PTO 164 | Annual Strategy Session

If there was ONE meeting you should have each year in your business, what would it be? In this episode, Nathan Shields talks about the MOST valuable annual meeting that an owner should have - the Annual Strategy Session. This is the one meeting in which you can step aside from the day-to-day and assess your business as a whole - weak points, strengths, upcoming issues, internal dilemmas, etc. - all at once.

The Annual Strategy Session can invigorate you and your team while coming together to determine what items are essential to achieve our goals this year. It’s a highly valuable meeting and a MUST for clinic owners. Listen to this episode to discover tips on how to have successful annual strategy sessions.


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Coaching Moment: The ONE Meeting You Must Have Each Year

I want to talk about the one meeting that you've got to do every year especially if you have a partner and a leadership team. Even if it's you running solo, the important meeting that you have to have is one of an annual strategy session. The annual strategy session allows you the opportunity, especially with your team, to focus on what's most important over the upcoming new year. Take your heads up out of the muck and the mire of the day-to-day activities that you're performing and focus on the business. Look at the bigger picture. Look at the things that are coming up down the road so you can address them appropriately and in a timely manner so that you're not that you're being proactive and not reactive.

The annual strategy session that I did and most people do, was usually done at the end of the year, looking forward to the next year or at the beginning of the year that they're in, trying to look forward to seeing what they want to accomplish in the upcoming year. The annual strategy session's goal is essentially to get clarity on what are the most important action items that will move your company forward and clarify your goals for the year. It also allows you to recommit to your purpose and values and assess your business from a greater perspective including weak points and potential threats. The beauty behind an annual strategy session is it gets everybody on the same page if there's more than just you. It allows you to focus on the business and what you want to get out of it.

When you're looking at the number of things that you want to do and accomplish over the course of the year, everything can seem like it has high priority. There could be many tasks out there that you're not sure which ones are most important, which ones are most vital to accomplishing what you want to accomplish in your business. It's my recommendation that you do this on an annual basis. You can move your company forward, clarify your goals, reassess your purpose and values. Get a 30,000-foot perspective, reassess business from a greater perspective, including the weak points and the potential threats that are coming up down the road.

One of the recommendations that I have and it's a shameless plug because I offer this as part of my coaching program but it is to utilize a third-party, someone outside of your organization to guide you, challenge you, force you to be clear on what you want to obtain. It will force you to actually put words to the things that you're talking about not just the thoughts that are in your head but words to your concerns or what your goals are. Enforce that clarity to be verbalized.

It's someone you can even be accountable to in the future. It's important in these situations to be most effective, to recognize that there must be a commitment to brutal honesty and recognition of those pink elephants that could be in the room. A lot of you might not have heard of pink elephants before. The pink elephants are the 500-pound gorillas that are sitting in the corner, the sacred cows.

Recommit to your purpose and values and assess your business from a greater perspective yearly. Click To Tweet

A lot of times, especially in a group setting or in a partnership, there could be things that are going unsaid that need to be addressed that are irksome or could be a bone of contention between a partnership or even within a leadership group. The sacred cows are those things where we all believe a certain thing to be true, even though it might not necessarily be that way.

A sacred cow in physical therapy might be something along the lines of we don't treat that way because it's unethical. Maybe it's not unethical but that's just a sacred cow that we've postulated and we need to consider if that's true or not. A 500-pound gorilla could be some serious issues that partners might have between each other and they're just not addressed or haven't been addressed to that point. These are your pink elephants. You need to be brutally honest with each other and amongst the group to recognize that there could be a pink elephant in the room that needs to be addressed.

It's during these annual strategy sessions in which you can address those things if they haven't been addressed to that point. That's a good time to do that to make sure you're all-purpose and value-aligned. Where do you start with an annual strategy session? The first part that I take people through is to envision their ideal scene at the end of the upcoming year. After 3 to 5 years, look and see what you want to accomplish at the end of this year but then also push it forward to see what that looks like 3 to 5 years down the road.

Take that ideal scene and compare it to the current scene. That gives you an understanding of where the gap lies. I want to get to this point but I'm at this point. It helps you understand where you need to get to and where you're starting from. I recommend this be done on both the business and the personal side because more than likely, as an owner at least, your business actions are helping your personal actions and your personal actions, vice versa. It's not something that the personal side of things necessarily needs to be shared if there's a large group of you but it's important to recognize that our personal and our business are significantly intertwined. Starting with the ideal scene working backward, what's our current scene, just to mind of the gap.

Next, reassessment of purpose and values, this is a time to discuss, "Are we living our values and fulfilling our purposes as a business?" This is a perfect time to readdress both the purpose and values as needed and discuss how to better fulfill and exemplify your purpose and values. Sometimes the values can be misconstrued over time. Maybe this is a good time to redefine the values if they're not clear between all the members of the leadership group that's in attendance. Just take some time. It could be a small exercise. It could be longer if these aren't well-stated but it's important to readdress them every year and see how things are going.

PTO 164 | Annual Strategy Session
Annual Strategy Session: Make sure you have measurable goals that can be accomplished within the next year.

The next step is what most people are used to when it comes to an annual strategy session. A lot of people have gone through typical SWOT analysis. SWOT is an acronym that stands for Strengths, Weaknesses, Opportunities and Threats. SWOT analysis allows you to address what are your strengths, weaknesses, opportunities that are afforded to us in the upcoming future? What are the threats that we see on the horizon or currently existing internally?

One of the weaknesses of a SWOT is that it doesn't assess past performance. However, that can be noted and addressed in the weaknesses and threats section of your analysis. Properly recognize we didn't do things right in the past year, this is where it lays currently as a weakness or a threat that still currently exists and needs to be addressed going forward.

Most people do a SWOT analysis and that's about where they start. They do this, they take a few minutes to write down the SWOT and put some goals associated with it. If you're doing this right, I should have said it from the forefront, these annual strategy sessions should be done in about a 3 to 6-hour period depending on what you're assessing and the size of your business.

If you're doing it within a single 30-to-60-minute period then that's not enough time to discuss, analyze and assess. In fact, I did an annual strategy session with a client and took us from 10:00 AM up until 8:00 at night and this was a single practice. It takes some time to hone in on what's happening within your business and in order to do that, you have to take the time and set aside the time to do it.

This is a great opportunity if you have a leadership team, to do a getaway, go someplace off-campus, away from family, away from the business or to go to a business center conference center. Stay overnight at a location and have dinner together after the fact. This is a great opportunity to do one of these getaways and to go through this annual strategy session.

Envisioning your ideal scene at the end of the upcoming year helps you understand where you need to get to and where you're starting from. Click To Tweet

Next, after doing the SWOT analysis, it's important to break all of these down, strengths, weaknesses opportunities and then flip those that are weaknesses and threats into opportunities. It's not that you're just taking those and saying, "That's an opportunity." Rather, just reword it. If you were to say, "One of the weaknesses of our organization is that we don't have a completed policy and procedure manual."

How would you flip that? You would flip that by saying, "We have a completed policy and procedure manual. That's one of our strengths and that's an opportunity we could take advantage of." If you wanted to take it further where if one of your strengths was, "We have a great leadership team," you could say, "We have a strong policy and procedure manual that is supported by a strong leadership team." That would be an opportunity to address in the upcoming year.

You take all these opportunities after getting rid of the weaknesses and threats, rewording them to make them opportunities and you break them down and filter those out until you come down to your 4 or 5 top priorities for the upcoming year. Sometimes it takes some discussion and it's important to recognize that this isn't a top priority for the upcoming year or this is a top priority for next year. It's just not a priority for this year. It takes some discussion after going through the whole SWOT, writing up and switching those weaknesses and threats and rewording them into opportunities.

It takes some real discussion amongst the group to get down to 4 or 5 top priorities for the next year. Maybe some that are super important get left off to the side but you have to sit down. You can't do ten. You have to break it down and get to 4 or 5 top priorities for the year. Break it down, filter it down to 4 to 5 top priorities.

Next, set goals for each of those priorities. Goals that would be accomplished preferably in the next year. Each priority gets a goal associated with it. That is measurable. We still have to remember the smart acronym when it comes to these goals but make sure it's measurable and can be accomplished within the next year. Work backward and set quarterly goals for each priority and goal along with some initial action items.

PTO 164 | Annual Strategy Session
Annual Strategy Session: SWOT analysis allows you to address the strengths and weaknesses of your business.

It's important to make sure these goals are measurable but it's also important to then next assign those action items, assign these priorities to members of your leadership team, if you have one. That's the beauty of doing this whole exercise with a leadership team. Some of your leadership team might be aligned with certain priorities or actually within their department are actually responsible for those priorities and the goals to be met. For example, if you have a marketing goal and you have a marketing person, that person is going to be responsible for that goal and that priority for the next year to get that goal accomplished.

That gives them a lot of inspiration but also accountability to achieve that. It's important to do this with other team members if you're able to. It's important to get their insight, the beauty of doing this with a third person to lead it out is that many times members of the leadership team, if they are present might not feel comfortable addressing certain issues. They might feel like they need to deflect to the owner.

Maybe they feel like their voices aren't quite heard or don't want to speak up because that might be counter to what the owner has said in the past. The beauty of having a third person navigate or moderate this annual strategy session is vital because it helps their voices be heard. It addresses the pink elephants that may need to be addressed. It also holds the entire team accountable for equally shared voices.

I'd highly recommend a third-party doing this especially if you have a leadership team involved so that the owner doesn’t have the loudest voice in the room. After getting all this done, we've gone through ideal scenes, we've done the SWOT analysis, we've assessed our purpose and values and we've got goals and action items in place. Everyone's well aligned for this entire next year. We know what we need to do. We know the goals that we want to accomplish. We have metrics in place to measure them. The last thing we need to do is celebrate.

It's time to celebrate what we've accomplished in this session alone. Gather some excitement going forward as a team. Celebrate with dinner, do a team-building activity, you name it. Go do something together to celebrate being a part of this group that we are aligned within shared purpose and values. The one meeting that you need to have each year to focus yourself and achieve the goals that you want to achieve for the next year and more is going to come down to doing the same version of this annual strategy session to put you on the path for success for the next year. That's my coaching moment.

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PTO 158 | Let Go Of Someone


Handling a team is challenging, especially when there are members who don't cooperate. So when push comes to shove, how do you let go of someone? Today, James Savas, the Deputy Chief Executive Officer at Hands-On Diagnostics, breaks down the process for us. James talks with Nathan Shields about how business owners should handle termination or resignation. It begins with mindset, clear reasoning, role-playing, and documentation, documentation, documentation! Taking on the role of leader and holding team members accountable can be difficult, yet it is necessary for the growth of your business. Tune in and let go of someone as clean and simple as possible!


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How To Let Go Of Someone Successfully With James Savas

I've got a returning guest, James Savas, who is an HR and Recruiting Specialist. He's working with Hands-On Diagnostic services as well as other business owners for their HR and recruiting issues. I'm glad to have him on. James, thanks for coming.

It’s great to be back.

If people want to learn a little bit about James, we won't get into it but we did an episode in 2020. What was the topic that we discussed, do you remember?

It was recruitment a little bit but the front end is onboarding staff. We touched on the operating side a little bit.

We had a follow-up episode about getting rid of the dead weight and that stuff. This is apropos that we talked about this topic because we won’t get into how to successfully fire somebody or offboard somebody. We are going to talk not just about firing somebody but also what to do when someone resigns and how to make that successful for you. I would highly recommend that the readers go back and read those two previous episodes because these will all be somewhat sequential in nature.

When this topic came up amongst my mastermind that someone said, “I've got an employee, a physical therapist who's resigning here in the next couple of weeks.” Another member of the mastermind said, “It would be valuable of you. You recommended that you should do an exit survey.” I thought, “Something we haven't talked about on the show before is exit surveys or exit interviews if you will, however you want to call it. Who should I talk to about properly offloading somebody?” and I thought of you.

Thank you. I appreciate it.

Where do you want to start with this? We talked a little bit prior to push and record about the mindset. Maybe that's a good place to start. There's always that inkling, “I need to let this person go.” Can you help us walk through where someone should start considering and how to consider letting someone go in the first place?

The first thing is understanding, acknowledging or re-realizing that you have a partnership with this person and you brought them into your company, right, wrong or indifferent. They are your great hire and deadweight but they are yours. A general statement in the personnel period is to take the viewpoint of responsibility because ultimately, you have them there.

As an employee, take what your management says and apply it. Click To Tweet

I'm not saying it's necessarily the owner's fault that things don't go right. However, if that's the viewpoint the owner has as senior management of like, “Why didn't they make it? Why didn't this employee make it?” That's a great mindset for you because then you go into correction, quality assurance yourself, your processes when they came in, on the training measurement when they were there and on the way out.

It is more enlightening to me when staff is on their way out for any reason. Enlightening yourself in your process because then you will see what you lacked, what you did right, and what you did wrong because again, that's your partner. You brought them in, you cared for them at some point and you pay them some money. Now you’ve got to end it. That's a quick mindset point I wanted to comment on.

That's valuable that you have to recognize where did things fall off. If you are not using it as a learning experience to improve, then you are setting yourself up to have the same issue over and over again. What could we do differently during the hiring process? What did they come with? What could we have vetted better in the recruitment stages, hiring process and interview stages? How could we have seen the red flags, you name it?

As you said, we brought them on, we were excited about them, and we vetted them appropriately but maybe our training processes could improve. How can we set them up for success? Essentially, your job as the leader is to set up your teammates for success. How can we improve that foundation that they can build upon? Did we provide them the appropriate expectations ahead of time so that they weren't surprised by anything that came up? Were they aware of all the policies that were expected of them ahead of time? If we didn't talk, can we do that differently?

No matter what has happened, we are in this position where they have either resigned or we recognize that maybe this is going in the wrong direction and we need to consider firing them. What I’m trying to ask is how do you decide if someone needs to go? It's time to stop all this and it's time to let them go. You, as an Owner, have been on the fence for a long time, how do you finally make the decision it's time to leave?

I don't pretend to give legal counsel. I just want to make sure that that's communicated. Take this from expertise and professionalism and what I have done with these own hands in my years. I want anybody that is on the HR personnel universe will tell you that documentation, the same way when you are treating a patient, reports, emails, and funkiness that have occurred, the good, bad, and the ugly. At this point, you want to go the ugly-ish. It's got to be data-driven like a physical therapist.

If you have an occurrence that on March 5th, X, Y, and Z happened, you have statistics or KPI that point you to where they had these targets to achieve and never have achieved them. For the last six months, they have not achieved them. Three major indicators or evaluators would be reported in their files. I don't have it verbatim but there's an old adage that if you investigate the employee, investigate but you have about an inch thick of a personnel file. We all use electronic stuff these days but you get the idea that if it has been a while and a few reports, let's look into this guy or this gal.

It’s the day-to-day data, reports, statistics, KPIs, trends, and their arrival to current and in between. If you make it non-emotional and no opinions are allowed. You want to get raw on the legal side, it's no opinions and no emotion. “Jack Smith was late these days. He failed to achieve the targets that he knew they had. We had our review and we went over it. He signed that he did it, bye.” That's it. Those for sure are things to evaluate.

It helps as I'm talking coaching clients through this when we can get as objective as possible and that's what we are talking about. Objectivity helps the situation. Subjectivity and emotion are not going to help. It's going to be he said, she said, it's going to get emotional, back and forth. It's not going to be a good learning experience for the person and the employee who is leaving. That's one thing owners don't do enough of is documenting the infractions so to speak. It’s simply writing up, “This is what happened and this is why it's an issue.”

PTO 158 | Let Go Of Someone
Let Go Of Someone: Build a system coming from the top down where everyone freely writes up comments about things.


I would take it a step further, which helped me and my clients in the past to determine and define, which value of the company they are going against by performing this action. If they were late and weren't meeting their productivity measures or the KPIs, those are infractions. Is it professionalism, integrity, accountability or empathy? You name it. What value are they going against? When it's a value-based decision, this person is not upholding this value. That also makes it objective and clear.

I fully agree and it's interesting because we will probably get into what form of documentation do you need or what checklists but on that point, which dovetails the two points. Ideally, reports are written or other reports call them statements. It's happening all the time and there's no particular pressure or no funky viewpoint about it between the staff. If Samantha is late, they write Samantha up. Not because I don't like Samantha.

It’s because she was late. That manager observes, following through with a policy or procedure, and documents it. That’s all. It’s clean, no opinion. It’s just, what happened is, I thought. In the same way, it's the same thing you are doing for patient incidents. When something happened, write down that Mr. Smith felt that he got hurt from that ultrasound. Did he really? Maybe not. Is it your fault? Maybe not but he felt that way, so you write it down.

Ideally, you do have a system that comes from the top down that everyone freely writes up comments about things. I will tell you something. That's not easy to do but if you can pull off at least a management group or your top guys and gals that back that viewpoint up, then what you have is what a sane environment you created. If you see a report occur and the report itself looks opinionated, nasty, and she never, I'd investigate the writer of the report but that itself tells you something.

If you can get your management and up, it could be one person, office manager or the billing manager in smaller offices but if you get their backup on the report writing, you are golden. If that's not possible, you are small or you can’t do it with, which dovetails to your last point, I would say at least every six months or every year, an official evaluation or whatever we call them an employee review.

At least, if the reports can happen for whatever reason under the sun, then the reviews or the evaluations. In those, exactly what you said, there are categories of viewpoints or a backup of overall purposes of the company. How does the employee align with the purposes, good, bad and indifferent? Why? It’s statements that you, Manager or Owner are writing that. If you want to know more about that type of document, it’s official. The employee signs. That review signs that they read what you wrote. It's all handwritten and right there. If not, which is again, you should look to do that if you can, then at least annual and biannual review.

That's where many owners fall short or don't feel comfortable as to, number one, have accountability meetings when issues do arise. As physical therapists, we like to be liked. That's the general personality of physical therapists. If we are going to hold someone accountable, now we are the “bad guy.” We don't want to have that feeling of confrontation in the clinic. However, that's the perfect way to allow people to walk all over you.

To be a leader, you need to hold your ground, set the boundaries, draw the lines if you will, and then have those accountability meetings and have regular meetings, one-on-one meetings with your team. They want that and deserve that. They want to know how they're doing. They want to know what their scorecard looks like. Allowing them to have an assessment and a review is appropriate.

We talked about the purpose. We also consider those value-based assessments. We would list the values and, as you said, “How did they exemplify the values over the past period?” We had to go both ways and they would fill this form out themselves, and then the supervisor would fill it out as well. The assessment interview itself, they would start like, “This is how I have shown these values. This is where I need to show improvement. This is what I'm going to do in the next period.” The supervisor would say, “Thank you. I agree. This is how I think you've shown those values. This is where I think you need improvement and this is what I need to see from you.” As you said, we both sign off on that.

Care about other peoples' success. Click To Tweet

That's just an example of an accountability interview like you talked about, but having those in the employee files as well as, “I'm seeing a trend of you not coming in early. Let's go to productivity statistics specifically. We have an agreement that you need to see 60 visits per week and you have been routinely at 50 visits per week, and I'm not seeing you do anything about it. What do we need to do about it going forward?”

Make sure that's written up and there's an agreement. Depending on the severity, and then maybe they sign off on it or not but you have to have those things to make it easier to let them go if that's the case but it also provides them the foundation to grow, understand, and invite them to, either join the team and say, “This is the team over here and these are the expectations to be part of our team, or you need to find another team to play with.” That accountability means that can be huge. We set up an employee file.

Let me give you this question because this happens more often. They do okay. They don't speak negatively of the business. Their performance is on the border most of the time. You ask for improvement, and maybe they improved for a couple of weeks, but then they go back again. How do you decide if you should keep that person or not?

It's a matter of, are they willing employees or are they something else? Are they an employee that takes what you say and applies it, that takes your direction and changes? When you give them orders, directions, viewpoints, policies, they understand it and do something with it or about it. On a low level, would they be able to go? I used to run a drill on the hiring side with the new employees. If you gave them a specific order at a restaurant, would they understand and duplicate all the little, “Mayo on this side and mustard on this side,” or whatever?

Do they understand your communication and can they operate based on it? Are they willing? Does that happen? Yes or no? “No, they don't listen to me. They do an average volume of work, or whatever their area is.” Are they willing or not? A non-willing employee comes in a few different shades. They can be defiant and be like, “No boss.” They should be out the door. That's just who they are. If not, you don't need that very long.

It's easy to fire them.

Yes, exactly. They let you know that you should fire them or there's a behind-the-back guy. The back-coverty like, “Everything is fine?” Big smiles but intentions are, “What?” In the statistics, you will see a division or area that it's not going well or we can't hold staff here. People are unhappy here or there are complaints. Tracking that down, it’s Peter or Sally. Either you have a willing person that responds to correction, communication, and changes as a result of that can duplicate and understand basic stuff needed by you, by the boss, by the managers or not.

If you can decide that they are willing, if that's assumed, and let's be truthful at the front end, do they have a general IQ and aptitude for the job? Generally, they have to ask to be assessed on it. Assuming those two things are valid that they are willing, they have a fair intelligence for the position, and they are not doing well, then the answer is they should correct with correction. They should change their operating basis. It should be an even keel, peer-to-peer, down to their level of conversation about, “What's going on? What are your future plans? How is it going here?” I wouldn't even necessarily document that at that point. It’s a conversation with your partner that you brought into this group that is not working out well.

If they are a willing person, generally good, emotional state, and so on, they will and you will find out what it is. You will find out that, “It's a rough year. It’s COVID. I just broke up with my girlfriend or my boyfriend.” You might get that stuff, too and you might get something else but that's through communication. That one if not handle the problem, you get the root of it, parts of that roots or pieces of the roots and there you go, “I get it. Things suck for these reasons. Can you do the job that you were hired to do?” “I guess I can, boss.” “If not, I don't think it's cool. Let's look at some other options here like part-time, you are in or goodbye.” You have to first evaluate that you’ve got somebody worth it, the production flow or are they are really not worth it. That's the first point.

PTO 158 | Let Go Of Someone
Let Go Of Someone: Letting someone go comes down to documentation.


What I see in owners oftentimes is they haven't had held somebody accountable in the past and they don't know how to start doing that now because that is a different culture. It's going to be a surprise to those employees that were finally holding them accountable. I did this in the past and you didn't say anything wrong. I'm learning to become a better leader. I decided that I'm finally going to sit down with you and talk to you about it. They have to get comfortable and maybe they don't also know how to hold that conversation.

I like how you brought it up like, “How's everything going? Are you happy here? Is there anything else I need to know about? Now, understanding that we will clear the air. Let's look at your statistics. Things aren't going in the right direction. You are not producing what the expectations are. Are you aware of what the expectations are or you are not? In order for us to be productive, helping our patients, and profitable as a business to sustain our survival, you have to see this many patients per week. Can you do that? Yes or no? If not, let's move forward. If you can't, I don't know if this partnership can work much longer. How are we going to figure this out?”

It doesn't have to be, “You just need to see more patients.” That's not going to go far and as you said, this is a partnership and you have an agreement between each other that you have established but you need to understand that both parties need to hold their end of that agreement. That's what that meeting means. It's valuable to, number one, start having those conversations.

If they still aren't able to come around, still not doing things, other patients are falling off left and right, they can't keep the patients in the door when they come in or they are leaving after the 3rd and 5th visit, it's time to have that conversation. What kind of mindset do they need to have when it’s time to part ways?

The owner?

Whoever it is.

In my experience, PT owners and other professionals as well but they are caring. That's why you’ve got into the field you did, among other reasons. You care about the staff. When you are at the point where you are having those conversations like we just said or get further into it like it's going to go, “Tomorrow you are gone or now you are leaving.” When you do it from the viewpoint of care, the same way you might have a tough conversation with a patient about it doesn't look good.

In PT, we don't have those conversations but you get the idea that it doesn't look good here. It's the same thing that you care about that person and you don't change that. You don't suddenly become a bully or something else. You are still that guy or gal with those purposes and partnerships with those agreements and you care.

Working relationships are all about trust. Click To Tweet

I have even used those words and guided owners to use words like, “I care about your success. I care about your future. I care about what we have done here. You are valuable to me in this way or these ways. You happened to be valuable.” Part of it has to be acknowledging the good, the agreement, and partnership so that care things should never go away. The ax comes down and you have to put your other hat on, and now you are the mean guy. It's not at all. You are the same person that had the same question. It's a viewpoint like you said, shift.

That's exactly what I asked. What mindset should you have going into the firing, per se? I like to avoid the details unless I have to and just say, “We have had some conversations and it seems things aren't going the right way.” Shaun Kirk who is a mentor of mine was like, “It's just not working out.” That was his famous phrase. I like to give them a little bit more and say, “We have had conversations in the past. It's time that we part ways. I care about where you are going to go but honestly, today is going to be your last day,” and go from there. What do you recommend in those conversations? What kind of wording do you use?

That is the phrase. Shaun is right. That is the blandest way to say, “You are out. That's it and it doesn't necessitate any other accountability but we are not a good match. It's not working out.” Those phrases are globally gray and okay. I like those, generally speaking. It's not going to work every time, I get it. I have had people and I'm sure some of your owners had people that go, “But I deserve to know, I want to know,” or whatever it is. Number one, I would always role play, by the way, prior to. Number two, always have somebody in the room with you.

A witness, the good cop or the bad cop, there are a million reasons why that's a good idea. Roleplay with that person and say, “We are going to do this. It's going to be maybe sticky. She's not going to like it.” I would be real with that manager. Ideally, it's the Area Manager and you, the Owner or the two owners, whatever. That is a good bland thing to say.

I had gotten into a conversation where they demand to know or something like that, and I have held my ground that, “I don't have to give you a reason other than what we have gone over in our last talk or other than what we have gone over in your evaluations. I will give you a copy of that if you would like. Its statistical point, I can give you a copy of the graph if you would like. If you went down, that's evidence here.” That's it.

If it gets heated, I have gone that direction where, “I don't have to tell you and I will give you some documentation if you want.” If you are going into it with the idea that it might turn into a legal issue for you like they are leaving, either way but it might get sticky, they might get you for something. Maybe you are not sure or they weren't a good employee but you kept them on because you had nobody else or whatever, it's going to go bad.

Again, I'm not the Owner of your clinic with the money or the lack of money but I would always have available a check on hand. I have done that before, too. If it goes great, maybe no check but you have it there, “I give you a week's pay.” A week's pay is planning for that general employee, maybe a payroll cycle of two weeks max. That's generous. I have done that not just what they worked up to that day because you owe them that, of course, but I would give them a little bit for their troubles and that thing. That's a little ammo, just in case.

I feel this way personally that if I'm going into that conversation and they are surprised like legitimately out of left field surprise, “Where is this coming from,” then I probably did something wrong as an Owner and not having more meetings prior to that point. Would you say that's fair?

Absolutely. I had gotten them in tears. It's rough.

Let Go Of Someone: If you're the one leaving and moving on to a different game, others will ask what's going on.


“Based on our prior conversations, things just aren't changing.” You should be able to say that. They can be in tears and be emotional about but they shouldn't be like, “What? I don't know where this is coming from.” They shouldn't be in that situation. You should have had previous conversations.

If we are talking about the viewpoint of what shoulda, coulda, 100,000,000% that is the case. You are right.

Unless they did something egregious and you said, “That's not appropriate. You are leaving now.” I have done that before. “Don't bother coming back.” You also bring up another point that there are certain people that you need to be careful with letting go. I had an employee, there’s an age discrimination issue that could come up if they are over the age of 45, 55 or something like that and a lawyer let me know about it. If someone is pregnant or has recently had a child and that has affected their work, then you need to be careful about how you let someone go in that situation, and race is always an issue as well. If any of those things could potentially be an issue, it's always good to talk to a lawyer first, especially one specific to your state.

Any good lawyer will tell you as a general statement to wait. If it's a pregnancy or a medical issue but didn’t come back, then decide. There are always exceptions. Again, it's always going to come down to documentation. If they were flagrantly doing things and now, they are pregnant or might get you for age discrimination or something else, then you’ve got the goods.

You still have to have the objective data to back you up. You have to have documented proof of what has gone on in the past. In those situations, there was one situation where their age was a potential issue. I had to provide them paperwork so that they understood that this wasn't an age-related firing. They had to take that home, review it, sign it and get it back to me.

That was an issue that I had to deal with. A lawyer walks me through it and eventually worked it out but you want to cover your bases and make sure you are doing everything legally prior to those situations. I'm glad that you brought that up. I would refer the owners to a lawyer for sure to make sure they cover their bases when they are letting people go.

You brought up another point that there should be a checklist. We call that our offboarding checklist but when you offboard someone, we needed to get the keys. “Did we have all the passwords? Have we removed them from access to all the software? Do we have everything we need? Did they have any access to bank accounts that they need to,” especially if they are in billing? “Have we done all these things? Have we signed all the paperwork? Have we notified the payroll company and make sure you have that checklist?” You make sure everything gets done appropriately.

One thing I would do on that, and you might have done this yourself is, you have to have the backline steps like remove the password. You are not doing that in the room with the guy. Necessarily, I have done that too. It's an interesting thing where if we were 90% sure it was going to happen and that meeting that they were gone or we had to let them go, then as they walk up the stairs literally, we were cutting off passwords and changing passwords.

It's a partnership; it's a team. It's not just employees. Click To Tweet

We would let the Building Manager know that we are talking. I have done that before. I agree with a checklist. You need that but I will make sure that some things are post-firing. Now they are gone and you don't have to do them, the keys, passwords, bank account data, and whenever they change keys and passwords to get locks and keys.

I have had the checklist in the room with me. I would call it two checklists. I had a master checklist of these processes like getting keys back that I control. No one saw that but me or my manager. That’s what I did, and then it went to the file when they were done. I had another final document in that meeting. It was the last meeting. I had that there. It’s interesting results. It was the list that the person has to acknowledge to the best of their ability. If they were not, they were not being let go for reasons like race, sex, age and so on.

That's, again, to the best of their knowledge because they can assume whatever. Is that a legal point or else? No. Imagine what that creates on the other side is you are going to get a little flack like, “What am I signing here?” “This wraps things up and we went over why you were being dismissed because of stats, objective data and so on. I want you to know that it has nothing to do with such and such.” “I guess not.” They won’t all sign it. Let's say that it has been overt about that. However, the idea of that document is that they have to mutually agree that it’s okay. It's a funky area, I know that but we always had that. It’s always nice to see the person has to confront themselves. It's always weird. I thought it was good to help end it.

What your thoughts then when someone resigns and says, “I'm putting in my 2-weeks, 4-week notice. I want to be done at this date?” There are some situations where you might say, “I will take your resignation and you can leave tomorrow.” I'm sure there are those situations. What are your thoughts in general about letting someone stay on for four weeks? Who do you let stay on? Who do you say take off tomorrow?

It's about trust. In my lifetime in the area, medical and HR, both separately and together, maybe 5 or 10 people on the hind side that I have let stay. Very few people stay. This is someone that either I know from prior work before this job, we have some connection prior to it, a PT from school, a buddy from here, my personal assistant or raw employee. I would say of those 10, 2, 3 or an employee I have no relationship with prior, that's few when I do that. If I would do it with a PT, I would say, “It is a standard for a PT, in my opinion, to give you at least four weeks’ notice.”

That should be policy, I believe. When I sign on their employment agreement that there's going to be at least 30 days’ notice for severing the contract or the agreement.

I don’t think they would need more than two. It goes back to this willing employee thing. If they are a good person, you trust them and you don't feel they are going to bad mouth you, call you names, or pull people with you, there is nothing objective there. There is no statistic of, “When you are leaving,” they are leaving but here's the thing. As an Owner-Manager, you have to know that if you keep them on, you cannot be surprised by what you get. Let me just say that.

Be willing to experience the situation, even if they are a good guy or gal. You have no other PT hired. You didn't create your bench of potential recruits. “I’ve got to keep them on.” I would say get rid of them. The general rule is to let them go and say, “At the end of this week or today, I would like to. Thank you.” That’s it. If you keep them on because you need them, they have to write up their job duties first or something else, or they were in the middle of all these notes like, “I finished their notes or whatever,” then don't be surprised that you might get somebody who is on social media, Facebook or texting your people that, “This didn't work out. See you then.” I have seen that happen, too.

All you can do if you think that might happen in that final interview is be upfront about it and go, “I'm going to agree. I’ve got your resignation letter. Thank you very much. I'm sorry. Can we salvage this if we want to or not?” “No, we can't.” “I’ve got four weeks. Thank you for giving me four weeks.” Acknowledge them for that and then, “I need you to do me a favor, John, Jack or Cindy.”

PTO 158 | Let Go Of Someone
Let Go Of Someone: You'll feel better when you get rid of dead weight, unwilling staff.


If you are going to keep them on, you have decided that. When someone is leaving, they can get a little funky because they are leaving. They don't want to be here for whatever reason or moving away for good intentions but it's not working out. I would say these things. You might not see it if you are the one leaving and moving on to a different game but others will ask, “What's going on? Why are you leaving?” the patients, too.

“You have been backing me up for years in this role in whatever, I would appreciate that you do not engage in any communication with any staff at all about your department. This is between me and you, and the Manager. When we hire a therapist, I want you to train them on to the role and train them up a little bit. I want you to introduce your patients to the new therapist, please, out of courtesy but I'm asking you, please don't share this with anybody else. I won't hear a bland nose.” That's it. If I hear about anyone else finding out about this, we are going to talk.” It's more of a casual, “Help me out.” If you decided they are willing, trusted, good, and will stay, that type of conversation is a must.

Even if they were saying moving to another state or something like that, would you ask them not to bring that up?

I would. When I leave a place and when I have resigned from a job, nobody will know. Maybe a day prior. I will give 6 to 8 weeks, even 3 months. That's a different level and things. The staff doesn't know anything because I'm not acting any different. I'm not going to assume they know anything. It's business. We’ve got things to get done. Maybe a day before, “Tomorrow won't be coming in. It's all good. We are doing this.”

I would say, “Go two directions with it.” I would say yes even if they are moving away. This establishes the area, no matter how they say it. They are an established person or a pillar that was there for block time. They are known for that job and those procedures. That smile in the morning, handshake and now they are gone. They are going, “You are going. Why are we losing staff?”

I would ask the person to zip it as long as they can. If their wife works there, their best friend or husband, it might leak, I get that but I would have a conversation every week with the person like, “Are we still good.” Meanwhile, recruitment and move your butt on that side but as a general rule, I keep very few people when they resign more than a week max.

People usually keep those people on because they haven't found the next person or out of fear that they might lose some productivity. If that person is not culturally aligned, not establishing values, and they are not productive in the first place, just let them go and deal with the pain of it for a little bit until you find someone amazing.

In Arizona, I had someone who he was just dealing with for a while and productivity was mad, and then he complained about things every so often. Some patients loved him but his number overall wasn’t the best. When that person was finally held accountable, he didn't like it and put in his resignation, which was a good thing but the client was scared. He has two new physical therapists on board that are amazing and he's like, “I don't know why I dealt with that person for as long as I did. We are going to move in a great direction now that I've got these other great therapists.”

There are better people out there. There are A-players, you can find and it takes some time. Don't be afraid to let them go. When the resignation does come across your desk, be okay with it. I don't want to say there’s plenty of fish in the sea because everyone is looking for a physical therapist now. There are better players out there and people that will work out much better for your clinic, and you will be a happier owner if you've got people who are truly aligned with you.

Part ways as clean and simple as possible. Click To Tweet

You are building a team. Again, it's a partnership and a team, not just employees. That is the illegal word for them or staff. At the same time, if the viewpoint is a bit more along the lines of they are partner, not my friend but they are my partner in crime, we are building this together and we are a team, that takes some of that separation out of the game of like, “Boss and Jr.”

I dealt with somebody and they had to let somebody go. She was an amazing therapist. She had a unique skillset but as you said, she did not align with the purposes, the goals of the group and was snarky. Some patients loved her and some didn't. She had to look at that and go, “Play loser. What happens?” The answer was you’ve got to go treat a little more than you want to. You get some PRN person for a few for as long as you like. In that case, they were gone a little more sanity above the clouds. You will be surprised when you get rid of some of that truly dead weight unwilling staff and you go, “Why do I feel better?”

It's very common that when you let some of those dead weight go, numbers tend to go up all of a sudden, productivity improves and you are like, “I have never seen numbers like this before. Nothing is different. My marketing hasn't increased but all of a sudden, numbers get better.” It happens so often. We covered a ton of stuff and you shared a ton of time with me. I appreciate that. One thing that we didn't cover and I alluded to it earlier, is the importance of an exit interview. Can you talk to me a little bit about the importance of an exit interview? What that should entail? What does a leader trying to get out of that exit interview?

I have some documents in place, checklists, and so on, as I mentioned. Let's say you exit. They are definitely going to go now if that's the viewpoint you want to get.

It's more than likely amicable. “We have agreed that this is your last day,” or maybe letting them go, you have prepped them enough and held them accountable enough where you say, “This is your last day.” They say, “I understand.” You could maybe go into, “Can I ask you a few questions if you don't mind?” Is that one way to lead into it or how do you lead into that?

It would depend a little bit on when we last spoke about any infractions or problems. Has it been a year since then? It's a bit of a surprise, as you said. Has it been three months back? “I looked at you, you are yesterday funny because you did something.” There's a little dependency on timeframe here. Mindset is care. Why do you want to get out of it? You want the person to understand that it would just be not a match for whatever reason. If they are moving away, that was a non-match, either way, we don't match. We are doing PT and in purposes, you are not living here, you don't agree with this and whatever.

If there's no agreement on basic purposes and values, then that's it. I would communicate it like that. How would you open the conversation if it's a request to leave? “I heard you are resigning. I’ve got your letter. Thank you.” Acknowledge them. If it's more of, “You've got to go now,” then say, “I want to talk to you about a few things.” If you are asked, if they are aware, and they will go, “Am I being fired? Am I being let go?” “I want to talk to you about something.” I would not answer that question. Let me say this as an asterisk.

If it's someone that it's going to be a bit of a fight and a bit of a verbal, you don't know how it's going to go but you need to go and they say that I have done this, “Am I being let go?” “Should you be? Should I let you go?” What does that do? It throws it back. “Maybe yes. What did I do?” If it's a salty individual, I have given them like, “You tell me what's going on, Jack? What have you been doing?” They will pause a little bit. You didn’t say anything you shouldn't say. “Tell me what's happening?” Let them originate, “I took that pen. I'm sorry for that,” or whatever.

Ideally, you want them to acknowledge and agree with what you say. You want to be able to say, “I want to talk to you about something. Since this, why it happened, stats, we have had talks that it’s not working out within reason? What do you say about that?” “You are right. Stats are down but it's Rebecca's fault.” “You are the manager of the area, you are the lead therapist or that's your patient. I'm sorry about this but we have to part ways here.” You would like them to understand.

PTO 158 | Let Go Of Someone
Let Go Of Someone: If there's no agreement on primary purposes and values, then that's the end.


It’s always the great first approach like, “It’s not working out. We don't match up here. Sorry.” 9 out of 10 times, 8 out of 10 times more than that has to happen because that's just not enough. They are assaulting individuals or you didn’t care for them more. It can go both ways. These things occurred. “I have reports, emails, stats, checklist, and all that is my ready to go, so what are you telling me?” “Today is your last day. We are going to pay you for the rest of the day today and I will give you money or not.” That's it. Have it role played, have your head straight how it could go. Run it how it could go, not how it's going to go because you have no idea.

In HR, the rule is you have no idea what’s that distinction. If they are having a bad day, you are getting that bad day. I would drill it two ways, completely the worst firing ever and that was easy because you will say one of those things afterward. That was horrible. That was nothing. I would always role play it both ways and communicate it's just not a match. “We are not matching up on some things. The statistics I gave you are not matching. A lot of that not matchy, and then we are going to part ways here.” That can be as clean and simple as it is but you can get heavier handed, a little more, “Will you tell me what's going on if you need to?” You have to be ready for that and skilled a little bit.

If a parting of ways goes relatively well, it's professional, there's an agreed-upon date, you trusted that person for some time, then moving on to something else, and you understand whatever, I like to have conversations with them not just, “It's your last day and you are packing up your things. You’re here. Cut the cake. See you.” I would like to have what we call an exit survey or exit interview to say, “What went well in our relationship here at the clinic? What recommendations would you have for us to change to do better? What are parts of the company do you think we can improve on? How did you feel about your training? Do you think you have trained appropriately?”

I don't want it to be a bitch session or a lot of griping but you are looking for ways you can constructively grow from the relationship and their parting of ways. Not every firing or resignation is set up to allow you to do that but if you are not looking for that opportunity, you are losing out on that opportunity to get proper feedback and criticism. Some of it could be emotionally charged and you might just forget about that stuff but you could come away with some nuggets for improvement.

I love that idea and I didn't answer that point for you. What I have done differently but that aligned with that exact thing is, when a policy I implement when I'm in a company is that employee reviews or evaluations happen every year or six months number one, as a standard by that manager, and as needed in other words but it's the same basic format.

At the front end on their three-month probation and employees will do both ways, it will be, “I didn't like it. Training has not been good. I'm worried about my job or whatever.” There's your version and their version. On the standard normal evals or reviews, there's more of a generic format we talked about a little bit.

On the exit end, I use the same document. Also, if you have 3 or 4 of those in the file, it's not a mystery. You already heard that it has been going bad, I'm not happy and they have heard that. I love the idea of having an evaluation at the end, of course, but it's going to be skewed for sure. Maybe not every time. Let's say most of the time, it will be skewed. I have no problem with that idea, I love it, especially if you have no system prior. Ideally, it's happening so often that you didn't miss it.

I love your point there that even if you did have the survey at the end, nothing they bring up should be a surprise because you have given them the opportunity to express their concerns all along the way and you have them properly documented, noted and you have made changes to correct those issues along the way. I love your point in that regard. Anything else you want to share about how to successfully let go of somebody? We covered a ton of stuff.

I started up with and I said a couple of times here that these are your team members and prepare for both sides of it, the ugly and the good. Consult an attorney where it might get sticky. You should certainly do that to seek for documents to sign and certain legal points like that. As you said a couple of times, Nathan, as an Owner yourself, our practices and you are not just a PT or a doctor, you are a business owner, it doesn't have to be something like Jekyll and Hyde here. It's not like, “I have to run a business and be a mean guy but I'm your friend.”

When you discipline your team, it's just a matter of changing your tone a little bit. Click To Tweet

You can be the same person.

If you operate standardly and professionally as an Owner with respect for your team, care for your team, and are never too friendly, then when you have to let them go or even discipline them, it's a matter of changing your tone little bit. You don't have to get heated or crazy and go, “What happened yesterday?” “I'm sorry.” That's the reaction you want. If you are a standardly professional, respectful person that cares for their team and they see that, have the systems in place, it will be a lot easier on the back end because it's like, “Sorry, it's not working out. We had a good run.” It's a little bit more like that and a little bit less like, “Sorry.”

I love a lot of the conversations that we have had so we can make that conversation and make that process less emotionally charged. The more you can look at it, you can scrutinize the person and their performance based on what's in the best interest of the business, then it's easy to come up with statistics, incidents, you name it in which they have valued malalignment that you can appropriately let them go without it being emotionally charged. If you can hold them accountable throughout their time with you appropriately, then a firing can be a very easy and simple process.

A lot of times, it's not because we are not the best in the documentation and that kind of thing but the invitation is to start documenting and hold one-on-one meetings where it's appropriate and accountable. If you see someone going the wrong way, love them enough to say, “You are going the wrong way and it needs to get corrected.” Also, recognize that you are not necessarily the best place to work, there might be a better fit for them somewhere else, and you need to help them find that better place.

I can't tell you how many people I have let go. They didn't come back and say, “That was the best thing you did for me. After you let me go, I decide I want to go back to nursing school. I want to do these other things. If that hadn't happened, I wouldn't have changed direction in my life.” Recognize that you are not the end-all-be-all. You are not the final resting place for all employees. You are more than likely 90%-plus of the time a stepping stone to their next place and help them along the path. If people wanted to ask you about HR-related issues, you doing some consulting, how do they get in touch with you?

I have a website if you want to check that out. There are some little tips and media there. My phone number is fine. It is (917) 312-4294. I don't mind a quick text or call, and then

Thanks again for your time, James. I appreciate it.

Anytime and we will do it again whenever you need me.

Thank you.

Important Links:

About James Savas

PTO 158 | Let Go Of SomeoneI love working with ambitious, driven individuals who have dreams of going big(ger) and just need the right support, backup and capacity to see it accomplished. I help them get that done.

The majority of my professional career has been in the Medical sector with the majority of that time in the Human Capital Management/Recruiting and Business Coaching/Development spaces. Over 20 years I've strategically planned and executed programs and projects for my partner-businesses' expansion from as few as 4 offices to up to 16 offices across 3 states. In my time working directly with various Owners and their staff throughout the boroughs of NYC and down the Rocky Mountains, I've hired well over 500 effective and productive Owners, Executives, Managers and Professionals, as well as created the training regimens for those people and their staff.

In addition to my savviness and acumen as a business expansion professional, I'm a successful soccer director and coach and a very very proud father of 3 amazing beings.

My Mantra is - Keep the create in life and be surprised by nothing!

Additional Points of Interest (some outside PT and some for fun):
* Published article in Impact PPSAPTA magazine (2008) "Hiring & Retention"
* Nationally Licensed Soccer Coach
* Director of Development of several Soccer clubs/groups
* Certified Assistant Teacher
* Co-owner (former) of a small family-owned retail dessert business
* International traveller (school in Italy & worked short-term in Ireland)
* Avid survivalist/camper/outdoorsman
* Humanitarian (as I'm able), directly assisted during 9-11 @ ground zero NYC
* Interned w/ MSNBC out of college (Broadcasting Major)
* Was a celeb-host at the 1996 Grammy's and 1997 ESPN Awards (some good stories not for air)
* Was on HGTV (with my family) in episode of a Montana HouseHunters
* Music composer/Short Story writer (Sci-Fi)
* Best hat I wear - DAD; pays shitty but great rewards!

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PTO 124 | Workplace Culture

Business goals usually look and sound good when written on a piece of paper or hung in the office, but most of the time, they are easier said than done. By putting an effective workplace culture in place, these goals can be brought nearer to reality. Nathan Shields talks to Jim Stoker, PT, advisor for 8150 Advisors, about the importance of nurturing employee relationships, frequent company meetings, and integrating accountability in reaching every goal laid out for the success of a business. Jim also talks about going beyond the usual team-building strategies, emphasizing the one thing every leader is afraid to explore – challenging your goals and seeing if they are truly worth the shot.


Listen to the podcast here:

The Secrets To Inevitable Growth With Jim Stoker, PT

I've got Jim Stoker, an advisor with 8150 Advisors, and also a past partner with Clemson Sports Medicine and Rehabilitation. I came across Jim because he wrote an article in the November 2020 issue of Impact Magazine, talking about how to review past goals, adjust your expectations, and create goals for the upcoming year. It's a good time to reassess, adjust and projecting the plan for 2021. Thanks for coming on, Jim. I appreciate it.

Nathan, it's a pleasure to be here. Thank you so much for the invitation. I'm looking forward to this conversation.

I know you've got plenty of experience to draw from, and I'll reference the article as we go through a bit because he hits some great topics in terms of assessing and creating goals for the future. Tell us first a bit about yourself, your professional experience and what got you to where you are as an advisor.

I'm a physical therapist. I've been practicing for several years. I joined Clemson Sports Medicine and Rehabilitation when we had just three offices. Over the years, we grew from three offices to 30. That culminated in August of 2016. We were acquired by ATI Physical Therapy. I continued to serve with ATI Physical Therapy for South Carolina, overseeing the operation of 60 clinics for about three years. During that time, what shaped my appreciation for planning, goal setting, and even more specifically, strategic planning was a lot of my involvement with our state association, the South Carolina Physical Therapy Association. I have served as the Vice President, President, Legislative Chair, Reimbursement Chair, many roles with our PT association. In one of those roles, we completed a strategic plan a number of years ago. That was my first introduction to strategic planning and goal setting, and how that's such an important part of any organization.

PTO 124 | Workplace Culture
Workplace Culture: Looking past yourself can help determine where you are, where you want to go, and how you want to get there.

What's interesting in the way you approached it in the article is that you started by reassessing your goals from the previous year. I don't think that's a step that a lot of us take. Me as a coach, sometimes that's a step I overlook, like how did we do in this past year? We'll think generally we hit some targets and whatnot and things were great, but we focused a little bit more on the ideal scene going forward and what we want to hit. Tell us a bit about what you recommend in terms of reassessing the past. Do you spend a lot of time on that? How much energy do you put into it?

You have to be willing to be objective and self-critical to look at the past and be honest about what did we do well, but at the same time, what could we have done better? Hindsight is 2020, so there is some knowledge to be gained from looking at the past, and take an opportunity to say, “Where did we fail? Where could we have done better? What would we like to do better in the future, and how would that translate to improving value for your company or for your organization?” Many times, acknowledging your missteps can teach you where to do better in the future and what you may want to avoid.

I liked that you referenced the willingness to look at some of those KPIs and assess them against not only progress in your own company but against national benchmarks. Nowadays, you can find those benchmarks here and there. They're more easily available to the PT industry than they used to be. It's nice to say, “Our arrival rate improved. We got to where we wanted it to be.” How did it compare nationally and what should be expected? That gives you a better sense of where you truly stand.

A shameless plug for the Private Practice Section that I've been a member of for years and have benefited from the knowledge of that group and the network that provides. The Private Practice Section published some benchmarking studies. We didn't have those several years ago, but many times it can be difficult to look beyond the thought that patients love me and like me. Unfortunately, there's more to business success than patients like me, and they recommend me to their friends. It’s having a standard but appreciating there are significant regional differences within those national standards. Something as simple as revenue per visit, then the KPI that people look at. If you delve into that, we understand there's a significant variance in the geographic price index that determines the Medicare fee schedule. There are some variations you have to appreciate per region. You can drill down to your practice setting in your region and compare it to some of that normative data. It is a beneficial exercise.

The personal goals of the owners directly impact the goals of the business. Click To Tweet

I came across an article that yes, it's a worthy exercise to consider why we got the numbers that we got. Sometimes our perspective can be a little bit tinted, but more importantly than looking forward is, how do we improve? How do we get to another level? How do we correct some of the missteps that we made prior and move forward in that direction? That starts a different conversation rather than looking backward and saying, “Why?” Yes, that's a worthy exercise. There was this, that, and the other, but “how” then generate some more forward-thinking. That was the takeaway message from the article that I was reading. It was focused on how and what we need to do going forward to those changes. As you're looking from the past, how do you then shift to looking towards the future as an advisor?

Looking past you essentially helps you determine where you are. You're focusing on where do we want to go and how are we going to get there? How do you bridge the gap? One of my colleagues at 8150 Advisors is Steve Stalzer. We were both passionate about our belief in the benefits of strategic planning. Strategic planning can look and feel different for many different organizations. If you're a one-person practice, if you're a large practice, or if you're a hospital department, there are a lot of different moving parts. The basic framework of strategic planning provides the necessary steps to objectively address the questions you outlined. You start with the strengths and weaknesses of your own organization.

This whole process requires honesty and the ability to be self-critical. You identify your own strengths and weaknesses. Where are we good? Where are we not good? Where can we improve? You then expand that strategic planning process to an internal plan, internal assessment, and then external. Most people can have the ability to control and influence their internal environment, much more than you can your external environment. There has to be a willingness to commit to the plan. Once you decide, these are the obstacles. What is it going to take to overcome these obstacles? That's where you use the strategic planning process to drill down to initiatives and action items that are going to take to address each obstacle to move you towards the goals you want to achieve.

As you're doing something like this, and you're referencing the SWOT analysis, do you start with that ideal scene first like what I want my clinic to look like and some of the numbers I want to see at the end of 2021? Do you do a SWOT analysis before that or does it matter?

It does matter. I mentioned to Steve, years ago, I was one of those individuals that felt a mission statement and a vision statement was mostly fluff. It was something that looked good on a piece of paper and it felt good. It wasn't until years later that I completed this type of process with our state association, and then went for our own company that I did appreciate how important mission and vision statement is. It does drive your goal setting. You start with your mission and vision statement and then determine what our overarching goals are. Do we want to expand our clinics from 1 to 3 in the next year? Do we want to go from 3 to 5? Is it a goal-setting just for your clinic? It improves aspects of that clinic. Is it a business goal or revenue bottom line? Do you have a philanthropic goal of community engagement?

A lot of people only think of business, which is important, but there are other worthy goals that may not be directly tied to your bottom line. I like to think of it as start with an agreed-upon mission and vision statement that helps you drive your overarching goals, and then you drill down. You start the big picture and drill down to the details through the specific goals. What are the specific KPI goals that allow us to achieve the overarching goals? What obstacles are in place, what initiatives, tasks, and specific action items do we need to take to achieve those goals? It was going from the big picture to small detail.

I love that you brought up that it's more than the clinical stuff because we're talking to individual and independent business owners here. In my experience, and maybe you've come across this as an advisor, I've had clients come to me and say, “What should my next steps be? Where should I go next?” I can't answer that for them. Much of these things originate from what the owner or the partners in that owners want to achieve. You have to be clear and figure that out first because not all of it is about clinical growth, financial goals, you name it. Some of it is maybe you don't want to treat 40 hours a week anymore, or you want to go to part-time treating or not treating at all. You want the freedom to explore a hobby, or there's a household revenue goal that you have for your household, and your business needs to create 100% of that, 75% or whatever. Some of these overarching goals stem from our personal and household goals that we need to be a bit clearer on as well.

When you have partners in a business, the more partners you have, the more potential obstacles. You have different personalities and characteristics, and those can potentially lead to different goals. One of the things that were a challenge for us that we do ask when engaging a client that has more than one owner is, is the leadership aligned with her goals? Many times, they're not. Without question, the personal goals of the owners directly impact the goals of the business. Business goal achievement is directly tied to an owner's personal goals. You do need to have that question. You need to have an agreement among the leadership of what are the goals together. You can't have two people pulling in two different directions. Many times, you have that down South here in the Bible Belt, we call that the Come to Jesus meeting place. You've got to get the leadership and ownership on the same page in agreement with, “This is our goals. This is where we're headed.” If you don't have alignment at the top, you're going to struggle to have alignment moving forward with the rest of the team.

That even goes so far as alignment with your spouse or significant other that might be a significant part of the business because there are some spouses that are a part of the business.

We recommend if a spouse is legally part of the business, potentially not officially part of the business. Input from all influencing factors is important.

What I thought was interesting in your article that I hadn't considered so much, as you look at these goals for the upcoming future, you go so far as to consider the ROI of change. Tell me a bit about that and your thought processes regarding the ROI of change and going past more than the goal setting, but what it's going to take to achieve that goal and considering if that goal is worth it.

As you go through the planning process, something might look nice, fun and pretty on paper, and it might feel good. You might determine as you drill down to the individual tasks and action items that are required to achieve that goal. You may find out it is going to take a Herculean effort to move the needle a bit. When we talk about the return on investment as you vet the various goals, you'll want to turn and say, “How much a difference is that going to make?” I’ll give you a specific example. If a particular company looks at a common KPI of visits per day, I don't think you can meet a physical therapist in outpatient work that doesn't talk about how many people do you see a day.

PTO 124 | Workplace Culture
Workplace Culture: A lot of planning success begins with the culture that you have.

If we move the average visits per day from 10 to 10.4 or 10.5, is it clinically relevant? Are we able to maintain the commitment to quality that we always have? You answer all those questions, and they say, “Yes. It's doable. It's reasonable. It's a goal.” What's the monetary return on that? You can objectively put a dollar amount. From January 1 to December 31st, if we're able to achieve a 0.5 increase, or maybe there’s a percentage increase, you know your revenue per visit and your expenses, and you put that number on top of it. You know exactly how much value you're creating for your entire company and your organization.

That makes me think about some clients who might say, “I want to double my gross revenues this year.” That's nice and good, but it is also important to recognize doubling your gross revenues means doubling your number of visits. Do you have the capacity to do that? Do you have the square footage? Do you recognize the staffing that it's going to take to double your revenue? Do you have it in your marketing budget to increase your marketing spend to get double the new patients? There are other things you can do to improve the efficiency and productivity of your clinic that can get you a bit more business, 10% to 20% better if you short things up. You're talking about a large investment. It's worthy to consider an exercise in which you're looking at not just the goal but also what it takes to get there. Is it feasible? Is it realistic? Do you have the capacity to do that?

That's the process we vet with clients about. If someone suggested that goal, “I want to double my gross revenue,” we're going to ask the difficult questions of, “Is gross revenue the best goal that measures value for a company? Is it net revenue?” If you focus on net revenue, you're acknowledging both sides of the business equation of income and expense. You drill down to where that can come from. How much of it are internal efficiencies through visits, appropriate charging, clinical efficiency, front office efficiency? Are we losing revenue because of authorizations or denials on treatment? Those are efficiencies you can create internally. How much is going to come from internal factors that we can control? How much potentially needs to come externally? How many more new patients are we going to have to generate? Do we have physical space? Do we have the staff? Can we recruit the staff? How long does it take to recruit and hire and bring someone on board? That would be an example of a large overarching goal that would have many sub-goals that would come for different aspects of the company to try to achieve.

I love the drill down to maybe focus a bit more on net revenues. See how that affects your business a bit better. I love the way that you redirect a little bit there. I also liked how you talked about how does that change occurs with the team that you currently have because then you further go on to talking about change management. Many of us as entrepreneurs have grandiose ideas and visions, “We're going to hit the arrival rate. We're going to improve it. It's going to be a 95% arrival rate this year. Let's go. Here it is, team. We're going to push.” A month later, “What did we talk about last month?” There's a lot of energy and spark at the beginning. How do we get a change in management to occur?

You described the mistake I've made more times than I care to admit. It’s multi-factorial. There are many moving parts. I do believe that so much of your planning success begins with the culture that you have. There’s so much at the end overall industries about how culture is important in an organization. At one point in time when I was more black and white, science-based, and right out of school and focused on clinical aspects. I didn't appreciate that as much as I do now. I learned that the hard way. To truly have a culture that will accept change, accept challenges, and focus on goals and improvement is paramount to the success of any plan.

That's part of the looking back process that you start initially. You answer the difficult questions about what culture is in place now. That involves communication style, frequency of meetings, are you a top-down culture? Do the owners decree, “This is how it's going to be. Do it my way. This is how we do it?” Do you have a culture of engaging your staff and your leaders, and empowering them to be part of the problem-solvers and decision-makers? You have to understand the environment in which you are going to implement the plan. That’s part of determining what obstacles are in place, not just physical obstacles, but environmental obstacles, and how does the team function?

Culture fosters the ability to work towards a common goal. Click To Tweet

I'm glad that you took it in that direction. Was it Peter Drucker or was it Brené Brown that said, “Culture eats strategy for breakfast?”

That was Mr. Drucker.

She quoted it though in her book, Daring Greatly. You could have many plans and ideas, but if your team isn't willing and isn't prepared in a place of reception from what you're bringing down from the mountain per se, then it's going to fall flat. If someone is reading this and they're like, “I don't know if I have that kind of team,” or “I need to work on my culture,” would you recommend they start improving their culture first before hitting some of these KPIs?

I do because it will be part of the entire plan. If an owner believes that and they acknowledged that that is an obstacle, we're going to help them create initiatives and action items to overcome that obstacle that is going to be occurring in concert with your other goals and your other action items. It boils down to leadership development. Developing leaders and identifying the champions may not be owners. That's going to differ greatly between the size of the organizations. If you have one clinic, that's three FTEs versus one clinic that's ten FTEs, versus 3, 5 to 10 clinics. You're identifying those champions that are going to help foster change. You need to begin with one level of leadership training, maybe it's two levels of leadership training.

When you were following the leadership training, you're investing in your team. You're communicating with your team. During that process, they become part of the team. That is building the culture. They are appreciative of the development in themselves. They see that there's more to this process than simply showing up at 8:00, seeing ten patients and going home. You’re part of the bigger picture. As you include them in the process, you provide transparent communication. They begin to appreciate the bigger picture, and then now being able to implement goals that impact the larger picture, which is the organization is much easier to achieve.

I talk to clients about leadership development. The limitations of the clinic are the limitations of the owner. If they are unwilling to delegate, train and develop these leaders, then the clinic will expand to the limits of that owner's time and capabilities, and also will mimic the weaknesses and strengths of that owner. Whereas you can be a much more well-rounded business. You can expand and grow if you expand that leadership team. When I bring that up to owners when I'm on a conference call, I get the deer in the headlights sensation because they don't know where to start. I don't know what you'd tell your clients, but I'm telling them to do what you did. If there are books that were influential for you, invite them to read some of those books and discuss what you learned.

If there was a consultant or a group or a training program that you went through personally for management training, invest in particular team members to take that same training or follow your path. You don't have to recreate the wheel. I'm sure there are companies out there that can provide management training for you. If you want to start from scratch, do some of the same things you did, and then give them morsels of leadership when it comes to leading out on a team meeting. If there's a charity that you want to endorse, let them start the toy drive or the canned food drive. Get that going and get everyone involved instead of you doing yourself as the owner. Those are opportunities for leadership and growth that you're talking about and can help with the culture.

I'm a firm believer that step one is getting to know your team. All those great examples that you mentioned may not apply to clinician number one versus clinician number two. Joe Brown is going to have a different skillset, characteristics, and value system than Jill Smith. In order to understand how to communicate and how to connect with your entire team, you need to understand and get to know the team members. I'm an old broken-down athlete myself. I'm an old basketball athlete with two old knee surgeries back in the ‘80s. Thank goodness they don't do those procedures anymore.

When I'm talking with folks, I equate to being a coach of a team. There are team members that responded to grabbing your face mask and physically challenging someone, versus your teammates that they more respond to put your arm around them, support them, ask them what they need and be more of a friend. It's one example that many people relate to having play sports throughout the years. Your various team members are going to communicate differently. They're going to absorb knowledge differently, and they're going to respond to challenge differently. Learning how to address and communicate with each team member will help you build that culture. That also develops trust because as you're getting to know your staff, you're developing trust.

I was talking to another client about creating culture. It's something that owners might think comes naturally, thus there's nothing special about it. As he's developing and writing out policy and procedure, I told him, “It's as important to be intentional and write out policy and procedure to generate your culture.” That sparked something in him. When we think about culture, we might think it happens naturally because it comes from us who are the leaders, and we generate the initial culture. If we want a certain culture, there are things that we can do intentionally with our clinics to generate more “culture.” You mentioned meetings on a regular basis, how those go, what you highlight, and how you address and communicate.

What I was talking about with him is he enjoyed a lot of crosstalk in the clinic between providers and patients, and patients with other patients. What are some of those things you can do to generate crosstalk? Whether that's a TV in the clinic, watch certain game shows or a sporting event, or a whiteboard that has a nice saying or a trivia. Some of those things can be intentional to generate culture. I'm assuming you would agree that it's almost as important to have things that do generate that culture in the clinic, as it is to make sure people are wearing their name tags and coming in on time.

I'll give a lot of credit to one of my former partners and mentor Skip Hunter. Skip Hunter was a PT and athletic trainer, one of the more fun individuals that you'll ever meet. He said from day one when I started as a staff therapist, "The most important piece of equipment we had in the physical therapy gym was the radio." Having the radio on the created conversation. It created much of the culture that you described. It creates an environment that is inviting that's professional but relaxed. That was the culture that we chose. That might not be the appropriate culture for everyone. Everyone has to choose theirs. We were in an orthopedic sports medicine environment that did encourage communication and cross-talking between clinicians and patients.

One example of how we encourage that, we felt it was important and best for the patient that they get to know other team members on day one. It's important for our clinic to be available to the patient at their most convenient time. If they have a stringent schedule and they need to be there at 4:30, we all know how popular that 4:00, 5:00 appointment is. I can't see everybody at that one time. On day one of the evaluation, before that patient leaves the clinic, I'm going to put my arm around them and we'll introduce them to at least two if not three of my team members. I tell them their name, have them wave and introduce them. I'm going to talk up my team members. I have known this person for 10 years, 5 years, they are one of the best shoulder specialists you can have. We worked together much. When the opportunity arises that is in the patient's best interest that they need to see a team member, it is a seamless transition. It creates that team environment and culture in the clinic. That's one example of something that we emphasize that I felt helped greatly.

PTO 124 | Workplace Culture
Workplace Culture: If there are books that were influential for you, invite your team members to read some of them and discuss what you have learned.

This conversation has gone in a different direction than I thought it would go. I thought we were going to talk about some KPIs, what the important ones are, and how we need to do that, but we ended up talking about culture and the importance of it, and I'm glad we did.

That's the mechanism that allows you to pursue the goals that you set, the KPIs. To jump back to our initial topic, the planning process allows you to drill down to the KPIs that you believe are most meaningful and are going to have the greatest impact on your organization. At the same time, it also helps you stay focused and know when to say “no.” You can't do everything all the time. If everyone on the team has agreed that these are the goals, these are the KPIs we're focused on, and we're not going to get sidetracked with the latest and greatest idea over here. This is what we're focused on, and this is where we're going to work towards in that alignment. The culture that we enjoy talking about fosters the ability to work towards those common goals.

As you have a team and a culture like that, then you can say, “We're doing our patients a disservice because only 20% of our new patients are completing their full plans of care.” The team is going to recognize. You talked about why that's an important statistic that we need to measure and how it affects our patients in our business. You get their buy-in and a sense of urgency, and then you work together. You can generate a plan as the owner, but as you start talking about it and get their feedback and input. We talked about how we're going to measure this and see for making growth and progress towards our goals.

When you have that culture that tends to stay in place and setting up some structure from the ownership side and being intentional about, “We're going to measure it at this stage. We're going to measure it the next month. We're going to address it at this meeting. We're going to see how we're doing, and we're going to have this conversation.” Having that structured implementation and a strategic plan on a solid culture keeps those statistics in front of mind, then you can see some real progress and change.

We enjoy talking about culture. In general, when you talk about culture, you start with the fun part and about the fun aspect of culture. There's a significant business professional aspect to culture. That's accountability. Accountability has to be part of your culture. Your entire staff needs to be aware of expectations beyond the only time and your patients like you. The expectations of every third Tuesday of the month, we're having a staff meeting and we're going to review the prior month. Every Monday at 12:30, we're going to have a fifteen-minute huddle to review our KPIs from the previous week. We do that every week. That's what we do. That's part of our culture. We're open and honest about, “My KPI of arrival rates slipped last week. Why in the world did it do that? What I could have done differently?” That conversation quickly expands to, “How can we as a team help each other manage?”

I had this conversation all the time. If you've worked in a clinic, your schedule never happens the way it looks at 8:00 in the morning. You get your schedule, and you see it's nice, and however often you schedule it, be it every hour, every 30 minutes, every 45 minutes, whatever you do, it never happens the way it looks. Things go haywire, people show up late or they cancel. That's where that culture of teamwork helps you achieve efficiencies that help drive those goals. The professional business aspects of culture boil down to accountability and the frequency and follow up. Everybody has these great either end of your meetings or beginning of your meetings, “This what we'll do next year.” A month later, everybody’s forgotten about it. The problem is you have to engrain accountability into your culture, so it does stay top of mind.

Meetings are a huge part of that. There are many clients that I talked to that don't have regular meetings with their team and with their leadership team to expand it out, or even with their billers. They should have meetings with their billers. It's in those meetings that you have the opportunity to maintain traction towards the goals and you take that. What we're talking about is a year-end projection, and you break it down by months and like, “How did we do in the past month? What are we going to do this next month to improve that? This is where we are, guys.” That meeting rhythm is important to the growth and acceleration and progress of the company. I love that you shared that. When we think about culture, sometimes it's about the fields, the atmosphere, the parties and how we engage with people, but there is a business culture that's also a sub-part of culture. That business culture involves regular team meetings, one-on-one meetings, and how we act and perform and how we hold accountable. I love that you brought that part of it.

That made me think of one of the obstacles. It's common that many times impedes the ability to have frequent meetings is accessibility and visibility to your KPIs. One thing we talk about with offices is, what's your visibility? How can you extract information from your system? Can you drill down to the individual clinician? How frequently can you calculate the arrival rate? Can you calculate visits per day for a clinician? It is common in any team and industry, if you put a handful of teams of individuals together and there's a team, you're going to have high performers. You're going to have middle of the road, and you're going to have those folks that you have to bring along. That directly impacts how you coach and what you do.

For example, you have a clinic and you believe they're a little bit low on arrival rate. “We can do better.” If you address that clinic as a team, say, they're five clinicians. You're addressing the team and challenge them, “This is what we need to do.” If you never drill down and see the details behind that number, you may see that you have three that are 98% knocking it out and they love it. There's one person that may be at 82% or 80% bringing down that number a bit. You're spinning your wheels because your high performers believe you are lumping them into the problem when they're not. Visibility to the KPIs and to the numbers, and correctly identifying where the opportunity is, and then addressing the opportunity as a challenge, but also thanking your high performers. Don't lump your high performers into the problem or the challenge. Thank them and then incorporate them into how they can impact, influence, and potentially lead the other folks that need some support.

A culture that will accept change and challenge is paramount to the success of any plan. Click To Tweet

I love talking to owners about their accessibility to numbers, and can they get the statistics that they need. Many EMRs aren't that capable, unfortunately. Some of them are behind the curve, but to get that down to an individual practitioner level is huge. You could be cracking the whip on your whole team like, “We're trying to get to 92% arrival rate and we're stuck at 90%. What's going on?” The high performers are like, “I don't know. What more do you want me to do.” You shouldn't be cracking the whip on the team but drilling down to that individual provider. It's equally important that they are capable of being able to track and find their own individual numbers so that they can see what their scorecard is. There might be only 1, 2 or 3 KPIs that you assess some of your providers on, but getting them to know the system well enough that they can see their own numbers can be labeled, so they can see how well they're performing.

Accessibility and visibility, and then understanding which ones. Not to get lost in the big picture because you can be overwhelmed with too much. That's where the focus of what we are working on is important. Something that gave me another thought is that you use the word intentional. One of the more common obstacles that I experienced and that I hear from many owners is the inability and the unwillingness to sacrifice treatment time or clinical time to designated time to work on the business. If you're expecting accountability, the frequency of the meetings with your staff, the owner has to set that standard. They need to schedule time weekly, be it 1 or 2 hours, be it in the afternoon, whatever it may be that’s appropriate for that size of the organization. It needs to be scheduled, uninterrupted, and standardized. What am I doing with this time? Where do I start? Where do I finish? What am I going to focus on? The shotgun approach. I have learned from my mistakes many times. Life became easier when I followed that mantra and learned from many other people.

Do you find that it's hard to convince some owners to take away productive time and hours from the clinic to have a meeting? I do. I'm wondering what you do to change their minds or convince them otherwise. What do you say?

That goes back to calculating your return on investment. If you're saying, “If we move these visits per day,” or whatever KPI is, this percentage point over the period of time, the cumulative effect of doing that compared to one visit once a day and you compare the time. You do the math. Easily, you see if you improve a KPI over the course of the team. You compare those two. It’s easy to see the benefit of creating long-term efficiencies versus squeezing that one patient in that one day.

I have to challenge the clients to do some of the meetings first. They understand the reasons why they're doing it because it's going to benefit them and it's going to get the team moving in the right direction. It's not until after a few meetings and their team members are saying, “I don't know what we did. How did we get by for ten years without having weekly meetings? How did we survive as a company?” They finally start noticing that things are getting done, things are improving, and numbers are improving. We're able to do things that we've never done before they finally recognized the value of some of those meetings.

It takes time and commitment. It's not a sprint, it's a marathon. That's also what creates long-term success. It's not a quick fix or a Band-Aid. You have to get over the hurdle of feeling like you've plateaued, and you have to stay the course. That's where you're going to appreciate the growth and the improvement over time. Many people get a little fatigued, “We're not making progress. We're still pushing.” It’s the commitment, accountability, and consistency over time that makes a long-term impact. Ultimately, it’s going to create value.

Those consistent little actions are eventually going to get us to that goal and that ideal scene that we want at the end of the year, but we have to stay the course and stay consistent. That's where those regular meetings, holding people and the team accountable, over time, we'll eventually see bigger goals being achieved. We've covered a ton of stuff. Jim, is there anything else that you want to add as we start wrapping things up?

I could go on forever. I enjoy the topic. We've proven that one topic leads to another. Many different aspects are intertwined. Bringing it back to the core of strategic planning, just as our conversation flow to many topics, that could also happen with an organization. You can get off track with chasing different topics and different goals. A strategic plan helps you focus on what you have decided is most important in this period of time for our organization. It helps you provide focus.

PTO 124 | Workplace Culture
Workplace Culture: To understand how to communicate with your entire team, you need to know your team members.

If people want to get in touch with you, how can they do that?

My email is

A simple Band-Aid fix cannot attain long-term success.A simple Band-Aid fix cannot attain long-term success. Click To Tweet

I'm going to do another interview with you. We're going to talk about something else that you're passionate about and you've had a lot of success with, and that is the utilization of athletic trainers and coordination with physical therapy clinics.

A little bit because we’re sports medicine in orthopedic clinics for so long. We've had experience with athletic trainers. I was a co-founder of a nonprofit organization entitled PlaySafe. We did that because taxpayer funds, state allocated funds for public schools are not allocated to public schools to hire athletic trainers. We tried to come up with a better way and a more sustainable way to help fund and provide athletic trainers beyond one entity, a PT clinic, a doctor's office or a hospital hiring them all. It’s an interesting topic and it's a passion of mine as well.

We'll wrap this episode up and use that as a little teaser for those interested or who have athletic trainers on staff and how they can utilize the program you guys have started. Nonetheless, thanks for sharing your wisdom and being a part of this.

It’s my pleasure. It was a lot of fun. Thank you, Nathan.

Thank you.

Important Links:

About Jim Stoker

PTO 124 | Workplace Culture

Jim has over 25 years of management and leadership experience in the healthcare industry and is passionate about helping owners reach their full potential. Jim specializes in strategic growth and clinic optimization of key performance indicators and clinic metrics achieved by creating an engaged employee culture of teamwork,
excellence, accountability, and leadership
His experience includes Partner and SVP of Clemson Sports Medicine and Rehabilitation, where he and his partners grew their practice from 3 to 30 clinics culminating in a successful sale in 2016. Jim also served as VP of South Carolina Operations with ATI Physical Therapy, President of The South Carolina Chapter of APTA. He also co-founded and serves on the Board of PlaySafe, a non-profit organization that provides Certified Athletic Training and Sports Medicine to secondary schools.
Jim holds a MA and BA in Exercise Science from Furman University, a BS in Physical Therapy from the Medical University of South Carolina, and he is currently pursuing a DPT from the University of Montana. Jim resides in Easley, SC with his wife Eleanor, 2 children, 3 dogs and their parrot.

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PTO 91 | Working With A Coach


Dr. Avi Zinn, PT, DPT, OCS, the owner of Druid Hills Physical Therapy in Atlanta, Georgia has been gradually growing his practice with the goal of giving high-quality care to his patients. Since our last episode, he has procured a PT business coach to reach the goals he has for his business. Today, Nathan Shields checks in with Avi to see how it's going so far, what he's learned, and his experiences since they last spoke. Discover what Avi has learned and the traumatic experience that challenged him as a young owner.


Listen to the podcast here:

Reality Episode, Ep. 2 - Avi Zinn, PT Begins Working With A Coach

This is episode two of my reality podcast episodes with Avi Zinn, tracking Avi's relationship that he's developed with a coach and consultant over the past few months. If you haven't read the episode, go ahead and do so. That'll give you an idea of where we're coming from because that was prior to Avi starting his coaching. In this episode, we want to focus on simply what his initial experience has been and some of the things that he's had to deal with since we spoke. He had some trauma that happened in his clinic and I hope we pay proper respect to the nature of the issue and how Avi got through it appropriately. It was a difficult situation for him and his clinic to go through. Hopefully, we handle that situation appropriately and understand that Avi had to navigate a ton of emotions while also trying to be the leader and a stalwart of his clinic on behalf of his team, patients, community and families involved. This is an interesting episode, but we got a lot out of it.


The Owner of Druid Hills PT, Avi Zinn. If you read the first episode with Avi, you'll understand that what we're doing here is simply tracking Avi's journey as he brings on a coach, a business consultant, if you will, to help him in his business. We shared a lot of his professional story and what he'd done before that point. Correct me if I'm wrong, Avi, you had hired the consultant as of our last episode but hadn't started doing anything with him formally.

Right, Nathan. I can't remember what month, it was a right around the same time. I may have hired them on, signed up with them, but hadn't gotten anything going.

I wanted to follow along with Avi maybe every quarter or so and see what his progress is like. What he's learning from his coach? What's helping, maybe what's not in some of his experiences as he's taking it on. I started asking you questions already, but thanks for coming on again. 

I'm glad to be back.

If you want to follow Avi's story and learn a little bit more about him, read the first episode. Since we talked, tell us a little bit about some of the things that you've done with your coach, some of the things you've learned and some of your experiences. 

First of all right from the get-go, things started well. Getting all of my numbers in order, taking all the analytics with WebPT. We had all these analytics but I didn't know what to do with them. We took all of our analytics, all of our metrics and put them all on a dashboard so we can objectively look at the numbers and track them and follow them. Right from the start, we were able to see an increase in efficiency, looking at better utilization. The numbers were able to be tracked. From the start of the coaching, it has been able to get me through a lot of not knowing, being able to like, "I see what that is, now I know what to do."

In relationship to the numbers, there's something to it, but there's a thing out there which is measured, improves, measured, and reported improves exponentially or something like that. What you find is as you start looking at the numbers, even if you don't put a lot of effort into improving the numbers, they start improving somehow. The universe starts pushing you in the right direction if you will. It's simply tracking the objective numbers and your KPIs in your clinic. That exercise alone seems to start improving things.

It feels that is happening by having those numbers on the dashboard and looking at them every month and comparing them, we see positive changes.

The cool thing about it is you're looking at it objectively and I'm not speaking for you, but for myself and maybe some other owners, you might feel things are getting better or you might feel things are getting worse. When you look at the numbers, you have the data right in front of you and you know if it is getting better or how worse it is getting or how much improvement you've made. It's good to have that certainty, if you will.

To get back to the question about how things are going. Having my coach that I speak to every two weeks and we talk about the numbers and see what needs to be changed, how could we change, what can we work on. Going back to the first one we did. Talking about The E-Myth originally and a lot of people read The E-Myth but they don't implement it. Having these numbers, the coach and the accountability is allowing me to stay focused and not get distracted by any of the millions of other little things that anything could happen, accomplish or try to affect and change what we're working on.

Considering you talked about accountability, do you feel a little bit of pressure? As you know that your meeting is coming up with your coach that you go, "I need to get this stuff done," whereas maybe you wouldn't have that before?  

I did.

That's why it's good to have that person. I'm assuming your coach is a physical therapy owner as well or was or something like that. They can relate to, they can talk about the same language and use the same vocabulary. You started using the metrics, started following your KPIs. You're meeting with your coach. Are you doing anything else on top of that? 

Always look at the numbers and make sure things are going as you want them to, and then go from there. Click To Tweet

The coaching program, there are also a whole bunch of modules that they have set up for let's say patient engagement or internal marketing or all these different modules. Another good thing that the coaching helps with is you're focusing on those numbers, “Let's talk about what we think can help change that.” If it's making sure that we're focusing on not having the patient drop off or making sure we're more efficient and completing plans of care. There are modules for, "This is what works and this is what you can do." There are all those things that I'm working on. At the end of each call, there's the plan of action and then by the next call, I'm like, "I finished this and I implemented that." That goes back to knowing that is coming up. I’ve got to make sure I get all those things done before the call so that I can say, "I've completed that module and let's work on the next thing."

You've got some homework to do in between. As I'm talking to people who are calling me about doing coaching, this is good to have this real conversation. Because when I tell them we're going to meet bi-weekly and discuss what's going on in their clinics, they think that it's just a call and that's it. What happens is you walk away with a ton of homework to do, sometimes even a little overwhelming if I'm not mistaken. 

There's still a lot to be done. It can be overwhelming.

There are many things to do where the coach can help you do it and maybe you've experienced this, help you prioritize what needs to get done more urgently or simply prioritize. “Let's make sure we hit this thing first and if you can get to it, that’s great, but let’s focus our energies.”  

My coach, being that he is a PT owner, it comes in handy because he can say, "This is what works for our clinic or proven in the program. These are the things that I can see based on the numbers, based on what you're saying, and based on what we're talking about, that this is what you should work on. If it's time management, then do that mount module and work on chunking your time so that you're efficiently using your time and not being all over the place and getting things done more efficiently. If it's patient engagement, then you start working on these things because that's what we ultimately need to get on to help with that.”

In your program, do you follow a step-by-step process? It’s like, “We're going to focus on number one first and we're not going to stop talking about number two until we get to number one figured out.” Are you able to work with them about things that are of a more urgent nature? Say if there's some disciplinary action that needs to take place, talk about disciplinary procedures and how to handle an employee. If you need to recruit somebody because numbers are going high. Are you able to discuss some of those other things as well in place of the program itself?  

There's flexibility within what needs to be worked on and what the priority is. There are the modules which are prerecorded videos, you can watch those at any point in time. We have our coach, we have our call, there's module one through however many, but it doesn't mean that you have to start with number one. “Let's look at what does Druid Hills PT needs?” We're looking at the numbers and visits are fine but maybe there's a poor utilization or I say, "This week, I noticed that we are having problems with cancellations still. Let's focus on that. This week, I noticed that my front desk isn't able to collect as much from the patients. How do we change that?" There's room for flexibility and working on what needs to be worked on, not just following step-by-step through the program.

What's a typical agenda for your meetings with your coach?

We get on the call and talk about some positive things that I've been able to change or implement since we talked. It could be anything, focus on starting on a positive note. It could go 1 or 2 ways but so far, I've had enough to bring up that I wanted to work on. Whereas there were 1 or 2 times where I'm like, "I need your help, what do you think should we work on?" A lot of times, I'm like, "This is what I've been focusing on. I've completed that. That's working pretty well." One of the things originally was working myself out of treatment. I got that under control for a little bit. I was like, "I've done that. How can I use my time better?" My coach says, "You can watch module whatever for time management and then talk about different strategies on what to do with the time and how to utilize it better." There's not necessarily one exact structure of the call other than trying to look at what we think needs to be done. We always look at the numbers and make sure things are going as we want them to and then go from there.

That sounds similar to what I do. It usually starts with what were the wins? What are the successes since we talked? What's top of mind that usually there's something that's happened that you want to talk to out and address? If there's not a whole lot there, then typically the coach will have something that he wants you to maybe consider or focus on as well. Maybe it's the next step or it's something that you might not have looked at, “Have you considered this?” There's some fluidity there based on my experience with coaching. Usually, you want to talk about things that are top of mind, but the coach then also can bring in things that you might not have considered at this stage of your ownership. Does that sound similar? 

I only know much and that's why I'm doing the coaching. Hopefully, a good coach can do exactly what you said.  

I'm assuming you're progressing fairly well towards the goals that you have set forth already for the year and whatnot?

Yes and no. A few things came up and it's been interesting. One tragic thing happened. One of our PTs was killed in a car accident and it's been crazy. That's what could have been a crazy, downward spiral for the business. It didn't turn out that way. It's ultimately because of the coaching and having that accountability. At first, it was certainly a shock and it was something that I never had to deal with. As a business owner, I had to make sure that the staff was okay. I had to make sure that all the PTs, the patients were okay. Some people didn't want to come back and that's completely understandable. Those are all things and dealing with the PT's family and it was overwhelming.

What a difficult experience and I didn't even think about this because you'd shared that with me but to consider what is expected out of you as the leader in this regard. You're not only responsible for your emotions and handling yourself, but you've got to consider the other team members, the patients that you see, this physical therapist's family and that's involved. Maybe any responsibility you have might have towards them that had to be overwhelming. How did you handle that? 

PTO 91 | Working With A Coach
Working With A Coach: A coach and the accountability can help in staying focused and not get distracted by any of the millions of other little things could happen.


I handled it all right. It was shocking. The first week, I was sitting in my office staring at my computer not knowing what to do. I will say going back to the coaching, you had to separate the emotion from it and then still recognize that this is still a business. Not to be insensitive, but the business needs to continue to move on. That alone that was tough to be able to put aside emotions and focus on the business. It felt insensitive, but it had to be done.

You want to honor them and you want to honor your emotions and your feelings. If you're looking at it from a logical standpoint, the business going down doesn't do anybody a service. You’ve got to keep it up and running because you've got multiple families and your community relying on you to perform still. That's got to be a hard position to be and to find the energy to move forward in that path. Sometimes some of these objective measures helped you out along the way. 

The objective measures, having the coaching, having accountability, being able to look at the numbers and at the end of the day everything that happened, I had to jump in and treat more and pick up those patients. At the end of the day, having the numbers and looking at them objectively and being able to look at them rationally and not emotionally and irrationally, allowed me to look and see. The business is not doing anything that different, maybe not growing as much as I was expecting and wanting to, but it wasn't falling apart and becoming this downward spiral. Everything was being able to stay stable. We were looking at the numbers and then having that accountability of talking through it with someone and getting a little bit more direction on what could be focused on more than other things that would be helpful had to have been what allowed me to get through that time.

I can't imagine the support that a third party like your coach provided at that time from the business perspective. The support that they could provide you because you'd laid a foundation, a framework of measurements of policies and procedures that we're able to keep you guys going so you can lean on it. It was a foundation. You could lean on this structure that you'd already built, even though it's not quite finished if you will, but you're able to lean on that and maybe give you space to work on your emotions as you were dealing through this issue.  

That's interesting that is what happened in that. Maybe we weren't getting this crazy growth I was anticipating or not even crazy growth, just moving forward. At the same time, because there was that foundation, the integrity of the business was there. Things were able to continue without having to get caught up in losing revenue and whatever. That allowed me to deal with what was going on maybe emotionally. Maybe there would be a time in the day where normally I would be super productive, but that hour I sat in my office and staring at the wall or something. That integrity and that foundation created the space to allow me to do that.

What was the therapist's name? 

His name is Tyler Wallace.

It’s a tough situation. I honestly haven't come across a lot of that in my interviews. I had to deal with the death of a longtime PTA that was part of our company. She was amazing. She was with me for fifteen years or maybe more. She was a big part of the company, a real light in our clinics every day. She almost became like a sister to me. It's something that I'm finding and it doesn't go away easily even a fellow employee is still working through their emotions in regards to that passing. It's a tough one. It can be hard because the team members become part of your family. Sometimes you see them more often than you see your family. It can be a difficult experience. I have to commend you for the work that you did ahead of time. You’re creating the foundation of policy and procedures, objective measures, and having the coach. It's hard to say what it would've been like if you didn't have those things in place? Hopefully, we can look back and say, "Some of those things we're able to carry you through."  

I believe that is completely what did it. This has been something I've been struggling with, not to be insensitive and not to honor the process. There were a lot of interesting things that happened with the business. By the nature of losing a PT, we had fewer PTs, but because we were implementing all of these different practices and trying to become more efficient and focusing on whatever we're focusing on. The numbers were improving at the same time. We were paying fewer payrolls because we had one less PT to pay and we still see the same amount of visits. The PT schedules were more full and we were becoming more efficient. We were having less drop-off because we are focusing on getting the patients to complete their plan of care. You've got two sides of the thing. This horrible thing happened, but in the end, a lot of ways the business benefited from it. It's hard to say that because of the actual situation but that ultimately goes back to the coaching and the ability to be able to objectively look at the numbers and see that these things work. By looking at the numbers, we can not only get through hard times but grow from them at the same time.

From a larger perspective, I don't want to minimize Tyler's passing, but you had gotten to a point where you weren't treating at all for the few weeks before his passing.

That's true. I was down to no treating.

Focused on business, time with your family, time for hobbies. I see it quite often, not necessarily that someone's going to pass, but obstacles come in the way. Whether that has to let go of somebody or personal issues show up as you're making these steps in progression, life is going to get in the way. It's because you have some of these structures in place that make getting through those difficulties easier. If someone does pass away, we've got these structures in place and we're watching the statistics. Someone who we thought was an integral part of our program and a rock that we couldn't let go of. Maybe they leave for greener pastures or for disciplinary procedures or whatever it might be. You come out the other end, things can improve. Whereas in the state beforehand, if you hadn't measured those things and structures weren't in place, then it would have been complete chaos with a lack of control or power or whatnot. You give yourself to whatever happens. You're simply riding the waves, but you're able to have some power if you're able to structure your business and your management appropriately.  

Having those numbers, having that accountability from the coach and having the structure, I was talking about in the last episode that we did, my PT, my first employee, she had reduced her hours. She was doing some home health. I started looking and I hired a new PT full-time and then she decided to do full-time home health. I had this new PT and she had this planned two-week vacation before hiring that we all knew about and it happened at the same time. This went from me backing myself out of treating, having three almost full-time PTs to then having one full-time PT for two weeks. One full-time PT and then me going back into full-time treating all of a sudden. After going through all of that and then looking at the numbers, seeing that at the end of the day, we were 20% more efficient with our utilization.

Our bottom line was in line with what we were even with one less PT. It came back full circle in that when you had asked me about, "How did I decide to hire someone on early?" It seemed out of the norm, usually you don't hire on that early because you want to make sure everything is more efficient, 90% full. It came back for full circle in that. At first, after all this happened, I'm like, "I need to start looking for a new PT because I need to fill that spot." That's not the biggest priority because I realize that we can become as effective as long as we're efficient. That's what the coaching and consulting are helping with is becoming more efficient. Ultimately we're doing the same with the business with fewer PTs, which is what exactly what we're trying to do.

It is ideal to build a culture and create a string foundation along with striving for business efficiency. Click To Tweet

What are some of the things that you're looking forward to now going forward? You've been through a tough experience that was his passing. What are you looking forward to as you're moving forward? Where are the things that you're working on as you progress through 2020? 

The first mastermind, the group with all the consulting, we all get together quarterly. Right after that, I came back and we had this whole meeting and talk to everyone about the company’s vision and trying to talk to the staff also to see, maybe they have some input on the vision. What do they want to see out of business? What are they looking for? How can we all get on the same page as the vision of this company? I've been thinking about that a lot. What is our vision? What is my vision? How can we include everyone that works here in that? What I am focusing on is I've got two great PTs that are working and I'm focusing on them and trying to get a great team, focus on the staff that I have. Try to get everyone to work together with the same goals in mind.

The vision as simply put is trying to help as many people as possible. We want to be there for the community. I'm telling all my staff that I'm doing the coaching and explaining to them that I'm focusing, anytime I come to the office and say, "We’ve got to do this and this is how we’ve got to change things." It's not because I'm trying to micromanage things. It's because this is what we're doing to try to get to that goal, that vision. This is what we're going to do to get there. I'm focusing in on the staff that I have to build the culture and create a strong foundation of not just the business efficiency, but also the team and the culture of our business.

You say that you're focusing on them, focusing on your physical therapists. What are some of the things that you're doing to focus on them? 

I had a meeting with the PTs. First of all, I acknowledged that I appreciate their hard work. That simple thing is probably something that doesn't happen often. Focusing on them, meaning they are my employees, but I also appreciate them and I want them to feel like they're a part of this as well. That is something that will help the business. It's not I'm doing it so that they can feel more appreciated. It's more like if we're all here doing this together, we're going to be able to make this thing work a lot better and help more people. Making it known that they're appreciated, not just tell them that you appreciate them, but asking them what they think we can do better. What is it that we're doing that they see from a different set of eyes that would be different, that would help out? I'm one person and there are a different set of eyes on the business and they see it differently. Their opinions are as valuable. Listening to them and trying to gain that and implement those ideas is going to be super helpful.

What a great way to develop your culture and also get your providers engaged and bought into the company by simply asking their opinions like, "What do you guys think? What should we do?" Recognizing that you don't have all the answers, that maybe they could do some things or have some answers that are better than yours. That's a great exercise that you started and you can continue to do with them to start developing this culture that you have in a new company like that. That's a great step. When I'm thinking about the vision, usually I see it as coming from the top down. It's an essential vision for the company but it sounds like you took them through an exercise where you wanted to see what their vision for the company was as well. Am I right? This is something that your coach has taken you through while you got it from the mastermind but your coaches had been following up with you and seeing how things are progressing

Correct, and giving ideas on how to even bring up the topic or the exercise like my coach was, "What's your vision?" I was like, "To be a good business." He's like, "You need maybe to have a little bit better vision than that." I went home and that was some homework. That was one of our coaching calls. It was like, "Next coaching call, I want you to have your vision." I spent the next two weeks, I watched some TED Talks about people, company visions. I read some stuff and created what I thought would be our vision, not just for the company's growth but also what we're trying to do for the community as well.

The effect in the community, the larger purpose, that stuff and how you want to be seen. You have some other mastermind groups that you're going to go to. You'll have your bi-weekly meetings. Are you going to any conferences then as well?

We have another mastermind coming up. We'll see what new nuggets we get from that. 

Based on your initial experience, you've only been with your coach for a few months. What would you tell somebody who's considered it or maybe even not considered? What would you tell our audience about your initial experience with having a coach?

I would say that if you haven't gotten a coach yet, you should go ahead and do it. Even if you're thinking of starting a business, I would say it’s probably better to do it even before starting so that you cannot have to fix what is broken, but start on a much better solid foundation having that. Having that accountability and those calls are helpful to have so you can be focused and committed to what you're trying to accomplish because it's easy to get distracted. There are many millions of things that you could spend your time on but are not important. If you need to get things done, you having that coach and that accountability not just to guide you but also to keep you accountable is instrumental in being able to grow the business.

What would you say your ROI so far on investing in a coach? Maybe you do not see it in sheer numbers, maybe you are, but what would you say are some of the ROIs on what you've invested in so far? 

I would say numbers are not the easiest thing to see yet, because of all the things that had happened and we're down a PT. We're at the same as far as the bottom line where we were. Everything else is more solid, more a better foundation. As far as the return, knowing that I have someone to fall back on after going through something like this and able to get through it in such a positive and productive way was more worth more than anything. There's no way that I could've gotten through that without having someone else to keep me focused, keep me rational, keep me objective instead of getting super emotional about it.

I'm glad you had that support. Condolences to you, the families and your team. It’s a horrible, horrific experience to go through. I wish you guys the best and I'm glad to hear that you've got some support and it sounds like you guys are starting to get your footing back and moving forward. I'm sure there are things to work through still, but you have some vision. You're starting to develop a culture and you're starting to get back on track.

PTO 91 | Working With A Coach
Working With A Coach: The integrity of your business can allow you to move forward even with problems tagging along.


We're getting there.

We'll stay in touch. I'll follow-up with you again. We'll see where you are at the time but expect huge changes.  

Me too.

Thanks for your time, Avi.

Thank you, Nathan.

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About Avi Zinn

PTO 91 | Working With A CoachDr. Avi Zinn, PT, DPT, OCS is the owner of Druid Hills Physical Therapy in Atlanta, Georgia. He opened his practice at the end of 2017 and has slowly built it up—transitioning from a staff of one (himself) to a team of administrative staff and treating therapists. He continues to grow the practice gradually. Avi’s main mission for Druid Hills PT is to provide high-quality, personalized care to each and every one of his patients.

Avi has his doctorate in physical therapy from Touro College, and is a Certified Orthopedic Clinical Specialist. He lives with his wife and three children in Atlanta.


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PTO 78 | Peer2Peer Network


The Private Practice Section of the APTA established the Peer2Peer (P2P) Network a few years ago and since then has provided a great opportunity for PT owners to collaborate with fellow PT owners and discuss how to improve their businesses. In this episode, Nathan Shields interviews Randy Roesch, PT, owner of Business Solutions Consulting Company, and Steve Anderson, PT, Executive Coach for Orange Dot Coaching. They are also current facilitators for P2P. Both have personally benefited from networking during the course of their careers, making them a great resource about the benefits of networking and what P2P has to offer. Nathan then also highlights his mantra for successful business ownership, which is Reach Out - Step Out - Network.


Listen to the podcast here:

The Peer2Peer Network Of The APTA's PPS With Randy Roesch, PT And Steve Anderson, PT

We are going to talk about networking. I've got Randy Roesch and Steve Anderson, both physical therapists and facilitators for the Peer2Peer Network in the PPS section of the APTA. If you don't know much about it, I highly recommend you look into it and possibly apply because the application process is closing during the month of January to join the network. I specifically want to talk about not only the network but also the importance of networking, whether it's the Peer2Peer Network or Entrepreneurs’ Organization, Vistage or BNI to name of the few networks that are out there on the country. Networking has provided to the people in my network, the benefits of growth and accountability. I'm sure there's more to it than that. The Mastermind concepts have been around a long time and seem to be initially labeled by Napoleon Hill in Think and Grow Rich. In terms of growth, usually what I find is that the benefit that leads to that growth is the fact that you've got multiple minds coming up with solutions to problems, specifically your problems.

You also now have access to resources, people that may have been there and done that or they may know a company that might be able to help you solve that problem. They might have someone in their network that they can refer to you to help you improve or grow. Secondly, the accountability as owners, we don't have anyone holding us accountable other than maybe our spouses, but the health of the business maybe. There is no one to hold us accountable to the goals that we set forth initially. We all know that if we have an accountability buddy, we'll do better when it comes to achieving our goals. That being said, I wanted to highlight The Peer2Peer Network, especially since it pertains specifically to us as PT owners. From a greater perspective, I want to make sure you all understand the importance of networking with whatever network it is. Let's get to the interviews.


I have Randy Roesch and Steve Anderson. They are both facilitators of the Peer2Peer Network in the Private Practice Section of the APTA. I wanted to bring them on because if you've heard my mantra before, it's, “Step out and network.” Not very often we talk about the importance of networking, especially as independent physical therapy owners, but it is huge. First of all, I want to thank you, Randy and Steve, for coming on.

Thanks for having us.

Randy is the Owner of the Business Solutions consulting company but also a doctor and a physical therapist. Steve Anderson is also a doctor of physical therapy. He's a former CEO of Therapeutic Associates on the West Coast and is an Executive Coach for Orange Dot Coaching. They both are working hard on the Peer2Peer Network and they'll share a little bit with us about the details here as we go along. Before we get into the details, I want to learn a little bit about you because you were both successful physical therapists in the past. I want to know a little bit about your path. Randy, do you mind sharing with the audience a little bit about your professional path and what got you to where you are?

I graduated from the Mayo School of Allied Health in 1973. I've been a PT for a long time. It started out, as most of us do, in acute care and decided that I wanted to do something on my own. I was practicing in Florida and the director in a hospital. I talked to the hospital about getting a piece of the action and they said no. I went out and started my own private practice. Over the course of years, I built that company. The name of the company was RehabWorks. Some of you may have heard that name. I think it's still around in some areas. Eventually, I had four partners and we had a company in 26 states. We employed 1,800 therapists at that time. We were in hospitals, nursing homes, school systems and outpatient clinics. It was a wonderful experience.

We finally reached the point where we couldn't continue to grow without some influx of funding. We pulled interest and joined a company called Continental Medical at the time and that company eventually went public. I've been in the corporate world too. It was an interesting experience. I stayed on for four years and then decided that getting back into private practice was what I wanted to do. I joined my husband in his private practice for several years and then started my consulting company. I've been working with PTs in private practice for the past years. It is a fun ride.

Steve, how about you? Tell us a little bit about your path and what got you to where you are.

It's a little bit similar in the sense that I started out as a staff PT. I joined a company that I was impressed with. The name of the company was Therapeutic Associates. I started with that company. In a few years, I became the director of one of the clinics in the company and eventually became the CEO. I was with the same company for 37 years. I was the CEO for 19 years. It's an interesting company because it is a shared ownership company. It's a legacy company. It's owned by physical therapists. When I retired at the end of 2016, I believe there were 50 PT partners. The directors of each of the clinics have ownership. It continues on and it's doing great in the Pacific Northwest. We also have a hospital contract in Southern California that we've had interestingly enough since 1954. I retired at the end of 2016 and I did what has always been my real passion, which is helping leaders become better leaders. I started Orange Dot Coaching. I now do coaching services for executives, NPT and in the business world as well.

Since we're talking a little bit about networking, specifically the Peer2Peer Network. For either of you, did networking play a part in your progression in your professional path?

Everybody is willing to share in Private Practice Section. Click To Tweet

It did for me. I was active in the Private Practice Section beginning in the early ‘80s when I started my private practice. It was an amazing experience. I met many wonderful people. The thing that I found in the Private Practice Section was that everybody was willing to share. It was amazing. You would go to these meetings and people would tell you what to do and what all the resources were. It was great. It was one of the reasons that I've stayed active in this section. I wanted to give back because it helped me so much in the development of my company.

For me, I felt like I was on an island when I opened up my own clinic at the younger stages. I thought I had to figure all this out on my own. I felt like it was up to me to figure everything out. Little did I know, once I started networking, that there are other people out there that have already been there, done that and know all the answers or can give you the resources. If I had only tapped into something like that earlier in my career, things would have gone so much smoother. What was your experience, Steve?

The Private Practice Section was great for me too. I've heard her say before and I felt the same way that you go to your first meeting or two and you say, “I've found my people. They understand me and they helped me.” Some of my dearest friendships continue to this day that I found at the Private Practice Section meetings. I love them. My story also goes in the sense that I was part of this big private practice company, Therapeutic Associates. I was elected by the board to become the CEO at 41 years old. I was excited and felt pretty cool about that. The real truth, I was scared to death.

Just like a lot of my clients, I’m overwhelmed with the enormity of the job and to do so networking was extremely important to me. I got a lot of help from friends in the Private Practice Section, but I also found something that we may touch on here a little bit too. I joined a group called Vistage, which is an international group that puts groups of CEOs together and there were 12 to 15 in a group. I did that for seven-and-a-half years. We met on a monthly basis and that was extremely valuable to me. I learned a lot in that period that we're going to talk about, how I learned a lot after that type of setting. A huge proponent of it, I felt that it took me to the level where I needed to be interacting in life in that environment.

That's a great point, Steve, because my business partner and I were part of the Entrepreneurs’ Organization. Much like Vistage, it gives you an opportunity to network, talk with and share issues with people who are outside of the healthcare, specifically the PT industry so that they can maybe challenge some of the perspectives that you have. “Why do you have to do it that way?” They don't come from where we're coming from. Sometimes it's helpful to talk to people outside of the PT industry to look for some of the answers. It gets a little bit different perspective on how things go outside of the industry, what expectations are, what company norms or business norms are. Whether it's a Peer2Peer Network, Vistage, Entrepreneurs’ Organization or BNI or any number of this business that can be hugely helpful in your ability to overcome some of the issues that you're having, but also mingle with other professionals.

The key to that set up or organization, which I know Peer2Peer does as well, is that you need to get to a level of trust and vulnerability with people to get to them to the bottom of things. The way they're set up like that, you can get there because you get to know these people. It's amazing. There were tons of business stuff that came up, but quite frankly, there was some personal stuff that came up too that shocked me at first. When you're running a business and you're working these long hours and doing things, sometimes you have issues at home that you'd like to run by people, “How did you handle this?” If you have that trust and vulnerability, I'm already set into the group, but you can go there and help there as well.

As far as Peer2Peer Network is concerned, Randy, what's the history around Peer2Peer Network? How long has it been going? What got it started?

A couple of people that were on the board, they always laugh about how they were out having a beer one night. Mike Horsfield and Jeff Ostrowski got to talking about how nice it would be if they had a board of directors that they could talk to and they could share problems. They talked about how they could maybe create this group. They thought they came up with this brand new idea that nobody had ever thought of. As Mike says, we realized that the Mastermind concept has been around forever. It started in the early 1900s. That's what it's patterned after is that Mastermind concept. We call it networking on steroids because it's a way for PTs to network with each other and learn from each other. They went to the board of directors of the Private Practice Section. They said, “We'd like to try a couple of pilot groups and if it's successful, then maybe this is something the section would want to offer.”

They had two groups, five people, who were in companies with gross revenues of less than $2 million and five people who were in companies with over $2 million. They started working together on how to better their company. They talk about the problems they had and the things that they had in common that they didn't understand and could help each other with. They loved the experience. They brought that back to the board and said, “How could we make this happen?” They decided to try this Peer2Peer Network. At the point that I joined them, I had been very active in the section as was Steve has for many years. I was very excited about the opportunity to do something like this that would be so beneficial for therapists. We opened it up. During the first year, we had 35 new people join. Now, we have 157 network members and 29 groups.

The groups are made up of 5 to 8 people. As I said, we have this arbitrary cutoff at $2 million. Steve and I interview everybody that's coming into the programs. We get to know them and then we put the groups together. We look at what your strengths and weaknesses are, so if somebody wants to learn more about social media marketing, we might put them in a group with a younger person who's got a lot of experience with that. If someone wants to own a building, we'd put them in with somebody who owns a building. We build and put these groups together. The groups meet on an annual basis face-to-face. We have a summit every year in April. It's a three-day summit and then the rest of the time, they meet on a monthly basis. Usually, video conferencing and then there are tons of emails and texts going back and forth. Most of them have a Dropbox as a way to communicate with documents that they want to share and so on. We're getting amazing feedback from everybody that's in the program. The one thing that I often hear is, “It's the best thing that PPS has ever done. These are the people who saved my practice. They helped me make some of the decisions I needed to make or learn how to move forward. I was stuck.” It's been a great program.

PTO 78 | Peer2Peer Network
Peer2Peer Network: For P2P to work well, you need to get to a level of trust and vulnerability with people to get them to the bottom of things.


The person who turned me onto Peer2Peer Network, and I didn't know much about it at all, was a friend of mine who owned a clinic up here in Alaska. He said the same thing. He met with a group of about 6 to 7 people. He was having issues with recruiting physical therapists, especially up here in Alaska, how to retain therapists and how to move his clinic forward in different aspects. He grew 85% over the course of one year and attributed a lot of that success to Peer2Peer Network. It sounds like that's not an uncommon success story.

It's really not. As I said, we've had several people who have said that it's made tremendous in their business. The thing that I find interesting and Steve maybe found this Vistage, but what people are saying is a lot of times, especially solo owners didn't have to be accountable to anybody. They had great plans but they weren't accountable. A lot of the stuff, you go to these meetings, you're all these great things, you come back with great ideas and then you get busy and it goes away. This is like having your own little board of directors and you have to go back and talk to and say, “I did that. I didn't do that.” “Why didn't you? What's up?” These people are setting goals and they're holding each other accountable. That's what they say has made a tremendous difference.

Would you agree with that, Steve?

Absolutely. That's what I experienced when I ran a bigger group. We hold each other accountable. I think for the smaller practices that don't have that, it’s a huge benefit. People you know and trust, you don't fool. You don't show up to the meeting and BS them because they'll call you out in a second. Sometimes, as humans, we need that. I would totally agree with Randy on that.

I've recognized the same thing as I've been in some of those groups. It's hard to make excuses for some of the things that you didn't get done and that you had committed to because they'll call you out on it. They'll say, “You can't use you are busy as an excuse. We're all busy. How are you going to prioritize and get things done?” I love that you brought it up, Randy. That accountability piece is huge because who's holding the owner responsible to get things done? If it's an employee, they can huff and puff and maybe they might even leave. It's nice when you don't have to get to that point and someone else out of empathy and an environment of security is providing that ability to hold you accountable. That's huge in the growth of small business owners.

In the groups, we talk about the rules of engagement. The things that people learn and help each other with is that they trust. They have this huge trust. As Steve said, that was important in this group, the commitment to the group. They show up for the meetings. They schedule these monthly meetings and everybody shows up unless there's some kind of emergency. Everybody comes to the summit every year. They work hard on balance sharing so that everybody's talking, sharing and not just one person taking over the group. It's important. We don't have any competitors in the groups. Number one, we have a wide variety. We have people who have been in practice for 30 years and people who have been in practice for three years and they might be in the same group.

We also are very careful that they're from different geographic areas. That vulnerability, you're not to talk about opening a clinic if you know that your competitors sitting there. I'm moving into that area. The confidentiality piece is extremely important and then the ability to play well in the sandbox. We've been fortunate because we've had very good results with the people who have been in the program. Very few people have left. We've had a few people who have left because they sold their practice. One of the criteria is that you're the CEO in your practice and an owner and some people are not able to continue anymore. We've had a few people who have said, “This isn't quite for me. I've gotten all that I could get.” We've had less than 10% attrition. I think that's pretty good.

What are the criteria? I think you've covered a few of them.

It’s a PT or a PTA and you have to be a member of the Private Practice Section. You are the chief executive in the company, which typically is the owner. I think we only have one person who was the CEO and not an owner, but he was the CEO of the business. There's a fee. It's $750 a year and that covers the costs of the summit as well as what we do for the program. It also covers benchmarking. PPS, we developed and started in Peer2Peer Network. Some people have probably heard about benchmarking opportunities through PPS. We have twelve KPIs that we monitor. That's done on an annual basis. We have an outside firm that does all the work. It's all anonymous, but we use it so that you can compare yourselves regionally and nationally to all the benchmarks and the groups use it to extensively compare to each other, “How come your cost per visit is this? Let's talk about how we can make me more like yours.” That's been a huge benefit for the members of Peer2Peer.

That is huge, especially when we don't have the business acumen and the ability to compare some of those finances like, “How much of my gross revenues am I spending on the payroll? What is my cost per visit? What is my average number of visits per new patient?” Those kinds of KPIs you want to compare and see where you're at. Am I below average? Am I above average? It's good to have an idea of what's happening in your clinic compared to the industry. There aren't a lot of benchmarking data out there for physical therapy owners. It is a huge benefit to have that available to us.

Solo PT clinic owners do not have to be accountable to anybody. Click To Tweet

We've expanded it now. We've opened it up so that other members of the Private Practice Section can also get into the benchmarking program. I think we are offering 500 slots, but we thought the more the merrier. We can have more information and more data. That's why we opened it up beyond Peer2Peer.

Steve, you're talking to some of these people who are considering joining the network. What are some of the issues that they have that you have to address? What kind of encouragement do you find yourself reiterating to the PA owners that are considering joining the network or any network?

Whenever you're running a business, it doesn't matter the size of it. There are two things that I see. One is being overwhelmed like, “I know I've got so many things to do, but I still have to treat patients. I still need to do this. How am I going to get it all done?” Seeing what others do and how others have handled that is extremely important. The other thing I see in my clients a lot too because I know I have it big-time is what's known as the impostor syndrome. When you're sitting there thinking, “Everybody thinks I know what I'm doing because I have a successful practice and I don't have a clue.” That's a hard thing to deal with. When you're in a group networking like this, there are two things that happened. One is you hear about people in the same boat so you can say, “I'm not weird thinking this.” Secondly, people are going to reassure you that you're not clueless, that you do have some skills and you are successful for a reason. You can build on that and that's what that group brings to you. They say it's lonely at the top and I would totally agree. Sometimes you need people that are very objective and willing to tell you what you need to hear and not just tell you what they think you want you to hear to the organization.

Randy, what are some of the common concerns that they bring up as to why they don't want to join the network?

I don't talk to very many people that don't want to join because my job is to find people who want to join. I would say that some of the people who have decided not to remain, it's been primarily a time issue. They don't feel like they have the time to devote to it. Even though in my mind, it's not a huge time commitment. It's probably a few hours a month for the call and then some emailing back and forth and those kinds of things. I don't know if it’s the true reason why they didn't want to stay with it. To reiterate what Steve was saying, we're finding that a lot of people, no matter what size the practice have a lot of similar problems. They appreciate the opportunity to be able to have someone to talk to about it and learn from other people.

To add to that, I find this with people I do work with as well. Sometimes they said, “I really want to do this, but I don't have the time.” It's a funny thing to say because the reason you do it is so that you can find more time and be better at what you're doing. It's like, “I need to hire somebody, but I'm not going to hire him because I don't have time to train him.” You just need to find the time to bring them on and train them and then help you expand it. The same thing goes with leaders is there's never going to be a good time. There's never going to be, “Now it's exactly the time to do this.” You have to decide, pull the trigger and go.”

I think you have to recognize that and I want to get your feedback on this as well, whether it's networking or something else that you might commonly recommend the PT owners do, but they've got to take the time to put on the owner hat and recognize that they are the leaders, the owners of their company. Sometimes, if they're treating patients full-time, they do not recognize that. They're putting on their owner’s hat sometime around midnight when they've already lost a ton of energy. They're neglecting parts of their business because they're not fully executing in that ownership seat. If you were to go back and talk to yourself or maybe a younger version of yourself that owned a clinic like some of these owners do, what are one or two things that you would highly encourage them to do? What kind of mindset or encouragement would you give to them at this stage if they are treating full-time, not much time to run the business type of situation? I'll start with you first, Steve.

You mentioned earlier when we first started about working on the business and not in the business. We probably all read The E-Myth book and understand what that means. It's one of those things where I find that when you're in small business and you've got all these pressures on, you tend to think very short-term. What I try and tell leaders is that you need long-term strategies so you can kill it for six months, nine months, a year, maybe a couple of years and do well and be profitable. At the end of it, you can't sustain it. A long-term strategy is what can I do to set things up now so that when I am 2, 3, 4, 5 years down the road, I can sustain what I'm doing and continue to grow because otherwise, you're going to hit it. There are only so many hours in a day one person can do and you're going to tap out unless you're preparing for that growth along the way.

What would you share, Randy, in terms of talking to that younger owner?

I think Steve’s spot on. They use the phrase, “We're running our business by the seat of our pants,” and that's how it feels as a PT because we didn't learn any of this stuff in PT school. I think as Steve said, we can work as we all did really hard, but at some point, you got to figure out how you're going to run this business and be able to not be working 80 hours a week and trying to have a life besides your business. Looking ahead and trying to make a plan, you got to start somewhere and you're going to work hard for the first few years. It's important not to neglect thinking about your goal, where you want to take this thing and how are you going to get there and plan it out rather than go day to day and figure that somehow it's going to work.

PTO 78 | Peer2Peer Network
Peer2Peer Network: Confidentiality and the ability to play well with others are extremely important in a group.


I love that you shared the long-term aspect because a lot of times we were thinking short-term, how many visits are we getting this week and new patients and not looking long-term as to what we need to grow in terms of company. If someone wants to join the Peer2Peer network, Randy, how did they go about doing it?

We take applications and the application period is open now until mid-January. They go to the PPS website, which is There's a networking tab right on the main page of the webpage and that's where the Peer2Peer Network lies. Once they go into networking, they'll see Peer2Peer and they'll see the application. There's a list of FAQs in that tab. Steve and I are also available to chat with anybody at any time to talk with them a little bit more about the program and see if they think that it's right for them. We often do that.

Is your contact information on that webpage? Would you be willing to share?

I'm willing to share it, but our contact information is on that webpage so that they can send us an email and then we get back in touch and talk with them, answer their questions and do interview calls with everybody to where I'm in. We want to make sure that they feel it's a fit, that they're going to enjoy the experience. My email address is

They can reach out now. You said that the application period starts now, but did that start in September or October?

The application period is open all the time but for the class coming up, we're going to have to cut off probably about mid-January. Steve and I interview everybody who's coming into the program. We put the groups together and then we do some group calls before the summit in April. We have a lot of work between January and April. We try to get things tied up by mid to late January. If people are interested, they need to apply as soon as possible.

It only comes around one time a year.

We do a new class and we bring in 50 new people a year. That's 8 to 9 new groups every year. We're continuing to grow at that pace, which is great. We're very excited about it.

The exciting thing this year is the conference is in San Diego, which I'm excited about.

We held it in Alexandria, Virginia, which is where the Private Practice Section headquarters are. We did that for the first four years and we have people from all over the country, like, yourself, from Alaska. We had people asking if we could possibly consider moving it. We said, “That's only fair.” This year we're on the West Coast, in the beautiful San Diego.

It's important not to neglect thinking about your goal, where you want to take it, and how you are going to get there. Click To Tweet

That's April 22nd to 24th or something like that.

The meeting starts on Wednesday afternoon. We end at noon on Fridays, so people can get back home for the weekend.

Anything else you want to share, Steve, in regards to the Peer2Peer Network or some of your insight to the audience?

I think we've covered most of it, but it's a wonderful program. I commend the people who came up with it, Mike, Jeff and Randy for driving it for the first few years. It is a top-notch thing in the Private Practice Section. I believe everyone could benefit from it. My advice to you is don't say you don't have the time. Find the time. It's not very expensive. If you take a look at Vistage and some of those other groups, you're spending some pretty big dollars and this is done very economically. I don't think the cost is an issue. You just need to find the time.

Thank you, both, so much for taking the time to join me here. I appreciate it. Thank you so much for sharing your insight and the work that you've done in the past.

Thank you, Nathan.

It has been fun being on the program.

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About Randy Roesch

PTO 78 | Peer2Peer NetworkDr. Roesch began her career as a Physical Therapist, graduating from the Mayo Clinic School of Allied Health in 1973.

She practiced at the Mayo clinic for 6 years and then moved to Sarasota, Florida where she was the Director of Rehabilitation at Blake Memorial Hospital for 4 years.

In 1983, Dr. Roesch opened a private practice outpatient clinic and began providing rehabilitation contract services to local nursing homes, Easter Seals, and the local school system. Over the course of the next 6 years, Dr. Roesch acquired 3 partners and grew her business, known as Rehabworks. Rehabworks employed 1800 therapists, and provided rehab services in outpatient clinics, hospitals, long term care facilities and school systems in 26 states.

Rehabworks was sold to Continental Medical Inc. in 1989. The new company then went public. Dr. Roesch stayed on as Chief Operating Officer for 4 years. In that capacity her primary role was to value and acquire businesses as well as lead the transition team for these new acquisitions.

In 1994, Dr. Roesch started Business Solutions, a consulting company to provide services to therapists in private practice. Today she concentrates her business in the area of succession planning and practice valuation.

Dr. Roesch has been very active in the Physical Therapy profession over the course of her career, including volunteer service with the APTA. She has served on the Board of Directors of the Florida Chapter, the Private Practice Section, and as Director, Secretary and Vice President of the APTA Board of Directors. She served as the Interim Executive Director for the Private Practice Section. She is currently a Trustee and Board Secretary of the Foundation for Physical Therapy Research. She is also the Facilitator/Director of the Private Practice Section Peer2Peer Network program. Dr. Roesch has received our professions’ highest honor being named as a Fellow of the American Physical Therapy Association in 2016.

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