Don't Compete . . . Tilt the Field

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Andrew M. Ball, MS, PT -> Don't Compete . . . Tilt the Field (February 4, 2000 7:57:00 PM)
Dear Forum, The following is adapted from Louis Palter's "Don't Compete . . . Tilt the Field," which I have found to be the most valuable book I've read for professional purposes in my capacity as both physical therapy clinician, researcher, and MBA/PhD student. Have an abreviated look: Albert Einstein once observed that most problems cannot be solved using the same kind of thinking that created the problem in the first place. I never fully understood his remark until reading the following clinical research finding in Louis Palter's "Don't compete . . . Tilt the Field!" "A group of behavioral psychologists recently conducted an experiment with a group of monkeys in a lab setting with one way mirrors. A dozen monkeys were placed in a room, in the center of which was a pole with a bunch of bananas on the top. Above the bananas, mounted in the ceiling, was a shower-head. When one of the older monkeys climbed the pole, the scientists sprayed her with ice water. The monkey retreated. An hour or so later another monkey made a quick dash for the top and was also hosed down. At this point (unbeknownst to the monkeys), the scientists changed three things: they removed one monkey from the room; they brought in a new one; and they disconnected the shower head. Soon, the new monkey in the room tried to climb to the top but was stopped by others. Eventually all the monkeys were replaced and each time the new monkey was stopped when they started climbing. Finally, though no monkey remained who had been present for the spraying, no one ventured up the pole. Thus they never realized that conditions had changed and the bananas were there for the picking." The moral of the story is best summated by brilliant orator and Hall-of-Fame Yankee Catcher Lawrence "Yogi" Berra: "The future just ain't what it used to be!" Experience is therefore the best - and at times the worst - teacher. If we are to solve the new problems of the profession, then we must adopt a new attitude or "thoughtware" that is suited to the times, and avoids being cut by Ockham's Razor. Too often, professional groups (and ours is no different) miss the obvious. If you are a jockey, and your horse dies, then you dismount. Unfortunately, most professions (PT included) have a tendency to delay, skirt, or complicate matters. Too often when the horse dies, we: 1. Buy another whip 2. Change riders 3. Say things like "This is the way we've always ridden this horse" 4. Write and rewrite the standards for dead horse performance 5. Appoint a team to revive the dead horse 6. Compare the state of our dead horse to other dead horses in today's environment 7. Declare that "No horse is too dead to beat" 8. Purchase a new computer or software product to make the dead horse run faster (e.g., more efficiently) 9. Shorten the track 10. Establish Benchmarks for industry dead-horse leaders In order to solve the problems of our profession, we must also consider the top 5 little known amazing facts about the world today (also from Patler, 1999): 1. On average, an innovation (usually in the digital technology sector), is copyrighted every three seconds. 2. In the US in 1960 there were 5000+ people over the age of 100. In 1996 there were 1,000,000. By 2010 that number will rise to over 5,000,000. In the western world, a child born in the year 2000 can expect to live well into the twenty-second century. 3. Libraries throughout the world are gaining popularity in tandem with the acceptance of the Internet. "High-Tech" therefore, continues to generate a commensurate need for "High-Touch/Simple-Contact". 4. More than 50% of many companies' revenues in a variety of industries comes from products and services that did not exist as little as two years ago. 5. Computer power today is 8,000 times less expensive than in 1966. Similar progress in the auto industry would mean buying a new BMW for $2 that could travel 600 mph on a thimble of gas! There is a BIG lesson to be learned here. Though I fear that not many of us in our profession have learned it: Don't try to out compete competitors, or outfox third party payers . . . TILT THE FIELD! Respectfully, Drew ------------------ Andrew M. Ball, MS, PT MBA/PhD Candidate [This message has been edited by Andrew M. Ball, MS, PT (edited February 08, 2000).]

Andrew M. Ball, MS, PT -> Re: Don't Compete . . . Tilt the Field (February 5, 2000 5:13:00 AM)
Forum, Several people have e-mailed me directly to ask, "What can I do???? How can I tilt the field???" Companies exist in vastly different operating environments. There are no one size fits all solutions! (Besides - - I generate part of MY OWN revenue by consulting to Health Care practices on the specifics of how they can reinvent themselves for success in the new millenium . . . My own way of TILTING THE FIELD!) There are some general guidelines that Palter outlines that can be utilized however. Reexamining the 5 most amazing little known facts, for example, four things become very apparent: 1. The demographic of the US population is shifting, in terms of culture, age, and health consciousness at older ages. 2. There is a market niche for the therapist that can utilize information technology and bring a personal touch to it. 3. Some patients are difficult to discharge because they crave personal interaction with the therapist or other patients . . . not because of the technical skills of the therapist (e.g., we are in the service industry too!) 4. More than 50% of many companies' revenues in a variety of industries comes from products and services that did not exist as little as two years ago. Don't be afraid to try new business plans . . . SACRED COWS MAKE THE BEST BURGERS!! It would seem to me that there is a market niche for the physical therapist who would be interesting in creating a wellness center with a few interesting twists: Let's suppose that your practice is primarily outpatient neuro, based upon projected demographic shift, you can expect an increase in referrals. The difficulty comes in figuring out how to work SMARTER, not HARDER. Most service industries recognize the 80/20 rule . . . that 80% of business comes from 20 percent of your clients. This does not translate well into physical therapy because unless you are going out in the middle of the night and causing injury to your patients . . . repeat business from the same client is less frequent. So what to do? Capitalize upon the fact that physical therapy is a SERVICE industry too. The majority of your patients would be interested in the social benefits of a structured wellness program. Enrollment at such a program, for say $60 per month, may include tai-chi, flexibility training, weight training, dance . . . anything that involves movement and caters to the lifestyle of older adults - post neurologic injury. In addition, you may wish to consider a juice bar, or a cybercafe with links and bookmarks set up to relevant social organizations for older adults, nationwide chats for older adults or people with neurologic injury, or MEDLINE, etc. This area could be manned by someone with specialization in computer information technology, library science, a medical student, etc. depending upon your client's specific needs. We've thereby introduced a "personal-touch" to information technology . . . to older adults who may be frightened of the computer, but crave the information that it could generate. BETTER YET, we've tilted the field to provide a service that is VERY different from that of our competitors, and have avoided insurance in the process. Traditional Physical therapy becomes the attractor to our operations, not the cash cow within the vertically integrated organization. That's one idea. The next thing I do, is force myself to come up with another idea, not using the same problem solving strategy. Anyone want to take a crack at another solution??? Solutions are not limited to ortho or neuro care alone! CARE RESOUCES, a pediatric physical therapy practice in Baltimore, MD, has done some very interesting things over the years in defining exactly what services they provide and how to capitalize upon them. Respectfully, Drew ------------------ Andrew M. Ball, MS, PT MBA/PhD Candidate [This message has been edited by Andrew M. Ball, MS, PT (edited February 08, 2000).]

Andrew M. Ball, MS, PT -> Re: Don't Compete . . . Tilt the Field (February 5, 2000 9:40:00 PM)
When I hear such negativity, I quietly laugh to myself. Innovators like Al Neuharth (USA Today), Bill Gates (Microsoft), Galleleo, Pasteur, and Colombus, were often laughed at and had the firehose turned on them too. I suppose I'm in good company. That's not to say that every idea is a good one, but ideas should be cultivated and explored before squashed completely. It's usually the wildest ideas the revolutionize a company, or an industry . . . and the critics are left drowning in the wake. A STORY adapted from "Don't Tilt the Field": Louis recently paid a visit to a friend at a large computer company in the Silicon Valley. When they sat down to eat lunch they were joined by a software engineer who talked their heads off for nearly an hour. The guy's ego was bigger than the French Alps, but he was funny and charming in his own way. Rambling on by free associating be described his passion for boxing, his recent trip to Montana, and his search for cowboy memorabilia. He went on and on, with each story equally important . . . at least to him. I'm sure we all know the type. As they were finishing dessert, Louis said something semi-sarcastic about going off to get some Milk of Magnesia to settle his stomach, a not-too-subtle reference to the engineer's ramblings. Not missing a beat, the engineer said, "That reminds me of a story about . . . magnesium. "It is very flammable you know, and needs to be handled with extreme caution. One of the most dangerous aspects of magnesium is that it can ignite instantly and once ignited it burns at extremely high temperatures." Then he looked up and asked, "Do you know the best way to put out a magnesium fire?" "With water? NO!" said the engineer, answering his own question "Carbon dioxide? Absolutely not." "Well," he said, "I didn't know either until my friend explained it to me. You put out a magnesium fire BY POURING GASOLINE ON IT!" Apparently, gasoline burns cooler than magnesium and once the gasoline is added, the temperature DROPS, allowing you to then use more conventional means to extinguish it. THE MORAL: Magnesium is like a creative idea. Fueling it is part of the innovation process. The innovation process does not extinguish anything, it simply makes the fire more manageable, and thus more likely to reach the marketplace. In the marketplace, our dreams and ideas sometimes (and sometimes not) burn as hot as a magnesium fire. For innovation to work, we have to let the dream expand and play itself out before we even consider trying to extinguish it. Unfortunately, most of us are much better at FIREHOSING than we are at FIRESTROKING. For example, we have an idea or passion, bring it to others, and they immediately (and predictably) give a million reasons why it will never work and is not worth pursing. The most insidious of all is another kind of firehosing much closer to home. We frequently turn the firehose on ourselves! Next time you run into someone on fire with an idea, try fueling the fire. At the very least, add some gasoline. -Adapted from Louis Patler,1999 Some of the world's greatest innovations come from resisting the urge to firehose. USA Today, Microsoft, the list goes on and on. All of these people however, started out dodging the firehose of "It just can't be done!" If you've been hung up on the cybercafe idea, for example, you've completely missed the point. Drew ------------------ Andrew M. Ball, MS, PT MBA/PhD Candidate [This message has been edited by Andrew M. Ball, MS, PT (edited February 08, 2000).]

Andrew M. Ball, MS, PT -> Re: Don't Compete . . . Tilt the Field (February 6, 2000 6:11:00 AM)
It's hard to motivate or teach someone who's a closet TILTER themselves because the same points are often argued. I'd agree with SJ in that, "We’ll probably just start doing things differently. We may start having more therapists being consults. We can consult on a whole slew of things. We can determine a person’s abilities and disabilities; we can educate on proper ergonomics; we can educate and help prepare a person for certain surgeries and what he/she should do after surgery and actually spend time with that person instead of handing out a piece of paper; we can assist with human resources and the hiring of prospective employees… (and all of that is just coming from an orthopaedic view). It all depends on how one markets oneself and whether someone is willing to pay for those services." That in itself is the creativity that eventually leads to TILTING! In any event, SJ segways us nicely with her comment, "the only way you can compare yourself to Columbus is if you actually act on your ideas to prove that you were right . . . Technically, at this point in time, you really aren't at the level of Columbus, are you?" into a slightly different topic: Palter's Second Principle: Innovation versus Creativity. "The average manager or executive uses the terms interchangeably. Yet "Unconventional Wisdom" makes some useful distinctions which, when part of a new mindset, readily help guide growth and development. "Creativity is defined as the generative side. It's the coming up with the ideas, the lightbulbs, the flashes of insight. Relatively speaking, coming up with the ideas is the easy part, although for some people, even that is tough. The harder part, as SJ quite correctly points out, is in the innovation side of things . . . taking it to the marketplace, making the core breakthrough and setting the new standard. Today, there is no "level playing field." Especially not in healthcare! An innovation is an idea that brought to fruition redefines the game and tilts the playing field. An innovation involves making breakthoughts that are by definition unprecedented. An innovation, therefore, "is an instance of a paradigm shift". Innovation however, cannot occur without creativity, and THAT is my point. Again In Palter's words, "To say that creativity is not enforced in most business environments is a HUGE understatement. More often than not, creativity is punished! There is retribution. People get blamed,or firehosed, or even fired, for having come up with an idea (albeit perhaps initially unrefined one) in the first place!" "Most companies are much better at blaming than they are at encouraging. These days, an employee, when in that kind of environment, has very few options. Employees are often seen mentoring or coaching their bosses rather than the other way around!" (Can I get a "Hell yeah!"). "Little by little, they find ways to get the boss to believe that the idea was theirs in the first place. The ultimate option, of course, when all else fails, is to protect the idea, gather as many skills and resources that coincide with your values, and then . . . leave. This is obviously not good for the organization's intellectual growth, and replacing employees is an expensive process. "Creativity gives you the raw materials and innovation gives you the tools to make things happen. If you expect eight out of ten to fail, that means you have to set them up inexpensively, quickly, and easily and see which ones survive. You doggedly pursue innovation without a lot of emotional baggage attached to what fails - or to what succeeds. "If you worship the successful innovative produces, your not any better off necessarily than if you never created it in the first place. Innovation is a continuous cycle. You can see the merits of something, see it's market potential. But, then it his the market and nothing happens. You must have some other idea to shift toward. Success can be counterproductive. That's the irony." SJ points out, quite correctly, that though creativity and innovation go hand-in-hand, far too creative people are innovative . . . Whereas the reverse is not true. "ALL innovative people are creative. They are creative people with a few added "psychological seasonings": 1. The ability to sort, cull, and select from a wide range of creative ideas 2. Entrepreneurial confidence 3. Higher level of comfort in a changing environment 4. Mindset of closely tracking the pulse, pace, and preferences of the customer 5. Ability to initiate independent action." It's not possible to tell the difference between a creative person and an innovative person on the basis of one idea alone. Truth be known, as a pediatric physical therapist, I'm more than happy to give away creative ideas relevant to other areas of physical therapy . . . I'm not interested in refining them, developing a business plan, and making them work . . . but maybe someone else out there is! You'll also note however, that I don't often (if ever) discuss my creative ideas on pediatric physical therapy because I don't want someone beating me to innovation! I've been innovating long enough to realize that if I'm lucky, out of 100 creative ideas that I've got . . . maybe 5 will end up being implemented and exert a paradigm shift. My point with the last posing appears to have been lost. I was trying to use it as a "teaching moment", but see that the message was not received. I've personally got a relatively thick skin, and it takes very specific button pushing to irritate me or shut me down from the creative process. Many of my ideas, that were initially firehosed, went on to be slightly modified and refined, then innovatively implemented. For the most part, I now just shrug off firehosing. Negative comments during the creative phase don't bother me. I welcome them because every now and then, there is a nugget of truth that I had not considered. More often than not however, I have a few more facts than the other person (which is usually the case with the vested idea-generator), and it is my personal limitations in COMMUNICATION SKILLS that are exposed . . . a particularly frustrating personal limitation that I'm desperately trying to work on. Most people don't integrate negativity in quite the same way, especially if they've had no experience with innovative success. For a manager or administrator to extinguish the fire so early in the creative process, operantly conditions employees to behave like Pavlov's Dogs. It inevitably reduces the frequency with which employees find themselves being creative. The less creative ideas generated, the less innovation that occurs. The less innovative the company is, the more missed opportunities for gaining competitive market advantage. In the end, the organization constantly plays catch-up to the industry leader . . . hiring outside consultants and the like, when the talent exists to tilt the field and outcompete everyone else in the business environment within the wall of the organization. Drew There are some of us, like both SJ and myself, that are very happy and comfortable with our lives as physical therapists. Tilting the Field is rather directed to the masses of therapists that I come across on a daily basis who bemoan the state of the profession, fear the future, and feel helpless in their efforts to do anything about changing what they believe to be inevitable. The future is NOT bleak. There are many, many creative ideas to be cultivated, brought to innovation, and ultimately the redefinition of what it means to run a succesful physical thearpy practice. ------------------ Andrew M. Ball, MS, PT MBA/PhD Candidate [This message has been edited by Andrew M. Ball, MS, PT (edited February 06, 2000).] [This message has been edited by Andrew M. Ball, MS, PT (edited February 08, 2000).]

NancyK -> Re: Don't Compete . . . Tilt the Field (February 6, 2000 3:21:00 PM)
Hello, First time poster here. I wrote to Drew regarding this topic of tilting the field and now thought I would share it openly. After reading previous topics dicussed on the stressors therapists are now presented with I thought this topic presented a sort of hope. At the facility I work at, we offer a gym program for patients who have been discharged. For a fee (one less than a gym membership) the person can safely be progressed with a strengthening and conditioning program. It has been effective for those patients who have limited visits due to insurance companies. It is also valuable for those patients who find therapy as a place to socialize and do not want to leave. I have also heard of places that offer therapy for postural education and technique critic for certain recreational activites. I know the question has been raised about not sharing ideas in fear of someone doing it before you, but I think in these changing and sometimes stressful times it helps to know that some places and therapists are tilting the field in small ways. And these ways can turn a stressed out therapist to a therapist who can enjoy themselves again. I hope that this message has helped make the topic of tilting the field seem a little more fun. [This message has been edited by NancyK (edited February 06, 2000).]

David Adamczyk -> Re: Don't Compete . . . Tilt the Field (February 6, 2000 3:46:00 PM)
Members, What do you identify as the specific PROBLEMS of the physical therapy profession? I invite all who have read this discussion to answer the question. Your answers may help us to identify changes that our profession needs to make. Welcome to RehabEdge, NancyK.

Barrett -> Re: Don't Compete . . . Tilt the Field (February 6, 2000 5:28:00 PM)
Why is it that the first response I always hear when people speculate about our future includes the construction of yet another gymnasium? What are those of us interested in actually quietly caring for others supposed to do when the only option left is a training facility? I get around, and the so-called "state-of-the-art" PT department is a noisy, bustling zoo full of demands, constant judgement and a staff bent on conditioning people with primary complaints of pain. This is senseless. If our attempt to "tilt the field" in our favor simply abandons the reason many of us went into PT (and it wasn't to become a personal trainer), then those who feel that PT doesn't do anything more than provide exercise instruction have already won the battle. ------------------ [This message has been edited by Barrett (edited February 06, 2000).]

Andrew M. Ball, MS, PT -> Re: Don't Compete . . . Tilt the Field (February 7, 2000 7:04:00 PM)
Can we PLEASE get off the gynmasium idea?!?!? I was just using to it illustrate a point. Tilting the Field may not be for all of us. Some of us are still professionally doing well, are optomistic about the future of physical therapy, and don't want to change a darned thing. To you I say "Kudos!" Keep in mind though, that the best way to loose competative market advantage is to not constantly seek it. I'm finding fewer and fewer PT's however, who are not concerened with the state of the profession. They are afraid of the future. They are romantically attached to the "Golden Age" of physical therapy. Some are students who haven't even graduated yet. They are waiting for the state of healthcare to "return to normal". I've got some bad news for you folks, THIS IS THE NEW NORMAL. Here's another idea . . . is there are market niche for a physical therapist with a paralegal certificate or law degree??? Would this open new opportunities for accident/injury work. Would being able to speak "leagaleese" put a PT in favor with local lawyers, and provide competative advantage over other PT's??? Could a PT work as a complimentary therapy for a lawyer??? Could a "one-stop-shopping" center of excellence for accident/injury survive in your area??? (Complete with MD's, PT's, DC's, Psych, etc. . . . AND lawyers?!?!?) Think of it, all the benefits of patients, and none of the hassles of insurance. Sure there are obstacles, but does the idea merit removal of those obstacles and progress toward an innovative new kind of clinic???? Drew Some have asked why I don't share more, and doesn't that contribute to the problem. I understand the frustration, but don't agree. As a clinician, researcher, and student of business management, I answer to three professional "Gods" or ideologies . . . two of which state very clearly that in today's environment "Intellectual captial and intellectual skills are a hot commodity . . . in those intellectually intensive industries, to talent is in the greatest demand." Make no mistake about it, we are in the BUSINESS of providing healthcare, so yes, my limiters are money, recognition, and protection of intellectual property. I make no aplologies for that, but I'm not off the spectrum into the BUSINESS OF BUSINESS either . . . that's why I'm willing to share and give away creative brainstorms that I don't have any intention of pursuing to innovation. Some people have a hard enough time with creativity. I thought I'd help 'em out. In the irreverant words of Steve Martin, "WELL EXCUSE, ME!!" What fun it it to go alone you ask??? I don't do it alone, in almost all respects (except for a few "golden nuggets" that I'm working on), I work within an organization . . . It's a HELL of a lot of fun! The clincians side of me however, agrees with you completely, share all. As a researcher, and as an MBA/PhD student, I've however been burned more than once by giving away or "sharing" intellectual properties, only to have a "friend" beat me to publication, or beat me to the market. I'm not about to repeat that mistake ever again. ------------------ Andrew M. Ball, MS, PT MBA/PhD Candidate [This message has been edited by Andrew M. Ball, MS, PT (edited February 08, 2000).]

Andrew M. Ball, MS, PT -> Re: Don't Compete . . . Tilt the Field (February 8, 2000 12:25:00 PM)
Forum, I just received an E-mail from Louis Palter, PhD and author of the books "If it Ain't Broke . . . BREAK IT!," and "Don't Compete . . . TILT THE FIELD." He informs me that his current project, as yet untitled, will hit the bookshelves in 18 to 24 months. These books are in my opinion, a MUST READ for the physical therapist of the new millenium. Also, I have invited Dr. Palter to join us in this discussion. For those of you who love to see me loose a battle of witts . . . stay tuned!! I'm not sure if he'd agree with everying I've suggested either! Drew ------------------ Andrew M. Ball, MS, PT MBA/PhD Candidate

charanderson -> Re: Don't Compete . . . Tilt the Field (February 14, 2000 4:02:00 PM)
Dear All, I continue to be impressed with the conversation being posted here. I must confess that I am not as intellectual as I am reflective. So in reflection of the idea "Tilt the Field" I must agree with Drew. I have seen a lot of responses from therapists who respond, from what I understand to be, the perspective of the profession of PT tilting the field, a social perspective, if you will. While from a social perspective, I have no solutions. I do have insight from a personal perspective. I believe that as individuals, we should tilt our own fields. If we do not like the position that we are in in life, tilt the field, "do a paradigm shift". How can we maximize our degree, strengths and skills while minimizing our weaknesses? For some that may lead us out of the practice of PT. For some it may mean opening up a practice in a healthclub. For others it may mean creatively reinventing PT which could later benefit everyone. If we as individuals do this then we can be passionate about the change. And possibly become leaders of the change. Regardless of how we choose to practice, I believe that those who are ultimately the most successful will be those who have the ability to tilt the field and then tilt the field again when times change again. Charlene K. Anderson, PT Independent Business Owner [URL=http://www.egroups.com/list/physical_therapists_in_business/]http://www.egroups.com/list/physical_therapists_in_business/[/URL] [This message has been edited by charanderson (edited February 14, 2000).]

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