Transcript
Kim Rosenlund (00:04):
Welcome to the PT Pod with PRN. I'm Kim Rosenlund, your host, and my guest here with me today is Brett Windsor, our Senior Vice President of Clinical Services. Brett, it's great to see you.
Brett Windsor (00:15):
You too. Always.
Kim Rosenlund (00:17):
I really love working with you. Wow.
Brett Windsor (00:19):
Thank you. I love working with you too.
Kim Rosenlund (00:21):
It's been what, 10 years?
Brett Windsor (00:23):
Yeah, 10 years this June.
Kim Rosenlund (00:24):
Yeah. So we've been obviously through a lot together.
Brett Windsor (00:27):
20th of June.
Kim Rosenlund (00:29):
iLooking back at the last decade working with you, we've gone through a lot. We have experienced quite a few acquisitions together and I feel like it's given us great perspective on, I don't know, just the state of physical therapy nowadays and how when we acquire companies, what really matters to the employees that join us and the partners that start to work with us. So I wanted to talk a little bit about that today from your perspective with clinical excellence. Why don't you tell us a little bit, of course I know you, but give me just a little bit about your background and I'd love to hear your passion. Your passion in physical therapy is what?
Brett Windsor (01:16):
Yeah. Look, I mean, I'm Australian. I've lived in the States now for 30 years.
Kim Rosenlund (01:20):
And I love your accent.
Brett Windsor (01:21):
Well, it's not all there anymore. It started to fade away. I'm told by my friends back in Australia, but I've been here for 30 years now. So all intents and purposes American. I've been in PT in the United States for 30 years. I've worked in every area of PT. I've never been a traditional operator. I've never been a spreadsheet guy. I've never been in charge.
Kim Rosenlund (01:40):
You're an innovator. When I look at you, I think innovation. You are a forward thinker. And that's what I love about you is you're always looking like, well, how do I go bigger? How do I go better? How do I improve this industry? And I love that about you.
Brett Windsor (01:57):
Yeah. I mean, that really ties to my passion. My passion is clinicians because all too often we forget that at the end of it all, if we don't have clinicians in clinics seeing patients-
Kim Rosenlund (02:07):
I don't have a job.
Brett Windsor (02:08):
There is no physical therapy business and none of us have jobs.
Kim Rosenlund (02:10):
Yeah.
Brett Windsor (02:11):
And I think over the last particularly 15 to 20 years, clinicians have been pushed to the back of the line. And I think my passion right now is getting clinicians back to the front of the line. And it can be anything as simple as just decreasing the administrative burden. So giving them ambient listening technology, making home exercise program prescription easy, helping them collect their outcomes, helping them interpret their outcomes, and then giving them an access to an easy, available framework of clinical best practices tied to evidence, but not so they have to pull through long documents. But we've started designed chatbot interfaces now where they can just ask a question about a patient and they'll get information back tied to the clinical best practices we have. And that's helping a lot, particularly new graduates, because what most people don't realize now is that the complexity of the patients we're seeing today is vastly superior to the complexity.
Kim Rosenlund (03:06):
Really?
Brett Windsor (03:06):
Yeah, absolutely. If you look at the percentage, 64% of Americans over the age of 45 years old are on at least one medication. And by the time you get to the age of 65, 44% of all human adults are on at least five medications. Seriously? If you look at what gabapentinoids do to cognitive skills, they dull cognition, which has a significant effect on how we respond to pain. If you look at some of the steroids and how they affect connective tissue, therapists weren't taught that in school. So these patients are coming in.
Kim Rosenlund (03:37):
So it's almost like a new frontier.
Brett Windsor (03:38):
It's a new frontier because you've still got the musculoskeletal problem, but the patient that's carrying it's fundamentally different.
Kim Rosenlund (03:44):
Different.
Brett Windsor (03:44):
So we're having to support clinicians much earlier in their career in a different way to bridge that gap.
Kim Rosenlund (03:49):
Well, and don't you feel like too, what I love about the work that you do in clinical excellence is that you're setting therapists up for long-term success. You hear about a high burnout rate in PT. And I've always felt like, well, yeah, we're not fostering them. We're not creating innovation so that they want to stay in the profession longer and giving them the support they need to treat a different patient population. Yeah. The burnout. So it's vital to keep it going.
Brett Windsor (04:17):
Yeah. The burnout rate not just in PT, but across all healthcare professions is really significant. And a lot of the reason is, is because we're putting them in environments that are far too complex for reasoning skills that haven't quite developed where they need to be yet. So we've got to have much better systems and frameworks of support early in the career so they can handle everything that's coming from at them. And it's not just the patient, it's the electronic medical record, it's verification, it's credentialing, it's handling the schedule and handling the other patients. It's all encompassing. It is. It's all
Kim Rosenlund (04:51):
Everything.
Brett Windsor (04:52):
And when you're in a profession where literally 36% of patients who come to PT aren't even hitting a minimum clinically important difference, then you've got a higher, not a failure rate, but you've got a lot of young therapists out there who are struggling.
Kim Rosenlund (05:07):
Not having success.
Brett Windsor (05:08):
And you show up to work every day and your patients aren't getting better for reasons that are completely beyond your control, it burns out. And you start losing perspective and you start moving around a bit.
Kim Rosenlund (05:18):
So talk to me, so if I'm a person, I'm an owner, I'm looking to partner, sell, get acquired by a company, this all sounds fantastic, right? I mean, I think it's what's going to keep the profession going and evolving, right? So what are some of the things that you feel like are really important for potential sellers to know about the way we look at innovation and the way we look at supporting PTs from a clinical excellence perspective? So you mentioned ambient listening technology.
Brett Windsor (05:56):
Yeah.
Kim Rosenlund (05:56):
Talk to me a little bit about that.
Brett Windsor (05:58):
Yeah. I mean, the larger picture is that we're providing a framework now that supports the ability of clinicians to do nothing other than focus on patient care, which means we can afford the resources and we can have the resources to look at things that decrease documentation time, that offer better ways to prescribe exercise, that offer the exercise frameworks, that offer the clinical best practices, and then that have the people around to support from a mentorship perspective, which you can't always do in a smaller practice. Ambient listening technology specifically is probably the single most transformational thing I've seen in 30 years of PT.
Kim Rosenlund (06:32):
Well the administrative burden, that documentation-
Brett Windsor (06:35):
It's gone. It doesn't exist anymore. So I think about-
Kim Rosenlund (06:39):
That gives them the opportunity to actually do what they love, right?
Brett Windsor (06:41):
It does. And what it does is it goes back to the days when I used to see patients, which was a while ago now, all I had to do was see the patient. Now admittedly, our notes were garbage and you can't get along with that in a day, but there's now no computer sitting in front of the patient and the therapist. There's nothing in between. It's a pure, just one-on-one connection with the patient. You see, you're able to connect and listen, which again,
Kim Rosenlund (07:07):
Which has been so hard to do-
Brett Windsor (07:08):
It's been impossible. ...
Kim Rosenlund (07:09):
In the last 10 years.
Brett Windsor (07:10):
When you're going to sit there and tie it, how can you blame a therapist for having to have their computer there because they don't want to be there until 10 o'clock at night. Now, you just talk, you have a natural conversation, you go to your laptop later, you read your note, click a button, it's done.
Kim Rosenlund (07:23):
And it's all done.
Brett Windsor (07:23):
And you're leaving work at the end of the day with your documentation completely complete. It's done.
Kim Rosenlund (07:28):
And that's available for every physical therapist.
Brett Windsor (07:30):
Every physical therapist-
Kim Rosenlund (07:32):
At PRN.
Brett Windsor (07:32):
That comes into PRN has access to ambient listening technologies.
Kim Rosenlund (07:36):
And the feedback, I mean, you've said has been outstanding, that the therapists love it.
Brett Windsor (07:40):
The feedback, as I said, I've never seen anything as positive and transformational in my career. It's incredible.
Kim Rosenlund (07:47):
So by reducing that administrative burden, my guess would be then that also frees up time for residency programs or like more ... Obviously clinical development's huge for physical therapists, continuing education, but sometimes they might be burnt out by documentation. So do you feel like it kind of goes hand in hand that kind of frees up more time to-
Brett Windsor (08:12):
The way I look at it is that it creates capacity. Now, the first thing a lot of people say, "Well, you get your documentation done quicker, they're just going to want you to see more patients." It's not really the way we look at it. What it does though is it creates the ability for you to get what you need to get done in a smaller space of time. And then there's just a question about what you do with that capacity. Now, some therapists will say, "You know what? I got a wedding coming up in six months. I got a kid going to college. I want to see more patients so I can be economically more successful." But others will say, "I want to participate in a residency program. I want to be a mentor. I want to work in marketing. I want to work in the student program." And we then can give them the opportunity to do that without taking away from the clinic.
(08:56):
And there's another group of people who say, "You know what? I've been working at this for five, seven years now. I just want to be able to go home on Thursday afternoons and spend time with my kids."
Kim Rosenlund (09:05):
And not work till nine o'clock at night.
Brett Windsor (09:07):
Yeah. So if you've got to see X number of patients during a week, ambient listening technology gives you the ability to get it done in a smaller space of time, which is really one of the big steps towards really good routine expertise is being effective and efficient, making the most useful time without degrading the experience and the outcomes for the patient.
Kim Rosenlund (09:25):
It's making it better, which is a
(09:27):
win-win all the way around.
Brett Windsor (09:28):
And if you're a happy therapist that's going to translate to your patient, and we know one of the biggest predictors of a positive outcome now is the relationship between the patient and the therapist. If that's right, good things happen.
Kim Rosenlund (09:41):
So talk to me about the opportunities for mentorship, residencies. I know that's been such a huge passion of yours for so long, and in my opinion, you're the best in the biz. Thank you. And what you've done at PRN has been incredible the last couple years. So what could a potential seller expect for his staff coming over to PRN with those types of opportunities?
Brett Windsor (10:07):
Well, I'm passionate and the people who work with me are passionate about creating expert clinicians who can solve difficult problems. Now, that starts with the ability to just develop what we call routine expertise. And that's the ability to take an average caseload that comes in during a normal day and be effective, efficient, prescribe an evidence-based episode of care and get a good outcome. And that's going to cover 80% of the patients that walk in the door. That's the residency program, that's the certification program, that's our baseline mentoring program. And there's a few different ways to get through that and access that. It's based on our clinical best practice documents, which are truly evidence-based and presented in a way that's interactive for therapists so they don't have to read, but they can interact with the chatbot and they can learn about it as there is a support if they need it.
(10:52):
They don't have to use it. Once those programs are done, and then there's always a group of patients out there, 10 to 20% who need more than routine care. They present with difficult to understand problems. They come with variations on a normal theme. They have complexities with comorbidities or personal circumstances that just make the problem more difficult to solve. And we have programs out there now to teach what we call adaptive expertise, which is the truly elite level of clinical reasoning and thinking, which is no better than the routine, but it just gives them the ability to approach a different set of problems.
Kim Rosenlund (11:27):
And this is not typically taught in physical therapy school?
Brett Windsor (11:31):
No.
Kim Rosenlund (11:31):
It's sort of like an added benefit.
Brett Windsor (11:33):
No, the school, the challenges, our transition to practice program, which happens really early in the employment piece, bridges the gap between PT school and what we need at the residency certification, routine expertise to get good, consistent outcomes across the major population load, and then it's additional programs to layer on top. So we present an entire continuum for any clinician coming out of school.
Kim Rosenlund (11:58):
Wow. So anyone can participate.
Brett Windsor (12:00):
Anyone can come here and it's a continuum based too. So you can jump in wherever you need to. We can assess your capabilities. We can understand your interests and we can plug you in clinically. And all I talk about is clinical stuff. I'm not here to worry about operations and spreadsheets and statistics. I'm here solely to look after the clinician journey and I think we've done a really good job of integrating that into ops. I think they understand it, they respect it, they know we're all on the same team, but you've got someone here who wakes up every day thinking about how do we make it better for clinicians?
Kim Rosenlund (12:32):
So you hit two major points. One, reducing the administrative burden so they can spend more time with their patients and develop that connection and then the residency, the mentorship, the advancement of their skillset to make them a better physical therapist, right? Yep. So the third piece, you said it a couple times is outcomes. So talk to me about like quality control. How do you make sure that our therapists are providing quality care? How do we measure quality? What investments have we made as an organization to make sure that all these things are creating a better experience for the patient and the clinician?
Brett Windsor (13:17):
Yeah, I think that's a really great question, Kim. I think quality is a lot of different factors. There is an element of quality just around operational control. So there's an element around the number of patients you're seeing in a day. We know the optimal range. There seems to be about 10 to 12. There's a few market variations. If you look at some of the big data sets around clinical outcomes and operational outcomes, we know that there's a certain episode length, so 12 to 16 visits for 45 to 60 minutes per session, two times a week, a lot more active than passive codes. So those operational constraints come in. So we measure those because we know when those are right, they lead to positive clinical outcomes. Now, we're not looking at operational statistics for the sake of looking at from a dollar's perspective, but they are leading indicators that tell us what's likely to happen with the clinical outcome.
(14:06):
And then on the lagging end, we look a lot at the actual clinical outcomes and we use the Limber Promise System, which is patient reported outcome measurement improvement system. And that allows us, it crosswalks to all the major legacies, so your ODI, your NDI, the who's the who's, all those type of things. We can crosswalk to that and then we can look at that score, not in isolation, but we look at it in different body regions over different periods of time and it's part of the overall quality perspective. Then we've also got Google five star reviews, we've got the NPS, which if you look at the research, people are going software on the NPS- Not
Kim Rosenlund (14:41):
Like super
Brett Windsor (14:41):
Reliable nowadays. Yeah, I don't like the NPS March, but there's also a couple other questions around just simply asking the patient, "How do you feel PT when?" We had that at another organization. We worked that together and I thought that was always really sensitive. So we're able to take all of that data and we can now put it into a clinical scorecard that we can present to an individual clinician on a relatively frequent, two or three times a year basis and we can give them real information about where they're doing really well and where there might be some opportunities to improve. And then on the back end of that, we don't just come to the table with, "Hey, you're really good at this, but we'd like you to take the opportunity to improve this. " We've got an entire educational infrastructure built behind it so we can give them very targeted micro learnings, whether it's asynchronous or we've got synchronous offsets and we've got face-to-face in- person courses that can help them grow in the areas they choose to grow in.
(15:32):
So there's an entire infrastructure built around it, which is just rolling out now and it's proven to be enormously effective and clinicians love to hear about their clinical
Kim Rosenlund (15:40):
Performance. That's what I was going to say. I feel like what I've noticed since you've been at PRN is just how appreciative the clinicians are that they have someone that's looking out for them clinically and providing the support they need to do their job the best they possibly can and to grow. If there's one thing I know about PTs, they never stop learning. I mean, it's one profession that I just feel like I've never worked in an industry where they're so hungry to get better and so hungry to learn and it's so great to see you build these programs to really support that. And I think you make a good point. It's much different from like the productivity conversation of like the financial part of the business. I think it's so important to note that, that you really are just focused on clinical care and making sure we're providing the best experience possible for the patient and the therapist.
(16:40):
If you're a seller, what would you want to say to a seller? I feel like sellers hear a lot of talk from companies. Everyone's out there saying they're the best, right? Even though I really do think we are a great partner. What would you say to them in regards to clinical excellence? What should they look for when they're vetting companies to partner with? What's like some advice you could give to them?
Brett Windsor (17:11):
Google us. We win. Sorry.
Kim Rosenlund (17:16):
Out to Cignetti.
Brett Windsor (17:17):
I know you can edit this later so
Kim Rosenlund (17:20):
I'm a big Indiana fan.
Brett Windsor (17:27):
Sorry, ask the question again and I'll do it properly this time.
Kim Rosenlund (17:36):
Sellers are out there, they're looking for companies to partner with, and clinical excellence is obviously a big piece. A lot of companies say they're the best. And so what would be a piece of advice that you would give them what to look for when they are vetting companies that has a genuine, authentic program that does really care about the therapist and it's not just smoke and mirrors and lip service?
Brett Windsor (18:03):
Well, the way I put it is everyone in our space who's engaged in the process of buying, everyone can answer the first question. And a lot of people can answer the second question. We'll answer the third, the fourth, the fifth, the sixth, the seventh, the eighth, the ninth, and the tenth questions. We've got the depth and my advice is don't just ask, "Have you got a mentorship program? Have you got a residency program? Have you got a certification program? Do you have clinical outcomes?" You've got to be willing to go deep and ask a lot more questions. How is the mentorship framed? What is it built on? Who does it? How often does it happen? What are the outcomes? What are your educational opportunities? And I think also, how is it all tied together? As is a framework, every piece is built to align to the next.
(18:47):
So we have the ability to right at the front, assess what the needs are, fill those needs, and then measure it on the back, and then apply a targeted educational intervention to it that the clinician wants to have that's going to help them improve their performance. But I think having been in other places, when you start to ask those second and third questions-
Kim Rosenlund (19:06):
It kinda all falls apart.
Brett Windsor (19:07):
The answers start dialing up. Exactly. The details aren't there. The details are here in ours and I will defend them to anyone. I can go as deep as you want to anyone.
Kim Rosenlund (19:18):
Well, and I think what's been great to see is that you're so willing to try new things too, right? You're not stuck in a certain way. You're not like, "Hey, it's got to be this way. I've seen you adapt and evolve and take feedback and adjust and try new things." And sometimes it works and sometimes it doesn't, and that's okay.
Brett Windsor (19:40):
Well, and I'll tell you the big change that happened for me and actually happened at ATI and I don't think it's unfair to mention Dylan Bates' name here. He was really instrumental in changing the way. When I came into ATI, we were very intent on an ideological perspective around treatment and it had to be done a certain way and there was a process. And what I learned from that experience was that physical therapy, we're in the service industry, we're all here to serve other people. In this case, we're here to serve patients. We just happen to be in physical therapy. And I'll never forget Dylan saying that and it really changed my perspective. So when you take that mindset, you're not married to any one approach. And as you know, things are moving so quickly with technology and approaches and innovations these days, you've got to be willing to try new things.
(20:30):
The students coming out and-
Kim Rosenlund (20:32):
You got to be forward thinking.
Brett Windsor (20:33):
You have to be.
Kim Rosenlund (20:34):
Who's going to want to work for us?
Brett Windsor (20:35):
If you're looking behind and you're always saying, "Well, this is the way we did it. This is the way it has to be done," you're dead because it's just not true. I think a lot of people in our industry really fail because they get locked into one way of thinking and you realize pretty quickly-
Kim Rosenlund (20:51):
They miss all the opportunity.
Brett Windsor (20:52):
You're 10 steps behind and somebody else came.
Kim Rosenlund (20:55):
Very quickly, like you said.
Brett Windsor (20:55):
Said. So we're always challenging ourselves, what's a better way to do this? How can we make it easier? How can we make it more effective?
Kim Rosenlund (21:01):
So last question, why do you think someone should join us? Why join PRN?
Brett Windsor (21:11):
I think there's two ways to look at this. If you're a new grad, I think we're the best place to be because we're going to give you a 12 month transition to practice program. It's a real foundational bridge between what you learnt in school, what you had to do past the exam, and then how you need to integrate yourself into the reality of practice today. Out of that, then you get the opportunity to do residency, you get the opportunity to do a certification track, you get the opportunity to design your own path. And all of it is supported by a real framework of mentorship and innovation. We are doing everything we can to take the administrative burden off you so you can focus on just treating patients. So there's really no group out there, I think that has the totality of the infrastructure and support that we have.
(21:55):
And look, we understand that these days, most therapists aren't looking for a lifetime job. They're looking for somewhere to get started and we want to be the place where you get started and we want to prepare you for a career. We're not just preparing you to be an employee, we're preparing you for a career and we believe that if we treat you well and we do the right things, then you'll want to stay. And that's what we want is we want clinicians who want to stay, not for clinicians who feel like they've got a job and it's too hard to leave. We want you to want to be here and we think we've got the tools to do it.
Kim Rosenlund (22:25):
Well, Brett, always a pleasure.
Brett Windsor (22:27):
You too.
Kim Rosenlund (22:28):
Thank you so much.
Brett Windsor (22:29):
No worries.
Kim Rosenlund (22:29):
Until the next great innovative idea that you have. Can't wait to talk to you about
Brett Windsor (22:34):
That. Hang around a few minutes. Thanks.