first date, it sets the stage for the entire
relationship. When done well, this can be a game-changing step for employee and employer satisfaction.
Important items to include in the onboarding process to reduce friction:

  • Productivity expectations for the role
  • Cultural expectations: the “always do” and “never do” lists
  • Customer service expectations
  • Patient quality of care expectations and outcomes
  • Communication expectations
  • Career Path: how to get from point A to point B
  • How to “win” in the organization: bonus structures, promotions
  • Any other expectations: mentoring, community involvement, etc.
  • How to find out information: FAQ list

Learning and Development

The learning and development available can offer information on how to advance to managerial roles or can simply provide
education enrichment that will help employees improve in their roles. A mix of both is a great way to engage employees.
During the initial onboarding process, setting up an employee development plan is important to get a baseline of the
employee’s development goals and allows a conversation around plans to get them there. Research shows that employee
development with active involvement of the employee in the actual planning and follow-up has been effective in reducing
turnover.

Ongoing Assessments

Frequent check-ins for alignment on expectations are important. Several authors in the leadership space have suggested
weekly touch points for managing expectations and results.3-6 Communication is key, and open discussion of expectations
and clarity is essential to keep friction in the workplace at a minimum.

Employee Scores

How do we know if the things we implement work? Measuring results is key to monitoring process improvement. Some ways to
do that are to implement an employee net promoter score or a basic employee satisfaction survey. The important thing is
to ask for feedback from employees on a regular basis. A combination of one-to-one discussions and company surveys are a
good mix.

PATIENTS: REDUCE FRICTION TO CREATE RAVING FANS

Just like employees, customers or patients have their own journey and vital stages and experiences with our companies.
As with the employee journey, each business operates with different unique processes, but the idea of evaluating and
optimizing the journey remains the same.

Identify Touch Points

For each stage of the patient journey, identify the operations that are currently happening in your business. Ask your
employees what they think is working and what complaints they are receiving from patients. If you have surveys in place
or net promoter scores, is there a common complaint that shows up frequently? All of this information can point to the
breakdowns in touch points.

Identify Areas of Friction

Ask yourself, “How easy is it for patients to do business with us? Are there things we can do to make it easier?”

IMPLEMENT CHANGE

Start with the biggest complaint and tackle that issue first. Make adjustments to systems, personnel, or equipment to
get the job done. Remove the barriers and friction to allow patients easy access to do business with you.
Some solutions to the above-listed friction points may be as follows:

  • If your front desk can’t answer calls, you are losing patients and revenue. One solution is to have a separation in
    duties in the front office. Can you have your incoming calls roll over to someone in the back office so live calls are
    answered? If you have multiple offices, it may make sense to create a centralized call center and develop a strategy to
    funnel these calls to allow more staff access to answer them. If the front desk misses one new patient call, it can
    result in significant loss in revenue. This touch point is one of the largest opportunity areas for most private
    practices.
  • Another solution for communication is to offer text communications with patients. Many patients choose texting as a
    primary contact option as it is easier for them during work hours and takes them less time
  • Patients jump through hoops to get referrals. Depending on your state practice act and the insurance specifications,
    patients may not need a prescription or referral to do business with you. Fully evaluate the state practice act and your
    insurance company requirements for payment and make a cheat sheet for your front desk and intake team. Reducing this
    barrier to PT treatment has taken our profession a long time to achieve, so make sure to optimize this opportunity by
    educating the staff and implementing the change.
  • Patients can’t get in because appointment times are not convenient. Is your office open from 8:00 to5:00? Creating an
    extended schedule with hours earlier in the morning and later in the evening can provide more access to care to patients
    who aren’t available during the day.
  • Patients wait too long for an evaluation and they cancel or no-show prior to the visit. If patients are scheduled out
    for an evaluation beyond 72 hours, several things may prevent them from showing up for that appointment — they may make
    that evaluation appointment, then call around to other providers to get in sooner, for example. Prioritize scheduling
    evaluations as soon as possible. When evaluations are scheduled too far out, the sense of urgency also diminishes over
    time and decreases the likelihood that the patient will show up for care.
  • Can’t get the prescribed plan of care scheduled out because the therapist is too busy? Schedule management is a
    struggle for many PT offices. One solution is to make sure each and every patient schedules the full plan of care at the
    evaluation date. That helps with schedule management and gives the practice manager an idea of staffing needs and
    potential growth for the location. Another strategy is to schedule a few follow-ups during the initial call. Some
    patients are fully committed to attending and will schedule more than the evaluation on that first call.

NET PROMOTER SCORES AND SURVEYS

The best way to get good answers is to ask the right questions. Net promoter scores are a way of measuring patient
satisfaction on a scale of 0 to10 and will highlight trends in the business. Surveying patients and allowing open areas
for comments will help clue the business management in on areas where service failure is happening. Adjusting operations
in the specific touch point areas will help reduce friction and improve business results. 

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References:

1Heskett, J, et al. Putting the service profit chain to work. Harvard Business Review. 1994.
https://hbr.org/1994/03/putting-the-service-profit-chain-to-work-2

2US Bureau of Labor Statistics. “Table 16. Annual Total Separations Rates by Industry And Region, Not Seasonally
Adjusted.” https://www.bls.gov/news.release/jolts.t16.htm

3Wickman G. Traction. Benbella Books; 2012.

4Horowitz B. The Hard Thing About Hard Things: Building a Business When There Are No Easy Answers. Harpercollins
Publishers; 2014.

5Zhuo J, Stanley P. The Making of a Manager: What to Do When Everyone Looks to You. Portfolio/Penguin; 2019.

6Grove AS, Horowitz B. High Output Management. Vintage; 2015


Jennifer Allen, PT, DPT

Jennifer Allen, PT, DPT, is the cofounder and former CEO of Bodycentral PT in Arizona and now serves as the Chief
Clinical Officer for Therapy Partners Group. She is a consultant and speaker focusing on business growth through
strategy, marketing, sales, and the patient and employee experience and can be reached at JenniferAllen112769@gmail.com.