In the time of Covid, Part 3: Triage for Crisis Management

I am getting better acquainted with my anxiety. I thought we were old friends by now and that I knew all of my signature symptoms: chest tightness, unease, jumpy and being on high alert. But this pandemic has upped the ante, and I am finding that my anxiety has more to teach me. Like you, I am sensitive to the anxiety of my clients, colleagues, family, and neighbors. Of course, the world news gets in, too. I get two newspapers a day and listen to NPR…so there is no shortage of worry in my daily experience.  

I find myself working with my own anxiety daily, to manage it and to remember to breathe. In my role as therapist, I have several methods of anxiety reduction I regularly recommend to clients. But in my role as a business coach, I notice that anxiety presents additional problems. It muddles the decision-making process needed to make good decisions about our practices and livelihood.

I have read neurological studies that show why this muddling happens: Anxiety floods the brain and the prefrontal cortex (the part of our brain that often acts as a traffic director, keeping our thoughts, ideas and solutions moving in a rational way) gets very confused; this cognitive area of the brain is easily upset and distracted when anxiety is present.

Normally resolvable business problems–both big and small–tend to collapse without the traffic cop part of our brain being on the job. This is why even simple worries seem so overwhelming to many people right now. Problems due to Covid-19 get combined with those of everyday life. Then our anxious brains deem all these issues equally (heavily) weighted. All demand our immediate attention right now. Its as though they all have a green light to rush in. We get flooded.

This is bad news for a small business owner. You need to consider business problems carefully, to weigh the risks and rewards prior to taking action. You need to think and plan without emotion clouding your judgement.

If you are dealing with worry and a sense of being overwhelmed, its time to have a mental strategy to stay clear and proactive. The mindset I like for dealing with business issues in a crisis is triage.

When Triage is Needed

Triage is a time-honored process that quickly and effectively prioritizes issues and problems during a time of crisis. You may use this process already, but when you are feeling overwhelmed, it helps to be reminded to slow down and be strategic. Here is an example.   

Joel, a therapist in private practice, is normally a cautious small business owner. But now he is overwhelmed and feeling frantic. Working from home using a telehealth platform, he complains that his internet connection is too slow and even cuts out. It’s frustrating. He meant to replace his router but never got around to it, pre-Covid. Now its essential to have a better way to connect with clients, but he is not sure how to proceed. He is having trouble with his billing software, too, a task he had hired someone to do and now tries to do himself. His young daughter is not doing well with the distance learning program the school offers, so he is worried about her. 

Of more concern, Joel says he doesn’t feel well. He still has clients and is using telehealth, but they are starting to worry about him as he coughs and sneezes through the session. Some of his clients have decided to stop therapy. He doesn’t know if he has the virus and has not been tested; he hopes to just tough it out.

“My wife is sneezing now too. She is blaming me for making her sick. So we’re arguing. And one more thing, Lynn, that is really on my mind,” he says. “Even though I have currently moved out of my office into my home to work, my landlord wants to renegotiate my office rent. My annual lease is up for renewal in two months. I am really irritated and upset about this and it keeps me up at night. I think about it constantly. It seems so greedy in this time of crisis that anyone would think about raising the rent. See why I am overwhelmed? What am I supposed to do next?”

I do see why Joel is distressed, and I empathize, but more importantly, I ask Joel if he can start to prioritize all of these concerns. Some are more critical than others. He says an emphatic, “No. All these issues feel immediate and equally important to me right now. They all need to be dealt with, I am just not sure what to do first.”

Joel needs to think clearly if he is going to make good decisions. It’s time for triage.

Using a Triage Process  

Triage is a medical term, used to sort out degrees of seriousness. Imagine a battlefield that is filled with wounded soldiers. You are the medic who walks among the wounded, quickly ranking the level of injury. Traditionally, triage uses 3 levels of prioritizing:

  • Emergent: Think emergency room, 911-quality critical issues that need first attention now.
  • Urgent: Pressing concerns that need care soon, but are not considered life or death right now.
  • Non-urgent: Conditions that are real, but can wait. 

For you, as the business owner of a private practice, triage can present like this:

Emergent issues:

  • I am ill or an immediate family member under my care is ill
  • I need to close the practice immediately
  • I am broke and can’t pay my bills
  • I am losing my license due to an ethical complaint or oversight

Urgent issues:

  • I am overwhelmed with too many clients (or I really need more clients)
  • I don’t know how to do billing or administrative tasks by myself
  • I have lost 50% of my clients due to teletherapy resistance
  • My cash flow is a very real problem

Non-urgent issues:

  • I am OK for now, but worry that my caseload may dry up in the future
  • I would like to add some online classes to my practice to have more to offer
  • I am not sold on telehealth and think more training could help
  • I want more clients in my area of specialty  

Steps to take:

  1. Make a list of all your problems, especially those keeping you awake at night or causing you to feel hopeless & helpless. Sort them into the three levels as best you can. Which are problems that you can impact (do something about) and which are out of your grasp? Stick with those you can achieve.
  2. Focus on resolving only the emergent and urgent issues on your list. This may take days or weeks.
  3. Then turn to the non-urgent issues.

This is what I helped Joel to do; it calmed him in that it gave him a focus of what to address first and what could wait. You can do this, too. Over time, keep updating and adjusting your triage list so you know what needs your first attention versus what can wait. This will provide you with a better sense of control; you can make thoughtful choices and decisions about issues that affect your practice, even during a crisis.

In the next email newsletter, I will look at the non-urgent issues that may be on your list and need resolution, by showing you how to position your business for strength in a time of crisis.

Some readers have asked for resources right now. The source book for much of what I am discussing in my newsletters is my earlier book:

Crisis Proof your Practice: How to Survive and Thrive in an Uncertain Economy (W.W. Norton, 2009)
It’s available on Amazon and at the publisher.
See inside the book at the website.

In the Time of Covid, Part 2: Taking an Honest Inventory

Depending on your background, the concept of taking inventory may be either a business or a moral task.

Those who have worked in business know that taking inventory means the tedious and exacting task of checking on your products. But participants in a 12-step program know the phrase from the internal rigors of the 4th step: taking inventory of one’s flaws to be accountable for one’s current situation in life. 

For our purposes, I want you to take a quick inventory that combines the best of these two concepts: I want you to become part accountant, part accountable. I want you held accountable for the finances, assets, strengths, debt and weaknesses of your business.

I can already hear the groans from some of you. This is not punishment, I promise. Instead, think about this inventory as though it were a camera. You are going to record an unemotional, but accurate snapshot.

It’s time to tell the truth of your practice as it stands today. Only you can do this task. And you need to do this right now, before you make any major changes.

Take a True Snapshot

To complete this first step in your crisis-proofing process, you need to be courageous. Fess up. Take note of the realities about your private practice right now, good and bad.

If we were working together, I would be asking you a series of questions to direct your attention, but the process of looking carefully and closely, without fear or judgment, is always up to you. For example, I would ask you to give me a profit and loss statement and a list of assets and liabilities, and I would want to understand your basic budgeting to know how money moves in and out of your small business. I would ask you to list your obvious and hidden resources, strengths, weaknesses and debt.

Time is of the essence today, so let me show you an easier way to take a snapshot. Take my Strong Start Survey.

Lynn’s Strong Start Survey

I began giving this survey to my business coaching clients and readers of my books, over 30 years ago. Here’s what I know: Reflecting on your practice this way is not a waste of time. It helps with business decisions. It allows you to quickly understand patterns and clues to decipher your practice’s health and well-being today. It suggests a path forward. Here are the 10 questions to answer:

Strong Start Survey

1. Where do you get your energy from?

2. Where are you most personally limited?

3. What do you love about your work — being a therapist, coach, healer, consultant, or other type of service provider? What are your unique strengths and talents?

4. What motivates you to take action?

5. What challenges and problems regarding your practice are you currently facing?

6. What challenges and problems regarding your personal life are you currently facing?

7. Of these challenges, which need attention immediately? Which are lower priority that can be corrected over time?

8. What are the 5 business opportunities that you are currently not making the most or anything of?

9. What are the 10 goals you want to accomplish in the next ninety days?

10. If you have an existing support system (friends, colleagues, mentor, therapist, coach, peer group, etc.) what should they know about you in order to best understand the challenges you face now? How can they best support you (strong feedback, gentle encouragement, listening, direct suggestions, advice, accountability?)

Understanding What Your Survey Reveals

Each survey explains a lot to me about the practitioner and their practice. I group the answers into four major topics: Energy, motivation, direction and action. To see the patterns within your answers, use this guide:

  • Energy level (questions 1, 2, 6)
  • Motivation (questions 3, 4)
  • Direction (questions 5, 7, 8)
  • Action (questions 9, 10)

Now sit back and analyze your own survey: What do you see about your situation right now? Are there opportunities to explore? Next steps to consider? Where are you blocked and where are you full of capacity? I hope it gives you a better sense of what is possible, even now.

In my earlier book written for the economic recession, Crisis-Proof Your Practice (W.W. Norton, 2009), I go into more detail with additional tools to help you take a complete inventory. This book is still in print and can be a resource for you now.

OK, readers and colleagues, this is it for today. In next week’s newsletter issue, we get serious about crisis management. Part 3: Triage– How to prioritize urgent issues that may be keeping you up at night.  

In the Time of Covid 19: Part 1, Anticipate More Disruption

We are in the midst of a sea change. I believe that the way we operate as mental health practitioners, healers and helpers will be changed forever as a result of this crisis. There is some good news in this. Evolution spurs us forward to respond with creativity and new ways of thinking and working with others. But it comes with a dose of anxiety, worry, pain and struggle.

As we get used to the new parameters of telehealth, quarantine, billing confusion, cash flow problems, client cancellations, and overwhelm of those in need — balancing our own anxiety and well-being with that of those we help is hard. Lots of issues that we have never dealt with before are already in the pipeline, ready to present themselves. I want to share my thoughts about the best ways we can all survive, strengthen and hopefully even thrive — in the time of Covid 19.

This newsletter is a multi-part endeavor. I will share the aspects, strategies, tips and ideas that I am relying on for myself and for those I coach. Today, its about mindset. Read on for part 1.

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Part 1: Anticipate More Disruption.

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How A Crisis Presents Itself

The last time I wrote about operating a private practice in a crisis was in 2007, during the start of the US recession. At that time, I could see the recession coming, because many of us in the mental health field had already been in an earning downturn for many years. The rest of the country was just catching up.

But this crisis is more than a simple recession. Its a pandemic added to a global economic downturn. One thing we can be certain about: More disruption is yet to come.

The first response in the face of a crisis is usually emotional: fear and anxiety courses through us and our clients. Most of us exhibit some combination of fight, flight or freeze. You might feel angry and pressured to make radical changes as you see your practice flailing. Or you have numbed out, hoping against hope that it will all go back to normal soon. Or you are stuck, in limbo, not knowing what to do or where to turn.

Even if your practice is operating as usual, and you are not yet feeling much difference in your working life, chances are you will soon. This crisis has further to go. You need to be ready for things to get more chaotic. So more emotional reactivity is probably on the way.

As a business coach, I want you to be strategic and smart about the steps you take in regard to your practice, so that the important work you do stays viable.

Are you noticing any anxiety, fear, sadness or worry influence your decisions and thoughts about the future of your practice? If so, its important to mark out a business mindset from an emotional one, so that you make good decisions.

Why Business and Emotion Don’t Mix Well

Did you ever hear the business mantra, often used when the results of business are going to be brutal to someone: Its nothing personal, its only business?

This mantra is true because business has its own energy and can run counter to empathy. Business works by a separate set of rules, tied to the profit motive. As helpers and healers, we try to intervene. We aim to bring our best awareness of who we are and what we value, to advance ethical commerce. It starts with separating fear from fallacy.

In a time of crisis, we can get caught up in some “stinking thinking” or irrational responses with business. Business myths or fallacies feel true, but aren’t.

Here are 3 that might be nagging at you right now, that I want you to watch out for:

  • The Fallacy of Control. Watch for assigning blame (to yourself or to others) as a basis for action. Trying to make sense of this crisis can lead to false feelings of control. The blame path will muddy your strategic thinking and planning. This crisis experience is not fixed in concrete. It’s more akin to shifting sands. Stay balanced, aware, open, and observant.
  • The Fallacy of Fairness. This virus is going to affect people and their practices in many different ways. We are all in this together, but some will be hurt worse than others. If your practice is suffering and your friend’s is fine, its because business effects are rarely even-handed or fair. Watch for feelings of envy (if your practice is hurting) or moral superiority (if you aren’t.) It’s not fair. Just focus forward.
  • The Fallacy of Heaven’s Gate. Many of us, as helping professionals, make a financial sacrifice for our work. We figure that our efforts to serve others and all we do that is unpaid and unheralded should protect us from harm. But business is business; it doesn’t discriminate for those with good intentions. Instead, we need to do good in the world and be good at our business.

The Solution to Anticipating More Disruption

Each newsletter, I will take you through the steps of a specific crisis-proofing process that I use as a business coach. It’s designed to help you to be as strategic as possible with all the practice-oriented challenges and decisions you will need to make. Here is what you can look forward to, over the next several weeks.

My Crisis-Proofing Plan:

  1. Do an “honest inventory.” How to do a quick review of the essentials in your practice — the strengths and weaknesses, assets and liabilities — so that any changes you make will be aligned with the reality of your business as it is now. Every client I coach begins with this customized inventory and I want you to start your planning this way, too.
  2. Triage for crisis management: Next, I want to show you how to assess your critical issues, to prioritize any urgent actions and know what to do right now, versus what can wait. This will calm any anxiety you might have, by making sure you are minimizing business risk.
  3. Check your positioning: Over several newsletters, we will look at how you can maintain, grow, or redirect your business. I will offer you examples of how to recommit, rebrand, or reinvest in your practice, so that it is stronger and more secure, depending on the larger practice goals you have for the future.
  4. See the opportunities inherent in the crisis: Yes, there is always a silver lining. What are the things you can consider now that can help you grow and expand, or become more profitable, or move in a new direction? We will explore what I see occurring for others during this time.

I will also post all of the newsletters online at my website, so you can review them there. If the newsletters are useful for you, feel free to forward to others. A rising tide lifts all boats, and we need to share what helps us with our circle of support.

If you have specific questions or concerns you want me to answer, email me at: info@privatepracticesuccess.com and I will do my best to include your concerns and ideas in future emails.