October 13, 2020

One Thing Keeping You From What You Want

PTO 118 | Tolerating Barriers

What are you willing to tolerate in your business?  Substandard performance, misaligned team members, limited time to focus on your business, sacrificing family time for work, unprofitable company structure - these are all barriers to our goals. But they can only limit us and continue to do so for as long as we tolerate them. Inspired by Jocko Willink's quote in the book, Extreme Ownership: "....there are no bad teams, only bad leaders...." Nathan Shields sees that there is absolutely just one thing that is keeping us from what we want. The fact is our team, the economic crisis, the insurance companies, etc. are not the issue; WE are the issue because of what we tolerate.


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One Thing Keeping You From What You Want

I'll start this episode by apologizing. I haven't been on for a couple of weeks and we're getting back into the swing of things. I went on vacation and contracted COVID thereafter. I've been behind on a few things. Forgive me, we're moving on. This episode is not a guest interview like I typically have. It's a solo podcast episode. I'm flying solo because I want to talk a little about something that I've seen both in my own experience and in the coaching clients that I have. It's related to a concept that Will and I discussed a few episodes ago and was then brought up in a different way and in a different perspective. You know how that is. You're thinking about something and then you read it a different way. It gives you further thoughts and ideas. Maybe it even shines a light on what you were thinking of in the first place.

In my episode with Will, we discussed the five secret actions that PT owners take to make them successful. The fifth one that I brought up was impatience. Not that it's a successful action per se, but it's a characteristic that successful PT owners and small business owners have in general. At the time, I didn't feel comfortable with the word because it's not necessarily patience that the successful PT owners are able to make quick decisions with the data that they have. They're decisive. They recognize that there might be repercussions, but they make the best decisions with the data that they have, and do so in a rather quick fashion.

Extreme Ownership: How U.S. Navy SEALs Lead and Win

This concept was addressed in a book that I'm reading. Our Physical Therapy Millionaires Mastermind read together what’s called Extreme Ownership by Jocko Willink and Leif Babin. In reading that, this is what got my brain thinking a little bit, in page 54, he says, “As a leader, it's not what you preach. It's what you tolerate.” He goes on to take it a little further in page 55. He digs a little deeper and says, “There are no bad teams, only bad leaders.”

What I got from that was that Jocko and Leif are stating a better way of explaining that one of five secrets that I discussed and labeled it as impatience a few episodes ago. Jocko might call it intolerance. The idea being that improvement, growth, attainment require us to look at ourselves and our teams and ask, “What am I tolerating? What negative performance or actions am I tolerating that are keeping me from my goals? In spite of everything I have to say and all the values that I espouse, what am I tolerating that's going against those things?” I believe that answering that question and purposefully addressing it head on is the key to our ongoing growth and fulfillment and our successes honors.

It's not a one and done action. This isn't something that you look at now. Maybe you address a current issue and then move on. It's like that never-ending mountain that doesn't have a summit necessarily. There's never a summit to be reached in this regard. Tolerating marginal or negative behaviors in ourselves and others is the antithesis of growth. We’ll continue to be a stumbling block going forward unless we create or develop characteristics within ourselves to not be okay with those things that we're simply tolerating. We could get into a deeper conversation about integrity and character. For the purposes of this discussion, I'll just say that most of the time, the things we tolerate are counter to our stated and unstated values and purposes.

What are you willing to tolerate to keep you from your goals? Click To Tweet

I want to share some examples from my own experience, the experience of coaching clients that I have to illustrate some of the things that are being tolerated. I'm not going to go through the consequences, but consider what those consequences might be if these scenarios are allowed to persist and continue. Usually we consider that it's a team member. That's the “issue.” Remember, there are no bad teams, only bad leaders. Consider what needs to be done as a leader in order for these issues to be addressed. I'll give 5 or 6 here. The PT that's not following train protocol to get full buy-in for the full plan of care at initial evaluation with a patient. Leaving the front desk and patient then to determine whether the patient should come once a week, twice a week, three times a week, and not taking a stand but saying, “You guys figure it out, whatever works with your schedule. We'll see you whenever you need to come in.” Consider what are you tolerating in that situation? What are the consequences if that continues?

What about the PT owner who finds out that, as I've stated here in my show or maybe found it in a different study, but less than 20% of patients complete their full plans of care? That PT owner does a little digging into their own clinic and individual provider statistics, and finds that most of one particular PT’s patients fall off after 3 to 5 visits and are in that less than 20% completed range. These patients are thus not reaching their goals or completing their full plans of care. When the PT is asked about it by the owner, he or she simply says, “I can't control if the patients are coming in or not. If they're busy, they're busy. I don't know what to do about that.”

PTO 118 | Tolerating Barriers
Tolerating Barriers: Tolerating marginal or negative behaviors in ourselves and others is the antithesis of growth.

What are we tolerating? What is the consequence? In that one, I'll tell you the average outpatient orthopedic clinic loses on average $150,000 a year because patients aren't completing a full plan of care. I'll give you that one. What about this? Front desk is found to be collecting only 50% of over the counter collections. That means only 50% of the copays, deductibles, and coinsurance are being collected at the time of service. Typically, this is struggled off by the front desk and maybe excuses are made that the patients forgot their purse or they don't have their credit card on them at the time or, “We'll just let the billing department handle it.” What are we tolerating? A lot of money and what are the consequences?

How about this? This might be a little bit more relevant to our situations. Six months into this economic downturn, there's a clinic that is overstaffed. Reserves are depleting and there's no immediate increase in new patients on the horizon. How much longer do you tolerate the overstaffing and negative profit margins? These next few are owner-specific. An owner has a team member that complained about their pay, their hours, even asking if meetings are on the clock or not. It's gotten to a point and sour the relationship to a point where this team member now avoids interaction with their supervisors and even the owner. However, they're productive and their patients have no complaints. Is that conduct tolerable? Are we tolerating something? What are the consequences?

The last one I'll share, all of your physician only marketing efforts have led to a stable yet a plateaued number of new patients that come in the door. You, the owner wants to expand, but you don't know what to do and don't have the time and effort to do it because they’re too busy treating patients full-time. You don't have the time to necessarily assess the alternatives because that takes even more time away from hobbies, family, etc. What are we tolerating and what are the consequences?

“There are no bad teams, only bad leaders.” – Jocko Willink & Leif Babin Click To Tweet

Most of these are real situations. Some are mine. Some are clients’ situations, but in each situation, I can promise you that the owner is tolerating the inaction of the employee or of their own that goes against their clinics, values and purposes. It’s going against what they preach. Remember, it's not what you preach, it's what you tolerate. That's where this whole conversation came from. Successful owners who have gained experience and have learned over time, they don't tolerate the affirmation scenarios.

They usually follow up pretty quickly with a four-step process and don't drag things out. Number one, they assess, revise and update any training or protocols that need to take place, and assess the situation to see what was missed in the training, what was missing in the protocols, or if the employee simply didn't follow through. Number two, they commit to change and improve both personally and as a leader of their team. Number three, they commit and expect higher levels of performance of themselves and others. Number four, they follow those commitments up by acting according to a higher standard and tracking the statistics that are related to them to that higher standard, and doing regular assessments either with themselves or with team members or in their leadership teams.

In the book, Jocko Willink says, “When setting expectations, no matter what has been said or written, if substandard performance is accepted and no one is held accountable, if there are no consequences, their poor performance becomes the new standard. Therefore, leaders must enforce standards. Consequences for failing don't need to be immediately severe, but leaders must ensure that tasks are repeated until the higher expected standard is achieved.”

PTO 118 | Tolerating Barriers
Tolerating Barriers: Successful leaders act quickly and decisively and don’t tolerate substandard performance.

What we tolerate leads to poor performance and that poor performance becomes then the new standard. The question is, what can you see in your clinic or in your own personal lives that you're tolerating that needs to be addressed? Simply address that now for immediate improvement. That's the challenge. I can think of a few things myself and they're not easy solutions. Nevertheless, if addressed, I can see the possibility for growth, fulfillment and attainment.

That's obvious if I simply address those things appropriately. I offer you that challenge. Open your eyes, pull your head up as the leader and be honest with yourself. What are you tolerating personally and professionally? Make a plan for immediate correction, including putting on your calendar exactly the hour and the day of when that item will be addressed. This is how successful leaders operate. They act quickly and decisively. They don't tolerate substandard performance.

If you are treating patients full-time, that doesn't give you the opportunity to assess and address your business accordingly to see and act on those things that you're tolerating. I challenge you to do those things. Hopefully, everyone's doing well, especially as we're recovering from the pandemic. I hope to see you here in the near future with another exciting guest, some great resources and content coming up. Stay tuned. I'll see you next time.

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