How Business Culture Starts with Accountability w/ Mark Henderson Leary (2024)

Welcome to season 2 episode 58 of Baktari MD! In this episode  we are joined by Mark Henderson Leary where he speaks on how his system of keeping your team accountable, and building culture within your organization will bring you success! Have you ever thought about how healthcare organization and private practices thrive? All of the tips and tricks you need are right here! Find out all of this and more in the full episode! 

Transcript

0:00

When I'm coaching leaders who are self-described as not holding their staff accountable enough, they usually are meaning I'm not mean enough to my people. I'm not threatening to fire enough. I'm letting people be late and i’m not yelling at them. And that's actually not how accountability works. Accountability works by first setting an objective and getting everybody committed to it. Hi. Welcome to another episode of Baktari MD. As you know, this year we're doing Crash CEO School, where we go over all the major tips that will help you grow your organization. And sometimes we bring on a guest that can speak to some of the things we have been talking about all season, which are the skill sets that people need to grow their organization and take it to the next level. Today I have a guest, Mark Henderson Leary, who really is a founder of a company that helps private practices take their practice to the next level. I don't want to speak for him. I want him to introduce himself. But, you know, I think systems like he's going to talk about are things that people need to think about, because sometimes just having a good product or having a great practice or having great bedside manners is not enough. You're going to need more. I suspect he's going to talk about that. But let me welcome my guest, Mark. Welcome to the show. Thank you so much for coming. Well, I'm so grateful to be here. Dr. Baktari, I really appreciate it. You know, we've talked in the past, and you and I have common, common goals, common beliefs, common DNA. And so it's, I'm excited for this conversation. Well, great. So we know, currently for for what you do is you help, you know, private practices, administrators, the lead clinician, the owners take their practice to the next level. But before we go into some of that, let's talk about your journey of how you got here. I know offline you gave me a little bit, but could you summarize that for me? And then we'll go into some more details about what you're doing now. Yeah, 100%. So, I was the classic flavor of the month CEO. That is to say that I was an entrepreneur growing a practice in every month, week minutes. I was almost I found the new new tool, new trick, the new book, the new system. And, you know, we need to sell better. And so I we're going to run this system. And then a month after that it'd be like, well, apparently there's there's a marketing problem. So let's, let's do this marketing thing. And, and apparently that's not we're not hiring right. Well then apparently that's not it either. It's probably it's a it's something else is something in the culture is something in the this and that in every single month for now we'll call it seven years. I was doing that with the expectation that this was the next thing that was just going to explode the business into the next level, which I got to be honest, had it’s opportunities to explode it in many ways through the seven years. In not the greatest way, but I was able to ultimately cobble together a system to run the business. And I sold the business. And when I did, the organization that bought mine was, trusted me enough to run the growth strategy for the new entity, even though I wasn't a shareholder. So I was privileged to do that. And we were able to grow that organization from about 7.5 billion in services revenue to just under 20 in, in a little under three years. And I thought, man, this is great to simplify what it is to run a business. It's fun to do this. And, and then after that, I mean, I had I was kind of I cobbled together system. I, I did find the system called EOS based on the book Traction, and, and I resisted it for a while because my friends were like, you should you should check this out and use this system. And I've got a system. I did this, guys. You know, I'm smart enough. And when I finally read the book, it was like, dang, if I if I had this ten years ago, I would have a different life than right now. And so that was a little over seven years ago and I never really looked back. it's been an amazing privilege to help these similarly frustrated leaders who know they can make a difference, who can build a great business, or a great practice that has a thriving culture that adds massive value, that gives them the life they want. And we don't have to reinvent the plumbing to do that. We just have to put some tools in place that are proven to do it, and then it allows us to lead and create the life and business that we want. Well, that makes a lot of sense. One of the things we talk about in our podcast is, you know, a lot of people just go to medical school or however they get there where they're in charge of their own business or practice. But it doesn't mean they have any training on how to run an organization, how to be an effective leader. Do you find that that's a struggle because, people sometimes equate the fact that they're the ones that put the money in or they're the ones that it was their idea, or they went to med school or residency and fellowship, and so they should be in charge of this practice without acquiring any additional help or skill sets. Because I would imagine when you approach these people, they they assume they should. They're doing a great job because they own the practice. Why wouldn't they be? You know, is is that a learning curve to let them know you need to get additional skills? Well, 1,000,000% what you're describing is right. There's a lot of there's a lot of layers to what you said. And the first is, I think that medical school does teach excellent technical skills, creates master individual contributors, craftspeople of in terms of mindset. And so that's not a bad thing. The most creative people on the planet are individual contributor craftspeople, designers, inventors and surgeons and things like this. But it is not. It is not. We're not teaching management on any level. And so when management is about asking questions and learning and adapting, individual contribution and skill is about having answers, and it's about collecting answers from a massive database and being knowledgeable. And so it's it's normal that I have a founding physician, founding practice leader come to me and say exactly what you said. I spent a decade in school or longer, and I learned so much, and 0% of it was management and running a business. And what do I do? The issue there then becomes there's a there's an aptitude and a desire, but what do you put in the bucket? And so what's most common is that founding physician looks across the street, looks at their their cohort graduates, and what are you doing? And they're like, well, I gotta figure it out because I'm the founding physician, right? It's my name on the shingle. I gotta, I gotta do it all. And they're like, okay, I'll do that too. And it doesn't work. And then they get frustrated and they get stuck because it's kind of the blind leading the blind, that it's been that way for half a century or longer, that that's the way it's been done. The DNA of private practice is, you know, just hang a shingle and have an assistant, you know, the mom and pop. And then there's the institutional side on the other end, and there's so little mentorship in the middle. And so, it's implied in my introduction that I don't come from health care, so I come from IT services and professional services, and I just kind of accidentally found myself working with private practice. And what I found was, like, you described this, this contradiction of desire to do it better, but a resistance to a lot of the things I was saying, well, we got to lead doctors and we got to drive accountability and we got to hire and fire on this level. And I was like, whoa, whoa, whoa, we can't do this. And I and I was really stuck. And I thought, well, maybe I'm maybe I'm doing this wrong. Maybe, maybe it is different in health care where the principles in other businesses don't work. But I was like, I was still I'm like, I think the principles still apply. So I was driving the principles and then I would be talking to the very successful health care organizations who had grown past. And I was like, guys, what do you do? Do you not lead your doctors? Do you not hold them accountable? Oh no, we do, we do. Okay, okay, so I'm not crazy. This- this is a real thing. So I would go back to my clients and say, all right, no, I'm not crazy either. We've got to drive accountability. We've got to do these things. And so once we just get through that resistance to the unknown and breaking the mold of what we see going on around us in equally stuck practices, the ignorance falls away and we start to be just like any other thriving practice with a great culture, with great accountability and management. But there, like you said, it's there's the ignorance that's known, but the resistance, which is like it's the unknown. Like how do I get comfortable doing something that I've never done before? And worse, I see people who are telling me I shouldn't be doing it this way. But in our mind we're like, but they seem like they're struggling too. Well, they are. What the. As I'm hearing you talk, then what do you do with the resistance? Because these doctors and I'm going to throw, you know, me and my colleagues under the bus sometimes we come out of training and we're we always think we're the smartest guy in the room. Yeah. And to let you coach us, we have to not be the smartest guy in the room. Not everyone's ready for that. And when they're not, how do you how do you help them? In other words, I'm used to barking out the orders that I'm used to directing the procedures. And now all of a sudden, the smart guy comes and says, okay. And, you know, I actually I know more about this than you do. so, you know, you're going to follow my lead. Again, I don't I don't want to stereotype. You know, there's all different types of physicians and health care workers, but is that a challenge for you? I mean, you when you pick and choose your clients, is that one of the things you have to size up, whether you'll be able to crack that sort of veneer of, I'm in charge. Most of the time, not. I do think the question is is valid even though that that's or question is useful. Obviously it's valid. it's useful even though most people self-select. Readiness is not something I can create. Readiness comes from one thing. Pain. Ah, they have to be in enough pain. Right. Right? Yeah. And so it's a very simple question if if I'm having a conversation with somebody who's kind of on the fence, I the question is very simple. Are you getting what you want from your practice or not? So they have their there's no problem to solve. And if you're not then what would you be open to do to solve that. Right. So they have to be either, let's say starting to burn out from that sense, or it's not financially as lucrative as they thought, or some other thing that tells them it's not going as well as they would have imagined. They need to feel some sort of pain. Okay, yeah. For sure. And so and I want to point to that because there's two there's two obvious pains there in outside of health care, lack of profit is is a really common problem. It's probably as common as any of the other problems. In health care, It's way less common. It's not it's not none. I mean, that's a that is a health care unique profit problem, because if you're running an IT services business or a plumbing business and you're not profitable, it's not necessarily a surprise. Right? Okay. Business is hard. We know this, but if you're in health care, everybody assumes you're rich. And so if you if you're not being if you're not as profitable as you wish you were as a health care provider, there may be a massive shame associated with that. Like, hey, I don't even I, I don't want to tell my staff what we make, not because they'll feel like I'm making all the money, but be they'll be. I'll be embarrassed. They'll be embarrassed that we're not making more money. And so when you have a profit problem that it's a different mindset. But 80% of the time it's it's not profit. It is. It's it's more about like it's hyper dependance. It's the more successful this practice is, the less I am happy because I can't go home on time. I'm I need to hire physicians and associates and like half of them I hate and like, the more we do. Oh, you're killing me. The more this stresses me out. Yeah, I'm getting stressed out hearing you talk. I really am. Okay, so. So all right now. So tell me about your system broadly. And then we'll see how how, without giving away all the goods. But tell me broadly about the system, what it's called and what are the core tenets of it, and how do you go about implementing it? And so I mean, obviously it could be a five day talk, but yeah, as best as you can to summarize it. Yeah. So I'll summarize it in sort of the 60 second overview. What I do is I help practice leaders leadership team, usually starting with that founding physician health care provider and or their number two, the administrator help that team implement a system of practical tools to develop the practice,

around three specific outcomes: 12:42

vision, traction, and health. What I mean is vision gets that leadership team on the same page with where this practice is going and how it's going to get there. What do we see the future looking like so we can row in the same direction? Traction is that leadership team gaining accountability and discipline to make progress actually towards that vision, not just do work, do work that moves us there and then health is when that team comes together as a healthy, functional team, not grinding gears and not stepping on each other's toes. Really right person, right seat from a leadership perspective is all too often that is not at all what we're having, especially in these high skill organizations where we got somebody who does something at a high level, but maybe culturally is off and we don't know what to do with that. So we got to get them on the same page. So once we get that leadership team on the same page with where we're going, accountability is happening and we love working with each other. And that's amazing, right? I love it. Once we do that, then we take that to the entire organization. Get everybody crystal clear on your vision, rowing in that same direction, everybody accountable and progressing and making progress on what they're supposed to do. And everybody loves being there, and you love them being there. And the patients love them being there. And you know, I use that word love a lot. But because it's an it's it's one of those things that, if you're coming from a, a scarcity minded or dysfunctional culture and I use the word love, you're like, come on, get out of here. I just want to get through the day with a profitable day without somebody yelling. But when people get through this process and they're like, Mark, I get it. I love showing up here. I love these people because they care about what I care about. These are these are not just the people I work with. They're like their friends and people who just share the planet with me. Do helping this vision come to life. And everybody in the organization is equally excited about the privilege to heal people and help people in whatever contribution. And I can assure you that it's absolutely real. It's absolutely possible to do that. And that's what we do. Amazing. You know, I want to get, on a higher level on that. But first I want to get granular on something you said. That you use the word accountability like eight times. I thought, in that description. So I, you know, I until I got into my own business, I didn't really understand what the word accountability meant. When you're a layperson or you're just an employee, you know, and you said, we need a cap where like what to the average person, you know, what is accountability to me? I have a better idea now that I've managed organizations and systems, but tell me when you use that word accountability, implementing, having account- What does that mean to someone who has not been ahead of an organization and doesn't know what it really means? Well, is is an interesting question to bring up, because I have kind of a rabbit trail rabbit hole down the rabbit hole deep definition of it. But I'll say, the outcome of accountability is getting the results that you predicted. So we start there. So what does it look like when you've got it? We set objectives and they happen, which could be anything, because the idea is getting what you want from the business, which starts with asking the question what do you want? You want more profit? You want a little less stress? You want better outcomes? You want more alignment? You want better staff? What do you want? So that you really got to ask that question. So accountability means we are getting the results we want. Taking a step back from that. When I'm coaching leaders who are self-described as not holding their staff accountable enough, they usually are meaning I'm not mean enough to my people. I'm not threatening to fire enough. I'm letting people be late and i’m not yelling at them. And that's actually not how accountability works. Accountability works by first setting an objective and getting everybody committed to it. And being crystal clear on what that looks like. And if you haven't done that, you're going to have a very hard time driving accountability because nobody knows what expectations are. So once we've got everybody galvanized on these objectives, then accountability. And this is the part that might I hope we will take as a nugget, because this is kind of a recent epiphany for me. Accountability is simply recognizing that the the gap between what we wanted to happen or thought was going to happen and what did happen. Guys, we said we were going to be on time to this meeting. Three of you were late. Accountability is the recognition that we did not do what we set out to do. And then then you kind of assess that, take a step back. Well does that matter? If it doesn't or let's move on. If it matters, well did we get the meeting time wrong? What, did you guys not take this seriously? Do I have the wrong people? Did I communicate improperly? You know, because if this was an objective that matters, let's troubleshoot this. And put the changes in place to fix it, which may mean better communication. It may mean firing somebody who's on the wrong bus. That's totally possible, but it's not about the negative consequences. It's about just saying, hey, are we going in the right direction? And if we're not, we got to make changes and not to keep going on this because this is a huge topic. I promise you in your organization, you think that the people who have jobs there that you pay every single week, every single month, you think they know what they're supposed to do every day. I promise you, they don't. There's no way that they are as clear on what their objectives are on a daily basis. What matters most, they they don't know. And they're guessing even when they think they know. And if they think they know and you ask them, you'll find out. That's not at all what you want them to be doing. And you cannot have accountability without first getting clear on what the end goal looks like. Got it. You know, I've never heard it crystallize that way, but I love that concept about the gap between what you thought was going to happen and what happened. But but on a system level. So I, you know, I got a 15, 100 of 200, 500, a thousand. But then you have to implement systems to manage that accountability. Talk to me about that. So okay, I got the high level theory. Yeah. So so I know I'm just like you want to drive this down to something real. And I know I've been living very conceptually. Let’s bring this right to the ground, right? Right to the ground. The tool called the accountability chart to use the word accountability for the 101st time in this conversation, the accountability chart is when we start looking at the structure of the business. Looks a lot like an org chart. It, however, is not. It is when we look at our functions in the business, starting at the highest level of the organization and say 3 to 7 major functions. Now, a typical business has at least three functions. You'll recognize them. Sales and marketing might be a function to go get and capture new customers. Operations might generically be what you described to be the service you provide in exchange for money and finance might be the function that involves reporting and finance, and making sure the money is where it needs to be. Those are the three basic functions in any organization. You might have. You will have another function that sits on top of that that glues that all together. Historically, you look at this if you imagine this in your mind, it's three boxes, one box on top, and that's the boss, the president, CEO. And in system I teach EOS, we call that the integrator helps us get clear on that this harmoniously integrates these three functions. Sometimes we have to where we always have to customize it in some way. And so your practice we might have totally different words for that. We might have a patient experience function. We might have a clinical operations clinic success. We might have research success. We might have retail if we're in, optometry or something like that, we might have different functions where finance and administration and billing, whatever. In the end, 3 to 7 functions that this business must have to be successful in the next 6 to 12 months. If this is something for the practice now and then that integrator function got to have the boss. Now we might also have another function called the visionary which we can talk about. That's that might be that founding physician who is passionate about the future may not have the genetic DNA to manage people on a routine basis and have those hard conversations. And if that's the case, we got to call that out, because the visionary is a very different leader than integrators. Integrators very often that practice administrator, somebody who can drive ongoing weekly accountability and stick to the plan, and then that visionary, somebody who can really paint the picture of where we're going from a cultural and a long term perspective and really drive that standard of excellence very high. We have both of those. So at this point, your imagination might be imagining 3 to 7 major functions and the visionary and integrator. And then we drive a couple roles into these functions to see if it's patient experience. What's the number one thing we need from patient experience? Well, they need to manage the patient journey end to end. And then we do that until we're crystal clear on each of these roles. Now you'll know from an accountability perspective what we're doing is saying these are the critical jobs. This is what has to be owned to be successful, for us to be successful. And so then you start putting people into these seats. And accountability can now be held to like, this is what the function is. I need the right person in the right seat in the EOS, we say, GWC; gets it, wants it and has the capacity to do it. So we found somebody who gets patient experience. They want it, they're excited about it, and they got the tools, talent and the DNA to make this happen. Put them in that seat. And now it's crystal clear that that person has a lane that they can focus on. And the other three to or, we'll call it 2 to 6 seats on the organization. They are now crystal clear that that is not their job. They do their lane. And now we're getting very efficient and accountability starts to become possible, because now I can look and see who's doing what functionally in the organization and if there are any gaps. Whether I put somebody in the in the patient experience and we're getting exactly what we expect because the patient journey is there. You know, the full schedule is there. And you know, and the cancellations are low. Now we really got some GWC. Over here in in billing. You know we've got all this AR is accumulating. The reports are inaccurate. Now accountability can flow because we see right here that this is the person whose job it is to hold down this major business function. And we if they don't get it, don't want it, or don't have the capacity to do it, we can now drive accountability and get the right person. So there's a whole lot of things that flow from accountability and measurement. But the tool I just described in the accountability chart is disproportionately powerful in setting the cultural standards of what accountability is on do we have the right person in the right seats? Because we started by asking what the right seats are and what do we need from them for the next 6 or 12 months? It has to start there. That's powerful. eNational Testing makes getting a simple laboratory test as easy as ordering something online. With three simple steps, you can have your test ordered for STD's, general health, allergy testing, diabetes screening, blood titers, and more. You can simply go in for testing the same day and get your results quickly to your email. eNationalTesting.com’s complete health care panels come with easy to understand results at over 2700 locations nationwide. It's time to focus on yourself. eNationalTesting.com; easy, convenient and tailored to your health needs. So tell me when you're when you're given this task, where you look at a new organization, you're trying to implement this. So given the more common blowback that you get, the resistance like and how do you overcome the typical. Because first of all, change is hard no matter what change you're trying to do. Changing, you know, changing someone who's already a high level professional and what have you. So describe to me the typical blowback you get when you come into the leadership, or certainly to the rank and file, and how do you try to address that and overcome that? Now, you said earlier they have to be ready, but still, it's just because they're ready doesn't mean they're it's going to be fun. You know, not not being that they are the big honcho and calling every shot. Well, you know, I'm fortunate because the tools that I implement are very, simple. They're not necessarily easy because they tell you some, some things that you got to respond to. You can see very quickly, that we do or don't have the right person in the right seat? You know, I'm facilitating conversation with a leadership team. When we put that accountability chart up on the whiteboard, which I do in whiteboard capacity, we're not I don't even need computers for this. We can do this on the wall and the whole team said, yeah, that's that looks right. That looks like the leadership team we need. Okay. Now we put people in the seats. Oh yeah. I think that was that. Is that easy? Is that easy? Because one of the the challenges that I would imagine is, hey, I can't find the billing person that, you know, has that set of skill sets, right? That has that level of commitment. I can't make, you know, the front office receptionist is a revolving door. You know, we you know, we get a new receptionist or how do you help these practices? Yeah, address that. So so 100%. So what we always encounter is that if we can get the leadership team. All right people. Right seats. That's a miracle. it doesn't happen all that often, but does occasionally happen on that sort of first day of this. but by the time we get to the rest of the organization, there's definitely people problems we've got. Oh my gosh, we don't have that that front office. We've we've never gotten the front office coordinator. Right. And I can we need somebody to manage it. I don't know what to do with this. Well that just goes on this thing we call the issues list. We just write it over. Okay. Let's write it on there in green ink. I don't know what we're gonna do with that, and it keep going. We got more people issues. We've got other things, and, I want a different process. Oh, we don't get an issue with, like, you know, where do they even sit? We got an extra another office opening up. And what you encounter is that there's a thousand problems. Somewhere between 10 and 210 issues crop up within the first couple of months of doing this. Wow. And so now now I'm saying, all right, well, these are the issues. I don't know which ones are most important because every business has got something broken in it. Every business has got lots of broken stuff in it. What do you guys think the most important thing is? And now we're sort of bubbling up like, well, you know, this finance situation is an issue. Is it one of your most important things to solve in the next 90 days. Yeah. Oh yeah. Yeah. All right. Cool. Well then what is what is done look like on that for you. And we are if we have a candidate that we could potentially put in that seat or, or if I can handle it for a while and just co-create what the objective looks like. And so it's not me telling people what, what to do. I might share experiences and principles, and I do that a lot of what my experiences have been. If you go left, you might experience that you go right, you might experience the other thing. But this team is sort of selecting, well, we got ten people issues. What's the first most significant people issue we're going to solve for? You know, I might not even agree with it, but if they're willing to tackle it then, all right, we're going to do this one at a time. And that's how that's how change in an organization happens if you've got. Say you’ve got 50 people in the organization and you look in the mirror and you think, oh my gosh, 20 of these people should not be here. You don't fire 20 people and hired and hire 25. You you say, where do we start? Who's the leader manager. Most significant making the biggest difference. And let's let's tackle that. And then what you'll find is that as the dominoes fall, lots of these other problems start to either change on their own, they really take care of themselves or we get the right leadership in place. It starts to rise. People, people you thought were lost causes so suddenly wake up because they've got a real good leader, a manager, and so you don't solve problems out of order. You solve them, the big ones first, and you only solve the next problem when it's when it's time, right? You're amazing. How often do you get in a situation where you just give up? Say like this is just beyond me putting things back together or do you find that 80, 90, 100% of the time, as long as there is, they're open to the change. You're successful. What is what does that look like? I mean, that's a great question. So I've never had to give up on somebody. I have definitely worked with clients who I thought were going in slow motion. And I'm like, are you going to do what what these tools are telling you or not? We see that your culture is not in good shape. We see you got the right leadership team. You see it, I see it. What are you going to do in the next 90 days? And their commitment is to try it again with the same people over and over, and I and I and I have been like, oh my gosh, are we doing this? And I found 100% of those eventually get it. Oh, really? Eventually. Well, that's probably a testimony to to you and your technique. So maybe I really a rest on the shoulders of giants in terms of Gino Wickman who created the system. And so it's it's a it's a well known system and the principles are sound. And I have a lot of trust in the principles of simplifying the business, delegating, predicting things, with measurables and goals and systematizing it and creating a solid structure. Those principles sort of glue it all together. what we talked about, I think the real answer to your question, though, is when this doesn't work, there are those leaders who just refuse to look in the mirror. And if they do look in the mirror accidentally, they think there's something wrong with the mirror or just look away. And so I see that very quickly with, you know, the next session and we're not ready. Can you give us another week or a month? And I’m like No, no, this is time to measure the progress. And that's and so we're always off. That's not the problem. If you're always off, this means you're normal. Now how much are you off. We had these three objectives. So for the 90 days we thought that we're going to see this many patients. We thought revenue would be this. We thought profit for encounter would be that. And we're going to look and we're going to say how close were we. Not close. Okay. Why. And let's have an open conversation that this is going to set our our objectives for the next 90 days because we need to be more accurate. But if you just like, you know, I'm going to go in that room and Mark is going to look at me like, why I haven’t I fired this person. And I don't want to answer the question why I haven't fired this person. So I'm just going to avoid Mark. I can't help that person. Now, and I and I say that, like, I'm challenging these people to fire people, I don't I'm going to let you do it on your own time frame. It's going to be you who's like, I don't want to look in the mirror and realize that I committed to do this, and I know this will take the pain away and I haven't done it. And I encourage people who are in that spot, like, actually, I'm going to sort of reverse course on this because it sounds like that's the failure. If you're one of those people listening to this and you've got somebody on your team and you know they're not a fit and you have not let them go, have some compassion for yourself. This is hard stuff, right? You might not be ready to do it. And you are suffering too. Now, I'm going to encourage you that you probably could eliminate a lot of suffering. If we get your head clear on how to get this person out of the organization in good faith. But if you're not ready and you haven't done it, don't beat yourself up. It's perfectly reasonable to ask for some help. Reach out to me. I can talk you through how to get the language right, and make sure you're on the path to get this person to a seat and to a job where they are in the right seat and you can get somebody who you need. But but do not beat yourself up if it's if it's difficult and slow going, it's very normal to be like that. You know, in talking to owners who who are in the situation you just described, one of the most common things I hear about why they haven't done something like that is in small organizations, there's often not enough redundancy in, you know, people's role. Yeah. And and it's because of that that I think there is this, you know, tendency to hold on because there's just like no redundancy. So I, you know, it's better than nothing. And so they, they keep going. Have you seen that or is there other factors that contribute to that. Well, so the input side of that is how do you solve for that. Number one thing and particularly in a health care practice is if you getting a hold of the recruitment process, we got to have enough supply of talent. You have to solve for that. Because when you don't, you are perpetually held hostage. By nonfits in the culture and it's terrible. Say that again, you're held hostage by what. You say that again. By non fits for the culture and nonfits for the position. You get a lot of terrorism because you know, you're this person is not a cultural fit. They got a terrible attitude. But they're the only one that knows that process, even knows where the inventory is. Right. And so you talk about redundancy. I would lump it into a broader category of just capacity. We don't have enough hours of people to get the work done. what I experience with that is, again, we solve at the, at the root. And so we've got to get leadership in place. And that's where you start one person at a time. And if we've got the wrong leader in place or if we know this person's toxic, over and over again, what happens when you remove any toxic nonfit. Even though the workload goes up, the joy goes up and everybody is like, so, oh my gosh, at least we don't have to hear about that. And and then we can and we can. It is it is kind of it's not sustainable when you take up too much capacity. Right. But it is rewarding to the culture. Who's there really working hard that the remaining people are on board with why this matters and doing quality work and taking care of patients and doing it. And so, I mean, 80 to 90% of the time you're better off doing with less, but of the right people then with kind of hanging on to these, these, these people who are just truly, truly the the answer to the question is they are actually creating more problems than their solving, even though it seems like they're they're rowing in, they're in the right direction. You know, they're not. And when they're gone, you're like, oh my gosh, you know, they're not doing the stuff I wanted them to. But now they're really not making all those problems. And all those people aren't in my office upset. And it's really helpful. Yeah. Yes. Sometimes, like you said, you don't see the benefits until afterwards. When, when. Yeah. And so I totally see that. And I see the other side where they struggle with it. But once they can do it, then they say, oh my gosh, you know, why do I do this like years earlier or what have you. All right. Well, I had this, this issue revelation for the 50th time or thousandth time. One of my clients or friends, I don't remember who it was, call me and said it was a client. And they said, oh, we let, let so-and-so go. And, you know, I just can't believe how much more stuff is broken than we even thought. Yeah, right. And I was and I was like, you know, that's only the 100,000 time I've heard that. Right? And so if there's two real important messages in that, one is if there's somebody on the bubble, you should assume that that's the story and you're going to find it out later. So if it's bad as you experience it, know that it's actually worse. Oh my gosh, you're right. It's so so it is right now. Worse. Now the flip side is also true. And this is what I think is so exciting when you have right person, right seat and you unpack what they've been doing, they've been doing so much more than you thought. They get it, they want it. And that in the organizations lift it up by these things that are going on even without your knowledge. And so really driving in to getting those right people, starting with the leadership team. And this whole conversation boils down to I think if the listener takes one thing away from it's one critical person at a time, starting at the top, getting the right person in the right seat. Don't solve for the entire culture, just one critical person at a time. Until you build that culture up with people who really get, want, and have the capacity to do that job at the highest level, and that will take care of itself over time. Wow. That's amazing. That's a great, great, great advice. Great advice for anybody who's struggling with this where they're stuck in an organization. And it's just like walking in quicksand. You're and you just have to. Yeah, bite the bullet and do the right things. I know we're pushing time, but I want to add one thing to that. Yes, because I was generic about people. And you talk about pushback, I and I didn't answer about pushback because, I mean, the way to did with the issues list. But there is pushback. Oh, there is one concept in particular, and it is around leading what I call high value individual contributors, really important experts that are very, very special in your organization. You might know them as doctors. And so these people are very valuable to the organization. They're also by default most of the time not good managers. And so we should not have them managing. That's a separate topic. But the pushback is who do these doctors, these associates, these partners, whomever. Who do they report to you? Oh, whoa, whoa whoa. They don't who there's who's their boss. Let them. Oh, they have a boss. If it's God, they've got a boss. We've got it. We've got to get clear that these. Every leader needs a leader. Every leader needs a leader. And so we're going to have to solve for that. And I get pushback on how we do that. Long story short, we crack it open piece at a time until we get these. It's so interesting. So you're you're saying some of these practices, some of these health care professionals are just free agents roaming in the office and it's like an academic- It's like an academic institution. It's like they're just tenured professors. Right. And we just hope we don't upset them. Right. And so that's that's not what's going to work. And I see organizations get very large with that. Yeah. Especially with very rare unique talent with research and grants and all that kind of. Yeah. You know, when I get a tip off like that, a lot of times someone, a staff will come to me and they'll say, you know, I want to speak to Susie about, you know, something that is not going well, but I'm afraid to talk to Susie. And then multiple people will tell me. I'm afraid to talk to Susie about this. I'm afraid to talk to. I'm like, okay, so what is going on? Not that what you're saying is good or bad, but why is everyone afraid to talk to Susie or Bill or Fred? because what does that even mean? And what what does that say about what kind of lack of accountability that they've set up, that sort of little fiefdom that they've set up, that they've sent the message that, you know, you can come joke around with me, pal around with me. But yeah, don’t go there and and think, well, there's two conditions that create that. The two conditions we see are, scarce skill. Like you're the specialist. Are you the only retinal oncologist in the in the state that does this? And so like, if I don't have you, I've no one. Right. That scarcity creates a problem. And then the second one is high stakes. If your skill set is the difference between life and death, well then I have a massive aptitude for collateral consequence. Like, you can be a jerk if you if you're high on if it's a 1 to 10 scale, if you're a nine and a ten on this specialty skill with high stakes like I have to tolerate you. And so what that creates, that's the perception anyway. And so what that creates is a withdrawal of two other conditions; feedback and consequences. And so over time we get reticent to to share feedback. You know I was was really great with the patient in terms of that. But they were kind of rude to the nurse. Right. What do I do. And so I don't know what the criteria are. And so then, then we withdraw from giving feedback. So now these doctors are kind of in the dark. They don't even know that their behavior is not bad or is bad because we're not telling them. And then if we do eventually tell them they've been doing it ten years, like, well, what do you even mean? Yeah. So there's no consequence. There's no there's no meaning to this. Like, well, okay, so you're saying I was rude to the nurse. So what I got, you know, I rule this place, right. So so we have to kind of get away from that, which goes back to accountability. You build that accountability chart and say, all right, we got doctors. What are the five roles of these doctors? Are they just doctors? Because I I've discovered that in the industry we don't really write job descriptions for doctors just because we've got doctors who are diagnostician. We got doctors who are research folks, get doctors who are very, very specific in something they treat. And if we need to get crystal clear on it, hey, Doctor Smith, one of your key roles is patient experience. Did you know that? Did you know that they're supposed to like you? A minor point, and you can decide, like in some institutions that might not be part of it, but once we sort of set that rubric, yes. Now we can invite with some discipline and some courage. Hey, Doctor Smith, can I give you some feedback? Because we need to, you know, we have a governing board here, by the way, if I and if I share this, like they might say you shouldn't work here anymore. And so we we can bring both feedback and consequences back into it. But a lot of organizations are really slow too. You know, for those two reasons I'm telling you, have almost everything you talked about is things that I've struggled with and try to cobble together my own system. So I relate to you more than you realize. All right. Now it before we end, tell me, is there anything I didn't ask that you feel given up. Whatever else we talked about that would be helpful, pertinent to what we've talked about? Is there, anything I left out? Well, you know, I could go on for a long long time. But one thing that I'll try to encapsulate is we talked a lot about, you know, my my system or. That's not my system. Gino's created the system, and I just am lucky enough to be able to teach the system, particularly to health care. But in the health care space, if you read the book traction, you won't see some things in that book that that really show up, like this leading doctors thing we just went through. So we covered a lot of that. But the other one is if you if I've worked with, you know, a plumbing contractor and or any kind of company that's like that, even just a plumber and the founding plumber of the organization, when I'm working with the leadership team and saying, how did how best did you spend your time? I don't have a plumber say, you know, I just need to get out and unclog some toilets more. That's really what my I'm here on this planet to do. I need I need the plunger in my hand. Unclogging toilets. Never has been said no. So they're in the leadership. They're saying I got to run the business. I got to drive vision. I got to do some part of selling something in a leadership team level. That is not true in health care. You I will and have seen over and over again. Look, Mark, I know someone's got to lead the vision. I know someone has to drive the numbers, but I also got to be in surgery. I'm the one who is the who's the world's number one plastic surgeon for this type of surgery. And so there is a very unique additional pull time and soul of the founding physician who was thinking like, I've got one job, I'm supposed to run this practice. Well, it's not one job. It's at best three. It is. There's somebody leading the organization's vision, probably from that clinical outcomes. I can see a world where mindset and there's somebody who is all through the numbers driving accountability, making sure that leadership team is executing every week. And those are almost always different people. And then we've got this other pull, which is do I see patients? Am I is my highest value contributing right. One patient at a time. And it's and if so maybe I'm maybe he's at four days a week is a one day week. What is that. And so it's really a very difficult I like to describe it as like it's like a stem cell. Right. You think you're just a cell or you're not a stem cell. You've got it. You've got to split off. And these other, other things. And at some point you're going to decide which one really are you for the rest of your life. Are you a visionary leader who does a little bit of surgery, or are you just a business person that works? Or what are those identities? And so I'll have to say that you realize if you haven't split yourself out into those three roles and properly budgeted, that time and energy, then you're probably feeling like you want to explode. And so having a conversation about how and where that first sort of cell differentiation should occur can be really life changing makes a lot of sense. You're right, because people think they're just a. A, a stem cell that, you know, can turn one day into this, one day into that. You know, I'm I'm visionary, I'm administration, I'm involved in culture, I'm hiring and firing. And you got you got to figure it out. amazing stuff. I have to tell you, as you're speaking there, I feel twinges of pain when you hit on certain points that I've struggled. I’m sorry, I was built to bring peace and happiness and everything you say, like, oh, you're stressed. You're stressing me out. Oh my gosh. Anyway, no, I'm half, half joking. Half of your I hear the other half half. I'm not. I'm so hey, so tell people if they want to get a hold of you, they want to learn more about your system. Learn more about what you do. what's the best way to for them to get in contact with you? Yeah, the easiest way is to find me at Practicfreedom.com. I've got the podcast out there. Resources and tools. Happy to help in any way. There's lots of free information out there. You can also check out the tools. EOSworldwide.com for some of the systems I teach. but if you're interested in a conversation and I'm happy to help in any way, you can get on my calendar simply by going to Practicefreedom.com/schedule. We can just take a couple minutes and see if we can get you unstuck and get you on the path to getting that that practice that you love, that gives you the life you deserve. Well, Mark, listen, after hearing that, I the only thing I could think about after listening to this whole, the whole thing is if you didn't exist, we'd have to create you. Because this is this is a necessity for a lot, a lot of people. So I'm so glad we had you and I, and I, you sort of dovetail right into our, other things that we talk about leadership. So you hit on a lot of the points accountability and vision, culture and, you know, getting people in the right seat. We talk about that here in this show all the time. So this is just a breath of fresh air as I'm listening to you speak. So thank you so much. All right. Well that's it for today. If you like this episode, don't forget to comment, like and subscribe. Get ahold of Mark, see how he can help your organization, and we will see you on the next episode of Baktari MD. Take care. Bye bye.