An Introduction to Evidence Based Business in Physical Therapy

As physical therapists, we have been taught to treat patients according to Evidence Based Practice. Evidence-Based Medicine (EBM) is an approach to medical practice intended to optimize decision making by emphasizing the use of evidence from well designed and conducted research.

"The term was originally used to describe an approach to teaching the practice of medicine and improving decisions by individual physicians about individual patients. Use of the term rapidly expanded to include a previously described approach that emphasized the use of evidence in the design of guidelines and policies that apply to groups of patients and populations ('evidence-based practice policies')." (Source)

While the physical therapy profession has widely embraced the importance of EBM to our practice, we have not yet fully embraced the principles of Evidence Based Business (EBB). Though perhaps an over generalization, I will say that I believe that we are not graduating physical therapists who are prepared to own a business, or even “own” their caseload as an employee in a practice. This is true not only of physical therapists, but also physicians, attorneys and other service-oriented professionals.

When it comes to marketing, customer service, referral generation, customer loyalty, leadership, strategy, organizational development, human resources, and financial analysis we are generally just taking our best shot – often at the expense of our employees and patients.

This month on the Strive Labs Blog, we’re taking a look at EBB – what it means, what we need to measure, how we need to utilize the data we collect to inform our decisions, and how to best teach EBB principles to DPT students.

I recently sat down and talked with Jim Hoyme, PT, MBA about this topic. Jim is one of the owners of Therapy Partners in Minnesota and serves as the CEO. He has also been a partner in OSI Physical Therapy since 1980. Jim helped start Therapy Partners as an MSO for independent therapy practices in 1999, and the company has grown to become a highly respected, influential resource for therapy services in Minnesota and Western Wisconsin. Jim has a special interest in leadership, and a passion for teaching the next generation about leadership in business, which makes him a great resource for talking EBB.

What is EBB?

Jim shared that EBB includes business principles proven to get good outcomes. These principles include productivity metrics, employee engagement measures, and patient engagement strategies. There are many tools out in the business world that are great fits for physical therapy businesses. Jim likes using the Balanced Scorecard in his business because it provides “a performance measurement framework that added strategic non-financial performance measures to traditional financial metrics to give managers and executives a more 'balanced' view of organizational performance.” (More on the Balanced Scorecard)

He finds this to be a useful way to look at an organization, as it pulls in evidence that dives deeper than looking at purely financial data. He believes that some organizations are too focused solely on metrics at the risk of losing touch with the people who make up the company. He believes that when employees are disengaged, they become complacent. This starts a negative cycle where productivity decreases, customer service decreases, and the financials take a turn for the worse.

Leaders and leaders

Jim and I discussed the fact that in many physical therapy practices and organizations, the clinic director or manager often treats nearly a full caseload. In his work, Jim often sees therapists wearing their patient caseload like a badge of honor on their sleeve (“I run the clinic and still see the most patients out of any therapist here!”). We talked about the need for Managers to become Leaders, which involves an investment of time and energy into building up the team in the clinic.

He says, “Leadership is undervalued in our profession. We need to create leaders throughout our organizations, not just at the highest levels. We need all therapists to be engaged, to have the passion to develop programs for the organization, and to serve as role models for newer team members.”

Jim calls the Leaders at the top of the organizational chart the “Big ‘L’ Leaders” and all therapists in an organization the “little ‘l’ leaders.” Clinic directors are the “Leader Managers,” which is a really great way to think about the system overall. He believes that leadership can be developed when team members are supported in their areas of strength. This allows them to shine in their own way while contributing to the overall success of the organization. In our clinics, we need to achieve while being flexible, demonstrate respect, exemplify character, show emotional control, strategize, drive change, connect with patients, mentor and inspire.

While it can be easy to measure the financials in a company, it can be much more difficult to measure the culture. A vibrant culture where the mission and vision are not only known, but also embodied by all team members, will likely produce good patient outcomes and a positive P and L sheet.

Thank you Jim for talking EBB with me!

Join us this month as we take a look at the principles of EBB as they apply to our profession. Click below to be the first to hear about our posts!

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Ann Wendel



Physical Therapist, Writer, Speaker, Consultant, Kettlebell Lover. Director of Brand Marketing for @strive_labs and @APTAtweets Media Spokesperson.