I book my appointments in Cliniko, and it synchronises with my personal and family calendars on iCal. For privacy you can adjust the level of information displayed in iCal, choosing first name, full name or initials. It’s straightforward to book clients in for blocks of sessions and Cliniko emails the parent a reminder before each session. I’ve set it to go out 2 days before the appointment, at 10am. The email simply reminds families of the date and time of the upcoming therapy session, which parents tell me they find useful.

I write my clinical case notes using a form that I’ve customised. It’s a mix of check boxes (e.g. where the appointment was and who the child attended with) and free form text boxes for things like the session’s aims and information about how the child responded. It’s easy to look back over past sessions and see how the child is progressing.

The other features I use are invoicing and file attachments. You can upload your company logo to Cliniko and make a professional looking template for invoices. It’s quick to produce them and the system can either email the invoice to the client directly or you can save it and email it yourself. It also lets you track who has and hasn’t paid. I use the file attachment feature to upload documents to each patient’s record. I scan in the case history form and any assessment record sheets – once you’ve made a pdf, it’s a drag and drop interface to add them to a patient’s record. I also upload all the reports and letters I write so they’re in one place, secure and available whenever I need them.

There are some fun touches, like it reminds you when it’s a client’s birthday, as well as lots of features that I don’t yet use. For example it supports clients booking their own appointments directly online, via your website. You can also use it to track your business expenses.

Cliniko has allowed me to run an (almost!) paperless business. I can write and review case notes wherever I am. And the automated appointment reminders increase attendance rates. I recommend it. (I pay for my Cliniko subscription, and they don’t know I’ve written this review!)

People have asked me how I advertise my practice. When I ask clients how they found me about half say someone they know recommended me. Some tell me they found me via the ASLTIP directory, and the rest searched google and found my website.

Encourage Personal Recommendations

Happy clients tell their friends! I’ve worked with a former client’s next door neighbour, been contacted by a woman who said her sister’s friend suggested me, and had parents recommended me to their child’s classmates.

I told people in the NHS and education department where I used to work, that I was leaving to work independently, and I’ve had enquiries and recommendations from them. I also tell people I meet that I’m a paediatric SLT – I once worked with my yoga teacher’s son! So carrying business cards is useful, I have these mini ones from moo.

I receive personal recommendations from other independent SLTs in the local area. Several friends work on a part-time basis, or specialise in particular areas of therapy. When these therapists receive an enquiry from a family they don’t want to take on (for various reasons) they recommend the family contact me. And I signpost families to particular colleagues if I think they’ll be a better fit for the child.

Use the Directory of Independent Speech and Language Therapists

I am a member of the Association of Speech and Language Therapists in Independent Practice so have an entry in their directory. Parents who find me here often haven’t seen my website, so they aren’t always aware of how I work and my prices.

Finding My Site by Searching on Google

I haven’t tried paying for google ads. I attempted to make my site findable by thinking about what parents might search for and including relevant content. I write blog posts about things I hope parents will be interested in, and I added myself to google maps. You can use a free or low cost service, like Squarespace, to make a website without having to hire a designer.

What didn’t work?

I haven’t had much success with adverts. In 18 months I’ve had two enquires from a (free) advert on netmums. I spent £20 on an advert on a local parenting website (I think they also included me in their newsletter) which didn’t generate any interest. I’ve written articles about communication development that were included in local parenting magazines, but again these didn’t lead to any enquiries.

I emailed around 25 local nurseries to introduce myself and explain what I could offer, attaching a pdf of a flyer I’d made. This led to me meeting one nursery manager, and then assessing one child and running a staff training session. So, it wasn’t a complete waste of time, but didn’t keep me very busy.

This post is part of a series about Becoming Independent. Next up, choosing where to work.

I’m in a transition phase; I’ve left my NHS role and started work as an independent therapist. I find change tricky. I had an interesting conversation with Abi Roper and Tom Starr-Marshall that made me think — why is change in the NHS so difficult? And in a solution-focused kind of way, what makes particular projects successful?

Looking back, there was a pattern to my attempts at service development (try and follow along with the diagram!):

• I’d have an idea, then it felt like people were blocking me, I’d hear: “sounds great, but….” followed by a long list of why it wouldn’t work, or we couldn’t try it.
• I’d feel angry, frustrated and disappointed.
• I’d either: ignore the objectors and try the idea out, maverick style.
• Or start asking questions. This takes time and requires persistence.
• I’d try for quick wins to show the team that the idea was worth piloting.
• Then cycle through the process again, asking more questions and making more small changes, to try and show value.

Sometimes it worked and sometimes it didn’t! So what helped?

• The 5 Whys is a useful exercise for identifying barriers and understanding what was really getting in the way,
• using “yes, and….” (rather than “no, but…”) helped me stay open to other people’s ideas and viewpoints,
• working with allies, and
• focussing on both the end goal and the details, kept me on track.

Have you managed to push new ideas through and make changes? What helped? I’d love to hear your ideas.

We’ll be exploring this issue at the Therapy Ideas Workshop on 17 May. Join us! If you’d like to discuss whether the workshop would be a good fit for you, email me.

Godin describes a linchpin as “an individual who can walk into chaos and create order, someone who can invent, connect, create and make things happen… linchpins are geniuses, artists and givers of gifts.” He says that although we were trained to be cogs in a giant machine, we can choose to re-train ourselves to become indispensable.

Linchpins don’t wait for instructions, they make their own maps. They overcome the resistance (the lizard brain that tells us our ideas will never work and everyone will laugh at us) and get their ideas out into the world.

In a recent team meeting at work, it was easy to see the therapists whose lizard brains were in control; they suggested we stop trying new ways of working and go back to the old way! Fortunately my team also has a linchpin or two; they’re generous with their gifts and keen to make change. I’m trying to be a linchpin too; we’re starting to draw our own map, overcome the resistance, and ship our ideas.

I recommend checking out the Linchpin Manifesto (PDF link) and reading the book. We need more linchpins in the National Health Service! What do you think?

The change made me reflect on the positive aspects of the old job, so I’m jotting them down here.

Positives

It was a large, friendly team of therapists and I was well supported. I worked autonomously: free to manage my own time and workload.

I spent 18 months working with the same caseload, so I was able to get to know the families. When we met in the street, they would stop and chat; I felt a part of the community. I was also able to develop good working relationships with other professionals, such as staff in the Children’s Centres.

The team has a good universal service in place; they are working at the population level to raise awareness and prevent difficulties arising. In this respect they’re ahead of many other boroughs!

We were encouraged to carry out clinical projects, so I developed a drop-in group focussing on parent child interaction strategies, in my patch. With support from the Children’s Centre I was able to grow this group and access hard to reach families.

What I’m looking forward to

I think the new job will also be a positive experience; when I’ve moved through the initial ‘information overload’ phase and begin to find my feet, I hope I will enjoy the new challenge. I’m looking forward to developing the universal service and working with nursery settings.

I find starting in a new team difficult and admire locum therapists, who move from team to team regularly—I wouldn’t cope! If you’ve got any tips about how to make the transition as stress-free as possible, please add a comment!