In his bestselling book, Good to Great, Jim Collins asks the question that all of us beg the answer to. “Are you a hedgehog or a fox?” An odd question for Chiropractors you think, considering his book focuses on what makes companies great after being less than mediocre for over a decade.
But what the answer to this question indicates, has far reaching implications beyond how our practices are run; but filters down to the most fundamental objective we all seek in trying to achieve both personal and practice mastery.
What say you, fox or hedgehog? Collins explains,
“The fox is a cunning creature, able to devise a myriad of complex strategies for sneak attacks upon the hedgehog. Day in and day out, the fox circles around the hedgehog’s den, waiting for the perfect moment to pounce. Fast, sleek, beautiful, fleet of foot, and crafty—the fox looks like the sure winner. The hedgehog, on the other hand, is a dowdier creature, looking like a genetic mix-up between a porcupine and a small armadillo. He waddles along, going about his simple day, searching for lunch and taking care of his home.
The fox waits in cunning silence at the juncture in the trail. The hedgehog, minding his own business, wanders right into the path of the fox. “Aha, I’ve got you now!” thinks the fox. He leaps out, bounding across the ground, lightning fast. The little hedgehog, sensing danger, looks up and thinks, “Here we go again. Will he ever learn?” Rolling up into a perfect little ball, the hedgehog becomes a sphere of sharp spikes, pointing outward in all directions. The fox, bounding toward his prey, sees the hedgehog defense and calls off the attack. Retreating back to the forest, the fox begins to calculate a new line of attack. Each day, some version of this battle between the hedgehog and the fox takes place, and despite the greater cunning of the fox, the hedgehog always wins.” Pg. 90
Simply put, the hedgehog understands that the key to his success, not just in survival and adaptation, but also in growth and development, is to focus on simplicity. Rather than focusing on many things and constantly trying to find the “new thing” to win the battle, the hedgehog knows one thing and understands that that one thing is what they do best. Our forefathers knew this principle and understood that in order to grow and develop, our profession needs to keep things as simple as possible. In his study of movements and organizations, Bill O’Brien stated that the further an organization moves from its founding tenets, the closer it meets its own demise.
Our profession is full of foxes, constantly trying to introduce outside-in thinking and concepts into a profession that is gradually moving away from its original idea. Acupuncture, laser-therapy, even hair removal has been advertised in our professional magazines in the realm of “increasing revenue” and “tap in to a new market,” all the while continuing to undercut our vitalistic paradigm that is so simple in its singular purpose. It’s no wonder the public is confused and cynical about our profession. The complexity we have created in our corner of the health care arena has caused so much confusion and skepticism, it’s no wonder enrollment is down at all schools and why our grip on the market is slowly eroding. It’s how billboards can be put up in
We lost our ability to keep things simple. We lost our ability to be hedgehogs.
How simple is the concept that “nature needs no help, just no interference.” Or “the power that made the body, heals the body.” These are examples of hedgehog concepts that are so simple and so clear, that they are often overlooked for more fanciful and romantic notions that are the gimmicks we use everyday to get ahead. Collins defines a hedgehog concept as: a simple, crystalline concept that flows from deep understanding about the intersection of the following three circles:
1. Understanding what you can be the best in the world at. (and, equally important, what you cannot be the best in the world at). When you look in the mirror as a Chiropractor, what do you see? I was presenting to a group of chiropractors not long ago and a new practitioner asked the question that plagues many of us. He said, “I can’t seem to get things going…I mean, I have everything you could ask for, new tables, new x-rays, new office. I’ve been to all the seminars and have all these ideas to implement, I bought this and this and that, but I’m just not growing.” When I asked him this question, he paused for a long, uncomfortable moment and then the light bulb came on. You see, he was a fox, thinking that the next big purchase he made was going to transform his practice (outside-in) when the answer to exploding his practice lay within him. He had to decide and make a commitment to be the best in the world at something, at anything, before his practice could grow. What you can be the best in the world at stems from the core essentials that you learned from your experiences, your education, your practice, etc. So what can we as chiropractors really be the best in the world at? Collins makes it very clear that we should not make this judgment based in bravado, but with a very succinct and clear understanding that we can be the very best at something. The answer is simple. We can be the very best in the world at locating, detecting and correcting vertebral subluxation in as many people as possible so that humanity can achieve its optimum potential for health and life. We can also be the best in the world at communicating this idea with passion and enthusiasm to our society. Of equal importance is what we cannot be the best at. And the answer is again very simple, anything that doesn’t involve what we can be the best at. We can never be the best diagnosticians in the world, we can never be the best physical therapists in the world, we can never be the best acupuncturists in the world. What the good to great leaders did once they realized they could never be the best at something was simply stop doing what they couldn’t be the best at and focus all their energy and resources into what they could be the best at. Most chiropractors go through school and learn the core competencies of the philosophy, science and art of chiropractic, but due to lack of confidence and conviction of these concepts end up dabbling in other pursuits never quite gaining mastery and fulfillment in the fundamentals of chiropractic, ultimately being competent and mediocre in their practice but never becoming great. You say, but I’m doing great, I make huge amounts of money and have achieved great success. It’s worth noting and Collins sums it up quite nicely when he states “to go from good to great requires transcending the curse of competence. It requires the discipline to say, ‘Just because we are good at it – just because we’re making money and generating growth – doesn’t necessarily mean we can become the best at it.’ The good-to-great companies understood that doing what you are good at will only make you good; focusing solely an what you can potentially do better than any other organization is the only path to greatness.” Pg 100
2. What drives your economic engine? This reminds me of the equation the Dr. Guy Riekeman has shared with thousands of people. The answer, however, has nothing to do with profits and revenue directly.
NP x PVA = OV x AFPV = GI – OH = NI
(New Patients x Patient Visit Avg. = Office Volume x Avg. Fee/Visit = Gross Income – Overhead = Net Income)
Ultimately our income is decided by the four factors that we have control over: NP, PVA, AFPV and OH. The latter two are concepts that are easy to adjust. You either charge more per visit than you are now and you decrease your overhead. Yes, it means paying cash for everything. If you don’t have the cash to pay for it outright, then you cannot get it. But the first two, NP and PVA, are the concepts to focus on, and they come down to one thing: patient education. If you have the type of practice where the doctor and staff have no real philosophic or scientific objective for your patients in taking them through initial intensive care or even reconstructive care, then your practice will simply be a pain based practice, dictated by the patients perception of chiropractic; which is treatment of low back pain and neck pain until the pain is gone. The outcome of this type of practice is short-term care, minimal clinical results, high turnover and high overhead. However, if you have a clear vision (hedgehog concept) and see the definite need for initial intensive, reconstructive, and wellness care and have the ability to communicate that vision effectively, you will have well-educated patients who stay longer and refer like-minded people to participate in that vision because they understand and make informed decisions about their health and life. The outcome of this type of practice is well-educated patients, high retention, and a practice built on internal referrals, ultimately reducing overhead.
What about insurance, managed care and Medicare, these our ruining our reimbursement? Collins tells us it’s not about the industry we’re in. I know plenty of Chiropractors, who only take cash that are earning seven figures.
3. What you are deeply passionate about. Easy question for us Chiropractors, right? Not really. All too often I run into Chiropractors and students who are just not satisfied or can’t seem to get motivated to dedicate their life spirit to Chiropractic. We see too many great DC’s that come to a point in their life and in their practice where they’ve lost their creative inspiration and move onto other projects. They enter real estate, restoring old cars, buying and flying airplanes, which all very fun and appealing and believe me, I know the need for a hobby. However, they get so wrapped up in these ventures, they lose focus on what got them there. If you lose focus and get distracted by these issues, they will indeed become your reality and your practice and relationships will suffer because of it. Chiropractors who maintain their passion and zeal for the principles of Chiropractic have a sustained sense of purpose that carries them throughout the course of their careers.
As a profession we must remain hedgehogs. If we are true to the principles on which we were founded, we can and will be successful. We must always remember where we came from, what drives our ability to succeed, and what fuels our passion. Having those in mind and taking specific action on each of the three circles ensures that our future remains bright.
Brian Flannery, DC, LCP, DPhCS is the Coordinator of Principles of Practice and Business Management at Life University in Marietta, GA. He can be reached via email at bflannery@life.edu, followed on twitter, and befriended on facebook.