February 9, 2021

Strategies And Challenges To Improving Culture With Beth Winkler, PT

PTO 131 | Improving Culture


With 15 years of experience as a clinic owner, Beth Winkler has dealt with her fair share of challenges – from the aftermath of Hurricane Katrina to multiple providers leaving at the same time.  Through all of that, Beth and her partner Lisa Taglauer, PTA have built clinics that thrive and grow on policy, procedure, and a healthy dose of quirky, fun culture. Those foci have allowed Beth and Lisa to grow from one clinic to four and focus on solidifying their company culture to weather any future storm. Beth and Lisa own and run Magnolia Physical Therapy in New Orleans. You are going to learn a lot about culture building in this episode as Beth shares that story from her point of view with Nathan Shields.


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Strategies And Challenges To Improving Culture With Beth Winkler, PT

Our guest is someone whom I've wanted to have since the beginning of my podcast, and I finally tracked her down and got her. Beth Winkler is a physical therapist, CEO and Cofounder of Magnolia Physical Therapy in New Orleans. Beth, thanks for finally coming on. I finally got you.

Thanks for having me. I'm glad to be here.

You've been in New Orleans for a long time and you've successfully built up four clinics. Will and I looked up to you and Lisa for the longest time during our ownership. We thought, “Here are two women who are great owners, they created a great culture and they are doing everything right.” That’s why I'm excited to finally tap into some of your wisdom and knowledge. You guys have always been someone that we've looked up to as owners.

Thank you.

Tell the rest of the audience a little bit about your professional path and what got you to where you are now.

PTO 131 | Improving Culture
Improving Culture: A bit of slow growth can help you get your people connected to your core values and culture so that they don’t leave and work for the big hospitals.

Lisa and I met when I was a new grad, a couple of years out of school. She came to volunteer at the clinic that I was working at, and we became instant friends. We talked about not opening our own clinic as of yet but we work well together. She has gone in a PTA school, so I wanted to make sure that when she got out of PTA school, I'd love to have her come back and work here and work together in some capacity. While she was still a tech, I got offered a position at another clinic where they were going to pay for my manual therapy fellowship. I couldn't pass that up and that was when PTs were in great demand. It was like, “Name your price,” which was nice but there's one caveat. I said, “I don't come alone. I have a great tech that I want to come with me,” and the owner was happy to hire her. He was looking for someone, so we worked together through her. She went off PTA school and we hired her back as a PTA.

There were some changes in the company that we weren't too happy about. We had suggested a few different things on how to become more efficient and have Lisa go out and do some of the marketing while she could also see patients. It was like, “Thank you for your input but no thanks. This is the route we're going to go.” It felt like our voices weren't being heard, so I started talking about doing our own thing and we could be our own boss. It was never to grow to four clinics and see all these patients, it was just so we could have more freedom to do what we wanted to do. Lisa thought I was joking all along. When I finally said, “Let's do this.” She's like, “You're serious?” I'm like, “Yes.”

Honestly, we looked at our bosses that we worked for, and no offense to our former bosses, but we're like, “If they can do it, we can do it.” Let's go ahead and start this thing. We always have the default at home health, which as a PT, there's always the default of home health. I knew I didn't want to do that. That was the alternative, so the alternative was not an option. It's like, “We need to make this go or I'm doing home health.” That was not what I wanted to do. It wasn't my vision for future plans.

The irony was the day that we were going to put a deposit on a tiny space, I don't even know how Lisa and I would fit in this place. I was dropping off home health notes across the hall from where we used to work, I saw the owner in the hallway, and we were still on good terms. He's like, “What are you doing here?” I said, “I’m dropping off notes.” He had lived out of town and I said, “What are you doing here?” He goes, “My therapist quit. Do you want your old job back?” I was like, “No.” He goes, “Do you want a clinic?” I'm like, “Maybe.” It was the old text phones and I mentioned this at Will’s where I was texting Lisa like, “A, B, C.” I was like, “David is selling his clinic and he offered it to us.” We took over his lease, the patients, bought his equipment, had it owner-financed the equipment, and there we go.

You were all set up and ready to go. It was that easy. You opened up a clinic and you immediately had a room full of patients and everything went hunky-dory after that, right?

Not really. Three weeks later, a little storm called Hurricane Katrina hit New Orleans and that was a little insane. My friends would ask me, “How did the clinic do?” I said, “I don't know.” We didn't have that many patients to begin with. I was getting going and I was ready to go. Lisa and I were so driven to get back. We both lost our homes. Lisa's home completely went underwater. The water was all the way up into her attic, so her home was completely destroyed. I had 4 feet of water in my home, we had to gut it and completely renovate it. We didn't move back into it until a year later and that was considered as, “You're back in your house soon.” Everything is relative. We have the clinic, so we would take turns. She’s like, “I'm going to go.”

Our husbands were not there because they needed to be with our kids. There was no daycare in the city, so that's why most people were back, you couldn't bring kids back. My husband and I are not together anymore, but at the time he had got a temporary job up in DC, so he kept our daughter up there. We would alternate going to my house and Lisa would go to her house, gut it a little bit, and try to salvage some clothes. It’s the same thing with me. We were doing that and also seeing home health patients, which is the other irony of that.

That's what we’re trying to get away from but there was no one doing that. They didn't even have nurses going out to some of these people's homes. We were bringing people supplies. Lisa and I will go to our church and get toothbrushes, toilet paper and clothes, then bring them to these people. She got a puppy for a patient one time. This woman's dog drowned in the storm and it's awful. She's like a vigilante coming in with these hot pink colored scrubs that she had donated, “Would you buy some new scrubs?” It was funny. It was an interesting time but it was one of those things that if we were starting off that way, there's nowhere to go but up.

I was going to say the same thing. Everything had to be easy after that.

Pretty much.

When was Hurricane Katrina? That was how long ago?

That was August of 2005.

You're always learning. When you stop, that's when you have a problem. Click To Tweet

You've been a longtime clinic owner and you've run the gamut. You've done many things opening up new clinics and you started by purchasing a clinic. You've got a ton of experience. What were some of the biggest challenges that you had in developing your clinic over the past couple of years?

We were talking a little bit about it before. It’s finding that sweet spot. When you have therapists that are working for you, it's like, “When do you hire that first new therapist? When do you hire the second one?” In the beginning, we thought we had a formula. What was happening is we would get to a certain percentage, hire too quickly, and we would be inefficient for a while. It was nice because you can sit back a little bit as far as a treating schedule but the profits on the other end suffered for that because you're not having efficiency. You have the other end where you don't have enough therapists. We've had two waves of 3 to 5 therapists leaving at a time. It was like, “How do you rehire?” Us going back into patient care where you have a ringleader that doesn't agree with something that you're doing and takes everybody with them. That was challenging.

You have the therapists that are there with you who are overloaded and overworked. That's no fun either. Still to this day, I'm still struggling with that. What is that perfect balance because we were growing so quickly and we were hiring people, but if you're hiring that quickly, do you have time to get people on board and hone down on your culture, your core values and that kind of thing? That's what we're going to focus on in 2021. Let's do a slow growth so we can get people connected to our core values and what our culture is like so they don't go and leave and work for the big hospitals.

It’s focusing on the training and not sending them out into patient care immediately. They may do start seeing patients but you're going to focus on what it means to be a part of Magnolia Physical Therapy, “This is how we do things, these are the expectations, and laying that stuff out upfront.” We wanted to talk a little bit about the culture that you have created in Magnolia over the years. It started with you guys and everything that you did to focus on making it survive after Hurricane Katrina. You guys are so much about service and you want to provide that service for your employees. You want them to work in a great environment, you want it to be a place where people enjoy working and will attract top talent. What are some other benefits that you might see in creating a culture in your clinic?

One of the best benefits is having fun. Work doesn't have to be about coming in, going with the grind and pushing through. I know that Lisa and I are goofy. We have different senses of humor. Bringing that into the clinic with our patients and our team, we have students that come in and they see how silly and goofy we are in the clinic, that’s one part of our culture, that's not all of our cultures, but it's a big part. We make fun of ourselves. It's opening up a sense of vulnerability when you can make fun of yourself and poke fun at things that the team might be like, “Here they are trying to push this policy in or whatever.” We go ahead make fun of it and it lightens it up a lot.

That was one of our values as well. We had our core values but we did have a cultural value that was about fun. There was so much about me and Will that was about humor and a shared sense of humor. That was one of our cultural values and we define it. We let our teams know that if it's not fun, that's not worth working like this. To be intentional about that, it’s important because it's a place where you want to work. You’re the owners, so you should be in a place that you want to be on a regular basis. You don't want to be in a place that you dread especially if you're the owner of that company. Maybe not specific to having fun, but what are some of the things that have worked culturally? Then we'll turn to the flip side with things that haven't worked.

It’s investing your time to spend in the clinics. There was a period in time, especially in the beginning of COVID when it was like, “If you can stay put, stay put.” I wasn't visiting the clinics a lot. Being in the clinics and having team members see me interact with patients. When we first open and we've hired our first therapist, it's like, “How am I going to make this person a mini-me?” Not an exact stamp or replica, but how am I going to get them to instill how I would treat a patient or how I would have fun with a patient?

It's important for them to see us immersed. It doesn't have to be necessarily treating patients, although that can help. Sometimes I'll go to a clinic, sit in the waiting room and talk to the patients. It’s like, “How long have you been working here?” “How long have you been coming here for therapy?” I’m like, “No. I’m one of the owners.” I'm talking to everybody and I love doing that. How nice is it when you go to a restaurant and a chef comes out and talks to you? That's how I look at it, not like, “You're the owner.” It gives a sense of that patient feeling special. It’s like, “I met the owner,” that kind of thing. It’s to create that feeling in them a little bit and show the team too that I'm interested in what the patients have to say.

I've come across owners who have got to a point where they've got some freedom. They're not treating patients and they could work from home remotely. I have to remind them sometimes you need to still be there because they get too comfortable working from home. They’re like, “They don't need me. They're doing fine.” I want to remind them, “It's important that your presence is there on occasion because you want to exhibit part of that culture and personality.” Honestly, you want to make sure things are going well and make sure everyone is following the policies that you would expect. It's nice to have your ear in on conversations, whether that's at the front desk or between provider and patient. That's part of maintaining culture and having that presence. You can still maintain that culture at larger clinic members like 15 to 20 clinic members. That means you simply have a lot of other people that already know the culture, how you do things and have bought into the purpose, values and all that stuff before you can feel comfortable with not physically being present in the clinics.

I've done it wrong the other way. At the beginning of the COVID crisis, I’m not going into the clinic and having team members get these videos for me. It’s not an order but it’s like, “Let's work on this,” and here I am sitting at my house. They don't know what else I'm doing and that didn't come across well. I remember our COO was like, “They don't see you as I see you.” They need to know the goofy Beth so you can create that mutual respect in that.

There was a clinic that Will and I had. It was always awkward when we visited. We weren't that present often. It was a little bit out of the way but it was successful, our guys are doing great numbers and they don't need us. When we'd show up, there was a weird vibe. Sometimes, you get that sense that something is off here. That's when we had like you where someone quit, another one will quit soon thereafter, and another one quit a little bit later after that. Being present and recognizing the feelings and atmosphere, you can get a lot of sense simply by observing and being present.

There are other times where I might not have been so invested. It’s not only going to clinics but even with a marketing team. I've been working closely with them and we had a couple of team members in that area that were not getting along. It’s like, “Let's dive in and figure this out.” Let’s get in, work on rebuilding trust, and spending a lot of time with them doing that. I can tell you that they've told me, “We would not be here if you would not have done that. If you wouldn't have taken the time to show that you care, you value both of us, and us getting along, that meant much to you.” That was a wow moment.

It's cool to hear that you share some of the issues that you're having even years across four clinics. I see you as a successful physical therapy business owner and Lisa as well. It's still a work in progress. Things aren't perfect. You have your own difficulties. Who could have guessed that the pandemic would come along and it presented its own set of difficulties? This is something that you're constantly working on. It's not a one and done. It's not like you can open up a McDonald's franchise and it's going to run as it would anywhere else in the world. You guys are still working hard at developing the culture that you want.

It's still a challenge. It ebbs and flows too. You have periods that I look back on where we were doing even better than we are now. For Lisa and I, we took off a whole summer and we came back to a mess. Our numbers looked good, we were doing well and the culture was good. To me, it's not always about how well are the numbers and how are our profits are. It has become more than that now. We have four clinics and instead of doubling or tripling, our purpose is let's get what we have and get it humming. Get everybody happy and engaged. I look back to the team, we had fun but it wasn't like this team approach where it's like, “I’ve got that, I’ve got your back.” Whereas now, I feel like we have that. It's more fun and inspiring to be here.

When things were running well or at times when the culture was good, what were some of the things that you recognized from that? What were some of the benefits of having a culture that people bought into?

PTO 131 | Improving Culture
Improving Culture: When you do have team members leave, it's hard. You have to regroup, revamp, get back in deep and go over your core values.

We've been working a lot on trust and getting people to be more open and willing to say what they think and feel. We started with these anonymous surveys. Be careful what you ask for because you'll get it. We got back not so great feedback and I was like, “What's going on?” We started honing in first with the management team. Let's be open and vulnerable. It was hard work on my end because I had to sit back and say, “What am I doing that is creating this environment of people not wanting to speak up?” It took a while to recreate that trust.

We're so used to this top-down management approach, which got us far to a certain extent but that's not how I wanted to run my company anymore. I wanted it to be more of, “Let's get everybody's input, and let's come up with decisions together.” Number one, you've got more brains that are pitching in. People who are on the front lines know the systems better and can come up with better ideas than I can. It’s being open to that instead of, “I want things done yesterday.” I can sit here, write up a whole plan, have it done tomorrow, and try to shove it down everyone's throats but that I learned does not work. It's taken a lot on me to sit back and say, “Let them come up with a solution or whatever.” Most times, it's better than what I would come up with. Even if it wasn't something I would have done, it still gets the end result. It's like, “Why does it matter how you get there if you take Road A or the scenic route?”

Creating that and having everybody pitch in and not be like, “Why would that person say that?” One of our core values is giving everyone a chance to surprise you and me. Let them come up with it. I've noticed that they take more ownership that way. It's been a little more fun. Our management meetings and team meetings to be able to see they are pushing the core values instead of me, Lisa or Ron are on an island by ourselves.

Give everyone a chance to surprise you. Click To Tweet

That's one of the keys to a functional team is the relationship of trust. Are there certain books that you've read that have helped you develop that team and that feeling of culture?

It's called Leading with Gratitude. That was a good one. The Five Dysfunctions of a Team takes you through the different steps. It's like a workbook and implementation on how to do it. That's been great getting people to open up a lot more. We also hired a coach using the Scaling Up Methods. What he helps us with is making sure everyone's voice is heard like the quarterly surveys, “What worked? What didn't? What are some of your barriers that help us create that safe environment for people to say what they need to?”

I immediately thought of Five Dysfunctions of a Team when he talked about open conversation and vulnerability because my mastermind group is reading that book. That’s first thing that came to mind. Our leadership team went through that book very much so to make sure that we were addressing things openly and people felt they could talk honestly. I don't know what it is but there's something about that lack of trust. When the team members can't feel like they can share their opinions and their voice isn't heard, that's when they start looking elsewhere. They're like, “I'm not being heard here so I'll go someplace that will.” That can sow a lot of discord. As you've been through this process when culture is good and culture is bad, what are you learning about your team in general? What do you learn about some of the people who have been with you for years at a time?

The ones we’ve been with us for a while, I think of resiliency because there are team members that come in that aren't a culture fit. The more we have those core values honed in, the more they stick out a sore thumb. It's that loyalty. You have someone who might be for whatever it is behind our back saying negative things about management and owners. Other team members are like, “We don't do that here.” It's the loyalty to the team and not loyalty to the complaining, that type of thing. When you do have team members leave, it's hard. You have to regroup again, revamp, get back in deep, and go over those core values because it can be a disruption. That's the biggest challenge. If a therapist leaves, they want something different, they think better or whatever. It's different when we're not a match and how that affects the team.

There are other things where people aren't a culture fit where other team members might not see that. They see what they see and they don't know what goes on or what has been done behind closed doors. That team member has lashed out at another person. That's something we're not going to share with the whole team, so that’s a struggle. It's like, “They let that guy go. If they let him go, my job must be in jeopardy.” That's been a real big setback that we've had. People are thinking that if someone is being let go, they may be speaking out of a meeting, and it so happen to happen after that but that wasn't it at all. It's trying to rebuild that trust again.

When you've had people leave, and it's such a blow to your company, you almost take it personally. I did and I'm like, “I’ve got to re-assess what I'm doing and I've created.” We’ve got to go back to the drawing board, “How can I make sure this never happens again?” It's not the type of environment that you want to create. It's not an experience that you want your employees to go through so what do I have to do to change it? As you said, that's the dirty work you have to get. Get back into it and decide, “What are we going to do to make this better? How are we going to hire? Who are we going to look for? How are we going to filter those people out that aren't good fits?” You have a little bit more determination as you go back to it but it's not easy work.

You want to be able to be safe for the people who are working their butts off and pushing, and not bring someone on who's going to gossip, argue or do whatever. If you want to let that person go because they're not a culture fit but you also don't want to create that feeling of fear like they're going to lose their job. That's one of our biggest struggles that we've had with our culture, especially since COVID. All our cups are empty and we're running on fumes. It’s the smallest thing. It's the frustration, so you’ve got to maintain that.

It's not all rosy and things don't always go swimmingly. Even at your size, you're still dealing with issues with the pandemic, and in your case, a mass exodus which doesn't help. At the same time, you're always going to be coming up with these problems as an owner. The strength that you have is the management team. You have a shared experience with Lisa, a commitment to each other and the clinic that you guys are going to get through this. It's like weathering another Hurricane Katrina, it's not as bad but you're in a completely different place as a company and you have some idea of where to start from at this point.

That has made us more resilient with things that happened. This has been the biggest blow since Katrina but almost everything else is like, “We can handle this.” I see the light at the end of the tunnel, so that’s good.

We're talking so much about the culture and it's something that you're working on. You've had these issues related to the pandemic come up, but owners should know that Beth and Lisa have policies and procedures in place. You've got many other things that are going well and you're doing swimmingly. You've got the admin in place, you're following your KPIs, so you know what to do. You have so much of that established, I assume that coming back around is going to be a little bit easier because you know which buttons to push and where to look. Your focus is on training. It should be simple because you do have many policies and procedures in place. It's a matter of, “How do we train people on this?”

It’s finding the right time to train them. One of the famous things that we say is, “It fell out.” It’s like, “I thought we had that in.” We joke that I'm the Chief Reminding Officer but it is. It’s like, “Let's get back to basics on what fell out that we need to get back in.” Our percent arrivals have been below 90% and I can't tell you the last time they were below 90%. I’m like, “We need to start from square one.” We have what works. We don't have to recreate that wheel, we just have to get it back in.

Congratulations on getting 90% on a regular basis because there are plenty of people who have never been to 90%. I’ve never talked to them before, so you guys are doing something right for sure.

Thank you.

Work doesn't have to be about coming in, going with the grind and pushing through. It can also be fun. Click To Tweet

As you're looking at creating this training program to hopefully improve your culture and the people that you have come through the company, what are some of that looking like? If you had someone in front of you who is a newer owner and they said, “Tell me what does your training program look like.” What are some of the skeleton structures of something like that?

We started using an online system for our training. I forget the fancy term that they use for it but it's online. You can assign people lessons and we've created different lessons and paths for their receptionist. There might be 8 or 10 lessons for that receptionist. It's videos, it's interactive and we can ask questions. If it's a receptionist, we can have them talk about percent arrivals like, “What would you say if somebody cancels?” We'll show a video of us doing a drill pretending to be a patient and we'll have the new team member video themselves telling a patient why they shouldn't cancel. We can see what their reservations are if they are someone who might be a strong candidate and hone in on where they might need a little bit more work.

That’s been fun and cool to be able to set someone up on these training programs. We still have people do it. That's the second phase but it's not so much legwork on the front end because we already have it into a system and we can refer back to that. That’s been great. In doing in-person training, we have some of the key components that we do for our patient compliance. We'll revisit that every 3 to 4 months to refresh people. I’m sure you're familiar with some of the stuff we've learned with our previous consulting companies, the awareness characteristics, getting them to realize how this is affecting their lives, and how it could get worse.

It’s reminding people to use this and the eval, that helps with the percent arrivals and things like that. I’m also looking at leadership training, not just our own policies and procedures but let's pick a book. The chiefs, me, Mary, Ron and Lisa are reading Crucial Conversations. We're reading a chapter a week, we're discussing it and starting at the top there. We're going to help figure out how we can filter that out to the rest of the team. When you're ready to be vulnerable and say what you need to say, that helps you figure out how to do it. I’ve worked with many team members who have conflicts with each other using that strategy and that's been helpful. It's that model of constant learning. You never graduated from PT school. You're always learning and when you stop, that's when you have a problem. It’s the same thing with leadership.

When you do training with a front desk person, are you taking them off the front desk for 1 or 2 hours or once a week? How do you schedule your training?

We're revamping that especially now that we have this new program. They take the lesson and there's an observed period. We observe them for 1 or 2 weeks with an existing receptionist who does well. We have someone who's an essential scheduler and now in our HR department. We have two other people who are rockstar receptionists that are in different positions. We might have them observe them doing it. Have them watch you do it, have them do it and mastery. That's still in the baby phases. What we used to do is have them read the manual and two weeks shadow a receptionist that's doing well. We would do drills once or twice a week to try to hone in. We're working on doing a better job of getting that onboarding process more solidified. It's never just done. There are always ways to improve, hone in and make it better.

If you want to know an intense training program, go back to the episode with Blaine Stimac. For their training, they go out for six months. For the 1st and 2nd week, there's a little bit of training every day. It's weekly, monthly and quarterly. They've got it all lined out and I'm like, “That is involved.” The results speak for themselves. They're a plug and play company now. They've got 30 clinics, so when they want to open up a clinic, it’s plug and play, train the right people or move this guy over here to over there in the new clinic and it's successful. They've got this successful method and he ties a lot of it back to the training, which then cultivates a culture of this is how we do things. It's not necessarily the atmosphere culture that we might be thinking about, that's their business culture. This is how we train, do, interact, run policy procedures and run a meeting. It goes on and on. That, in itself, is also a culture.

I have to go back to that because organization is not my greatest attribute. That's why I have Lisa.

I wish I was more organized. As you were thinking about culture and coming into this interview, was there anything that came to mind that you thought was important that you might want to share with the audience or even younger PT owners, if you will?

The one thing that sticks out to me is you're never done. You talked about Blaine, you have these systems in place and you have these training so it's plug and play. It's a constant work in progress because things change and industry changes. We have lots of industry changes. I'm finding more with the team members that we hire, they are demanding to be more part of the process and to have more of a say, and they should. It's our business model of, “This is how we do it here. Here is the policy and you better do it this way.” It doesn't fly that much anymore. Try to create something where we can have the team's input and come up with ways to constantly improve and evolve. That’s what I've learned in 2020.

PTO 131 | Improving Culture
Improving Culture: Try to create something where you can have the team's input and come up with ways to constantly improve and evolve.

Thank you so much for sharing. I brought you on because I know you guys are successful and you've created something great in New Orleans. This goes to show that even the seasoned owner is going to come up against different hurdles. Some of these might be similar hurdles that you had when you were a younger owner, but you visit them now on a larger scale. I’m thankful that you're willing to be open and share that in that regard. There are still issues that people are dealing with. The pandemic is something that hit all of the owners in different ways. Even the larger practices suffered like you were talking about in one way or another. It's cool that you're willing to share as we're talking about culture and some of the benefits of it because you've seen the benefits of it. You know what it’s like, what it could be, you have to reset and get that mojo again. Thanks for your time, Beth. I appreciate it. I've finally got you in. It's been great to talk to you.

Thanks so much for having me. I appreciate it.

We'll talk to you later.

Thanks. Bye.


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About Beth Winkler

PTO 131 | Improving CultureBeth received her Bachelor of Science degree in physical therapy from Northeastern University in Boston in 1995. She specializes in treating various types of spinal and pelvic disorders and completed a three-year residency program with the Manual Therapy Institute. Through this training, Beth earned “fellowship” status in the American Academy of Orthopedic Manual Physical Therapists and is practiced in advanced clinical, analytical, and hands-on skills in the treatment of musculoskeletal disorders.

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