Create The Perfect Winning Culture In Your Business​​

Thomas McCarthy

Yeah, Cheng, it’s great to be with you. Ever since I met you a year and a half or two years ago, you’ve been a very important part of my life. So it really is great to be with you today.

Cheng-Huai Ruan, M.D.

Likewise, thank you so much. And I can’t wait for our doctors to actually hear you speak because I think we’re so used to hearing other doctors’ perspective, but I think you are a high performance coach. And I think we’re all high performers as physicians just naturally speaking. Otherwise, we wouldn’t have really gone into this.

Thomas McCarthy

Right.

Cheng-Huai Ruan, M.D.

But you work with the top notch people who have scaled, who have really understood what it takes to team build and everything like that and that’s what we really wanna get into. So let me ask you this. Why is it that whenever we talk about team building, it creates so much anxiety for a lot of people wanting to do it and not only that, when they try to do it, even a most small amount of failure makes us almost cower in fear. What is that feeling from?

Thomas McCarthy

Yeah, you know you mentioned a couple of statistics earlier when we were talking about the stress and the burnout that physicians face. And they didn’t come into their jobs or their roles, they didn’t go to medical school to try and have to manage a team. They wanted to heal people and then managing a team comes with the territory a little bit. And that’s just more added stress. They’re already under a lot of pressure trying to take care of people that aren’t well and get them well or keep people healthy. And now you’ve got this human dynamic component where everybody’s coming in that’s working there and they’re bringing in their own issues into the practice and the physician has to make sense of it all. So culture is really important. And there’s a couple things we can talk about today. One is how do you create that winning culture, a culture that makes your job more fun as a physician, that it just is people are more engaged, they enjoy being at work more for the physician, it just is enjoyable? And that’s what I hope we can delve into today.

Cheng-Huai Ruan, M.D.

Yeah, absolutely because honestly most medical practices when we talk about statistics, most medical practices when they hire someone, they only keep a new hire like a medical assistant for about 3 1/2 months. And that’s where the turnover is. And the turnover is massively high. And that’s why you got 46% of physicians burnt out, seven days a week and if you talk about four days or more per week, it’s over 86%. And this is the study that was done at Mayo Clinic. And so here’s the thing. I think that when we as physicians get very narrowly focused as doing the things that we’re trained to do and we wanna develop things for ourself, allow creativity, here’s something that you may not know, Tom, is that when we become a doctor, we’re taught you should only do the standard of care, don’t go outside of it. And that’s the way we actually practice medicine, don’t go outside the guidelines. But from a leadership perspective, creative perspective, it seems to be the opposite. At least, that’s what I experienced. Do you agree with that?

Thomas McCarthy

Yeah, look, with leadership, when you talk about people coming into a practice and only staying 3 1/2 months and then you gotta hire somebody else, that is frickin stressful. That really is gonna stress anybody out, especially if that person was really a talented person that you would’ve wanted to keep later or longer. So I think that one thing or couple things for people to think about as doctors and creating a culture, when you hire somebody you want two things. Number one, you want competency. You want people to be whether it’s a physician assistant or whatever role, the secretary even, you want someone to be very, very competent. You’re not gonna function well if they don’t have competence. But you want something else too. You want them to fit into the culture. You want them to embody the values or the principles that you have as part of your practice. Now, here’s the problem. 

Most physicians, most practices, heck, most companies that I work with haven’t thought through their culture. They don’t really know what it is. I ask them do you have a culture, they go, “Yeah, we got a culture.” Well, what is it? “I don’t know.” And maybe even years ago, they put together six values and they stuck them on a wall, but I’ll ask them, hey, what are your values? And they go… They wanna look at it, but they know that would be silly. They don’t really know what the culture is. So one of the things I think would be important for practices to do and really any business, I literally just got back from San Francisco last night and I was up there working with a part of a company called Salesforce and we defined their culture. This large group within Salesforce, we put together their culture in about a day. But the way I like to do it is you have three statements that embody the behaviors that you want from people that are gonna be part of your culture. And then you measure those. Once you’re clear on what the culture is, you can measure it. So this assistant that’s coming in… What role did you say only lasts 3 1/2 months?

Cheng-Huai Ruan, M.D.

Medical assistant, medical assistant.

Thomas McCarthy

Yeah, so this medical assistant that’s only lasting 3 1/2 months, and let’s say that they’re an A player, they’re very competent and they’ve got a lot of talent, what if there were a culture that when they came into it, they could see it, they could feel it, they could experience it, they could fall in love with it? They wouldn’t stay 3 1/2 months. They would stay a heck of a lot longer. And you know what? They wouldn’t even leave if someone offered them a couple bucks more an hour. If the culture is strong enough, it keeps people engaged and it’s so much more fun for the leadership, for the physician and the physicians have to be leaders. Everyone’s looking up to them, so they have to embrace leadership.

Cheng-Huai Ruan, M.D.

Yeah, that’s a great point. And I’ll tell you, I experienced that firsthand is that when we first started, we had relatively high turnover because there wasn’t really a culture that was stated. And I thought just like most other physicians when you first start out that, hey, when you start a medical practice, my job is to save lives and help patients and that should be just the culture, but that’s not necessarily the culture. That’s just job description. And so when we started defining what our core values are, what our cultures are, people started buying into the process. And I’ll tell you, I’m really emotionally proud of my team because we went through some hard times during COVID last year. And last year at this time was not a pleasant time. And we had a group, a third of my team said that, “Listen, Dr. Ruan, we wanna do what’s best for the company. “We pooled our money together and actually we’ll work “for free for the next three months if you wanna do this.” And then I just started bawling my eyes out. I’m like, this is such a great family to have. And then a week later, we got the PPP and we didn’t have to do that. So thank all the energies out there. But I experienced that firsthand. It was very transformative. I will never forget that moment for the rest of my life. And I’m gonna tear up even talking about it. But I think that’s the culture that I experienced and I just don’t wanna let go of that.

Thomas McCarthy

Yeah, well, no, you’ve done an amazing job. And first of all, you have a huge heart. You are a true physician, not just in the academic sense or the scientific sense, but with the emotions that you have and the confidence you bring and just your love for humanity and other human beings. And that also is what you have for your team. And no doubt that they would want to be part of it and even forgo their salaries to make your clinic continue to survive when it looked a little iffy. But that’s what a great culture looks like, Cheng. You’ve accomplished it there.

Cheng-Huai Ruan, M.D.

I think it was by accident because I didn’t really know what I was doing at first. But let’s talk about this for a second ’cause I don’t want myself to be a unicorn case ’cause I’m not. So what are really the attributes of having a winning culture and winning team members? What are they really like?

Thomas McCarthy

Yeah, so I like to imagine the nine block. So nine block, you’ve got an x-axis, a y-axis. On the y-axis, we measure competence. So I’m gonna go from my left to right, maybe it might be different for you, but you evaluate people in any role. So it could be the receptionist, the medical assistant, the lab technician. Whatever role they’re playing, they’re gonna have different skill sets but some are not very good, they’re low performers. Some are mixed, they have their good days, they have their days not so good. And then some are high performers. Now obviously, you want a culture that would attract and retain and keep a high performer, like the Tom Brady. At his position, he’s been a high performer for a long time. The Patriots didn’t keep him and he went and won another Super Bowl with Tampa. But you wanna evaluate where is somebody on the performance. And that’s what most people do. 

That’s typically all they do. All right, is this person doing the job, yes or no? What we do as I mentioned earlier is we add another measurement tool and that is the y-axis where we’re measuring alignment with culture. Some people and we’ll start down at the bottom left, they don’t align with your culture. They walk in and the whole energy leaves the room, like it’s just a bad vibe. And then some people kind of do, they kind of don’t. We call that mixed. And then you have people that align with your culture. So ideally, the best practices, the best companies, the best teams are stockpiling people on their team that are high, so we’re gonna go up a right-hand corner, they’re high performers and they fit your culture. And then the other people that we’re willing to take on because also as a leader, you wanna be a coach. So you’re trying to move them over. So the other level is that block right to the left. 

So the upper right block is high performance, high culture. And then right next to it is high culture, mixed performance. That person might need a little more experience, some coaching on how to do their role, but they’ve got potential to be in that high level. Now, are we asking everybody to have the same skill set? No, because the performance metric, you’re gonna have a different skill set than your medical assistant as the physician. So you figure out what those are, you make sure you get high performance. Here’s what we don’t wanna have. We don’t wanna have someone who’s really a nice person, fits into our culture but can’t get the job done. That’ll kill a practice. The other thing that could potentially kill a practice though unfortunately is someone who’s really skilled at what they do but they’re, I hate to use this term, but they’re like a chronic disease or a cancer in terms of what they bring every day in terms of energy and alignment with culture. Now, the thing that you have to do though, Cheng, is you don’t wanna say, all right, you’re a good fit for my culture, you’re a good fit for my culture, you’re not. And then they ask you why and you go, I don’t know, it just feels like you’re a good fit. I just don’t really like that person’s energy. 

That’s not fair. So what I work with teams to do is to say, all right, what are the behaviors you want everybody to have? And they could say things like be constant learners, creative, focused, gritty, can work through things, courageous, whatever they are. And then we take all these behaviors and then we try and compile them and say, all right, you said gritty and then we also have determined. Are those kind of the same things? And then we start lumping them together. And what I like to come up with at the end of the session is three I’d call them mantra statements. A mantra is something you repeat over and over again, everybody knows it. So three mantra statements that call out the most important behaviors that make us unique as a culture. And so then we create those. And we like them to be kind of quirky. So not like the standard we work hard. Okay, great. Come on, let’s come up with something more unique and different. And that’s what we just did with Salesforce. And we’ve done a ton of these with different companies and I think practices can do the same. And when it’s quirky enough, people remember it. And they also take pride in it. 

Yeah, that’s us. This Salesforce group, one of the ones I remember that they put together, and this may or may not work in anyone else’s practice, but they had one of their statements was we play with our hands free. Now, what does that mean? See, it’s quirky enough for you to go, what does that mean? Oh, let me tell you what it means. And what it meant was one of the leaders had that as one of their statements and the whole team adopted it, but you know when you’re tight and you’re just trying not to make a mistake and you’re trying to be too perfect, which maybe in the medical field, that is what you want, I don’t know, but they’re sellers. They’re selling Salesforce software. And then they’re too tight and they’re going into a client meeting, they’re not natural, they’re not creative, they lose their mojo. And so this person’s like, hey, we play with our hands free. And if you’re gonna make a little mistake, it’s okay. Again, probably not right for a medical practice, but if you’re gonna make a mistake, make it early so you figure out what it is so you can now try something else. 

Maybe it is right, like if you’re trying to heal somebody, let’s figure out what doesn’t work quick so that we can get to the next thing. So that’s just one idea a little statement where now everybody, look, we’re gonna play with our hands free. Now, the last thing I’ll say, and I know I’ve been talking a long time, when you create a culture, you’re not trying to create it for the masses. You don’t want every medical assistant to go, yes, that’s right for me. You want some of them to go, no, I don’t want that. That’s not the kind of culture I want. So there’s some people that don’t wanna play with their hands free. They wanna be dictated and told what to do every single minute, but that team doesn’t want those people. They can go somewhere else. They want people that wanna play with their hands free, that wanna be creative and curious.

Cheng-Huai Ruan, M.D.

I can’t think of a better term, playing with our hands free. And so but what you said earlier was absolutely true even for medical professionals because yes, we gotta have room for some play here, even in practicing medicine because it’s still called practicing medicine. And even from surgeons and stuff like that, a lot of the interactions, we have to have some play here and we have to focus on the things that we desire in our culture. So today for example, once a month, we have a culture day. I call it our grand rounds day. And we put out the six human needs of how we communicate with ourselves, between ourselves, our family and our patients. And we had a lot of emotional conversations behind it, but that’s part of our culture is that we wanna be unapologetically us but connected at the same time.

Thomas McCarthy

I love that.

Cheng-Huai Ruan, M.D.

And that’s the way that I’ve always been. But I also appreciate ’cause I have another friend who’s in private practice, it’s not like that at all. But that’s okay because he has his own set of cultures that’s allocated to him and that’s totally fine. So when he asks me, “Hey, do you know of any good medical assistants to hire?” I was like, well, first of all, we are two very different leaders.

Thomas McCarthy

Yeah, yeah.

Cheng-Huai Ruan, M.D.

Yeah, what I think is good may not be necessarily good for you. So I wanted to warn that for a second. But is there a structured stage that companies or teams go through to ultimately becoming that high performer or is it just random?

Thomas McCarthy

Yeah, so I think creating the culture is the foundational step. Culture and strategy, start with that. Then you do what I call surround yourself with winners. And a winner is someone who does, again just that little nine block, you can draw one out. You can even evaluate your own team right now. As long as you have the culture clearly defined, you don’t wanna make it random where you’re judging them and they don’t even know what you’re expecting. But surrounding yourself with winners is critical. Think of somebody that’s not embracing your culture showing up to work every day. They’re literally draining the rest of the team and probably you too. So you surround yourself with winners. And then assuming you’ve got winners, now you come to this what we call our third step, which is you mold the people you have into a winning team. 

Now, even though they’re winners, they might not be a team yet. And so there’s four stages that teams go through. And this is important to know because sometimes you’re not in that high performing stage and you feel like you’re failing. You’re not, it’s just growing through the progressions. So the first stage is the forming stage. And actually teams come back to the forming stage quite often because any time, even if you’re a high performing team, if you hire some new assistant or a new doctor to come into the practice, you now have a new team. It’s not the same team. You go, well, no, it’s pretty much, just one new person. It’s different. Everybody has to get acclimated for it to be a team. So the forming stage is where we’re learning the guidelines, we’re learning the culture. It’s like you’re getting ready to have a new baby soon and what I use the example is the first day of school and first grade. 

People are showing up. It’s like, okay, what do we do here? And the teacher’s waiting for them and some are really excited, some are scared, some are clinging to their mom and everyone’s gonna have to learn. It’s just we’re forming up, we’re creating something new. And the next stage is actually progress, but it doesn’t seem like it. So the next stage after you form up, now you storm. There’s some disagreements. Why do we have to do it that way? The other place I worked in did it a completely different way. And so there’s bashing up against each other. It doesn’t have to be brutal, but it’s uncomfortable. Guess what? That is a perfect stage for growth. And actually if done right, it can elevate everybody. Think of the best ideas you’ve ever had. I know my best ones are not ones that originated within me. An idea might have originated but then I talked with you or I talked to someone else and you give me an idea that bashes into mine, like whoa, okay, what’s going on here? And then I have to figure it out. And that’s what storming does, that’s that second stage. And then the most dangerous stage, so forming, storming, storming doesn’t feel too good. 

It’s like the kids in first grade, they’re talking and they get lectured to and it’s like, whoa, or they get in trouble or they have to sit in the corner. And so it’s a little uncomfortable for the teacher and for the kids, but it’s how we learn and how we grow. And then the third stage I think is the most dangerous stage. It’s called norming where you get out of storming, yeah, and you get comfortable with everybody. You go, hey, we made it! This is high performance, but it’s not. It’s a trick. You’ve just normed out. You’ve just settled down and there’s a whole nother level of performance, it’s called the performing stage, but most teams unfortunately they think they’ve made it, they settle in, the leader doesn’t push for more or encourage more and so they just stay there. The best leaders will challenge people, not in a mean way, not in a discouraging way, but in a way that we’ve got more in us, let’s go for even more. And it’s funny, I play a little game sometimes with people where I get a little ball and we gather them in a circle and I go, hey, everybody’s gotta pass the ball from one person to the next, you only get to pass it once. 

This is a good game to play with your team, by the way. You only get to pass it once, you only get to receive it once and you can’t pass to someone standing right to the right of you or to the left of you. So they come up with a little… They get together and they talk and they go, okay, let’s do it this way and they pass it around. And let’s say there’s 10 people and they do it in 12 seconds and they think they’ve done a great job. And I go, all right, hey, great job. And sometimes I even create competitions. I’ll do two groups and all right, who’s the fastest? And someone will do it in 12 and someone does it in 10 and the 10 are like, yeah! And they’re all part of the same team, but they’re so proud of themselves. I go okay, great job. Hey, now, do it in five seconds. They go, what, five seconds? Come on, we just did it in 10 and we worked really hard. And so now what do they do? They go in there and they storm ’cause I don’t wanna let them just storm. They storm, they go and try. No, that won’t work, try it this way. And then eventually what happens, they come up with a way and they get to five seconds. And now they think, pshaw, world record, five seconds. Come on, how can anyone do it any quicker? The reality is I’ve groups do it in about one second because I keep pushing them. And that’s what you have to do is you have to keep breaking the paradigm for people to get to high performing and stay at high performing. But that’s the ultimate level of having a team.

Cheng-Huai Ruan, M.D.

This is so counterintuitive because you said norming is a dangerous stage where you come into, hey, we made it is normalcy. I feel that we’re all trying to get to this norming stage. And it’s very interesting that you’re saying that a good leader challenges people in normalcy. Like I said, to me, it’s very counterintuitive. And maybe it’s counterintuitive because that’s the way I was taught within through medicine. Let’s rewind for a second ’cause when you start forming and then you start the growth process and people start butting heads, you said that could be a very constructive stage. I feel like I fear it because of so many conflicts. Just walk me through, how can that stage actually be constructive to go to further?

Thomas McCarthy

Yeah, now, if it’s mass conflict, that’s different. But we’re talking about somebody maybe challenging a rule. Let’s take that example first of all. So somebody challenges a rule or challenges our culture. If we just go, oh, no, it’s okay, it’s okay, don’t worry about it, you can just settle down here, all the sudden, you don’t really have a culture. But if it’s like, hey, why do we have to do it this way or why do I have to be nice to my team members? Something like that, why do I have to be a good person? I get the job done, why do I have to do that? So that’s a form of storming. I said, well, because it’s more than getting the job done here. We can get people to get the job done. And there’s lots of people who can get the job done. 

We also wanna have a camaraderie, we wanna have an energy, we wanna be around people we like to work with and we wanna be inspired by team members. And so a couple things happen there. This person can go, okay, well, that makes a lot of sense. They may embrace it, they may not. And you might have to move them out of the business. So that storming stage, what happens though, the benefit of that happening is that everybody sees the culture being challenged and they see how you reacted to it. And you go, wait a minute, wait a minute, no, no, no, no. This person doesn’t have to be nice ’cause they’re really good at what they do. We’re gonna let them not be nice. Everyone else be nice, not them. You have no culture when you do that. So even just that example of the storming created a learning and awareness. It maybe caused a tough decision ’cause you might be going, that would be a hard person to lose. Maybe that role is hard to find. But guess what else is hard to find? Losing a bunch of other people because you keep this person onboard and their behavior just drives people away. No one wants to be around bad energy. Also, the other thing I would say is just as a physician, whatever your culture is, the number one indicator of whether it’s a strong culture or not is your behavior. Do you live up to it? Do you embrace it? That’s gonna be really important.

Cheng-Huai Ruan, M.D.

Yeah, that’s a hard one for me because I think as I developed the company, I realized that I’ve learned so much about myself and the qualities that I have within me, which before I saw them as a weakness, they were just growing pains I think. And as physicians, this is what happens with physicians. So we come from a very structured setting, elementary school, middle school, high school, college, medical school, residency, fellowship and then you’re done. And all of a sudden, we’re left with a completely disarray of a lack of structure. And so what happens, a huge population of people who finish end up being in academia, which is continue the same structure but not everyone likes that structure. So there’s some people like myself who veer off and do our own thing. And the minute we do our own thing, all of a sudden, all the things I value before, which is accelerate through academia, no longer apply because it’s a very lonely world. 

I’m just looking around myself. I’m like, this is such a lonely time to be because I am outside of the comfort zone. And not only that, there’s very few mentoring programs or people to walk a lot of people through this and a lot of the private practice docs are also burnt out as well. That’s where that tinge of hopelessness comes in. And so whenever we think culture, we think back to residency and fellowship and stuff like that. And to be honest with you, those cultures weren’t very good. Maybe some were, but majority of the people I talked to where it’s like there’s a lot of people who are in higher positions who are very bullying to the lower positions. We see it with charge nurses to regular nurses, from department heads to attendings and down to fellows. It’s like this jumping of brutality that exists and we think that’s a normal thing within our culture. So we have to complete change a mindset, does that make sense?

Thomas McCarthy

Yeah, it does and I think that’s probably one of the most dangerous aspects of being a physician. You’re supposed to be this leader, you’re supposed to make great decisions and a lot of people think that comes with I need to have a big ego, I need to always be right, I need to be on this pedestal above everybody else. And number one, it’s not that reassuring to or not as reassuring to a patient because they don’t really feel your heart. As a leader too, people will maybe do what you want them to do, but they’re doing more out of fear. They’re not doing it out of wanting and caring for you. And one of the things another part of my Leading Winning Teams model is you have to be the CEO of your team. 

Now, a lot of people go, CEO, chief executive officer. Yeah, that’s my title of my practice. But I’m not talking about that. I’m talking about their chief emotional officer, their chief energy officer, their chief engagement officer. So it’s actually CEO to the third power. And I have someone on my team that just pinged me today, said, hey, can I talk to you over the weekend on a personal matter? Now, do I want to do it? Not really, it’s my weekend. But am I gonna do it? Hell yeah, I’m gonna do it. This person’s got something where they need some help, I don’t know exactly what’s happening for them, but I’m gonna go and take that time to do that. And then you just spot when you come into your practice, you wanna be noticing. I mean, we’re healing everybody else. People come in with wounds, people come in with ailing family members or somebody treated them poorly in a relationship. Now, I’m not saying we have to be there every minute of the day for them, but a kind word or a question and do you need anything? Things like that as a CEO just being able to spot through body language, through the way they’re talking who needs to have their story changed, who needs to be picked up a little bit. These are all things that are really important.

Cheng-Huai Ruan, M.D.

Yeah, no, absolutely, so speaking of CEO because I made the mistake earlier on, like just most physicians do as well that because I’m deficient in this part of whether it’s business or management and stuff like that, I’m just gonna cover it up by hiring these people and I’m just gonna let them do their thing. I realized that was a mistake. And then when I corrected the mistake, things became better. So I feel like there’s a lot of things that doctors delegate to outside people or maybe hire into positions, but then they don’t act into that CEO role. So what do you think are some things that CEOs or leaders should not delegate?

Thomas McCarthy

Should not delegate, well, listen, I’m a big proponent of delegation. And when you delegate though, you wanna have somebody that embodies the culture, that will be a co-CEO or a sub-CEO for you. But there’s things like… Well, if you look at what inspires people to stay engaged, Gallup did a survey quite some time ago and they came up with some reasons why people disengage. So in an average company, average team, probably average practice, you’ve got about two people working in the practice that are engaged, that are into their work, that are doing their best for every one that is disengaged. So two to one, yeah, two to one. Actually, let me make sure I’m getting the numbers right. 

So yeah, two to one and actually two to one might be… Two to one I think… Oh yeah, two, excuse me, two to one is the average. Peak performing teams, 10 to one, 10 people engage for every one person that’s pulling the team away. Now, why do people stay engaged and why do people disengage? Well, one of the things, I’ll just give you a couple. One of them is positive feedback. So the average leader doesn’t give enough positive feedback or encouragement. I’d call it feedback or encouragement ’cause sometimes they didn’t do anything great, but just like, hey, I know you got this, right? You’re built for this, things like that. The average person probably, the average leader probably does maybe does one to one. 

There was actually a study that was done at a company, Pacific Care. I think they’ve now been absorbed by United Health. But I was working with them and we took the top 10% of leaders in that organization in a big department there and we just looked at them versus the bottom 25% and we said, what are the differences? And one was in their feedback. The bottom leaders were basically one to one. For every constructive or negative thing they said, they put out a positive or just some sort of positive feedback or encouragement. And the top leaders though were four to one. They would walk in and they would notice someone doing something and they would not just walk by and go to their office. They would say something. And they would say, hey, great job. How did you pull that off? That was amazing! Or maybe something someone did yesterday. The way you handled that patient that was really afraid, that could’ve been a clinic. What was your strategy there? And by the way, the one thing you wanna do whenever you give positive feedback, whether it’s to someone on your team or to your daughters in your case, Cheng, or anybody is notice what they did. Say great job, I love the way you did that. And then ask them, how did you do that? Why is asking them so powerful, why do you think?

Cheng-Huai Ruan, M.D.

Maybe it’s an open-ended question to entice thinking or why?

Thomas McCarthy

Yeah, they have to remember how they did it. So they’re gonna be more likely to do it again, plus that extra 30 seconds you spent there listening to how they did it just makes that positive feedback feel so much better to them. But positive feedback, you should be four to one. Well, how can I be four to one? How do I notice all the great stuff? Hey, some of it’s encouragement, but just be focused on going into your practice every day and what, you go, I’m an introvert, I’m not a real positive person. Well, you better change that or you’re gonna lose people. So just find people, just connect with them, even for two seconds and just light them up a little bit in the day. Another thing is asking for feedback. As a physician you’re used to being the one telling people what to do. And I’m not saying you’re dealing with a person with a really critical condition and you ask the receptionist, hey, what do you think we should do here? Not that type thing, but you can ask the receptionist, hey, what’s a better way to set up the waiting room, have any ideas on that? I’ve been thinking that we might try something different. I had a couple of ideas, but what do you think? ‘Cause when you ask people for their opinion, they’re now more bought in, they’re more engaged. And you can find little ways to do that throughout the day. Those are just a couple things you can do.

Cheng-Huai Ruan, M.D.

I think it’s massive. A four to one, that’s actually a really good place to start because that’s something I can track myself too. I do think I definitely need to encourage more. And I already do, but I think that it just needs to be more consistent basis. And I think I’m a big believer in track it and hack it. So definitely gonna stick to that four to one at least.

Thomas McCarthy

Now, I don’t know if people can track it. Here’s what I just tell people to do. Focus on getting more positives out. We’re all gonna have our own negatives. I don’t know what my ratio is. I did know when my son was growing up and I learned this. I’m like, man, I’m beating the heck out of this dude ’cause my son’s awesome but he would challenge me on everything and I’d just man up on him and this is the way we do it. And I wasn’t noticing any of the great stuff he did. I was just finding all the things that were irritating me and I just said, I gotta get a lot better. I gotta notice different things he’s doing really well and notice even the fact that he challenges me. Hey, I love the fact you challenge me and don’t accept everything. I don’t like it every single time you do it, but I like it sometimes.

Cheng-Huai Ruan, M.D.

Wow, yeah, so more positive than negative. So at least that gives me an idea in my head what I should be doing. But let’s talk about coronavirus for a second. A lot of things have changed since COVID, a lot of businesses, we had to pivot, a lot of practitioners. All of a sudden, a lot of the things that we learned before no longer apply. And so we had to switch to telemedicine, instead of patients coming into the office. We had to close off some of our service lines ’cause we absolutely have to because they’re more elective procedures, which is a huge revenue stream for a lot of doctors. And so how do you keep your team engaged in this time of pivot and crisis where it’s just chaos everywhere? How do you keep them engaged?

Thomas McCarthy

Well, a couple things. One is just the end goal, like letting people know why we’re going through this. I mean not why we’re going through it because of coronavirus, but why we’re making these changes and the ultimate end goal of where we wanna go to. The other thing I think that’s really important is just this is real life. This is people think that… I used to think that I had the fairytale existence. One day you make it. Maybe it was someone thinks one day I graduate from medical school or I open my practice and then I don’t have to work for anyone else and now it’s gonna be all great. No, no, no, it’s gonna be messy, you’re gonna get your hands dirty. I still remember when my best friend had a child before I got married. And so he and his wife, I was visiting them and I’m still this single guy, I’m 24 years old. And his wife and I are in this conversation and she’s changing a diaper. And as she’s changing the diaper, she got some poop on her hand. And I’m just in shock, like does she realize she’s got poop on her? And she’s just talking, she’s got poop on her hand. And I couldn’t believe, like, shouldn’t you be freaking out? You got poop on your hand. 

Now, two kids later, it’s like I’ve had poop all over. But life is you’re gonna get poop on your hands and no one knows it better than physicians. But it’s messy and the messiness is the beauty of it. One of my favorite things I teach people is there’s always an advantage. Well, what was the advantage of COVID happening and we had to do this and had to do that? Hey, happened in my business too. 98% of my business and the people that work for me were out around the world getting face-to-face with people. Guess what, now it’s 100% where… Well, not quite ’cause I’ve done a couple of live engagements recently, but it’s about 98%, we’re on a screen with people and we’re having our best year ever financially. We had to flip it really quick, but I saw that coming in because this is one of my philosophies. 

I said there’s an advantage here. We should’ve probably changed more of our business to virtual years ago. Many doctors should’ve probably embraced telemedicine years ago. You were on the cutting edge. You did a lot of these things already. You just let the coronavirus accelerate your change, but medicine’s gonna continue to change. And I don’t know all the rules and laws and reimbursements and different things, but I know you’re doing this summit because medicine will continue to change. You’re trying to help people get ahead of that change, be the people that are benefiting from being first in line when change happens. And I think that’s gotta be the way you run your practice, though. That’s the way I run my business, even though coronavirus showed me I wasn’t doing it quick enough. And that’s the way that the best people run even the big companies. They have a saying that if it ain’t broke, break it. Break it just on purpose ’cause I tell people you will either disrupt or you will be disrupted. I don’t wanna be disrupted. I wanna be the one disrupting. And I don’t need to disrupt other people, but disrupting my own processes, my own thoughts, my own thinking so I can be on the forefront of improving without needing a kick in the butt to get me to do it.

Cheng-Huai Ruan, M.D.

Yeah, so true because it’s crazy to think about last year and what happened and how much trauma I thought I was gonna endure. But we also had our most profitable year.

Thomas McCarthy

I know you did. You had an amazing year. I’m proud of you.

Cheng-Huai Ruan, M.D.

Even without counting the money from the PPP and stuff like that. And it’s because what I learned and that blew my mind, I didn’t know why I didn’t think of this before. It’s not about revenue generating, it’s about how much you keep at the end. And what we were able to do is we were able to lean down, cut out and trim out the fat. We went from three locations to one location. That one location was too big. We went from even to a smaller location. And all of the sudden, our profitability doubled.

Thomas McCarthy

Nice.

Cheng-Huai Ruan, M.D.

Yeah, but our culture became better and we have this massive bond that came from it. So I’m very proud to say that my team and I, we truly blossomed from this situation that were seemingly very, very bad at the very beginning. And yes, we had a lot of help and then we had the engagement. We also had the engagement of our patients too. And I really have to thank my team for that because we have such a strong culture and communication connection with the patients as well. So it’s really this massive effort, but you’re right. I should’ve done this years ago. I should’ve trimmed the fat years ago and I don’t know why I didn’t. So even though our team’s a little bit smaller, our profitability is double, but that allows me to be more creative in thinking what’s next. And that’s what this summit is. It’s all about what is next. For example, what coronavirus did is that it increased the adoptability of telemedicine in those people age 65 and over dramatically. So now you have marketed adoption of technology that wasn’t really there before. Now, finally more than 40% of age over 65 prefer telemedicine because of the coronavirus. And that was less than 10% prior to coronavirus.

Thomas McCarthy

I prefer it. I don’t wanna have to go in an office and wait and I’d rather be right here on an appointment, yeah.

Cheng-Huai Ruan, M.D.

Well, Tom, you can’t be older than 27. You look pretty young. And so yeah, I think that that’s the lesson here. The lesson here is that out of challenges comes triumph and we just have to be resilient to do it. And from a leadership perspective, it’s crazy to think that you were in San Francisco in the gigantic Salesforce building talking to this massive company about exactly what we’re talking to right now, but it seems so congruent no matter the size of the company.

Thomas McCarthy

Yeah, I mean, an organization’s an organization. Your practice is a team like any other team. You go, well, we’re specific and yeah, you’ve got skill sets that are specific, but at the end of the day, you’re human beings. That’s what you are, you’re human beings. It’s human capital that every day has a choice to either come in and do a great job and help humanity and heal patients or they can come in and half ass it. You are in charge of that team and you’re in charge of who gets on that team, you’re in charge of the culture of that team and you have a big influence on the level of engagement of that team. You can be one of those practices like yours. And that’s why I’m so glad you’re doing this summit, Cheng, because you really do have a model practice, not only in profitability, but just in culture, in the vibe and you are the ultimate physician. You’ve got a huge heart, you’re incredibly smart and you combine those two things. It’s not just head, it’s head and heart. And I think the more that physician leaders understand that, embrace both those, you can be super smart and still care about human beings and help uplift them. It’s gonna lead to more profitability and a lot more fun. It’s just gonna be more fun to come into the office every day, the practice every day.

Cheng-Huai Ruan, M.D.

Tom, thank you for the kind words. It really means a lot coming from you. And I think I’m under this always constant, never ending improvement and it’s something that I truly value but I really want to appreciate what you’re saying, your validation, so thank you very much for that. What we really need to do and it’s exactly what we did on this talk is really come together across industries and say what are the most successful attributes of leaders and what really works because in the end, a lot of this is just psychiatry and psychology and moving people forward are in different stages and it seems to be very congruent even across industries. 

So we as physician leaders aren’t really, we’re special, but we’re not really that special in terms of uniqueness within our business model. Because I’ll tell you, most of the doctors that I talk to, especially the physician leaders that I talk to or physician practice owners, say, you know what? My business model is we’re at the mercy of the insurance company. So are roofing contractors. We’re at the mercy of our patients and stuff like that. I’m like, a lot of this is very similar, but we have to get outside of our head, get a little uncomfortable, see what’s across different industries and bring it together. And that’s why we have so many different types of people on this summit, like yourself, Tom. And so let me ask you this last question before we get off this. What is the most valuable lesson that you have learned recently that you wish you knew maybe 10 years ago?

Thomas McCarthy

Oh, that’s a good question. So just on a personal level and I probably did know it 10 years ago, but I wasn’t doing it. Now as I get older, I do realize that we have these stories of who we are from a lot of it’s from childhood. I’m great at math, I’m not great at this or I’m an extrovert, not an introvert. By the way, I’m an introvert, naturally. So a lot of my job is extrovert, just for those of you thinking that if you’re an introvert, you can’t communicate. And I learned how to do it. And so I think what one of the things that I’ve learned recently and maybe it’s around leadership is I’ve embraced it in the past, but even more now is vulnerability. And I know as a physician, that’s probably a little bit scary. I can’t be vulnerable, that’s weakness and I’ve gotta be strong, I’ve gotta face all these things and not get too attached to it. And I’m not talking about getting too attached to it, but I’m talking about going down underneath where you are. 

When you say all these people are burning out, that’s because they’re trapping all these emotions and not feeling them and not being human. And the body’s just not meant to do that. The mind’s not meant to do that. And so I’m probably speaking out of turn because people go, well, I know more than that on that topic than you do, but it is a passion of mine, so I do a lot of peak performance. And when people can go down in and see the pattern of the trapped emotion or the old memory they keep replaying over and over again and let go of it, as a leader, I was not a good leader when I started. I was actually bad, which is why I discovered, I started discovering what does it take to be a great leader. Because I was leading an organization when I was in my mid-20s and I realized, man, I do not know what the hell I’m doing. Now, here’s the good news. If you wanna be a better leader, you can be. You go, well, I’ve never been a leader before. I wasn’t the captain on my team. I wasn’t the president of my class in school. 

So what, you can be a leader. It’s something anybody can learn. You have to have a desire to do it. But here’s what I believe. You should have a desire to do it because you’ve got human beings every day that are showing up in your practice that are looking to be led. And the extent that you upgrade your leadership, you’re gonna have people and it’s not just what they do in your practice, you’re gonna have people that you influence a big portion of their life. Think about how much of their time they spend at work. And so for me, it’s a privilege to be a leader. The more vulnerable I become and vulnerable meaning, hey, I don’t know everything, I don’t have to know everything, I can keep learning. Just being okay with that, it’s made me a better leader. And so I think I just get better and better at that as I get older and don’t have to put any front or airs or anything like that.

Cheng-Huai Ruan, M.D.

Yeah, that hits really close to home, Tom, because I think the more vulnerable I get, the bigger the blossom becomes within my team as well. And it’s very counterintuitive ’cause I come from my family members are very stoic, don’t show any emotion, be very militaristic. And then when I tried the opposite of it, I got a lot of positive feedback. But from the leadership perspective, I think vulnerability is definitely needed within the physician environment. And physicians actually make terrible patients. Talk about doctors being actually someone else’s patient, the compliance of that other person telling the doctor is very, very… It’s almost close to zero. And so I think that we don’t necessarily advocate for ourselves a lot. 

We feel like we have to hold everything in, that we have to bottle it because that’s the way that we were trained in this hierarchical type of training system. But I just wanna really challenge the people who are listening to this is I wanna challenge you to just to be vulnerable, vulnerable with yourself, to be altruistic and also vulnerable with your families, and get vulnerable with your team as well and see what really happens. And what you might find is that there is a spark that comes with vulnerability that’s going to really ignite your chance to create something beautiful. So thank you, Tom, for saying that. Really appreciate that.

Thomas McCarthy

Fantastic, yeah, it’s been an honor being with you. And as I mentioned, you’re such a great friend and I’m so excited you’re doing this summit. You are a role model. I hope people will take what they learn from all the different speakers and particularly from watching and listening to you and they’re gonna have really successful practices if they do.

Cheng-Huai Ruan, M.D.

God, I hope so. Thank you so much, Tom, for being on. We’re gonna sign off right now. Tom McCarthy, everybody. Thank you very much.