Let's Be Frank: How to Save Your Wound Clinic From Failure

Issue Number: 
Volume 12 Issue 4 - April 2018
Frank Aviles Jr., PT, CWS, FACCWS, CLT

“Failure is simply the opportunity to begin again, this time more intelligently.” — Henry Ford 

Successfully operating an outpatient wound care clinic hinges on many variables. If certain aspects of one’s clinic performance are not appropriately monitored, problems may not be identified until it’s too late. While growing up in Puerto Rico and Winter Springs, FL, I was fortunate to learn important business concepts and advice from my father. I witnessed him build multiple successful businesses even though he encountered many obstacles that most people would not attempt to navigate. My father’s general advice was quite simple: Be honest and trustworthy, work hard and have excellent work ethics, be transparent, and be mindful of customer service. He also believed in reassessing the business regularly and being flexible in adapting to future market trends. He also always emphasized the need to help others, without expectation. But the one pitfall my father wanted me to avoid is what has actually made me feel like I’ve succeeded in everything I have done throughout my career — and that is experiencing failure. How we respond to and learn from our failures often makes the difference in whether our business thrives or fails. In my younger years, I had to apply what I learned as I opened a few non-healthcare-related companies. Today, 15 years later, I continue to run these businesses during my “spare time,” and they remain viable (although there have been struggles along the way). Even though they are not related to wound care, many of the same principles to effectively running these businesses have been applied.

This article will discuss methods that should help wound clinic directors turn around the performance of their clinics when failure appears to be imminent but is not a welcomed option. 


We encounter many moving parts and challenges in today’s business environment. Statistics indicate that about 80% of businesses with employees will survive their first year, but that number falls to 66% the second year, according to the U.S. Bureau of Labor Statistics’ Business Employment Dynamics. About 50% of businesses will survive into their fifth year, but only about 30% will survive into their 10th year. In other words, 20% of small business will fail the first year while 50% will fail in their fifth year.1 Going by these stats, those of us who are facing challenges within our clinics may be inclined to not attempt implementing a fix. But that would amount to a poor response in the face of failure in most cases. To address this point, I’d like to talk briefly about Henry Ford, a gentleman who is a household name today, but could have drifted into obscurity had he not properly addressed his share of failures. As early as age 16, Ford was a machinist’s apprentice with big dreams.2 His first company, the Detroit Automotive Company, was his first lesson in failure, as the automobiles produced were of a lower quality and higher price than he wanted. The company would go on to dissolve.3 Ford went on to create the Model T automobile in 19084 and the Model A in 1927.5 Ford’s willingness to learn from his mistakes and implement changes helped lead to the mass production of affordable cars. Now, I am not at all trying to compare myself to Mr. Ford, but I will go as far to say that my career success is partly due to learning from my failures. 

Many of you don’t know that I moved into a rural area — Natchitoches, LA — for personal reasons in 2005. Rural areas lack resources and specialists, pay is typically decreased compared to
urban counterparts, and we tend to work longer hours all the while. Over the course of six years, I attempted to bring a wound center to this area two times before finally succeeding in April 2015 with the help of our new chief executive officer, who was instrumental in launching the center. Our center, Natchitoches Regional Medical Center, required much planning, preparation, and hard work, and we have continued to grow exponentially while reaching milestones (including the establishment of our wound care services division, which has earned multiple awards based on operations and outcomes). Having prior experience and involvement in assisting startup clinics and operating several businesses has helped me to identify underperforming wound clinics and see them in a different light. What follows is a list of steps for wound clinic directors who are experiencing financial issues in their clinics to consider. Remember that the first step is always to ask yourself honestly why it is that the clinic may be struggling in order to understand what contributed to current predicaments. 

Step No. 1: Establish a plan for preparation.

  • Take the time to revisit the business plan by reviewing goals and setting new goals if need be. What were/are the short- versus long-term goals? Have you ensured that all staff members understand them?
  • Formulate a plan by establishing the clinic’s mission and discussing the plan with the healthcare and administrative teams. Determine whether the clinic needs new leadership, assistance from a consultant, the help of a management company (or management company switch). Or, it could be determined that a management company is no longer needed. There are pros and cons to operating under a management company, but if the clinic is struggling and resources are scarce, options must be weighed. Compare the idea of completing one’s taxes versus hiring an accountant. There’s a significant cost involved, but the accountant helps to educate on locating deductions and will be well versed on tax law, and any gains from an accountant’s experience should outweigh actual costs. Just as with anything else, research is necessary. Interview various companies to determine if there is one that fits the clinic’s specific needs.
  • Frequent dialogue with hospital administrators is important because having their support is key for the making of necessary, timely changes.
  • Understand the market. List referral sources, know the competition, and understand possible barriers to getting patients through the door. When we opened our center, we developed a survey for all clients to complete in order to understand their perceptions and existing barriers across the continuum. This was helpful, and the data demonstrated an increase in referrals.  
  • Data collection is a must. Wound clinics should collect and interpret data to determine any success or if implemented plans are making any difference. Data collected can include finances (billed versus collections), new patients seen, clinical outcomes (eg, healing rates, number of referrals, no-show rates, clinic expenses, patient discharges). Real-time data will allow for prompt decision-making and rapid adjustments. Clinic directors who are not financially oriented should hire someone who is.

Step No. 2: Assess operational performance.

  • • Have carefully written (and frequently reviewed) policies and procedures. These are your clinic’s “rule book.” All employees need to follow consistent practices for appropriate guidance. This also ensures accountability.
  • • Define and refine services being offered. Existing wound clinics that do not provide patients with available appropriate services will risk not only healing opportunities but possible streams of revenue. Remember that most patients are going to search the clinic online before arrival and will seek out experts online if they feel like they’re being shortchanged.
  • • Implement (and frequently review) plans for growth strategies. Healthcare continues to change rapidly, and businesses must adapt to grow. Are you adding services to complement the clinic? 
  • • Evaluate management and make changes as needed. Effective, experienced leaders are import because they know how to set the right tone and expectations. Independent clinics and clinics run by management companies alike continue to fail because they may lack the skills to recruit and properly manage employees. Remember that we are trying to motivate people. 
  • • Be mindful of reimbursement, coding, billing, and payments. Someone with real knowledge in this area is a must, as is keeping staff members updated on current changes. Do not rely on the vendors for this information. 

Step No. 3: Maintain positive employee relations.

  • • Hire for success, not to “fill a position.” The interview process is important, and it flourishes only if there is a process in place. Remember that hiring the wrong person results in lost money and can lower employee morale and performance.  
  • • Employee education and training is a must. This is not only effective for retaining employees, but it accomplishes better patient outcomes, patient satisfaction, and clinic recognition. These three elements increase word-of-mouth marketing and can present possible candidates to fill empty positions. Provide staff members with available resources and mentors with strong clinical skills.
  • • Employee accountability only happens if management consistently monitors staff and offers a system of checks and balances. If a procedure is not followed, then it needs to be brought to the employee’s attention (with action followed as needed). Employees who are disengaged and not performing may need to be off-boarded. Coworkers may choose to work harder with an empty position than work with those who are not doing their jobs competently.

•Seek employee input on clinic matters, as sometimes they will have better insight into certain issues. Ask if they need help tackling any barriers and if they have the necessary tools to do their jobs.

Step No. 4: Define clinical practice parameters.

  • • Provide all employees with best-practice guidelines. Policies and procedures should include these tools, along with normal and abnormal testing values with recommended interventions.
  • • Focus on outcomes. This is the clinic’s “scorecard.” How effective is the team in helping patients? Sometimes data will show trends indicating that certain team members may not be following processes.
  • • Review the wound clinic’s caseload, and let others review as well. Sometimes, an extra set of eyes on charts can give a different perspective and can validate if the team is following guidelines.

Step No. 5: Pay attention to the customers/clients. 

  • Request ongoing feedback from patients, referring physicians, vendors, staff members, and other hospital departments. Remember that feedback is only as good as one’s listening skills. Make needed changes based on feedback that carries merit.
  • Do not ignore complaints. Instead, be thankful when someone complains, because doing so allows us to investigate and to have resolution. Miscommunication and/or misunderstanding will be the culprit most times. Remember that an angry customer will tell far more people about their bad experiences than happy customers will share positives. Don’t become defensive when negative feedback is given. Accept that there’s some truth in what customers are saying. Remember that patients/family will sue to find out “what happened” before asking. Taking a proactive approach decreases the potential of a lawsuit and provides an opportunity to educate all parties involved.

Step No. 6: Have marketing plans and goals. 

  • Develop marketing strategies (eg, social media, mass mailings, word of mouth) and test their effectiveness. Are data demonstrating that marketing dollars are being used effectively? 
  • Know the market area. Who are the competitors? Know referral sources and stay abreast of changes.
  • Learn applicable laws.

Step No. 7: Instill a sense of accountability. 

  • Set expectations.
  • Create a culture of accountability by explaining what is expected, and ensure everyone is engaged and committed. Objectively measure performance, provide objective feedback, have consequences imposed when necessary, and follow through with everything that’s communicated in relation to these measures.
  • Remember: work input = work output.

Step No. 8 – Evaluate existence of profits.

  • Determine if the clinic is profitable. A busy clinic does not always correlate with profitability. A clinic director who is knowledgeable on the financial side is critical to the success of any clinic. 


Frank Aviles Jr. is the wound care service line director at Natchitoches (LA) Regional Medical Center; physical therapist/wound care consultant at Louisiana Extended Care Hospital, Natchitoches; wound care and lymphedema instructor at the Academy of Lymphatic Studies, Sebastian, FL; and a physical therapist/wound care consultant at Cane River Therapy Services LLC in Natchitoches.