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"Frontline Excellence"

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Megan Walker: Hello, and welcome to Market Savvy Conversations. My name is Megan Walker, your host, and today coming back for round two, our special guest is Kaye Frankcom, Clinical Psychologist based in Melbourne. Hi, Kaye, how are you?

Kaye Frankcom: I'm very well, very well for somebody who is locked down for the sixth time, I'm good. Thank you, Megan.

Megan Walker: Oh, and counting. Kaye and I had a fantastic conversation recently, all about a waiting list risks, which once we started getting into that conversation, I certainly realised a lot more than I didn't know, things like, who's on your list, patient and optimal caseload, what you can and actually can't handle. So if you haven't seen that episode yet, I do really recommend that you check it out. Kaye has got some very fantastic suggestions about how to sort of have a more hygienic list and manage that process and thinking about your duty of care. Kaye, did you want to add anything to that before we talk about our follow-on piece?

Kaye Frankcom: Not really, I guess I would, except to say that I would say that waiting list management is like the canary in the coal mine. So it will be the thing that is telling you things are not quite right, either out in the world, which is true. And the mental health demands are pretty massive as everybody knows, but also maybe it's pointing out to you that some of the things you need to do in your practice, you're over due in wanting to do those. And so to that extent, I'd guess I'd say, it looks a bit like, let's all argue over how to manage wait lists while really, so we've got to, I think get our heads screwed on about the fact that the wait-list management is just a symptom really of other things. And some of them are extrinsic. Some of them are intrinsic to our practices. So just being clear in your own mind about what's going on and why, and delving into your own reporting systems and the way in which you're managing things. So we'll talk a bit more about that today, I guess.

Megan Walker: Absolutely. In that conversation came up quite a lot about the importance of having a really good reception or frontline response to inquiries and juggle things. And so we thought today we would focus on how to increase your customer service and your client intake process and some of those policies. And Kaye is approaching this from a position of expertise, having been in the field directly as a business owner. Kaye, do you want to just touch to that quickly for people who haven't met you yet?

Kaye Frankcom: Yes, well, I've had two or three practices over my lifetime as a psychologist, which is nearly 35 years worth, but the most recent was here in metropolitan Melbourne, nearly 20 years in Williamstown, where I had a practice of 16 clinicians that I sold that practice, not sold them, some practice, in 2018. And I've written a book about how to set up a private practice back in 2016 with a couple of other authors. And so I'm in my third career iteration as a coach and with both the business side and also the clinical and supervisory side of running psychology practices in particular, but much what we'll talk about today hopefully also applies to many Allied Health services.

Megan Walker: Impressible. Fantastic. Okay, so we're going to kick off with talking about a good triage system. So when the phone rings, and that's an issue even in itself, I should have a question even before that, the different options for receiving that potential appointment, be it mobile phone to message bank, be it reception, be it outsourced reception. Do you want to even just touch on that first?

Kaye Frankcom: You kind of stole my thunder because I guess I would say I was just sort of preparing some slides for another presentation, and the title of the slide, you'd love this, is things that you thought you would or could never do. And the list goes like this, digital notes, and there's a bunch of other things, but one of them was streamlining and automating, but the other one was, stop picking up the phone. Now scary. Many of us, obviously if you've been a solo, sole trader and you still are a sole trader, picking up the phone seems like a pretty natural thing to do. But of course it leads to a number of, I guess, activities and tasks that then flow from there, many of which are manualised or have some manual aspect to them.

Kaye Frankcom: So I guess the question for me is, should we, if we're in solo practice, be operating off a phone-based contact approach, or do we say to people, and we talked a bit about this last time, "Please access the client portal or the inquiry portal of my website, go in, upload your documents, answer the forms there, and we will take that as an expression of interest in coming to our practice. And then we will be in touch with you." So that you, and basically you're also potentially saying on that site, "Unless we receive all of the documentation, then we can't progress your inquiry."

Now this may sound very elitist and kind of high handed. We will just think about whether we really want to work with you, but I think there are ways of explaining this to clients. And it goes to the other question later on, which is, what do we do about client cancellations and no shows, especially off a wait list. And I guess it really, what I find when I'm reading a lot of the materials that I see from practices, those practices that I coach send me their policies and procedures to review. And what you see is a lot of these. "Don't cancel in under 24 hours, or you will get a cancellation fee. You don't send us all your documents, you will not be progressed to the wait list."

So as soon as you hear that little, that voice, that ticking you off voice, you probably know that you're not actually talking to the client from their perspective. Why do we have cancellation fees? Why do we have wait lists? Why are there forms? How we explain that to clients that makes it clear to them, "This is a way to get a better service. You don't want to spend time on a wait list for a clinic that is not for you. You don't want to spend time on a wait list when you can't afford our service, or it's the wrong type of presentation for our service, or you don't have a care plan. And then you're going to have to go back to the doctor and we're going to be offering you an appointment off our cancellation list today or tomorrow," and you go, "Oh, I haven't got my care plan."

So if you don't have your paperwork, the problem if you want to get a reimbursement, however, explain to people what then needs to happen, referring them to the appropriate resources of which some have been written very nicely by a number of psychologists or Medicare, if you really want to go to the bureaucratic route. But I think it's just thinking about how am I going to express this to my clients or potential clients in such a way that they'll go, "Oh yeah, okay. I see why they're doing this," rather than, as we all do, "Not another form to fill out, not another password to create."

Megan Walker: Fax machine to find.

Kaye Frankcom: Fax machine. Because we're still working on that sort of basis where we don't need to, which I guess then goes to, you really need to think about what is your practice management system doing to help you with this?

Megan Walker: Yeah, interesting. So you've got, I hear what you're saying, so if you are a sole practitioner, you can use your website to be a far more powerful tool to triage and flow through people as a workflow. And there's definitely tools that can allow that.

Kaye Frankcom: And also, Megan, can I just say also, if you want to use a virtual assistant, speaking of administration, like you were just speaking, it's so much easier for a virtual assistant, somebody remotely to look at that material for you and then give you a list of who's got all their paperwork, help you to make the right calls about who you can help and who you can't. Whether you're going to keep a wait list, how long people can be on the wait list for if they can't be off an appointment as I mentioned last time, within six weeks, you need to think carefully about whether you should continue to have that wait list open, this sort of stuff. So you've just got a lot more maneuverability and it's not click, click, click, click, click, click, finally finished task.

Megan Walker: No, not at all. And I absolutely hear the need for that when you're flying solo and you've got high demand and you're in a high pressure situation, I think that's really good sound advice. When you can allow for reception and a person who knows you to answer the phone, lovely customer service factor, 10 out of 10 score there. Not always possible, I appreciate, but we're going to talk a little bit more about that model. So if you've got someone answering your phone, what's some of the good triage systems that you can set up in place so that that person answering the phone, whether they are a virtual assistant or they are your own reception, can help get that information out of people without breaching any privacy and can support that person to get an appointment?

Kaye Frankcom: Well, I think the first thing is, people often want to tell you the story straightaway, don't they? And the poor administration person has to listen to some extended rave about something or another that has happened to the client, which is often, can sometimes be tragic and quite sad. Sometimes it can seem quite weird. And various other thing, reactions can come from somebody who is not a clinician or from, even from clinician side, let's say. So I think part of it is about sort of thinking about what happens when somebody answers the phone and says, "Kaye Frankcom Consulting," and then you might ask, "How can I help?" And that person says, "I'd like to see Kaye." All right, so what happens then? So for me, what we don't do is slow down, often what we do is speed up. So we start saying this, "Now, what do you need is." Then the response is, "We had a look on the website."

People often aren't listening. And they get past, they might listen for five or 10 minutes, but they're so keyed up to tell their story and to get that appointment that they don't really listening to what you're saying. So part of it for me is working out, what do we want to say in those first few minutes that will settle people down and where we can elicit basic information and then guide them. So for me it's about saying, they've said their name and they want to see me. The next step, if I was answering the phone might be to say, "Can I take you through the process of what's going to happen from here?"

And if you want to know anything about it, then you can go and look on the website, it's all repeated there. What I'm going to tell you now is also on the website. So you might have already read it, but let me tell you one human to another, which is, "If you wish to come and see Kaye, you need to know that there's a wait. We don't let people wait any more than six weeks. So at the moment we are under that timeframe for new clients to come in to see her. So, which is great, great news for you. Secondly, you need to have all of your paperwork to us. If you want to know what the paperwork is, go to the website. If you can't access a website, give me an email address or a postal address and I'll send it to you. But know until we get that, all we've had is what is called a introductory conversation."

Megan Walker: Brilliant.

Kaye Frankcom: "And it's not until we get the paperwork that I can actually then offer you an appointment."

Megan Walker: I love that, Kaye. I can see that on the website. Here's our four steps, process for getting an appointment. That's what the person wants. So let's match them, map it out, repeat it on the phone. Follow up in the email with the booking. Here's the four steps. You've now ticked off step one, you've got followed two, three, and four to go. So clear, that's great. Especially if a person's in a situation of trauma as well.

Kaye Frankcom: That's right. And if they're in a, they're highly anxious because they've had to ring you anyway. And somebody said, "Oh, you've got to ring them yourself. You can't just get somebody else to ring." I mean, that's another thing. Sometimes people do ring for other people, you need to decide, are you going to accept that kind of call? You might on the basis that they fill out all the stuff and then you can offer them an appointment. You might say to them, you might have as part of the form filling, "Tell us what your availability is. And are you willing to do telehealth, which is all we're offering at the moment. If you're waiting for something else, then I will not be taking you onto our wait list, it's not fair to you. Because I can't tell when our lovely premier and other people are going to tell us that we can do that."

So you know, to me it's about recognising that we just need to, so you can hear this calm voice, that I'm not stuttering and thinking, "Oh, I don't know. I don't have an answer to that." Because I'm on the front foot and I've got the answers, because I already know what the questions are generally. Now, if somebody stops you there and wants to give you the rant, may have to do that. It won't work in all cases, but let's say at work in 75% of cases, you'd be pretty happy with that.

Megan Walker: Absolutely. And Kaye, when everyone rings up, they're all urgent. How do you work out who's more urgent than others?

Kaye Frankcom: Well, I think this goes to the forms business, which is trying to get some information from a GP referral, trying to get some information from the client as to what they are looking for, how they express their problems. I think asking them what the presenting problem is, is a bit sometimes would come over as perhaps a bit too particular to a professional sort of way of describing it. But just saying, "What did you discuss with your GP that made you ring our practice," something like that. Or, "What have you identified that you would like to work on with a psychologist?" Because what we know is that when people haven't had psychological treatment before, they have very little idea of really what it looks like.

Megan Walker: Yes, and the language to use.

Kaye Frankcom: That's right. And they're expecting it to be the same kind of experience as going to a cardiologist is what I'll often say. When the cardiologist says, "I'm the specialist, I know everything. I've got all your tests here. Can tell you what to do. You're going to go away and do it. You're going to wear a heart monitor for 24 hours. You're going to go and have an ECG. You're going to go and have a look at your heart and whether it's got any plaque in the arteries. We've got a bunch of tests and then you're going to come back and I'm going to tell you what's going to happen next." Now, that's a very instructive, directive, procedural way of doing things. And some people bring that to the table when they inquire, especially people who come from cultural backgrounds where doctors in general, including psychologist appear to be god-like. They've got all the answers, they're the experts.

So we have to be aware of that. And on the other hand, I think we have to be aware that young people watch way too many in-therapy type of programs. There's so many around, and it used to be the idea that everybody lay on the couch and whatever came into their mind, which is sort of the Freudian kind of school of things. But now it's that we've seen so many TV shows and movies and so on with various actors playing to better or worse extent therapists. So we have to try and define in plain English no more than year seven level, what we're on about.

Megan Walker: So good, and applies for all communication, year seven level website. That's a whole other topic for another day. Kaye, tell me, what are some good systems to avoid having numerous spreadsheets of different lists?

Kaye Frankcom: You see, I've actually got an aversion to Excel. In fact, I think I'm allergic to it. Although I do recognise it's a very good, obviously it's a very good spreadsheet option. And of course there are so many others, there are apps that are essentially project management apps, such as Asana and Trello and so on and so forth. All of which are perfectly fine. The main thing that people need to consider when they're going to use these spreadsheets is, who's going to look at it and make sense of it? And what happens when the spreadsheet pages or the items, for example, on an Excel spreadsheet, get to a certain point where they don't all fit on one page, or they can't be viewed on one screen? Or we've been doing this now for six months and it's not working.

So I think this is where the issues lie around, there are many practices who would have all their clients on the list with whose care plans, whose reviews are ready, due when. All of these things, and they feel very comfortable, because they feel like nothing can be missed. This is a control thing. They don't really trust the practice management software, frankly. And some of it may not be trustworthy in the sense that it's not all as a capable, not all of them are as capable as others. And so I think the question really is, because you see this constant thing on Facebook saying, "Could somebody tells such and such software company to do such and such, because it's not there, I need to be able to do this." Another person, "Yes, I agree. Yes, I agree. Is it good?" And it's like, "Do you think they've got nothing else to do, but to think about what you need, I'm sure they're aware of it, and it's probably in the works, but they all have their own processes."

So I think this is the question for people is, choosing your software system is really important in terms of thinking about this issue of tracking, of making sure that when you've got multiple practitioners, particularly, that the flags come up at the time and maybe you want a manual system, which essentially was what a spreadsheet is, even that's electronic. But I would say to you, you want to be not using that any more than you really have to. You want to have a software package that controls wait lists, controls and where it pops up when there's a cancellation pops up, so-and-so would take that time, because you've registered them. Many of the, most of them, I would say, most of the practice management softwares do have this basic facility. It's just people aren't using it.

Megan Walker: Absolutely. I've found that many times when a client, we've got a marketing thing. If we want to have this workflow and I said, "Look, I'll just ring them and find out." And you'd get a lovely tech helps you. "Oh yes, we've got a free webinar on that. Or go on to YouTube and there's someone's done a video on it." And it's just taking that next step of either asking or looking or finding or logging a job. Most of the top ones have what people need I found, but it's just been, I'm too busy, understandably. I don't have the head space, and how will we implement that change?

Kaye Frankcom: And I think it's the old adage of, "I didn't go into psychology to be an IT person. And I didn't go into psychology to be a businessperson." And I guess I say, "Well, guess what? In private practice, IT and business are basically at the, they are the foundational things that you need to have in place. And if you don't like doing that stuff, then go find somebody who does and pay them." 

Because those kind of people will be worth their weight in gold. But of course, psychologists are notoriously tight. I say this, because I know them so well, and they're my people. But I think they've been used to being, running things on a smell of an oily rag a bit and doing a lot of things for themselves and not really thinking kind of strategically, "Like if I pay this person X amount of dollars and I train them up to do it the way I like them to do it. And it's going to be one person doing my work," or whether it's in the office or wherever, then that may well be a much better outcome than you having to spend time learning the ropes if it's not your cup of tea.

Megan Walker: Absolutely. Oh gosh, you'd need to be an eight headed monster if you did it all yourself, wouldn't you? You've got to outsource, stick to your knitting and find the team.

Kaye Frankcom: Let's find the team. Have a team behind you, because practice management systems are not just the software or the apps. It's actually the people who run them, both run the systems and run your system and the integration of your system and the digital health system that they provide.

Megan Walker: Yeah, absolutely. Never hurts to send a few bottles of wine to the tech guy at the practice management software company.

Kaye Frankcom: I'll remember you, for sure.

Megan Walker: Now this is one. Kaye, have you got some good policies around the gnarly topic of client cancellations and no shows? What is fair?

Kaye Frankcom: Look, this is a values question, I want to say, because I think there are people who feel their time is valuable and people book in for it. And if they don't show, then they need to pay a cancellation fee. And I understand that. And in this day and age, having, if your optimal amount of people to see per day is six and you lose one or two of those every second day, that's quite a lot of cash out the door, or not coming in the door, put it that way. And also it can really leave you in a bit of a mess in terms of trying to manage that wait list and trying to fill those spots and so on.

But the difficulty with cancellation fees is it's sort of a blunt instrument to get clients to comply. So first of all, is this thing I'm talking about of how do you explain to people why there is a cancellation fee. And often I read stuff that says things like, "Our therapists are very busy. If there is, either in one or two, if they're not fully booked on a day and ... Sorry, if they are fully booked today and you cancel, then that is one service that they will not get paid for." 

That would persuade me to go, run the other way, not so much about the cancellation fee, but to think, "Is that what you value?" So this is my point. So, one of the things I think is being clear about the idea, that's one of the things I'll often say to people is, "You need to show and demonstrate subsequently that if people come in, you have a sense of urgency to help them as quickly and effectively as you can." So that is our driver. And then from there, we're basically mapping out a treatment plan. And we're saying to our clients, "It's going to take us two or three sessions to really be clear about our treatment plan, and then we will pursue it in this way. Given what you've told me today, I would suggest to you, we're going to need weekly sessions for three to four sessions."

It's just talking about adults, just a straight up adult client with high prevalence, depression, anxiety, stress type of problem. "It's going to take us three sessions, individual sessions, weekly apart for preference. And then we possibly will go to a fortnightly routine and then review that at about session five. And that's what we're going to be doing. So if you're good for that, and if you feel the connection with me and the way I've described what we've got to do, in the way I've responded to your, the information you sent us beforehand, which I've read thoroughly, and I hope you can hear that in a way I'm talking to you about this. And I've got a fair idea of what's going on here, but I just want to go away and reflect on it, make sure I've covered off all of the parts that are important and come back to you with that treatment plan in the next session or two.

If that's all in place, then what I want you to do is to go out to the desk and booking those five sessions, if you're willing. Worst case scenario is we get to session three and you go, 'You know what, I'm feeling pretty good. I think I can have a break. I might actually cancel the next one and just wait for four weeks.'"

Now this is a conversation you can have with the client at that time. But it basically says, "You're booked in that's our treatment plan." And if I was a cardiologist and I said to you, "I would need to see you this frequently to monitor everything and to come up with an outcome by session five with me, that would mean you, hopefully you never had to see me again." Would you sign up for that? Yeah, I would. 

All right, well feeling the same way. We're supposed to be providing in that way a specialist mental health service. 

And we don't use it as specialist, because it's a protected thing, protected title, but I think we're specialising in that extent we're at that, where in primary health care, we're actually offering that kind of secondary level. It's very confusing, I know. But just I think I'm saying to people, think about the idea that we need to create that motivation. When people walked in and make it clear to them, if they prosecute this process of the treatment plan in a frequency you've told them, they will get the result they're looking for.

"That's promising something that I'm not sure I can deliver." I guess it's like, well, I think one of the things we have to back our own capacity but generally speaking, that's the why I work with somebody with your presentation. And I think that's the whole thing that psychologists and very ... I get very tense about this. They don't like to predict or give suggestions about how long something will take. And then when people cancel, they don't really have any way of knowing why. Was it they had a better offer? In your opinion, there's no better offer than getting along to your psychologist, is there? But let's say it's a nice day and somebody rings up and says, "Do you want to go out for a coffee?" And they go, "I've got my psychologist appointment. I'll just cancel it." What brings on that attitude?

And what we've got to recognise is that's something we're not offering. It may be something in the client, I'm not saying it isn't. But we need to think about our responsibility to create that therapeutic alliance and that therapeutic connection. So that person is looking forward to and prioritises seeing us over the coffee or some other activity. And if they can't do it, they give us notice and all good.

Megan Walker: Yes, I love the respect that that creates. So you, because you've come at it from a values perspective, not an operational need, it does increase that, "Oh, I'm respecting the help that this person is giving me. So then I'm going to increase the respect of the arrangement and vice versa." Without any of the guilt of, "If you cancel this at the last minute, someone else will miss out on their vital health service." We don't need that guilt either, do we? It's, "This is the plan. Give us 24 hours notice if you need to change it." Or, and if someone's sick on the day, which is going to happen, you don't want them to come in and be sitting across from you. 

"Oh my child's got measles. I'm at home. I can't come to my appointment. No, thanks." Well, telehealth, reschedule.

 And we're not going to charge you for that, surely.

Kaye Frankcom: Well, and I guess it is without saying, at any one point in time you can waive these things. I think in a group practice, you can ask the psychologist whether they want to waive it, if it's a contracted situation. Often psychologists want to pass it off to admin, which then leads to this sort of more, what would you call, perhaps a more bureaucratic or more administrative response, which is, "Other people will be deprived of this position." And I think sometimes administrators can take on the anxiety of the practice director or the practitioner, and know that knowing that, that means that person won't have six sessions, only have five or four or whatever it is. And then they kind of are punitive towards the canceling client who then doesn't come back at all. Because they feel like, "Well, it's not fair. I've got all these people on a wait list and you just decide on the day not to come."

And I understand that, but it's again for us as leaders of our own practices to help that administrator and realise, "You might feel those things, but you need to keep them to yourself or talk to me about them." What we need to do is express something different that will actually engage people and motivate them. Because if they were people who are naturally motivated, naturally resilient, naturally capable or were in it in a circumstance where they're capable of looking after themselves, then they wouldn't be coming to see us.

Megan Walker: Exactly. Where is the compassion?

Kaye Frankcom: So let's have the compassion. Let's think about it from their point of view. And then let's be, if you like, the bigger person and think, "How am I going to express to them the reason why they need to come here and keep up with appointments at the pace that we try to sit out at the start?"

And I guess I say, that's when you may say, if the client's unhappy about the cancellation fee, so you may have a policy that says, "If you're unhappy, I will hold that back at this point, make you another appointment and you can discuss it with your psychologist." Because now some practice directors would say, "I'd rather administration dealt with it. I don't want the psychologist involved, they'll only go soft on it," which is true. And it's the same reason I had this conversation the other day with someone who said, "Oh, I think what we need is clinicians doing intake." I said, "Well, that would mean that whoever was on intake, got all the clients," because they build this therapeutic alliance with people and then they'd be full, and then that would be it.

That's not actually the skillset. I think it's got, what is the skillset? And then how do you deal with, I guess, what are human reactions related to relationships within the clinic that then lead to sometimes unfortunate outcomes for the client and for the practice eventually.

Megan Walker: Yeah. Everything starts with a conversation, doesn't it? I'm just thinking about some chats that I've had with anesthetists many times that say, "Look, we have a terrible problem getting people to pay our bill, because they don't see us. Sometimes they don't expect that it's going to be that high. That we've sat there for six or eight hours while a person had their surgery. And the first thing they hear of us is the invoice in the mail. So Megan, will you come in and train our staff on better customer service to get that money paid?" Well, hang on. I think we've got a horse and a cart issue here. All starts with a conversation, doesn't it? If you were going in for a procedure, you'd want to know, "Well, what are you going to do? What's your role? What's the involvement. Can I have a ballpark figure? Yeah, so I've signed to agree on that. I understand what's going to happen next. And okay, so there's not going to be that sticker shock when it shows up."

And I think sometimes we forget that health is going to feel like to a consumer as a rude shock when they have a different expectation, isn't it?

Kaye Frankcom: Well, it's personal. And I guess what I'm saying to, what I'll be saying to people listening to this podcast, don't take the process, excuse me, establishing a cancellation policy and then implementing it personally. Think strategically, think about it from the point of view of the client. 

And think about then how you're going to express that in a way your staff interact with them, you interact with them, your website, the forms, the whole process, because then you're going to get less of that. You have five to 10% of people who are still problematic. 

So sometimes people say, "What do you do about repeat offenders? People cancel all the time."

Megan Walker: I get that question a lot.

Kaye Frankcom: And the answer for me is, somebody needs to talk with that person about their repeat cancellation tendencies. And take again a compassionate viewpoint. "So it seems that you have difficulty keeping appointments in advance. If we keep booking appointments and you keep canceling, you're just going to rack up fees that you can't pay. And also your psychologist is going to get a bit jack of the fact that you're not there for them to pursue the treatment plan that they've set up with you, that they really care to help you with. So how would it be if on a Monday I ring you, knowing that you're," these are people often who aren't working, but a very chaotic high functioning, et cetera.

"I'm going to ring you on a Monday. And I'm going to look at Kaye's program, and I'm going to see where there's a couple of cancellations and I'm going to offer them to you and you need to choose one, knowing that once you choose that, then there will be a cancellation fee if you don't show. So we'll do it one at a time. And that will be me calling you at the start of the week to say, 'There's one 11 o'clock on Wednesdays available. Are you in?'" 

"And you need to say yes, and we need to talk about how you're going to make that happen."

Megan Walker: That's so good, Kaye, for accommodating different people's thought processes. You know, if you don't have very good short-term memory, whatever else the issues that people have.

Kaye Frankcom: You're cognitively impaired in some way because of your mood and various other things, yep.

Megan Walker: Yep. Your expertise, definitely not mine. Then why are we treating everyone the same way with appointments that are set so far in advance when some people don't have diaries and don't keep information that way?

Kaye Frankcom: Yep. I started doing that probably about two years into running a decent sized group practice. And it did me well right through to the end of doing that. So, and we had very little out of that that went wrong, except for reasons that you couldn't necessarily have known. So again, in that five to 10%, that will just always be difficult to manage. And unfortunately, and then we'll probably spend more of the time on them. And then the whole idea of 90% of the rest of them, client group.

Megan Walker: The business that we're in, hey. Kaye, wrapping up our conversation of which again we could talk for three days on, and I love talking to you. Tell us about support for front office people?

Kaye Frankcom: Yes. So a couple of things I would say that are really important about your front office people is first of all, I think we often attract people to those roles who like the timeframe that we're offering. So there's many practices offer a nine till three type of job as their stalwart, if you like of reception and then they might have students or, so called provisional psychologists, registrars, whoever, who are being paid as an administrator to do the after hours stuff. Now there's nothing wrong with that system. That said, if you can recruit somebody for whom this may become their idea of a career, that is gold. And I think part of it is if you're going to go looking for somebody like that, because you see yourself working in your clinic for at least the next five to 10 years. And that's about as far ahead as you need to think really in this stuff. 

And, I guess I'd say, don't just think about next week and the week after. Think about that two to five-year period, possibly longer. If you're 40 and you're going to do this and have somebody working for you, then you need to think about offering them the opportunity to do a practice management diploma. You need to think about offering them opportunities to do some of the online trainings that are around these days for administrators, such as some of those that you offer and there others around as well. And really giving them input that you can then talk with them about, what did you learn out of that? What did you find useful? Because they're doing training in stuff we never did training in. So there, especially these practice manager courses, a lot of them will have people doing practice management in Allied Health, but also obviously in GP practices alike.

And what can they bring to the practice from their studies? Why not give them study leave to do that? You might say, "Well, I'm prepared, if you sign up, I'm prepared to pay part of the tuition fee. And I'm also prepared to give you some study leave, which we can discuss." So I think it's really thinking about that and thinking to yourself, "How do I actually put that money into that so that it actually flourishes," and that person will be, usually if you've done the right, I guess, selection process that goes talking about high expectations along with them. But you can actually get the right person on your team, leading your team. Then that person will be hopefully loyal to you. And loyalty and trust, and having somebody who has your back, you can't pay for that, you have to cultivate it and create it. And this is a values, I guess, values discussion as well. And I've had to get rid of a few people, don't worry, out of administration.

I've had some, I've made some bad choices and they made some bad choices coming to work for me, possibly. You know, it's not always easy, but once you find that person, then you need to think carefully about what can you spend on supporting them and building their career?

Megan Walker: Fantastic advice. I love that. And this notion of, I'm getting whoever I can to fit that time, the person who will accept the rate that I'm offering, I'm often a bit shocked at the expectation of what people pay practice managers.

Kaye Frankcom: I always say, people say, "What should you pay them?" I said, "Go on the university employment sites for students and check out what they say is the minimum wage for an undergraduate person to come and do some work for you." 

You'll find it's around the $25 an hour mark. And you want to pay somebody to staff your front of, be the frontline worker for your practice, $19. It's a false economy. I do understand that sometimes people have to make shortcuts and there are problems with cashflow, but I guess I'd say, then the old fashioned overdraft may have to be thought about. You may have to have a budget that says, "I'm going to extend what I'm doing and need to take some money out of a mortgage or on an overdraft in order to do so." And then I guess in discussion with your accountant and work at, how am I going to recoup that by having that person doing that work in a much more effective way that doesn't require me to be there doing running along behind them, fixing up things they've stuffed up.

Megan Walker: Exactly. Start out with the practice of doing those automated strategies we set at that at the beginning. Until then you can fund the person and get the right person and pay and look after them properly.

Kaye Frankcom: I've got a young mental health care social worker I've been working with who I have a lot of time and regard for. Young, early career, like probably five, six years out. She spent an inordinate amount of money and time building an effective administrator team, building her practice. Her ultimate goal is not to work as much as she is to do a lot of the things many of us want for ourselves, which is hopefully get somebody else to make the money, and for us not to have to work on the tools quite as much as we do. But she knows that's quite a few years off and she's in the right place in her life to be able to do that. So if you're not in the right place in your life, then you need to think about how to modify. You may need to have to pay people to help you with this if you have a young family that you need to be with, or whatever it is. So again, it's a values story and cutting corners on either side, the work-life balance sort of process probably won't get you what you want.

Megan Walker: Yeah. Oh, Kaye, you're just firing up a couple of other really good topics there. The HR one, I'm just thinking, "Okay. Recruitment marketing, growing from one to two," that's the question I get asked all the time. Contractor versus sham, contractor versus employee, versus rent a room. If any of these are resonating with anyone that's listening in, please drop me an email if you'd like Kaye and I to do a topic on these, but also what you just said then about the time it takes to grow a business. I had someone say to me the other day, "Gosh, you're doing well." And I said, "I'm a 14-year overnight success." This stuff takes time, doesn't it? It's not magic.

Kaye Frankcom: Absolutely. I mean, I've been doing, strictly doing coaching for four years and I'd say I'm just sort of getting there and I've done training, I've done so much. I've done that as a practice, run practices and so forth as you know, and wrote the book and still I haven't got it right. I don't have all the answers and I am continuing learning new stuff and yeah, it always takes longer than you like, doesn't it?

Megan Walker: Definitely. Absolutely. Kaye, is there anything you wanted me to ask you that I haven't?

Kaye Frankcom: I think we pretty much covered it off. You gave a sort of a draft question, which was what makes an ideal front office team member? And I guess I'd say the final thing, I'd say that there are many people who are blessed with family members who work for them. And that's an interesting topic as well. So whether it's children, adult children, or a partner, and that might be one for another time. But I think like most things, it has its pros and cons, but if it's done well, it can be the making things. 

And so that's something to take into account.

Megan Walker: There are some amazing family teams out there, and then there are some others where it's just better off kept separate, isn't it?

Kaye Frankcom: Yes. Yeah, that's right. And I was very lucky at a point in time where I was really getting into this coaching stuff and I really want to get the standards of my practice schmick. I had my daughter who at the time was training to be a lawyer, come in and work for me sort of like a gap year that she had. If I hadn't had her detailed mind, which was as annoying as hell, I have to say. "You know, Mum." She always start with, "You know, Mum," but really that was very helpful. But I think it's an interesting question just how you deal with that. Because I think people often do have family members, especially doing after hours things on reception and so forth. So that may be a topic for a special group who are doing that and would like to have a bit of group therapy on that.

Megan Walker: Support group for family members, oh dear. Kaye, thank you so much as always, so good to talk to you and we will be talking again soon.

Kaye Frankcom: We will.

Megan Walker: Thank you.


Visit Kaye's website: Kaye Frankcom | Clinical Psychologist & Coach

Email: [email protected]

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