Building a successful practice means identifying not only things we need to do but also knowing what could kill a practice from growth and success. Without elaborating on the obvious -- numerous things like attitudes of positivity and love, smiling, dress code, a neat clean office, etc. -- I want to identify a dozen things that will kill practice growth and success every time they are not implemented.

1. Lack of mission and purpose. In short, your mission is your duty and direction and your purpose is why you are performing the duty. If you have no purpose, you can't have a mission, therefore, your practice would have no direction.

If your mission was to serve as many people and their families through chiropractic care as possible and educate them that they need to have a D.C. on their health care team to monitor their spine... the purpose behind this duty would be because many health problems are a result of subluxations, and adjustments are to improve nerve integrity and wellness for the entire family.

With mission and purpose, you have a reason to do what you do. With your mission and purpose in place you can now set goals which are merely points of achievement in life to shoot for.

2. No system. Without a systematic way of running your practice, you can't move from point to point with any predictability. Consistency of operation means efficiency in practice and patient management. Systematic communication is the most important because it works on what I've coined the "belief subluxation," the one between the patient's ears.

Systematic procedures should be integrated with this communication to enhance the patient's value to your purpose and mission so he or she become part of it. A system is crucial for patient compliance and retention, and doctor and staff certainty.

3. No options. Within your system, give the patient options. Most practices do this automatically by giving different appointment times, days, payment plans, etc. One of the most important options to give the patient is on the first visit. Our history form asks patients what type of care they want-- temporary relief or maximum correction.

In my seminar, I teach doctors how to communicate options to patients so they don't feel pressured to do something, yet are enabled to choose the most empowering response, i.e. spinal wellness which includes correction, then maintenance. They follow through because the option was available but they feel comfortable and comply because they chose it.

Patients should also be informed that there are two types of chiropractors: those who do non-corrective spinal manipulation for back pain (musculoskeletal D.C.) and those who do adjustments to correct the spine to its normal spinal model to enhance maximum nerve integrity for optimum health potential (traditional wellness D.C.). These options give patients the chance to choose what they want for their health care.

4. No guidelines to follow. Once the patients have chosen their option for care, payments, appointment days and times, they must be given guidelines to follow to get the best results. Without guidelines in your system, people will miss appointments without calling, drop prematurely, not bring their family, fail to come to orientation class, etc.

Your practice will stop growing because you'll be spending your time and focus chasing people rather than having them take the responsibility themselves. Your practice becomes a headache instead of a vehicle for helping them. (One of my previous articles on guidelines to use in your practice can be read on our website.)

5. Focus neutral, negative, or none. Focus determines actions, plain and simple. Focus should be enthusiastically on your mission and purpose. With all the previous points in place, your system allows you to run from point to point without distractions or thinking of what your next move should be. This, in itself, improves focus.

Neutral focus is simply having your focus on daily tasks without remembering the big picture. It's robotic, scripted, rehearsed actions versus innate and purpose-driven. If focus is negative, it's usually on problems not solutions, dwelling on the mistake, not on what is to be learned and changed. No focus is apathetic survival. In all cases, review your mission and purpose, move toward it step by step in a system.

6. No specific technique for spinal correction. Each doctor has to define his or her practice by the practice techniques he or she will use with patients. This should be part of your mission and purpose or you'll simply be popping backs indiscriminately.

Your technique helps you define your patient management, how often they come, monitoring, criteria for end point, wellness care, etc. Your technique not only defines you as either a musculoskeletal back pain D.C. or a traditional/wellness D.C., but it gives patients the option of choosing a D.C. for spinal correction and wellness care versus non-corrective spinal manipulation for back pain.

Stop practice death by starting to implement the first six principles in your practice. Next time, I'll continue with the remaining six practice killers. It's guaranteed that your practice will take on new life if -- like thousands of D.C.s I've taught -- you simply follow these principles.