The Loss of Community

On this date in 2001, a good-sized segment of the Minnesota chiropractic educational and business profession was glued to television sets early in the morning. I remember being called from my office next to the NWHSU president, Al Traina, to the faculty lounge that was still pretty new off the cafeteria. There, on a television set, was a smoking tower…tower 1, of the World Trade Center, in New York City, soon to be followed by an attack on tower 2, then a physical collapse that defied reason, engineering, hope and expectation. Continue reading

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Hollowing of a Brand

When we speak of something being ‘hollowed out’ in business, the phrase is intended to convey the fact that core functions are being lost or outsourced, while aspects of the subject (eg, supply chain) look undisturbed. So too in woodworking, where it means removing the internal structure of something, leaving a shell that looks intact.

Remembering that a ‘brand’ is a perception of something based on customers’ or consumers’ expectations and experiences, effective brand management seeks to ensure that actual experiences match what the brand’s managers want their customers to experience, cultivating expectations of future, repeating experiences. Like businesses and blocks of wood, brands can be hollowed out, too. One example in the news is Sears, Roebuck and Company, which has lost more than $9 billion in recent years. The brand has been hollowed out, in that its customers’ experiences are not keeping them coming back. They are voting with their feet and flocking to competitors. Continue reading

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An Integrative Algorithm: Identity, Roles & Responsibilities

Writing a short article on integrative health care recently gave me a chance to reflect on what’s taken place in the field over the last two decades. The system is evolving, slowly in some places and quickly in others. In 1997 a team at Northwestern College of Chiropractic developed a set of seed algorithms for integrative care teams. Based on the experience of opening the Natural Care Center at Woodwinds Hospital (now closed), I wrote a somewhat tongue-in-cheek take on working with hospitals and ‘health’ care systems. At that time, medical staff were commonly entrenched in opposition to integrative services. That dynamic has changed a lot, but it still may serve as a guide to the relationship dependencies required today. Continue reading

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Navigating the Issues of Integrated Health Care

In December of 2000, I wrote this article for the Journal of the American Chiropractic Association. I can’t remember if it got published or not. It’s interesting to reflect on the observations in the piece. Not sure much has changed for the chiropractic profession.

Navigating the Issues of Integrated Health Care

By Stephen Bolles, DC

In the last decade and a half, doctors of chiropractic have borne witness to a changing health care market that has moved at a dizzying pace. Pressured by a variety of forces, health care delivery has fundamentally changed for virtually every person in the United States. Whether on the cutting edge or the bleeding edge, chiropractic physicians have had a front row seat to the rapidly changing landscape before them. The process has already placed tremendous pressure on our profession, and we are well advised to watch the forces of change at work. Continue reading

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Gain The World, Lose Our Soul

As a preacher’s son, parables and examples in Scripture are never far away in my consciousness. Even though a good deal of what passes for theology makes my teeth hurt these days, there is poetry in the Bible.

Seeing some of the information being distributed by those who would expand the profession’s scope of practice to include the ability to prescribe drugs, I’m reminded of one verse in particular: ‘For how is a man benefited if he should gain the whole world and he should lose his soul?’ (Mark 8:36). Gender-slanted language aside but in the context of today’s professional struggles, it might also read, ‘How will the profession retain its soul if it becomes more like medicine?’

It’s a hard question to answer when the profession itself hasn’t had the conversation about what its own ‘soul’ is. If soul is ‘…moral or emotional nature or sense of identity’ and describes what is enduring about that nature, how would we describe chiropractic’s soul?  Continue reading

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Transformation or Plug and Play?

Shifting roles, relationships, marketplace positions and economics have every aspect of health care under strain. A leading observer, leader and chronicler of integrative health care for decades named John Weeks recently wrote a perceptive piece on his analysis of the opportunities for doctors of naturopathic medicine (NDs) in this challenging landscape. Can we learn something from his analysis that might affect chiropractic? I believe so. Continue reading

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Chiropractic: Subtract Drugs, Don’t Add Them

A recent personal health crisis brought a practical example of the role of chiropractic into sharp focus. As passions heat up over the contentious issue of scope expansion and prescription privileges, and with no real information about what health care consumer/patients actually want, anyone who has an opinion about the issue is making a lot of value-based assumptions. With that in mind, and with the historic and inclusive ACC Paradigm of Chiropractic as a starting point, here’s one man’s story and some potential insights for the profession. Continue reading

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New Provider Marketing Realities

Three articles from different sources highlight just how different providers’ needs are for marketing in today’s emerging retailized health care marketplace.

Why is this important for doctors of chiropractic? Because as the health care marketplace increasingly functions like a retail marketplace, providers and systems will have an opportunity–if not a need–to have a more direct relationship with their patient/customers. And the basis and content of that relationship is significantly different than ever before. Continue reading

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Changing Marketplace, Changing Terms of Engagement

At the point of completing his first year in place as president of Northwestern Health Sciences University, Dr. Christopher Cassirer offers a kind of report of findings and environmental assessment on the profession in July/August issue of the Minnesota Chiropractic Association’s MCA Journal. He lists a number of observations and proposes what I’ll call ‘design principles’ for solutions to the challenges the profession is facing. He notes that:

  • The US health care system delivers very poor outcomes for the enormous sums of money spent.
  • Novel delivery system processes (accountable care organizations, etc.) are going to be used as payment vehicles for many efforts.
  • Scope of practice competition requires an ongoing legislative effort, while at the same time demands for more data supporting and detailing chiropractic clinical contributions will only increase.

He notes pointed concerns, as well, calling out intraprofessional squabbling on differences that perhaps consigns us to a ‘Nero fiddling while Rome burns’ position as health care reform goes forward.

Does he offer a blueprint for solving some of the profession’s concerns and issues? Continue reading

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Identity, Authority, Scope, & Role: What Do Consumers Want?

A recent news tidbit referred to new training being undertaken by California dental hygienists seeking to provide temporary fillings without dental supervision. As a regulated profession, this is a scope of practice (legislative) issue. As an effort to expand the role being played by a profession in the health care system, it’s one among a very crowded field.

Doctors of medicine have had essentially open-ended scope of practice laws for close to a century, largely consistent from state to state. They have established a degree of cultural authority against which others’ practices, laws and education are measured; all regulated professions outside medicine have a kind of templated required prohibition, typically something like [the profession in question] ‘is not the practice of medicine.’ For decades, other professions have sought to establish and expand scope of practice legislation to legitimize their professions, confer as much autonomy as possible within the bounds of their education, and to wedge open a new or larger role in the US health care system. Doctors of chiropractic have sought and achieved this as well in a number of places–and some are seeking further expansion to include prescription rights. Are all these efforts helpful? Important? Do the professions get what they want? Continue reading

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