Jobs Applied: Simplicity

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“It takes alot of hard work, to make something simple, to truly understand the underlying challenges and come up with elegant solutions”  Steve Jobs

Steve Jobs was famous for his focus on making complex problems and products more simple.  When Apple wanted to disrupt a market – it looked for industries or categories that were making products more complex than they needed to be.  I think itunes is a great example of this.  Love it or hate it, it is simple to use.  So simple, in fact, that millions of people prefer to pay $1 or more per song, when they can quite easily find the same music for free.  You might argue its about copyright infringement, but I’d argue its about simplicity.

“Simplicity is the ultimate sophistication.” – Leonardo DaVinci

Surely the US healthcare system could use a dose of simplification!  Let’s review the steps required for a patient to come in to see me in my private practice.

  1. Get hurt (simple)
  2. Make physician appointment (referral required by law in most states)
  3. Explain to physician that physical therapy can help injury
  4. Brush off advice to take medication and ‘actively rest’
  5. Obtain physical therapy referral
  6. Schedule physical therapy appointment
  7. Give receptionist ~30 pieces of data for insurance verification
  8. Fill out 8-10 pages of paperwork
  9. See physical therapist and begin treatment (unless its a work injury, then see steps 10 – 12)
  10. Physical therapist sends in paperwork requesting permission to begin treatment
  11. Wait 5-7 days
  12. Begin treatment

This got me thinking.  A great deal of this could be simplified by moving to Pennsylvania (a direct access state – remove 2,3,4 and 5) and by accepting cash only (that would take care of 7, half of 8 and 10-12 ).  The downside, of course, is that this simple solution only works in certain states and for patients with cash to burn.  There is alot of this that is simply outside of our control other than advocating for a change.

Simplicity is about subtracting the obvious and adding the meaningful.” – John Meada

Steven Covey writes about a useful principle called the ‘circle of concern’ vs. the ‘circle of control’ (here’s a neat review).  Clearly most of the steps a patient has to go through would fall into our circle of concern, but outside of our circle of control.  However, there are a few that we do control directly.  Probably the highest leverage item in our list that we could simplify is #8. the paperwork a patient fills out when they hit our door.

intimidating_stack_of_divorce_forms_and_papersIn most practices we already had to collect more information than the patient has to give to get a credit line to verify their insurance.  Looking through my forms (yes, guilty!) we ask the patient to write their name and birthdate no less than 7 times, their social security number 3 times, etc.   We also ask them to describe their pain numerically, graphically and in detail… then proceed to ask them about it verbally not 5′ later.  The entire process is redundant, since we use an EMR anyway.

A believer in the circle of control – I’ve got a new Next Action.  I’m going to think like Steve Jobs and simplify steps 7 and 8 for every patient trying to connect with our practice.

Next: Take Responsibility End to End

Jobs Applied: Focus

“Deciding what not to do is as important as deciding what to do” Steve Jobs

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One of the major strategic shifts that Steve Jobs made upon returning to the failing Apple in 1997 was to sharpen the focus on the company on creating just a few products… but pouring all of their energy into making those products fantastic.  That’s why even today Apple, arguably the number 1 computer company in the world, only has 46 products.  Only 13 of those are in their core hardware business (the rest are software or accessory products -I found that tidbit here).  Spend a few minutes browsing the Dell website and you can see how remarkable this is.

Isaacson, in the article that spurred this Blog series, describes an annual strategy meeting Jobs would hold with his ‘top 100’ people.  He would ask them to brainstorm what 10 things they should be doing… slowly narrowing all the ideas down until he got to 10.  He’d prioritize them… and then drop the  bottom 7.  This narrowing of priorities down to 2 or 3 is a strategy theme that seems to be everywhere once you look for it.  Perhaps the most well known of these ‘no more than 3 priorities’ advocates is Jim Collins, of ‘Good to Great’ fame.

Create a ‘stop doing’ list. Work is infinite; time is finite. If you have more than three priorities, you have none … – Jim Collins

The principle of playing to our strengths and figuring out what one or two things your firm can be excellent at has been an ongoing theme in our Executive Program in Private Practice Management.   Part of focusing on your strengths is to accept that it is acceptable – perhaps even preferable to be mediocre or even suck at alot of things if you are going to be world-class at anything.   I, for example, am steadily losing my skill at manual therapy.  For the first decade of my career, it was all I thought about.  I obsessed about it, studied it, practiced it… I practically manipulated anyone who I could get to lie down on my portable manipulation table.  I did my best to put in Malcolm Gladwell’s 10,000 hours.  Now I’m focusing on other things – such as learning to write better blog posts.  If I want to become a master at THIS, then I can’t spend a big chunk of my time practicing THAT.

“My success, part of it certainly, is that I have focused in on a few things.” — Bill Gates

Our practices, similarly, can’t be amazing at everything.  We probably can’t be the best place for an endurance athlete to be seen and also the best place to go if you have a stroke.  We probably can’t be the women’s health mecca and also the very best at treating cervicogenic headaches.  We could certainly collect some people who have these skill sets – but we as a practice can’t be the best at everything and as the number of therapists gets larger, Cindy’s special skill set in treating elbow pain becomes more and more difficult to use as a differentiation.

“A person who aims at nothing is sure to hit it.” – Anonymous

The lesson the rest of the business world is trying to get across (and that was executed on by Steve Jobs) is that it is better to figure out what you are the BEST at and then use that to differentiate your practice from the others.  Everything else is a distraction and could prevent you from achieving the amazing practice you envision.

Coming up next week…. Simplify.

Intro to ‘Jobs Applied’ Series

One of the ongoing themes of this blog will be to take material presented from outside of the world of private practice physical therapy and to repurpose it to illustrate and guide our businesses within the healthcare industry.  There are a great many ideas and well thought out models out there… I intend to dig them up and present them in ways we can apply to our world.

Being a huge fan of all things Apple, I have over time come to appreciate the genius of Steve Jobs and the organization that he created.  An Apple fan or not, few entrepreneurs have a history of not only creating a company (in a garage in 1976) but then also coming back to it after being ousted to save it (almost went bankrupt in 1997) and take it to dominate entirely new markets (iPhone, remember?).

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In April of 2012, six months after Steve Jobs died of cancer,  Walter Isaacson published a compelling article in Harvard Business Review called ‘The Real Leadership Lessons of Steve Jobs’.  You can find it here or the full biography here.  He described 14 practices that Steve Jobs brought to Apple – leading his company to innovate and succeed in a style simply not found elsewhere.  These 14 practices are:

  • Focus
  • Simplify
  • Take Responsibility End to End
  • When Behind, Leapfrog
  • Put Products Before Profits
  • Don’t Be a Slave to Focus Groups
  • Bend Reality
  • Impute
  • Push for Perfection
  • Tolerate Only ‘A’ Players
  • Engage Face to Face
  • Know Both the Big Picture and the Details
  • Combine the Humanities with the Sciences
  • Stay Hungry, Stay Foolish

As I was reading this extremely well executed article, I was struck how most of these principles resonates within our private practice physical therapy world.  They are also, to some degree, not new ideas but principles that pop up in the business literature over and over.

For these reasons, I decided that I will write a single blog post applying each of these concepts and the lessons of Steve Jobs (thanks to Dr. Isaacson) to our world.  I will likely skip a few that I don’t like as much, but over the next 3 months keep an eye out for these posts… one each week.  Or look for them all under the ‘Jobs Applied’ category.  I look forward to your comments here, on my twitter page or on Facebook.