EP65: Beyond the Yes: 5 Steps to Getting Real Commitment

Most practice owners think the “yes” is the win. A patient says yes to care, a team member agrees to a plan, or a client commits in the moment, and it feels like the hard part is done.

But the real work starts after the yes.

In this episode, I break down my framework for going beyond verbal agreement and creating real commitment. You’ll learn the five steps that help turn interest into follow-through, reduce drop-off, and create more clarity for the people you lead and serve.

If you’ve ever had someone say yes and then fail to act, this episode will help you understand what was missing and how to fix it

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Transcript

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This is the Austin Cohen Podcast where we talk real strategies for chiropractors ready to grow beyond the adjustment. If you're building a business, developing your leadership, and trying to build wealth without burning out, you are in the right place. Let's get to work Don't forget to subscribe so you never miss an episode What's up, everybody? Welcome back, Austin Cohen Podcast. Man, I'm fired up right now. Why? Just got off my ascent call. Freaking love you all, by the way. Teeny closing it down today, giving us all chills. All these office managers on the call today just stepping up, showing some really bomb leadership over bo- both of them actually from Texas which was really cool. Man, all the doctors just being vulnerable and sharing certain behaviors that have been modeled by their team members and how that's gonna translate into growth by making some changes, which we talked about today. So I'm fired up. So you got the fired up version of me today, baby, which is great. And I know the last few weeks we've done a lot of behavioral stuff, personal development, professional development, which honestly, at the end of the day, I think is the most important stuff. Today, I'm gonna go tactical, but I really do still think to this day that the stuff that will-- the content that will get the people moving forward and move the needle for their practices and their lives is always gonna be on the personal professional development side. Usually, it's personal development first, working on themselves, but at the end of the day, I still wanna give you guys some tactical work for those that are putting in the work personally. What I wanna talk about today, though, is what happens when a patient says yes after that. And I know a lot of practices do spend a lot of time and energy and money. They're trying to get patients in the door, a lot of money on new patients. So whether it's marketing, Facebook, Google ads, referrals events, reactivation, social media, whatever, all of it is very important. But usually there's a hidden leak in a lot of these practices, and it's not always that they cannot get people to say yes, because a lot of them can. It's what happens after someone says yes. The practice does not have a clear enough system to help that person stay committed. And the patient says yes to care 'cause, listen, everyone gets to close, but I want the commitment. The patient says yes to the care, they get them scheduled, they start, and then over the next few weeks, something starts to happen. They may miss a visit. They reschedule an appointment. They start asking, "Oh, do I really need to come in this often? Do-- I'm starting to feel better. Actually, I'm kinda busy right now. Let me talk to my spouse. I'll call you when I get back and know my schedule better." And before you know it, the patient is gone. And the office will usually justify it saying something along the lines of, "Oh they're just not committed." Maybe. But also, maybe they weren't guided well enough after they said yes. And this is what I wanna unpack today. Because retention does not start when a patient starts missing their visits. It starts the moment they say yes. And the concept to grasp, and the big idea of this is that a yes, and at least in our company, is not the finish line. That is the beginning of the patient's belief-building process. If that belief is not reinforced, the patient starts to drift. Now, the patient may still be showing up physically, by the way, in your office for their appointments, but mentally, they are already questioning the plan, and they're starting to think things such as do I really need this? Is this working? Maybe it's my supplements. Why am I coming this often? I could just do inversion tables. Is this worth the money? Maybe I come in when it hurts. What if I miss this visit? How long am I supposed to do this?" If your practice does not have a way to keep answering the silent questions, the patient starts creating their own answers. And you've heard me say this before, a confused buyer doesn't buy, and a confused patient is gonna be very hard to retain. So when I say onboarding, I'm not talking about the video you send them, the paperwork they fill out, the folder you're giving them on their day two. What I'm talking about process-wise is helping them understand what's happening, what the plan is, why does consistency actually matter, and how does that benefit them? What should they expect in your office? What does progress look like throughout this patient experience? Who's the person who's guiding them, and what's their role in the patient experience too as well? What's the patient role in this? That is onboarding, and every good business understand this. Software companies, when you sign up for a new software product, the best companies don't just swipe your card and disappear. They walk you through the first steps. They show you where to click. They give you a checklist. They send reminders. They show you how to get your real first result. Why? Because software companies know the first win is what turns a sign-up into a user, and if someone signs up for the software but never uses it, they're gonna cancel. If they log on and they feel confused, they're gonna cancel Chiropractic is not any different. If a patient doesn't understand the value of the care plan early, they emotionally churn before they physically disappear from the schedule. And a first win, by the way, could easily be symptom relief. Like we always talk about getting that first win in our coaching group. But also it could be clarity. It could be the patient saying, "I finally understand what's going on and what we are doing about it." 'Cause it could be them feeling like the team knows their name or exactly what the next step is. It could be them being able to explain a care plan to their spouse. If they do not get some kind of first win quickly, most likely they'll drift. Like for us at Chiro180, for example, we always talk about this, where our first win for us is getting people to know their black hole. Then we wanna get people using the L10 meeting structure, where they're able to have the best staff meetings in the history they've ever had, and then maybe we move on to spinal health scores. But it's gotta start with them getting the first win. So just something for everyone to think about as you're dialing in your patient experience. When you think about gyms, a person joins a gym when they are motivated. But every gym owner knows the same thing. The motivation that got someone to join is not what's gonna keep them around. That is why good gyms don't just say, "Oh, here's the key card. All right. Good luck." What do they end up doing? Maybe they give you a good workout. There's a trainer. Maybe there's a plan. There's progress checks. There's reminders. There's community. There's milestones. Joining is an emotional buy when you join a gym, most likely. Staying is gonna be a behavioral decision, and that is, I think, a huge lesson for chiropractic, right? The emotion that gets someone to say yes to your care is not always strong enough to keep them consistent. A patient may say yes in the room because they are hopeful they're motivated, they're finally like someone understands them. Two weeks later, life hits them. Work gets busy. Kid gets sick. Money feels tight. Maybe they start to feel better, or they're still sore and wondering if it's working. And if the practice is depending only on the motivation from the ROF, that is not enough. You gotta have a system that keeps reconnecting the patient to why they started. Another example, restaurants. To me, a restaurant can have great food and a bad experience. Walk in, no one greets you. You wait too long. Server maybe seems distracted and doesn't fill up your water regularly. I love a good fill up of water. No one explains the menu to you and the value around it, where it comes-- food comes from. Food comes out, nobody checks on you. And by the way I'm not saying the meal's bad. The meal actually may taste good, but the overall experience was pretty disorganized. Am I gonna rush to go back? Probably not. But what if I had the food was okay, but I had the best experience in the world? I'm more likely to go back, and I think chiropractic offices are the same. The adjustment is not the whole experience. Very important, by the way, and you should be really good at adjusting, but it's not the whole experience. The patient is noticing literally every single thing that you're doing. Hey, do they remember... Did you guys remember their name? Did the front desk know what's going on with the patient case? Does the doctor seem rushed when they're moving from patient to patient? Does anybody explain to them what happens next? I always love "Here's what I felt, here's what I found, and here's where you're going." Felt, f- felt, found, future. Patient, maybe they feel like the place is disorganized. You can deliver great clinical care and still lose patients if the f- patient experience is not clear or disconnected. Another example, financial advisors. To me, a good financial advisor does not get someone to sign paper and then disappear People second guess financial decisions all the time, wondering if they made the right move, if it's too risky long term. What does a good advisor do? They create a process, and ours did the same thing for us, right? They built backwards. They clarified goals. They explained the plan. They take me through implementation process. We have follow-ups. We have progress check-ins. They're just constantly educating. Financial advisors to me have done a really good job. When someone makes a long-term decision, they've gotta have reassurance after the decision. That's what happens in chiropractic. A care plan is to me a commitment. If there's money, there's time, behavioral changes, sometimes there's gonna be delayed results. I'm not always getting people to feel better immediately. So after someone starts care, I gotta keep answering the silent question or that they're thinking in their brain, "Did I make the right decision?" That's what we gotta go through. Last example I wanna share, Disney. What does Disney do the best? They think through guest experiences before the guest ever gets to the park. So if you look at for those that have been to Disney you know this, right? The parking, signage, the lines, the language of the staff, the cleanliness. They used to use a language Walt Disney used to say clean windows. Why? Confusion creates frustration. And what happens in a chiropractic office? Confusion creates doubt. So if the patient doesn't know where to go or what happens next and why they're doing something, lowers trust. And the more confusing the experience, that to me is more likely and it makes it easier for them to quit. One of the best things that you can do for retention is very simple: reduce the amount of confusion the patient has to carry. Now, there's four Cs that I like to call to this. And so there's the four Cs to the patient onboarding that I'm gonna share with all of you. Number one, clarity. You've heard me say this a million times. Does the patient understand the plan? Not just did you explain it, but do they actually understand it? And can they explain what's going on, why they're coming in, how often, what the first phase is, what they should expect, what progress looks like? If the patient can't explain that back in simple language, they probably don't own it yet. And if they do not own it, they are more likely to question it. That is one. Two, confidence. Does the patient believe they made the right decision? Confidence is not built in one moment. It is a reinforced thing over time, especially early. The patient's gotta hear, "Hey, you're in the right place. I'm glad you're here. This is why we recommend this. Here's what we're looking for, by the way. By the way, here's also what normal looks like, and here's what progress may look like. Here's your next step, though, too, as well in this process." People do not stay committed to a plan they are unsure about. I... Listen, this is true for anything. Like my clients in Ascent program, in Empire, they've gotta consistently have confidence in me to lead them to where we're going, and I know exactly where we're going. But I gotta keep emphasizing that to them and show them the plan. Most of these people who are in my coaching groups have been burned by their coaches too as well, or they've had other coaches, and everything's still the same. Why? There's a lot of reasons why I'm not gonna go into, but there's really good systems that we've done, that I've done and executed. I've opened up 20 clinics. I've done this so many times, probably more than most chiropractic coaches, actually, that exist personally opened. I got I got this. The third thing is consistency. Does the patient know what they need to do next, and do they understand why it matters? A lot of patients, I believe, fall off because the practice thinks that they understand consistency. Now, they may think, "Oh, if I feel better, I can skip one. If I miss one, it's not that big of a deal." I want you to remember this line: Consistency makes more sense when it is explained before the patient needs to be corrected. If you only talk about consistency when the patient is already missing their visits, that to them may feel like pressure. But if you can explain it clearly from the beginning, and I like to do it at the ROF, and I like to do it at the handoff, it feels like part of a plan. And number four is connection. Does the patient feel known by the team? Front desk has gotta know their name. Team's gotta know what they're working towards. Does any remember that they wanna golf again, sleep through the night, pick up their kid, get through work without headaches? Like, why are they here? Most people are less likely to disappear from a place where they feel seen. Hands down, without a doubt on that one, okay? So- I think what would be important is to share maybe a r- g- idea of a 30-day patient onboarding map, and use this as your guide. It doesn't have to be what you do. I'm just gonna give you an example. But I want you to think about this. So day one, anchor the decision. And by the way, in these podcasts, you could probably transcribe these podcasts through Spotify and upload them to some AI platform, whatever you use, and have it build certain things out for your practice too as well. So hopefully you're taking notes, but also, yes, you could also transcribe this. And there's probably transcription websites too as well that'll transcribe this podcast, and then you can build it yourself. Now or what you could do is get on our wait list for Ascend for the September 8th cohort 2, get the same awesome results that everybody else is getting, and let's do this thing together. I'm-- don't do contracts long term. I- if you're not happy and you're not getting results, just stop. Very easy. Not one of those coaches. If if you don't find value in my stuff, then no hard feelings at all. Knock on wood here we are. We haven't lost anybody in the year that we've-- in the, what, five months, six months we've been working together with ev- all these different clients. But, I think it's... 'Cause I do think there's an element of what people think they can do on AI and what people can do in group settings with a coach. I do think there is a level of difference, like when somebody's questioning and asking certain questions to what you're saying. So the 30-day patient onboarding map, day one. I think what's important is anchoring the decision. When a patient says yes, to me, the next step is anchoring the decision. They're not leaving confused. They know what happens next, what the first few visits are about, what you're watching for. If they have any questions, who are they gonna ask? Why does the schedule matter so much? "Hey, listen, John, you made a great decision today, and our job over the next few visits is to help you understand the plan, stay consistent, and know exactly what happens next." So what we're gonna have you do is we're gonna have you schedule your appointments with Angela, and we're gonna do your first 12 vi- visits first, and we're gonna schedule that to your re-exam and then also your re-exam report because at that appointment, we're gonna talk about where you were, where you are, and where you're going. Also, if you know the most important days, if you know the da- if your schedule doesn't change so much, we- what's actually for you to get the best ROI and get some of the best results is be consistent with your days. So if Monday, Wednesday, Friday, you can be here between 9:00 and 9:30, your body will get built into a pattern, and your results will actually be even better than they're already gonna be. Can you commit to those days, Monday, Wednesday, Friday, 9:15? Yes. Great. So what we wanna do is just we wanna reinforce that, especially the handoff. Number... At week one, th- I think that's when doubt starts to show up. Patient's gone home. They're talking to their spouse. They're looking at the schedule. They're starting to think about money. Maybe they're sore. Maybe they're better. Doesn't matter. You gotta reinforce the plan in week one. Th- Things, questions that I would be thinking about are is it normal to feel this way? Validating that. What happens if I miss one? Hammering that home before they say it. Do I really need to come this often? To me I could see how a lot of chiropractors could say, "Oh, these are such annoying questions." These are onboarding moments that I believe actually are questions you would want from a patient to be asking, but I think there's a way that you could hammer out these questions before they start asking the questions to you. Week two is where I think it's important to start watching for the drift. Like by week two, the newness and the honeymoon phase is really starting to wear off. You're starting to see signs of leaving before they leave, like more rescheduling, missing visits, less engagement. Maybe they've already asked you, "Hey, I'm starting to feel better. Can I come in less?" Or it's becoming harder to schedule them. Drift from a patient usually starts small, and if nobody catches it, that patient will be gone for sure, and that's where usually week two is gonna start to come into play and really be important where you can hone in on building why it's important to be more consistent too as well in that office and how close they are. "Hey, you're... Johnny, wanna give you a heads-up. You're halfway to your first re-exam. Hey, man, in two weeks, we're gonna be checking to see all the changes your body's made so far, and I actually have some custom exercises that we're gonna be giving you. Really looking forward to that visit. That's gonna be in two weeks, so make sure you're consistent Monday, Wednesday, Friday the next two weeks, and we'll do that and go over your progress report after that re-exam visit." Week three, man, like just reconnecting to goals again. I think by week three, Just reconnecting with why they started. "Hey, Johnny, what are you noticing so far? What feels different? What are some things you think we still need to be working on?" And connect it back to "Hey, that's why this next part of the plan matters." This is leadership. You're connecting everything back to the next phase, the next plan, your future pacing. And day 30 once you get to that four-week mark, that's the recommit. So like at 30 days, there's like usually a checkpoint, so you're probably a re-exam, progress exam, whatever you call it, and then you're gonna review the progress, you're gonna reinforce the next phase, answer any questions, remind them of the bigger goal, and recommit to the plan. Now, fortunately, there's no finances usually to recommitting to the plan going forward. It's more just a verbal about what you guys are working towards. And, the first 30 days are not about getting the patient started, they're just about helping them become the person who understands the value of staying consistent, right? That to me is gonna be what we're looking for. And I think mistakes I see in practice are like, chiropractors think that the report of findings is enough. Yeah, it matters. The patient's not gonna remember everything you said. And if your whole retention strategy depends on that one conversation, to me, that is very fragile, by the way. The second mistake I see too as well, like team's not aligned. So like the doctor may explain something one way, but then the office manager explains a different way. The front desk doesn't really know what the patient heard, and if your team is not aligned, then yes, your patient will feel it. Is it okay for a patient to miss to the doctor? No. Then why is it okay for the office manager? And vice versa. Another one could be like the only... like you only address objections after the patient is already leaving. So if the first time you talk about consistency is when the patient's trying to cancel, you're late. To me, good onboarding answers come before the pa- like, you wanna say something to the patient before they come up with reasons to quit. You know the predictable concerns they have. Why not already address them, okay? And I think another one I see too as well that's pretty common, is they assume silence means commitment just 'cause the patient is not complaining doesn't mean they're bought in. Some patients are quiet right before they leave and that's where I think it's important to invite them to questions. "Hey," "Johnny, what questions do you have so far about your plan? What feels unclear to you right now? What would make, what's, what would make this easier to be consistent with? 'Cause you've actually been doing an amazing job. Has there any been any hiccups or anything that I need to watch out for?" "No. Hey, Austin, everything is going great." I think if you look at your first 30 days with your team, and you start asking what happens after someone says yes? Who walks them through the next step? What does the front desk say? What does the office manager reinforce? How do we check for confusion? How do we catch early drift? When do we reconnect them to their goals? What happens at day 30? I don't, I think if you can't answer those questions clearly then you don't have a retention system. You have good intentions, which is good, but it's not enough. And for those that are looking to build systems I think that's the most important thing, right? Take a piece of paper out. What happens after they say yes? Day one, week one, week two, week three, day 30. And you're starting to write out, and those- you're starting to write out under those five categories, right? What does the patient need to understand? What questions might they have? What might cause them to drift? What should our team say or do? And who owns the step? And I think right there alone, you're closing the gaps. And if you take one thing from this episode, let it be this: patients do not usually disappear all at once. They drift before they disappear, and that drift does start early. It starts when the plan is unclear, team's not aligned, patient has questions. They start to feel better. So yeah, keep working on getting new patients. I am not against that. Keep improving your marketing, 100%. Building your brand, love it. But before you spend more money getting people in, make sure you fixed what happens after they say yes. To me, the cheapest new patient is the one you don't lose. And if you build a better first 30 days, you will 100% improve your retention. You'll build more trust. There'll be better patient experience, less pressure on the team. That to me is the work. So it's not just getting people to start, it's helping them stay committed long enough to get the result they came for. And like I said, for those that are looking to do this with me every single week, make sure you join our wait list for Ascent. It's ascent.chiro180.com, A-S-C-E-N-T. We're like ascent the mountain. I'm taking you to the top, baby. And it's ascent.chiro180.com. Join the wait list. We only take 20 people per cohort. This first cohort's results have been unbelievable. And if you're in my first cohort, please, hey, share this episode with people that need to join because to me, the more chiropractors that are doing the work that you've been putting in and that we've been doing together really builds a strong profession. Hey, love all of you guys, and I'll talk to you guys next week to learn more about building your business, leadership, and life on purpose, visit chiro one eighty.com or follow Austin on Instagram at Dr. Austin Cohen.