From Doctor to Impactful Leader: Scaling Your Practice

Introduction to Brant Lacey and the Topic 0:00

Everyone. I have someone really special, with me today. That's Brant Lacey. That's Brant Lacey, who's a gastroenterologist. He's here in Texas with me. He's passionate about not just his patients, but also about guiding physicians, succeed with business and personal finances. And, you know, as a physician, he really understands how overwhelming can be to really step out of clinical a career into a career that, we've just just trained for. But we also have lack of training and personal finances, and it can be just absolutely overwhelming, to go into this world.

And so, out came the scope of practice, podcast and website, which is actually how I found that two ways you have to listen to one of those podcasts. So I have them on. And today I want to cover my favorite topic, because this is the one thing that really allow me to do the things that I really want to do and decrease in tremendous amount of burnout, which is leadership skills and team building. So, Doctor Lacey, thanks for coming on tonight. Sharing is going to be awesome. I mean, what a what a great topic for a summit like this, because, I mean, as much technology as you may have, as many things as you have to automate the process and simplify your life.

If you don't have a good team behind you, if you don't have a good culture, if you don't have a good organizational concept, then none of it's going to matter. So this is a great, great topic for us to be talking about. Yeah. So, you know, I was talking to, one of my friends who's actually an office manager, and I was asking, you know, hey, how's your how's your, like, company culture over there? And he's like, well, we're mostly Hispanic. And, like, that is what I'm talking about. But let's let's, I want to start with culture and then jump into leadership because I think they kind of go hand in hand.

But that's doctor. Let's see. Let's define a what do you think company culture is. What is the culture. So it's it's going to be a different framework for everyone. But the basic concept of the culture is what is the the general feel of the organization it encompasses what's what's the mood, what's the what's the standard interpersonal dynamics? What's the typical relationship? What's you know, what is your extracurricular activities. And so it encompasses a wide variety of things. So it's you know, how do the staff interact with each other?

What what kinds of values do you share? What kinds of things do you celebrate? What for? What activities and what character traits and what work related accomplishments do people get promoted? It's the things that you choose as an organization to inculcate in all of your members, and then celebrate when you see those those values and those character traits and those qualities exhibited by your members? Absolutely. I think company culture, is a, it's a make or break. I think that it starts with leadership.

It ends with, every person that is part of the company. And so, in company culture, developing a really core company culture is not easy. Especially, in the medical climate, medical community. And there's such a huge turnover in employees, and, and that turnover,

Defining Company Culture 3:30

can detriment a company culture if the leadership allows it. Right. And so my definition of company culture is, just, as you said, is the feeling in the company. But it's also the direction, the unifying body and the direction that's required, for a company to move as a unit. But at the same time, you want everyone to be all in. So I like to call, sort of the all in culture, because that translates to how we speak to patients and how we speak to each other, to each other, doctors and stuff like that.

And so but this is and this is a fabulous topic. But let's talk about, company culture and how to get to where we wanted to get to. So what do you think are some of the core components of building that good team and a good culture? So it's it starts, I think, with hiring the right people. You have to have the right team. And so there's, there's a saying in, the culinary arts. And so if you're a chef, you'll, you know, people, you'll hear people say things like, you can't make a good meal if you don't cook with the right food.

And so if you don't have good ingredients, if you don't have, you know, good meat, good vegetables, good spices, you're not going to be able to produce anything of value and quality, no matter how much training you have and how many stars you have behind your restaurant, you need to have the right people in your organization. So one of the books, that or two of the books that I recommend people read if they're going to be in business or if they're going to be in leadership, are both by a guy named Jim Collins once called Good to Great.

The other one is called Built Celeste. And in those books he describes a series of very important concepts for any business leader. And one of the things that he talks about is the idea of getting the right people on the bus, the bus being an analogy for your company. So you have your company like this, like a bus, and you're trying to take it from point A to point B, so you need the right people on the bus. You need the right people in the right seats on the bus, and you need the wrong people off the bus.

And so that all starts with the hiring process. So you want to have good people on your team. You want to have them doing the roles that they were meant for, like roles that are that actually utilize and showcase their unique talents and gifts in a way that is beneficial for the organization. And you have to get rid of the people that are dragging the culture down. So bring in the good people, get them doing the right thing, and then get rid of the ones you know that are not that are not meeting it.

And then I think the second thing that you have to do is you start from day one with your onboarding process. And as I'm saying this, I guarantee you that between a third and two thirds of the people listening are saying, I don't think we have an onboarding process for our team members. And especially if you're in a small practice, it's very normal, you know, so maybe you have maybe your your onboarding process, maybe as simple as the office manager's going to take them to their desk and show them, here's your phone, here's how you dial.

Here's how you dial for an outside line. Good luck. Right. That's very, very common. But I think it's very important if you're going a that's like residency man. Oh straight up. Yeah. And so I think it's very important if you're going to have a culture that is permeating throughout the organization that is that is a positive influence on your company's direction. You have to start by by really instilling those values and coaching people as they are coming on to your team. And then I think the third piece of it is that is, is this a consistent daily grind and a consistent weekly staff meeting?

So consistent monthly celebrations, however you want to do it. But consistently recognizing the cultural values that your team members, your employees exhibit, and then celebrating those and promoting those and being excited about those you know, at your weekly staff meeting. It's like, you know, one of our company values is, relentless optimism. And here's how I saw Susan show that this week. And we're celebrating Susan, but we're also celebrating the values. So you got to get the right people.

You got to get them doing the right job. You got to start instilling those values, those cultural values when they onboard. And then you got to keep promoting those. And imbibing those on a daily, weekly, monthly basis. That consistency is going to be really key. You know, that's hard. And I think it's part of the reason it's hard because that's not how we were chiseled out of a rock in residency and fellowship. Right. And I think that, you know, culture is not really talked about in medical training.

It's it's very much of a hierarchal approach. But in business, it's not necessarily like that. And if you try to treat a business more like an educational institution, it can potentially fail in a not so great way. And so, you know, we talk about, you know, having the good ingredients, getting the good people in. Right. Like what is good? Like, how do you know what's good? Like what is your definition of good. Like, is there like is it do you do you particularly have a screening process for people on your staff?

Yeah, absolutely. It's a great question. So there's there's two basic ideas that I think you can select for when you're trying to hire somebody you can hire somebody for is a fit of their skill set. And then you can hire them for a cultural fit. Okay. So for example, so let's say let's say that I'm so I'm a gastroenterologist. So let's say I'm looking to hire a new junior employee.

Hiring for Fit and the Ideal Team Player 9:00

So I'm interested in someone who is proficient in colonoscopy, proficient in upper endoscopy, maybe proficient in RCP and is a good clinician good diagnostician okay. And so I'm talking to their residency directors. I'm talking to people who know them. Maybe I had them moonlight with me, but I'm trying to get some kind of sense of if they are a fit from a skill set perspective, that's one thing. And so from a physician standpoint, you do have to have that. But for your employees, that skill set fit is much less important than the cultural fit.

Okay. If I had to pick only one that I could get a fit for, I want the cultural fit because I can train anybody to do almost any job if they're reasonably motivated. So. So you want some people that you want people to come in with a reasonable amount of skills, and then you coach them and you train them to hone their skills, but you can't train lazy out of somebody. You can't train apathy out of someone. Not very easily. You can't train dishonesty out of someone. So you need to hire for those cultural values that matter to your organization, and then you can coach the rest.

And so the framework that I use for hiring people for a cultural fit, it's actually very simple. It's based on another book that I really love called The Ideal Team Player by a guy named Patrick Lynch, zoning. And he posits, and I think he's really right about this, that the ideal team player, the person that you want on your team has three characteristics. Okay. So number one, they're humble. The humble team member is going to be someone who is constantly looking to build up other people in the team.

They're constantly looking to give other people credit to show excellence on the part of their team members. So that's the person who's humble. They're not they're not all out for themselves or not out for glory. The second characteristic is that they are hungry is the term that he uses. And what he means by hungry is that they're never satisfied with just good enough. They're always looking. How can I be 5% better? How could this be 8% safer? How can we do this in three minutes? Fewer per, you know, per action.

So they're always looking to make something better. And then the third, characteristic is, people smart. And so like a high emotional quotient or high IQ, that kind of thing. So you want someone who's good at recognizing social cues. They're good at interpersonal dynamics. They're good at communication. You know, they're good at, integrating. Well into the general milieu of the team. Okay. So that's the ideal team player. So those are the kinds of things that I'm looking for. If I'm hiring somebody.

And it's really hard to know even just, you know, when you first interview people because people may seem very different within an interview. But do you have sort of like a timeline or a process, where they're like, you know, what would a do a trial period for a month or three weeks or three months, whichever. And then there's a review after that. How do you assess that? Okay. I love that you asked this question. This is critical in almost every company I've ever worked with. Almost every physician team that I've ever coached doesn't do this very well.

Okay. The normal business hiring process is an interview. Two interviews, you know, calling the references. It's very simple. All right. And as you're pointing out here, you know, the I think the question that you're getting too is, yeah. How can you really get a gauge of who someone is in two 30 minute interviews? And the obvious answer is you can't. It's impossible because anybody can fake being a nice person for 30 minutes, right? If they can't, they're specific and you'll easily get them out.

But but almost anybody can fake being a nice person and say the right things in an interview, but it becomes a lot harder the more time you spend with people. And so what I generally advise people is that you need to have a longer hiring process, and it needs to be more complex. And so, just like you pointed out earlier, employee turnover is incredibly costly in terms of time, and it's incredibly costly in terms of just money expense. So employee turnover, if you can minimize that on the back end and get your employee turnover rate from 18% a year, down to 4% a year, and then you put all that time into hiring the right people.

So you're not turning people over as often. You'll have better culture, you'll have fewer expenses, you'll have less, you'll have more time saved. And it's absolutely amazing. So what I usually recommend is increase the number of interviews and change up the format. So and I've seen lots of people get very creative with this. So for example, I've, I knew one company that they always included as part of their interviewing process a trip somewhere. And maybe it was, you know, going out shopping, you know, just or just going out to the mall and just kind of hanging out, or maybe it's going to a baseball game under the guise of like, hey, be which 1 to 1? And, Danny, we want to we want to show you who we are.

But really what you're doing is you're observing, you're gauging who they are. So because if you go out to a restaurant with somebody, a person who's rude to a waiter, you know, or who you know laughs when a waiter drops a dish or something like that. I mean, if that's if that's who they are, when they're when they're, they think they're not being watched. It's definitely who they're going to be when they come into your company. So I think that's a really cool idea. Another, another one that I've seen that I think is really interesting is where a leader and, their spouse will go out to dinner with the applicant and their spouse.

And so, you know, how does the interviewee treat their spouse? Do they hold the door open for them? Are they speaking about them with respect, or are they constantly talking over them and running over them in conversation? Does it is it apparent that they, you know, are that they are a good dynamic? You know, you know, in a good dynamic relationship. And so the way that they interact with their spouse can be very telling. So those are, ideas that you can do. And I love the idea of the probationary period.

I'm a big fan of that. And so my general advice to folks is have a probationary period. And I recommend 90 days. So work that into your contract where you can say either the employee or the employer can choose to terminate the employment contract without cause within 90 days. Because if you give people a long enough period, they will let down their guard and they will show you who you are, who they are, so they can maybe fake it for a week or two weeks, or maybe a month. But it's really hard to fake who you really are for 90 days.

And so if they make it through that 90 day period, then they're going to be pretty solid. That is a great, great idea. I love the probationary period concept. And you know, for those people listening like, why are we talking about this? And I upgrade something. And one of the reasons is because we can use technology all we want. But what to do with the information is so important, and a lot of that has to do with leadership and company culture. So, you know, I think that when we hire humans and humans are just naturally inconsistent, none of us are going to be 100, point 0%.

Right? The really good ones are maybe 95%, but there's always going to be 5% of something that's dropped. And with technology, if it's built right, you can overcome a lot of those processes by being, you know, ten out of ten, 100% on some of the smaller processes. But using, you know, technology in AI and using all that data requires a very strong culture and a very strong team. And so, you know, with that note, I think that, I want to talk about things that no one likes to talk about, which is this is what I see, when a lot of, clinical practices and then you just tell me if that's sort of the same thing that you've seen, you have a leader, whether that could be the physician or the office manager, whoever it is, you have a leader in these starts and what you notice is a pattern.

They start hiring people who are just like them. And so if they're, one personality, and there are other people are very similar personality, a lot of things gets missed. And so, over time, if you have a lot of similar personalities within the company, in my experience, a lot of things can get dropped. And I'll give you an example. So, you know, we use this profile, the risk profile, to profile all our employees and myself. And within this profile, I'm someone who's relatively influential, but I'm very like, big picture and not too detail oriented, and I get a lot of, like, ad like, like symptoms, right?

When I, when I look at certain projects. And then so, I, I notice that I tend to gravitate towards other people who are very similar because it kind of hypes me up. But then it just accentuates my weaknesses, I believe. But then I started, looking at my other employees who have different aspects and people who are basically put me in check, and that really helped me out. And so, but I think the the problem is that a lot of this is subconscious thoughts that you subconsciously attracted to, hiring people that are that are a lot like you.

So tell me your experience, and what that dynamic looks like. Yeah. So you've hit on a really important point here when you're when you're in the hiring process, and this is part of what we were talking about a second ago remake or deliberately making the hiring process more complex. It is critically important to get different people with different personalities interacting with those candidates, because they're going to pick up stuff that you want. So you mentioned the risk profile, and I'm a big fan of Desc.

Probation, Feedback, and Managing Underperformance 18:30

I think it's a great, a great tool. Desc is great. The, the fascination advantage is a great tool. You know, Strengthsfinder is a good tool. Myers-Briggs is okay, but not really, you know, as widely applicable, I think, in the hiring process. But any one of those tools and, you know, so I'm a on the desk profiler on the high ass. Right? So I'm going to be I'm very people oriented. I'm very outgoing. Like, I like everybody to be included. I want to get the group together, motivate, that kind of thing.

But, you know, someone who is, really high C is going to be maybe more detail oriented. And so, it's very helpful to have different perspectives from different people, because I may feel like a guy that I'm hiring is, is kind of abrasive and kind of brash, and I just, I'm not getting a good vibe from him. But then someone comes along behind me, you introduce them and they're a high ID, and they go, oh, this guy really gets it. He's got he's got a really good head for, for for big picture. He's got a really good concept for strategic thinking.

And so then we start to integrate all these different perspectives and see okay we're painting a picture right. It's like putting together a jigsaw puzzle or a patchwork quilt. You're putting all these different items together and saying, okay, so, so painting a picture of this person, you know, what are some of their strengths? What are some of the areas that we need to, you know, pay attention to as potential shortcomings or potential places where there's going to create conflict or friction among the the other team members, or with people that are leading people who are leading them.

And so you start to recognize some of those things and pay attention to everybody's perspective, and that becomes hugely helpful. So, yes, getting people of different, perspectives in on a hiring process and on the onboarding process and continually, assessing the culture of the organization is absolutely critical. And I think that also comes from like a very strong leadership. Right. You know, I think that, one of the things that I learned, a little bit later on in private practice, is to establish a sort of set of core values, within the company and adhere to those core values.

And I think that, most people have a, generally a pretty good intention, but a lot of times the core values of a company, over medical practice, can be lost on people. So what I think that, yes, there's people who are inherently good, but leadership needs to have some sort of cohesive structure. So always have those core values and know what direction we're going. And, and if the direction changes, just like earlier on in 2020 when Covid hit, our direction changed and when the directions changes, that leader has to put everyone in the same direction, which is not an easy task.

Right. But that's that's part of the, leadership and culture. So how do we as physicians, as physician leaders, how do we become that person that becomes the glue and becomes the cohesion of our company? So I think the things to remember is that as leaders, our goal is not to do everything. Okay. Our goal is to get the team where it needs to go. So if you go back to the bus analogy, it's like we are the the bus driver or, you know, the unseen hand guiding the bus or something. So, I think it starts with the core values that you mentioned.

As leaders, it's important to model and exhibit and celebrate and recognize those core values among your organization. So like where you mentioned last year with, the Covid, you guys are making a big direction shift, okay. That's a very dangerous time for an organization. Because if you make it, if you make a shift or if you have to, you know, you know, call an audible and make a big change in the way your organization's going. It's very important that you, as the leader, keep the organization tethered to those core values.

Okay. So, for example, in the middle of the pandemic, if you know you're going from, you know, 100% in office to 100% telehealth, okay. And then an opportunity comes along for you guys to do some, some kind of investment in a telehealth startup company. Right? So maybe that's not the right thing for you guys to do. If your core values are, you know, maximize time with patients, you know, maximize education of of our patient population. Then getting into, you know, tech startups, speculation. While it might be a good opportunity if it doesn't jive with your core values, it's completely taking you off your game.

It's going to completely rock the culture of your organization. So I think that's the first thing is, as a leader, it's up to us to keep those core values front and center all the time. And keep us tethered to that. So whatever decisions we make, is it in line with those core values. So I think that's number one. I think the second thing is providing some, some kind of, structure and some kind of framework for allowing people to get their work done and get their job done in the best way possible.

So one of my favorite books of all time, I think probably my top, the top one or top two is a book called Ender's Game. Was a sci fi book from the from the 80s, and they actually made a movie of it some years ago. But one of the things that I was really impressed with in that book is how they, they really talk a lot about leadership and culture and tactics, is actually a really fascinating book. But one of the things that they talk about is how the, you know, the, the, the army commanders that when the do the best aren't the ones that are the best riflemen, they're not the best tank drivers.

You know, they're not the best. They're not the best, spies necessarily. They're the best at getting the best from talented people. So as a leader, you need to be constantly asking yourself not, what can I do to today as far as like, what can I do mechanically within the hospital? It's what can I do to support all the people that are doing their jobs? Because if you're focused only on what your job is, then then your company is going to move at the speed of you. But if you're instead focusing on making your job the the the responsibility to have everybody else do their job more effectively, you're saying, how can I support my team?

How can I get them more resources? How can I get them more time off so that they don't face burnout? How can I make sure they get paid on time? And you're multiplying the genius, multiplying the talents of everybody in your organization. And that's your primary motivation. Then your organization can come up with instead of one brilliant idea at a time from you. It's coming up with hundreds of brilliant ideas for everybody on your team. So I think those two things, as a leader is keeping the company tethered to the core values and figuring out what are the best ways that I can support my people and give them the resources, the knowledge, the education, the training and the the money to be able to do their job more effectively.

I want to cheer on that one. Yeah, I know that you put that so brilliantly and I 100% agree. And, and the only reason I agree is I've been in the opposite, realm, and it wasn't very fun. Right. Well, and I think we probably all have I mean, know, you think about you think about all the organizations, all the rotations that you've ever had, the ones that were the most miserable were the ones where the leader was overbearing or was ineffective or was was just a really nasty personality, or they were just ones that were really hard physically or mentally or emotionally, but the ones that always burn me out the most are always the hardest.

Were always, always the ones where it was a rough cultural fit. So if our attending was just was mean and malignant and, you know, if he, you know, I still saw it as my responsibility to try to learn from the guy or from the gal. And if they taught me something, I was like, okay, well, at least I learned something. But I don't remember any of those rotations fondly by any stretch of the imagination. So yeah, we all have experienced that kind of thing. And this is a real problem among team members and employees.

People do not leave companies because of money as a general rule. I mean, that is always an aspect of it. But by and large, people don't leave jobs because of money. They leave jobs because of their leaders. They leave jobs because their boss is the number one thing. And every poll that's been done in businesses for decades is people leave their leadership, you know, and with leadership, and getting the core values out there, and having people understand what the core values are, but also remember where the core values are.

And that's a that's a challenge on its own. Right. And so, you know, if I want to keep my employees right. So let's look at health care for example earlier I talked about the turnover rate for employees is astronomically high within health care, especially since during Covid. Right. And so if I, if I want to prevent something like that, you know, let's say, you know, there's another pandemic, there's some sort of structure where the or there's just a collapse on a lot of systems. In order for me to prevent that, I have developed myself as a leader who understands the core values, can build a company culture so that when that happens, people aren't leaving.

Right. And and thank God, you know, doing the pandemic, you know, all our staff actually stayed and and everyone was very much into, our what our goal is trying to define which is was just fabulous. My staff has been absolutely. So I was towards it. But if I want to prevent that, if I'm if I'm a guy, I'm a physician leader, I want to prevent people from leaving. I want to make sure our culture is good. And I currently have not such a great culture. What should I do? Yeah, I mean, it's a great question.

And there's several things that I think you can do. The first thing I think you do is you got to take a hard look at what your culture actually is, do a real cultural assessment. And I think it starts with just just observing, just paying attention to things. Okay. So, for example, as you're, as you're in, in the clinic, as you're sitting in the break room, as you're as you're walking around the offices, what are you hearing? Are people talking to each other? Are people smiling to people say hi to one another?

Is there trash on the ground that, you know, people keep walking past all the time? I mean, you know, they don't they don't take pride in their workplace.

Leadership, Core Values, and Supporting the Team 28:30

What is your actual culture right now? So so do an assessment of that. And after you do some observation, start talking to people. And what I think is one of the best things to do is just start asking it, start asking polarizing questions. What's the hardest thing about working here? What's the most frustrating thing about working here? What's the worst? I know you're right. It's very counterintuitive. Yeah. And so but and here's the thing. When you when you polarize it like that, everyone has an opinion suddenly, okay, if you say so much of, you know, is this a nice place to work, do you like being here?

People just want to go along to get along. Right? It's like, oh yeah, it's fine. You know? It's the standard answer. How are you doing? I'm all right. And and really, your life is falling apart, right? You know, your you know, your kids are sick and your you know, your job. Your job's hanging in the balance, and you're worried about your mom or dad or whatever, right? So, but so if you if you ask questions that give people an easy out, they'll take it. But if you ask them a polarizing question, say, you know, what's what's the biggest waste of time that you have to deal with on a daily basis?

That one question would you will find so many people ready to answer that question, like, let me tell you, doc, do you have a pen? I got six of them, right? And they're all happy to tell you what's the biggest time vampire of their lives. So, that's a great place to start. Also, and so then as you're trying to figure out, you know, what the culture is, I think one of the next things you do is you start, you start talking to your leaders. Okay? So we're asking questions of your leaders, you know, what are what are some areas where where we're falling short?

What are some areas that people complain about? You know, what's what are some who are who are people that are constantly having the most trouble? And then I think the third thing you have to do is start taking a really serious look at who's working there. And this is one of the things that gets very tough. So if you're new and you're coming into an organization, you're trying to figure out, okay, how can I impact this culture? How can I, like, make a difference here? Almost guaranteed. If you're coming into a culture and you're new and you're being hired to lead a team almost every time there's at least one person and usually it's three.

It starts with a little triangle of people, but there's almost always at least one or 2 or 3 people that are at the core of some negative, toxic, you know, gossip mongering, you know, hate spreading dis disenfranchized discontent, you know, personalities. And very often times what's required is a publicized firing. So I don't mean that you go and celebrate. We're firing today. Right. But you you need to look at your organization and see who is it that isn't cutting? It isn't isn't pulling their weight.

Who's gossiping all the time is constantly writing. Other people down. I guarantee you that if you are new to an organization and you're finding that there's a problem in the culture, there's at least a few people that desperately need to go. And it's up to you as the leader to root that out and then to give them, hopefully give them an opportunity to rehab themselves. And if they don't, you need to fire him and let him go. Because here's the thing when if you want to have a if you want to have a stable of thoroughbred race horses, right.

And you let one donkey in there, okay. And everybody sees that the donkey is given, you know, special privileges and special treatment because, well, we're not willing to enforce the rules, you know, who cares if they show up 30 minutes late? I'm never going to chastise him about it. No. Then you know what's going to happen. All the thoroughbreds are going to leave and go somewhere else, and you're left with the donkeys. And that's just the reality. So if you don't get rid of the bad people, the good ones will leave.

And the bad ones are all that you're left with. Yeah. I'm going to summarize that two statements that I, that I got from Tony Robbins one time. The first one is you get what you tolerate, right? That is so true. Yeah. And then the second one is, you're not necessarily who you hire. You are who you don't fire. So it kind of ties towards the same thing. Well, and one of the questions that I've heard asked, and I think this is a great way to do this. Okay. So if you're not sure, if you're not sure if you want to keep somebody, ask yourself this question about any role in your organization.

If I was going to hire someone for this role today is the person who is currently in the role. The person that I would want to hire. And if you say no, that person needs to be rehabbed. Give them an opportunity to change and improve and give them some expectations and tell them they have to meet those expectations or they need to be let go. Yeah. And, you know, a lot of people listening to this, it may seem contradictory to what we talked about, when we opened up is maintaining that company culture and, you know, make sure that everyone's involved and have a good feeling.

Right? And you're like, well, if I'm going to be going around and seeing who I am, I need to get rid of, how is that good? So, you know, one of the things that I learned is that a good company culture is not a company that lets you bring your dog to work every day and just chill. It's not a company culture. Right? So, it may be a place where people want to work because it's relatively lax, but a good company culture is a strong leader with core values, with direction and so whenever, whenever you're, you're there looking at who doesn't belong in this position anymore, maybe you've the company may have outgrown this, this person.

Think about it as I am making this decision to protect the family and protect the culture, within there. And you're right, because there are just one or 2 or 3 people that may be too toxicity, within the actual culture. And if you as a leader don't do anything about the toxicity that's already recognized, then that disrupts the entire culture, you know, completely. And so, I would love to, to I would love to think that a good company is all come by, but it's not. It's about, it's about direction, and it's about going in the direction where everyone wants to head in the same direction.

And even if the employee has been great and does everything that they're told, if their job involves more than doing things that they're told, then you might then the company might have outgrown that person. So, so thank you for saying that. I feel kind of validated because that's sort of the direction that that, that we're taking in my company as well. I think as leaders, one of the things that we can and should do is to set those expectations in a very clear way. So if we've got someone that isn't meeting expectations very often, I think it requires some deep introspection and say, okay, have I really enforced my expectations on this person or are they just doing what they think they're supposed to do?

Because I haven't said anything different, right. So it's like when you're dating someone or you know, and they say, you know, and you can tell that something's wrong and they say, and you say, well, what's wrong? What's the matter? Said, well, if you can't figure it out, then I'm not going to tell you. What the heck do I do with that? Right. So, so if you haven't made those expectations very clear to your team members, then I think it's important as leaders that we own that. So if I'm having a conversation with an employee that is really not making the grade, it might go something like this.

It's like, hey, listen, Phil, this is going to be a challenging conversation and I'm going to express some things that may sound kind of difficult to hear. And if I don't express myself very effectively, I'm going to ask you to forgive me for that. But I want you to succeed here. And I think that this is a great place to work, and I want you to remain a part of it. But the truth is that you're not meeting the expectations that we have. And I feel like I have not done a good job as your leader in setting those expectations and making that very clear to you and then holding you to those standards.

And that's my fault, and I apologize. That's that's on me. Okay. But here's what we need to do, okay. Starting today, we're going to make a change. Okay. Here's the expectations that I have of you for your job. And you bring something written. Okay. Needs to be written down in black and white to be very clear and say, these are the key performance indicators. These are the key results areas. Whatever you're going to use. Let's say these are the expectations that I have for you. You're going to do these things. You're going to show up on time.

You're not going to show up late again. You know, you're going to start dressing better, gonna have better grooming standards. You know what? You know you're going to have, increased productivity, better efficiency, whatever the things are, set those expectations say, this is what I expect of you, okay. And what I need to see over the next 30 days. And you give them a finite period of time, 30 days is pretty good. So over the next 30 days, what I need to see is significant progress towards these goals.

And by the end of 30 days, I expect you to be meeting each one of these key points, okay. And we're going to get we're going to meet together at the end of every single week, okay. For the next four weeks, we're going to meet together every Friday, and we're going to go over it. And I'm going to tell you where I, where I think you're doing better and how you can improve. And I'm going to coach you. I'm going to help you because I want you to succeed as your leader. But I'm going to show you where you're still falling short and you're going to and you're going to ask me questions and you're going to, you know, we're going to work together to try to get you where we need you to be.

And then the next week you have the meeting and you say, okay, you're doing great with these three. You're not doing so great with these six. So let's work on those. And then the next week the same thing, next week the same thing. And one of a couple things is going to happen okay. One of three scenarios. One they're going to go oh my gosh I had no idea. No one said anything to me in the last six months. I just assumed I was doing a great job. Thank you so much for making this clear. No problem. I'm going to step this up.

And within a week, two weeks, they're going to be on their game. They're going to be doing awesome. Scenario number two is that by the by the end of the month, you know, they just they just are they're great people. They're wonderful person. Or maybe they're not. But for whatever reason they're just not cutting it. They're not meeting your expectations. And you say, listen, we've we've really worked this hard. We had a we had a set plan. It's been 30 days. You're not meeting the expectations. Unfortunately, I don't think this is going to be the right company fit for you.

We're going to let you go and we're going to write you a great recommendation because we really like we want you to succeed, but this is not the place where you're going to succeed. This is not the best fit for you. That's the second scenario.

Assessing Toxic Culture and Making Tough Personnel Decisions 38:30

The third scenario is interestingly will happen a lot of times. And I've heard you talk about this before. As a matter of fact, I think you talked about this on my podcast is that people will select out. So week one you're like you've made 5% improvement on every area. Okay. And then week two you're like, you've made you've made you've made backward steps in three areas. And you know, you just keep you keep having the same conversation. And by week three or something they're going to go, okay, writing's on the wall. I'm just going to quit.

And they just leave and they'll just select out. Either way, at the end of that 30 days, you either have given them the opportunity to rehab themselves and they did or they didn't. And you let them go, or or they just got better on their own. Yeah, absolutely. And, and, I've experienced that myself as well. And so I think that, a lot of people hearing this are going to be like, oh my gosh, I see patients all day. When the hell I'm going to have time. You set these structures up. So the next part, of what we're going to talk about, which very, very few people do, is something I like to call creating, standard operating procedures.

SOP is right. I think that, whenever we as leaders are spending a lot of time with our employees and setting expectations, doing stuff, we expect a lot out of them, but a lot of them are just just very heavily undertrained, because there's little tiny details and they might not have been trained. And so, you know, we started using, some platforms to, to create these standard operating procedures on a digital platform. But I think let's, let's, let's really dive deep into this one, because the last example you just used, is something that I, I myself experienced with a lot of employees.

But whenever we started creating structures and training and spend time doing that, a majority of that actually started going away. And then we were able to to spend more time on culture and revenue generations and have a lot of fun with that, because, you know, it's not really fun, you know, reprimanding somebody. Right? But let's talk about how important it is, for us to document the procedures of what we are actually doing from administrative point of view. Well, it's important for a couple reasons.

So it's important for standardization because you don't want people to be automatons. You don't want mindless widgets. But at the same time, we do have to meet a certain standard of care. And so we do have a minimum set of expectations that people are going to do certain things. So let's say let's take an example of a family practice. Family medicine practice, let's say. And so, they're they're doling out vaccines. Well, there's a standard way that we do vaccines. Okay. And so but you may have four employees and they, they have six different ways of doing vaccines among the four of them or something.

And so, you know, some of them use alcohol, some of them use chlorhexidine, some of them use this gauge needle, that gauge needle, and it's all over the map. So but if you have a standard operating procedure for okay, here's what you do. You need this set of equipment. You have a checklist maybe let's say. And then you do this first this first this next this next. These are the things you document. These are the codes that you put in. This is this is the note that you need to send me to sign. You know, whatever it is and you do that and then it gives you a standardization so that you can meet your minimum standard of care.

And then you can give some people some freedom to innovate, beyond that. But certain things are just going to be standardized. That's first thing is that it gives you some, some standardization. The second thing is that it, it massively buys back time. And so the way that I kind of think about it, it's, it's a, it's a time investment. So, you know, we talk about, for example, with you know, saving for retirement. The earlier you start, the less money you actually have to save because of the effect of the compounding of the interest. Right?

So you make a small investment upfront and it reaps huge dividends down the line. But yeah, you're having to put in some startup capital. So now you take that same concept and apply it to what you just talked about with the standard operating procedures. If you take the if you take the opportunity to spend a little extra time training people, getting them up to speed, giving them the, you know, the best skill set to be able to accomplish things, it will pay off in efficiency and time saved down the line.

So if you have someone that normally takes ten minutes to administer a flu vaccine and through training and and repetition and, you know, some coaching, you can get them down to five minutes. Okay. So let's say I spend two hours, let's say I spent two hours training someone how to do vaccines. And I say five minutes per vaccine okay. So that's 120 minutes. So that's what you know, 1224 is 24 vaccines. And I've made up that time and then I've made I made five minutes times every vaccine that they do from now until forever.

So now they can do 20 vaccines, let's say, in the time that they used to be able to do ten. And so now I've increased the number of vaccines that I can give. Now it starts to open up a lot of interesting ideas. So I'm just, you know, kind of, you know, riffing here. But now, now I'm saying, okay, all of a sudden I can do 20 vaccines in the same amount of time. I can do ten. What if we set up a vaccine clinic somewhere? What if I sent this person to a school and said, hey, we're going to come to your school with a truckload of vaccines?

I got four people that can do 500 vaccines in a day, and you just send me all your kiddos and with permission slips. And here's the form. And you know, you can upload it digitally for mom and dad and just send them through. And we're just going to get everybody vaccinated against the flu in a single day. Right now, that's just one example of of a way that your time investment can pay off. Or, you know, maybe it's maybe it's not about creating a new program. Maybe it's just freeing up more time. So now in the same amount of time that they were doing the vaccine, now they can be, you know, triaging another patient, or maybe they can be answering a phone call or checking an email or coming to talk to you about, a problem with your supply chain, where you're freeing up that time by investing a little time upfront.

So you reap the dividends later. Yeah. No, that's that's such a great point. And when you put it into that perspective, you're turning something that's seemingly very boring, which is making SOPs and enhancing it. But what it allows you to do is innovate on the back end, and so you create the structure and then you innovate and create and innovate. A lot of people with, with this profile, I like myself and you, sometimes we tend to innovate and innovate. And then we have a little SOP here. And, and that can, you know, really break everything down.

But what you just said is it's such a fabulous point. And so, but that's why all these little, intricate details, needs to be documented somewhere, and it's even if it's absolutely obvious. So I was talking to, another practice whose ob gyn practice? And, there's six of them, and each of the doctors do something a little different. And so when the medical assistance cross cover, it is very difficult for them to do that. Right. And I'm sure you experienced and GI as well. So what my suggestion is, hey, what I want to use that's created either either do things the same or just create, training programs for the doctor.

And then let's say if there's employer employee turnover was there recently was then you can train that for this particular position. You know, this is you know, this is the Maa for Doctor Smith and this is the actual training program that, that that is allowing me to work with Doctor Smith. And here's a little test and go ahead and do it. And so and that's worked out really well. And for us, you know, a lot of times we work with virtual assistants. We work with a lot of virtual assistants. And they could be across the country or across the world.

We have virtual assistants in the Philippines and in Africa, and one in new Jersey. And so, and in doing all this, we have to make sure that there is sort of a digital platform that that they can do it. But it's not just about the space, it's about adopting new programs. Let's say that you're watching this AI summit and you say, hey, this this company looks really cool. I want to adopt this, maybe this texting platform with the patients. Well, what you do is you take that and then you say, well, how do we incorporate this into the process?

You don't just drop it on your staff and just start using it. You know, it's not that obvious. And so you have to create, procedures around it. And how do you incorporate with this particular program? And so I think that, a lot of times when we are searching for technology, to overcome pain points, we tend to skip over the operating procedure part because it's not a sexy thing to do. At the very beginning, until you've tasted the bitterness and you're like, okay, maybe we want to set up a structure around it.

So that's a fabulous point. But I think you also one of the key leaders. Right. Well, and one of the things that you can do is, is a way to multiply your time even more is empower your team members to do the SOPs. So if you in your example, you just gave, if you have an SOP or a way of doing things

Standard Operating Procedures and Team Training 47:30

or a new technology from another company that you want to bring home, you can give that to one of your, you know, one of your go getter team members and say, hey, listen, we've got this thing here. It worked really well. This other company, I saw it. I think it's really cool. I think if you work for us, can you put together an SOP for me? You know, or can you take a look? Is this adaptable to our culture and our business model and our organization? And, you know, if you think so, I want you to take a crack at an sop of how how would you teach everybody that's at your level how to do this?

And so you're not even the one spending the time. That's a five minute, that's a ten, 15 minute conversation with someone saying, these are the goals that I want this to achieve. I want you to figure out how to make that work. And then they bring you a draft of the SOP. You work with them, maybe that's another 20 minutes and then, you know, you send them back and then a week later they come back with a new draft and then, you know, you send it back and then maybe you spent an hour on that. Okay. Over the course of, say, a month. All right.

But you're, you're, you're doing two things. Number one is you're offloading things from your place so you can focus on things that only you can do. And a second is you're empowering your team members to do something valuable. And the more that you get your team members involved in the process, the more that they are likely, to have buy in, and the more they're likely to actually come up with something that works. Because here's the other thing to think about. So like in the setting of of, say, a gastroenterology practice, what I think I'm going to I'm going to want out of an SOP may not end up being the best thing.

So I've got, you know, GI texts that have worked for us for, you know, ten, 15 years and they've, they've tech for thousands of cases with dozens of doctors. And so what, what I do in my idiosyncrasies in the procedure room may be very different from what somebody else does. And so what the way that I would write in a SOP may not be something that can be standardized across the entire organization. And so getting someone who's really boots on the ground, who has really has their fingers in the the inner workings of that particular process can be hugely valuable.

So because you're getting better expertise and you're getting, you're getting more up to date, you're giving them opportunities to grow, you're getting opportunities for them to have more buy in. It's just great all the way around. But that's a great example of what we talked earlier about, which is instead of me trying to do it all, is me empowering my team to do the best job that they can. And so then I'm multiplying the genius of everybody in the organization instead of just moving at the speed of me.

Yeah, and not only that, because if you standardize the approach and standardize the training, you're also able to gauge employees. I was like, hey, you did this training, you know, two and a half months ago, yet you're still, you know, missing the mark here. What I do is that we as employees retrain as part of the corrections program, and so that, and most people do just fine after the second time. And so we were able to have quality control over the procedures, over the employees. But it allows, allows everyone else, a sort of a sigh of relief, you know, right now, what a lot of clinics are experiencing is that there's rapid turnover, and now you have the most senior mas trained, all these different people, and then right when they're trained, they're like, no, I don't want this job when they go somewhere else. Right.

And that turnover is, is hideous to the bottom line because the fixed cost is so astronomically great. And so with the standard operating procedures, these SOPs, we're able to get people trained in very uniform and come in. And then the your senior staff may they may act as leaders rather than direct trainers. Right. And that allows them to be part of the process, which I think hits three very human, emotions. One is significance of if you're significant, you want you to feel significant. Two is a sense of contribution.

They're contributing to, the company by being those leaders. And the third thing is connection. Once you if people are going to a standardized training, it allows more time for that connection and more time to have those conversations. And I think, by documenting these things and they're, and they're not fun, for me, that we're able to achieve that. But like you said, you know, sometimes, we feel like we have to do everything on our own, but we do have our employees, create things of their best practices, and they come up with the most innovative things I've ever seen.

It just amazes me how we have so many great ideas. And when we have to, when we when we change things up, everyone's on board. And so and I think that allows me to be a good leader, and allows me to really spend time on the conversation for making sure that their lives are okay. And, and, and that significantly reduces, turnover. And so that's a one of the points we made earlier when we were talking about the hiring process, about hiring for a skill set versus hiring for a cultural fit. If you've got those SOPs in place, then and people have a basic set of skills, you put them through that training.

You don't have to worry nearly as much about hiring for the skill set, because you can hire for the cultural fit and then train the skill set. Yeah, absolutely. And so, what are three things you wish you knew about leadership when you first started private practice? So the first thing is that, difficult conversations are painful but necessary. And so I, I'm very much a people person, very much a people pleaser. And so having difficult conversations where I have to dress somebody down or tell them that they're not meeting the mark or, or even fire somebody, that kind of thing.

Those are incredibly painful. I mean, it's like a piece of my soul is being ripped out. Whenever I have those conversations is viscerally painful to me, but just so necessary. And so I've had conversations with people where we had to let somebody go. And then a day or two later, one of my employees would come to me and say, thank you so much for being willing to take a stand and let that person go. We are all just so relieved that they're gone, and immediately the productivity of the entire company goes up.

It's it's like, well, dang it, sorry I waited so long to do that. Yeah. So. Yeah, so so that's the first thing I would say. The second thing I would say is that, never underestimate the ability of an empowered team. And so what I mean by that is that if you, as the leader, are giving your team direction and encouragement and then just turning them loose to do whatever it is you want them to do, just sit back and prepare to be amazed. You get the right people. You get them doing the right job, and you give them some direction and just watch them blow your mind.

It's amazing. Like you were saying a second ago, I mean, it's just it's just phenomenal seeing the stuff that people can come up with. It's great. And the third thing I would say is do not, do not, do not underestimate the value and importance of a healthy team culture. There is just no substitute for it. Okay, so I read in a in a leadership book one time the this this maxim culture eats strategy for breakfast. And that's 100% right. So if you've got great vision, great strategic thinking, great planning, great supply chains, you know, a great five year plan, and your culture is lousy.

Leadership Lessons and Closing Resources 55:00

None of it's going to matter right. So it's it's like going into battle with with an army that has just horrible morale and everyone hates each other. It doesn't matter how good your strategy is, you're going to get slaughtered, right? So. So don't underestimate the value and importance. And the critical role that a leader has in, that a leader plays in shaping that company culture and take charge of that, take ownership over that, make that a priority for you, even if you don't feel like you don't have time.

Trust me, you do not have time to not pay attention to that and to not do it. Wonderful, everyone. If you haven't already, clicking the link, for the Scope of practice, podcast, I listen to a lot of them, and a lot of this actually is covered in there with the different physicians, in very different scenarios. And it's something I truly enjoy. So, that's lazy. How do people find you? So the the website is the scope of practice.com, and, you can get access to the podcast through there. And so people need to go listen to your episode because that was absolutely phenomenal.

You know, and, you can get access to the blog archives. You can connect with me. But I want to give the listeners something to, to take away because, I think it's, I think it's helpful to have some tools as leaders, something practical that you can actually start to, you know, deploy in your own practice. And so I created a guide just for the summit watchers here. It's called five critical tools that every physician leader needs. And, and so it'll, it'll help you, you know, find ways to celebrate your team members.

It'll give you a ten day challenge to, you know, to make your clinic better. It'll help you set up, you know, mission statement for organization and a few other things so people can download that. That's for free. The scope of practice.com/physician leader tools. And so, they can just download that guide for free at the scope of practice.com/position later tools. And the link is in the description of of this episode. So thank you so much for coming on today and taking out of your valuable time. And this has been an absolute enlightening conversation, and somewhat validating as well.

And I think it's really important for all us all to be fantastic leaders, for our patients and for our employees and our staff and our families as well. Thank you. Thank you, Doctor Ron. Appreciate it. Thanks for having me. Thank you for.