Secrets to Easy Scaling: Update Your Process Engine

Chris Ronzio

Absolutely. Thanks, Dr. Ruan. It’s great to be here. Thank you for your support over the years and thank you for the introduction.

Cheng-Huai Ruan, M.D.

Yeah, no problem. So today’s talk when we talk about physician practices and some of the main pain points that’s I feel is like within over 90% of the practices. And I think that as doctors, I mean, honestly we’re trained to be doctors, right? And so we sort of had this heroes mentality when taking care of patients, but then when you get too stuck in it other things that come out, it’s really hard to focus on. And so for doctors in private practices, not only are we physicians but we’re also owners and operators at the same time, so it becomes a really hectic as you can imagine.

Chris Ronzio

Yeah. And it’s not just physicians, it’s not an uncommon thing. A lot of people start a business as a technician, they’re really good at the thing they do and then you realize, “Oh, I own a business too, I need to figure out how to do that part of the job.”

Cheng-Huai Ruan, M.D.

Right. Yeah, absolutely. Absolutely. So I wanna start by just kind of summarizing what we’re gonna talk about during this portion of the summit. Well, which is one, is employee turnover and company culture, I feel like they kinda go hand in hand. And two is that a lot of practice owners don’t know how to invest in systems, so they invest in other things but not necessarily systems which can make or break a business. And another one is there is extremely high turnover of employees in all medical practices in the United States, especially after or during the global pandemic, and then also physician burnout. So 44% of doc are burnt out nationally and it’s 76% for primary care docs is believe it or not. It’s really crazy. And this is a survey that’s done before the pandemic so I’ll have no idea what it is now, I’m sure it’s a little higher.

Chris Ronzio

Yeah.

Cheng-Huai Ruan, M.D.

And I wanna talk about working on the business versus working in the business, not a lot of people know what that really means. And so that’s where the layout that I’ve kind of wanna discuss, but let’s start with the first one is, what are the consequences of us as physician leaders of not having systems and processes documented? What are our actual consequences?

Chris Ronzio

Yeah. Well, so let’s take a step back and actually define systems and processes because whenever you pick up a business book, you see those buzzwords and you think, “Oh, I got to work on my systems and processes.” What does that actually mean? So I think it’s actually the reverse, it’s processes and systems because every business has process to it. You already have a way that you do things, right? So a process is just the sequence, the way that you do something, it’s the way that you register a patient, the way you interact with them in a visit, the way that you bill someone through insurance, there’s a sequence, a way that you do it. 

And you probably know those things intuitively or your people know those things and they’re stuck in their heads. And then you’ve got your systems, which is the technology that helps facilitate and speed up the process. And so an example I like to give is, when you’re driving a car and you drive onto a highway or a freeway or something like that, that is a system that was put in place to get you from point A to point B which is the process. So you could walk through the woods on some path and then maybe that path if it gets enough foot traffic, they decide to pave it or they turn it into a freeway.

It’s a place it’s a way to get from point A to point B. And so in your business you have these processes, just point A to point B ways to do things, investing in systems and infrastructure is just how you handle more capacity, how you get more volume through your processes. And so when you’re building a private practice, when you’re a physician, the number of people you can serve has a cap on it and so if you wanna scale your business and not be working so many hours, not be having so many visits, you’ve got to invest in that infrastructure and those systems to make your business as profitable as possible and that’s what we’re all after.

Cheng-Huai Ruan, M.D.

Yeah. And I think we’re a little beyond profit for example, I’m gonna give you this sort of a case example, right? So I was talking to a buddy of mine and he owns a gynecology practice and he’s like, “Man, I had three of my medical assistants quit when I was on vacation,” which people always quit when the boss is on vacation for some reason, right? “And I’m relying on my senior medical assistant to train the new ones that are coming in but she’s on vacation for two weeks. And then if I hire them they’re just gonna be sitting on their butts and doing nothing.” Right. And so tell me how this can really destroy the processes and cause a lot of burnout for the people within the company.

Chris Ronzio

Well, think about that idea of quitting on vacation. I’m like, why would someone quit while the boss is away? In my experience it’s because they don’t wanna face the boss and a lot of times when you don’t wanna face the boss, when you’re putting in your notice, it’s because you’re leaving the company in a bad place. And so why would you be leaving the company in a bad place to take a great career opportunity? Well, it’s because the knowledge of the business and what you do is stuck in your head and when you walk out the door you’re taking that knowledge with you and you know it’s a problem for the company. So if that’s the problem, we go back to say, well, how do you fix that issue? And it’s good for the employee and it’s good for the company if they can write down and codify like what they do in the business so that if they ever do decide to move on they don’t feel so guilty. They can actually approach you and say, “I have this other opportunity, but don’t worry, everything’s written down and the next person will just hit the ground running,” and then you feel pretty good about it as a business owner. I like to give this analogy of, if you had the money and you could either choose to rent or buy a house, what would you do?

Cheng-Huai Ruan, M.D.

I would buy the house.

Chris Ronzio

You’d buy it, right? Because you’re getting an asset, like that’s why you do that. And so if you think about all of the knowledge, the collective experience of all of the people in your business and you’re paying for that, payroll after payroll after payroll after payroll, if you’re not writing it down you’re not building an asset, all you’re doing is paying salaries like rent and you have nothing to show for it. And so the knowledge in a business is what makes the business valuable, it’s what makes it an asset, so you’ve got to capture what people do and it’s good for everyone.

Cheng-Huai Ruan, M.D.

Building equity from process, I’ve never thought of it like that. That’s brilliant actually, that’s a really good analogy. But yeah, you’re right. If you’re just kind of relying on people to do the stuff and not have it down, you don’t own that knowledge, you don’t own that process. It just in someone’s head or your head and then you’re literally just renting it. Yeah. That makes a whole lot of sense

Chris Ronzio

Yeah. I remember this, before Trainual I was consulting for this daycare and I went in and I used to interview all the employees, these confidential interviews, and there was a teacher, a kindergarten teacher that was like, “You know what, over the years I’ve had so many opportunities to leave this business. The kids wanna hire me as a private tutor.” And I said, “So why didn’t you leave?” And I thought she’s just so loyal, it’s the best employee ever and she said, “No, if I left this place would crumble.” Like, think about that burden for any person that they feel so responsible to your business that they feel trapped and I don’t think that’s good for anyone. So writing down what you do is good for the company, it’s good for the person and it’s a productive thing. It’s a discussion we should all have.

Cheng-Huai Ruan, M.D.

Yeah. Well, there’s writing it down and losing your notebook. Right. And then there’s writing it down digitally. Right? That’s a big difference, correct?

Chris Ronzio

Absolutely. I’ve a strong recommendation on where you write it down, but we can get to that later

Cheng-Huai Ruan, M.D.

Absolutely. So now the question and I can hear people thinking about this, like, what is really the anatomy that goes into what my playbooks should really look like? What should that look like?

Chris Ronzio

So your playbook has four things, DNA, if I wanna use medical terms, right? It’s first your profile of your company or your business, your practice. So the profile is just a snapshot of what makes you unique as a business, as a company. It’s your story, your founding story, it’s why you left that hospital and decided to start your own private practice, it’s the types of people that you serve, is what makes you different, it’s your culture, your values, your vision, your mission, all of that stuff is just the about the entity stuff and that’s your profile, that’s the first piece. 

The next piece is your people. So every business has different people and those people have different stories and backgrounds and bios and titles and lists of responsibilities. And so being able to orient your whole team to here’s who’s who and here’s who does what is a really important part of your playbook. After that is your policies. So policies are just like your handbook, it’s the rules, it’s the norms inside your business, the legal requirements. And then you’ve got your processes and all those are the how tos, the standard operating procedures of how you do things. And so it’s those four elements, your profile, your people, your policies, your processes. That’s what makes up the whole playbook. If you had to turn over your practice to someone else, that’s how they get a hundred percent up to speed on what you’ve built.

Cheng-Huai Ruan, M.D.

You said profile first, that’s very counterintuitive for me because I mean, the minute I think about a handbook I start with processes. We set profile first?

Chris Ronzio

Yeah.

Cheng-Huai Ruan, M.D.

Why?

Chris Ronzio

It’s totally the opposite. When you start with processes and you’re training people, the first thing you’re training them is on a how to on a process, you’re micromanaging them, you’re looking over their shoulder and watching-

Cheng-Huai Ruan, M.D.

Guilty. Absolutely

Chris Ronzio

And so you wanna give them the context of why do they even care about you? What are you up to here? What do you do here? And when we first jumped on this call, you started to tell me about why your practice is unique, why you’re unlike other people, because we connect over that. There’s a story element there and you want every single person that joins your practice to have that same experience where they get to know you, they build the emotional connection, they wanna work for you. It affirms what they thought about you before you hired them. It says, was this a good decision to join this company? Do I fit in here? Is this a culture I’m gonna thrive in? That’s what you’re teaching someone upfront, that’s the building block for everything else.

Cheng-Huai Ruan, M.D.

Okay. Well, now that builds the culture, but you talking about building experience. So your experience can be scaled at large by documenting the profile. Honestly, never thought of it like that.

Chris Ronzio

You invest in your customers experience, that’s a lot of the process part, but then you invest in your employee experience and that’s a lot of the profile and the policies and the people. So as a business starts they’re first trying to figure out how do I serve a customer and how do I just collect dollars and make this thing work. Right? But as the business grows and has more people in it, now you’ve got to shift and say, how do I make this a great place to work? And how do I invest in my people so that they are operating consistently and building a culture together?

Cheng-Huai Ruan, M.D.

Yeah. So I mean with if and I’ll, dude, I’m guilty ’cause I started with processes first and it wasn’t really until right pre pandemic that we started to change some of our staff that I started documenting why we’re doing this in the first place. And what’s really interesting is that the tone of the culture of the company has to change quite a bit because people were like, “Oh, so that’s why you do this, Dr. Ruan,” or, “That’s why we wanna do this.” And our monthly meetings became a lot more robust and people were able to take the profile into the own creative energy and come up with even better systems and processes than I could even imagine. And so I recently experienced that and so it’s very awesome and it really takes a lot of the burnout away from me. So that’s awesome.

Chris Ronzio

Yeah. It’s a hundred percent a culture builder. And like you said, it helps people innovate and see beyond just the scope of their role. If you bring people on and all you do is train them on how to punch the clock and do the narrow job description they were hired for, they don’t understand where they fit in the whole organization. And so by investing and just training everyone on the foundations of your company, they get the whole operation. Like my first company was a video production company and we would hire camera operators to film sporting events and broadcast people that would come in that were used to filming different types of events, they might zoom in on someone’s face because they’re trying to get all the emotion. And if they didn’t understand that, no, our video goes to the judges for technical replays, you need to be this far zoomed out, this is the context of why we shoot this video and what everyone else does, then they couldn’t do their job well. And so you have to train people first on what the business does before you train them on what they do.

Cheng-Huai Ruan, M.D.

Very artistic Yeah. Processes are very artistic things. A lot of docs, including myself, especially in the beginning, we didn’t really invest into systems like this. I mean, we definitely didn’t invest into developing a profile or a company’s core values if you will. Right. And a lot of times not everyone’s on the same page and we suffer a major consequences of it. So I’ve tasted that pain and it sucks So let’s talk about how this can actually improve employee turnover. So do you think documenting these processes can improve employee turnover?

Chris Ronzio

Yeah, absolutely. There’s a lot that influences turnover. First, some turnover is predictable and expected. Some businesses are seasonal businesses, some roles that you hire you might expect someone to come in for a residency or whatever and they’re not gonna be there long-term. And so some roles have predictable turnover, but it’s the unexpected turnover of people feeling like they don’t have opportunity at your business or they don’t quite fit in or whatever, investing in your upfront company training will weed out people earlier on. And so just as an example, everyone that starts at Trainual, they go through a really grueling interview process and we try to weed everyone out at the very beginning before they’re even getting an offer. 

But when they make it through the front door and they’re training on the company, we give them at their end of the training and opportunity to leave for a payment that if it’s not the right fit they can leave two weeks after they started. And again, it just reinforces, is this the place for you? And so I think there’s a lot you can do to improve your training so that you preempt unexpected turnover. You cause that this person was likely to turn over, let me identify that in the interview process, or this person’s not gonna be a long-term fit, let me identify that in their first week or two. If people make it past that, then they should be a long-term fit in your business for the expected lifecycle of whatever that role is.

Cheng-Huai Ruan, M.D.

And so, I mean, that’s all well and good, but I think a lot of people are thinking about this and say, “Hey, I am so busy, like working in my business right now. I’m an operator.” Like, where do I find time to even do something like this and how do I even start? So how do I start?

Chris Ronzio

Yeah, it’s a catch 22, right? Because you know investing in this stuff, investing time now is gonna save you time later. If you spend eight hours or 10 hours or 40 hours writing down a bunch of stuff in your business, short-term it feels like, wow, that was a waste of time, but when you multiply that over the 5, 10, 15, 20 people that you hire and how much more efficient they get, how much stronger your culture gets, how much your retention improves, then those efforts start to dramatically pay off over time. So it’s something that you can’t look at with a short-term lens, you have to understand, here is the longterm place I’m trying to get my business to and if I don’t do this work there’s no way I’ll scale to that place.

Cheng-Huai Ruan, M.D.

I think a lot of physician operators kind of operate in this perpetual fight or flight stance when it comes to business, because there’s just so many unknowns within a medical practice, which I’m sure is in other businesses as well. But when there’s a business and the talent of the business is the physician themselves and also the operator, how do you think that we should actually divert our time? And I shouldn’t say divert, allocate our time, I should say, to developing things and the processes on the business versus just full force in the business. Like, is there like a ratio? Is there like once a month, a week?

Chris Ronzio

There’s no perfect ratio, but the way to think about it, the whole in your business, on your business thing, that actually originated from a book called “The E-Myth,” Michael E. Gerber. He has a physician’s version of that book if you’ve not read it, but he’s becoming an advisor for me and a partner at Trainual. And so one of the things I disagree with him on actually is that not everyone has to go from working in their business to working on their business. There’s some people who would just be very happy having a lifestyle business, having a couple people and you’re just in the business forever and that’s what you do, and if that’s what you want there’s no problem with that. 

So it’s really only when you’re raising your own hand and saying, “I don’t wanna work this many hours, I wanna have some other physicians here in my practice, I wanna support myself with an administrative team that takes a lot of the business load off of my plate.” That’s a decision you’re making or any of the other listeners are making and if that’s what you want, then that is your rationale to go invest the time in building this sort of structure. So I don’t think there’s a right ratio for anyone, because I’ve had friends that buy a business that they were never the technician of, they buy a business and they are 0% in the business. And then I have other friends that are same thing, a physician, a hundred percent in the business and all they do is billable client time, patient time. And so there’s a balance, there’s a mix somewhere in between but it starts with what you want.

Cheng-Huai Ruan, M.D.

Man. That’s a tough question to answer. And I think everyone watching this has a sort of a different desire, right? A lot of us went to medical school for a reason, we went into residency and fellowship training for a reason and when we get out of it a lot of times it’s not what we expected. Right? And our desires change and for those of you listening out there, it’s okay to change your mind. During residency, I think a lot of us really wants to work hard and wants to work every day everything servicing for our patients, but as we develop families and relationships and relationships with ourselves, and especially in the current trying times where there’s a huge stigma and when it comes to physicians and mental health, we’re really had to take a step back and reevaluate, what is it that we really want? But whatever it is that we want and I believe that we have to build a system towards the things that plague us the most and so that we’re able to engineer either a strategy of less burnout or exit strategy or something like that.

Chris Ronzio

There was this movie that came out on, I don’t know if you ever saw it or maybe saw the movie, poster, “Horrible Bosses.”

Cheng-Huai Ruan, M.D.

Yeah. Yeah.

Chris Ronzio

And I used to give this presentation and talking to people about, oh, isn’t it the worst when as the business owner, you’re working all these hours and you’re doing this and I put up that poster and it’s like, you know what, you’re your boss, you are the boss. And so you have to write the rules for what you want. And I think it’s an important reminder that everyone kind of needs to step back every once in a while and rewrite the rules of their business. If your life is trying to fit into your business, you’ve got to flip a 180 and say, what is the lifestyle that I’m looking for and how do I build my business around that?

Cheng-Huai Ruan, M.D.

Well. If the lifestyle that we’re looking for isn’t consistent with where we’re in right now, that’s one of the time to build the systems around it. But hey, we only have 24 hours in a day and I wanna sleep some of those hours. I can imagine that we wanna get our entire staff involved in building this playbook, right? Like, how do you corral your staff to say, “Hey, we wanna be able to build this.” Do you have any tips on that?

Chris Ronzio

Yeah. So first you need to give them a reason why you’re doing it, because if you come at your people one day and you say, “Hey, guess what? We’re writing down, everything that you do and that’s all you’re gonna work on for the next few weeks.” They’re gonna be like, “Oh my gosh, I’m getting fired.” That would be the the first thought. And so you have to kinda preload some context and say, for this reason and this reason, we wanna open an additional location as you’ve heard about, or we’re trying to move into this bigger building that has more capacity and we’re gonna see this many more patients, and you’ve got to have some reasoning to want to do this work and so you’ve got to share your vision and share your motivation with your team. 

And when they hear the motivation and then you explain, this is the project, this is how we’re gonna do it, it makes total sense to them but they’re more bought in than they would be if you just said, “Hey, write down everything you do.” So the first piece is just context, again it’s just being open and being a good communicator. Now where you actually start is gonna depend on what you get the most ROI out of for your business. And so if you’re anticipating hiring a ton of people, you might start with that profile section, your orientation, because you know that if you don’t write that stuff down and make a consistent experience, it’s gonna be a grind for you week after week or month after month repeating yourself over and over on that same story and so you might focus on that. 

Whereas if you’re rolling out policy updates or something else to all of your existing people and there’s some big legislation change that’s coming up, then that might be the burning thing for you to focus on. And so I always try to think about what to document first in terms of what am I gonna get the widest ROI on. Like writing down what one person does in the back office that’s been with you 20 years and isn’t going anywhere is less of an urgency than writing down something that everyone needs to know how to do consistently.

Cheng-Huai Ruan, M.D.

Right. And by the way, ROI is return on investment for those who are wondering. And so you’re obviously investing time as well as energy as well as money into it and so you have to know what that return actually looks like and the ROI is just important picture that a lot of people kinda neglect. But Chris, this is the problem and I think it’s really rampant amongst physicians is that, okay, there’s a doctor’s mindset and that doctor’s mindset is, I’m gonna take care of you no matter what, right? If you bring that doctor’s mindset into business setting and say, I’m gonna take care of you no matter what is sub constantly turns into, I don’t wanna overwhelm you with more work, therefore I will take it on on my own. Right? So tell me what you think about that.

Chris Ronzio

I think it’s empathetic first of all, and that empathy is a great baseline to build a great culture with your business. So the fact that that exists is a good thing, but you’re not doing anyone any favors by doing all their work for them. If you’re having to step in and do someone else’s job, then chances are you don’t have really clear cut roles and responsibilities or you haven’t given your team members clear priorities on what they should be focusing on. And so we do this responsibilities audit all the time, like every quarter at Trainual. And what I recommend every single person in the company does is they just take us a current snapshot of everything they do. And so I can run through this really quick for it’s a quick exercise if it’s helpful for everyone, you wanna to go through it?

Cheng-Huai Ruan, M.D.

Yeah, absolutely.

Chris Ronzio

All right. So really simple like I said, just start with what’s top of mind, ask every person you have to just make a list of what they do, what they think they do every day, top of mind. Next, jog their memory with time periods. So say, write down everything you do on a daily basis, on a weekly basis, bi-weekly, monthly, they might start thinking of reports they run or meetings they have, or other things that just have that time-based cadence to them. The next thing is for anyone that uses email or communication tools like that, I ask them to go back through their last two weeks of sent email. So very specific trick here but a lot of people get junk in their inboxes and if you look at your sent email, it shows you what you actually engage with, is the stuff you forwarded to someone else for them to answer, it’s replies you’ve given someone, it’s outgoing messages you’ve sent. 

And so you can capture a lot of responsibilities in that. And then you look at your calendar or your EMR system or your task system, any other place that you’re capturing work that you do. And again, it’s just jogging your memory. And so if you ask every person in the office to do this, you’ll end up with hundreds and hundreds of little micro responsibilities and it provides such an amazing snapshot for each person to say, here’s what I love doing, here’s what I don’t like doing, here’s what I wish someone else could do if we’re gonna hire another person and you start to do this role planning that is really a helpful exercise for any business owner to make sure that you put people in the right seat so that they’re doing a job that they’re actually gonna love and wanna stay with you and keep doing.

Cheng-Huai Ruan, M.D.

Yeah. And the audit actually lets you know ’cause we do this on a monthly, whether two or more people have the same job and I feel like if there’s two people with responsibility on one thing it gets missed. And so I think that it allows us to build a handoff and we actually use that through Trainual actually.

Chris Ronzio

Yeah. So you can find things that multiple people think, oh, they’ll get it and so no one does it, right. It slips through the cracks, but then you can also find things that multiple people do and they do it in consistently and you can say, “Wow, let’s get our heads together and write down a consistent way to do that because this person does it way better than this person.”

Cheng-Huai Ruan, M.D.

Right. Right. Yeah. Best practices. Absolutely. And even within multiple physicians in the same practice, some physicians are documenting one way within the EMR and another physician another way. And I always learn from my colleagues and they’ve learned from me of the best practices and it becomes a very valuable thing and whatever we decide on we’ve put it into playbook. Until someone else finds a better strategy or fastest strategy and then we’ll replace it.

Chris Ronzio

And that’s it. So I wanna stop right there because what you just said means that you’ve built this into your culture. A lot of people think that making a playbook, writing down SOP, standard operating procedures is a one-time project. Like, “I’m gonna do this, I’m gonna get off my plate.” That’s not the case because unless your business is never going to change again you won’t have a static playbook. If your practice is always changing and evolving and finding new and better ways to do things, then you’ve got to update what you wrote down or what you recorded. And so it’s something that is a cultural change, but it amazing that you said that, so I just had to point it out.

Cheng-Huai Ruan, M.D.

Oh, thanks a lot. I appreciate that. But with all these changes we have to make sure everyone’s on the same page as well, right, and without a playbook it’s near impossible to do so. And it’s like having a meeting with everyone expecting one to know but half the people are are missing. Right. And people will have to rely on secondhand storytelling, which I actually find that a lot of medical practices, that’s exactly how they train everything and they’ve been doing that for decades

Chris Ronzio

Yeah. Like that game of telephone. When I started Trainual, the name like you alluded to came from training and manual. And so you can write down a manual, but if you don’t put any effort into training then you have no accountability to know that everyone actually got it and understands it and acknowledged it and signed off on it. And so it’s definitely two halves of a coin, two sides of a coin where you need to document the thing, you need to write it down, but then just as important, you need to make sure the person on the other side understands it and acts on it as you intend.

Cheng-Huai Ruan, M.D.

Yeah. Absolutely. And so, I mean, as a leader and we go through these things and I used to populate the original playbook by myself, which was a terrible idea. But once other people got onto the systems and we had a culture, like I said, we built a culture where we recognize and appreciated the way that people do things very differently and rewarded people for having really clean processes and adopt that company on, it was such a big game changer for us. But speaking of leadership, like how do you not burn out as a leader, especially in businesses?

Chris Ronzio

Well, geez, that’s a loaded question. So I’ll answer it a couple ways. I think the first way you don’t burn out is I preschedule a ton of vacations and family time. And so the beginning of the year I do my entire calendar for the whole year where I put the vacations and the time off on the calendar first. And I just have random free days that I’ll book for long weekends, it doesn’t mean that I’ve booked some travel I’m going somewhere, but I have days throughout the year that are pre-booked because then life fills in around those days. And so I think it’s a simple trick but it’s one that everyone can do to just put those days on the calendar and then you don’t get to the end of the year or the end of the month and say, “Oh, I didn’t take any time off.” So I have those preloaded. 

Let’s see, I have another trick which is a second cell phone, so I turn off my work cell phone and use the other one when I wanna disconnect and the only people that have the number are my family and our chief of staff, if there’s some emergency. So I like that one. But really it’s just holding yourself accountable to not burning out, not building a business that requires you to burn out, again, you write the rules. And so if you accept commitments that you know are gonna require working late hours, working on weekends, that’s your fault for accepting that commitment. So you have to kind of prioritize and say, “How much can I get into a normal work week? That’s how much I’m gonna do.”

Cheng-Huai Ruan, M.D.

Yeah. Call the non-negotiables, right. You set your non-negotiables at the beginning of the year, set that time for yourself and for your family and it’s something that most physicians neglect to do ’cause we’re not taught that way.

Chris Ronzio

Yes. So that’s simple time management kind of stuff, but I think the next big thing is hiring incredible people because as my business has grown I’ve brought in leaders that are specialists in the different areas of the business and they know so much more about it than I do. And so then my role becomes just guiding them and coaching them, but there aren’t those burning fires that pop up because we’ve got this lineup of firefighters that would put it out before it gets to me. And so I think as you build a business you wanna put that lineup in front of you so that anything you’re dealing with is really the biggest most urgent problems.

Cheng-Huai Ruan, M.D.

Yeah. And it’s building trust and the culture within the company to not just find those great people but manicure those great people into people that are even greater than themselves and that’s what really challenges team culture. I can’t remember what book it was, but it was talking about a perfect company culture has nothing to do with bringing docs to work but executing at the highest level so that everyone’s on the same page.

Chris Ronzio

Yeah. I love that. Yeah. And we could talk I’m sure the whole time about culture, but we do things over here. Like again, these responsibility audits which get baked into scorecards and everybody should have a very clear sense of their current roles and responsibilities, everybody should have a clear sense of what their next promotion is or their next title and whatever professional development they have to do to get there. What’s is their path at the company? And I think if you can articulate that and be consistent about having those conversations, then you’re building a culture where people know there’s room for growth. And if they start to question whether they can grow with the business, that’s another reason for turnover to spike because people are looking for that opportunity elsewhere.

Cheng-Huai Ruan, M.D.

Yeah, absolutely. So I wanna shift the focus to your company now, Trainual which has been with me since the very start when I started the practice since 2017 at Texas Center for Lifestyle Medicine. And it was such a simple concept when one of my friends introduced me to Trainual. So can you just tell me a little bit background about your company, how did you found it, and then where is it as today?

Chris Ronzio

Yeah, sure. So my first business I mentioned before was a video production company, we did youth sporting events in all 50 states across the U S and as I was growing that business as first a kid, and then through college, and then as an adult. We set up three offices, we had hundreds of camera operators and sales reps and basically it was a logistics company. And our success came down to can we do hundreds of events around the country consistently and look and feel like the same brand? And so I got so passionate about standard operating procedures and process and technology and we kinda hacked together this system of training our people remotely, but that started to create the building blocks for Trainual. 

So I sold that business, started a consulting firm just to kinda help other business owners, entrepreneurs, physicians, kinda across industries on how to build their business, how to build their practice. And I saw across the board everyone wanted this turnkey kind of business where everything just works and somebody can come off the street and learn how to do it and they don’t feel like the whole business depends on them. And that’s where the playbook concept emerged. So it started at Trainual, the software started as a prototype inside my consulting business, ran it with a few dozen clients until it was really proving value and then it spun it off as its own company. So Trainual, the software company started in 2018, which you got in before which we were just talking about is pretty cool that you found it when very few had. So we’ve been around formally as a business for almost four years now and thousands and thousands of clients, hundreds of thousands of people using the product and 177 countries around the world right now, we’ve got a team of almost 70 here at the office and it’s been a fun story.

Cheng-Huai Ruan, M.D.

Well, that’s awesome. And one of the things I noticed on the Trainual was when I log in is that there’s actually templates from other people’s businesses that can be shared. Right?

Chris Ronzio

Yeah. So we built this template library because there were things we saw almost universal across businesses. Like everybody does an orientation, everyone has some kind of handbook, everyone has some form of a sales process. And so we created like these guiding templates that is at least a shell that you can modify and customize for your business. And so we have a bunch of those in the system. And then over time, we’ve given some of our consultants, certified consultants the ability to submit templates and now customers can submit templates if they wanna look like an expert.

Cheng-Huai Ruan, M.D.

So yeah, we can just share and then gather businesses ideas and playbooks and see what the best practices are on everyone, which is really cool.

Chris Ronzio

Yeah. I’d love that.

Cheng-Huai Ruan, M.D.

And so I just wanna share my story with Texas Center for Lifestyle Medicine, so everything that we do is on Trainual, like every tiny little thing. But it’s so cool because we would have processes that we forget about and now we’ll go back and say, “Oh yeah, we already did this and this is great.” It’s nice surprise sometimes of how deep and intricate we actually get, but once it’s documented, it’s in there, I mean, it stays in there and we can have people kinda signed to it as well. And it’s been such a game changer for us. So Chris, tell me how can people find Trainual, how can people find you?

Chris Ronzio

Yeah. So Trainual is just trainual.com, T-R-A-I-N-U-A-l.com. You can check it out and try the software for free, no credit card required or anything. You can find me at chrisronzio.com or on LinkedIn, Instagram, YouTube, all the places I hang out.

Cheng-Huai Ruan, M.D.

Oh, that’s great. And the link is it with a description of this video, just go ahead and click on it and go check it out. It’s something that it’s risk-free, just go and do it, go into the system, check out some of their templates which is actually really cool ’cause I had a lot of fun doing that and also play around with it and start documenting the processes and start working on these things. And Trainual is just one of the tools in my practice is actually a fundamental tool of what we use, not just for training but part of team culture, part of execution and part of business planning for one year goal, three year goal and five-year goal and it’s been an absolute game changer for us. So Chris, thank you so much, I really appreciate you coming on tonight. I appreciate it.

Chris Ronzio

Thank you for having me. This was fun.

Cheng-Huai Ruan, M.D.

Yeah. And if you are a physician out there and you’re having trouble with your systems and documentations, go ahead and click on that link with this video. Go sign up, you won’t regret it, trust me. Thank you, everyone.