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.

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?

Time Management Hack: Signal to Noise Ratio

Inbox massive

We live in a noisy world.  The level of information that is constantly flowing into our lives is at times deafening and overwhelming.  Hidden within all of the spam, advertisements, emails, texts, facebook posts, tweets and photos is a tiny thread of signal that we are desperately trying to hear.

The Signal-to-noise ratio compares the level of a desired signal to the level of background noise.  This term is sometimes used to refer to the ratio of useful information to false or irrelevant data.  Our social world has made it easy to get information… I can google just about anything and find a ream of information on it.  But the more closely tied to a product or service that can generate money the data I am looking for is, the harder it is to pick out the signal from the noise.581516radio_frequency_smaller

Here are a few ways I have found that help me focus on the signal to stay more productive:

1) Go on a data diet.  Avoid social media, stock tickers and other non essential data when you are trying to be productive.  Don’t give in to the urge to constantly ‘check in’.

2) If you use Gmail or Google Apps – set your inbox so that the ‘important and unread’ messages stay at the top.  The junk and notifications are filtered out and you can delete them all at once at the end of the day rather than constantly having to filter through them.

3) Use a service like  This clever service searches your email for subscriptions and ‘rolls’ them all into one email or lets you unsubscribe with a single click.

4) Avoid using your email as a to-do list.  I forward to-do emails to Nozbe, which automatically creates a to-do list item for me and adds the body of the email and any attachments to the list.  This way I can work through a list of things I need to do without getting distracted by incoming emails.

These are just a few ideas.  The more you can filter out noise and get to the signal, the more effortlessly productive you can be.  What are some other ways you have filtered out the noise to help with time management?  Tell me here or on social media – I’d love to learn a trick or hack from you.

Browdering – what its all about.

Welcome to and my first (official) blog post.

Over the past few years I have had an unbelievable opportunity in my role as a faculty member and now program director for Evidence In Motion’s Executive Program in Private Practice Management.  I have been able to spend the past 5 years learning about the owners of over 300 private practices and their businesses.  In the process of staying connected with many of our alumni, I came to the conclusion that the topic of leadership and management is just not something that has received enough attention.

I started this blog because this is an area that I am passionate about.  The purpose of ‘browdering’ is to allow me a place to write about all the things I am learning as well as to drive discussions so that I can learn from you.  I hope that the strange confluence of my background as an Air Force Academy graduate and Air Force physical therapist will combine with my experiences as an educator and private practice owner to create interesting content.  Most of all, I hope that I can connect with other practice owners and help to create profitable paths for private practice physical therapy in what I think will be a challenging healthcare environment.

My friend Chris Stanley came up with the name ‘Browdering’ as I crowdsourced blog name ideas  to my Facebook network. He even gave it a definition!  This was perhaps one of the best compliments I’ve ever received and seemed to capture the essence of my mission… so I went with it.

My goal is to help PTs better manage their time, optimize their practice and lead their staff.  Most of my posts will be in these areas.  I will also feature several new courses on this site, including a Time Management course for PTs and PT Practice Owners that will launch in the next few months.  Look for a post every Monday, with a scattering of other quotes, book recommendations, etc. mixed throughout.

I truly hope to connect with you, so please follow my blog, sign up for my mailing list (only cool things, I promise) and hit me up on social media as well.  I am looking forward to getting to know you better and I hope to add value to both you and your practice.