Ep 11: From Evidence to Action: How Clinics Can Use Research to Improve Outcomes

Michael Dermansky:

Hi everyone, and welcome to the show that explores with allied health business owners and managers, what’s important about being in the allied health business today. My name is Michael Domanski, I’m the senior physiotherapist at MD Health and I’ve got a special guest today, Josh Blankow, he’s one of our senior osteopaths. Welcome to the show today.

Josh:

Thank you very much, Markle. Pleasure to be here.

Michael Dermansky:

Great, well, I’ll tell everyone why you’re here as well. Today we’re talking up research within your practice. We’ve been doing this, I don’t know, it’s about 12 months or so, maybe a little bit longer than that now too.

Josh:

Yeah, yeah, just over a year, yep.

Michael Dermansky:

every year and I really wanted to talk about why we’ve done it and it’s been a major part of improving the quality of the service we provide to their clients and it’s something I’ve been passionate about for quite a long time and so we designed a research unit within the practice so we have certain staff members that are responsible directly for improving the quality of what we do and looking at the research and implementing it too and that’s why I brought Josh aboard because he’s been leading it until very recently where you’ve stepped up in a role of clinical staff manager but you’ve had a major role in the research role. So guess I want to start the question is about a year ago I spoke to you about this and you and Conor was sitting at the research arm. we spoke about this topic what did it mean to you at the time and how did you feel about

Josh:

Yeah, so I felt really good about in terms of just my own personal learning wanted step into something different. being on the high theoretical side of things, I really enjoyed the whole learning different things to better myself as a kind of brought this up to yourself Steph as well and yeah we kind of created this role to yeah obviously get the most out of out of myself and for the business as well so yeah I felt really good about that a smooth transition moving into that as well because it was it was something I was quite passionate yeah which which made me thrive into starting in that position which was

Michael Dermansky:

But when I said do your research as well, I create a research team. What does that mean to you? What does it mean in your head?

Josh:

look in my head it know, keeping up with the evidence for pathologies so we can transmit that our patients and to get the most upmost dated information about those conditions so we’re not falling behind, we’re not using old evidence. that can get very outdated in time. So we’re up to speed with everything. So we can make those changes and to improve our patients quality of life and to really reduce their symptoms.

Michael Dermansky:

Well, that was the idea when we spoke to it, which is, you you want to be the latest in what we do. So then there’s a practicality of making it happen. So when we had that conversation and then afterwards, what did that research team really look like? And how did we set up the process and how did it run after we had this idea and went for it?

Josh:

Yeah, so we started off with just putting some time aside to look at research articles, et cetera. Then we started using a lot of a service, Learn.Physio, and there’s some really, really good stuff on there. with, they have certain practical sessions, they have master classes on certain conditions run by some really good researchers out there from certain unis and et cetera as well. that’s how it all kind of started. And it was run… We’d have a meeting each week and we would brainstorm ideas that we thought would be necessary to implement into our service. And then we would kind of… Collaborate together, you know with that idea work How could we make that work? What can we do to research a little bit further? If it was say quite a big general topic like the hit for example, which you know, there’s You know a lot of conditions around that area as well So yeah, just a lot of brainstorming a lot of a lot of teamwork around that Yeah with myself you Mike and Connor came on board about six to eight months after we started this off because he’s quite, well he’s very high theoretical as well. Yeah so we, that was how it was run and yeah it was a really good process that we started.

Michael Dermansky:

Well, let’s break it down because if someone wants to set this up themselves, what they need to do. you started off, say, for example, you read you what looked at one of the videos from learn physio, physio or something else like that, too. And we looked at one for hip. We didn’t have that. So we had a certain things, but you want to at the latest stuff. You watch the videos, you looked at what happened after that. What did you do with that information?

Josh:

Yeah, so that information, I just created my own notes. And we, as I said before, we have a weekly meeting where that idea would be generated. And then I would use Learn Physio predominantly to look at… the practical side which is really important for assessment and hands-on approach to that particular condition and then the master classes as well would break it down further into diagnosing those conditions via assessment tools and then putting that into a practical setting with specific exercises that would be around that, certain protocols as well, which we would discuss in those meetings. And then from there, Mike, would relay that information on to all of our other clinicians in a training, one hour training session that we have on Monday.

Josh:

which therefore we would run that in a just on zoom and we would collaborate those ideas and present that and get everyone to be active in performing certain tests performing certain exercises and practicals so that everyone has a good base of knowledge for the new idea that we were generating.

Michael Dermansky:

I mean, it’s interesting to say that too, but when we do this kind of stuff, one of the things that’s really important is the back and forth as well. So you did the learning and you write down the notes of what you thought was important from that. And then we compare what we currently do, what we have to what was being added in and where did it add extra value and how do we implement it too? So the biggest practical part is like, okay, out of all these things that you learned about here, what was different that what we don’t currently

Michael Dermansky:

And then we looked at that and said, okay, right, well, how do we test for it? How do we test for it? How do we test for it practically? And then we would give this a go between the research team. So we would look at, so we can look at this ratio, we can look at this movement, or we can look at extra part here. And then we would end up with a much narrower list of things we needed to change.

Josh:

Yes. Yes, absolutely. Yeah, so a classic example of that within our application was, yeah, being more specific with a diagnosis that could be diagnosed incorrectly, and we would eliminate that by creating increase in specificity and sensitivity using these updated testing. So a classic example, we could differentiate

Michael Dermansky:

Yeah.

Josh:

a condition like FAI or even most recently we’ve got more suck into hip dysplasia as well. And then also GTPS, so great atric anteric pain syndrome there as well. So very similar pain locations for those conditions. However, the testing will vary quite significantly. And we were able to using latest research and using Learn Physio, we could make those changes and implement them into the application via yourself and Noel through IT. And we could, yeah, make those changes that would create more specificity to those conditions, which would therefore help the clients and patient in their journey because we were very much hitting the nail on the head with our direction. and it wasn’t, I guess, skewed with, it might be this or it might, maybe that, no, it is this, we are very confident with this, and that’s because we have all those orthopedic tests that were the most current at that time. So it was really, really good to see. And this was not just the hip, but a whole multiple difference array of different conditions over the space of Yeah, a year and a half now, at least. Yeah, and the changes that we’ve made through the application have just been absolutely fantastic. yeah, so that’s why this role was created for that reason, but it’s really just taken off now and become just, yeah, overall really fantastic for the business and for our patients.

Michael Dermansky:

I mean the interesting thing as well as you said there’s multiple steps. You start off with this idea, reading broadly to figure out what’s in the latest research. Then you take that back a bit narrower, work out, okay, what’s different between what we can see, what we can test? And then we really break it down and say, can I differentiate A from B? Can I differentiate A from B? Is there a way of getting A from B? So that we come up with a really clear way for the conditions to be able to implement Then we implement that through our testing that we happen to use a computer program we developed, so I made it very easy. We can write those tests and the algorithms into our program and that allowed access to all the other clinicians. And then we had the algorithms into our software. If you don’t have software, have paper form, it will still work the same process if they’re all the same. It’s just that you need to distribute it by paper versus a computer program, but that’s easier for us. And then we made that algorithm really, really clear to the other clinical staff members and then we teach them how to do it. But it doesn’t stop there either, because then they actually implement it and the feedback from what the other staff members give us, what works, doesn’t work, what’s practical, what’s impractical, then goes back and loops back again and we come back with an even tighter way of being able to get an outcome for client.

Josh:

Yes, absolutely. Yeah, that feedback was really much appreciated because when we were going through, obviously creating these ideas and presenting all these ideas, yes, it was a lot in that kind of short period of time. So getting good feedback off our fellow clinicians was really helpful. because, you know, it’s like anything, if you’re researching it, you’re very familiar with that at the time because you have studied it, if you will so whereas the others haven’t. So a lot of repetition was needed. So we often come back to these ideas and these changes. So we get that repetition going. So then it becomes very subconscious in our clinical approach as well. So that feedback was really critical and really important for overall clinician and business development as well.

Michael Dermansky:

you Well, I’m going back to the point of view that we’ve talked about as well. From your perspective as well, what results have you seen in the outcomes to the clients and the business as a result of some of the things we implemented? Can you give us some specific examples?

Josh:

Well, we’ve, well, primarily, you know, we’ve got a lot of different avenues we could take here, but you know, we see a massive reduction in pain for a patient. see their ability to obviously reduce pain, increase functionality, and then ideally what we want to get them doing is making it specific for them so that they can achieve their goals. So every client that we take through an assessment that comes through our doors has a specific set of goals that we want to work on and get them to those goals. So an example could be, you know, the run Melbourne was recently taken place. We’ve had a few people here who have been training for that. And that has been their, I guess their dream to, you know, some have been, I just want to complete it. Some have been, want to do it in a specific time and be PBs there. So a lot of different avenues as well, but mainly the goals is where we get the greatest satisfaction from and why we do what we do. Because we want to get the most out of every individual that comes through the doors here at MD Health. So which has been super rewarding from a clinician perspective. So it’s interesting, we talked about an idea of research and improving the way we do things. I mean, this isn’t primary research, this isn’t going to the experimental stuff. This is taking those ideas and making it a practical reality within a clinical setting. And the outcome for that is better long-term outcome for clients as well. Better specificity, better outcomes, larger goals. And we can be more satisfied as clinicians, because we’ve actually better outcomes as well. Is there a particular case of a person that you can think of that because of the learning that you did as part of the research team, the outcome you would have got from now is much better than you would have otherwise got if you hadn’t done that for a hip or a shoulder one because once you leave, you’re going have done quite a lot.

 Yeah, I think probably not anyone in particular per se, but a lot have been down the thought processes of, I might need surgery for this particular condition. And what we’ve been able to do is really suppress that surgery with… critical tailored exercises and assessment tools to give them the confidence to say no, no, no, we can conservatively manage this very easily for you and that really gives them the peace of mind that you know, no one wants to have surgery and it is a last point of call. So we with our research and with our interventions, we can ultimately suppress that and that gives them really good peace of mind as I just said and confidence moving forward. So if they say delay that surgery for five years, that’s five years, you know, that they can continue to keep working on their goals and to have that good quality of life and all those factors as well. So nothing specific, but a lot of surgery reductions, I would say. Some good really awesome goal setting so a lot of overseas kind of trips as well which require a lot of walking so there’s been like some really good Stories that have come from yeah a lot of clients over the different clinics In you know, they’ll send us photos They’ll send us a report on like this was just the most amazing trip and I didn’t think I could could do this this giant giant walk or this week-long walk and seeing all these fantastic locations but I was able to do it because A, I was dedicated and I was consistent with my sessions B, the specificity and the tailored approach done at Kewy Templestowe Carlton and up in Brisbane there as well gave me that opportunity and my functionality was just fantastic. So there’s been a lot of really, really awesome stories like that, which have been really awesome to see, because you’re like, well, that’s why I come to work. That’s why I do what I do and I enjoy doing, because I’m helping them. And they’ve had such a good trip, because I know that I’ve done the best that I can do for that person. And then they’ve reaped the rewards of that by challenging their body and getting the most out of it.

Michael Dermansky:

good. Yeah. And I’ve got a very specific example as well as a young boy of training recently as a footballer. And he came, he had this back pain injury and since multiple other clinicians as well. And because of the research we had worked on with hips and really differentiate A from B, A from B, A from B and how you manage that. When we did the assessment, it was really clear what we needed to work on. And that clarity wouldn’t have been there. a year and half ago before we started having the research team and the research projects as well because we didn’t have the degree of clarionic testing and that allowed us to narrow it down and be super specific. he’s already gone back to playing football, he’s really stoked with the outcome and I wouldn’t have been able to give him as clear a guide and a clear outcome if we hadn’t been working through this process.

Josh:

Yep, absolutely. Pretty great more.

Michael Dermansky:

And finally, one last question as well. As a clinician, mean, we’re doing a project managing for ideas. What has being part of this research team, what we’ve been doing research meant for you as a clinician?

Josh:

Yeah, look, it’s taken my skill set, it’s taken my confidence as well to a whole new level. know just doing the research for a year and a half and being here for almost, yeah, roughly four years now has just really increased my overall capacity. So confidence was a big one as well. I really, enjoy a challenge when I see something that comes through the door that is quite interesting so it doesn’t really make sense some of the subjective feedback that we get from some patients as well. And then knowing that I have done the research over several different regions and topics, I now have the confidence and clarity around, if I do this test and this test and go through this whole screening process, I know that I can make a solid clinical judgment on ruling this out or ruling B and C out and I’m like, okay, we’re dealing with this. This is what we need to do. This is how we can improve this and giving them the insight into that really builds rapport and really builds their confidence as well moving forward. I think if I was to put myself in the shoes of a client or patient coming through the doors and I had a clinician that didn’t seem very specific on what the issue actually was, then I would kind of lose a bit of faith through that. So with this research as well, it’s really given me the skill set and capacity to make some really solid decisions as a clinician and really eliminate the guessing as well. Look, not saying that I know everything because there is some cases that can be quite peculiar. But if that’s the case, we simply refer on to more specialized practices where, gets certain imaging done if we’re really not sure. But for me as a clinician, I think it’s really upgraded my skill set and confidence massively. So that’s been really, really fantastic for me as an osteopath.

Michael Dermansky:

No, that’s really good. And I’ve seen several times as well where we’ve had a specialist come in and present to us or a surgeon as well. And the first time we have one in an area, there’s some new tests and I can see you and kind of scribbling down a test really quickly and like, okay, we can do this better. And then the second time another person comes along and like, yeah, you know that, I like that. So the knowledge, you know, that, that knowledge consolidation and workshopping those ideas to make sure that practically possible just, you know, elevates your

Josh: Yeah. Yeah, exactly right. Yep.

Michael Dermansky:

confidence of clinicians so much by being part of that process.

Josh:

Absolutely, yep, it’s been fantastic.

Michael Dermansky:

Well, thank you very much for your time, Josh. I wanted to really talk to the listeners about, know, share our experience of setting up a research team. It was something I’ve been wanting to do for a long time. And, you know, as an idea and a concept, and now that we’ve actually done it, the real benefits for both clinicians, for the business, for the clients of having this as a normal part of what you normally do. And again, it’s very different to running primary research. We’re not looking at randomized controls trials. We’re not looking at those kind of things. That’s really a university setting. From a business point of view, it’s for us, how do you take those ideas, those research papers, and make it into a practical process that other people can follow and get better and better outcomes for clients?

Josh:

Absolutely, yep, yep. Puts all those pieces of the puzzle together really well. Works tremendously, that’s good.

Michael Dermansky:

All right, Josh, thank you very much for your time. It’s been great hearing your perspective on our research team as well. And I’m really hoping that the listeners will give it a go and have a go in their own businesses, setting up something that’s a bit more creative and a little bit more, not risky, but try something they haven’t tried to be able to improve their business to that next level. You don’t know what it’s gonna look like in a year and half down the track.

Josh:

Absolutely. Thank you both and thanks for everyone for listening.