Joe Sanok 00:00:00 The group practice boss. Conference tickets are on sale now. We expect them to sell out in just a couple days. There are only 120 of these available. Head on over to practice of the practice. Com forward slash conference to read more and grab your ticket. This is the practice of the Practice podcast with Joe Sarna, session number 121. Welcome to the practice of the Practice podcast. I’m Joe Stanek, your host, and I am so excited you are hanging out with me today. Today we are giving you behind the scenes in regards to our membership communities. And so a lot of our consultants are doing teachings every single week. every Tuesday, Wednesday and Thursday we have live teachings going on in our membership. So we wanted to give you a little behind the scenes. So we’re going to be hearing from Nicole Ball talking about what to do when referrals are slow. HR basics with Andrew. Client retention with Ashley, scaling with Nicole Ball choosing the right project management systems, and all sorts of other things over the coming weeks. Joe Sanok 00:01:15 I can’t wait to dig into this with you. If you want help from one of our consultants, please head on over to practice of the practice. Com forward slash apply. I’ll chat with you for 30 minutes to determine if one of our membership communities or consulting might be right for you. Now let’s get started with this episode. Ashley Mielke 00:01:32 Hello, everyone. Hi, Sabrina and Esther and Kathryn and Michelle. So nice to see you. Thanks for joining us today. I’m very excited about, the three part series that we are starting on client retention. And this is really only been something that I’ve been paying attention to, like, more thoughtfully. And, actually looking into and looking at strategies on improving. Honestly, this last couple of months in my business and I thought, this is a really great opportunity to share with the group practice boss community what I’ve been working on as a business owner and how how actually important this is in our businesses, whether we are a team of one or we are a team of 50, it doesn’t matter. Ashley Mielke 00:02:23 And the bigger we get in our practices, the more important it becomes. And really, staying connected month to month on how we’re doing in terms of our retention as a clinic and with our employees or contractors. So before we get started, I always like to to ask our community about one recent win in your business, something that you are feeling really excited about. You’re proud of something that’s happened this past week that you want to share. If you want to pop it in the chat, that would be wonderful. It’s a great time to celebrate each other and really just give life to what you’re doing right now in your business. I see, I see fingers typing. Sabrina hired my third clinician and second intern starts next week. Congratulations, Sabrina. That is amazing. It’s been a great pleasure watching you on your journey over this last year. Milo. Oh, would you please repeat the prompt? The prompt was, and thanks for joining us, was one recent win in your business that you want to share with the group? In the chat, Katherine just started offering short term disability benefits to clinicians. Ashley Mielke 00:03:44 That is amazing. Katherine, how many people do you have on your team? Curious. we have 11 clinicians. Amazing. Look at you. That is wonderful. Congratulations on that, Heidi. Getting close to onboarding several associate licensed staff. Yes. Congratulations, Heidi. That is so wonderful. It’s great to start to see the traction in your business when you start hiring and how it kind of just, like takes on a life of its own once you get those first couple clinicians hired. April, I hired my first clinical supervisor. That is amazing. Great addition to the team. Thank you for sharing, Michelle. I have had three people reach out to intern with my group practice in the last two weeks. That’s amazing. Hopefully you find a great fit. Or maybe you’re looking to hire more than one person, Michelle, as an intern. So that’s great. And Milo bringing on a practicum student this summer. Awesome. Congratulations and Esther, I’m excited about an intern starting in the fall. So a theme around interns, which is great. Ashley Mielke 00:04:48 It is that time of year and there’s just so many benefits to training, mentoring, and then hiring after they graduate. And you know, it’s always great if you can find the right fit and someone who sees themselves growing with your practice. It’s a great funnel for new hires, something that we have done historically as well in our business. Well, thank you all for sharing. So glad that we’re here. So we’re talking about client retention. So before we dive in, I’m curious what you know about client retention, why this would be important, why you’re here today attending this live webinar. And you can just unmute yourself if there’s anything that you would like to share contribute. Before we before I share my screen, anyone. Speaker 3 00:05:35 I was just going to say, I think, if you have any ideas. I think what’s so challenging for me is having kind of pre licensed therapists on board and building up their confidence, and you see it in how their their client retention shows up. and that’s a tough period of time to to kind of have clients maybe stay or maybe not stay as the clinicians, building their confidence and feeling good about setting some limits with scheduling and really kind of seeing themselves as an expert and, someone that can support the client. Speaker 3 00:06:13 so that’s always been my challenge. I think it just kind of that period of time before the clinician really starts to feel like they’re good to go, and they can really start making some suggestions and, getting their clients to stay pretty consistently. Ashley Mielke 00:06:29 Yes, I love that. That’s such a great question. And great, just even concern to bring forth. Who else has felt that or experience that? I know I can certainly relate, April. And this is such a big part of the leadership and mentorship that I have with my team. So I am so right there with you next week. Okay. Next Tuesday, the part two of this series, we’re going to be focusing all on these key conversations leadership, mentoring, building up our teammates to improve them in their individual practice within your business. With my business coach and consultant Kristen Edmiston. So she this is like her jam. This is her background. So she is joining us next week to talk about all of these things. April. So I hope that you are able to join live. Ashley Mielke 00:07:17 Okay. anyone else I’ll hop in. Hi, Michelle. one of the hi there. One of the things I’m seeing, Speaker 4 00:07:26 I why do I do this? I think I assume that this I have in the past assumed that this is just part of the package, and what I’m just seeing is it’s for some people, the way they’re wired, it’s it’s naturally easy. and they, they have a ready set, they have ready made set of skills that they can apply to this. And I feel like they just are flourishing. And other clinicians really do need to be, held by the hand. And we need to teach them how to do this. And I think the gap on that has been a little surprising for me. And so, yeah, I’m it’s just more of an observation that I’m seeing with some of the people that I’m working with. Ashley Mielke 00:08:05 Yes. again, it’s like one of those things that we don’t quite anticipate. Or maybe we’ve been so great at building our solo practice, and then we start a group practice, and we assume that everyone we hire is going to have that same level of skill set and personality characteristics, like, I really think and I’ve had this conversation with my leadership team, you have to have a certain personality and flexibility to work and be successful in private practice. Ashley Mielke 00:08:34 It is not working at the community nonprofit, right? It’s not working in a hospital setting. Being in private practice requires a certain level of skills. So even when we think about hiring and onboarding that initial interview process, their experience, do they seem like a fit for someone that would work well with clients and private practice, where they can really sell themselves and be confident is so important, and maybe they’re the right person, but they don’t have that experience yet, so helping them build up that confidence. yeah, it’s it’s definitely a part of business that’s really important. If we want to leverage the intakes that we do get and keep those clients like it costs money to market and acquire a client. And everything is so expensive right now, at least, like we think from a Google marketing perspective. We did the math. I think it was we used to acquire client for like less than $20 per client, but now it’s like closer to $30 a client for us in our business. So if we’re not retaining those clients, that’s costing us a lot of money. Ashley Mielke 00:09:42 So this is why this conversation is really important and things that we want to get ahead of, before we get too big or where we’re kind of throwing our money away to marketing and not keeping those clients. Hi, Barbara. Nice to see you. Okay. Good to see you, too. Thank you. Thanks for joining. Okay. So I am going to share my screen. Hopefully everyone can see this. Okay. If I flip the slide, can you see it change? Does someone say yes or no? Okay. Okay. Perfect. So I will do it that way okay. So the basic definitions of client retention what are we actually talking about. So this is the likelihood of a new client returning to work with a therapist okay. So what is that likelihood. The percentage of a new client returning after they have done their intake. And then the other perspective is the number of total and repeat visits with a therapist. And overall as a clinic during a certain period of time. So whether you’re looking at month to month, what is the the total visits and repeat visits of a client. Ashley Mielke 00:10:51 Or you’re looking at 12 months. When I am looking at client retention, we do a month to month report. I have my administrative team do a report for every single therapist and the clinic in general. But then it’s also important when I see that a therapist, there’s maybe a low retention. I like to do it over an extended period of time. That’s important. So we actually gauge what is going on with clients, especially for those total visits, because there might be it might seem like low retention if someone’s getting a lot of new clients, but they haven’t rebooked within that period of time. So if I’m looking at a 30 day window, and they’ve had seven new clients and none of them have rebooked within that 30 days, it looks like their retention is 0%. But really, if we extend that over several months, we will see that they have returned outside of that 30 day Window. So we have to also take a look at the context when we are measuring and tracking client retention. So here are the basic things we want to look at in our business. Ashley Mielke 00:12:01 We want to track these I do it every single month. And I look at it from an annual perspective as well. So how many new clients are booking first of all right. How many new clients are actually arriving into your business. So we use the EHR called chain. I highly recommend it. It allows you to see how many, new files, client files have been created. you can look that up in your reporting, but you can also look at on a day to day basis, how many new clients have arrived versus return clients on a day to day or month to month? And then you can even do a comparison month to month as well. And are you satisfied with the number of new arrivals. You know, that’s kind of another conversation around marketing. But we can have a smaller number of new clients. If we have a really high retention, then we we need less new clients coming into the practice. Right. This is why this is important. The second point here on return visits, how many new clients are actually rebooking. Ashley Mielke 00:13:11 So if we’re getting a bunch of new clients, but they’re only coming in for one session and never returning, that’s a problem. We want to get to the bottom of. If they are returning. That’s wonderful. How many of those are rebooking? Hopefully 100% of them are rebooking. That would be ideal. Total visits is how many times the clients have attended overall over a certain period of time, and then revisit repeat visits is how often our clients returning for sessions. So is that a weekly? Is that bi weekly? kind of some different trends that you can look at in your business. And again, I made a note here. Some EHRs like chain, have reporting capabilities that allow you to determine the percentage of total visits and repeat visits during a particular reporting period to determine a therapist client retention. So if you don’t have an EHR that measures and tracks this very easily for you, and you have a smaller team, you can do a quick gauge of their schedule. And I actually encourage you to do that if you haven’t already done this and you don’t have reporting capabilities in your EHR, go to your therapist calendar. Ashley Mielke 00:14:21 Look at the new intakes that they’ve had. Even do it over the last like three months. How many new clients have they gotten and track how many visits that client has had, and how often are they rebooking? Is that a once a month? Is it every two weeks? You can even create a little Excel spreadsheet to get exactly what that retention looks like for each therapist and, and then look into your EHR to see if they do have reporting capabilities. Or as you grow, you do want to consider having an EHR that allows you to look at reporting as your business grows. Because if you have, you know, I would say even over 5 or 8 therapists and then definitely anything above 10 or 15, it becomes too complicated. You have too many clinicians to be able to track these things on an individual basis, and you’re just booking too many sessions. So definitely something to start to think about right away. Does anyone have any questions about these numbers, these kind of basic numbers to start to measure and track. Ashley Mielke 00:15:29 And I can’t see anyone. Just so you know, when I do share my screen, all I see is the PowerPoint. So you will have to unmute yourself if you do have any questions. Okay. Great. Let’s keep going here. So now we want to look at well what is a good retention? Every practice, I think, will be a little bit different what your expectations are. Our expectations are quite high and I also think they are reasonable. One way to get an idea is really figure out what your retention is as a clinic right now. If it’s very high, then that gives you an idea of what you can expect of your clinicians. If it seems a bit low and it’s something you really want to work on, then think about what is that kind of percentage range that you would like it to be at. So I gave an example this. The acronym here is for my business the Grief and Trauma Healing Center. The overall clinic retention month to month is between 91 and 94%, which I feel like is really outstanding because it allows that normal room for clients to drop off because they have gotten exactly what they’ve needed from therapy. Ashley Mielke 00:16:42 It’s that natural termination of services. It could also be a financial barrier. Someone moves. There’s all sorts of reasons why a client might not return. so I’m very satisfied with that. And the minimum expectation that I have of my clinicians is 85%. Again, that’s giving them lots of room to work with those, different reasons why a client may not continue. So when I look at this month to month, if there is a therapist that is repeatedly not performing at that 85%, I have conversations with them. And this is something we will talk about next week about what are those conversations we have, how I support them, and really getting an understanding of the context of why there might be a struggle with retaining clients at the level that we expect. And then if it continues to be a long term issue, that’s a whole other conversation around possibly not renewing a contract or letting someone go if they’re not performing at the level that we require and expect them to in our business. Does anyone have any questions about this or you’d like to comment or share? if. Speaker 5 00:17:55 You set your expectation to or to be, the retention should be, you know, if a new client, have eight sessions or more, as a retention number, how do you calculate the percentage? Ashley Mielke 00:18:13 So, yeah, that’s a really good question. I don’t know what that how would we directly. Yeah, that’s a really good question, Barbara. For like a manual calculation, we’re talking. Yes. Yeah. Speaker 5 00:18:27 I mean, you got your 91% and 84% from Jane. Yes. Oh, okay. Okay. Ashley Mielke 00:18:34 Yes. So that was calculated. And that’s a great question. I know in Jane there’s a whole blurb on how they calculate. It’s like total visits divided by repeat times 100. I could pull up the calculation and share it, in circle of how they calculate, a total visits retention versus a repeat visits retention. So stay tuned. I will follow up after the webinar and post that in circle. Speaker 5 00:19:01 Thank you. Ashley Mielke 00:19:02 I’m just making notes so I do not forget because that would be important especially if you’re doing it manually. Ashley Mielke 00:19:08 Yeah. Great. So that will that will answer that question if anyone else was curious about that as well. So then once you kind of determine that you can look at what your expectation would be in, and maybe it’s 70% like, I know when we kind of when I wasn’t really digging into this with Jane before, I sort of had an idea that I felt comfortable with anything between 70 and 75% as like just something in my head. I’m like, you know what? That feels reasonable. And then, when I actually dug in to how we’re actually performing as a clinic. And because we are doing so well, like our clinicians are performing so optimally. I thought 85% was more than reasonable as an expectation, given how most of the therapists are performing. So they are performing in that high mid to 90 range, most of them. Okay. So now we’re going to look at these are so good. And you might be doing a lot of these things already. If you’re not these are going to make a difference in your business. Ashley Mielke 00:20:09 So these are administrative tips for improving client retention right away without even having those conversations with your therapists. Number one, it is so important that we turn on our online booking for new clients and return clients. This is this is often a hesitation that I experienced with my one on one consulting clients and have also seen in the group practice, launch and group practice. Boss communities around. There’s these fears and hesitations of turning on the online booking, because maybe you have a process where every new client actually does a phone consultation. First, we want to make sure that they’re fit. We want to make sure that we can address their presenting concerns. All these big, these big, very important aspects of our business. And yes, they are important. But as we grow, that is going to become the bottleneck in your business. If we have to have a phone call with every new client, what happens when you’re when you’re doing 100 new intakes a month, how are you going to manage that? How is that scalable? So we need to start thinking in the mindset of scalability. Ashley Mielke 00:21:25 If I want to scale my business and my intakes, I have to set up operations and processes that allow for scalability. This one is very, very straightforward. The one way that we have helped to minimise issues around, say, booking with the wrong person or someone not being maybe a fit for what they’re looking for. Or not, not knowing about our third party billing with insurance companies is directly on our Jane booking page. We have a whole list. It’s this long. It’s like ten different points that we say. Please read this before booking if they choose not to. The onus is not on us. It is on them. If it ends up being someone we have to prefer internally, or maybe they they realize they can’t pay out of pocket or whatever the case. It doesn’t happen often though, so we put all of the important points that someone needs to know before booking. They book with their therapist. We do require credit card on file at the time of booking for the case of a late cancellation or no show, and that has been worked beautifully about, on average, 30 to 33% of our new intakes every month come from online bookings. Ashley Mielke 00:22:37 Write their booking at night. When administrative is not available, administration is unavailable. They’re booking on the weekends. They are. They just prefer not to talk to anyone and so they just do it themselves. So if you do not have online booking turned on, I do highly recommend this for those reasons. This is going to, just improve that intake process, make it more streamlined and encourage new clients to join your practice. If you don’t have that, they might. Someone might say, you know what, I want to work with a practice that has that ability. I’m going to go somewhere else, and that is not what we want to happen. If you do have any questions about the things that I’m sharing, please write them down. We’ll go through the clinic tips first, and then we’ll open up for questions, and then we’ll talk about some of the therapist tips for improving retention. Next. Joe Sanok 00:23:38 As a therapist, I can tell you from experience that having the right EHR is an absolute lifeline. Joe Sanok 00:23:44 I recommend using therapy notes. They make billing, scheduling, notetaking, telehealth, and e-prescribing incredibly easy. Best of all, they offer live telephone support. It’s available seven days a week. You don’t have to take my word for it. Do your own research and see for yourself. Therapy notes is the number one highest rated EHR system available today, with a 4.9 out of five stars on Trustpilot. Com and on Google, all you have to do is click the link below or type promo code Joe on their website over at Therapy notes.com and receive a special two month trial. Absolutely free. Again, that’s therapy notes.com and use promo code Joe on the website. If you’re coming from another EHR therapy notes will also import your demographic data quick and easy at no cost so you can get started right away. Trust me. Don’t waste any more of your time and try therapy notes. Just use promo code Joe at checkout. Ashley Mielke 00:24:44 Second point here. Turn on automated reminders. You probably already have this. It’s built into most EHRs, but it really is a game changer. Ashley Mielke 00:24:54 This can help reduce missed appointments by 25%. So we have every reminder set. We have the 72 hours, the 24 hours and the three hour. So we have like I think it’s like nine different reminders going out because it’s text and email. So we have like we have nine different reminders and it’s it can feel like it’s it’s overkill a little bit. But our clients do appreciate it. And if they don’t like it, it’s too much. We can just go into their profile and change it. If they say, you know what, I’m good with one. I’m good with the 24 hour, then great. But this is a really great way to minimize those missed appointments and to improve our retention. Turn on automated wait lists if you have that in your EHR. Jane also offers that as an option. So when a client is added to a wait list for a particular day when there’s a cancellation in Jane, the waitlist is, automatically sends out that there is the option for for booking for that day, which can also help to, just improve retention and also that that return visit for those clients that are looking to get in. Ashley Mielke 00:26:12 Okay. So look and see if that is something your EHR offers. If not, you can do a manual waitlist. If you have an admin person and they have a waitlist going, then that is something they want to execute every single day. How can we make sure those therapists, calendars are plumped full when there’s cancellation? Boom. Go to the waitlist. get those clients in. Another thing, send a return visit reminder. If a client cancels or is not able to rebook right away, Jane allows us to just click of a button. Send a return visit reminder to reschedule. You can also do this manually via email as well. So if a client is not able to rebook because they have to look at their schedule or if they cancel, we always, always follow up. This is a really great process for improving retention and getting those clients back in the schedule. Another thing that we do is follow up with cancellations received via voicemail and email if they don’t have any future sessions booked. So when a client calls, it’s maybe they call in, they’re sick, they can’t attend the visit today or they’ve cancelled. Ashley Mielke 00:27:21 They’ve got appointment in a couple of days. We have our administrative team follow up immediately with them in an email and a voicemail with upcoming times Time’s available to reschedule if they don’t have any future sessions booked again, it’s that helping reduce the drop off of these clients and getting them back in the schedule if they’ve had to cancel for whatever reason. Other clinic tips to consider track email enquiries to ensure follow ups are conducted for those who don’t book in right away. So this has been awesome. We started this I believe it’s about three months ago now. So what we do with every email inquiry that comes in, either through the contact page or is a direct email, the contact page on our website or a direct email is we have a Excel tracker. We put the name, the email, what email? It came through because we have more than one location and the date that the inquiry happened because they always are. Admin team always responds with the information they’re asking about, right? They’re asking about do you work with children? Do you do eMDR therapy, whatever the questions are. Ashley Mielke 00:28:33 We follow up with all the information. But then what happens? We don’t always know who’s actually following up to rebook after that inquiry’s been responded to. So then on our tracker, what we do is we have a follow up date, which is, a week later after the initial inquiry. And we do all of our follow ups the following Wednesday. So we’re like kind of streamlining it. So every Wednesday we follow up from the previous week’s inquiries where they will check, they will look and look up the email. They will look to see if the person responded and either booked in, maybe they didn’t respond. And then we follow up with another email if they haven’t already booked to say hey, just checking in. Wanted to see if you’re still interested in booking. Then three weeks later on our tracker, after we put the follow up date, we follow up again to see if they’ve rebooked or not. We don’t reach out again, but we do make a note that says either booked or not booked. Ashley Mielke 00:29:31 When we started doing this over the last couple of months, we have had an increase of it was a believe, 25% bookings just by following up. So had we not followed up, we may have not got those new clients in one month. We had gotten, I think, seven new intakes just from this follow up process, which is pretty outstanding. So we’re not paying for extra marketing. We are simply just following up because people get really busy or they forget whatever the situation is, and they often appreciate us following up to say, hey, you know, remember us? We connected. Are you still interested in booking? And then the booking happens. So I definitely recommend you start this, this process as well. The next point tracked first visit cancellations to encourage them to rebook so that can go with the can. You know when someone cancels. But first visit cancellations, a lot of people do them online. We find like they’ll get the the appointment reminder from Jane and then they cancel it. Ashley Mielke 00:30:37 And what happens to these people. So these people set up a file. They were going to be a new intake for us. They were set to arrive and for whatever reason they cancelled. We have our administrative team, they have an Excel spreadsheet. We do the exact same thing with our first visit cancellations. They are listed in Jane, so we can track those easily, to encourage them to rebook. Another tip that’s something we might not even think about is ensure your office is easily accessible with clear directions and instructions for parking. If it’s really tricky to get to your office. If parking is terrible, they don’t know where to park. It doesn’t feel like I, you know, the accessibility wasn’t great. Maybe they’re not going to return. Maybe it felt too stressful the first time coming to your clinic. So if you have it very clearly laid out, how to access your building where the front door is. Again, it depends on how it’s all set up. where they park, where there’s free parking that is going to make their experience very positive and hopefully encourage them to return. Ashley Mielke 00:31:45 Design your office space for warmth and comfort. Again, it’s like that client experience is really important. We’ve talked a lot about this in group practice, boss, over the years around, really setting up your space that’s inviting and encouraging and is a place that your clients feel really safe and connected. So make that experience really positive from that. Second, they walk into the door and they’re greeted by your administrative team or greeted by another therapist. you know, having beverages that can have a cup of coffee or tea, maybe you have some nice music playing and maybe have some, you know, essential oils that they can smell, you know, really making that an inviting space for them can also help with retention. So I’m going to pause there before I move on to the therapist tips. I would love to just hear your feedback on that. Questions. Anything you want to contribute that you’ve done that could also help the group practice boss community. Speaker 5 00:32:47 I have another question. Hi. Yes. When you say that, you have your sign that one day so your office manager can follow up on people who can. Speaker 5 00:32:58 So, if they want to reschedule. So if you have, you know, like five clinicians and people are canceling either online or through email or through text, how they gather all that and make sure that they, they, then going over every cancellation so they can follow up. Ashley Mielke 00:33:23 They just do it right away. They would get it done that day. Speaker 5 00:33:27 And then just they just put it on the list. And then on a Wednesday they. Oh yes. Ashley Mielke 00:33:33 That is only for email inquiries. We do that. Speaker 5 00:33:36 Oh okay. So only for email. Got it. Okay. Thank you. Yes. Ashley Mielke 00:33:40 You’re welcome. So cancellations we do follow up right away. First I get them to look in Jane see if they have a future booking. If they already have a future booking we don’t bug them. If they don’t, we follow up. Yeah. You’re welcome. And it’s really helped. Like we, for example, even on our, like, a slower month. Like, what if we haven’t arrived? On average, we get over 100 new files created in a month, but about 75 arrive. Ashley Mielke 00:34:09 Okay, so of those hundreds. So we’re like, we don’t really know what happens with those extra files that are created. but when they arrive. So we do that. But then when we do these other small things, like following up with the email inquiries, flying with cancelations. It makes a huge difference in terms of how many sessions are actually, I guess performed, if that’s the word we want to say by the end of the month. So we do over 700 sessions a month. We only have about 75 new clients a month. So it’s like, you know, we could focus on getting a lot more intakes, but we don’t need to. Our clients are our therapists are full for all these little steps and also just ensuring that they are performing optimally as well as clinicians. You’re going to save money in marketing. That’s a big thing. And we’ll talk more about return on investment in our third session of this series. Speaker 5 00:35:02 And then when you follow up on the emails, you follow up, through email as well, where you have them call. Ashley Mielke 00:35:09 We do follow up in email as well. Yeah. Yeah. It’s game changer. Such a small thing that makes a big difference. I have a. Speaker 6 00:35:18 Question about turning on the online booking. Yes. When you say that, is that are you saying for first sessions or for consultations or for both? Ashley Mielke 00:35:28 Both. Speaker 6 00:35:29 Yeah. Okay. so, so like you’re saying for your clinicians, you have it so that anybody could book a first session if they wanted to. Ashley Mielke 00:35:38 Yes. Speaker 6 00:35:39 So a question about that, like how do you I have, I have online consultations turned on for people to do or for consultations. But some of the reasons I’ve been hesitant to, or my fears that I’ve been hesitant around turning on people, being able to book first sessions with clinicians is like, what if they don’t fill out their paperwork? Or what if they just don’t show up? And that’s like an hour, I guess, of of the clinicians time that’s, you know, what do you do with that? Do you pay them for that hour? What are you. Speaker 6 00:36:06 So I don’t know, I guess a lot of questions come up when I think about the logistics of letting people come in for a first session without talking to them first. Ashley Mielke 00:36:14 It’s a great question, and thank you for asking that. So what we do is we have our admin. So okay, so say it’s a Monday. One of the first things that on a Monday task that we have our administrative team do is look for all the first visit. So on Jane, it says first visit on the little block for the new client. They check to see if the forms have been completed. If they haven’t, they reach out and encourage them to do that, okay. And say, hey, please remember to fill out your forms. It’s going to save you time. If they don’t, that is something the clinician will do with them during that first like 15 20 minutes. And really we just say like it’s it’s their loss that now their first session is cut in half because half of it’s doing paperwork and it’s not really our problem. Speaker 6 00:37:00 And they just do that on their phone right there in the session. Okay. Ashley Mielke 00:37:04 Yep. And we really just encourage the client and say you know what. This is your hour. It’s really important you get that done. If not you’re going to waste some of that time doing that with your therapist. And it is what it is. Speaker 6 00:37:18 Interesting okay. Ashley Mielke 00:37:20 Yeah. And it works really well. Like we put the responsibility on the, the client and, you know what? We do what we can to get that out of the way. But as we know, it doesn’t always happen. Yeah. Speaker 6 00:37:34 No, I appreciate that. I had I really considered no, just make them do it in the session. So I appreciate that feedback. That seems like a solution to what I was being a complex problem. Ashley Mielke 00:37:45 Yeah, absolutely. And one thing we do not advertise is phone consults because we find that people will they will sort of a crutch for them to not commit. So we offer them but we don’t advertise it. Ashley Mielke 00:38:00 So only if someone calls or emails and says, you know what, I’m really interested, but I really would like to have a phone consult, then we will set that up, but we don’t have it as an option for booking. Speaker 6 00:38:13 Okay. Thank you. Ashley Mielke 00:38:13 Something to consider for sure. Great question. Thanks for asking. Speaker 5 00:38:18 Piggybacking on Corey, would you mind to just put it some kind of a structure of, you know, like a before you book online statement type, on circle as well? Ashley Mielke 00:38:29 Yes, absolutely. I can I can just like copy and paste what we have. Of course, it won’t apply for your business, but you can kind of get an idea. For what? Like there’s certain sections we won’t allow for online booking. Like we don’t do child bookings because we do parent consults as the first session so we don’t allow them to. Bill. sorry to book online for child sessions. Okay. we’ll. Speaker 5 00:38:55 Never think about that. Ashley Mielke 00:38:56 Yeah, because we always do a parent consult first. Ashley Mielke 00:38:59 And we need to get as we know, we have to get informed consent from all the parties. So we only do it for adults and couples, but we have that very clearly labeled. So I will I will I will share that. Speaker 5 00:39:11 Thank you so much. Ashley Mielke 00:39:13 Okay. And of course you don’t have to implement all of these things all at once. you’re probably already very busy and very full in what you’re doing now. But if there’s even one thing from this list that you could implement right away and then kind of build from there as you get the administrative support, because some of you still might be doing most of the admin in your business as well, which can make it challenging. If you do have an admin and they’re not that busy, maybe it’s like, great, now you can really fill their time by taking on a lot of these tasks for you. Okay, let’s go back to the PowerPoint here. Now we’re looking at therapist tips for improving client retention. Now again as I mentioned next week we’re having more of that in-depth conversation around the person of the therapist, improving their confidence, building their confidence and private practice. Ashley Mielke 00:40:06 This is focused more on the administrative side okay, that we can quickly share with our therapist today without having those in-depth conversations as a way to improve their retention. First one. Again, some of these things might be very obvious, but they’re not obvious. This is why we want to talk about them and share them with our team. Try to accommodate clients availability as much as possible when rebooking. If a therapist availability doesn’t work for a client, they’re probably not going to have that client return or return as frequently. Maybe a client says, you know what? The lunch hour every other Tuesday works perfectly for me. Let’s try and get them in at noon every other Tuesday and pre-book. So I’ve got here the second point. Pre-book those sessions in advance. If they say only evening works on Thursday nights. Okay, what can I accommodate this client or do we have a therapist that can best accommodate this client? Or maybe telehealth sessions work well for them, so really do our best to accommodate them. And that second point pre-book future sessions whenever we can. Ashley Mielke 00:41:18 So we do grief and trauma therapy at our center, so we know that a client is going to be with us at least ten sessions. Most of our clients are with us for over 30 sessions, depending on what they’re working on. Okay, so it’s not uncommon, like if I’m working with a new client and say I’m working through the Grief Recovery method program with them, I will pre-book seven sessions right away. That holds them accountable. It gets them, in this schedule during the day and time that works well for them. Also being very mindful of what my availability is of course. But then there’s that accountability and it’s already in when a client is hesitant after an initial session regarding their treatment goals, which can be common. And this this I think is really good for newer clinicians. you know, a therapist might say, okay, well, you know, thanks for coming in. And you don’t really know if this is going to work for you or this is a fit. Well good luck. Ashley Mielke 00:42:19 Like if you want to rebook, just call the office. While a handful of those clients are not going to come back, they might not think that the therapist is very confident in what they’re offering. They might not be familiar with therapy. They might not know what to do. Sometimes, as the therapist, especially in private practice, we have to, step in and really encourage them and say, here’s what I think would actually be best for us moving forward. So what I would do in this situation, and what I encourage our therapists to do, is to rebook a follow up session in two weeks. So, you know what? Yeah, think about what we talked about today. We’ve discussed a couple of different treatment options. We kind of were you know, we’re thinking about what your goals are for therapy. Go home. Think about it. Sit on it. Let’s come back together in two weeks and let’s see how that feels. Let’s see if we have a bit more clarity about where we want to go. Ashley Mielke 00:43:15 Great. Very simple action to take with a new client to improve retention. And then hopefully, you know, hopefully they’re hooked and they’re ready to start to execute on their therapy goals. Next point here try to accommodate clients financial circumstances if possible by offering a sliding scale or spacing out sessions. It’s good to again, this is going to be different in Canada. It’s a little bit different how we do things with insurance. we might know that an insurance covers $1,000 a year, which isn’t a lot of money. Or maybe they cover $3,000 a year, or maybe it’s, 80% per session, unlimited sessions. It’s good to know what their insurance company will cover so that they can get an idea of like, okay, I can afford to come once a month. Perfect. Let’s work with that. Or I can afford to come as often as I want or maybe finances aren’t an issue. I don’t care, I’m paying out of pocket. This is important to me, but get an idea of what you’re working with so that our clients aren’t dropping off early because they can’t afford it, or they’re really overwhelmed by the cost of therapy, or their insurance is ran out very quickly. Ashley Mielke 00:44:30 Okay. And if possible, sometimes we need to make maybe we offer a signing scale, right? All of our therapists do offer a sliding scale, very limited case by case basis. But we also have interns and we also have mental health therapists that offer reduced rate. So sometimes making that internal referral is something we can consider as well. Very obvious, but really important. The next point here ensure treatment plans align with your client’s goals. Again, this goes to what are those key conversations that we want to have with our therapists around their approach and understanding a client’s needs and goals, and ensuring their treatment plans match so that it’s a value to the clients when they’re coming to your practice. Help your clients set realistic, realistic expectations for therapy. I mean, sometimes people think they’re going to come for 1 or 2 sessions and their life is going to be changed forever. I mean, that would be a really a miracle if that were to happen. but we want to be realistic in what we offer and what the process of therapy looks like and the ups and downs of that journey so that they know what they’re committing to embrace client feedback about their experiences. Ashley Mielke 00:45:46 Some clinics have feedback forms after every session. or it could be that, maybe it’s just a verbal conversation, right? How how is this process going for you? Is there anything I could do better, different, more to support you as your therapist? really take their feedback seriously because that is also going to improve on rapport and retention. And as always, attend regular consultation meetings for clinical support. If you aren’t already doing that in your group practice, I do encourage you to have weekly or bi weekly, or maybe you can only do it monthly. Right now we do bi weekly team consultations online for the team to attend for free. It’s a part of being in the group practice. We are a contractor based practice, so they get to attend and not pay for that. And our clinical directors facilitate. The team consults every two weeks as a way to just continue to hone and nurture those skills. And of course talk about difficult cases. So I will stop there for a moment. Questions, feedback, ideas that you’d like to share with the group. Ashley Mielke 00:46:58 Thinking about some of those kind of basic ways that therapists can help improve their retention. Speaker 3 00:47:05 I have never. Speaker 4 00:47:06 Tracked. Speaker 7 00:47:07 Like retention, but I know that within my practice, a long time ago. I actually started doing a lot more reoccurring sessions. so I give them this is like their time that they have in my schedule. and I found that it was easier for them to remember that their appointments are always on Tuesday, every other week or every week at the same time. and that really does help when our clients are so busy. There’s so many things like to try to keep track of that appointment is hard. and so that was a huge piece that I started doing. And I’ll even notice if like something comes up and we have to, like, skip a few weeks because my schedule is off or theirs is, they’re more likely to miss that, that following session. Yes. And then I would also like encourage for like the rebooking when they’re not quite sure what’s going on or what’s happening. I would always tell them, like, listen, I’m okay with a cancellation. Speaker 7 00:48:01 Like it is easier for us to like book right now in you to reach out and cancel. Like, I’m okay with that because sometimes people feel bad that they’re canceling on you, and I just kind of give them that. Permission of canceling on me is fine. that’s helped too. Ashley Mielke 00:48:19 That’s a really great point. Thank you for that. Yes. And they feel less pressure that. Okay, I can go I can rebook. And if I do need to, to cancel that, that’s okay. I love that. That is so good. Thank you. Speaker 8 00:48:34 I appreciate the, the thoughts about challenging beliefs related to opening up online scheduling, because I know that’s certainly been a hangup of mine. the bottleneck, you know, I hadn’t thought about what the implications of that would be down the line. another kind of example, though, of, to build on what Esther said about, clients who were hesitant. I picked this up when I worked at the Department of Veterans Affairs because there’s a lot of treatment hesitancy. Speaker 8 00:49:03 There is. I’ll just propose, like, why don’t we why don’t we schedule four sessions? Right. And why don’t we decide, like together? How will we know if this is helpful for you and for sessions? That way they’re not locked into this, like, unending process. they have a clearly defined way of knowing if it’s helping for them. And it also gives them time to build some rapport as a clinician and help them to get a little bit more buy in if they’ve never been in therapy before. I’ve found that’s been really helpful for retaining clients who are hesitant. Ashley Mielke 00:49:40 Oh, that is so good, Milo. Thank you for sharing. I love that and even just managing like, hey, this chunk, this chunk of sessions, this chunk of time is all I, all I need to kind of think about. I don’t have to think about six months a year from now, ten years of therapy, which could seem so overwhelming. It’s just four sessions. Love that. That is so encouraging. Ashley Mielke 00:50:05 Would anyone else like to share? What I do encourage you to do today is one pick one thing we talked about, one thing you’re not already doing, and implement that into your practice. Or it’s a small changes lead to stunning results. That’s a quote by Robin Sharma, one of my favorites. Something like that or small steps lead to stunning results. And it’s like those little things that we add and become a part of our practice of our, our procedures. And, that can really make a big difference. Okay. And I think I had one more slide here that I will share. It says part two of the series will explore how to engage your teammates in a way that encourages and empowers them in their capacities to build reports, clients and improve their retention rates. We will have a special guest joining us. So that is, as I mentioned earlier, Kristin Edmiston will be joining. She’s amazing. You will absolutely love her. She’s been a group practice boss, speaker in the past a couple of times. Ashley Mielke 00:51:10 She’s wonderful. And, I can’t wait to see what comes out of that conversation. around leadership and mentoring our teams to become the best clinicians they can be and be really successful in their practice within your business. Are there any other questions or anything else while we’ve still got time today before we wrap up. Can I ask you if you already know what this thing is going to be, if you could put it in the chat? One thing that you are going to integrate into your business right away, just so we can see it, just so you have that accountability. And I’m very curious. I want to know okay. Yes. Online booking Barbara such a game changer Sabrina. Online booking return visit reminder. Yes Michelle. Great Heidi, I need to do more training more and training my team on some of the ways as a clinician to retain clients. Beautiful. I think we all need that. I feel like that’s an ongoing journey. So I’m right there with you, April. I’ll do some research on online bookings since we were primarily with kids and families. Ashley Mielke 00:52:21 Okay. See if we can find ways around that. April. Thank you, Emily and hello, Emily. Thanks for joining. I’ll train the clinicians to book multiple sessions at a time with their clients. Yes. So good. I really hope that you implement these right away and start to see that return on investment. Milo. Develop a tracking system for inquiries and templates for follow up on people who do not schedule. Awesome. It makes a difference. People are busy, they forget. So if we can be that little little birdy in their ear reminding them to book, that’s going to improve your retention and your new intakes. All right. Wonderful. Thank you so much for your participation and for joining me today and hopefully I will see all of you same place, same time next week. So you all take care and all the best. Speaker 5 00:53:14 Thanks, ash. Ashley Mielke 00:53:15 Bye. Bye. Joe Sanok 00:53:23 Well, thank you so much for listening to the practice of the Practice podcast today. These trainings are available in our membership communities. Joe Sanok 00:53:31 Now we’re going to be opening up our membership communities more than just when we’re opening Level Up week. So if there’s one that you are interested in, I would love for you to head on over to practice of the practice. Com forward slash membership where there’s more details and you can get notifications when those open up. So if you are in solo practice just getting going, if you are building and sustaining a sustainable solo, practice, next level practices for you. If you are looking to launch a group practice, group practice launch is for you and group practice bosses for all those group practice bosses out there. You know, we also couldn’t do this show without amazing sponsors like Therapy Notes, therapy notes is the best electronic health records out there. They will help you switch over from your current EHR. they also give you two months for free or, just money off if you use promo code Joe at checkout. they are phenomenal. They help with automated billing. it’s going to make it easier to outsource your billing. Joe Sanok 00:54:26 So many reasons to switch to therapy notes. Just head on over to therapy notes.com. Read about it and at checkout just use promo code. Joe, thank you so much for letting me into your ears and into your brain. Have a great day. I’ll talk to you soon. Special thanks to the band Silences Sexy for that intro music, and this podcast is designed to provide accurate and authoritative information in regard to the subject matter covered. It is given with the understanding that neither the host, the producers, the publishers or guests are rendering legal, accounting, clinical or other professional information. If you want a professional, you should find one.