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Darryl Yardley


Over the past decade, healthcare has been transformed by consumer demands, governmental regulations, and financial pressures. One consequence of change is that physiotherapists (PTs) are under increasing pressure to deliver a high quality service and run a successful business. But in order for our practice to thrive, PTs everywhere -not just those in the private sector – need to respond. PTs need to find a balance between treating patients and earning income and here’s my take on how we can.


One way that PTs can promote service accountability (and also financial sustainability) is through performance measurement. A PT, clinic or organization can monitor important aspects of their practice, and also their systems and care pathways.1 They can use data collected through performance measurement to identify strengths and areas for improvement in clinic operations, as well as PT effectiveness. This information can then be used to strengthen PT skills, make clinics and organizations more efficient and drive decisions in service delivery. By measuring what we do, we can learn from it –and continue to strengthen how we work with clients and how we run our practice and business.

For a clinic/organization’s operational sustainability, your physiotherapy practice can be divided into four domains (see figure 1.0):

  1. Customer satisfaction
  2. Outcomes and growth
  3. Clinical operations
  4. Finances

These can be further organized into:

Clinical measures (red) focus on improving client care and a PT’s self-development by looking at health outcomes and customer satisfaction.

Business metrics (grey) concentrate on accurate operational processes and financial data.These can be used for a clinic/organization’s financial sustainability and growth (through business development).

If you’re successful in all four, I’m confident that your clinic or organization will thrive. I’ll pose some questions throughout; keep them in mind and let me know how you promote these four domains:



  1. Customer Satisfaction – Understanding your client’s needs is critical to giving exceptional service –and to retaining your clients. Research shows that a culture of service creates higher levels of customer satisfaction, which ultimately leads to customer loyalty (Wiley et al., 2006). First-class customer service begins at the first clinical encounter. Making the commitment to focus on customer loyalty is likely to grow your business.


    Figure 1.0: Yardley D, 2015

Think about it: What strategies have you implemented in your practice to excel in creating a service-oriented organizational culture? Have these strategies resulted in growth of your word-of-mouth marketing?

  1. Outcomes and Growth –In order to be the leaders of healthcare change, PTs need to fully endorse measurement, analysis, and interpretation of clinical outcome data. Comparing your outcomes against a larger database can show your management plan’s effectiveness and can have a profound impact on how PTs are viewed when managing clients. This type of measurement can also provide PTs with a self-reflection tool to help identify areas of professional development. This type of ongoing learning (and resulting action) can improve clinical performance and efficiency.

FOTO Inc. is an electronic outcome measures system that is risk-adjusted to accurately predict expected improvement in your patient’s functional status. This system provides measures of effectiveness, efficiency, utilization, and client satisfaction, in both individual patient surveys and in the aggregated quarterly reports. Clinics can use this information to promote their clinic’s effectiveness, and can stand out from the crowd in successfully and efficiently treating specific injuries. For more information on the power of FOTO, read “eOM: powered by FOTO” and “the future is electronic.”

Think about it: How do you use professional development to enhance the ‘value of physiotherapy’ and market your business?



  1. Clinical Operations – It may not always feel like it, but PTs in any setting ‘own’ their practices. Executing effective physiotherapy business and practice management strategies is critical not only for success, but for survival.

In order to manage a business at any level, you need to define metrics to drive your practice operations (Table 1.0). This means that you record and manage administrative procedures, financial statistics, client flow, service capacity and productivity, and episode of care maps on a daily, weekly, and monthly basis. Do you collect, analyze and base decisions on your clinic metrics?

Think about it: What metrics do you monitor to sustain and grow your business?  

Table 1.0: Common Metrics in physical therapy practice – Yardley, 2015


  1. Financial Accountability– For many, the bottom line is the single most important part of a balance sheet. The point of a balance sheet is to provide a snapshot of your current assets and liabilities that will give you a snapshot of how your business is doing. Knowing whether you are in the black (net positive) or in the red (net negative – losing money) can allow you to adapt, plan and change accordingly.

You can generally grow your business through various revenue generation strategies and by controlling or lowering your expenses.

(a) Revenue Generation Strategies

Do you engage in a marketing plan to increase new referrals? Do you get support for your plans and initiatives from your team?
How many income generating revenue streams do you have in your facility?

  • Single PT service versus multi-disciplinary clinic.

Do you provide specialized services (unique selling proposition)?

  • Pelvic Health Physiotherapy, Vestibular Rehabilitation, etc.

What is your model of service delivery?

  • One:One versus Team model of care with support personnel (PTA)

Do you participate in ethical-retailing of products?

Think about it: Is your bottom line a cause for celebration, or does it tell you that you need to make a change?

(b) Expense Containment

Only a small portion of your revenue generation is the money that you take home. In contrast, a dollar saved from any cost goes directly to your bottom line. Some common expense areas that clinic owners commonly face are listed in Table 2.0. Keep an eye on these, because they can inflate quickly without constant monitoring:

FYI: To help with cost control strategies, CPA has developed the ‘Clinic Owners Program’ to give significant savings and resources specific to private clinics and practitioners –it’s free to join. Inquire today to learn more about this invaluable program.

We want to hear from you

If you’re excelling in all four domains, congratulations! Not an easy feat to accomplish. If you are not, hopefully these tips can help you improve.

After thinking about your practice (or clinic/organization), have a look at the questions below –let’s get a discussion going!

  1. What strategies do you use to create a service-oriented organizational culture?
  2. How do you use professional development and outcome measures (electronic outcome measures are better!) to enhance the ‘value of physiotherapy’ and market your business?
  3. What business metrics do you monitor to keep track of where your business or practice is headed?
  4. Do you have benchmarks? Examples: Wage cost = 50%, Unanticipated D/Cs = < 10%
  1. If your bottom line is not a cause for celebration, how do you know where to look to make a change?

Ask questions or post comments and a member of the Private Practice Division will be happy to respond.