Five free technology tools you probably aren’t using.

Inbox massive

Let’s face it – there is too much to do.  We have a constant onslaught of data coming our way, endless data to plough through and somewhere in that mess we’re also supposed to get some work done.

As physical therapy practice managers and owners, we also have the challenge of needing to provide service to patients to generate revenue.  We’re – literally – paid for our time, but also typically are shouldering a management job that could be a full time job in itself.  Here are some tools that I use to help me get things done more efficiently.

Gmail’s Important and Unread Inbox.  Our companies use Google apps for our email services.  This lets us ‘live’ in Gmail for our work email.  Since most of us use Gmail for our personal email accounts, all of our email can be in one place.  The Important and Unread inbox filters our the unimportant emails that land in my account.  Google learns what I pay attention to and over time becomes more and more successful at deciding what is important and what is not.  For example – if I regularly delete an email from a particular person without opening it – not important.  If I regularly open and reply to an email – likely more important. Once each day I go to the ‘unimportant emails’ – scan them and delete them all at the same time.  Here is how to set this up.

Zoom Meetings.  I love video teleconferences – especially for larger groups.  There’s something about seeing everyone’s face and being able to share a screen that makes having meetings work better.  I also hate paying for things I don’t use all the time.  Enter Zoom meetings.  You can have a video meeting with a bunch of people (I couldn’t find a limit but we’ve had a dozen on without a problem), share a screen and all the other things you might expect for free.  One catch – you have to keep your meeting under 45 minutes (not a bad idea anyway).  Need more time?  Upgrade for $9.99/month.

NozbeTime Management Physical Therapist.  Nozbe is my to-do list of choice across all of my devices.  It does a bunch of useful things, but there is one feature that keeps me using it.  My Nozbe to-do list has its own email address.  My inbox used to stay full of things that I needed to reference later.  You know – that email with the attachment you are saving?  I would keep that unread until I had dealt with it.  Now I just forward the email to my Nozbe account.  Nozbe creates a to-do item and adds the attachment.  If there is an entire conversation the previous emails are added as comments to the to-do item.  This has been so useful that I have an entire to-do list called ‘Attachments I will need later’.  It does a bunch of other things but this is the feature that keeps me using it.

Doodle. One of my recurring tasks is to have 1 on 1 meetings with all of my directors each month.  These are busy people who have patient schedules trying to schedule with me (a busy person with a patient schedule).  I used to spend an inordinate amount of time making this happen until I found Doodle.  This free app allows me to block out times I’m available, put out a survey and then my directors can pick the time that works for them.  Its one step instead of 376 emails.  Trying to schedule a single meeting for 6 people?  It does that too – again saving the giant email chain or requiring a phone call to set a time for a phone call.

Waze.  To get from our clinic in Georgetown to Central Austin can take me 30′ or it can take me 90′.  Sometimes traffic creates unavoidable problems, but I’ve found an app that has made it much easier to find the fastest way during peak traffic times.  Waze uses traffic data and crowdsourcing to send you down the path of least resistance.  Side benefits? You occasionally see back roads you didn’t know existed, and you can set the GPS to sound like Elvis. “uh – Turn Right, Baby”.  It takes some trust to hit the back roads, but Waze hasn’t failed me yet.

What are your favorite technology tools?





Priority v. Prime

time management hacks for physical therapists

“This task is a priority” is a phrase we hear, and say, all the time. But what does that truly mean?

When used as an adjective like this, it indicates that whatever we are talking about is taking precedence over something else.  We might say something like “this is my highest priority”, but more often say “I have these priorities”.  Over time the meaning has softened…  ‘taking priority’ simply means ‘ahead of something else’. Trying to decide what to do next might look like this:

Key Project > Email > Family Time > Facebook >  Sleep > Exercise > Food prep > Breaking Bad > Twitter > etc.

Each thing in the list has priority over the thing after it. So in this example, exercise ‘is a priority’ over watching Breaking Bad (not all of you will agree) and both of those are at the end of a long list of other tasks. Its no wonder that this word has softened to the point that it isn’t all that useful.  We can execute on ‘our priorities’ all day long, and still not make any real progress.

I find myself doing this all the time. I have a list of tasks – priorities – all of which really need to be done. If I tackle them depending on their urgency, I’ve often wasted my most valuable time. Inevitably the thing that gets pushed to another day is the one that requires the most focus and attention but isn’t urgent. (Quadrant 2 for my Time Management Students)

Bad news! – this is often the one that would have had the biggest impact. It is usually important, but not urgent.11351771_m.jpg

Instead lets consider the word PRIME. As an adjective prime means of the first importance; demanding the fullest consideration.

One of the things that helps me to get things done is that instead of asking myself “what are my priorities today?” I try to decide what my “prime” is for the day. This idea is all over the place in the personal productivity literature, most recently in a great book by Gary Keller called The One Thing. It is also mirrored in The 4 Disciplines of Execution by Chris McChesney and others. Both of these authors recommend finding something to focus on at the exclusion of all the other things that might pull us away from our most important task.

Try this experiment. Ask yourself:

What is the one thing that I could do today, that if I got it done with excellence, would make everything else either easier or irrelevant?

then do that first! Make it PRIME. Don’t open your email, ban Facebook and twitter… don’t let distraction in. Focus on your prime task until that task is done… then everything else will be easier or irrelevant.

I hope you have a prime day.

3 simple steps to reach your goals.


Ever heard about the 1953 study on goals where only 3% of Yale students had specific written goals for their future?  20 years later that group was earning 10 times more than their other classmates.  I must have heard about this study a dozen times – its made the motivational speaker circuit for years… even just yesterday I was listening to Darren Hardy say that by writing down my goals I’m joining the top 3%.  The only problem – this study never happened!

Setting goals is the first step in turning the invisible into the visible. – Tony Robbins

Don’t despair though, a researcher named Dr. Gail Matthews from the Dominican University in California set out to find out whether writing down our goals actually matters.  Matthews recruited 267 participants from a variety of countries, occupations and ages.  They were randomly assigned to one of 5 groups.

  • Group 1 was asked to think about their goals.
  • Group 2 was asked to write their goals down.
  • Group 3 was asked to write their goals down and formulate action commitments.
  • Group 4 was asked to do all of these things plus send the action commitments to a supportive friend.
  • Group 5 was asked to write their goals down, formulate action commitments and send a weekly progress report to a supportive friend.


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The participants were asked to rate their progress and how effectively they had achieved their goals.  While group 1 only achieved 43% of their goals, group 5 achieved 76%.  It is worth noting that while writing down goals gave the participants an initial bump from 43% to 64%, there wasn’t much difference added by writing down action steps or even sending the goals to a friend.  The next big jump came with adding a weekly accountability task.

Accountability breeds response-ability. – Stephen Covey

If you want to achieve your goals you should:

  1. Write them down
  2. Formulate action commitments
  3. Send a weekly progress report to a supportive friend, coach or mentor.

Simply by taking these steps you’ve dramatically improved the chances you will reach your goals.3938181491_4c93e8ac56_o

If you go to work on your goals, your goals will go to work on you. If you go to work on your plan, your plan will go to work on you. Whatever good things we build end up building us. – Jim Rohn



Three games to drive your business.

time management for physical therapists execute on goals

The team won’t play at their best unless they are emotionally engaged – and that happens when they can tell if they are winning or losing. – Chris McChesney

People work harder when they are keeping score. If you don’t believe this, just hold a competition around anything… fundraising, customer service survey results, even completion of compliance items. Games are a great way to engage your team, often with surprisingly effective results.

Here are three games you can play to meet common challenges in physical therapy private practice.

1) Ever find it hard to motivate your team to consistently perform marketing activities?

The featured image this week is an amazing scoreboard created by one of our teams to track a contest they held over the course of 3 months. All of the staff (including front desk personnel, therapists and aides) formed teams that competed to earn points. Each time a potential referral source was contacted in person (5 points), via phone (2 points), handwritten note (1 point), etc. the team advanced along the racetrack. The goal was for every team to complete the race to earn a clinic celebration. This not only became a team building exercise but this group generated more than 400 referral source contacts in a single quarter. All those contacts paid off; the following quarter they broke the clinic record for the number of new patients referred.Kiss halloween

2) Ever felt like your social media efforts are stale and require too much effort?

Have a team halloween costume contest! Texas Physical Therapy Specialists’ annual halloween contest has a $300 first prize. Each team chooses a theme and creates a video that is uploaded to youtube and linked to on Facebook. Patients are encouraged to visit the Facebook age and vote for their favorites. This single event drives more traffic than any other during the year and engages the entire company in a fun, team building activity. The prize goes to a team celebration which creates even more camaraderie and social media content.  Check out the 2013 winners!

yelp-5-star3) Want to fill Yelp! and Google Plus with positive reviews?

Place a laptop ready to go and have a staff member help patients leave reviews as they graduate. As a thank-you for participating patients choose a prize – a branded t-shirt, tumbler or coffee mug or enter them into a raffle for a larger prize. Create a scoreboard that tracks how many 5-star reviews your team has received with a celebration once the goal is achieved.

Set a goal, design a game and build a scoreboard. Friendly competition can be a great way to mobilize your team. I would love to hear about games you have played to drive your business forward – what is working for you?

You might have to let the rubber ball bounce.


Highly successful people, especially entrepreneurs like private practice owners, often take their work life to extremes. They push well beyond a typical work day or work week at the expense of family and relationships. For these people (I might as well say my people), Gary Keller, author of The ONE Thing recommends counterbalancing. In other words – taking the same approach with leisure time that you take with your work life.

If you are going to work extreme hours… you need to spend some extreme time in rest and recuperation mode as well. If you don’t push your life out of balance, you might get away with a typical work week and relaxing on the weekend… taking the 60-70% of your allotted paid time off each year as many Americans do. For those of us that push hard for long periods of time, failing to counterbalance can lead to big health, relationship and even professional problems.

While our personal rhythm of push and counterbalance might work for us, we often expect the people in their lives to accept the same sort of rhythm. The challenge is that most relationships don’t do well with extremes. If you check out emotionally and don’t focus on your family for a month or two while you are pushing on a work goal, you should not expect everything to be great after a little counterbalancing with a family vacation. Relationships – and particularly spouses and children, require counterbalancing with much greater frequency.

A frequently cited metaphor in the literature around work/life balance comes to us from Bryan Dyson, then CEO of Coca-cola in his mid ‘90s commencement speech at Georgia Tech. He says:

6613406_mImagine life as a game in which you are juggling some five balls in the air. You name them – work, family, health, friends and spirit – and you’re keeping all of these in the air. You will soon understand that work is a rubber ball. If you drop it, it will bounce back. But the other four balls – family, health, friends and spirit – are made of glass. If you drop one of these, they will be irrevocably scuffed, marked, nicked, damaged or even shattered. They will never be the same. You must understand that and strive for balance in your life.

Similarly, counterbalancing with diet and exercise just plain doesn’t work. Ever tried pigging out and avoiding exercise for a few months and then trying to get back in shape with a few weeks of eating healthy and exercising? Health requires daily attention… going to extremes doesn’t work.

Failing to counterbalance the stress and fatigue from pushing toward our career goals leads us to begin to pull attention away from the daily and weekly rhythm of relationships and the habits that lead to health, energy and longevity.

Keeping the habits and rhythms of diet and exercise, family and relationships, church and spiritual life (the glass balls) provides us with the resilience we need to launch our professional rubber ball as hard and as fast as we can.

Which ‘ball’ do you tend to have trouble keeping track of?

Top 7 Lessons From My First Year in Practice


Before I left for physical therapy school, I had one great fear: no matter how hard I tried, I was going to be a bad PT. I confided this fear to a mentor of mine, a well-respected PT himself. His response is one I’ve thought about regularly since that day- that with a solid foundation in school and good mentorship afterwards, there was no doubt I would be a great PT.

 Having now completed my education and practiced for a year, I realized that my mentor’s comments ring true for not just me, but for anyone entering the profession.With a new cohort of freshly licensed PT’s and PTA’s coming in to the profession, I took some time to reflect upon the major lessons I have learned over my first year in practice. The below points have resonated with me most, but please feel free to add your own in the comments section below!

 1. Mentorship is made by you, not provided by someone else. When interviewing for jobs, we all hear promises of weekly mentorship time and guided learning. Yet, if you do not prioritize this time, it’s likely to get lost in the pressures of the day. It’s our responsibility to make sure our mentorship time actually happens and is effectively used. Here are a few practices I have found helpful: a) block off your mentor time on your schedule- it’s simple, but makes the time more official; b) make sure your mentor is someone who you want to learn from; c) plan it out- set individual goals for yourself each time you meet with your mentor.

 2. Don’t compromise your values. Coming out of school, the lines between right and wrong seem pretty clear. However, those lines may quickly blur by pressures to bill more units, see more patients, or take on a practice outside of your ethical comfort zone. Remember that these decisions are ultimately in your hands- it’s your license and happiness that’
s on the line by being in a job that challenges your morals, ethics, and ability to take quality care of your patients.

 3.   Develop self-management strategies and remember your role. Patient care is hard. And a lot of responsibility. While we may see 60 patients per week, our patients only see us once or twice. Many times, we are the only health professional caring for their well-being. Because of the time we spend with our patients and trusting relationships we develop, many patients often end up airing all of their concerns to us. We may not be trained as social workers or psychologists, but the nature of our job demands we play a role as a quasi director of their care. There’s no doubt about it- doing this for patient after patient is mentally, physically, and emotionally draining. In response to this fatigue, I’ve developed a couple strategies to make my day more manageable. First and foremost, I always try to remember my role- we don’t have the time or training to be everything to everyone, so I make sure to refer to other professionals when appropriate, even when it means embarking on a difficult conversation. Second, I try to take 2-3 minutes between patients to decompress. Just a few minutes allows me to refresh, knock out a bit of documentation, and ensure I approach the next patient as a clean slate. I find I can bring more to the treatment session with those couple minutes to myself, even if it means I’m slightly late to the next treatment session.

 12080051_m4. Attitude is truly infectious. It’s easy to fall down the wormhole of complaining about patients or co-workers, but finding ways to stay positive, smile, and bring joy to the clinic is much more rewarding. We all have difficult days, but bringing a positive attitude to work can change the entire culture within a clinic. I challenge you to be that compassionate and empathetic person that brings positivity to a clinic. Once you do, your colleagues will start to look at you as a leader and your patients will notice.

5. Recognize your needs. Then verbalize and fight for them. Everyone has an idea of what it means to be successful, but only you know what you need to be successful. Too often, I see new employees try to conform to a system and environment that does not work for them. Whether you feel you need more mentorship, want to attend a continuing education course, or even would like something as simple as a slightly longer lunch, do not let a resentful feeling brew- approach your employer in a respectful fashion. Chances are that your employer is looking to support you, but does not see your needs. If your employer is not willing to acknowledge or support your needs, it might be time to consider a change.

 6. Reflection really is important. Be a conscious practitioner. In PT school, our class reflected on everything. In fact, I’m pretty sure we reflected on our reflections. We reflected so much that reflection became a dirty word. However, I have come to find great power held within reflection. Make sure to periodically ask yourself, “what could I have done better during my last treatment session,” or “what could I improve upon from last week?” It’s easy to go through the motions, but approaching your treatment session consciously, by analyzing what you are doing, why you are doing it, and how you can improve will lead to greater growth and fulfillment.

 7. It’s worth it. Patient care is challenging. Most days are exhausting. Yet, if you give it your all and fully engage with your patients, it can be extremely rewarding. The feeing you get when someone looks you in the eye, shakes your hand, and says a genuine ‘thank you for your help,’ is a feeling I have never reproduced elsewhere in the world. We play a special role in our patients’ lives, giving them our time, touch, and knowledge. Cherish your relationships with your patients and never forget what it feels like to help someone achieve their goals.

 Any big lessons I missed? Please consider adding your own lessons to the list in the comments section below!

About the Guest Blogger: Josh D’Angelo, PT, DPT served as APTA Student Assembly President in 2013 and is now active with APTA’s DC Chapter and Private Practice Section. He graduated from George Washington University’s Doctorate of Physical Therapy program in 2013, where he was the University’s sole student to win the George Washington Award. Josh is also a former APTA Mary McMillan Scholarship awardee and is currently practicing in the outpatient orthopedic setting in Washington, D.C.  He is a regular contributor at PTHaven.

What is Quality in Physical Therapy?

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I have had some interesting interactions in social media over the past few weeks that have had me thinking about the definition of quality in physical therapy. Therapists are paid for our time and the procedures we perform. Because of this (or at least I blame this system) we tend to define quality around ‘actions taken’ and method of work. For example:

  • Quality providers are able to manipulate an acute low back
  • Quality providers avoid modalities
  • Quality providers provide good home exercise programs
  • Quality providers set and track goals
  • Quality providers use evidence based interventions
  • Quality providers spend (however long) with each patient
  • Quality providers do not use PT Assistants or Aides
  • Quality providers have this or that certification
  • Quality providers have/avoid the latest gadgets
  • Quality providers use/have/do whatever is important to you…

We do this in large part because these are the most visible parts of a practice we might judge it by. However, I would argue that while there are a host of factors that the best practices have in common, quality is not defined by actions or our broken reimbursement system. Quality is defined by patient outcome and by patient experience. In this post, I’d like to provide a window into how we measure quality at Texas Physical Therapy Specialists.

In our practice, we measure outcome using a national database called Focus on Therapeutic Outcomes (FOTO). This system uses adaptive surveys to determine a risk adjusted baseline when a patient starts physical therapy, and then tracks their progress. The results can then be used to provide feedback to individual therapists (i.e.”Dr.____, your outcomes with ankle patients aren’t as good as Dr.___’s, lets see what they are doing that you are not) and more importantly can be used to compare outcomes with other participating practices across the nation.

The other component of quality in physical therapy practice is patient experience. We break this into two components: customer service (all staff interactions) and providing quality connection between the therapist and the patient.

We measure customer service with a survey that has multiple components but centers around the ‘net promoter score‘. Often called ‘the most important question in business’ it is simple and captures the desired customer service outcome for most practices.11268773_m

“How likely is it that you would recommend us to a friend or colleague?”

Much harder to measure but equally important to patient experience is the quality of connection between patient and therapist. This is how well a therapist listens and how much empathy they show. These things have a powerful impact on clinical outcome so we measure them separately using a survey specifically for these items (Consultation and Relational Empathy instrument or CARE) at the completion of the first visit. Interestingly, our therapists scored significantly better in this area after receiving training specific to compassion and empathy.

The confluence of these three things is the product our practice produces.

The amount we charge a cash-paying patient, the contract we sign with an insurer or the assignment we accept from the federal government is simply how we receive payment for that product.  Our current payment system bases this on time spent and a host of other items that have no direct relationship to quality.  Paying for time without accounting for outcome is like paying a mechanic for the time spent on your car without accounting for whether the problem is solved.  Regulating work methods is like mandating that a mechanic can’t use helpers and again not accounting for whether the problem is solved.  We have to comply with these external definitions (which vary wildly by state and payer) but we do not have to let them define what Quality is.  In my opinion, quality in physical therapy is a simple equation:

Quality = Outcome + Patient Experience.

There are many ways to get there, and undoubtedly some are better than others.  Having the ability to measure quality gives us the opportunity to find bright spots and emulate best practices.  How do you measure the quality of your service?