Q&A With the Ascend 2023 Practice of the Year

One of the highlights of Ascend is the Practice of the Year award, handed out to one outstanding practice among several exceptional organizations nominated every year. The Ascend 2023 Practice of the Year winner was Rehabilitation and Performance Institute (RPI), which boasts 13 locations across Kentucky, Indiana, and Illinois. Over seven years, RPI has managed to grow and expand under a strong business model while raising the bar when it comes to satisfaction with both their patients and providers. 

I was fortunate enough to talk to RPI Owner and CEO Craig Phifer about the secrets to his success and what he still hopes to accomplish.  

RPI has some impressive Employee Net Promoter Scores at a time when the industry is struggling with burnout and turnover. How have you built a culture that keeps providers engaged and satisfied, and what do you do to maintain that culture?

From day one, we’ve built RPI around a culture of autonomy, mastery, and purpose. We never felt like we needed to motivate or engage anyone—the people we are hiring all come to us as highly motivated and engaged individuals. Our job is just to not screw that up.

To provide autonomy, we tell people the outcomes we need, let them know some of the secrets we’ve learned that drive success, and then get out of the way. For example, if we say we need 45 patient visits a week to make it all work, then you can determine when you want those to occur.

With mastery and purpose, our strategies are somewhat connected. The big challenge was that we needed to find ways to keep workloads manageable. So, we developed strategies that allow for fewer patients, more time spent with each patient, and more time to reflect on what is going well or what needs to change. Our team members work incredibly hard; they just pour more of that work into fewer patients. We also make sure they have room for personal development. Inherently, there is tremendous purpose in the work we do. Our job was to build a system that allowed our therapists to develop outstanding relationships with patients so that they could fully experience that purpose.

One of the interesting things we do is called ThinkTank. Every therapist participates in a weekly pro bono treatment session that our orthopaedic residents or new graduates lead. We treat a patient throughout the course of care together, allowing us to talk about what we’d like to try and why. Our one rule is that we must test our hypotheses to know if what we did created the desired change. 

Interestingly enough, the autonomy and purpose we create allow for the financial savings to do this. Many decisions are made as locally as possible. Through decentralized decision-making, we’ve maintained a very flat organizational structure. That structure helps keep costs low so that we spend less on managing people and more on letting them engage with each other and our patients.

Similarly, you’re seeing remarkable NPS scores and retention with your patients. What are you emphasizing in your workflows and culture that keeps patients returning?

We’ve been competing against large hospital systems and physician-owned physical therapy groups from the beginning. We knew we’d need to become the primary care option for patients with neuromusculoskeletal conditions. We also knew that no one would hand us that designation and that the only way we’d get there was to provide a patient experience that drastically exceeded expectations. We needed to do more than create loyal patients—we needed them to be believers. We needed them to leave our offices knowing they had an incredible experience and one they couldn’t wait to tell their friends and family about it.

So, to make it happen, we sat down and mapped out every interaction with a patient—from the first message or phone call to the final bill payment. Patients have inherent expectations for each touch point and every visit, and we mapped out these expectations. Then, through a combination of mentorship, training, and process development, we built systems that allow our team members to exceed expectations at every step.

You have several clinics in areas with a relatively small population. What are the biggest challenges in growing and expanding in rural areas and smaller towns, and how have you overcome them?

The reception we’ve had in rural communities has been one of my favorite things about RPI. I grew up in a small town where physical therapy wasn’t a “thing.” I didn’t know the profession existed until I was 17, and many of the communities we are in have been that same way for a very long time.

The patient reception in these areas has always been incredible. It feels like we get a review every day where a patient mentions, “I can’t believe we have something this wonderful in our community!” Coming from a small town, we were always somewhat conditioned to believe that medical care simply wasn’t going to be as good. That was just part of life.

So when people find out care can be just as good—if not better—than it is in large communities, they are thrilled. We have become the primary care practitioners for neuromusculoskeletal health issues in these communities faster than anywhere else. We have an office in a town of 2,000 people, a county of 7,000 people, with five full-time clinicians. Those numbers only happen when communities genuinely embrace you, and it’s incredible to be able to transform health and happiness there because we get to see that needle move quickly.

The biggest challenge in these areas in the beginning was hiring. However, when high school and college students come in as patients or observers and see how much we love what we do and the difference we make for them, their friends, and their neighbors, they know they want that for their careers, too. 

What’s the biggest lesson you’ve learned since becoming a business owner, and what are you still trying to improve?

One of my favorite quotes comes from W.P. Kinsella in his book Shoeless Joe, which inspired the movie Field of Dreams. In the book, the character Moonlight Graham says, “Hardly anyone recognizes the most significant moments in their life at the time they happen.”

As I look back, my life and the history of RPI are littered with these moments. I never saw them coming, but RPI has always seemed to thrive after them. From these moments, I’ve learned to always make room for reflection. We’ve learned more lessons than I can count by now, but I strongly believe that the reason we’ve learned and thrived through most of them is because we checked in with ourselves, and we checked in with each other. If any of us—myself included—ever seemed like we were drifting away from that, there was someone to pull us back in.

I love meeting challenges with simplicity and clarity. And this lesson helped us solve problems and create and capitalize on opportunities.

One of the best elements of being part of a rapidly growing company is that our roles frequently evolve. The work I do today looks nothing like the work I did just two years ago. We’re still trying to improve our collective ability to embrace that our growth as individuals creates opportunities for ourselves and RPI. Achieving our vision–one person at a time, we will drive healthcare transformation and change the world – means that we’ll need to touch many lives to make the level of difference we want.

So, our continued challenge is to embrace growth as success toward achieving our vision and to realize that while change is hard, it is necessary. And we can continue to drive change by embracing the mantra Chip Heath laid out in his book Switch, “Just look for a strong beginning and a strong ending and get moving.” We’ve had our strong beginning. We have a vision for our strong ending. Now, we just need to keep moving.

What’s your sales pitch to someone skeptical about coming to RPI and starting physical therapy?

We’re big believers in honesty throughout the process. The first thing we do when a patient calls is to ensure we are genuinely the best answer for them. Our job is to listen to their story and ask them questions so that we can understand their goals. 

That initial conversation allows us to learn more about the potential patient, and without us saying anything, they learn what to expect from us, too. They learn that we’ll listen to them and consider their unique needs throughout the process. If it seems we’d be the best solution for that person, we’ll tell them the reality. 

No two people are the same, but we’ve helped many people with similar issues. The way we’re able to help is that you’ll work with the same therapist each session if you’d like to. Our therapists listen incredibly well and will take time to explain things in a way everyone understands. They’ll work with you on all your unique needs and build a plan with you that helps you reach your goals (insert the goals they just told us about earlier). We know you may have to drive past another couple of therapy offices to get here, and you may need to wait a little longer for your first appointment, but that’s because you’ll never be double-booked with another patient at RPI. Your therapist will focus entirely on helping you—and you alone—throughout the session.

This process works incredibly well for us because before we TELL them that our biggest strengths are listening well and finding personalized solutions, we SHOW them that we listen well and find personalized solutions. Secondly, it works because we’re honest about our faults, which helps create a greater belief in our strengths. 

What big goals do you have for RPI in the next few years? 

Maybe one of the strangest things about us is that we don’t really believe in long-term goals. I don’t think we’d be where we are if we had set goals for it, nor do I think we could have fathomed how much we could accomplish together in such a short period. We would have always undershot our potential if we were setting goals.

Instead of setting goals, we’ve always been more values-focused. We believe the most important thing we can do as an organization is build a fantastic culture. So, through our people and processes, we build systems that foster a culture of shared purpose, mastery of what we do, and the autonomy to learn, grow, and do it in our own way. That work is never done. So, by not setting a goal for it, we’re always striving to find ways to make it a little better. 

We believe in creating a remarkable experience for our patients. We create what we call “before and after experiences.” For each patient we get the opportunity to help, we want their interaction with RPI to feel like a pin they can place on the map of their life. We want to improve each person’s life meaningfully over the course of care. For some, it may be helping them through their journey with chronic pain and emerge on the other side feeling in control of that. For others, we can help them establish an entirely new relationship with their own health and thus become engaged in how certain behaviors and activities drive how they feel.

So, in the next few years, our plan is to continue to work to understand ourselves, the people we help, and the world around us. Then, we’ll use that information, along with our drive to continue to learn and grow, to find new ways to improve our culture and the experience we provide to the people who trust us with their health.

Thanks again to Craig for shedding some light on his team’s formula for success, and congratulations to everyone at RPI for their well-deserved win as the Ascend 2023 Practice of the Year. 

Do you think your practice deserves some recognition at next year’s Ascend? Be sure to apply when the nomination process opens up in 2024.