Taking on equity partners Part Two

In part one of Taking on equity partners I talked about the importance of having a process to choose the “right” potential equity partner based on their skill and ability as a practitioner, personality, work ethic, ability to add value as a partner in the business, commitment to the task etc. I also covered the steps that a client called John needed to take to attractively present his business equity proposal to Belinda. Some of these activities included having a clear vision for the ongoing business, considering the quantum of equity to make available and at what price, understanding the competitive landscape, what sort of financing he would need to start his new business with Belinda etc.

John and I have worked some more of the above planning and he has now compiled the detail he needs to make the first presentation to Belinda of the opportunity.  We needed to discuss some of the contractual matters like the type of entity that would offer the equity (in his case and country location a Limited liability Company suits him more than my favoured unit trust structure), the detail needed in a shareholder agreement and a contract of sale that will outline exactly what needs to be agreed and committed to ensure there are no outstanding matters.  One key element was to identify what happens in the event of the equity partner wanting to exit (or indeed needing to exit due to unforeseen circumstances), what happens if John is approached by another party wanting to purchase his business etc.

In our most recent discussions before Xmas 2024 John advised that the timeline had changed as Belinda needed to provide some family support and wanted her timeline to be deferred. She remained keen but the timing was not right at this moment. We decided to discuss where to go from here in the new year 2025. This has created the possibility of John taking a different path as he still wants to expand his business and is now not sure how to proceed.

The path this potential transaction has taken is not uncommon and it is prudent that it happens now!! John has readied his business to move forward, and the next steps will be to now explore other options.

The first option is to identify another investor who works with him already and the other is to consider the option of taking an external party who wished to invest but is not another therapist. In John’s case he does have external parties who have followed his progress and have suggested that they have capital they wish to invest in his expansion and see the opportunity as a secure way to park their capital and assist him. We have agreed to discuss this option and work through a new set of considerations! We will need to discuss:

·       How much capital are they interested in investing and how much equity do they wish to purchase

·       What skills could they bring to John in terms of advice, support, ideas for growth and mentoring

·       Do they want an active or passive role.

·       What is their timeline to see returns from the new start up

·       Do they want equity in his existing practice as well as investing in his proposed new start up

Given the progress that John has made it will be helpful to work through his options as he is ready to move forward and can always accommodate Belinda’s interest in equity in due course.

Should you have your own business and looking to expand to another practice or take on an equity partner then make contact with me via email on michael@michaelkenihan.com,.au to see how we can work together or visit my web site at www.michaelkenihan.com.au.

If you also want to read more and learn about how I see practice growth then consider purchasing my book , “The Health Practitioners journey”, available from my web site.

https://www.michaelkenihan.com.au/book

Wishing you all best wishes and every success for 2025

Taking on Equity Partners - Part One

Recently I have been contacted to assist business owners who wish to build their business interests by taking on equity partners. This step in your business growth trajectory is an important one to take and should be considered carefully to ensure you and the interested other party gain a result that will benefit each of you.

In part one I will set the scene of the most recent assistance I have provided to a business owner.

The business owner, I shall name John, in this instance owns a Chiropractic practice working in a near Asian neighbouring country. He has operated for over 10 years and has built a solid practice over a 10 years period.  He has an associate, Belinda, who is keen to pursue her future career in partnership with him. She has worked with him for three years and has developed a practice where many of her clients are referred directly to her from a variety of referrers, social media and via word of mouth. They have just started to discuss the option for her of taking equity and have identified an opportunity to grow into a neighbouring area (some 20 mins from the main business) in the coming 6 months.

I have asked John to commence developing a number of different documents and to firstly consider the strengths that Belinda will bring to his new business.  I list some of the role considerations for her below:

Ø  Access to capital (but not essential as vendor finance is an option)

Ø  Commitment to the practice

Ø  Belinda’s current role

Ø  Amount of time she spends at the practice

Ø  Her ability to establish to new business and then to assist the practice to grow

Ø  Special talents to offer (education officer, great mentor, proven ability to increase practice billings etc)

Ø  Have met certain stated goals required to be met to be offered equity

I advised timeframes will need to be set once the interest has been declared where the practitioner has the chance to evaluate the opportunity.  Such timeframe will be between 90 and 120 days.

While he is sorting the role that Belinda will take, he is planning that:

-          his business vision, mission and values is clear

-          he understands the Capital he will need to establish the new business

-          the amount of equity he will offer Belinda and at what value

-          he needs to better understand the competitive landscape

-          does he need outside investors

-          what are the risks he is prepared to take to develop another business

There is much for John to consider!

In part two I will provide more detail of the process that I am taking John through and highlight some of the potential pitfalls for him to avoid as he moves forward!!

Why I built a stem cell clinic and laboratory

It is dispiriting to treat patients with traumatic or degenerative osteoarthritis and know there are only so many things you can do to help – and that those treatments often don’t help enough.

As a sports physiotherapist, I know patients face a long treatment journey. 

I know how the progress of the disease will likely curb their mobility, test their pain tolerance and damage the function of their joints – cutting their involvement in sport and negatively affecting their lives. 

When I started my career, osteoarthritis treatment options were limited to pain relief, exercise therapy to strengthen the muscles around the joint, weight loss, surgery to “clean out the joint” and, eventually, joint replacement surgery.  It was the 1980s and even then we wondered if there was anything else we could do.

Surgical techniques, such as  joint resurfacing, injections of synthetic substances and other products, came and went. 

None proved to have disease modifying properties – and so far none are seen as part of the solution.  

Sophisticated supervised exercise regimes show efficacy but only when attendees are highly motivated and continue the exercise program long-term. 

At the same time, if patients manage to lose weight, take a sensible and gradual approach to activity and seek supervision, they attain results that on average are 20 per cent better than other approaches.

Then, in 2013, a sliding-doors moment. At the time, I was manager, operator and part-owner of LifeCare Prahran Sports Medicine. We were approached by a group from Monash University’s Monash Stem Cell Laboratory. 

The scientists and veterinarians had been using stem cell therapy to successfully treat osteoarthritis in dogs using donor stem cells from breeds that were known to suffer a significantly lower incidence of osteoarthritis. 

The Therapeutic Goods Administration, the federal regulator, allowed humans to be treated with their own blood and tissue, so stem cell treatment using people’s own cells (autologous) was legal in Australia.

After decades of wondering what else we could do to alleviate the suffering of osteoarthritis patients, I finally saw a possible new approach. 

With our accountant and a number of doctors, including Dr Julien Freitag, we invested as individuals and established a clinic and laboratory in Box Hill. 

We engaged the necessary scientists and other professionals and gained regulatory (TGA) approval, we began treating osteoarthritis sufferers with their own (autologous) stem cells harvested from their abdominal fat via a limited liposuction procedure.

The cells were processed, cultured and expanded to therapeutic numbers.

To date, about 1200 people have been treated with their own cells. Our published research results across all trials demonstrates that 75 per cent of those treated gained more than 70 per cent efficacy from the treatment. A significant improvement on other treatments.

Soon we found that taking fat from every patient’s abdomen and having them wait eight weeks until we had enough cells to inject is expensive, unwieldy and unaffordable for many people. 

The obvious solution was to develop an allogenic (donor) stem cell product and again gain the necessary approvals and do the research.

Earlier this  year, Phase I and Phase IIa safety and efficient studies of the donor product were published and  demonstrated that using donor mesenchymal stem cells is safe and the studies showed some strong signs of being effective. The results were published in Osteoarthritis and Cartilage Open. 

In early September, the Australian Government, via the Medical Research Future Fund, provided us (that is Magellan Stem Cells) with a $7m grant towards further late-stage donor stem-cell research.

It has been a long journey that is not over yet. The science is more than promising. 

We hope Magellan’s upcoming late-stage research with hundreds of patients will demonstrate how well stem cells work for osteoarthritis and lead to the registration of the donor stem cell product, MAG200, for the effective treatment of osteoarthritis.

I think we are very close to answering the “what else can we do” question that has dogged me for decades. Watch this space!

Clinical Mentoring is a pathway to clinical excellence

I am always inspired by the enthusiasm of practitioners to improve their knowledge and skills. When we recently opened Lilydale Physio and Sports Medicine www.lpsm.com.au we had a mix of experience among our team.  From new graduates to those with more than 10 years' experience the opportunity was there to ensure that we focused not just on training our grads but also providing the opportunity for others to learn as mentees and have roles as clinical mentors. Megz is part of the team with experience and has spent the last few years helping others but not developing her own skills as much as she would like. I met with Megan and Laura (both joint practice equity holders) at Lilydale and we chatted about the process of learning and mentoring and how to get the best outcomes for both mentor and mentee.  I devote significant time to the achievement of clinical excellence in The Health Practitioners journey.  Clinical Mentoring is the pathway to clinical excellence. https://www.michaelkenihan.com.au/book

Both Megz and Laura are high performing physios clinically and eager to share their knowledge with others. This can be done in a random or ad hoc way with younger team members asking for assistance at times when treating someone. We try to assist in these cases and quick assistance can be provided but often those with expertise may be too busy to assist then and there. This means that we need to have a structure with all mentoring. Some ad hoc, just now, assistance can be provided but the bulk of mentoring needs to be applied in organised sessions of 45 to 60 mins with topics advised beforehand.

Mentoring sessions should always have both a clinical component where techniques are taught and demonstrated and a theory component where more complex cases are introduced and can be discussed where critical thinking and clinical reason can be encouraged and developed... Ideally the mentee can apply the learned technique to the mentor. If the mentee is well prepared, they will bring one of their own cases to the sessions and discuss them with their mentor.

Towards to end of our discussion Megz asked how we could mentor her. She felt that she had much to learn, and the opportunities had not been there recently for her to do so. To further assist Megz, we plan to organise leading therapists to come and visit and provide input to those with experience. Our other leaders with post graduate study behind them will add a higher level of mentoring to those who wish to avail themselves of such learning.

All clinics need to look how they can mentor their personnel more effectively. This is part and parcel of developing an empowered work environment and a way to improve the retention of your people and ensure that the results of treatment will be maximised for the patient’s benefit.

It takes time to become an effective mentor and the best way to develop the skill is to seek out persons to mentor you. Indeed, this is what I have strived to do in my career, and I hope to be able to instill in others the important role they can play in assisting others to learn and grow.

Sharing The Health Practitioner's Journey Through Speaking

I have been fortunate to be invited to speak several times recently. This has eventuated since the publishing of my book “The Health Practitioners journey”.

The notion of a career journey and how that journey can be built in stages has been what has resonated with those who have invited me to speak.

Being a health care practitioner to many is a chosen vocation to be in a position to serve, support and assist the injured or sick. All of us at some time will need to care of the many who choose such vocations. It is apparent that being clinically excellent with your tole is crucial but so is having a career that will provide satisfaction, enable growth and at the same time provide a sustainable income. It is because of the above that I have focussed on these matters in the presentations.

I spoke with Paul Wright's “practiceology” VIPs a few weeks ago and fielded questions about how to assist with motivating personnel, how to encourage people to consider taking up equity options with them at their practices and how generally to assist the practitioners to develop career options that extend beyond seeing and performing a great job treating their patients. The notion of how to be an effective mentor was discussed as well and teasing out how best to engage with staff and practitioners to see their practices grow and thrive.

Last week I delivered a webinar for Sports Medicine Australia (SMA) where practitioners and students from many disciplines were in attendance. It was encouraging to see the enthusiasm for a plan to develop career options, be more effective with managing time and understand the elements needed to advance a career. I also discussed how to build knowledge and networks by attending courses, volunteering at events and with local clubs, and to seek support from more experienced people to assist you. The webinar focused on both growth in your practice but also how that can lead to a career path as one harvests knowledge on their journey.

This week I will be working with learn.physio recording with Randall Cooper a series of round tables. Randall and I will host guests for three round table discussions that will cover:

Session 1

The First 2 Years Out with two recently grads, Laura Mackenzie and Dan Chang who will provide key perspectives on how to use the first years to set up your career. Laura works at Healesville Physio and Sports Medicine in Melbourne and Dan Chang has just started his own practice

Session 2

Career Crossroads with two successful clinicians who have built careers based on excellence and successful practices to work in academia and practice development. Cate Boyd operates a successful business in Eltham in Melbourne and has had roles with elite sport in Netball and Jill Cook a fabulous career as a clinician, tendon expert and now Emeritus Professor at Latrobe University

Session 3

Harvesting Knowledge where Randall and I will discuss what a career can look like once operating a practice has been achieved. I am pleased that Dr Peter Brukner (amongst his other accolades, author of best selling Clinical Sports Medicine with Prof Karim Khan) will join us in session three with Ms Anna Yerondais who has harvested her knowledge to move from being a regarded myotherapist operating her business to transitioning to be CEO of her discipline’s peak body.

Finally in August I will speak with Melbourne University Physio graduates about career development and then host a “Careers in Sports Medicine and Sports Science” event for SMA where six leaders in the disciplines of Physio, Podiatry, Sports Science, Dietetics, Sports and Exercise Medicine and in Orthopaedic Surgery with provide input on how to develop a career in sports medicine practice in the clinic, academia and in team environs. It is such a pleasure to meet and connect with those wanting to understand the stages of career development and thanks to all those who have attended already and will attend the events in the coming months.

Have a look at my speaking experiences here.

Harvesting Knowledge In Your Career

Building a career as a health practitioner should be a structured process. As I outline in “The Health Practitioners' Journey,” structuring your career in stages of development can lead to a satisfying and financially rewarding path. I outline four stages and see the journey taking a linear approach where you move from one stage to the next. This approach may not suit everyone, but most of us will seek to harvest knowledge on the journey, whichever direction it takes us.

Harvesting knowledge involves approaching your career and experiences as opportunities to learn, experiment, and expand your understanding. If you embrace your journey this way, you'll be well-equipped to take advantage of any opportunities that may arise during your career. This is the key to success, opportunity, and fulfillment across all stages of your career. It ensures not only commercial and professional success but also personal growth and satisfaction.

Many practitioners who have ‘harvested’ well have seized or created amazing opportunities. These include positions in corporate healthcare companies, developing courses to teach their unique skills, or using their harvested skills to embark on new directions, such as speaking at events or becoming facilitators or consultants for similar businesses. As the industry constantly evolves, new innovations arise. For example, AI is becoming more widely adopted, enhancing operational efficiency in our practices.

The above may sound reasonable and achievable, but there are examples where practitioners have taken on too much and pursued opportunities they weren't fully equipped to handle. This happened to me early in my career when I was thrust into managing a sports medicine business without the necessary knowledge, training, or experience. Fortunately, with support from mentors, I learned as I went along. I continued with my clinical practice while harvesting more knowledge, attending courses, reading widely, and listening intently to those with greater expertise. This path eventually improved my competence.

Throughout your career, continue to apply your skills to various opportunities, putting the concept of harvesting knowledge into practice. Here are some key takeaways to ensure you make the most of the knowledge you’ve harvested:

• Develop a Continuous Plan: Ensure you have a plan that involves developing your clinical skills throughout your career.

• Understand Commercial Success: Gain an understanding of what is involved in achieving commercial success.

• Network: Build connections with colleagues in your profession and those in related fields.

• Seek Mentors: Find mentors to guide you through different stages of your career.

• Enrol in Courses: Start with courses in your area of interest, then progressively take courses that broaden your knowledge and challenge you.

• Be Present to Opportunity: Always be aware of opportunities. Luck is often just the awareness of an opportunity and the willingness to act on it.

Too often, people miss out on important opportunities due to a lack of awareness. For example, I once shared a room at a conference with someone I didn’t know. That chance encounter led to the establishment of a sports medicine clinic and a move from Adelaide to Melbourne a few months later.

By following these guidelines, your career will become dynamic and fulfilling. Embrace the harvesting process: seeds sown in autumn will sprout in spring, but you must be aware enough to plant the seeds at the right time!

Stage 4 Leveraging Equity for Exit

Writing Stage four of my book “The Health Practitioners Journey” I challenged myself to include the many pathways that practitioners may take to a new opportunity or exit. The stage is named ‘Selling your list – Leveraging equity’. When exploring this stage, I reflected on one of the habits that Stephen Covey talks of in his book “The Seven Habits of Highly Effective People”. That habit is “begin with the end in mind”.

I have always advised practitioners that it is crucial to keep an eye on how you will eventually exit what you do and move to something else. This may happen at any stage of your career. I made the focus in Stage Four about selling your asset to claim the financial return on your equity. Of course, this implies that you have established a business to sell which not everyone achieves.

I describe the possible scenarios to illustrate who this stage for:

‘The Opportunist’ is the practitioner who takes the unexpected offer that is made to him which was very financially beneficial.

‘The Retiree’ is the practitioner who has operated their business for some years and wished to unlock some money to use in preparation for retirement.

‘The Life Changer’ has worked fruitfully for some years but feels that there is something else they wish to contribute to, or commence and they want to do that while they have the passion and can devote time to that passion

‘The Corporate Opportunity’ can happen to a practitioner who has worked over 10 years in the industry and established a network of practices. The approach from the corporate company was not only to purchase their business but there was the added attraction of developing a role for the practitioner with the Corporation. This scenario was similar to that which I availed myself of a few years ago in my career.

The final scenario I describe is ‘The Career Changer’ who wishes to move onto something that is completely different.

If you see yourself in of the above scenarios you need to make some preparation! To make your business attractive you need to consider how the business looks both figuratively and financially. Identify the services you offer, the patient database you have developed and the current documented systems and processes e.g. recruitment, induction, HR, stock etc that you have or may not have in place.

Some questions to consider are:

• How will you set a value for your business?

• Who will assist you in the process?

• Do you need an advisor?

One important word of caution for you. Ensure that you maintain confidentiality about the process; if you broadcast your intention it may affect the purchaser or destabilise your stakeholders. Change is a frightening thing to so many of us so don’t create fear by telling others of your intentions until you need to. If nothing happens with the process then no one is any the wiser.

Moving on from what you have created can be a painful process as you are passing on what you have built and will not be able to control what happens from then on. Make sure that you give due consideration to whom will purchase the business so that what you have built has the best chance to continue successfully when you are no longer in control of it.

This part of your journey can be exciting and rewarding, if approached with appropriate planning, support and forethought.

Building Partnerships in Allied Health

SMA Chair Kay Copeland at SMA Board Meeting

Establishing partnerships in allied health can be a personal and professional growth strategy for practitioners looking to expand their options, enhance their impact, and advance their careers. I have experienced firsthand the benefits of developing partnerships in many different arenas and can attest to the profound difference it has made in my own journey, particularly in the creation of my book, The Health Practitioners Journey. I will discuss some of the partnerships that I been involved in and detail they have shaped my career.

Partnerships come in various forms and serve different purposes. 

Equity partnership in clinical environments

My first foray into a clinical partnership was the creation of one of the first MD clinics in Australia, Malvern Sports Medicine centre. That centre with a focus on Musculoskeletal sporting injury management involved partners who were Sports Doctors, Physios, Podiatrists and Dietitians. This partnership evolved and developed a further four sport medicine practices in Metro Melbourne and provided three weekend sports casualties as well as services to elite sports clubs. Mutual growth, learning  and support were hall marks of those businesses.

I have mentored many practitioners  looking for equity partnerships in practices, and businesses where they are exposed to opportunities to invest in the success of a venture while sharing risks and rewards. These partnerships are built on trust, transparency, and a shared vision for growth and prosperity.

Network partnerships 

When my sports medicine  group I was a partner and General Manager of was approached by LifeCare Health (LCH as listed Co on ASX in Perth) it was clear that LCH were keen to acquire our business and to partner with a larger clinical group on the East Coast of Australia. This formed a great partnership vehicle to see our service expand and as  a group develop a number of clinics  in Victoria as well as having a corporate partner to guide that growth. The collaboration lead to LCH being acquired by Foundation health care and the two entities became Independent Practitioner network (IPN). An opportunity was created for me to build a corporate career and learn many skills from senior managers and staff from the industry partnerships.

Another noteworthy partnership was a more personal one that built with sports medicine industry association that was with Sports Medicine Australia (SMA). By aligning with SMA I learnt the importance of networking and worked together with SMA on many projects be it with sport event coverage, teaching sports trainers, being involved as President and even CEO where  I was able to amplify health messages and effect meaningful change in healthcare policy and awareness of the importance of excellence injury management and the need for all of us to increase our physical activity to improve our health outcomes

Commercial partnerships

Additionally, partnerships with other consultants have been important to gain industry knowledge and understand the needs of up and coming clinicians who are building their own careers. Speaking and delivering webinars at events and collaborating on commercial matters, have enriched both my knowledge and reach within the industry.

I have recently been developing partnerships where I offer a promo code to those I collaborate with to promote my book to their network to purchase at a lower price point. I hope to set up a collaborative partnership with Universities in the US to include my book as part of the curriculum in their Allied health courses.

Sports Teams and clubs

Furthermore, partnerships extend beyond the realm of healthcare into sports clubs, where mutual support and reciprocity thrive. By partnering with sports clubs, I not only contributed to their members' well-being but also gained exposure and credibility within the community. 

In conclusion, partnerships are a cornerstone of success in allied health, offering opportunities for collaboration, innovation, and growth. Whether it's working closely with consultants, collaborating with industry associations, or partnering with government entities, the possibilities are limitless. By embracing partnerships as a strategic imperative, professionals can unlock new opportunities, amplify their impact, and achieve greater success in their careers.

Stage 3 for Experienced Practitioners

Stage Three is where you aim to 'lead your list' and maximise equity.

When your career is up and running and you feel you have developed a strong level of clinical excellence and a vibrant, regular list of patients, you will experience satisfaction knowing that people seek your services and advocate for your practice. If this resonates with you, take pride in your achievements.

If you're someone who seeks new challenges and feels ready to embark on a new journey, establishing your own business may be the path for you. However, this new and exciting path can be daunting.

One way to ensure you take the first steps towards success, where you begin to maximise equity (simply put, developing an asset that doesn't solely rely on your billings), is by dedicating time creating a comprehensive plan. This plan should outline your vision for the future business, its operational aspects, and considerations such as name, location, fit-out, and personnel requirements.

from Stephen Coveys 7 Habits of highly effective people

Spending time in quadrant two (non-urgent but important) of the time management matrix, where planning takes precedence. Whether you're considering buying into an existing business or starting from scratch, thorough due diligence is essential.

Consider how you will market your business to increase billings. Determine whom you will employ or contract to assist you and contribute to the business's growth. In my book, "The Health Practitioners Journey," I've included MK Laws of Growth, some strategies to increase referrals and patient flow, aiding in the growth of your team's lists.

Implement robust induction, training, and mentoring processes for your team. Introduce meaningful performance measures or Key Performance Indicators (KPIs) to guide progress and performance.

Additionally, you'll need to consider

• Understanding the financial aspects, including fair pricing for acquisitions or greenfield startup capital requirements

• Comprehending the operational processes and systems

• Identifying your competitors and ensuring compliance with regulations and permits

• Defining your business's vision and the patient demographics you aim to serve

• Planning for necessary equipment and creating an ambience in your premises that reflects your business's values and professionalism. I suggest creating a checklist as a valuable exercise to ensure no crucial matters are overlooked.

Utilise the example checklist provided in my book to guide you through the various considerations.

This step is a big one and it is challenging but very rewarding and undoubtedly worth considering, so ensure you are prepared to embark upon it confidently!

My Speaking Journey

In my journey within the healthcare industry, I've had the privilege of engaging with practitioners through various communication channels. Whether it's been mentoring sessions, discussions with business partners, delivering lectures, presenting at conferences, or simply sitting down with business owners, each interaction has been invaluable in sharing knowledge and insights.

In today's interconnected world, the avenues for communication seem limitless. With the release of my book, 'The Health Practitioner’s Journey,' my focus has shifted towards sharing the model outlined in it and my experience through speaking engagements. Speaking has been an incredibly rewarding way to connect with audiences, and I'm passionate about sharing my learnings gained over the years to benefit others in my field.

Let me take you through some recent examples of how I've been able to educate and inspire through speaking:

Productivity Videos

I developed a series of comprehensive videos aimed at helping practitioners and businesses enhance their productivity. These videos, delving into time management, activity planning, and overall efficiency, were well-received by various healthcare associations, providing practical insights for those seeking to optimise their work processes.

Webinars

Hosting webinars allowed me to delve into the intricacies of practice and business operations within the healthcare sector. These sessions attracted a diverse audience, and I had the opportunity to further collaborate with attendees through my consulting services, offering tailored guidance based on their specific needs.

Multidisciplinary Conferences

Speaking at conferences covering a range of topics, from business operations to career advancement in healthcare, provided a platform to share expertise and engage with professionals from all backgrounds.

Workshops

Hosting interactive workshops provides a more informal setting for exchanging ideas and feedback on various aspects of business operations, fostering a collaborative learning environment.

Podcast Appearances

Participating in podcasts allowed for engaging conversations about my professional journey and the insights shared in my book, this interactive platform provides a unique opportunity for dialogue and knowledge exchange between professionals.

Each of these speaking opportunities has not only enabled me to connect with audiences but has also served as a source of inspiration and fresh ideas. As I approach the later stages of my career, I'm excited about the prospect of tailoring my speaking engagements to address specific themes from the model in my book, catering to the needs of different audience segments with the different phases of the Health Practitioner’s Journey.

I'm eager to share insights that resonate with individuals at every stage of their professional journey. It could be guiding students and recent graduates on building a solid foundation for their practice. Or assisting established practitioners in maximising their commercial success, possibly moving into their own practice, or considering it may be time to take on a new challenge or look at options to exit their business

There's a wealth of topics I'm keen to explore further, and I look forward to the enriching experience of speaking to diverse audiences, each presenting a unique opportunity for learning and growth.

Michael A. Kenihan

Stage Two for 1st-2nd Year Physiotherapy Graduates

In my book "The Health Practitioner's Journey," I outline four stages in a health professional's career. The second stage is Commercial Success. This entails maintaining a patient list consistently over 80% full, with referrals coming from various sources, including word of mouth. Through diligent efforts in achieving clinical excellence, this stage yields commercial success as patient lists and referrers grow.

Owning your patient list

Stage two is an ongoing process that can set the groundwork for starting your own business. At this point, I discuss a practitioner "owning" their patient list, a figurative term signifying patient loyalty, where they would follow you if you moved from your current practice. This loyalty is established through advocacy, as patients recommend you to others, as detailed in the ladder of loyalty in my book. 

During this stage, you become more aware of the conditions and patients you wish to treat, possibly developing a unique selling proposition. For example, targeting specific referrers, like a sports club, can help you focus on treating athletes.

The journey to commercial success

Working towards commercial success is a rewarding part of a practitioner’s  journey. Treating more patients, enhancing clinical skills through courses and mentorship, and staying informed through reading all contribute to your success. You may find yourself sought after for specific niches or invited to speak at events, reflecting your professional development. It's crucial not to become complacent; hence, developing strategic plans to nurture existing referrers and attract new ones becomes vital in this stage. While seeking new referrers is important, understanding the associated risks and benefits for the referrer is equally crucial, this allows you to establish trust and  a strong relationship. I dedicate a portion of my book to discussing managing the benefits and risks associated with gaining referrers. These are integral aspects of becoming a commercially successful healthcare practitioner.

Methods for improvement

I have mentored numerous practitioners on achieving commercial success. After collaborating with my colleague Jon Ford to implement a clinical mentoring program during our tenure at LifeCare, we shifted our focus to enhancing practitioners' commercial awareness. The process primarily involved gaining buy-in and understanding meaningful key performance indicators (KPIs).

Jon and I developed what we believed would be useful measures, including:

• The average revenue generated per practitioner hour.

• The average number of patients seen per hour.

• The average revenue per consultation or the average fee charged.

The introduction of these KPIs provided practitioners with a baseline from which to work. A managing director of the listed company network at that time advised me that creating meaningful KPIs and actively monitoring them would lead to improvement. This is precisely what we observed. We ensured that the KPIs were easily accessible for practitioners to review monthly, leading to increased engagement. We witnessed their commercial improvement, and the enhanced KPIs became a proxy for growth.

We combined the KPI approach with a planning document titled "Achieving Your Career Objectives," which I have included in the appendix of my book 'The Health Practitioner's Journey'. This document helped practitioners plan their quarterly objectives for improvement. Goal-setting and planning encompassed not only clinical aspects but also their referrer base and targets for increasing referrers. Teaching them to utilise their time more productively in both clinical and non-clinical aspects further boosted their productivity.

To illustrate the impact of these activities, we devised a league table for the network, highlighting those who generated the highest dollars per hour KPI. We realised that those with the highest numbers were also among the acknowledged best clinically. While not entirely surprising, this revelation served as motivation for all and confirmed that clinical excellence leads to commercial success.

I trust this glimpse provides a taste of the comprehensive details in my book about this stage of your journey. 

My book is available on my website, www.michaelkenihan.com.au or from Amazon.

M.A.Kenihan

Stage One for new Physiotherapy Graduates

When I was at Lifecare we established three levels of education for our practitioners. The initial stage was for graduates, 1 to 3 years into their careers. They were in the first stage of education which I call Clinical Excellence. 

It was important to have mentors who would teach these practitioners. I had guided Ross L through commencement of practice at Lifecare Prahran Sports Medicine Clinic and was fortunate to mentor him through stage one (with assistance from exceptional clinical mentors) and into Stage two commercial success. Just six years after graduation Ross was ready to fly!

I asked Ross if was interested in taking a new step, involving becoming a mentor and teacher of others. Despite his initial reluctance, Ross eventually agreed, thanks in part to some persuasive encouragement from me.

We were eager to commence level one mentoring with formal group sessions with the group of graduates from years 1 to 3 that were working at the Lifecare practices in Melbourne. In all we commenced with some eight graduates from six different practices. We named the sessions ‘manual handling and clinical reasoning’. 

I cover those aspects of learning in detail in my book 'The Health Practitioner's journey'. We identified that upon graduation these two aspects of practice need further teaching and by building up the skills in a group environment we believed we could facilitate greater clinical excellence in the graduate’s practices.

Learning in a supportive group of peers where you share what you know and learn together is a wonderful way to enhance your skills. Encouragement from both Ross and peers created an environment where the graduates rarely missed a session. 

The sessions also developed into an opportunity where participants could bring case studies to the session and collaboratively problem solve to find how to best treat or progress these patients in their recovery. A majority of those who participated found that their patient list grew quickly as they had acquired new skills that they applied to their practice. This also prepared them to enter Stage two, of Commercial success and they were well prepared with a solid base of clinical excellence.

Ross took to the challenge like a duck to water and contributed significantly to the development of these practitioners’ skill base. Equally importantly, Ross learnt valuable skills that he was able to apply to his own practice. Stephen Covery calls this approach three person teaching as I had assisted and trained Ross, he had trained his new grads and then encouraged them to share what they had leant to others at the businesses they were working in.

Structured learning needs to be interesting, relevant, and fit for purpose. By combining Ross’s acquired skills and engaging with a thoughtful, enthusiastic group of individuals who understood their position in their journey and the skills they needed to progress we created a very successful learning environment. We had cultivated a generation of new leaders in the Lifecare practices.

The Health Practitioners Journey Model

When I was planning  the structure for my book, “The Health Practitioners Journey” I thought about how a career in health practice usually unfolds. I thought it would be easier to explain by breaking it down into four stages.

Stage 1

The foundation of a successful career needs to be one of becoming as clinically excellent as possible.

Whomever I worked with, I reinforced that initial credibility as a practitioner comes from having a degree of mastery of the technical/clinical aspect of the craft. I also advise that years 1 and 2 from graduation are not about focussing on what you earn as the primary goal, but on building your clinical ability.

Stage two

Focus on commercial success where you start earning more and become busy.

The focus for stage two becomes more about developing referral relationships and gaining return patients. There needs to be some training from mentors and others for this stage. Maybe even some short courses that relate to commercial matters of customer service, finance and business development.

Stage three

Direct your career towards starting your own business to maximise equity.

This stage may not be for everyone. If you are comfortable with stage two and earning a satisfactory salary then you may choose to continue practicing where you are but if drawn to start something for yourself, commence a new challenge and apply the new knowledge then stage three maybe a natural progression for you.

Stage four

Leverage your asset by selling the business.

At some point you may want to realise the value of your asset by selling the business. You may continue working but with the business you started in the hands of someone with new energy. Stage four may mean retirement but may also be about new opportunities too.

If you have worked hard in the stages outlined above along the journey you will have harvested knowledge. Such knowledge will be invaluable as you move on to new challenges or want to grow the assets you have created

I use the metaphor of the “list “ as practice clinicians have a “list of patients/clients” that they see, particularly in private practice. In stage one you build the list, then in stage two you own your list, in stage three you lead your list, and finally in stage four you sell your list.

The notation at the base of the model indicates a timeline but this was never meant to be interpreted as tightly linear, many practitioners dip in and out of the stages or stop at a point in the journey where they find their satisfaction.

As I mused about the stages of the journey, I thought that perhaps the best way to convey the stages was by developing a model for the journey. That model is the essence of this book.

The Health Practitioner’s Journey

Today, I received the first copies of my book, “The Health Practitioner’s Journey.”

It was with great anticipation and excitement that I opened the box at my home surrounded by my family and Andy Ford from Social Star, who published the book for me. Chris Grierson, my editor and coach, wasn’t able to attend but was in my thoughts. The moment was emotional as the two-year journey of the book had finally come to fulfilment.

Reflecting on the two-year process as we celebrated together, I thought of the many times I sat at my kitchen table to write another 1000 words or engage in some research. During these moments, I was largely alone but knew that my family was always there, encouraging me and inquiring about my progress.

Having the physical book in my hand and experiencing the completion of a project that was so close to my heart, made me reflect on why I wanted to write this book. The word "legacy" comes to mind, as does the phrase “I always thought I had a book in me.” I wanted to showcase my experience and share what I had learned, primarily from the many interactions while mentoring and coaching those who worked with me or under my direction. I now have a record of the experience, and I hope it becomes a document that will assist and inspire others in a career in healthcare practice.

I am so grateful for the support I have received from friends and, most importantly, for the belief that my immediate family has in me. That support alone was enough inspiration to complete my journey of personal discovery. The book is also a compilation of the many topics I have taught and discussed with such a wide array of people over my career.

I hope as you delve into the pages of the book, you find inspiration and insights that resonate with you.

P.S. If you are keen to secure your own copy of the book head over to our shopping site here.

Sports Medicine Australia tour of Karachi 2019

I was very pleased to be invited to present a sports trainers course with my team of physiotherapists from Sports Medicine Australia in Karachi, Pakistan in 2019. It was a great experience and enjoyable to be able to pass on my knowledge to fellow sports trainers. They kindly made a video of our experience.

Sports Medicine Australia, training with Michael Kenihan and team of physiotherapists

Why making timely and better decisions is important

For Practice managers and Clinician in the business of operating more sustainable Health
Care Practices

For many years I have been fascinated in the process of making decisions in business. I have learnt that if this skill is developed then enormous time can be saved/gained and productivity made rather than seeing paralysis by “over analysis”. The formal discipline of decision analysis has a rather turgid definition, sourced from a modification of a definition from Investopedia: “Decision analysis refers to a systematic, quantitative and interactive approach to addressing and evaluating important choices confronted by organisations in the private and public sector. Decision analysis is interdisciplinary and draws on theories from the fields of psychology, economics, and management science”.

Well, that is a mouthful so let me distil my thoughts about making decisions into six words that cover what I suspect are the key considerations.

Knowledge:

Over time one gains knowledge about finance, human resources, time management, team building and assessing what is truly important. This knowledge is crucial in the process of making decisions. Work on building your knowledge base.

Team:

Understand the capability of your team. We all have strengths and weakness. Some speak a lot and achieve little and other don’t speak up enough and contribute to the discussion. Assist them by putting them in the position to make decisions and even if they are wrong they will learn to make better decisions next time. The only bad result is for no decision to be reached!

Wisdom:

None starts with wisdom. Wisdom is the synthesis of experience, knowledge, judgement and learning. It is gained over time. Assist you team to explore how they may gain wisdom and that it takes time. Greater wisdom will lead to better decisions.

Confucius once said: “By three methods may be learn wisdom. The first by reflection which noblest, the second by imitation which is easiest and the third by experience which is the bitterest”.

Execution:

Sometimes just doing it is required and sod the consequences. There are always consequences so being aware of both the negative and positive consequences need to be outlined/discussed with those making decisions.

Confidence:

Being confident will help with the delivery of a decision and convey a sense of being in control. There are negatives with over confidence so beware how the message of the decision is delivered

Learning:

Establish the environment of learning with your team. Make sure you direct them to important books, articles etc to learn from and ensure that you regularly follow my aphorism of “teach don’t tell”. Empower them by advising that you want good decisions made and that you will help but at the end of the day they should use their judgement to move forward and act when they feel they have the resources to make the decision.

Remember that unless you assist them to develop this skill you will end with a beautifully coined phrase by one of my leading managers, “needlepoint management”, where all decisions end up coming to you to make… a sure sign of a dysfunctional working situation…

To see how I may be able to assist you with your Health care Practice

How to delegate in a way that doesn’t undermine your team

Leading a team means you will invariably have someone or several people reporting directly to you.

The most important thing is to get the best out of your team members.  This does not imply that you must constantly be directing them or chastising them when a job is not done to your satisfaction.  The mantra of “others never do the job as well as I can, so it is not worth teaching or delegating to them, is part of the reason that team leaders often fail to get the best from their team. This “I will just do it myself” attitude renders them unable to build a strong and productive team. Instead, the leader must forego their ego and accept that the delegation process can be slow, acknowledging that at first they may have to receive work that may be at a lower level than their own.

Delegating tasks is a crucial part of achieving an objective and to developing strong independent workers who make decisions with confidence and authority,  instilling greater competence and growth within them.

This said, it is still important to find the right balance of delegation. The lowest level is to tell somebody to do something and report back immediately. This base level delegation  is common in parenting when teaching one’s child to be more independent. In contrast, the highest level of delegation is to trust your team to make decisions and report routinely about progress and outcomes.

My biggest bug bear with watching leaders delegate is to see them constantly undermining those in their team. This includes asking them several times about progress or even chasing up others to see if the task is done.  Finally, what really irks me is when the leader has their direct report delegate a task/message to a subordinate, and the subordinate, unhappy with the task, bypasses the authority of the direct report and contests the leader. The issue then arises when the leader grants the subordinate's request without reference to their direct report. This is a breakdown in communication that shows little respect towards the direct report by both the subordinate and the leader themselves. This often leads to a lack of trust, unhappiness amongst team members and in a lot of cases, resignation.

The fabric of leadership is a fickle one, and the onus is on all parties to maintain balance.

Be Efficient with things but effective with people!!

I constantly meet Managers and others who have difficulty getting the best out of the people they work with and those who report to them.

I also meet people who are tremendous workers and their productivity with the “things of the job” is outstanding but…….

Effective with people

Over time I have realised that some people are naturally effective in their dealings with people. They seem to be able to get the best out of people, are well liked and manage their team very well. Such people instinctively adopt a position of being effective…

This means that they:

• Take time to explain things to people
• Use the “right time” to interact with people ie when someone is unhassled and not likely to be interrupted or in the middle of something
• Schedule meetings effectively
• Are generally kind and positive in their dealings

Efficient with things

Being Efficient always relates to things:

• Do the accounts before time,
• Reply to email quickly,
• Process mail quickly.

In all these instances the object of the work will not be upset at how it is dealt with, so efficiency rules. Those who are good at this too  often try to be efficient with people and it doesn’t work….just think about the last time you were speaking with somebody and engaging with them, eye contact, good body language and they are talking with you while they take messages or look at the phone.. they are trying to be effective and efficient and it doesn’t work! Even worse they don’t know why it doesn’t work!

In the world of work, we need to be both efficient and effective. So to be both just make sure you do your best to not be efficient with people as this is a pathway to ineffective management of people and interpersonal interactions with anybody.  

How Do You Work With Your Team To Assist Then To Improve Their Performance?

We often hear about people having a performance appraisal……In my experience this invokes fear, discomfort or even the notion of “we suggest that you add value somewhere else because you are not adding value here…”

Performance appraisal should be about improving performance and be for the benefit of the individual. It should never be about putting someone down or rubbing their nose in areas where they may have done better. In my experience these necessary procedures should be called “how to be better at what you do”. Consequently a number of strategies should be employed when assisting your people to grow and improve the work they are doing. It might help to consider that you are always working to assist improvement and thatyou just do this often and informally (with feedback), then more frequently and a little more formally (assessment)  and then with a more structured formal event (review).Thesethree methods that can be used to assist your people in their performance, so let’s tease out some more detail.

FEEDBACK

Feedback should be provided regularly and informally. By often we mean several times per week or in the early stages a couple of times per day. Try and ensure it is provided in the first person with many “I” messages. An example of this may be “when I was stuck for the best response to make to a difficult patient I used to restate what I perceived them as saying……..”.

 It is never good when you hear “you should have done…….”. Providing an observation is a good way to minimize the reaction and will often produce a quick dialogue, ideally this observation should be factual and objective, not judgemental. Once again an example “I have noticed that when you take a client from the waiting room that eye contact is not being made and a smile will help to create instant rapport”. Try and invite a response as this may remove any unwanted over reaction and build positive communication. Always start with a positive comment. We say that even if the only thing you can come up with is “I like your shirt/dress today..” then that is a good start.

ASSESSMENT

Making an assessment of progress is a more formal activity and should be done with some but short notice. This sort of activity may be used weekly or every couple of days at commencement and will involve sitting down out of ear shot of others and when both parties have the time to be productive. Time allowed for such activity should be around 15 minutes. Similar types of approach to feedback as mentioned above but the following factors make this interaction more structured:

Provide objective and non-judgemental feedback and invite a response
Impart details regarding why an action is appropriate/inappropriate e.g “maybe it is a good idea to go out of the room while the clients gets dressed”

Offer suggestions or provide directions or alternative actions if required
Provide resources to assist behaviour e.g an article about a topic like e.g“empathetic listening”. The reading of the resource prepares the person for the meeting
Provide personal demonstration of desired action
Role play. We cannot urge you enough to use this activity as a learning tool. In this way you can help your personnel to see a situation from another point of view.

QUARTERLY AND ANNUAL REVIEW

This type of activity is something that is formal, structured, has preparation required by both parties and done at distinct and scheduled times in advance. We suggest annually when a detailed plan is prepared and hopefully able to be measured against some KPI that were set at the time the person was engaged to work. Hopefully such KPI’s will be a mixture of qualitative and quantitative

People can be very poor at setting objectives and need much assistance. SettingS.M.A.R.T objectives when someone starts work that they create and own will assist with the review when it happens. 

• Specific
• Measurable
• Achievable
• Realistic
• Timely

See what difference you can make in your team by following some of the simple advise outline above and good luck!

In Business Coaching, Business Education, Michael Kenihan, Business Tags improve, performance, team, goals

Building Business Capacity in your Health Care Practices

Most of us have visited health care practices. We visit expecting a service and generally judge the practice on how friendly the staff are, how the facility is presented and on the "feel" we get while waiting for our visit. Generally speaking we have little ability to judge how good the advise or treatment we receive is and whether one clinician is more technically effective than another. We just know what we "feel" about what we have experienced and if we "feel" listened to and engaged with we are mostly happy. I have highlighted the word feel because when receiving a service that is how we judge that service not on the technical competence that may be delivered.

How then does this relate to business capacity in health care practices?

It matters because what a business needs is the engagement of their clients whom they hope will become advocates for that business. Such engagement may need to be something that we train our people to deliver, both from staff and the clinicians. Technical ability is assumed by clients so by paying attention to the feel good factor we will build business capacity.