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Better Outcomes: A Manifesto for a New Healthcare


Let’s get real: Healthcare is broken. You know it. I know it. Every clinician who came into this field from a desire to care for others, knows this to be undeniably true. We feel it everyday when we enter our clinics, hospitals, and practices. We feel the burden of time-based productivity metrics, utilization rates, and the expectation to behave like cogs in a giant, soul-crushing machine aimed at extracting revenue from our patients in exchange for “units” of treatment. 


Day after day, millions of patients go to clinics, hospitals, and other healthcare facilities to address issues related to their physical, emotional, and mental health. More often than not, they are met with indifference or bulldozed by procedures. And that’s not surprising, when the healthcare environment pushes clinicians to the point of burnout and apathy.  


Healthcare should be about one thing: PEOPLE! Yet how many clinics, organizations, or healthcare professionals live their lives by the numbers? Metrics & spreadsheets drive most of our healthcare decision makers and administrators. That leaves patients -the people we serve- lost in the mix. Patient’s feel lost, forgotten, and ignored by a system that prioritizes efficiency & productivity over their own personal experiences, priorities, or goals. 


That’s probably why nearly 70% of patients never complete their course of care. 


It’s time for clinicians to finally stand up and say what we’ve all been thinking for so long: enough is enough!


It’s time for healthcare organizations to commit to serving the individual needs of each unique patient that they are charged with serving. 


To do this, we need a new framework, a new paradigm, a new way of looking at this noble profession of healthcare. Below are the 8 foundational commitments to create a new healthcare: 


Commitment #1: We will care for the whole person, not just a diagnosis. We will adopt a Biopsychosocial approach to healthcare, rejecting cookie-cutter treatment protocols with one-size-fits-most, plug-and-play protocols that fail to address the nuances of each individual patient. 


As I have written about here, there is always more at play than the issue or diagnosis that a patient is seeing you for. We are all people, and people are affected by biological, psychological and environmental factors, each of which is unique to each individual. We can not simply rely on a diagnosis or symptoms to determine which treatment option, assessment tool, or outcome measure will be most effective for each patient. Everything from the patient’s social environment, past experience, and readiness to change impacts the issue they are now dealing with. 

In the past, a biomedical model of practice placed symptoms, diagnoses, and physiological issues at the forefront of clinician’s mind. While these factors are important, they represent only a fraction of the whole person, the individual patient, sitting in front of you now. It’s time to start addressing individuals and their unique situations and factors, instead of focusing too heavily on diagnoses. 


Since, we understand how physical, psychological, and social/environmental factors interact throughout a patient’s experience of a disease, injury, or illness, we understand that there are too many factors at play for rigid treatment protocols or “cookie-cutter” treatment programs. 


Commitment #2: We will prioritize improving our interpersonal skills and abilities and focus on building meaningful relationships with each patient; relationships built on trust, empathy, & caring. 



It goes without saying that —at the very least— patients expect to be treated by clinicians who are professional, competent, friendly, and caring. Research also shows that patients place a great deal of weight on the clinician’s ability to communicate effectively; from explaining a diagnosis to educating the patient of self-management strategies. In fact, this research concludes that high-quality patient-therapist interactions are more important to patients than convenient clinic locations, parking, organization of care, and even in some cases the treatment outcome.


Given that information, we as clinicians and clinic owners should be trying to do anything we can to improve the interactions patients have with our staff and clinicians. This starts with the way the clinician communicates including language, word choice, body language, and active listening.


Healthcare is a personal service involving a human experience. Patients want that experience. They want to feel that their clinician understands their situation, knows how to help, and truly cares about them. 


The best clinicians —those that are sought out by patients— are those who are able to make that human connection felt.


Commitment #3: We will put people ahead of procedures and policies. 


I once worked for the Department of Veterans Affairs (VA) in an outpatient clinic at a VA medical center. This environment, in particular, highlighted one of the major issues in healthcare today: we tend to prioritize policy and procedures over people. Part of that stems from our biomedical history, as well as the environment of efficiency and productivity healthcare now finds itself in. When everything is a number, a unit, or a line on a spreadsheet, it’s easy to make decisions without considering the impact they will have on the real people on the other end. 


Take for example, blanket requirements or protocols (we were fond of those at the VA). If you run the numbers and determine that X% of patients with diagnosis Y successfully manage the diagnosis or recover after completing a certain treatment, it’s very easy to make the blanket policy that every patient with diagnosis Y should complete that treatment first. On paper it looks great. You can make projections and calculate recovery rates, costs, and the like. However, blindly applying that policy to every patient with diagnosis Y fails to consider the individual circumstances or factors that may make that treatment ineffective for that patient. Many patients are stuck in treatment plans that aren’t appropriate because some bureaucrat somewhere made a blanket policy about their diagnosis, and now the patient —not the bureaucrat— suffers as a result. 


Commitment #4: We will confidently communicate the value that our treatments and services provide to the patients who receive them. 


For decades, clinics and clinicians have relied on being “in network” to avoid having to talk about value. And, in reality, they didn’t have to. Patients simply went where their doctors sent them. But, all that has changed. Patients are beginning to be more picky about which provider they seek out. 


Rising healthcare costs —deductibles, copays, coinsurance— combined with the advent of the internet means that patients now have a choice in who they see. And they’re beginning to use it. That means we must be able to effectively communicate the value we bring to the table. We must have value discussion with our patients —having them identify their desired goals or outcomes, attaching metrics to those outcomes, and framing the cost of treatment in terms of achieving those goals. 


Commitment #5: We will prioritize patient engagement & experience. 


If all you want to do is run a therapy mill or an assembly line practice, then you don’t really care about patient engagement or experience. I mean, you want them to have a good enough experience that they’ll come back for their next treatment, sure. But you don’t necessarily care about their engagement in treatment. 


Clinics and clinicians that want to make an impact in their patients’ lives think differently. They prioritize patients being actively engaged in treatment. They want patients to be involved in the goal setting, treatment planning, and benchmarking. This ensures that each patient has a higher chance of achieving their desired goals and outcomes.  


Commitment #6: We will embrace transparency throughout the entire treatment process, including financial costs for our patients. 


You know what sucks? When you call a clinic to set up an appointment for an evaluation or treatment that your doctor prescribed and you can’t get the answer. The answer to the questions “How much is this going to cost me?” Most of the time, clinics respond with something like, “With your insurance, your copay is $X”. And that’s not untrue. That is the copay. But everyone knows it: about three months after that appointment, you’re going to get a bill, and hopefully it’s small. Sometimes it’s a “what the hell is this!?!?” bill. 


Either way, this has to stop. We need to do everything we can to be transparent with the patient about what their financial commitments will be. This may be an estimate, range, or we may even go so far as calling their insurance to get hard numbers. What is important is that we begin to pull back the curtain for our patients, to provide them with as much information as possible upfront, so they don’t get an ugly surprise afterwards. 


Commitment #7: We will forget time-based productivity metrics and find alternative ways to measure our effectiveness as clinicians and organizations. 


Whether you’re a new grad or a seasoned clinician, you’ve run into the productivity paradigm; using time-based productivity as a way to “maximize revenue” or “improve efficiency” in the clinic. Healthcare organizations, hospitals, practices, and clinics run on productivity. They focus on productivity. They require productivity. 


However, by focusing on time-based productivity measures, we miss what we truly should be assessing.  We miss out on measuring the quality of the healthcare service being provided. This system creates an incentive structure that causes clinicians to try to “get the most out” of every patient interaction (in terms of billable units) which cuts down on documentation and administrative time. However, what is often lost in this environment is the ability to focus on individual patient needs. It’s time we all decided to begin focusing on what really matters: patient-driven outcomes, rather than treatment units & number of minutes billed. 


Commitment #8: We will lead our patients and guide them through the treatment process towards achieving their desired outcomes & goals. 


Are you a licensed, experienced clinician, or a vendor? Are your services and treatment plans “off the shelf” or “one-size-fits-most”? Put another way: do you lead your patients, or do you take orders like a good waiter? 


Most clinicians worth their salt will respond “Absolutely not! We develop individualized treatment plans for each patient.” And, inreality, most clinicians strive to meet that goal. 


However, sometimes, clinicians find themselves being driven by their patients. They allow their patient’s desires, expectations, and views to overly influence the course of treatment. Sometimes this stems from poor communications or not addressing expectations early. Rather than deal with an unhappy patient (or negative online reviews), the clinician decides to placate the patient.  The problem with this is, that it doesn’t necessarily prevent the patient from leaving bad reviews or ending up dissatisfied with treatment. In fact, these patients can be more likely to have a negative experience. By allowing them to take the leadership role, whenever it must be taken back, they become upset and frustrated. To prevent this situation, clinicians must lead patient relationships and treatment plans.


A higher Standard


We are on a mission to create a world where skilled, competent, and caring clinicians serve and care for engaged patients to promote better clinical outcomes, unmatched patient satisfaction, and lasting relationships. 


We envision a world where skilled, competent, and caring clinicians serve and care for engaged patients to promote better clinical outcomes, unmatched patient satisfaction, and lasting relationships.


Given the right goals, strategies, and processes, clinicians and organizations can create uniquely awesome patient experiences that lead to better relationships, better outcomes, and more referrals. After all, healthcare is about one thing: the patient! That’s where we come in! 


Are you tired of spinning your wheels in the world of traditional (conveyor-belt) healthcare? 

Then reach out to us today and let’s build a new healthcare together!


Reach Out Today!


PDF of the Manifesto

Our Story

Rehab U Practice Solutions

Our story begins the summer before his senior year in high school, when an accident landed Rafael E. Salazar II, MHS, OTR/L in emergency surgery and then in an outpatient hand therapy clinic 2 days a week for 3 months. In that time, Rafael was exposed to the world of OT/PT and physical rehabilitation. After that experience, Rafael set his sights on a career in Occupational Therapy, to one day work in a hand clinic. Graduating from graduate school with a degree in Occupational Therapy, Rafi started out on his journey as a rehab practitioner. From managing OT caseload across multiple skilled nursing facilities to leading an outpatient specialty OT clinic at a VA medical center, Rafael has treated patients with a variety of physical, neurological, and psychosocial dysfunctions.

During that time, Rafael has become recognized as a leader in field of outpatient orthopedic rehabilitation and in the field of Occupational Therapy, being asked to serve on multiple committees for the National Board for Certification of Occupational Therapists (NBCOT), as a subject matter expert for examination test content development. In August of 2018, he was elected to the Board of Directors for NBCOT. He was also appointed to the Georgia State Board of Occupational Therapy, as a licensed board member. He has taught courses on Evidence-Based Rehabilitation, Applied Kinesiology, Psychosocial & Mental Health, and Professional Development & Competency for the OT department that he was graduated from at Augusta University.

After several years as lead clinician in an outpatient specialty clinic, Rafael left the VA to begin consulting with the State of Georgia, assisting in transitioning individuals from State-run institutions to community residences; a position that allowed him to leverage his clinical knowledge & expertise as well as his ability to effectively communicate, educate, and train people in order to ensure that the individuals transitioning from these institutions received the highest quality care and support possible. His role in developing provider training materials and templates became a crucial part of transition planning for the State of Georgia. He also worked to develop a framework for community engagement as part of the transition process.

Through all of these experiences, Rafael became aware of one glaring issue: the healthcare system in the US is broken. Regulations abound. The way therapists provide services and do business is broken. Therapists are getting burned out, trying to hit productivity numbers and pumping patients through their clinics like a factory assembly line. Patients feel that the services they receive are cookie-cutter and sub-par at best. Neither therapists nor patients are achieving the outcomes they desire. Rafi knew something had to change, and that’s when he started Rehab U Practice Solutions.

Combine his knowledge & clinical expertise with a gift of education & speaking, a unique understanding of the rehab world & healthcare environment, and a desire to empower therapists to radically change the way they do business & break out of the paradigm that causes burnout and poor clinical/professional outcomes, and you get Rehab U Practice Solutions.


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About Us

We approach each of our clients with fresh eyes to develop customized, unique strategies to improve reimbursement, grow referral lists, and create additional sources of revenue. We specialize in tightening up documentation, discovering niche market opportunities, and getting the word out about your practice.

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