a sonographer's guide to entrepreneurship

Talking tech

Episode 19: Processes, predictability, and the path to optimal workflow in your business

So many times when we start our business, our focus is on all the obvious things – legal, sales & marketing, getting our first clients. But, if we don’t spend equal time putting together our step by step processes to ensure premium customer service and optimal workflow, we are missing the mark. In this episode our Ops Director, Liz Jefferson, hangs out with me to discuss the ins and outs of creating and implementing strategic process flows in your business.


Grab a seat and a cup of coffee because you just enrolled in Ultrasound Business School. We are obsessed with all things ultrasound and are here to take you on a journey through the messy and the magical side of business ownership. Think marketing, contracts, vendors, admin, growth mindset, and that’s just the tip of the iceberg. This is the Talking Tech Podcast, a sonographer’s guide to entrepreneurship. Here’s your host, Jennifer Lindsey.

Jen (00:31):
All right, guys. I have a special treat again for you for the podcast for today. Liz Jefferson, our operations director at Advanced Imaging, is hanging out with me again today. She is going to go over a ton of amazing information. I’m so excited for this podcast because we kind of bounce ideas off of each other on just different things that she can bring to the table with these. I think having someone who is in the day-to-day specifics of the ultrasound business is so important because these are a lot of details you don’t think about when you’re considering getting started or if you haven’t already started your business. These are some things that can help bring everything together and make things run as optimally as possible. So we are calling this podcast Processes Predictability and the Path to Optimal Workflow. How’s that sound? Hello, Liz.

Liz (01:29):
Hello, Jennifer.

Jen (01:30):
Welcome back.

Liz (01:31):
Thank you.

Jen (01:33):
Well, I’m so excited to have you on today chatting about these things. For those of you who may not have listened to our previous podcast together or maybe are new to the podcast, Liz is me multiple, multiple years ago when we first started our business, I was, of course, doing all the day-to-day stuff and working directly with all of our physician clients and our techs and all of that. And if your goal is to grow past one tech, you need to consider that at some point, you may be hiring someone in administration like Liz is for us, or a virtual assistant or something like that. So we’re going to kind of touch on a lot of the different points today of how to make all these processes as optimal as possible. And then Liz is going to chat about just different things that she does in her day-to-day to make our processes move as smoothly as they can. 

Liz (02:30):

Jen (02:31):
All right, we’ll go through a couple of questions here so you can elaborate and give people an idea of how you put these things together to make things run smoothly. So my first question for you is, how does a set workflow make implementation easy for clients and techs? We’re trying to make things as easy as possible.

Liz (02:51):
Absolutely. And as an aside, when I first started, eight years ago, maybe, I don’t know, it’s been a long time. When I walked in on my first day, there was this beautiful binder, and you were like, okay, have fun. Because I walked in on my first day, we had like a conference thing going on. So I’m sitting at my desk and like, oh my gosh. Like, I don’t know what’s happening. This is my first day; I’m nervous; I want to put my best foot forward. And by the end of the day, you were like, oh my goodness, what have you gotten done? And I was like, I have gotten everything done because this beautiful binder was full of processes that led me through my day. So, queen of processes right here, I’ve learned everything I know from you about processes.

I’m not sure about that, but it makes things so much easier, and I think that’s so much easier. That’s a point we were chatting about before we started recording, was that you know, in the beginning, it makes so much sense to start writing everything down and making these binders, whether it’s in an actual binder or on your computer or wherever you feel most comfortable keeping things. Because if you do end up hiring someone later, it will make that process so much easier. I think that it’s hard for people sometimes when they know in their head what the process is, so they feel like it’s almost a waste of time to write those things down initially. But I think it can make a big difference as your business grows and you start adding more people.

Yes. Because you may never hire an admin person, but most of our students end up hiring additional techs because they want to go on vacation every once in a while. Even if it’s just them, they want to have someone to cover vacation when they’re sick—those types of things. And we have other students whose goal is to build a business that has multiple technologists, multiple machines, and all of that. So the sooner you start writing all of these things down in a processes and procedures handbook, whether on your computer, print it out however you want to, in a notebook. Whatever people like to do makes it easiest. And I’m so glad that you remember that from eight years ago.

Absolutely. And as we’re already off our trajectory, let me also say that we have found some of our processes that we’ve put together and published for our students. Or, in the beginning, before everything was online and our students were coming to us in a different format. We have worked with PACS groups, and we have found our processes published under their name.

That is so true.

Because we took the time to make a process.


Like the layout of a manual that they didn’t take the time to do, so those processes are great.

I actually forgot about that. That’s funny.

Yes. I thought you had.

So we are the queen of processes.

We’re the queens of processes over here.

In the title of our podcast, predictability is so important. And not just because you might bring in new staff, but because the people that you’re serving need to know how you’re serving them. I need to be able to walk into a place where we implement and say, here’s exactly how we’re going to get your patient’s exams to a radiologist and reports back to you. They need to know that every week that’s going to happen so that if something doesn’t happen, they know who to contact. Yep. And they know where that hiccup is, or they know how to get that hiccup fixed.

Yeah. And that’s a really good point to make too. We’re not just talking about the processes behind the scenes, with like the administrative side of your business. We’re also talking about implementing very specific processes for your physician clients so they know exactly what to do, how to do it, and what we need when we come in. And, like you said, exactly what to do if something doesn’t go as planned.

Absolutely. And I think that providing a way for everyone to get from point A to finish is important because if you don’t know the steps to get there, things are going to go willy-nilly. Even with, you know, we start with little kids, right? Okay, here’s your morning checklist. Brush your teeth, make your bed, put your clothes on. We need that as adults; I don’t want to spend all of my mental energy trying to remember how to get images transferred, or if my tech knows how to get images transferred, I need a path. It needs to be clearly marked, and people need to be able to follow it because there are also times when you are throwing in a substitute at a moment’s notice. A substitute admin person, a substitute tech, or you’re coming back down to that admin level, you know, let’s say I’m sick or something, which I don’t know that this has ever happened, but it could happen. Where you know I’m off for an extended period of time, your admin person’s off. You need to be able to jump in; someone needs to be able to jump in so that things happen. And so having those processes and that path lined up. We can then share it with other people and have people jump in and insert themselves where they need to be inserted.


And those step-by-step processes, if you know every step to get where you’re going, even the silly simple steps, then you know exactly how to identify what’s going wrong. What needs tweaked, and what do you need to insert? And if you don’t have the step-by-step stuff, even the small stuff, it’s really easy to overlook something you would assume people would know and understand.

And when that one little thing is off, sometimes you don’t think to ask, did you do this one little thing? Because you assume people know they should have done it or that it would automatically get done. So sometimes, it can take you longer to figure it out.


Then you’re trying to fix something and don’t know exactly where it went awry.

And we do not need dramatic death spirals of breakdown. We need things to just run smoothly. And so a lot of times when we’re talking to our students, we may go back to the very beginning, especially with like machine setup or that kind of thing. Did you do this? Can you send me a screenshot of this? And I can audibly hear the sigh on the other end of the phone. But oftentimes, we get to some little step, like three steps in, and I’ll say, did you do this? And they’ll go, oh no, that’s the problem. And so it’s important that we just have a step-by-step system in place. And everyone understands every step of that system, not just finding flaws in your plan. It’s important to be able to notice where there was a disconnect or a ball was dropped.

So if I have a system laid out in front of me and we are all human. We are all very human. I’m on mistake five this morning; Jennifer’s counting. We can go back through the system and see exactly where that breakdown was, and then we can fix it. And then we can say, here’s what I’m going to do so that that doesn’t happen again. We’ll talk about this a little more later, but those checks and balances of any process are important. Right. And so, having a process allows you to then check, balance, and move forward.

Yep. For sure.

And then I think again, going back to that mental exertion, saving our time and energy, I know that we’re all multitaskers, but that’s a lie. Multitasking is a lie; you’re just sapping your mental energy and have other things to worry about. Jennifer does not need to worry every day that all the images got where they need to go; she has things to do. So having a process in place allows us to quickly be accountable to Jennifer that everything got where it needs to go and allows everything to happen smoothly. And then, if something goes wrong, Jennifer can quickly walk back and say, okay, this is what happened. Let’s work together to fix it. And make it sound like there aren’t more mistakes happening around here than there are.

But these processes really work.

They do. I think that’s the point, though. I mean, that’s how you come up with processes. Look, we started our business at this point 16 years ago. When you start your business without someone helping you, guiding you along the strict, narrow path, you make a lot of mistakes, and most of the time, that’s where your processes and procedures manuals come from. So, I love that what we offer to our clients and students is step-by-step; here are the protocols and procedures; you can customize them to your liking. But these have been made over years and years and years of practice. So I think that makes a good point. It’s not that you are making mistakes all the time, right? It’s that these help you prevent that from actually happening. But when they do, you can quickly go back through and figure out how to make it right.

Absolutely. And it also allows you to assign those specific roles to people. If I know every step of the process. In that case, I can assign the person who is responsible for that role, and then I can let other people see who’s responsible for that role or if it’s automated or, you know, if I know that our PACS system does this piece, and all of a sudden something doesn’t work. I know who to contact, or my tech knows who to contact there. Because that’s where the problem is that they need to work on their process and figure out where the problem is on their end, and I think being able to tell your physician clients exactly who’s doing what is really important to them, too because they know it’s all taken care of. It’s not just like; we got this.

Yeah. Don’t worry. 

You know, being very transparent and formative and saying this is exactly how your stuff’s going to get done. It builds trust from the beginning, and then being able to say this is exactly what happened. And this is how it’s going to be fixed. Or being able to say this is what we need from you because you’re assigned to this piece. So that we can make everything run smoothly, so that’s important stuff. And then again, I am a firm believer that everything needs at least two sets of eyes. I pride myself on being a person who can catch errors and mistakes. But I make as many as I catch. Especially like writing an email or something important, things need two sets of eyes, especially in a process that you take for granted because you do it every day.

Right. So we have an admin person who helps me out, and her job is to touch stuff before me or touch stuff after me. That’s it. So then I can sign off on it. And some of them are like these micro-tasks that you would never want to give to someone, and Jennifer and I are actually working on this. I’m so proud of her because she does not want to burden people. But I’m like, hey buddy, let’s figure out how can we take this little thing off your plate so you can perform better. And also it gives us two sets of eyes on things. So that’s been really an exciting new journey for us.

Jen (14:26):
Yeah. It’s ingrained in Liz and I’s personalities.

Jen (14:30):

I think it’s two things for me. I am a control freak.

Liz (14:35):
Yep. Me too.

Jen (14:37):
Liz and I are basically the same person.

Liz (14:39):
We are. I’m like the hobbit version of Jennifer. We talk about this all the time—the geeky hobbit version.

Jen (14:44):
I love it. Hey, I am a control freak, and I also don’t like to bother people. So it’s like, okay, this is something I can do. And we talk about this all the time. This is something I can do. It’s only going to take me like two minutes to do it. But if I do 10 of those things a day, that’s 20 minutes out of my day. When I can, you know, as the business owner, the person with other responsibilities. If I can say, okay, this is an administrative task; this is something that I need done so that I can do these other things. I have administrative people; I should be asking them to help me do what needs to be done. As Liz said, it gives you a second set of eyes on things to check off your list. So any of you control freaks out there, which, we’re talking to techs, so I’m assuming there are quite a few of you. We all have very similar personalities. We have found over the years, we like things done a certain way.

Liz (15:43):

Jen (15:44):
So if, you know, we want tasks done a certain way, we often feel like we have to do them ourselves.

Liz (15:48):
That’s true. And again, if you like things done a certain way, have processes in place with those certain ways. And then, conversely, and speaking to that, I, on the other end of that, am like, I don’t want to bother Jennifer with anything ever in the history of ever because she is a very busy individual. She’s helping our students, and she’s running a business, and she’s like this mogul of power and industry, and I just, I love you, don’t want to bother you, but I take time every day to be accountable to her. This is what our students need, this is who I’ve talked to, and shoot her a quick overview of what’s happened, and we’ve built that into our process; then she can help me say, oh, did you follow up with so-and-so? Did you do this? And so it’s an accountability thing both ways where we’re taking extra work off of each other, but at the same time, two people are seeing and touching stuff. So everyone knows what’s going on. 

Jen (16:49):
We’ve solved the world’s problems.

Liz (16:50):
We have in point 1.

Jen (16:52):
I know.

Liz (16:53):
That’s it. Sorry, everybody.

Liz (16:54):
It’s been 15 minutes

Jen (16:55):
Around point one. We’ll try to hurry along the next few. This is what happens when Liz and I get together.

Liz (17:01):
That’s why I only come every so often.

Jen (17:03):
Exactly. Bear with us. Alright, are we onto question two?

Liz (17:07):
We are onto question two. Jennifer. We got off the rails.

Jen (17:09):
You all should just expect this by this point. Okay. So moving on, what are some of the procedures we have in place for our business so we can tell people that keep our processes running smoothly?

Liz (17:25):
Absolutely. And a lot of these are things we share with our students too. So we provide them an outline so that they can customize it to their business. But we have service workflows for each of our service models. There’s a service workflow. It comes with a checklist so our techs know what’s happening. That checklist is available to our locations so they know exactly what the tech’s doing when they’re there. And I will tell you that processes sometimes become rote in our heads. And so having that checklist, I can go back and say, oh, I don’t think you’ve been putting your timestamp in the system. Can you do that for me? And so that’s been very helpful to all be accountable but also know that that piece of the process is done. Right. And then we also have processes for cancellations if there’s a service location cancellation. We have a process, and I think you need to understand the difference between policy and process. Because policies punish people, and processes allow you to work with people.

Jen (18:30):
That is a great point, Liz. 

Liz (18:32):
We have a 24-hour cancellation policy, which is the hardest thing to enforce in the world. But when we look at it and say, this is our process. If you haven’t canceled by this time, I’m going to do my best to reach out. But the expectation is that you are responsible for letting us know. And if we show up, our process is that we will show up because we want to provide you with service. Right. And if you don’t have people, then we will just assume that you’re responsible for that amount of time out of our day, and you’ll be billed for it.

Jen (19:05):
So just as a back note to that, in our service agreement with our physician clients, this is the service agreement that our students have access to as well. We have a 24-hour case cancellation policy. So obviously, when we’re scheduling out our physician offices, let’s say we go once a week on Mondays. They are expected to have patients on their schedule every Monday. If, for some reason, we don’t see that schedule on our system, and we see that there are patients there, we assume that they just have not put them on there yet because they have not called to cancel. Now groups don’t usually when you set things up to a patient load, you know when you’re looking at their patient load, you are going to say ahead of time before you close these contracts, we should be here every week.

Liz (19:59):

Jen (20:00):

We should be here twice a week. We should be here twice a month. Whatever that is based on their patient load so that you’re not getting cancellations on a regular basis. But there are times when physicians are out of the office. There are times when you know they need to move things around or whatever that case may be. Our contract has a 24-hour cancellation policy so that they are billed X number of hours if they don’t cancel. So I just wanted to say that as a background to those of you on how our contracts are set up, that explanation makes sense because it is true. It can’t be something where we are consistently contacting our groups all the time for all the things they’re supposed to be doing. We are going to go along with our procedures and policies.

Liz (20:46):

Jen (20:47):
That’s how that works.

Liz (20:48):
And that procedure was actually put in place because we were finding that we would close out service for someone. So that they could save money, and then they would have patients, exactly like you said, nine times out of ten, they really do have patients because you’ve already determined all of that. So we developed a procedure, and then when we communicated that procedure to our locations, it eased their sense of peace of mind about those service days. Because, again, they don’t want to pay extra money, but worse than paying extra money is not having a tech show up. So that was kind of a procedure we put on the backend that when we communicated it over and above our policy, helped create a better relationship when it came to that piece of our contract.

Jen (21:45):
Because that’s the point is providing great customer service to our locations. And so, as Liz said, if you’ve got a policy in place, but you have procedures on the back end that make your clients comfortable with that policy. A way for you to work with them if something comes up that’s providing great customer service and the best way to do business is to provide amazing customer service so that when you get this contract, you have it for years and years and years because you are just easy to work with. You provide a great service, and when something happens like that, you know, when these policies are infringed upon or those types of things, when you have a process on the back end to help walk people through that. People appreciate that. Rather than just saying, well, you did this, we’re not doing this. It just makes a lot better relationship.

Liz (22:33):
Absolutely. For sure. And cancellation policies within your service day as well. When a sonographer goes to a service place and does not tell them what our cancellation policies are for their patients, we are flexible and always work with our locations within our timeframe and to the best of our ability. And that it’s always better to fit that patient in and be a little bit behind and say, hey, next location, we’re running a few minutes behind because of service to this other location that’s going to keep everyone happy, including the patient. If you don’t communicate that to the tech who’s coming in, they’re going to try to stick to their schedule, and they’re going to say no. And when you say no at a referring physician’s place, it’s not your tech saying no; it’s your business saying no, and that creates walls and barriers that can lead to service cancellations. 

Jen (23:30):
Yep. Absolutely. That is so true. It needs to be every single person on the same page within your company understanding what your processes are.

Liz (23:39):
Having a process makes that possible. So we also have like little these micro-processes; if I don’t have enough gloves on hand, my techs are going to let me hear about it, so we have a supply process. I know that our lead tech goes in, looks at the closet, marks a little reorder sheet, and puts it on my desk. And I know that if that doesn’t happen, and he knows if that doesn’t happen, he’s probably not going to have gloves. So having that expectation and process keeps us from running out of things we desperately need. Then also having an image transfer and report delivery workflow like that is a given, obviously. But that’s where you need to have those minute details every step of the way. Then we also do reporting workflows.

So Jennifer knows at the end of the month that she can expect certain reports, usually in a certain order. And if those reports haven’t come in by a certain day, Jennifer knows that she should check back. So having a report workflow, a report procedure in place, number one, it allows us to have multiple people working on those reports. A lot of times, one report builds off of another. So I know that I need to do my radiology report before I can finish my complete overview report. And if I don’t do stuff in that order, it gives me a lot of heartache on the backend. Putting those little workflows into place allows your admin staff to get their jobs done like clockwork as well.

Jen (25:18):
And I’ll just make mention of this too, just as a side note to that, Liz is able to pull off, well, all of us, but I never remember how to do it. See processes; I need to look at processes, Liz’s list. But there are easy ways in the PACS system that we use, and it’s the same one that we give access to on our student vendor list. It is like our hub. We love this thing. We can pull so many different reports off. So Liz isn’t just talking about like interpretation reports for the exams?

Liz (25:49):

Jen (25:49):
She’s talking about we can pull off radiology reports that show us turnaround times. Yes. So that we can review that on a regular basis to say, Hey, you know, we had been getting X number of hours as a turnaround, and now we’re getting this. Or you know, gosh, this looks like it’s been a little bit delayed as, yes, as far as, you know, opposed to last month or whatever it might be. It’s cool because we can have an overview, kind of a bird’s eye view of our business. I think this is especially true for, you know, you sonographers that are the business owner, and you don’t have an admin person yet because you’re in it every single day. Yes. In the minute details. It’s so nice to have an overview. So Liz will pull different reports for me each month so that we can invoice our clients.

Yes. So it would be scheduled hours that we were at the group for that past month so that we can put an invoice together—just different types of reports that allow us to look at an overview. We can also pull reports on different types of exams ordered by each of our client offices and physician client offices. So we can see if that number’s going up or down—just a nice way to really look at your business as a whole. However, you decide to pull those different types of reports each month or quarter. But obviously, you would want to pull the invoicing report monthly to see what to invoice your clients. But it’s really nice for us to be able to have that easily on hand. We don’t have to keep track of it; it’s just reporting. We can pull straight off that.

Liz (27:17):
Yes, yes. It is made life so much easier. It’s just a game-changer.

Jen (27:21):
It is. I love having that.

Liz (27:23):
And then, we also have our in-office patient workflows. Some people will have their own, you know, our service model is often to go out to other businesses. For us, because we’ve been around so long and we have this beautiful office. We’ve incorporated an exam room. And so we’re able, we are able to see patients here, and that looks different than when we see patients somewhere else. And before we recognized that it looked different, things got a little hairy because our techs do a lot of the checking in, checking out, and all of that. And so having that process in place helps them know what to expect. And I did want to go back really quick just as an example of why processes are important and why the step-by-step is important. So we have multiple radiology groups we use. We have some that invoice us at the end of the month. And we have one great resource where we pay ahead of time. We load this little wallet, and they read our exams, and they shoot them over. But we don’t load thousands of dollars onto this account. We load them based on our normal patient load.

So when we don’t load that, our reports don’t turn around right away because they have sent us a message and say, hey. So I just regularly update that. But with the way that numbers fluctuated for everyone, the last couple of months, we had been putting a little less in, well things are on the uptick the last month. And so Jennifer, at least twice, has had to email me and say, Hey, I got this notice. Get it together, Liz. And so, I have amended my processes; there you go, Jennifer; I’m being accountable to you instead of just checking that on Fridays; that’s part of our admin process twice a week now. Just so that we make sure that we have that wallet full. And now I don’t have to email you about that little tidbit; we’ve shared it with the podcast.

Jen (29:27):
We shared it with the world. That’s why I everyone Yeah. That is awesome. And, I will say that’s another thing I think has been such a benefit for this PACS, too, because we use multiple radiology groups. Yes. Cause we have a lot of physician clients, and some of them want to use this group, and some of them want to use that group. And so having that hub again where all of our techs only need to learn one PACS. Yes. We only need to learn one PACS. Yes. And then we can push it straight out from there has been so nice. Plus, then all of our reporting, any of those reports we can pull, comes from just one place, which is really nice.  I mean goodness because when we first started doing mobile, I mean over a decade ago, we had to save stuff down on CDs, and I would drive it to a radiologist that was local.

Liz (30:16):
Oh, the good old days.

Jen (30:16):
Guys like the amazing fact that we can just put it in a computer now.

Liz (30:21):
It’s magical. And we’ve converted clients, some of our students who were doing that. And we say there’s this PACS, and they’re like; I don’t have to drive it anymore. Nope. We’re good.

Jen (30:31):
No, it’s 2020.

Liz (30:32):
2020 is the year you’re driving nowhere.

Jen (30:36):
Oh my gosh. That’s so perfect. We’ll talk a little bit; we’ve touched on this in our in just little tidbits of the other questions we’ve already asked. But tell us again why workflows are so important—just kind of in those, you know, in a few sentences.

Liz (30:53):

Jen (30:54):
Here is the reason why we really need to have these.

Liz (30:56):
Yes. And just circling back around to correct ways to do stuff. There are lots of them getting from point A to Z. There are lots of ways to do that. Having one standard saves everyone time. We also want to make sure that we’re being accountable. That’s an accountability mechanism for everyone on every side. And then there’s also that if then factor. So being able to mitigate what if something goes wrong, building that into your process. What does the tech do if the patient cancels but then shows up 20 minutes late? So being able to give them solutions reduces stress on your staff. It reduces stress on your referring physicians. And it also reduces stress on your patients. Yes. Because they should not have to deal with any of that.

Jen (31:49):
No. And I will say, I think we talked about this particular client; you’ll know exactly what I’m talking about. I just have to say this first. 99.9% of our physician-client offices are lovely and easy

Liz (32:02):
To work with.

Jen (32:03):
Lovely. We have a couple that give us gray hairs.

Liz (32:08):
A little bit

Jen (32:10):
But the fact that we have processes in place help keep us from having an entire head of gray hair. For example, we have an entire process where we ensure, even though this is an automatic setup from our PACS, we love the fact that when we bring on a new physician account, we can tell our PACS this particular group wants all of their reports emailed to this email address. So as soon as the radiologist hits finalize on their report, it is shot out to them via email. And then Liz has in her processes multiple days a week that she looks at our PACS system to ensure that that actually happened. Because we all know technology is supposed to do what it’s supposed to do. But there are always times where there may be a glitch, something doesn’t go through correctly, etc. Well, we have a particular client that likes to call very panicky.

Liz (33:10):
Very panicky.

Jen (33:10):
She doesn’t get any of her reports ever.

Liz (33:13):
Ever. None.

Jen (33:14):
If we didn’t have processes in place, that would give us an immediate heart attack.

Liz (33:19):

Jen (33:20):
Because we would assume that she never, ever, ever gets her reports.

Jen (33:24):
But because we double check, we can see that it was finalized and sent, and the send was successful.

Liz (33:33):

Jen (33:34):
We understand that. Likely they didn’t look at their fax. I think this person gets faxes.

Liz (33:41):

Jen (33:42):
We can assume that they didn’t check their fax.

Liz (33:45):

Jen (33:45):
Or something happened on their end. So, of course, we don’t say that to them. What we say to them is, please let us know which ones you need, and we will resend them. But on our end, I’m saying that we have a process in place to ensure that when that call comes in, we know that our processes have worked. And that things have actually gotten there. They just likely haven’t looked for them in the right place, or something has happened on that end. So I always like to say that because I think that is so important because you want to provide that amazing customer service. And if you don’t have a process to do, let me double-check to make sure my reports went to our office. And if you haven’t done that for two weeks since and an office calls panicking. And her reports actually didn’t get there.

Jen (34:36):
So my point to that is having those processes, I think, is so important. And I think that’s; those little things are things that can turn into big things. When you get into business, you don’t think about all these little things on the backend, and you likely wouldn’t think because the system is supposed to send it. And it’s supposed to be automatic. You would assume that that’s just happening. But what if it isn’t, and you did not check? So I just had to use that as another example. We have all kinds of examples.

Liz (35:05):
All kinds of great examples.

Jen (35:07):
This is the great thing about us also running our own mobile ultrasound business. Because we don’t just teach our students there how to do it. We deal with this stuff every single day ourselves.

Liz (35:17):
Absolutely. Absolutely.

Jen (35:19):
Okay, Liz, so tell us a little bit about how are techs out there listening should start putting these workflows in place when they should be doing that and all of those types of things.

Liz (35:31):
So Jennifer mentioned this at the beginning, but start at the beginning. Until you have your first staff member or someone, you’re partnering with on some level. Put everything you can in place when you start working with a radiology group, and write down every step they require of you so that you have that in your processes. Write all of that down the first time you pull a report or make a report. And it seems like it’s taking work on the front end, but if you wait and do it later, you will be overwhelmed. And you don’t need to be overwhelmed; you have a job to do. We talked about this a little bit in our admin podcast; go back and reference that if you haven’t seen that, but you are creating these building blocks that are going to make your life so much easier.

And so starting at the beginning and writing it all down, even the things that seem silly, this sounds awful, but the first time that we have someone set up their system, when a student gets their new system, and they’re so excited, and I have a list and on that list is plug your system in. Because if you don’t plug your system in, if you don’t insert each side of the plug into the, because it’s like the power pack and then it plugs in and there’s a plug here if you don’t plug everything in, you are going to panic before you even start. And that’s no good for anyone. Then that takes more time for you. It takes more time for us; we don’t need to do that.

Jen (37:10):
It sounds silly, but multiple times this has happened.

Liz (37:13):
Yes, exactly. So we want to make sure that any system we put in place has all of the steps there.

Jen (37:22):
Not just ones we think are obvious.

Liz (37:25):
All the steps because, and not just because people need those steps at the beginning, but because again, going back to you have this tech, they’ve worked for you for 20 years, everything’s written down. It’s really easy to miss a simple step. And once you’ve missed it, if you’re not being accountable to that.

Jen (37:42):
You’ll have something to look back to.

Liz (37:44):
And then a year later, you’re like, I’ve never done that. What are you doing? Well, this is how I’ve always done it. So it’s an accountability thing. So start at the beginning. And so you’re going to write stuff out, and then as you need to share that with other people, we advise that you start using pictures and videos. There are all kinds of programs where you can record if it’s on the computer; you can record what you’re doing on your screen. To show them that whenever we start a new location when we work with our students, we send them information with screenshots of exactly what their system should look like. What their computer should look like so that they know that they’re doing the right thing.

Jen (38:30):
Liz and I were chit-chatting earlier about her kiddos. They are E-learning because they can’t go to school. So we were talking about having these processes in place and the way that everybody learns differently. So we were laughing about everyone; everyone learns differently. And so you can’t always just do one way of learning. You can’t just write everything down in words because some people need that visual image to correlate to. So I think that makes such a good point, is that sometimes this seems like you’re overdoing it almost, you’re not.

Liz (39:09):

Jen (39:10):
I love personally to read something and then be able to see a picture. Liz mentioned earlier a lot of the teachers are doing a lot of videos. And she had a 16-minute video she had to watch on setting up her son’s iPad for school. But she doesn’t want to watch a 16-minute video. She wants to look at it in words so she can quickly go through it with her eyes and see, oh, okay. This would’ve taken me 30 seconds to figure out my one question, but I had to watch a 16-minute video. So everybody is different. So if you do things where it’s, you know, it’s set up where you have screenshots, where you have different things for them to be able to learn with, it’s much easier for people because everyone views things differently.

Liz (39:57):
Process-wise, anecdotally, as far as Advanced Imaging goes, when we first started with our PACS, we were like on the ground floor. And they were developing things that we suggested we’re pretty much rock stars here. It was great. It was. But they would set up a call anytime they had a new process. We would block out 45 minutes of our afternoon, find time to schedule, and sit down for this call; then we would go over things, and Jennifer and I would be muting ourselves and going, oh my gosh, let’s just move on to the next step. Because, again, we’re process people where we want to see it; we want to see the words and get it done. So you’ll notice, as you learn with us, that we often provide you with the words.

But when you set up your system, the first thing I’m going to do is send you, Hey, here are directions. Get these pieces in place, and then let me know when you’re ready. Like, explore the world out of our PACS. Yeah. And then you let me know when you’re ready. And that also helps when you’re working with vendors because you can say, well, my machine’s set up, so we can skip that piece. Because you’ve already got those things done. So having those processes in place not only helps you keep things going but it helps you save time on the front end when you’re working with new people.

Jen (41:24):
Absolutely. Yes.

Liz (41:25):
So, make sure you are not the only one developing your processes. If you are the only one working on them, that’s one thing. Yes. But if you are developing processes for people working that process for you, please understand that sometimes we think we’re being helpful by making things more efficient. And that’s not always true. Like, think about your first part-time job, and they were like, we are going to be, the corporate was like, we’re going to be efficient. And you know, you’re like, that is the dumbest thing I’ve ever heard. And it’s not because people are trying to mandate all of these changes. It’s because people are; they pay people lots of money to come in and create these systems. But if you’re not working the system, then you don’t know what will work best for you.

Jen (42:16):
I think techs can probably relate to this if they’ve worked for a hospital.

Liz (42:20):
I didn’t want to call out all the other hospitals, but yeah.

Jen (42:25):
No, and it is what it is. Hospitals, just like any other corporation, you have, you know, administrative people that are coming up with all these processes and procedures. But it doesn’t always correlate to the people doing them, as you’re saying. So I think what’s wonderful about owning your own business and then employing your own staff is that you can say these are the processes. Let’s say you’re the tech; you’ve worked your business for X amount of months, years, whatever it is. Before you bring on someone else, you can say, these are my procedures. This is the end result we need from them.

Liz (42:59):

Jen (43:00):
Go through these with me, and if there’s absolutely a better way that you like doing it, let’s create your workflow specific to you. But let’s have that written out as well. Yes. So that this is your specific workflow, and it may be altered a smidge from mine. Right. But that way, you have someone, you know, setting it up. The way that they need to with the end result in mind. Yes. I mean, because we did that when you came on with us. 

Liz (43:29):
We said, here is this magical manual, the protocols and procedures for Advanced Imaging. 

Jen (43:31):
If you want to change them up, have at it. Let’s figure out the most efficient way for you to get the desired result. I think that’s super important.

Liz (43:44):
Absolutely. And I’m going to pause it. Just put this out into the universe that oftentimes, when you work for a hospital or a bigger location, the reason that policies or processes become so restrictive is because they didn’t start out as processes. They were policies put in place because someone did something really wrong. So then they had to mandate this to avoid that. And no one ever wrote down exactly how something should be from the beginning, from the ground up. So instead of getting a workflow, you get a rule. And so if you start from the beginning with workflows, you’re going to have a lot less rules. Everyone’s going to feel a little better. Right. We have no rules here. It’s willy-nilly. I’m kidding. Once you start creating those, and they don’t have to be perfect.

Right. This is trial and error; we’re going to get it done. But you need to keep those in a space where it’s a manual that you can edit. That you can change, and then you need to have a manual or whatever you want to call it that you can publish as well. For each one of your workflows. So we had a hard copy manual, but then we had everything on the computer. Now it’s mostly paperless. Just because of how we work. But I still have this cool carousel thing with cheat sheets and certain workflows. So we, you know, make sure you have a space where you’re storing the editable drafts of your manual and then a published list of your workflow so that people who need to see that process can see it. 

Then make sure after you’ve gotten people’s input and before you implement this workflow as ta-da, we’re ready to go, that you try it out because the silliest things can go wrong. That, in theory, you’re like, da, da da, this is perfect. And then you go to a location, and someone calls, and they’re like, it’s not working. Well, did you try that before? Did you make sure that that process really works? So that’s, it’s easy, but we often overlook it because we’re rushed, and we want to get it done. So always try your stuff out, and again, that’s that second pair of eyes. You’re revisiting it. And then, that’s pretty much how I would get started. If you update procedures, especially on a file you’re sending back to people, make sure you write when you revised that. So that you can reference to people, okay, the 2020 and June 2020 revisions were just sent to you. Please use that. So when they come back to you and say, this isn’t working, you can say, okay, before we even get started, make sure you have the right copy. I want to make sure you have that. So that’s important.

Jen (46:37):
That is a great point. Okay. We’ve gone off the rails again.

Jen (46:43):
But I think we gave a lot of wonderful information because, as I talk about a lot, when you are first starting your business or if you’ve already started and you’re kind of in the beginning kind of throws of getting everything together, you are worried about getting started. Getting clients, sales, and marketing.

hat’s what your mind is wrapped around. And if you don’t consider that once you get these accounts, how to provide the best implementation and customer service. AKA, backend processes that are going to make things run as smoothly as possible. Your mind isn’t wrapped around all of the things that it needs to be wrapped around. So I think these types of podcasts and this type of information is so important for people. It really allows them to realize what they need to put in place to keep those contracts long-term. So let’s wrap it up with just some takeaways from today.

Liz (47:41):
Let me just say, and this is kind of the first takeaway. All of your processes should include checks and balances. And when you are partnering with another group to create a process, for example, like billing or radiology. Understand that they probably don’t have a process in place. They just don’t; they have the basics in place. So you’re going to have to help them understand exactly how you’re going to do things right. And make sure that you know what they need from you so that you can spell it out and everyone knows what needs to happen. Automate what you can, but always make sure you add that human touch to anything you’re doing as checks and balances. Make sure that everyone involved knows what’s going on and feels comfortable coming to you to say, this isn’t working; let’s change it. And then lastly, I would say make sure everything is documented and whittle it down so that it’s easy. Don’t get rid of the important steps, but don’t make it this huge grand plan. Make it what it needs to be to get the job done. Get rid of the flourishes, get rid of the bows and everything. No fluff; we don’t need fluff. We’re fluffy enough without that.

Jen (48:58):
I love it. Liz, thank you so much.

Jen (49:02):
Such wonderful information. I hope that everyone took away a lot of the details they need regarding the administrative processes and backend stuff so they can provide the best service without pulling their hair out.

Liz (49:19):
May you all be a little less gray.

Jen (49:22):

You go. I love it. Thank you again, Liz. All right, everybody. Until next time, we’ll be over here cheering on.

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your strategy-obsessed ultrasound business coach.

I'm Jennifer -

Welcome to the Talking Tech podcast, where we answer your questions about legal, marketing, admin, sales, and so much more. After nearly 20 years in the industry running our own mobile ultrasound business and helping techs across the country do the same, I'm so excited to bring you industry insight, mindset, productivity, business tips, and inspiration to help you design the business of your dreams.

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