Tips Of All Sorts

Here’s a nice piece in the Fashion & Style section of Thursday’s (4/17/08) New York Times.  The article details the training regimen of  Sara Hall and the evolution of her preferred race from the 5K to the 1500 meter.  She hopes to compete in this summer’s Olympic games in China.

Money quote:  “The most common mistake” that recreational runners make, (her coach Terrence) Mahon said, “is running the same pace all the time.” Occasionally making yourself run fast, he said, “is the only way to make yourself a fast runner.”’

Interval training is crucial to improving your performance in most sports.  Read the whole article here.

This article from Gina Kolata of the New York Times discusses the measurement of heart rates while training and “maximum heart rate.”

I’ve always been a strong supporter of wearing a heart monitor, particularly when you first start working out and when you are doing interval training.  The monitor can provide a significant aid to your workout since it gives you an immediate and unbiased view of how hard you are working.  I’ve also always thought that the monitor is extremely useful in gauging recovery, which measures your overall  fitness.  For example, if your exercise regime brings your heart rate near your maximum and then you stop and rest, it’s important to see how long it takes your heart to return to more normal levels.  If, after a minute of rest, your heart rate is still severely elevated and has only dropped a few beats that is definitely not a good sign for your fitness level.  Use of a monitor is particularly necessary in interval training, which many experts feel is the most effective type of conditioning.  It allows you to precisely track the cycle of your heart rate and lets you know if you need to push harder or less hard during an interval.  The monitor is also extremely useful as it provides your resting heart rate, a measure of fitness worth knowing.

While I’m happy to see an article that discusses heart rate monitoring during exercise the article loses some of its focus by worrying too much about one’s absolute maximum heart rate—after all, it can vary significantly from person to person and may not be a great indicator of fitness, per se.  The article  also throws in an anecdote of a person with a maximum heart rate of 400 which no doubt just serves to confuse readers.

Some of the key points from Ms. Kolata’s article:

The maximum heart rate reached may vary by sport.  For example, swimming tends to produce a lower maximum heart rate than sprinting.

Nerves can affect heart rates.

The heart monitor allows you to keep track of exercise intensity to meet performance goals or improve.

Ms. Kolata’s article drew a wide range of animated comments from her readers:  Many of the comments that  readers posted on the NYT site were excellent.  Some excerpts:

Resting heart rates may be more important than maximum heart rates, with lower being better.  (Normally, “a trained athlete” has a resting heart rate of 40-60.)

“I’m a personal trainer and I’ve been using a heart rate monitor for at least twenty years. I won’t train a client without one. When I design a workout regime for a client, one of the most important ways for the client to comply is to understand what’s going on with their body. I want the client to push themselves within boundaries and the heart rate monitor allows this. I also teach people to see how long it takes the heart rate to return to lower levels. What I have found fascinating is that perceived exertion is not necessarily a good gage of true exertion.  Most people at the gym on the equipment are working at such low rates that they might as well be taking a walk in the park. They don’t know this since they have no idea what heart rate training really is.”

“Think of an HR monitor as a tachometer which allows you to understand your own “power” usage and help endurance by keeping a pace slightly below your anaerobic threshold.”

“The correct Maximum HR can best be obtained in a sports med lab or in a real world sprint/ride, but for the recreational rider/runner/exerciser, the 220 minus age formula is a good start.”

“Notably, endurance athletes alternate intense workouts with lighter “recovery” days; HR monitors are at least as useful for exercising control on those days, keeping HR below a certain point, as they are for making sure intensity level is high enough during intense workouts.”

“Likewise, they are useful for pacing “long slow distance” runs and monitoring recovery during interval workouts.”

“Also, note that max HR is personal, and yes, it’s generally not an indication of ultimate cardiovascular capacity, and further, it’s testable! It’s probably a good idea for anyone who pays attention to HR in the health club to learn what his or her max HR is. See any of the good HR training books for advice on how this is done.”

“By basing my speed off of heart rate, I noticed that I covered more ground on each long run over the same time period, and have gotten all-around faster.  I agree that heart rate may not be the most important for everyone, but it certainly has helped my aerobic fitness and keeps me from overtraining on days when I don’t need to push myself to exhaustion.”

“Recovery time is not something that the general public should ignore. I am neither a pro or competitive athlete. But I do cycle a lot. If you are older or you do a lot of intensity and/or volume, you should pay attention to recovery time.”

“By simply cycling your intensity up and down (interval training) so that your heart rate repeatedly approaches, crosses and then drops below your anaerobic threshold, you can achieve dramatic fat-burning results, both during exercise and while you’re going about your daily business.”

“Before beginning to use a heart rate device 10 years ago, my exercise sessions and recovery were inconsistent. Knowing the zones, the heart rate, and following a program that works for me, I feel better, sleep better and am more confident that my exercise plan works.”

It’s a typical of the power of the internet that many of the comments on the original article provided more depth of understanding and detail than the article itself.  Be sure to read them all here.

A couple of years ago we noticed that although we’d had a great year as far as new patients were concerned, our return visits seemed to have flattened out. Patients seemed pleased with the service, success rates were high, but it still felt like we were gaining new patients but not growing.

The problem, of course, was in the scheduling.

If your office is reasonably busy, a great booking strategy can increase your profitability almost overnight. If you’re not-so-busy, there’s good news here as well: Effective booking drives return visits like nothing else.

Here’s how we worked with our staff to create a more effective appointment strategy.

Strike While The Iron’s Hot
There will never be a better time to book the patient in question than right now. Whether they’re on the phone, or standing at your front desk, do it now. The patient who doesn’t book now is going to come back fewer times. Or never. It’s that simple.

Tell, Don’t Ask
You need to approach booking from a place of confidence. Adopt the attitude of assuming patients will book/rebook. Why? because your inner confidence is reflected in how you speak, in subtle ways that shift the likelihood of success.

• Wrong: “Did you want to schedule a follow up?”
• Right: “Let’s schedule your follow up.”

Small difference in words. Big difference in outcome.

Leverage Our Love of Routine
Humans tend to be creatures of habit. We like consistency. Giving your patients recurring appointments in the same time slot makes it easy for them, and gives them a sense of ownership in the process.

• Wrong: “When would you like to come back?”
• Right: “If this time slot is convenient, I can get you in at the same time on Wednesday at 10:30.”

If you can’t offer the same time, offer the same time of day: “We can get you in again on Wednesday morning next week.”

Narrow the Options
While you’re at it, consider offering just two options for any appointment. It’s easier for everyone. There’s some surprising research that shows that people buy more when their choices are not overwhelming.

• Wrong: “What day is good for you?”
• Right: “We have an opening on Wednesday at 10:30 again, or Thursday at 2:15.”

Don’t Create Islands
When you’re offering up those two time slots, pick them carefully. Cluster your appointments back to back. You’ll work more effectively than if you schedule appointments haphazardly over the day, and you won’t end up with tiny windows that people who might need longer appointments, like new patients, can’t fit into. There’s nothing more frustrating than having a day full of holes, but not being able to see a new patient.

Create Scarcity
Many people (like me) don’t want to book a follow up if it’s too far in the future. Others just don’t want to commit ever. What gets me every time is the idea that if I don’t book, I might not get an appointment.

• Wrong: “Okay. Call us in three months.”
• Right: “The schedule tends to fill up quickly. We should book it now so that we can be sure to get you in.”

Remind People
I also don’t like to book too far out because I’m afraid I’ll forget. Reassure your patients by giving them an appointment card, and by telling them you’ll call a few days before the appointment to remind them.

Step On a Crack
We also have a monthly protocol for catching those stray patients that might fall through the cracks. Every month, we print a list of every patient whose birthday is in that month. That report shows the patient’s status (active, inactive, etc.) and when their next appointment is. Every active patient who doesn’t have a next appointment is examined to make sure we haven’t lost someone along the way.

If you know the annual value of a patient, it’s not hard to see that the few minutes it takes to scan through a few pages of names is well worth the time.

Protect the Schedule
All your best scheduling efforts are in vain if your patients don’t respect their appointments. Read our master list of tips for reducing no-shows, cancellations, and reschedules so that your booking strategy pays off.

Implementing most of these strategies is as simple as educating your staff. This list is essentially the blueprint that we used to write up a short booking policy for our front-line people. Use it if you find it helpful. What works even better is to use this list as a starting point for discussion - have your staff read it over, and then discuss any additional ideas and adjustments they might have.

Then, of course, let us all know in the comments!

Related posts:

1. No “Islands” – A Patient Booking Strategy for Your Alternative Health Practice
2. Reducing Cancellations and Reschedules
3. How to Reduce Cancellations, Reschedules and No-Shows: Our Strategy
4. Avoiding the Pitfalls of Advance Patient Scheduling
5. Charging for Missed Appointments

We’ve discussed scheduling problems in the past, pointing you to a few resources here and there, but we’ve never really provided a comprehensive approach for those scheduled appointments that go off the rails due to patients canceling, rescheduling, or simply not showing up at all.

Here are the exact strategies we’ve put in place over the last few years. If you’ve got something that works in your practice, leave a comment and share it with us.

Make Reminder Calls
We all forget things, and appointments (particularly those with a long lead time) are among the easiest things to lose track of. Appointment cards are helpful, but in the end, a phone call is your best bet. Email, text message and other automated solutions are starting to make some headway, but a good old-fashioned telephone call is still the most effective tool to combat schedule disintegration.

• Provide some lead time. Don’t make your calls the night before. Give patients at least 2-3 days notice.
• Don’t leave wiggle room. Saying, “Call us if you can’t make it,” is an invitation for people to reschedule.

I don’t think we started making these calls as early as we should have. When you’re not busy, it can feel like it doesn’t matter as much, but the truth is that it does matter. In fact, you could argue that it matters more - those cancellations are pretty painful in the early days.

Some practitioners argue that reminder calls encourage people to reschedule. I don’t buy it. Better to know, and take steps to deal with it, then have a sudden hole in your day.

Stay on Time
If you want patients to respect your time, then you need to start that process by respecting theirs. Make sure you stay on time. Don’t reschedule patients. Keep regular office hours.

Yes, emergencies crop up, but your clients will accept that if you explain it to them, apologize, and don’t let it happen regularly.

Book Tightly
What we’re really after here is teaching your patients to value their appointment. A large part of that is demonstrating that you’re busy and run a tight ship. Many practitioners tend to spread patients out over the course of a day, but for us the looser the schedule gets, the more reschedules we seem to encounter - patients figure they can get an appointment on just about any day, so what’s the big deal? It is a big deal, and it starts with effective scheduling.

Don’t Overbook
However, if you’re tempted to treat your appointment book like a discount charter flight and book it 120% full, you’re going to have problems. Overbooking to deal with last-minute scheduling changes is like treating symptoms instead of causes - it’s not getting to the root of the problem. In fact, just like running late, it’s probably creating more of them.

Book Acute Care Visits ASAP
Acute care visits are fertile ground for scheduling glitches. When patients call with an acute care issue, it’s because they want to be seen now. If you can’t see them soon, recognize the fact that they might get better or find someone else in the meantime. That increases the likelihood of a no-show or cancellation.

Follow the 1-2 Month Rule
When a patient wants to reschedule or cancel, remind them that they may not be able to get another visit for 1-2 months. Patients often reschedule simply for convenience, and this technique can often resurrect the appointment. You can read more on this approach here.

Deal With Repeat Offenders
You may discover that a large proportion of your problem appointments are with the same small group of patients.

We do have a no-show fee, but we use it with discretion. And while we don’t often charge people for missed appointments - unless they have some hard cost like custom formulated IV treatments - we do try to educate these people over time by explaining that someone else could have used their time slot.

Failing that, we follow a three-strike rule. After they bail a third time, we usually don’t hurry to call them back. If they call, we try to fit them in that day, or tell them to call back again another day when we might be able to provide same-day service.

Track Your Results
Although you may have a general sense of how well your appointment book holds together over the course of a month, nothing beats having some hard data. The easiest way is simply to have your staff track the numbers. This also lets you identify patterns that might crop up based on the time of day, week or year.

If your software doesn’t do this for you, it’s still easy to implement using pen and paper. Head to CalendarsThatWork.com, and print a lined version of their monthly calendar. Use the first line for reschedules, the second for cancellations (with no reschedule) and the third line for no-shows. Have your staff just put a tick on the appropriate line each time, then add them up at the end of the week/month. You can even enter your email address, and the site will send you the same calendar just before the start of each month.

Everyone has a role to play in keeping the schedule healthy -you, your staff, and your patients - and much of this is about teaching everyone involved about the value of a scheduled appointment. Consider yourself the Dean of the School of Appointment Value, and train your students accordingly.

We’ve noticed some dramatic improvements over time using these strategies - if you’ve got any other tips, we’d love to hear them!

Related posts:

1. Reducing Cancellations and Reschedules
2. Avoiding the Pitfalls of Advance Patient Scheduling
3. Building a Busy CAM Practice By Acting Like One
4. Why Your Practice Needs a Receptionist: Missed Calls
5. How To Handle Free Advice-Seekers

  This NYT article by the well known health and fitness writer, Tara Parker-Pope, dissects the standard push-up.  Here are some highlights from the article.  Read the article in full here:

1. The push-up is a good barometer of overall fitness engaging muscle groups in the arms, chest, abdomen, hips and legs.
2.  The obesity epidemic has made push-ups more difficult to perform for the average American—pushing up all that extra weight is not easy.
3. The aerobics revolution has shifted emphasis away from maintaining upper body strength, which is not a good thing.
4. Lots of people can’t do push-ups, including for the reasons listed above.  Kids are failing push-up tests at an alarming frequency rate.
5. Being able to do push-ups is particularly important as we age as push-ups can provide the strength and muscle memory to reach out and break a fall, and it’s well known that falls can be debilitating for seniors.
6. People lose strength as they age but regular exercise enlarges muscle fibers and can mitigate the decline.
7.  A 40 year old man should be able to do 27 push-ups.  At age 60, the number is 17.

While the article focuses on the time honored push-up, it is really another wake up call regarding the importance of exercise in life and particularly as we age.  Let’s face, how many 60 year old men can hit the deck and crack out 17 push-ups?  Staying in shape confers huge health and lifestyle benefits as we age.  Push-ups are a good barometer of your overall fitness and should be part of any training program.