The Medical Management Podcast_Building Your Leadership Team: Audio automatically transcribed by Sonix

The Medical Management Podcast_Building Your Leadership Team: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Jay Holmes:
Welcome to the Medical Management Podcast. A podcast focused on helping you level up your practice. Through interviews with some of the most successful leaders in the industry, we help uncover resources, tools, and ideas to help you level up your practice. Thanks for tuning in and we hope you enjoy today's program.

Jay Holmes:
Hey everybody, welcome back to the Medical Management Podcast! We are fortunate to have Jesse back, and in the second part of this episode here, we are going to talk about building your leadership team. The first episode we talked about direct reports and how many direct reports of too much. This episode, we're going to dive into what goes into building a great leadership team. So, Jesse, thanks for joining us again.

Jesse Arnoldson:
Thanks for having me back, Jay.

Jay Holmes:
So, Jesse, we talked a bit on episode one about the correct number or the number that is a healthy number of direct reports. And so now let's shift gears a little bit and let's look at really the management team and how we go about putting the best foot forward. Can you double-click on that? Tell me more about it.

Jesse Arnoldson:
Of course. You know, I, before I got into the pediatrics clinic, I was doing interim assignments kind of all over the northwest. And in almost every situation I'd come in, and one of the reasons that the manager before me had struggled was that they had 20+ direct reports almost every single time. And it was usually one of my normal go-to's to try and find a key person on the clinical team and a key person in the, on the business side, front office, or billing to help me get things back on track. And whether they got an actual designation for or a title or got put in as a mid-level manager or not, that was my strategy. And I was able to move mountains doing that, using other people to get there. And so that was a lesson that I learned from that. I got to experiment about five different times of using a middle layer of leadership to help steer a rather large ship. And so now coming into, to Thrive Pediatrics and where I'm at now, that's been key in our success, not letting it get to the point of having 20 direct reports but trying to keep smaller teams managed probably by a working manager and using that to create the culture we want, move decisions more quickly and help people get the right amount of leadership time and attention.

Jay Holmes:
I love it. So you've got clinical, you got front office, where do you start? How do you assess that? Is there a prioritization that goes into this or is it those are the two buckets, and I just I've got to film as fast as possible? How do you look at that?

Jesse Arnoldson:
Yeah, no good, good question. I think that every clinic probably thinks that they're unique and maybe there's a different seat than a clinical one and a business one. But I would say probably 90 percent of the time in most independent practices of kind of a medium to small size, those are the seats you need. You need a business person and you need a clinical person. And I think that where that comes into play is you start counting bodies, how many are on the clinical team? How many are on the front team? And sometimes it'll be a little out of whack. You know, maybe there's four front desk people and 10 clinical staff. But still, that's about the time where you see that you need somebody here and maybe not full-time. Maybe they are. Maybe you need a working manager, somebody who's at reception three days a week, but can act as a leader and do an admin day. But that's where I begin to look, is at filling those two seats. Yeah, it is necessary to move on those seats quickly, but you got to find the right person. I think that when I was doing interim assignments like I said before, there were a couple of times I pulled the trigger too fast and then realized that that wasn't the right person. And there was somebody else that would have that was in the organization that would have done that well, or I would have realized that, hey, maybe we should have hired outside for this because it just the talent or the skills or even just the willingness to participate wasn't already inside the clinic.

Jay Holmes:
Yeah. And that's kind of where my head was going is, you know, there's issues, obviously potential issues with bringing up someone that appear with, within the organization that might be sitting next to someone else. Someone else is well, that should have been me, why is this here?

Jesse Arnoldson:
Yeah.

Jay Holmes:
And so that's an initial thought. But as you, as you tripped on a couple of these, what was it, what was there a thread there that you could follow, or was it just different issues based on different circumstances? Where were, were there a couple of things like this was the this is the thing that I didn't get right and I started to get it right, or just I didn't assess the actual person to the seat.

Jesse Arnoldson:
I think person to the seat. I think probably it's the traditional issue of promoting your best nurse to a management position or your best bill or your best receptionist and then finding out, oh, what made them great in their role as a receptionist, nurse or biller is not what's going to make them great in a leadership role. And so you've got to be watching for those leadership skills and trusting that that's going to work out. Your point of, hey, you know, I work twice as hard as that, I put, you know, twice as many claims through as that person or I've been around longer. Any of those things, those things will come up and we shouldn't be afraid of those, because doing what's right, promoting the right person, no matter what, those questions are still going to exist. And you've just got to have the courage to stand up and address those and help the other people see the justification. And maybe that leads to some people exiting the organization, that's OK, because you don't want those feelings of resentment or envy hanging around. It's human to have those, but hopefully the people who stay are ones that can work through them and get over it. One of the things it's almost like the baby and King Solomon where you say, OK, you know, we don't promote this person, then we're probably going to hire from outside. And they're like, oh, no, never mind, you know, we'd rather have somebody that we know than going to some absolute unknown. And so instead of cutting the baby up, they prefer to let one of their peers get promoted.

Jay Holmes:
Makes me think of, I'm sure there's a, there's an official name for this, but in the corporate world, generally, you get elevated to the position you're horrible at. And until you're bad at something, you keep moving up the ladder.

Jesse Arnoldson:
The Peter Principle?

Jay Holmes:
It's something like that.

Jesse Arnoldson:
Like when you get promoted to the level of your incompetence?

Jay Holmes:
Exactly. And it just happens so much because of that. You're good at that, so we're going to reward you by putting you in a position where you have no way of succeeding. And, oh, I saw that in the public accounting world so much, which is why public accounting working in bigger firms is so horrible, is that the technical skill needed to get to a certain level was great, so, so much greater than actually being a manager and a coach and a mentor. And so you had a bunch of very, very technical people as managers or partners that were not great managers. And that's, happens in most professional organizations where what's needed to get to a certain level isn't what's needed to be an effective leader.

Jesse Arnoldson:
You know, Jay, just, to put two bullet points on everything we've set up until this point. So where do we start? First, it's identifying the seats and getting exactly what you want. And that's, you know, who, how much time, and what are they going to be doing. And then it's going out and looking for leadership traits, good manager traits, rather than just the best person in their department. That's where you need to start. Seek creation and find the people that will be good leaders, not just good nurses, good billers.

Jay Holmes:
Gotcha. Yeah. So really identify, OK, identify and prioritize. This is a seat that's needed the most, or maybe it's two, and then assess.

Jesse Arnoldson:
Yeah.

Jay Holmes:
Right?

Jesse Arnoldson:
Seat first.

Jay Holmes:
Yeah absolutely. We learned that well, right?

Jesse Arnoldson:
Yeah. Yeah.

Jay Holmes:
Or at least we're, we're continuing to learn that, that how true that is. Now we talked about this in first episode here about how many direct reports you should have. But let's talk about the conversation that you're going to have with the owners, the docs, that, hey, I want to pay someone more to potentially do something that you think is my job. So how do you have that conversation well?

Jesse Arnoldson:
I think that there have to be higher things for you to be working on. Most doctors, most hospital administrators understand this. Doctors want to be able to delegate certain tasks to the clinical staff. They want to be able to push a few things down so they can work at the top of their license so they can see one more patient. So you've got to be able to appeal to that motivation because they know it. They feel the same way. If you're going to them just saying, hey, I'm burned out, hey, I don't want to do my job anymore, hey, I'm tired of doing payroll or I'm just so tired of people that I just want to, I want all the complaints to go somewhere else. That's not going to go anywhere, man. But if you can go back to them and say, hey, I know that it's a priority for us to get to patient-centered medical-home status, I need to be working on that. I need this much time. I think that I can get it if I'm able to delegate these things to somebody in this, you know, in this mid-management position. Hey, I think that I'm not able to get to these people. And these are the things I want to happen in our practice. I want one-on-ones. I want coaching. I want good training. I want to be able to sign off on competencies that can't happen with just me. And so I'd like to have somebody, I'd like to see us promote somebody within the reception team to take care of that for the front desk. You have to have good reasons. It can't just be because you're burned out or you don't want to deal with some of the stuff on your plate.

Jay Holmes:
I like it. You know, you're really paying that picture, to say that, would you like to live and or work in a clinic that looks like this? And you get that buy-in and then you say, well, guess what, I can't do that alone, so, you know, I can't do what I'm already doing it alone. So here it is. Here's the path forward and.

Jesse Arnoldson:
Yeah.

Jay Holmes:
Yeah, and say this and spell it out. I think it's important, I think, to be prepared with one, the cost, the resources, and the value that, that will bring, brings it all into perspective. And you don't come in as just the whinner because everyone has to work harder than they used to and is getting paid less than they used to. And so, hard to make that argument and feel important or perceived as, important by someone else that feels the same way.

Jesse Arnoldson:
Yeah, I'd say there's, there's two more points. You know one is you hit it. You have to have the data behind it. You know, I, whenever I'm having these conversations, is, hey, we talk about what we're wanting to aspire to and all these things, but oh, yeah, definitely, I've done the benchmarking data and yeah, I have the budget, the financial work workup for this position, that's what it's going to cost. And that's the difference between our budget, and where we're going to be. You have to have your due diligence done. So it sits on the side. If they ask questions about it, it's ready to go. The second thing is you have to be willing as well to take a hard look at what you're. What is on your plate, and if you're doing it right. If you let's say, Jay, if you're taking 80 hours to do your month-end process, maybe it's not time yet to hire that mid-level manager, maybe you need to systemize a little better. If you're spending all your time on payroll, maybe there's a better system out there. So you've got to be willing for some give and take. You've got to be able to streamline some of your stuff if you haven't already.

Jay Holmes:
You know, and go and rewind a little bit to just how do you get the buy-in. There's always a pain point and it can be different for different clinics. I think understanding the pain point, you know, sometimes a business will need to make more money, sometimes the complexity's too high and it's too stressful, or needs to be simplified. And so those are the kind of the themes that I've seen in the past where you get a hold of that and say, look, here's the pain point and this is how I want to solve it. And it's not all the time, it's not always about money. It's about patient flow, patient satisfaction, all these things that, you know, you've got to bring up and say, hey, there's a pain point, this is how I want to solve it. And then that's, that's where the negotiation, the conversation can really work well.

Jesse Arnoldson:
Glad you brought it back to how you get buy-in, Jay, you know, let's say that I'm coming to you and I'm trying to make that decision. Jay, what would you like to see me spending my time on? Like what, what's the most important thing is, for you as an owner, Doctor Holmes, for me to be spending my time on? And, you know, asking them it's the priority from the strategic plan that we talked about.

Jay Holmes:
Right

Jesse Arnoldson:
We need to get to X or hey, well, I don't know what I want you spending your time on, but I sure as heck don't want you talking to patients half the day or doing, you know, 30 percent of your time on billing. Like, that's not what we hired you to do. Yeah, you're right. I don't want to I don't know what I want, but I know what I don't want. But asking them gives them a chance to create that buy-in. And maybe there's stuff that you didn't realize you should be spending time on it and it further justifies what you're asking for.

Jay Holmes:
Yeah, absolutely. And then allows you to have the conversation, because oftentimes when managers have the dialogue with the doctors-owners, there's just different perceptions of reality. And I think it allows that conversation to say, OK, well, you know, the owner might say, well, you know, I don't want to work four days a week. I want to work four days a week, I don't want to work five. You know, I just want to be in the office four days a week and have Fridays off, or Mondays off. But at the same time, you can't, and in that sense, with, but I want to make more money too, necessarily, right?

Jesse Arnoldson:
Yeah.

Jesse Arnoldson:
Because we know we all know how this business works and but that, that's allows.

Jesse Arnoldson:
I want to work less make more.

Jay Holmes:
Yeah. And you say, OK, well that's, that's, we can get there, but there's lots of things that things to discuss afterwards. But you can address the contradictions to say that I'm a single provider practice and I don't want to work anymore. Well, it's going to be kind of hard to make more money, but we could potentially hire someone else and offset some expenses, get some revenue, and that's going to create all this stuff. And then you really start to have that dialogue around, I know what you want. I'm the operations person, so I'm going to inform this conversation of how difficult that's going to be to do or what I'm going to need to get that done. And now you're really talking, and I think, but once you have that really clear alignment on, OK, this is, this is how I'm going to help you get there, then I think it makes a little easier. All right, man, we're going to end with a quick, with another quick question, maybe another quick answer here, which is, close your eyes, what's it look like? What's this highly functional management team? What does it look like? I hope you see it.

Jesse Arnoldson:
I love it. When I close my eyes and I think about it, I see a team that gets together regularly. It's very, it's moving decisions through, is rumbling on tough issues, and is growing together. They're influencing each other that they're almost an accountability set or a set of accountability partners for each other. That's what a good management team looks like.

Jay Holmes:
I like it. I'm going to add something to it. A good management team is diverse in their characteristics or personality types.

Jesse Arnoldson:
Not in their values, but in their experience and background and the way they think.

Jay Holmes:
Yeah. Diversity, diversity, you know, let's just take the normal diversity conversation out and just say diverse in where they've been, how they think, and really how they look at life. Because all of that allows for more growth, faster growth, faster learning. And,

Jesse Arnoldson:
Absolutely.

Jay Holmes:
You can't shy away, you can't surround yourself with a bunch of people, that think like you do or go through certain steps because you really miss out on that friction, that allows us to think a little bit deeper and grow a little bit more. And so I'd add that, to say, you know, you want, you know, you want a little bit more diversity in your management team. That being said, here at Medan, we've been so fortunate. The former owners are, all are on the different spectrum of the DiSC profile, which I think has helped us so much. And Jesse, you're just a perfect example. You are the social butterfly,

Jesse Arnoldson:
Of a group!

Jay Holmes:
Of a group, man. And I'll tell you what, I'm not, just the amount of energy it sucks from me to go into a conversation and just have a small talk is just enormous for me. But to have that, you know, to have that strength there to offset some of that is so relieving. And we have that all around. And rather than looking at it like, oh, that person is this way and they're such a drag because they're so different, it's relieving to me to say I don't have to put that hat on or act that way because I've got other strengths there and I can feel OK pushing people and maybe being the more D of the DiSC profile, I can feel OK with that because I feel like I'm doing my part, which is being me. And it's not a personal thing, but I'm going to be one that disrupts a little bit and pushes people to an edge. And I think overall that's a healthy thing and nothing's personal. It's all for the good of the organization. And yeah, I love it. I absolutely love it.

Jesse Arnoldson:
Yeah, likewise. I had a, just a very fast story, but I had, we have a decision for a seat that we're trying to create in our clinic and it's gone through all sorts of different conversations. And I thought that it was completely done until today and make up right up at our provider meeting. And I got a different provider point of view and it was really good. It forced me to justify what I was trying to get to, you know the justify what we were proposing and in the end, the decision still looked the same. And then later one of our nurse managers pulled me aside and we had a side conversation about the same thing because she wasn't in that meeting. And her point of thinking actually drove me a little bit different, like, so I have the provider one, my, the ideas survived, but we're just a little bit more, better justified, better thought out. And then with that nurse, a different point of view, a few things changed and that decision continues to get kind of beaten. What's the analogy of, man, the sword that goes to the blacksmith process and just keeps getting beaten until it's perfected, like, that's how I feel like a good team should beat a decision until it is.

Jay Holmes:
Yeah. Right.

Jesse Arnoldson:
It is exactly what it should look like. And that requires beatings from different directions, different points of view, different diversity.

Jay Holmes:
That's awesome. And this is going to be totally irrelevant to this overall concept that we're talking about, which is building a leadership team, but a nugget on that point of, and I want to say it was the Jim Collins interview, just this last one on the Knowledge Project podcast.

Jesse Arnoldson:
Yeah.

Jay Holmes:
But anyway it was, it was just about, but maybe it wasn't, maybe it was, it was an episode before, it came down to analyzing great leaders and how they made decisions. And there was no correlation on the speed of which decisions are made, of how much thought goes into it, pretty much everything but this one thing. Which is how fast do the risks change in big decisions, right? Not just what I want to eat for breakfast in the morning. Obviously, you're going to make that relatively quick just for survival, you know.

Jesse Arnoldson:
Right. And there's no risk.

Jay Holmes:
Yeah, yeah. Just, I mean, the risk is you never make a decision, you die because you don't, never eat.

Jesse Arnoldson:
Yeah but, but knows.

Jesse Arnoldson:
Goes hungry at nine.

Jay Holmes:
Yeah. But it was more on just this, this idea of, do risk change and how long do you have until the major risks change in this decision. That's going to dictate how fast we react. And so if we have market conditions that will change in the fall and we have to figure something out in the next two months, we've got two months to digest this, to beat that sword over and over and over to get it as honed as possible. Or it's, we see a shift or something coming down and we have a week to make that decision, right. And then speeding up. I just thought that was really fascinating, looking at how the speed of decision making and how much time we give ourselves to allow for that process of refining and re-forecasting what it might be because that's a big difference. There's times where snap decisions and then there's times up. But that's for another episode, which we already talked about a little bit. We should probably do it again, which is decision-making and how to be better at that.

Jesse Arnoldson:
Let's do it.

Jay Holmes:
OK, Jesse. Awesome, man. I again reiterate this is the best times talking with you. I appreciate it.

Jesse Arnoldson:
Likewise!

Jay Holmes:
We're going to wrap up. And today we've talked about building the best leadership team you can. Last episode was about taking, really assessing how many direct reports you have, what the right number is and what you can do to get better. And so, Jesse, thanks so much for hanging out with us.

Jesse Arnoldson:
Thanks, Jay. Thanks, everybody.

Jay Holmes:
All right, everyone listening today. Thank you for tuning in. I hope you enjoyed our conversation with Jesse. Again before you get distracted, click that subscribe button so you can always stay updated on new content! We hope you enjoyed our episode today. And thanks so much for tuning in.

Jay Holmes:
Thanks for tuning in to the Medical Management Podcast. We hope you enjoyed today's featured guest. For the show notes, transcripts, resources, and everything else MedMan does to help you level up, be sure to visit us at MedMan.com.

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