The Medical Management Podcast_The Danger of Too Many Direct Reports: Audio automatically transcribed by Sonix

The Medical Management Podcast_The Danger of Too Many Direct Reports: 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:
Welcome back to the Medical Management Podcast. Thank you so much for tuning in today. Jay here, and I've got the privilege of interviewing our very own Jesse Arnoldson. Jesse, welcome to the show! So glad to have you.

Jesse Arnoldson:
Hey, Jay. Hey, everyone.

Jay Holmes:
OK, so let's just start off with an easy one Jesse, just how are you doing today?

Jesse Arnoldson:
I'm good. I'm really good. There's lots of reasons to be happy. The sun's shining. Our twins are kind of sleeping, clinics are going well. I mean, things are good.

Jay Holmes:
Good, man. Good to hear. Jesse, we had a question come in from one of our listeners that had to do with the right amount of direct reports a leader should have. So today I want to spend some time really thinking about the danger of too many direct reports. And so first off, I want to see what your line is as far as how many direct reports a leader should ideally have. Is there an ideal amount?

Jesse Arnoldson:
Yeah, I think that there's going to be people that argue that that more is OK. And so I always like to kind of draw a line in the sand and, the ridiculous line in the sand, OK, is a thousand direct reports, OK? No, no, of course not. There's nobody is going to be OK with that, right? And then you start to walk back and you see where their line is. For me, and the experience that I think MedMan has had in managing medical practices, the ideal perfect number is seven. And, you know, if you want to put it into a range, 7 to 10. You start getting above 10 and the wheels start coming off.

Jay Holmes:
Well talk to me more about the wheels coming off. What do you see as far as the, once you get over that, what seems to begin to burst?

Jesse Arnoldson:
Yeah, you know, lots of them. Let's just take, for example, the amount of time each of those direct reports needs from their manager or their leader. That's the thing. Every single one of us that reports to somebody needs a certain amount of time from that person in order to move decisions ahead, progress on projects, advice, guidance, and sometimes even just a swift kick in the butt. You need your manager every once in a while to be motivating you or pulling you back from bad behaviors that you're committing. And if you have, let's say, 20, because I think that that's a pretty normal number for managers and leaders. You have 20 direct reports and each of them needs something from you, at that point, progress is slowing down because of you. You are the bottleneck at this point. You can only make so many decisions. You can only spend so much time with people. And so decisions stop being made on time, projects stop progressing, people don't feel cared about, or that they don't have enough quality time with you. And then you put it into the mix, "you're probably spending the most amount of time on the people who aren't your top performers. And that's true whether you have seven reports or one hundred. But with seven at least, it's more manageable. With twenty, the people, your top performers, are probably getting little to no quality time with you and that's a problem.

Jay Holmes:
I would agree with you. Let's take a little detour here. I think that what I'd like to think is, hey, we've just haven't created a well enough defined operating system.

Jesse Arnoldson:
Okay.

Jay Holmes:
to work this in.

Jesse Arnoldson:
Yeah.

Jay Holmes:
Right? But at the same time, right, we've created complexity. We've created these, we've created the stoplights, right. I always go back to the stoplight versus the roundabout analogy, right.

Jesse Arnoldson:
Oh, right.

Jay Holmes:
So we've, we've created through management that we get to hold up a green light or a red light or a yellow light. And everyone reacts to that because they come to us to understand when to go, how fast to go, what direction to go, rather than creating a framework where there's one simple rule, which is yield to the left, and now you can interact. And I wonder, you know, just have our complexities gotten so great that it's really hard for us to distill how we interact with an organization down to maybe ten fundamental rules, yield to the left and you're good, right? There's no one there that's in the roundabout, you get to enter, there is, you don't. And rather than you've got a yellow light, sometimes you've got a blinking red light, you've got a maybe a green light, an arrow, sometimes you don't. All these different rules for different things that basically force you not to think. So I wonder, what's your opinion on the balance between being there to help guide versus being there almost as, as an impediment on your direct reports thinking on their own?

Jesse Arnoldson:
I think about, you know, let's take the stoplight and the roundabout to a direct application inside the clinic. I see one almost perfect application to it is the schedule, the schedule templates that you put together. If you are trying to make sure that only, there's a new patient slot here and an established patient slot here, and a med review here and only so many things here, and this rotates here, and then, that you put all these different rules and that's the yellow and the blinking red and all those rules that make it super difficult. And what it says is we don't trust the people going through the system to work things out. And so we're going to put all these rules here, and all it does is create a ton of confusion, and when people don't understand all the rules, it just breaks down.

Jay Holmes:
Right.

Jesse Arnoldson:
And so if you can create like a schedule template that's a lot looser, you know, we're going to work in 15 or 20-minute increments. And here's a few parameters on how to schedule these other certain appointments within that easy system, here's the trust in you to, to make that work. I think that that works. And we should always be aiming towards the roundabout, right. We should always be aiming towards giving more trust and more power to our people. But I think that where we, where it begins to need a little bit more to the analogy is that we're working with human beings inside of this system and what we should be, trying to give them trust and, and power, there's always going to be that need for emotional attachment. You need motivation to get through the roundabout, right? You need motivation to actually do a good job. I think that Jay, you know, posing the question back to you, isn't there a more of a human element to it? Not that it's mutually exclusive. It's just that you're trying to get to the roundabout and you've got to deal with humans.

Jay Holmes:
Absolutely. You know, this brings me back to the book we both really enjoyed, "Work Rules!" By Laszlo Bock.

Jesse Arnoldson:
Right.

Jay Holmes:
And, you know, you've got to, it's all about Google, right, and the HR kind of environment there but, you have a bunch of engineers that pretty much said we don't need managers, they don't do anything for us. And because, because they're engineers, you know.

Jesse Arnoldson:
Yeah, yeah!

Jay Holmes:
They put it into surveys and they've analyzed it and they have data, and guess what? Managers made a difference. Good managers made a difference.

Jesse Arnoldson:
Good managers.

Jay Holmes:
Right. So, there you got a bunch of certain types of personality there with engineers that said, you know, which I think is a great test case of maybe on one side of the extreme, of probably could work through it on their own. And they realized that absolutely, you know, management is necessary and better management is better. So you work through that and we're in this, you know, this kind of in-between to say, absolutely, perhaps we can increase that seven or eight number, but maybe we can't just because there are a complexity at us, just different providers than saying, well, they have different roundabouts. They say that, well, I don't want to see a patient 15 minutes after lunch or on this day I do, but that day they don't and don't stack this next to that because that's not how I flow. And so all of a sudden, we have one big issue of too many stoplights. And the challenge is to reduce that. The reality of doing it is a challenge. And I think that's why we're having this conversation right now, which is what's the right number, given the complexity that we work in?

Jesse Arnoldson:
Absolutely. And I think, you know Jay, one key place for me as to why you can't just create a perfect system and push people through it and hope that it, just self propels is, it depends on the culture you want to have. And in the organizations that I've worked in, you know MedMan, Thrive Pediatrics, we want the people inside our clinic, the team that we've put together, we want work to be a part of their enjoyable life. We want them to enjoy what they're doing and who they're with. And that doesn't just happen with a perfect system or else somebody I would think somebody's a lot smarter than me would have created it by now and we'd be copying it. I think a leader plays a larger role in the actual fulfillment of their team feels and whether they actually achieve that at your organization or not.

Jay Holmes:
Absolutely. And so let's jump into this, this kind of last area here of, you're in a situation, either you designed it or someone above you designed it, that, that you have 20, 30, 40 direct reports. What do you think you can do about that to ease some of that pain?

Jesse Arnoldson:
Yeah, I think the first step is to figure out why you're in that place and why you're in that spot in the first place. If it's self-inflicted, sometimes it's because you just have a hard time letting go and delegating and getting things out. And so you just keep accumulating more and more people underneath you. Sometimes it's a badge of honor thing. I've had lots of people that are like, now that I've moved up, I have 50 direct reports. And you're like, dude, are you bragging? Or you like what it is? That's not good.

Jay Holmes:
Because I'd be complaining if I were you, but.

Jesse Arnoldson:
Yeah. Yeah, yeah. Oh no, it's, it's the it's the badge of honor thing. I'm, look how busy I am, look how many direct reports I have. It's that and sometimes you've got to self-check and humble yourself a little bit and get, you know, realize that that's not something to be proud of. If it's not self-inflicted, let's say that you work inside of a hospital system. This is probably where it's most likely to occur. What I've seen and I'm not anti-hospital, but what I have seen just as the nature of the beast, is that more and more will get pushed to you if you're an effective leader, an effective manager, more and more will get put under you until you cry uncle and crying uncle isn't even the end of it. It just is where you begin to get people to pay attention but more and more will accumulate under you unless you make it known that that, you know, that's not ideal and prove why it's not. So let's get into your real question of, you know, what do you do? So first, recognize why you're in it and what the motivations are behind that. It's self-inflicted, you got to take care of your own problems. If it's brought from above, then you've got to justify why, you know, you need to lower that number. The next step, let's keep going down the hospital path is that justification. You've got to prove the value of having perhaps a middle, mid-level management team underneath you. What's that going to allow you to do? What kind of work is going to get done that wasn't before? The quality of work, the culture, all of those things have to kind of go into a presentation and be pushed to those that are making the decisions for you. If it's self-inflicted, you've got to, I guess, put together the plan yourself and bring it to those that help you make the decisions. Quite possibly it's the physicians that own the clinic that are going to make that decision with you. And you, again, have to justify, just like with the hospital, why you need it and what benefits going to come from it. But I think that that's the key thing, is getting to the point where you have a leadership team that you're guiding that can take care of the team you have.

Jay Holmes:
Absolutely. You know, and thinking through that, oftentimes you have those feelings, well, if I don't do it, it won't get done right.

Jesse Arnoldson:
Right.

Jay Holmes:
And you know, I've been burned too many times and all that stuff. In all this, I kind of comes down to what I think through is not having as sound as you could, systems or processes of doing things that you can say, hey, go ahead, here's a pathway, walk down it, and here's the infrastructure support you. And really, it's to elevate and delegate, right. How can you elevate yourself by pushing things to other people at the same time you're elevating them. And that's ultimately what you need to do. But to your point, have that mindset of if I'm going to do this, I need a good way of tracking progress and the things that matter the most. And if you do have that, then it's pretty easy to come back and say, look at all of these things that happened, in a positive way because we have this infrastructure to actually support what needed to be supported.

Jesse Arnoldson:
Right. If I can take it back to one key place to start, it's right in line with one of MedMan's values of confident humility. You have to be able to recognize that you will not be the only reason for success in that practice. It's too hard to find somebody to delegate to, it's, you know, only I can do that. That's the place to start, because quite, quite often there is a better person to manage the clinical staff than you. You know, there's somebody that can probably do it better, that you can help coach, it all starts with being humble, recognizing that you are not the solve-all for the practice and then being confident enough to ask for that help.

Jay Holmes:
Mmhmm. And having the trust and the faith really that by doing so will make your life better down the road, which I think is the hardest hurdle to overcome because we get so far behind and it's extra energy to get there, but you just have to have the faith in, put the extra energy in the right way. And everyone's life turns out a little bit better and isn't what we're here for?

Jesse Arnoldson:
That's what we're here for.

Jay Holmes:
You know it, man. Jesse, I appreciate your time and the insights into really just talking about how many reports are too much, direct reports are too much. So thank you so much. You did an awesome job and always so fun to talk.

Jesse Arnoldson:
Thanks, Jay.

Jay Holmes:
OK, well everyone, thank you all for tuning in today. I really hope that you enjoyed our conversation with Jesse. Before you get distracted, click that subscribe button so you can always can stay updated on new content. We hope you enjoyed our episode today and thanks again 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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