As co-owner of PhysioFit Adelaide, Andrew Zacharia knows how to run a successful clinic. There are awards for these things, and he’s actually got one of them. In this guest post, Andrew shows us how his team welcomes new practitioners and nurtures healthy working relationships that last for years.
As health professionals, numbers aren’t always our strong suit. Even if they are, many of us believe numbers should not play a role in healthcare at all… But before you close this article, hear me out! I want to help explain how keeping better track of business metrics can improve the mentoring of your team and, ultimately, better care and outcomes for your clients.
I have been calculating my clinic’s Patient Visit Average (PVA) for roughly 5 years. This is also sometimes known as the Client Visit Average or CVA.
I just import the data from Cliniko into my own spreadsheets. Then, I set up calculations for the PVA by dividing the total number of appointments by the number of new patients in the system over the same period.
I used to track this as a quarterly and year number as well as over a practitioner's lifetime within my clinic to get an indication for what is common or normal within our clinic, and find out what may be an outlier in client care.
Cliniko has just made this easier by allowing you to automate the PVA calculation (you can find this in the Practitioner Performance Report).
What is a Patient Visit Average?
A Patient Visit Average is the average number of appointments a patient has with your clinic over a given period of time.
It is the total number of appointments a practitioner (or clinic as a whole) sees divided by the amount of new clients within the same time period.
(total number of appointments)/(number of new clients)
An important distinction is that this does not reflect how many appointments a client attends per injury. Rather, it is an average of the overall appointments attended throughout the period selected (regardless of how many different pains or injuries they have reported).
For example: If Client A attends 8 appointments within your clinic for their lower back pain in a 12 month period, the PVA will be 8. If Client B attends 3 appointments for their niggly shoulder and 6 appointments for a sprained ankle over that same period of time, the PVA will be 9.
When is Patient Visit Average meaningful?
Time frame is an important factor in how you interpret the results of your PVA. In general, more is usually better...
Within my business, I run a weekly performance report but noting the PVA over 7 days is of no worth at all, because it’s not enough time to provide the info I’m looking for. However, when running performance reports for 3-month, 6-month or 12-month periods, as well as the lifespan of the clinic itself, the results become much more meaningful.
A 3-month and 6-month performance report will give you a good indication of the number of visits on average per episode of pain or injury. This is because you are much more likely to have one episode of care in these periods, rather than a client returning numerous times. (Although not impossible, it would be very unfortunate if someone did have 3 or 4 different injuries in half a year!)
A 12-month performance report will indicate how many appointments, on average, a client has with you in a single year. This may be valuable to note and will likely include longer periods of care or numerous episodes of care.
A lifelong performance report, covering a number of years, will give you the truest form of Patient Visit Average, which is how many appointments a client has with you, on average, over a lifetime.
Each of these periods of time may provide very different PVAs, so it is important to keep that in mind when interpreting your results.
The type of services you offer or populations you work with may also impact the numbers represented by the Patient Visit Average. For example: A physiotherapy clinic may have a PVA of 10 in a 12-month period. A podiatry clinic offering skin and nail care may have a PVA of 5 or 6. And a speech pathology or occupational therapy clinic working with a child on a specific skill or function may have a PVA of 30, 40 or even 50+ in a single year depending on the needs and frequency of therapy.
Finally, the last consideration is the number of years a practitioner has spent at your clinic. A new graduate or new team member will likely see a higher proportion of new clients in their first 12 months, resulting in a lower PVA relative to team members who have been with you for several years.
As a team member passes the 24-month mark, it is much easier to compare data across the board as even returning clients don’t skew the averages too far at that stage.
It is important to keep in mind that because of all of these factors, there is no “Benchmark Patient Visit Average” in healthcare, just the reflection of what is occurring within your clinic.
How can monitoring Patient Visit Average help your team members and clients?
The PVA shows you what is occurring within your clinic. When you compare these numbers over a similar period of time, we can get an indication for what is common or normal within our clinic and what may be an outlier in client care.
Here is an example where PVA could be used to help our team members improve client care and outcomes. (Please remember to run this through the filter of time periods, types of clients, and number of years a practitioner has been with your clinic).
SCENARIO: The average clinic PVA after 12 months is 8.
- Experienced Practitioner PVA is 10
- New Graduate 1 has a PVA of 7
- New Graduate 2 has a PVA of 3
What we can see here is there is a different standard of care amongst the Experienced Practitioner, New Graduate 1, and New Graduate 2. As a mentor to young health professionals, I wouldn't compare either of the new graduates to the Experience Practitioner. Instead, I see this as a call to open up a conversation with New Graduate 2 around areas they may be struggling with, lacking knowledge or practice in, or needing further opportunities to improve.
In this case, I would not be comparing New Graduate 1 and New Graduate 2 to the Experienced Practitioner, asking them to improve their PVA to 10. That is too numbers-driven and forgetting client care completely. I may not even be too concerned with New Graduate 1’s PVA of 7 given they are 12 months into their career and should continue to upskill and improve. I’m looking at New Graduate 2’s client care. I want to find out more about this practitioner’s story. What I am looking for is what is occurring with this practitioner that is so different to the client care and client experience when compared to everyone else in our clinic.
In the past, opportunities that have risen from these types of conversations are:
- A lack of self-confidence from the practitioner.
- Uncertainty or self-doubt with explaining conditions or the plan ahead to clients
- Seeing complex cases where they simply need help with learning more about the assessments and management of certain conditions.
- Not having the knowledge in a specific area of client care such as acute pain management or exercise prescription.
- Opportunities to improve the soft skills of communication, goal setting, rapport building, and client-therapist alliance.
- Projecting their own beliefs such as financial concerns or poor time management, believing clients may not be able to afford their appointments or believe they are too busy to attend, without discussing these concerns with the client themselves.
Working on, and making improvements to, these areas results in clients receiving the best care possible. This creates better outcomes for the client, and more raving fans for our clinic.
It also means fewer clients are heading down the sad route of being lost within our medical system, getting prescribed pain medications, being referred off for unneeded surgeries, or progressing towards persistent pain conditions.
These are such important aspects of learning and growth for all practitioners (not just new graduates), and I truly do believe these conversations hold the power to improve the lives of our clients…and it can all start with monitoring this little stat we call PVA!
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