Retain Top Talent With Better Clinic Culture

Listen to the Podcast here



Retain Top Talent With Better Clinic Culture

Building A Scalable Practice And Retaining Top Talent

A quick heads up for all the private practice owners who are reading. If you've been tuning in to the show for a while, you know that it took me at least ten years of grinding in my own clinics before I finally figured out how to scale and sell my 4 practices for 7 figures, and about 3 times the national average. The biggest shift wasn't some secret marketing hack. It was how I thought about profit, systems and my role as the owner. That's exactly what we're going to be working on together with you at the High-Performance Practice Conference in San Antonio, Texas from October 15th-17th.

Adam Robin and I are hosting a three-day hands-on event for PT, OT, speech, mental health, peds, pelvic floor, and medical practice owners who want to build clinics that are profitable, scalable, and best of all, don't depend on them 24/7. We’ll dig into simple profit and KPI frameworks, real leadership and culture work and practical systems you can take home and plug in with your team.

If you're doing roughly 6 to 7 low figures a year and you want your client to feel more like a real business and less like a job/cage, I'd love to see you there. Frankly, I'd love to see you bring your leadership teams as well because we will have breakout sessions for them, too. You can get all the details and grab your seat at the link. Let's get into our episode.

---

Adam and I are going to talk about creating an excellent culture that retains talent. It's something that's fundamental. A lot of us are opening practices, starting practices with the idea that, “If I'm going to be doing this, I might as well be in a place that I like, a place that I love, or at least be doing it my way.” That's one of the fundamental reasons why people open their practices. There could be many reasons, but a lot of it is like, “I'd rather do this my way if I had the choice.” Was that part of the reason why you got into private practice?

I was just a psychopath, honestly.

What do you mean by that?

I just wanted to create something. I enjoy suffering. I don't know what it is. I was always like an athlete who likes to push myself physically and mentally. I saw this as a challenge and I wanted to conquer it. I was bit by that entrepreneurial bug.

I'll admit it. I was like, if I'm going to raise a family, I don't want to be reliant on a salary. I know I can make more as a private practice owner. As I started doing that, and financially was doing better and better, I started hating my practice a little bit more and more because there were aspects of the job that I hated, but it was what I created. Either out of abdicating responsibility, out of ignorance or naivety.

Defining Culture Through Leadership Energy And Firing Bad Fits

It could be a number of things, but I was ultimately responsible for the culture that I created that I didn't like. I was like, “You have a company that you don't like working in. It’s your fault.” It was my fault. I think that's why it's important to talk about culture because not only is it the way for us to gain fulfillment in our practices, but it's also, like the title says or the subtitle says, it's a way to retain talent. People aren't going to stay in places that they don't like, especially if they have a choice.

There's so much to go into that. Humans are weird. We're weird. It's hard to keep that balance where you're challenging them just enough. You're giving them some sense of purpose and fulfillment. You're also able to draw boundaries in a collaborative way that makes them feel heard. You're also compensating and motivating them appropriately. All those stars have to align. Maybe if you get it all right, they might not quit.

If there's one reason why they would quit, we can think about some of those reasons. It could be financial. I know a lot of studies have shown that it is a lack of respect or appreciation for their supervisors. That could definitely tie to a culture or maybe no buy-in to a bigger purpose or a mission of an organization. Some people are motivated by that. If they don't have that higher calling or don't know that they're working towards that higher calling, they might lose energy, steam, and try to find that somewhere else. For me, when we're talking about culture, I tend to always fall back on purpose and values.

You'd like to operationalize it.

When I talk about culture or when we talk about culture, where do you instinctively fall? What do you start thinking about?

The way about it is, depending on, because you're always learning. The way that you think about it is going to be different than the way you think about it tomorrow or next year. I don't think you ever like to master it, but the way about it is in two ways. Culture is the energy that you decide to bring every day as the owner or as the leader. It's going to start to rise and fall with the energy that you bring. What if you hate it? You got to figure out how to be happy and you got to bring energy. You've got to get people inspired by your energy. You have to be a believer. That's number one.

I'm not necessarily the rah-rah type dude. I'm pretty cynical, but I knew that wasn't necessarily the environment that I wanted in my clinic. There was that juxtaposition. I'm not the rah-rah dude, but I want some of the rah-rah stuff around me.

You got to hire those people.

That's exactly what I was going to say. The people that brought that and were in alignment with me are people that I tried to set up or somehow allow them to step up and step out and do more of that or encourage more of that, or show gratitude towards that. I knew that it wasn't going to come instinctively from me and to do so could be inauthentic. I had to find people who had that and let them grow.

That's awesome. That's great. Maybe when I say energy, you might say purpose and values. It's the same thing. My thing is like, I want to show up with optimism. I want to show up with positivity and gratitude. I want to show up with a sense of encouragement and a sense of collaboration. I want people to tone up a little bit. I want people to be grateful and be excited about being at work, even if it's hard. That's a decision that the leader has to make. It has to model.

I’ll get back to number two. I would say the ultimate driver is firing people who don't belong. That's the ultimate driver. Maybe firing is a harsh word, but maybe another way of saying it is protecting that energy. Protecting that energy in a way of like, “I can't allow people in my bubble that are going to deflate that. I'm willing to make hard decisions if that's what it takes.”

I remember when I started getting into the Gary Vaynerchuk stuff. I don't know if Gary Vee. He's on LinkedIn quite a bit. He's inspirational and motivational but one of the things he says is that a lot of times owners will find that their most productive people don't align with their values. They turn a blind eye towards their malalignment. Simply because these people crush it. They bring in money. They are productive. Maybe I'll overlook how they negatively interact with the other people, or even maybe put off some patience. That goes against our values. Whatever they're doing, but they're so productive. How could I lose them? He's like, “That's the first person you need to fire.”

It's so hard to see that. It's a tough decision to make. I will say I haven't necessarily been in that exact position. I've been close to that where they've been productive people and I had to let them go because it was just too much after all. I dragged my feet long enough that I finally had to let them go, but I was never negatively impacted for a significant period of time. We might've had a dip, but the good people that were around me that were in alignment tended to step up.

It was after the fact that they mentioned, and even some of the patients mentioned like, “That guy wasn't a fit. She wasn't a fit. I recognized that weeks ago or months ago. You should have let them go a long time ago.” I'm like, “Really?” They see it. Our team sees it when people don't align. When we don't let them go, show those people a path out the door. The people who are aligned get a little bit deflated or maybe even lose a little respect for you because you talk about values, but do you believe in them?

Are you willing to do something hard like letting someone go or hold someone accountable because they're going against the values? We're not seeing it. You're still letting this guy or this girl run around and be a jerk and going against our values. Maybe it's chronic tardiness or something silly like that. It's not silly because it goes against our values, but that's when the culture gets sacrificed.

That's a great way to think about it.

Other people see that and you need to protect it, as you said.

Not to get in too much of a tangent, but that's a great way to erode confidence in yourself.

I'm glad that you said that because it's not just about the confidence in your team, but there's something. In the back of your mind, you're like, “I'm not strong enough.”

“I’m letting that thing control me.”

I like that. You’ve started a number of companies over the past year or two outside of the PT practice. It sounds like you're creating good cultures in those situations. What is it that you think is part of the secret sauce? What is part of the recipe for creating cultures in these new organizations that you have?

I don't know. I probably don't have it systematized the way that you do.

Here's the things. I think you do it, but it comes rather easier naturally. A lot of owners who have good cultures say, “I don't know what the magic sauce is.” I think they do it. They just haven't sat down or maybe even haven't asked the team or patients, “What is it about us that makes this a great experience?” Once you do that, they'd be able to highlight some things and you're like, “I always do that.”

Maybe so.

Some of that is just water under the bridge because you don't recognize it because it comes naturally.

Designing An Intentional Culture That Inspires Practice Teams

I would say the first thing that comes to mind is it takes work.

It's intentional.

Correct. Maybe it's natural. It's got to be designed. Coming back to that energy piece. You have to put energy into it. You have to let people feel and see your passion and you channel that into them. It’s like, “I'm here for you. I want you to see possibilities here and I'm committed to that.” Not only because I say it, because you see how committed I am to you. They need to feel that on a regular basis and that takes a lot of energy to show up for people like that.

I'd say, that is probably where I'd start. It’s recognizing that. I always think that the thing that brings me the most passion isn't so much like what we do in the company, like the accolades and the accomplishments. It's more about like the people we're becoming. When I think about myself and the type of leader I want to be, I always think, “I want to be somebody who's capable and competent and who can be somebody that people can lean on in time of need. I want to be that person.”

My whole goal is I want to try to call that out of my people. I want you, Mary or Catherine or Joe or Ryle or Angela. You have a calling to be that type of person who can not only be there for yourself, but to be there for the people around you, to be a pillar. I'm going to hold you accountable to that because I care too much about you. Remaining committed to that breeds a level of inspiration. It could also create fatigue on your team. You have to know when to provide rest, but also, you have to know when to step on the gas and be like, “It's time to do more here.”

I'm glad you brought up the point about accountability because that's one of your strengths. If something's going out of line, you have worked that muscle enough to have the accountability conversation pretty quickly. You say, “Here are the guardrails and you're going outside of them. I need to bring you back in.” People need that. They’re like, “I touched the wire. I went outside the lines.” That guidance brings me back in and the people who are bought into the company appreciate that. They say, “Cool, noted. I won't do it again. I will recognize that when other team members do the same.”

That's a skill. I don't always get that right. I haven't always gotten that right, but I know what happens if I ignore it. If I ignore it, first of all, I allow that behavior to erode the culture, but it erodes me because I start losing confidence. I start becoming fatigued and I'm not able to pour into the people around me the way that I want to. I know that happens, so I can't allow that to happen. The antidote to that is you just have to have the hard conversation and trust that's the right thing to do.

As you have more of the accountability conversations, not only does your team become stronger and fall in line, but those who aren't aligned start self-selecting or acting out to the point where you need to let them out the door. It attracts people who are more aligned, because you start recognizing who's a better fit during the interview process. Whether that's the job shadow or in person interview.

If you get your team helping out with either one of those, they can then readily start seeing if this person's a fit, or that person's not. This is what I see. This is why they would be good. This is why they wouldn't work. The team starts recognizing who's a fit for the culture and who's not. That starts building on itself to create some momentum and an aggregation of people that work well together in a nice culture.

Driving Growth Through Tough Conversations And Team Accountability

Better communicating. I love the idea of getting people to a place where they can be themselves. I always see in teams where they'll have two leaders talking through an issue. This person's bringing the issue about 90% of the way. The other person's bringing it about 90% away. There's a real conversation that needs to be had right there in the middle.

I'm sitting there watching. I'm like, “Who's going to jump in? Who's going to do it?” They don't, especially younger leaders. I'm like, “It feels like there's a little more to be said here.” It's like one more sentence. Usually, that sentence is when you do that, it bothers me or when you do that, it's disruptive. It's something like that. I still love you, but that's disruptive. We worked through that. That's where the progress starts.

The uncomfortable conversations.

Correct. I'm like, “Yes, here we go.”

Isn't that part of, five dysfunctions of a team?

Yes, the trust pyramid.

That’s the very bottom, is some trust and honesty so you can have those kinds of conversations. You have to be there.

Going back to retaining great people. The owner has to be the designer of that. That's hard. That takes a lot of this.

For those who are reading, he was pointing to his brain.

My brain and my heart. That's maybe the ultimate gift that you can offer there, is to call people into a place of leadership where it's like, “We're going to have some authentic conversations here. We're not going to quit. We're going to argue and debate and figure it out because our people deserve that. Our customers deserve it. Our patients deserve that. This isn't about our inconveniences. We're going to have a conversation.” That's it. That's the standard. I'm holding on to that. That's a beautiful thing to create for a team.

What I noticed at least is that now fulfilling the purpose or mission of the organization is not something that I'm doing alone. I have other people beside me who are actively engaged in making sure that the company fulfills its purpose and mission. We have other people on the team who are tracking KPIs as intensely as I am. Sometimes some of these people are ensuring that policy and procedure is being followed better than I am.

There's a ton of support. When it comes to needing to step up and do more from a production side of things, they're all about it. They recognize how that's absolutely necessary for the benefit of the organization to survive and thrive. That's what I've seen as we've generated these cultures that people love to be a part of. It attracts talent and it retains talent to the subtitle of this episode.

It's freeing. There's nothing more heavy than allowing your insecurity and fear to stop you from saying what needs to be said or showing up because you're scared of somebody. When you let that go and people can just be themselves, now we're clicking. You'll see those stats rising.

If you don't have that, it's hard to say that people won't leave because if they're under some financial constraints, even if your culture is great, they've got to do what they've got to do to survive. If it's a difference between them joining your team versus another team and all things being equal, ideally they're going to pick the one that has the culture. If it's a matter of just a couple thousand bucks a year, they're probably going to stay with the one that has the better culture instead of sacrificing what they have.

There are huge benefits and it could be a huge part of your recruiting program as you're recruiting for providers, especially in this stage of the industry where everyone needs a provider. One way to stand out and sell your practices, the culture that you have. Do you find that's something that you talk about fairly often as you're recruiting? If I recall, you're maybe a little bit more focused on how your company can help those who you're talking to achieve their goals. I would assume that you're talking about culture a little bit.

Attracting The Right Clinicians As A Culture-First Practice

We're a culture first company. That's what I tell everyone. If you're coming here to learn how to be the best clinician in the world, maybe not the best. I'm not saying that we don't focus on that. Catherine is a wizard clinician. She's dialed in, but it's not the thing that, it's a thing that we do. We're more focused on who we're and how we're being in the leadership development that we're experiencing for our patients and our families and the people in our community. That's where we want the majority of our energy being spent.

For us, it's like, how can we help people paint a vision of what they want to do with their life and with their career and help them achieve it. Sometimes that means that being in your company is not a long-term goal. Sometimes that means it's a shorter-term goal to something better. At the end of the day, when you lose people who've been with you, who you've poured into, it does sting. I don't think that sting ever goes away but I can sleep at night knowing that I helped that person. I helped that person get to a place where they can open up their own clinic. They can lead out on teams or transition into certain areas of their life with confidence. That means more to me than keeping them in the clinic.

For sure. It means a lot that you can say, especially if you leave on amicable terms that you can say, “I helped that person develop into a better employee for the next person.” That might be right. That's one of the things that we always said was, our job is to help you find the next best job. Whether that's in our company or in another company. Our goal is to help you become a better version of yourself so you can have a greater impact in the organization that you're with.

That's part of it. We've lost a lot of therapists due to finances. People want to make more money and work less.

What can you do?

I'm not mad at them.

That's another conversation from another episode that I'm sure we've had sometime in the past months. It's how to make more so you can keep them.

As far as an employee experience, there's the culture piece, but there's also, how do we help our people earn more? How do we help them generate financial wins as well? Maybe that doesn't mean they stay with you for 30 years, but maybe that turns a 1 or 2-year employment into a 5 or 6 or 7-year employment across multiple different providers. Giving people a career ladder is part of it as well.

You can either lose them rather quickly because they're not a culture fit or you can keep them for a while because of the culture and they begrudgingly say, “If I can't get my financial needs met here, I'll find someplace else.” You might as well create a culture that's great, and retain them as long as you possibly can until they begrudgingly say, “I have to go.”

I never thought I would say this, but I've seen a lot more of the younger generation be less focused on culture. I'm not a young guy anymore. I'm not 26 or 27 with 1 or 2 years out of school. I didn't grow up in that era, but it just feels like they're a little bit more selfish. Not selfish in a negative way, but selfish in a way of like, “What's in it for me,” type of mentality. That's been hard. That's been different. It's almost like they want to be independent contractors and do their own thing.

I can see that.

Full transparency, we haven't cracked that code. We haven't figured that out.

They want a lifestyle job. We talk about building lifestyle companies as owners. They're taking it down into the team stage and saying, “I want a lifestyle job. I want all the flexibility and all the benefits without a lot of the effort.”

“I want to see patients one-on-one and get the clock out early on Friday.”

Aligning Therapist Compensation With Performance Expectations

Twenty-five hours a week, but get paid for $40. When this one comes out, it might be a week after another episode where I talked to Jason Wombold about tying their compensation to their production. That's something that's been going on in the physician world for decades, but is one way to help them understand.

Not that I'm coaching you at this time, but maybe there's a reason, maybe there's a trend that might follow along behind that of, “You can have your lifestyle job. I'm just not going to give you a guaranteed salary. What you get paid is going to be based on your production. You can take Thursday off if you want and spend time with your family. If you want to make the salary that you want, you're just going to have to make it up somewhere else.” I wonder if that's going to be not a backlash, but a reaction to some of that.

I think it will be. I've been pretty vocal about some of the cultural issues we've had over the past months and we're starting to think about how to redesign the way we're building our team, the way we're compensating our team and how the model is. What does the younger therapist want? Worth considering for people who are reading.

There's a lot you can do to focus on culture and the benefits are obvious. For me to go back to where I started is, I finally got to a place where it was a company that I could enjoy. That I was proud of. That I got a lot of fulfillment from because we focused on culture. It took a few years to get there. It's not an overnight success. As you said at the beginning, it was intentional on our part that we wanted to improve what we had then focusing on purpose, values and the whole employee experience was the way that we got there.

A question for you. What were some of the things that you operationalized that you felt like were a big impact for the company?

There were some things and we talked about them on our group call. The way we did staff meetings. We brought in discussion of values during our staff meetings and highlighting team members. Even giving out awards based on values using calendaring activities. National Physical Therapy Month was a big deal in our clinics. We had games with the patients, with the providers and the team members on a regular basis. We had contests throughout the year between clinics, like pumpkin carving contest for Halloween. I would take that throughout the year.

We would shut down at once a quarter and do a town hall where we closed down a little bit early on Fridays. We usually had half-day Fridays anyways, but we closed down a little bit earlier on Fridays and had everyone gather in one location and did training and team exercises. That promoted cohesion amongst the group. There are a number of those things that we made routine. Some of them were meetings. Some of them were activities. Within each clinic, there was probably someone who delegated to make sure birthdays were getting recognized. That the clinic was getting decorated for the appropriate holiday. That wasn't me and Will. That was someone within the clinics themselves that had those responsibilities.

Another question I have for you is, how did you guys handle staff drama? What I've noticed is whenever there's a cultural issue, especially all the cultural issues that I've experienced, not all of them, but most of them have not been with the patients. They've been more like team members. There would be drama and there would be little isolated groups of people who were in the shadows doing their own thing. How did you guys handle that?

Managing Staff Drama And Protecting Clinic Standards

We did have a policy on rumors, backbiting, and we called it nattering. It wasn't allowed. We'd call you out on it, like, “This is what I'm hearing. This is what's going on, tell me about it. What's going on?” If there were two individuals who had an issue, one person would bring them up and give them control and say, “Do you plan on talking to so-and-so about that?” They’d say, “I don't know,” and we'd say, “We're expecting you to talk to them about it because you brought it up. Do you need help in how that conversation might go? Do you want one of us present when that goes down?” To support and guide them through those conversations to figure that out.

We established the policy. We had a little bit of a SOP, a policy and procedure behind it, and an expectation and then held people accountable accordingly. That's inevitable. We just needed to tell them. Even in our onboardings, we'd have to talk to them about, “This is what that looks like. Have you guys ever seen any of this in a previous workplace experience?” One hundred percent of the time they'd say yes. We don't allow for that here. It could happen, but we're going to call you out on it. There's going to be disciplinary procedures if we see it happening.

It just goes back to protecting the standard. We know the culture that we want. We know the energy that we're looking for here and that takes work. It's part of the job.

It fell under the value of professionalism, which was one. That's just not professional.

It's easy to come to work, complain and nag and what'd you call it? Nattering.

Some people might say that you need to blow off steam. You need to vent. Not here.

Not in this building.

Not while you're here. You can vent to your spouse or your friends at home, but you're not going to vent here. Letting off steam, some people could say that's a good thing but not here. You're not going to do that. That doesn't happen here because that goes against our policies.

I love it. Very helpful.

We're doing all this because we want to highlight the conference that's coming up. We are weeks away as we're recording this. It might be just a week or two away when this gets released. Especially if you're in the Texas area, because it's not a far jaunt. We're going to be in San Antonio October 15th-17th for the High-Performance Practice Conference. Go to PPOClubEvents.com to register. We'd love to have you guys there. It'll be fun. We'll be talking about how to increase your profit and freedom and balance and all that stuff. I have some great speakers set up so far. Especially excited to hear from the keynote speakers that we've got but check it out.

By the way, a little nugget for those who are still here. We're going to be doing a promotion of all the speakers. I know in the Facebook group, potentially in some emails, if you guys get emails from us. You'll see bios of all the speakers, their accolades, what they've accomplished, and where their expertise is. Make sure you guys check that out so that you can see if something like this might be worth exploring and joining us.

If you see the material come through your inbox, don't disregard it. For sure. Good talks.

Important Links 

• Why Bonuses Fail To Keep Your Best Therapists, With Jason Wambold Of Prompt Compensation – Previous Episode
• High-Performance Practice Conference
• Private Practice Owners Club Events
• Nathan Shields on LinkedIn
• Adam Robin on LinkedIn
• Private Practice Owners Club Official