Ep112: Dr. Stephanie Estima

Today on the More Cheese Less Whiskers podcast we're talking with Dr Stephanie Estima from Toronto where Stephanie is a doctor of Chiropractic officially, but she helps people with optimal performance and she takes an amazing approach that focuses on your brain first. Not your mind and your thinking, but your actual brain, because that's what everything else is in place to support. It's a pretty cool approach. 

She's taken a doubling down approach, as she calls it, to focusing on patient care and it shows in her retention rates, and in the results she's able to get with people.

We had a really great conversation about what an advantage it is that she has part of her equation really dialed in, that people love her, and she's able to get amazing results for them.

We talked about the After Unit, where she could really make the most of some opportunities to orchestrate referrals and really see that her Before Unit will almost take care of itself, if we focused just on nurturing some of these exiting relationships in an orchestrated. Rather than just letting referrals happen.

I really enjoyed this. It went fast and I think you're going to enjoy it too.

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Transcript - More Cheese Less Whiskers 112


Dean: Dr. Stephanie Estima.

Stephanie: Hi, Dean.

Dean: How are you?

Stephanie: I'm so good. How are you?

Dean: I am super excited. I just got a massage so I'm fully limber.

Stephanie: Amazing.

Dean: I've done my calisthenics to get myself ready.

Stephanie: Perfect.

Dean: I have my evil, scheming notebook right here with me.

Stephanie: Your essential oils?

Dean: I'm always prepared. I don't have any essential oils, doc. I left that at home. I would be otherwise fully prepared.

I'm really excited because this is one of the rarer times that I get to do an episode with somebody that I know. This is exciting. The advantage of knowing a little bit of the back story, but what would be really helpful is if you tell me the story, like I don't know the story so that we can catch everybody up to the present day. Then, we can jump off and talk about whatever you want to get some focus and help on.

Stephanie: Awesome. Yeah. I've been in practice for 16 years. I'm in my 16th year right now. I run a clinic in Downtown Toronto called The Health Loft. The goal of The Health Loft, the reason it exists is a way to provide an absolutely stellar service. I want it to be an experience like nobody has ever experienced.

Myself and I have an associate doctor who works with me, we are classically trained as chiropractors. We are a wellness clinic, but we take a particular focus in the neurological model of healing. My big idea, if you will, is that and I've spoken about this on stages and I've talked about it briefly with you as well is that the brain needs to be healthy first before anything else can happen.

You can do all the rehab that you want, but if your structure isn't right, you're wasting your time, your energy, your money, and your focus.

Dean: Right. That was amazing to me because you get it. I want to underline the point that you're talking about the actual, physical organ of your brain, not your mind, not your reason why. Not all of that stuff. The actual physiological part of it. That was an interesting insight to me that I've never really heard anybody take that approach. It's something we could hear more about.

Stephanie: Yeah. We don't think about. Totally. To your point, Dean, a lot of us will think about the aesthetics of things. We say, “Oh, we want to look great naked,” or, "We want to be healthy so let's heal our hormones." Those things are all nutrition and fitness. Those are big passions of mine as well. Those are all healthy pursuits, absolutely, but if you're signaling, if the descending pathways in the brain are not there or the afferent, meaning that's the signals coming up from the body, there's a disassociation there.

Again, it's like the four precious resources that we have, time, energy, focus, and money are being wasted because you have to get the brain right first. We don't think about the brain. We are the brain. It's important rework or reframe for people when we're talking about an approach to healing that's potentially different than what they've heard in the past.

Dean: How does that actually manifest itself? How do you start or a protocol for somebody? What's your kind of come from?

Stephanie: A typical onboarding of a patient in our practice is, there's a two-day process. The first day is really all about the patient. We are really just trying to extract as much information that we can about their present life, about where they've been, where they are now? Then, what are their dreams and goals. Where do they want to go? It's really a snapshot in time. We want to look at the past, the present, and the future.

Then, there's a lot of ... I know functional medicine is a big buzz word now. We do something, I like to call it functional neurology. It's really looking at real-time, like a real time presentation, the real time feedback that the brain has to the body. A really easy example of that would be, I'll have patients close their eyes and shake their heads like they're saying, "No." Then, I'll have them shake their head like they're saying, "Yes," while maintaining and keeping their eyes closed. I'll say, “Okay. Bring your head back to where you think center is.”

What ends up happening is then we take out vision, which is a super important sense. It gives us so much information about our external environment, but when we take it away, now what you're relying on, especially with a head shake like whether it's a nod or a shake no, you're relying on the feedback from the joints telling the brain where you are in space, something that we call proprioception. You're relying on the proprioceptive input from the neck joint. If there's something, let's say there's faulty mechanics or there's a faulty flexibility, range of ... Some kind of mechanics are off in the neck, it gives them the wrong information to the brain and you're not going to be able to find center.

The way that I explain it to people is that when we think about the brain, I always like to think about, like the brain is like your cell phone, The spine is your Wi-Fi signal. If your Wi-Fi signal's weak, your phone's not going to work the way that it should. It's going to have to fill in the blanks. You'll see the spinning wheel of death that sometimes we see on our iPhone or whatever.

Dean: We want to get full bars.

Stephanie: We want to have full signal, full communication so that you can load your pages faster. Yeah.

Dean: How far off have you seen somebody be from actual center?

Stephanie: I'm very sad to report that it happens all the time. I would probably say, if we have 20 patients, 18 or 19 patients don't find it on that first day, on that first test. Then, there's a process that I've developed where there's almost like a three-month protocol that we take them through, where there's check-ins at every … There's examinations that we've built in, but by the end of that three months, you better believe that my batting average is pretty good there. People are able to find center at the end of it. That's one of the checks that we do. Yeah. There's a bunch of other ones as well.

Dean: Awesome. Okay. We're going to chime in with a little idea of what you do. I've anxious to hear about the marketing of it or the growth of it or the strategy for it and how we can help you with that.

Stephanie: Awesome! Yeah. I'm really excited to talk to you, too, because you are the man. You are the person on the planet that I think has the most unique insight and the most brain juice, if you will, like brain power to help me.

Dean: I appreciate that. Yeah.

Stephanie: When I look at my business, I have one, maybe two, main bottlenecks. I have double and triple down on patient experience. When we talk about this in terms of fails, my close rate for someone that comes into see me on day one. Then, on the day two, there's what we call the reports or really telling the patient where they were good, where they were not good, and how we are the unique solution to their problem.

On that day two, I have a 91% close rate. What that means is that someone will say, “Yes, this is a care plan that I want to be on and I'm signing up with you for the next three months of care.” Then, after that three months of care, there's another formal re-examination where we will do a lot of the benchmark testing that we did when they first came in. I guess, in sales term, is maybe you call it second money or their first formal re-evaluation, my close rate there is around 87%. Once they're in my office, they're in.

Dean: It that for another three months or for an ongoing care?

Stephanie: Oh, yeah. Thank you for asking that. Yes, so the first part of that care plan is for three months of care. Then, my goal, obviously is never ... I don't want people to be coming to see me three times a week forever. When we want to be able to give them strategies and hacks and tools so they're more self-reliant and more self-healing. That second re-up, if you will, or I guess that first re-up is less frequency of care.

Let's say someone was coming to see me three times a week in the first phase of care. The second phase of care would be once a week, maybe once every other week. Then, that will usually run for another 12 ... Let me do the math here. Sorry. It'll run for another 24 visits. 24 visits is about six months of care, if they're coming weekly. If they're coming every other week, then it's another year of care. The frequency is less. We also give them a break on the cost because they've been seeing us for three months at a pretty intense frequency and stuff. My close rate there is 87. I'm hyper obsessed with tweaking so there's always things that I can do. I want to try to find ways to automate how we gift and how we ask for referrals and all of that. My big bottleneck really comes in the beginning of care where I don't have enough bodies in front of me.

Dean: You got them a lead-in? Okay.

Stephanie: Yeah.

Dean: One more question, then, about after that second round of 6 or 12 months, what happens then? Is that like you just done the thing that somebody is basically, they don't need to be on an ongoing program with you or do you ask people who just indefinitely continue on seeing you once or twice a month or whatever?

Stephanie: Yeah. That's a really good question. I think that's really a conversation that the patient and I will talk about it. It's such a crappy answer, but it depends on what they're showing up with. They may have new goals at that point, right?

Dean: I got you.

Stephanie: They may come in. You know Giovanni, my partner and I.

Dean: Yes.

Stephanie: We are obsessed with super heroes. My philosophy around care is when they come in, they're sub-human, like they're in pain, they're not working well, or there's something wrong. My job in that three months is to get them to human. Then, after they're working the way that they should, we have a curve in the neck or we have a proper range of motion in the low back or whatever it is. Then, that point, it's to really work on becoming super human. That really depends on the goals and the dreams that the patient has.

If you were to ask me like I was just adjusted today, I'm actually sitting at my front desk right now at the office. If you were to ask me if today was your last adjustment, how do you feel about that? I would cry because, for me, if you have a spine and you have a nervous system, you should be getting adjusted, but for some people, you have to meet people where they are. If someone doesn't want to continue care, then I'm going to love them out the door. It's fine, you know?

Dean: Right, because part of the reason that I ask all those questions about the ongoing stuff is that, as you know, we break a business into three divisions, the before unit, the during unit, and the after unit. What you're really masterful at is the during unit in that that's where the client experience is. That's where everything is happening and that's where you can have the biggest impact. It's where you're actually delivering the care. Then, in that after unit, that would be all the sort of ongoing things, building a lifetime relationship with people and orchestrating referrals.

All these things are universally present in every business, but the metrics and the way that we draw the lines of where the division is between the during unit and the after unit, like where does somebody cross the line into the after unit?

I'm imagining that after that 6 or 12 months of care, some percentage of people just continue on coming back to you or they come back on an as-needed basis. It's not you're dead to me, that they're part of your world that you're their go-to, but they're part of your family there.

What we look for in that into measure the return on relationship, we call it, in the after unit. I'm going to start with the after unit just because I know we can do all kinds of cool stuff in the before unit for you, getting people to you, but I want to just get the lines drawn here. You've got a really perfect thing in that if I were overlaying this process here, I would consider your three-month program to be your after your during unit, that that's the one that your signature kind of setting the table kind of program to get somebody, as you would say, human and making that a big difference for them in that three months. Then, where they graduate from that, I would consider those people into the after unit, then.

When I look at it, I'm looking for ... If we took all of the revenue from your practice and we were to divide it accordingly among retribution for the before unit and attribution for the after unit of where it came from. What really is helpful is to understand how much of your business is actually coming from what would be your after unit, meaning people who have already gone through the initial three-month program.

I know that I've hit with these things. I'm not expecting that you've done the analysis, but just anecdotally. If we were with your best understanding of your business, looking at your day sheet or your calendar is where it would manifest, how much of your business or your day are spent with people who are under that definition in your after unit?

Stephanie: Hmm. I hope you don't expect an answer right now.

Dean: No. Just if you were to say, just intuitively what would you ... Yeah. If you were just to say … Did you work today?

Stephanie: I did, yeah.

Dean: How many people did you see today?

Stephanie: I don't know. I want to say 35-ish.

Dean: Okay. That's a good snapshot. This is a really good ... Was today a typical day or is ... Okay.

Stephanie: Yeah. It's a little like obvious did a little flow. We find that August is a little slower.

Dean: I got it. What I'm meaning by that it's not like you have new patients only on Thursdays and you just ...

Stephanie: No, no, no. No, no, no.

Dean: ... that kind of thing. Every day is like a mix of everything?

Stephanie: That's right.

Dean: If we were to think about the 30 odd people that you saw today, how many of them would be in what we would consider the after unit here, people who are at least that?

Stephanie: Yeah. I'd probably say somewhere between 7 and 10 people.

Dean: Okay. That means, then, that's 20 plus of them who were in their first three months of treatment?

Stephanie: Right.

Dean: Okay. You think that that's pretty standard? Do you think that's pretty common? If we were to take other day, that that would be about right?

Stephanie: I'd probably say that the people in the after unit, there's probably a few more because they don't take as much time as somebody who is coming in, they have a lot more questions and all that. Did you find that the ... Like the, as we are defining it, as the after unit, I'd probably say like a typical day would probably be closer to maybe even half and half like 15 and 15, something like that. Yeah.

Dean: Perfect. Okay. It's good to know that just to give you a sense of it that we're ... The opportunities that we have moving forward here is to maximize what's happening in the after unit. Already, you're setting an incredible conversion. That's 87% of the people that do the three months with you, we'll continue on. What we don't really know or have a sense of is what percentage, if there's a drop-off after that next six months of people continuing or that they just go into a maintenance program. Those would be all kind of valuable things for you to know because that's one portion of your after unit revenue is nurturing lifetime relationships with your clients. That can take the form of having a longer relationship with them, doing additional things for them or offering newer, new, and more varied services.

There are lots of strategies for growing the after unit, just serving the people that you have. That can be as simple as all additional things like you're talking about. I know you have the essential oils and I'm sure that, if I remember, do you have supplements and things that you are also offering to people?

Stephanie: Yeah. We have supplements that we build into the, as if the middle unit, is that what you're calling it?

Dean: The during unit, yup.

Stephanie: Sorry. The during unit that we have the supplements there.

Another offering that we do have is a nutritional program, like it's an online, virtual 28 day program that people can go through. That may be something that we can add into the after unit as well, like once we have your mobility and your mechanics and your nervous system back online, and now we can start working on some of the other pillars of health.

Dean: That's great.

Then, the other thing that we look at in both the during unit and the after unit is orchestrating referrals. When you look at where the new people come from, what percentage of the people that come in are referred by somebody else? That's one way of looking at it, but the other thing we look at is what is your return on relationship percentage?

If we take the number of people that you have who we would qualify as being in your after unit and the number of people in your during unit, but we just count them differently, the referrals, how many of them referred somebody to you in the last 12 months, let's say? That's a measure that we look at to figure out your return on relationship.

We do it as a percentage. How many patients would you have that you would say, just ballpark, would be either in your after unit or in your during unit right now?

Stephanie: Oh, man! I wish I had known these numbers before. Let's, just for ease of numbers ...

Dean: That's okay. Yeah.

Stephanie: ... let's call it 150 in the during and maybe 100 in the after unit.

Dean: Okay. The other thing is like, if what would also go into your after unit is all the people who have gone through your after ... What your during and after unit, but are just not on the program right now. I'm sure that you have people ...

Stephanie: There are.

Dean: ... who are inactive clients, that are sort of ... That are those. How many people do you think that would be if we counted?

Stephanie: Stragglers.

Dean: Yeah. In the old days, patients would have that back wall of all the color-coded files of all of your things, but how many patients' records do you have that have come and had any level of, that have gone through your during unit with you?

Stephanie: Yeah. We're talking about probably in the tens of thousands at this point. I've been in practice for 15 years so ...

Dean: Okay. Right on. Even if we took the ... What would you say would be the modern-day version of what you're ... Have you been doing it this way for 15 years or ...

Stephanie: No. Maybe the modern-day version would be maybe two years old. We'll call it two years old because we had a big fire here in my original place so I had to rebuild up to the current place where it is. If I had how many patients I've seen since two years ago, I'd probably say somewhere between, if I had around 10 new patients per week, talking about maybe 500 a year so a thousand in the past two years.

Dean: Okay. Perfect. This is the perfect thing here, that when we look at it, that we're looking that ... Is there any reason why somebody and I don't know where you fall on this, but do you think it would be ... Is there any reason why somebody would go for an entire year without seeing you at all? Would you even recommend that to somebody?

Stephanie: An entire year? No. No.

Dean: No.

Stephanie: Probably if people are thinking about when we're playing the long game with peoples' health. The longest I would really want in an ideal world, the longest I'd want people to go without an adjustment would be two weeks, two-and-a-half weeks. Yeah.

Dean: Okay.  All right. I'm saying this with love, but we're letting down about a lot of people, right?

Stephanie: Right.

Dean: We're letting them down that if you have just by your estimation and you may be off on your numbers there, but it seems like the biggest number that you shared with me are people who have gone through treatment and are not still getting treatment.

That I look at as an opportunity first, that you have to keep it on due to advocate for them, that if I'm one of those 2,000 people that has seen you or a thousand people or whatever in the last couple of years that have seen you and am not coming back right now, what level of communication do you have with me? How do you communicate with the people in your after unit right now?

Stephanie: Yeah. There's no standardization with that. Right now, the most formal that we have is an email that goes out probably at least once every other week. It's usually, if I've written a new article that I've posted on, wherever I've posted it, Medium, Thrive, we will let people know. "Hey. Here's, like, a new article for you to," because we're always trying to educate people so this is just like a way that we drip that, but that's about as formal and about as standard as we've gotten it. There's no formal, "How you doing? Do you want to come back into care?"

Dean: Because now we're doing it, that.

Stephanie: There's nothing like that.

Dean: Yeah, right. Right. No acknowledgement of even sending somebody a thing. It's time for your six-month checkup. It's like the dentist would do or the eye doctor or whatever.

Stephanie: Right. No. This is none of that.

Dean: No invitation that acknowledges that you are one of my patients. It sounds like that email, does that go off to everybody whether before unit, during unit, after … Everybody on the list gets that email?

Stephanie: Yeah. Yeah.

Dean: Okay. That's the most common thing. That's really the way people think about it is that they have a list. We're not demarking any differentiation in there. We're not treating the people who are unconverted prospects differently than we're treating people who came to you for a three-month program, converted to a 12-month program and then come back or graduated from a pre-growth program, did a six-month program and then didn't come back. We're not making any distinction in the way we ...

Stephanie: No. There's no segmentation.

Dean: See a patient or people?

Stephanie: Yeah. I'm not segmenting them, no.

Dean: Right. Just the awareness of that is really going to help.

Stephanie: I think so, too. Yeah.

Dean: Yeah. What would you say, out of the 250 active clients that you have right now, the ones that are in care programs, how many of them refer ...

Stephanie:  Yes. Sorry. Go on.

Dean: It's probably is low. It does seem low from what you're...

Stephanie: Yeah. That number's cut, in terms of active patients, I actually think it's about double that, though. But that's okay. Let's just use the numbers that we started with. Out of those active clients ...

Dean: Yeah. Out of the active clients, when we look at the during unit. Let's just say the people were in their first three months, the core objective for those people is to reach the goal of the three-month program, of what it is that you're trying to help them with to get them so that they get the results and that they're happy enough that 87% of them are going to go on and have the extended care and you're doing a great job on that because that's been your focus. You do great work and you get great results and people rave about it. That shows in the fact that 87% of them want to continue on.

That is the core objective. What we also have are strategic opportunities there. All the ancillary things that you're doing, all the things that are enhancement to that, whether it's the supplements or the essential oils or a nutrition program or all of those things we measure in addition to that as the strategic with goals that we have there. I don't know whether you track and look at that as a metric or whether that commercializes it too much, that it's not about the revenue opportunity of it that you're only recommending those things purely from the efficacy or the treatment calls for it, for them.

Stephanie: Yeah. I think that four things like the strategic, like the enhancements that you were mentioning, specifically with supplements. There is a recommendation in the during unit right at the beginning for them to take a certain amount of supplements or certain types of supplements based on whatever they're presenting with. We check in. In that three months, in that during unit, there are three check points where we reevaluate the patient. One of the question that's asked during that during unit is did you get your supplements? If it's a no, then what we have set up basically at the front is an iPad with the supplements where they can just purchase a supplement and it's drop shipped to them or the clinic, whatever they want. That is how we track specifically with the supplements. Yeah.

Dean: Okay. Those are great. When you look at it, that if you're looking at the ... Now, we're balancing your care protocols, what you're doing to really focus on what's the best thing for getting the result for somebody. We're coupling that now with, from a marketing perspective, of adding some sort of marketing metrics to it to look at the business opportunity within in. I'm sensitive to making sure that what you're doing is leaning on the care part of it, not that we're doing something just for the revenue of it. I think that's where you're coming from, too. That when you're recommending the supplements of it, it's not to get somebody on your auto drop ship program. It's because you, as a doctor, this is the best thing for them. That is the highest kind of integrity that I think you have for your patients. That's just now looking at it, though, that we have to ... You notice when I was talking about the after unit, that I'd look at the fact that there are so many people who are not getting care, that we have to take it on, that we're just from a ... It almost becomes a moral thing, in a way that we're failing with those people, right?

Stephanie: Yeah.

Dean: Because we're failing that they're not getting the care that you know that they need. Right. We need to take that on us and be more invested in making sure that they're actually getting the best outcome that they possibly can and advocating for that, for them, on their behalf.

They can tell the difference when it's literally just you trying to get them on some auto ship program. Your real attention to the relationship in the patient experience is going to really gives you the latitude to have that kind of conversation with them. Now, we can measure it, though, and we can do things that are going to measure how effective we are at conveying the importance of that message to people. I would look at it as a goal-keeping mechanism for us, to know that you know that they're going to have a better experience if they're getting the proper supplementation and that it would be a good metric for us to know that 86% of the people who go through treatment are compliant with the supplement protocol.

Stephanie: Yeah. I love what you're saying because I think sometimes I doubled down and tripled down and quadrupled down on the during unit, right?

Dean: Mm-hmm (affirmative).

Stephanie: I created, like I have an active campaign. I've created a drip sequence over three months for the people under active care, but I haven't done that for my after unit. Then, I'm sure we're going to get into the before unit as well.

I agree with you. I think this a huge opportunity for me to be not letting people down, as you said, and making sure that the messaging there is that I'm invested in getting them the best results because that's just who we are. That's what The Health Loft stands for. Yeah.

Dean: Yeah. That's it. I think that, on the subconscious level in some ways, sometimes, when people are really walking that line of being a practitioner, of being a caregiver, that there's, even on a subconscious level that you don't want to even have the appearance of it being just a money grab to get somebody on the supplementation. Yeah. Saying it in that way, we have to first of all get to the point that your core belief about it is that they're going to be better off and then, we need to accept that for people, so that you're doing it in a way that compels them to follow the protocol for the best results. The metrics back it up. Say you're not recommending a supplement that's not going to have a measurable outcome for them. That's going to be a great thing. Even just the awareness of it that that's going to really help. In a way that you communicate about it, too, it's going to improve.

Then, we've got that as one of the strategic objectives of the during unit. It raises now on the business side, the transactional value of the first three months because it's the first three months is whatever the care program costs. Then, in addition, the revenue generated from whatever the ancillary things are, that's going to be a good thing to measure. Then, perhaps even the more important one is to measure the referrals that you get before that 90 days is up. That's an interesting thing that we talk a lot of times people think about referrals as a reward for doing a good job. They wait until after the service has been provided and then ask for the referrals, almost as, "Did we do a good job? Do you feel that we were helpful?" Then, asking them to refer somebody as if it's a favor to you. The reality is that that's not how referrals work. The only reason that we refer anything is because it makes us feel good, right?

Stephanie: Mmm (affirmative).

Dean: When you tap into that, we want to refer things. We want to. We're constantly referring. If you take it down to a social level, we're constantly introducing new things to those that we care about from this new movie, this new restaurant, this new podcast, this new book, this new service provider. Whoever it is, wherever we have great experiences, you're spreading the word because you feel good about it and you want your friends to get that good thing, too. Just like we spread bad news on warnings about things. "Oh, don't go there. That place is no good," or, "Oh, that movie was so bad. I walked out," or, "I couldn't even read this book." We're constantly on the lookout for adding value to our friends and protecting them from bad experiences. We're wired to do this. It goes all the way back from an evolutionary psychology standpoint, it goes all the way back to when we were in tribes of 150 people that we would be on the lookout. If I was out on the trail and I'm coming back to camp and I'm telling you, "Hey, Stephanie. There's a bountiful blueberry bush just over that hill there. I'm coming back with my arms full of blueberry." I've done a good thing. I'm telling you, "Go over there and get some more blueberries," because everybody's going to benefit from that.

Then, you feel like you need to add value to me so you may tell me, "Well, watch out because behind those bushes, I saw a tiger on the way over here." You're protecting me from now this bad thing that could happen. We're balancing that out. That was the way we survived as a species. This goes really deep into why we're doing it. We don't need to incentivize people to do it or do anything. If we just tap into our evolutionarily wired-in desire to do it, we can now relax and just understand how it actually happens. How referrals actually happen is through conversation. When somebody's in care with you, they're going to be the most aware of it, your most infrequent conversation with them. Their most involved in it. It's on their schedule maybe a couple of times a week, right?

Stephanie: Right.

Dean: If they're in that first … They're talking about it. If they're starting to feel good, they're going to be talking about it. We want to equip people with what to do when they hear people talking about any of the things that could be a good candidate for a new patient for you. You see people for a lot of different presenting causes that they may come to you and they've got some list of issues that they have or some list of things that they're trying to resolve, right?

Stephanie: Right.

Dean: What would be some of the most common reasons that people come to you? What would they be presenting with?

Stephanie: Usually, they're concerned that their posture is changing or there's some symptomatic presentation that's already happened. It can be, they're experiencing headaches or they're experiencing low back pain or neck pain, shoulder pain, that kind of thing. Those are the top three, yeah.

Dean: Yeah. When you look at this now, this is how we want to position this, that those … Do you think that the people who are both in your during and your after unit, the people who know you, that you have them under care, do you think that they are in conversations on a daily or weekly basis that might involve one of those big three or four?

Stephanie: Oh, for sure. Even if it's just at the workplace, right?

Dean: Yeah. Anywhere.

Stephanie: Because everyone's sitting and like, "Oh, my neck. Oh, my shoulder." Yeah.

Dean: Right. Yes. Here's what has to happen. That's the raw material. It's already going on. We just need to equip people with what to do when they hear those conversations, because in order for a referral to take place, in those conversations, three things have to happen. They have to notice that the conversation is about neck pain or back pain or headaches or whatever it is. They have to think about you. Then, they have to introduce you to the person that they had the conversation with. That's how it all fires.

When you do get referrals, if you think back on the last people who came to you as a referral, they probably walk in your office or they probably call and say, "My friend, Emily, told me that she could help me with my back pain. Can I set up an appointment?" That would probably be 80% of the referrals that you get, right?

Stephanie: Yup.

Dean: Then, the other 20% might be one of your patients comes in or you're seeing them and they tell you, "You know what? I was just talking with my friend Emily about you, and she's been having neck problems. Can I have her call your office to get an appointment or what would be the best way to set that up?" Those are probably the two ways that you end up getting referrals.

Stephanie: Mm-hmm (affirmative). If you did the former, I could say that it's usually that people are calling in, saying, "You helped so-and-so." Can you help me, too?"

Dean: Yup. Passive referral. That's what I call those, that you didn't have to do anything for it. It happens and they come. They just show up. That's amazing and that's because you do such a great job in your focus on your patient experience. That's the reward of doubling, tripling, and quadrupling down on your patient experience is that your patients have a great experience and they want to talk about it. You end up getting the referrals that way.

But now, because you're already setting the stage for it, if we were to layer on top of it now an awareness of how it's actually going to happen and we've started instructing people with what to do when they hear those conversations, we're going to see it go up because I believe and I've seen evidence of it that for every one of those conversations that turns into a client that comes into your office like that that says, "Hey, you helped Emily." Then, there are probably three to five more conversations that were going on like that that didn't turn into a patient, that you probably have people say to you, "Oh, I tell people about you all the time."

Stephanie: I do have people say that to me. I'm like, "That's nice."

Dean: Of course. Yeah. They're not telling you about your people that they're telling you about because you look on your referral roster and you see that nobody has come in because of Emily. That's where now, if we instruct them how we want it to work that they will follow that protocol.

We use something that follows a very consistent pattern that we send a postcard every month to people. I have a postcard we call the world's most interesting postcard and just interesting from fact from the front of the card. There are 16 different little short one or two sentence facts that you would find.

Then, on the back of the card, we have what looks like a Post-it note graphic with a note that would say, "If I'm doing this for you," how this might sound is we follow this pattern of, "Hi, Stephanie. Just a quick note in case you hear someone talking about headaches this month," or just if you hear someone talking about headaches, "A lot of times, headaches can be caused by misalignment and it's putting pressure on a nerve," or whatever, in some white way of describing what's going on there. "If you hear someone talking about it, give me a call or text me and I'll get you a copy of my report," or my book or my video or my whatever you have, "To give to them that will explain how to know when it might be more of a headache," or something like that, whatever the title of the report like that might be so that there's something that your friend, your patient is going to have because they're concerned about people. If people are thinking, they're saying, "I keep having these headaches." If people are constantly having a headache, then deep in their minds, we go, "Oh! What if it's a tumor,"

or something. That's something. They want people to get help. If it was easy for them text you and you get an article that, a link to an article or a video that they can text to their friend, they get to look like the hero. They get to look like the caring, loving friend who's concerned about their well-being that they really are.

We're not saying to people, "Tell people about me." We're not saying, "Make sure you tell people about us," or, "Don't keep us a secret," or any of those things that are making us the focus of it. We're being helpful and giving them the, equipping them to give their friend a benefit that comes from them.

Stephanie: They get to be the hero versus …

Dean: They get to be the hero.

Stephanie: "I come and I'll save them." They're the hero and love at being a …

Dean: Right. They're the hero. That way, that now because if everybody. If you think about it. We're in a cell phone, smart phone world right now. If you can program it that whenever somebody is in a conversation and they hear somebody talking about they got a headache or they got neck pain or they've got back pain.  Even if you think about some of the outlier type of things. Jason from the big size system that people might present with, that would also be things for that you could help people with.

If they know that whenever they hear people talk about that, they could just text to you. You're going to get them something to give to them. Now you know that they've been having the conversation with somebody who's having the headache. It's much easier for you now to brainstorm with them how to get connected with them so that they can get the help that they really need. Not saying, "Hey, tell people about us so that they can call us." We want to lower the bar to make it so that they tell you about the people that they're having these conversations with. Does that make sense?

Stephanie: Absolutely, yes.

Dean: Yeah. Sorry. I was sharing with somebody that I had something that was both alarming and amazing at the same time happen a couple of months ago. I have a community for real estate agents. In our forum, somebody posted up, "Does anybody know where I could get carpet installed today? We have a closing tomorrow and it needs to be done today."

Without my permission and without my conscious thought, my brain immediately started singing, "800-588-2300 Empire!"

Stephanie: Empire! Without your permission.

Dean: That moment, that had been smuggled into my brain without my permission and had been living there rent-free for 20 plus years, just waiting to be triggered by somebody saying, "Where do you get same-day carpeting?" "Same-day carpeting? Same-day carpeting? 800-588 … "

Stephanie: My, gosh! That's something.

Dean: This programming is what we're doing with each month sending a postcard that says, "Just a quick note in case you hear someone talking about … " Insert high-probability conversation here. "Here's why you might here that now and if you hear someone talking about that, give me a call or text me and I'll get you this valuable thing that you can give to them." That's the pattern that we're doing. We dress it up a little more with more words and more context, but every month it's the same pattern, the same thing so that we're getting people used to listening for and paying attention to the conversation that they're part of.

Stephanie: It's amazing, Dean. I love it.

Dean: That's a really easy way to get more, your referral rate will go up. The only way we're going to know that it goes up is if we know what it is right now.

Stephanie: Mm-hmm (affirmative). Yes. My referral rate right now is about 70%. Everything else comes from an organic chiropractor near me, kind of Google traffic. But I don't have, to your point earlier when you were saying, "Are the referrals coming before the during unit is up?" That I don't know, but I do know that my total, when I look at the total pool of new patients, about 70% of them are coming from people within the practice, whether they're in the during unit or they're in the after unit.

Dean: Yeah. Doesn't matter. It's the same psychology, but we've just got … I think we've programmed them from the beginning in that first 90 days, but there's lots of opportunities there. We start to think how could we get somebody introduced to this? I don't know whether you do … Now, you start to strategize and you start to think, "Once we know what the metric is and we know what the objective is, now, we can start brainstorming and innovating on how can we raise that number or where is the easiest way for that to happen," you know?

Stephanie: Mm-hmm, mm-hmm (affirmative).

Dean: All of that really can be a … That's like the baseline, that's all low-hanging fruit for you because you've invested the proper energy that you've done in … I love your word for doubling and tripling down on the patient experience that that's the barrier to entry, that that's your … You get to get the rewards of that. That is the first thing. It's much easier to grow with the people who already are experiencing this than to find new people, but we also …

Stephanie: Sorry. Yup.

Dean: But we also can find new people.

You were saying, when you're sending out …

Stephanie: Oh, I was just going to say, the world's most interesting postcard, do you segment to the people that are in the during unit?

Dean: You can, absolutely. Then, you may segment … That strategy, no. I may do other things to that and maybe do that, introduce that in the after unit as an isolated thing, but certainly, for sure, in the after unit, that if you look at it, that somebody who's going through that care, we may do other things in that first three months because the real value of it is going to come month after month after month, that you're still there. You're still there. They're still in your care. That's the thought that they'll have when you continue it with them in the after unit.

Stephanie: Love it and I love doing that in the after unit as well because there's already rapport and trust that's built with the patients and obviously …

Dean: That's the whole point.

Stephanie: ... the results that have happened. That's really easy for them. You just give them the tools on how to introduce the person to me, yeah. Yeah.

Dean: That's exactly right. We get to do it in person. Throughout the during unit, we can orchestrate. There's be some unique opportunities that we have in the during unit to make that happen as well.

Stephanie: Amazing.

Dean: Mm-hmm (affirmative). But I think those are cool.

All that said, I still want to talk about the before unit stuff for you. If you've got a little more time, we can go a little long there.

Stephanie: Oh, I got all the time in the world for you. Yes.

Dean: Oh, boy. I love that.

Okay. Let's talk about the before unit now. The best way to think about it is to think about it. The reason that I separate them into the three divisions like that is I think about them as individual units of your business. The whole purpose of your during unit is to provide that in the office experience and giving people the actual care that they need. The after unit, if you take it once it's for managing the relationship with people who are not coming back as frequently as the people who are in the during unit, right?

Stephanie: Right.

Dean: People in the during unit, you're seeing them the most. We've focused on that as one of the things, but who is responsible? It can be you wearing all the hats, but you start to think about it as if you were only responsible in the after unit for nurturing lifetime relationships and driving that return on relationship metric. That's the accountability of it.

In the before unit, we want to think about the before unit as a supplier to the during unit, meaning you think about it as a separate thing, a separate business that in the business of finding people who have headaches, back pain, posture issues, neck pain, whatever the specific target markets are for the people that you can best serve in the during unit and delivering them to the during unit for a price that you would cheerfully pay for a new client as if it were a vending machine.

If we could create a vending machine and say, "Bring me 10 new back pain people here," what would you cheerfully pay to have a new client? In a lot of ways, when the business is organically bringing you people where we often get spoiled is not … It doesn't even dawn on you to have in the big pie chart of the distribution of the total revenue somebody brings in a portion for acquisition.

Stephanie: Right. This is where I have no game.

Dean: You know what I mean? Right.

Stephanie: Yeah. I have no strategy here. Yeah.

Dean: Right. Yeah. You don't budget for it in a way. I don't know how chiropractors work but among each other, if somebody was to refer somebody to you, would you pay another chiropractor a referral fee or is there any kind of context for what I'm talking about you paying for a new patient?

Stephanie: Between doctor to doctor, there's no prohibitory rule, as far as I'm aware so that's something that can certainly take place. I do receive a lot of referrals from other doctors whether it's people in my network or just a patient is moving to Toronto. They know who I am. They were recommended them, but there is no … Like, I don't have a formal … I don't even know it.

Dean: Probably a referral fee or anything.

Stephanie: … reimbursement or a portion. Yeah. I don't have anything like that in place and far as I'm aware, I'd have to double check, but I don't think that there's any prohibitory law or anything against that. Yeah.

Dean: The only reason that I ask that is that sometimes it's easier to wrap your mind around it. There's already an existing policy for that or an existing protocol for it. Among real estate agents, if a realtor refers a client to another realtor in another town that they would get a 25% referral fee, right?

Stephanie: I see.

Dean: For that client. For some people, they would happily pay that. A lot of relocation companies have this same thing or most of the hotel business works this way through online travel places like hotels.com or Priceline or whatever, that they pay a fee to Priceline or to hotels.com to book hotel rooms for them. They get, of 100% of the hotel room fees, they may take a third of it or whatever the standard percentage is.

Stephanie: It would just save us a lifetime value of the client as well, like if there's a …

Dean: Yes. That's exactly right, is that if you just knew, like if you could buy a patient. If there were such a service provider available, a supplier that you could just say, "Hey, send me over 10 new neck pain patients this week." How much would you cheerfully pay for them, knowing that you've got a 91% conversion program that …

Stephanie: Right. I know.

Dean: … can bring, 91% of them are going to come in. You've got that that your game is really strong. If somebody comes to you with actual neck pain, you're going to be able to help them, you know?

Stephanie: Mm-hmm (affirmative). Yeah. I think if we even … And maybe you can help me figure exactly what that number is, if we think about an average patient in this office spends between and this is the mean. We're talking about around $5,000. Over the course of their six months or whatever it is with us. I guess it'll be nine months with us. Is it like a 10% of that? Is it a 25%, like you were giving the example in real estate.

Dean: What is it now? What is it now? This is the other thing is that often are you spending any money in any way to provide that function right now? Okay.

Stephanie: Yes. No.

Dean: You're not. That's okay. Do you have a list of prospects that are.  You're not doing any kind of organic lead generation or is there anything on your website that people opt in for prior to becoming a member.

Stephanie: Yeah. I was just actually talking to somebody in automation this weekend. I have a lead magnet that is on the front page. It's a little e-book or cheat sheet kind of thing on pain relief, but it is disconnected. It's linked up to my active campaign or whatever.

Then, the other, I guess pool of prospects, but these are not local, mind you, but certainly, there's something to be said, maybe there's a separate conversation around virtual consulting and stuff but through my online writing with zero ad spend. I will just throw that in there. I've built up a list of about 35,000 people. There's a list that I have of people who really enjoy the work that I'm putting out there. Then, I also have the lead magnets on the clinics website, but I don't do anything with it.

I realize I was talking to this guy over the weekend. He was like, "Well, you have to think about the journey of the client and that they have this lead magnet and how can you bring them from … " You have to think about tacky. He talks about how you are attacking more if … How do you bring them from a red light to a green light, like how do you cold lead to slowly warming them up and to a point where they're ready to raise their hand?

The short answer is I don't have any game, but I do have pools … I have a lead magnet on the clinic website. Then, I have a bigger list in my online platform. Yeah.

Dean: Some of the people on that list would be local people with the potential to become a client, especially the ones who download it from the clinic website. Some of those people would be just people that are interested in that topic generally that are in some geographically not candidates for you. Okay.

The original thing that we ended up, that we decided this would be a good idea to come on the podcast and talk about was where you are located. You're surrounded by how many people did you say in the condos that you found hovers right around your …

Stephanie: Yeah. They're in the middle of a huge condo boom, like literally down the street from me. I think there's going to be 2,000 units, something like that going up within walking distance of a clinic over the next … Some of them are already completed and then there are other ones that are going. There is going to be a surge in numbers in this area, but it's already a relatively dense area as well. Yeah.

Dean: Yes. You had talked about the potential of doing some postcards in the …

Stephanie: Yeah, like a mailer. That's what I was, like going old school. Mm-hmm (affirmative).

Dean: Yeah, exactly. We may also be able to reach that same objective with some microtargeted Facebook ads that can get … I've been doing a lot of that here. I've just had a session last night. We've had our little innovation session with my Facebook team. We had figured out a new way of defining microtargets that is almost like a little loophole, which is fantastic. I'm going to talk to Nicholas about it to see the … I don't know whether he thought of this as a way of microtargeting as well, but I was pretty excited about it.

Then, they fit for you right around your thing, but the most important thing is if you were to do some sort of awareness videos around the types of things that you're able to help people with and doing it from your clinic, from there and even from the outside of it, if you're in the surrounding area, like you know, you have this spatial awareness. We're all built within it. If somebody saw you doing a video that was sitting somewhere that's outside right in the neighborhood where they live, they're going to go, "Oh, that's right … I know where that is. That's right out by the street from me."

That awareness of what that is and then going into so that people know where your clinic is so that they're like, "Wow! I'm going to go check that out because that's literally right underneath me there," or less than 200 paces away from me. Which, that's one of the benefits that you have from being so densely populated where people are.

Stephanie: I love it. It's brilliant.

Dean: Mm-hmm (affirmative). Of course, we have the unaddressed ad mail opportunity being in Canada to deliver postcards for very little money right to just those specific buildings is a pretty big opportunity. That's cool, too. We just have to figure out in all of these tools are going to be useful for all of the things that we talked about, like what would be the thing that you would have for … Like, if you think about what's the headache kit and what's the neck pain kit and what's the back pain kit, that if somebody's got those, what is the thing that people are going to go, "Oh, I want that," or, "Give me that"? That way, it's going to have value both as a referral magnet and as a lead magnet on the front.

Stephanie: That's a good thing.

Dean: As part of the before unit. That's how we think of it, that you're … I think there's just so much potential there. As I would definitely start with, it's almost like I look at, especially with a business like yours. I would call that because you've really got the during unit experience down. You've really got an active and ongoing business. You're not in startup mode, that shoring up the opportunities within the during unit and the after unit would be the first thing that I would do because it may get to the point where we never even need to go to the before unit.

Stephanie: Right. I love the idea of it, as those people in the during unit move to the after unit, they can replace themselves. They can replace with a referral, they can replace somebody so you go into the during unit. Then, there's also the maintenance of them and the after unit.

Dean: Yeah. That's the whole point.  That's the strategic objective that if we're starting to pay attention and we say, "Okay. 91% of the people that go through the initial three-month care program will convert to an after-care program and 56% of the people who go through refer somebody before the transactions over."

Stephanie: Yeah. That's really, really, really good. I love that, to be able to track that data because that also tells me where your pain points are, too. Again, for transparency, I also don't know where people fall off. I have people that are in their fifth round of that six-month protocol. I have people, they do one or they do two and they drop off, but I don't know why. I don't have a clear pattern there. That's something I'm going to start tracking as well. That'll give me some better idea about the clinic, yeah.

Dean: Yeah. This is good. I love it. I really enjoyed this conversation.  It's been a great opportunity.

Stephanie: Me, too. Me, too. I can't wait to report back to you to tell you how it's been.

Dean: Yes. I can't wait, either. Then, I'm going to see you in a few weeks. I'm very excited about that.

Stephanie: I'm going to see you in a few weeks at Archangel. Yes. I really excited to be seeing you. I just saw your post about your special group. I'm really excited to see you and all the brilliance and genius that you are.

Dean: Yes. Yes. Thank you.

Okay. Normally, I'd say, "We've said it all," but we haven't even begun, really. We're just at the beginning of this stuff. You've got so much. That was a good intro session here. We could do a whole podcast series just on this.

Stephanie: I love it.

Dean: But there you go. I think we got a good jumping off point for you. I'm always happy to talk more with you. I love you.

Stephanie: We can make it a recurring series if it works for you. I'm happy to come back on and report on what worked, what didn't work for me. Then, we can also mastermind on other things, too. Yeah.

Dean: There we go. Perfect. Okay.

Stephanie: Thank you so much, Dean.

Dean: All right. Give Geo a big hug for me. I will see you guys in a few weeks.

Stephanie: All right, Dean. Have the best day. I'll talk to you soon.

Dean: Thanks. Bye.

Stephanie: Goodbye.

Dean: There we have it. Another great episode. Thanks for listening. If you want to continue the conversation and go deeper in how the profit activators can apply to your business, two things you can do. Right now, you can go to MoreCheeseLessWhiskers.com. You can download a copy of the More Cheese Less Whiskers book and you can listen to the back episodes of course, if you're just listening here on iTunes.

Secondly, the thing that we talk about in applying all of the eight profit activators are part of the breakthrough DNA process. You can download a book and a scorecard and watch a video all about the eight profit activators at breakthroughdna.com. That's a great place to start the journey in applying this scientific approach to growing your business. That's really the way we think about Breakthrough DNA as an operating system that you can overlay on your existing business and immediately look for insights there. That's it for this week. Have a great week. We will be back next time with another episode of More Cheese Less Whiskers.