PTO 156 | Leadership Development

Leadership development is not a topic commonly discussed within the PT industry. However, just like any business, leadership plays a big role in growing and expanding your business and practice. Dr. Michelle Bambenek is the Regional Vice President of Operations at Empower Physical Therapy Group. She is also a leadership coach and consultant for both PT owners and people outside the PT industry. In this episode, she joins Nathan Shields to break down the critical components of leadership that empower team members to grow and, in turn, your business. Michelle emphasizes the importance of values and imbuing a sense of mutual responsibility within the team. Learn more about the steps and successful patterns to expand your PT practice.


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The 5 Critical Components Of Leadership Development And Business Expansion With Michelle Bambenek, PT, DPT

I have got a special guest, Michelle Bambenek, who I have known for years and worked with Will and I at Empower and Rise Rehabilitation Specialists back in the day. Thank you, Michelle, for joining us. I appreciate it.

It is a pleasure to be here. I’m happy to be on the show with you.

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Thanks for coming on. At this time, Michelle is a Leadership Coach and Consultant for both PT owners and people outside of the PT industry. She did great work for us working with our leaders of the team that we had at Rise at that time. We want to talk a little bit about leadership development. It is something that I haven't touched on a lot on the show and it is something that she is specializing in and invaluable for those therapists and owners who want to grow their practices. Before we get into potatoes of everything, share with us a little bit about you and what got you to where you are at this point.

I appreciate being on with you. I'm excited to talk about this topic. By way of introduction, I am a PT, graduated in 2007. I immediately went into an outpatient orthopedic setting and pretty quickly after that, I was thrown into a clinical directorship position. In 2011, I had the opportunity to transition to working with, at that point, Affinity Physical Therapy, where I met Will. I was the Clinical Director at Affinity Physical Therapy at Coolidge and progressed from there and building as things started to take off or leaving some of the pressure off of Will. He was still treating in Florence so I took on the directorship of Ford's Clinic and then we had the Anthem Clinic. We were fortunate enough to go through the merger with Pinnacle Clinics.

I functioned as a Vice President of Operations for the four clinics at that time, I think. Maricopa, Coolidge, Florence and Ocotillo, the Chandler Clinic. I went in through there. Along the way, I was able to learn a lot from yourself as well as Will and a lot of the expert coaching that we were able to be a part of. I found that I had this natural desire to build, lead teams and offload the owners of the company and help in that capacity. I found that to be invaluable to the overall growth of the company as a whole. I quickly realized the importance of developing leaders, not only of myself but those around me to take that to the next level.

Since that time, you have been strictly in leadership capacities, right?

Soon after I took on the Vice President of Operations and running the four clinics, due to the sprawl of them, it did take a lot of time to be able to work in each one of those clinics, get to know the team and find out what's needed and wanted around what their specific needs were. I was mostly in a capacity of leadership development and training, running meetings and doing accountability sessions and things like that versus the hands-on treating.

It is important to note that for any of you owners looking for opportunities, expansion in the future, or if you are at two clinics looking for a 3rd or 4th at some time along the line, you have to find someone who can manage. Would you consider it middle management, would you say?

Middle management to upper management, depending on the number of clinics. I would say I was in the upper level. It is a necessity for that growth to happen. I would consider the clinical directors that I would have underneath me as the middle management. I was overseeing those and helping in that capacity of a step above them. You always wanted to say, “Everybody is important in that team.” One can’t function without the other. Every single person is an essential team member to make the whole thing move. In terms of an org board or communication line, command line, that is how it functioned for us. I found it very valuable.

Owners can't expect to oversee multiple clinic directors, multiple front offices, the billing, and the marketing. At some point, you have got to offload the oversight of those positions. That is where the value of an upper-level executive like yourself would come into place to take on those responsibilities, a foreign owner, for sure. When you are getting to a third clinic, that position is necessary.

I would have to agree unless you want to burn the candle at both ends because I can see it. It has been done, but it does not last for too long and things start to fall through the cracks. In some of the programs or things that were successful, actions start to drop off because there's not necessarily somebody set up in line to make sure that line is being held. I think it is imperative at that point. It is difficult to run the business and be in the business. There has to be a separation at some point for middle management or upper-level leadership to come in and support in that capacity.

Every single person is an essential team member to make the whole thing move. Click To Tweet

Your growth in the company, your management, and the oversight was essential to our growth in the clinics at the time. Our conversation is a lot about that. How do owners grow leaders, whether that is in the PT industry or outside of it? It is something that takes time, but it also is something I think, because we do not have that training from the past, we do not intuitively know how to do it. Maybe there's not a lot of books on how to develop leaders.

There's a lot of books on how to become a better leader and better owner. Maybe that is the next book you need to write is how to develop leadership teams. We do not have that training in the past. That is what we want to get to is how do owners train their leaders? In saying that, if you want to preface anything, that is fine but where would you start?

I think it is very important. I know that when you are an owner, you go in with a vision of a clinic and we're coming in as PTs. We're PTs, but in PT school, we're not necessarily given the tools or even a course on how to open up a practice. That is something that is missing in our profession as a whole. We do not necessarily come in inherently knowing how to lead a team and be a leader of multiple people outside of treating our patients. Oftentimes, that is what happens.

We have great producers that come in. Immediately, a great producer becomes our leadership because they have the ability to turn out a product and have a high capacity of production for the company. Some people may inherently come in with some tools, but that still needs to be developed. The first thing that I would think of is it does have to start with ourselves. We have to do our own work. We have to develop our own leadership voice that comes from surrounding ourselves with people who know a lot more than you.

PTO 156 | Leadership Development
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It's coaches and mentors and reading the books. I have a myriad of books here that I have gone through, from E-Myth Revisited, Leadership and Self-Deception, Crucial Conversations, and Good to Great. Five Dysfunctions of a Team was pivotal for our team. One of the ones that I'm gravitating to which do not to underestimate the importance of emotional intelligence. I have this book by Marc Brackett, Permission to Feel, which has been mind-blowing to me.

Those are the things that I found were important for us. Not even necessarily one book or one training coach. We've gone through the Gazelle, the Measurable Solutions, Scott Fritz, multiple people surrounding ourselves with thought leaders and people in that space knew how to help us grow to our next level, developing our own way of thinking and knowing the rights and the wrongs on how to approach a conversation and the importance of accountability. All these different things that a lot of us do not inherently come in knowing that I think are important to do. We’re starting with ourselves first.

As I’m thinking about our experience with you, we were sharing and we wanted you to read some of these books. It wasn’t scripted per se, but it was part of our leadership development. We wanted you guys to read the same books that Will and I were reading that we thought was super valuable. Even Good to Great and some of those books.

It was important that we share important books that we had strong beliefs in with those people who we thought were going to be our leaders and who were tagged to be our leaders at that time. We want to make sure that we’re having conversations about those things and get on the same mindset page. There is an assumption you brought it up in your preface there that we assume that good producers inherently become good leaders.

I do not think that is the case all the time. If someone is a great producer, they can see all the patients and get all the results. We inherently think they’re going to be great leaders and that is where they want to go. Sometimes, the conversation needs to start with them to be like, “What is your path? Where did you go?” You were upfront, if I’m not mistaken, with Will that, “I want to be a leader. I want growth.” Those conversations are crucial at the very beginning.

It is one of those things of even finding out what’s needed and wanted with the team going in like, “Is this even something that interests you? Is that something that drives you or is it something that you see yourself doing? Do you find comfort in that? Do you find energy in that?” It doesn’t do us any good to have somebody placed in that position who doesn’t want to own it.

We all have a purpose, a product and a key stat. If you do not even vision yourself in that purpose, then it is hard to turn out a product and the stat just dies. It is one of those things that is an important conversation to have. It goes along with developing that team and earmarking people. Only because they are a great producer doesn’t necessarily mean there are value-aligned, which goes into my second thing. First of all, you have to set a purpose and your values.

PTO 156 | Leadership Development
It starts with us. We have to do our own work. We have to develop a leadership voice, which comes from surrounding ourselves with people who know a lot more than you.

Set up the purpose of values first as a clinic.

Unfortunately, I still witness it in some of my coachings that it is something that is locked away in a cabinet or was developed at the start because people know it is important, but it is not breathed into the environment. It is not living in the clinic. It is not something that people even know. Maybe the executive team knows and not even the executive team knows the purpose and values.

I hear a lot of people when I go in. I’m like, “What is your purpose? What are your values?” They give me a tagline, which is great, but it is a valuable thing you need to build in your company because it is the foundation of how you will ultimately function. I would encourage people to develop those, spend the time, spend the effort, find out what’s important to you, figure out exactly what you value, and the ethical and moral fibers you want to bring into your company and have that happen? That then leads into the development and you are marking who your team players are.

There was a flection point that I noticed during our ownership and developing leaders like yourself in that. Will and I came up with values and purpose, and it was based on coaches pushing us to do so, like talking about those values on a regular basis. All of our weekly meetings started with us verbalizing the purpose and values in unison. For me, that was a little uncomfortable at first, but as we did it, I started recognizing that you and the other team members started taking it on. I thought this is weird that you guys care about this business as much, maybe more than I do.

It was valuable for me to see that other people could care about your purpose in the clinic. I always thought that was something that was here. It was within me and now it is Will and me. This is our thing and we developed it in a secret room in the back of the clinic. When we started sharing it, living it, and talking about it often with our team members, they started buying into it as well. That is where we saw a lot of growth and development of other team members and the growth of our business. There was a direct correlation between the growth of the business and establishing that purpose and values.

That is the basis of the culture that was being developed. Your visibility and sharing that with the team and giving people the opportunity to not only hear it but feel it and be asked, “What does that mean to you? What does that vision or that purpose mean to you? How do you see that?” Taking it even a step further where we were having a regular meeting, rhythms, and getting into a position of like, “How have you demonstrated that? How have you seen your teammates demonstrate that? How do you see that happening in our clinic?” That invites people.

It wasn’t uncomfortable, to begin with, but then everybody was like, “These are my people and they honor and we created a safe place for people to be heard and listened to.” Everybody wants to be part of something bigger than themselves. When you pull them behind the curtain and you share with them those visions, those values, and get to be a part of it, you do want to hear from them. I want to so badly. I do not enjoy standing in front of a team and talking to them. I want a team meeting to be something that is theirs. They are developing and their voices are being heard.

That comes from the development of those values and that purpose and breathing life into that. They become part of something bigger than themselves and immediately have an onus in that company. That is exactly what you want. I loved it or felt it more than you. That is me relieving my primary customer of the responsibility in holding that. I’m doing my job to allow you to do that.

As you start working, breathing the purpose and values, that is when a culture starts getting established. When you start developing that culture, you start recognizing that certain people fit and certain people do not. Either way that is okay, but you want to find those who fit, live, and breathe the same purpose and values you do and have also bought in. That makes it easy then to find the people that do not fit and find the people that do fit, then hiring and firing, holding people accountable becomes much easier at that point, doesn't it?

That is the third facet of what I think we need to talk about and what owners need to gravitate to because sometimes they are going to have a high producer. They may be value-aligned that are very low on the scorecard. You have to evaluate that and see if that is something that you want to carry through. This is hiring and making dismissals and even making business decisions based off of your purpose and your values. Do you fit? Do you align with what we’re trying to accomplish here?

We have the desired impact that we want to create within our team members but also our community. That has to be carried by the entire team. Not one person can do it. Not one leader, rehab coach, tech, aide, PCC or PT. It has to be a shared thing because it is something that is very valuable to the community and to the team.

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One person that doesn’t align can make havoc in your clinic. It can cause A-players, high-value aligned and high production team members to leave your company. When you are breathing it into the clinic like we talked about and talking about it on a day-to-day basis, it makes for an easier accountability conversation because then you can clearly align or delineate where they align and where they do not align like, “This is not necessarily professionalism. Explain to me or help me understand why you did not take accountability for this,” or things like that.

It makes those accountability meetings, the hiring and firing, become so much easier. I guess we’re leaning more towards disciplinary actions and letting go of those people who aren’t value-aligned. When you can do that with a values-based conversation, it almost makes it more objective and less emotional than simply saying, “You went against one of our primary values and we can’t tolerate that. Here’s what we’re going to do next or we’re going to have to let you go if it is severe enough.”

What I also see is not only is it important in helping find those people but those people whose purpose aligned, they want to do more in the business. They want to take on leadership opportunities. You have PTAs that want to become clinic directors and more, like Stacy, not just clinic director but also marketing, supervisor and director of marketing, and did great. She was not only value-aligned, but she was in a company that she could fall in line with and found other ways to live out her desires and what she wants to do. There are opportunities like that come up when you find people who are value-aligned.

All of those things are 100% accurate. Sharing them, to begin with, so that people know those conversations become easier. Also, people start to realize, “I do not fit in here. You guys are drinking the Kool-Aid and have this desire to take this to the next level. I only want a paycheck.” Those people do not fit on our bus. Those aren’t the rock stars that we want. It creates an opportunity for other people outside of it to have that ownership. Even if it is not in marketing, VPO, or clinical director, we found that we had rehab coaches, PCCs, and billers jumping at the first opportunity they could to help like, “I want to be a part of this.”

I remember one time, Savannah came in and she was the rockstar for one of our events. She was going to do an insurance verification right on the spot. We have our rehab coaches, our techs or aides coming in, setting up and taking down for big events. Everybody wanted to be a part of this. I can’t tell you how energizing that was. That even took the pressure off me. It was like, “Am I needed here? What is happening here?”

When you find those people asking for volunteers, doing voluntary events and community events isn't a burden anymore. People are like, "I want to hang out with these people. You are my people. I want to be with you more. How can I do that?” Even if it is outside business hours, right?

That would belt off of our values, too, being in the community and part of that. Having a clear delineation of our expectations, you automatically got those people on the board because those are the people you are hiring, service-oriented, and willing to go above and beyond. I remember during our recruiting process. It is very specific that we're looking for rock stars and do more. We do not want people that are only coming in for a paycheck. That is all fine and good if that is what you want, but it will probably not be a sustainable thing for you and us.

As it pertains to leadership development, another aspect of things that I think is helpful in developing your leaders on the team is giving them some of those responsibilities. When the owner takes it upon himself to have the year-end party, do it all themselves, and figure that all out, you are wasting an opportunity there to develop leaders on your team. Maybe they do not have the title. They do not have to be clinic directors or marketing directors.

What if you had a tech or a front desk person who was in charge of it? Could you be okay with that if you gave them a budget, some parameters and let them go? Those are opportunities to develop leaders on your team to give them small things. Even thinking smaller, give them the opportunity to lead out on your staff meetings or the in-service. Of course, it is one thing to share purpose and values, have them read all the books, talk about them and all that stuff, then you need to give them some responsibility and say, “Here is a little piece of responsibility. Number one, it is an opportunity to do so and show us how you can do it. Number two, it is also an opportunity for us to see how well you do and how well you can coordinate the team.”

I remember being a very young leader and coming in and being like, “I have to hold everything because I want it to go a certain way. I want the pat on the back.” Also, all the successes were mine, but then all of the defeats were also mine. We started off by surrounding ourselves with people that know more than you. I want to constantly look at who’s coming up behind to take my job because that pushes everybody to the next level and pushes me as a leader.

Being that young leader, wanting that praise and accolade but also taking the brunt of everything becomes pretty heavy. Once I started handing things off, having people even write up programs, run the team meeting or do things like that, I realized that there was so much more satisfaction out of that. Now, at the end of something, we were a team like, “Look what we accomplished. Look what we did. We did this together.” I come from sports and a team background, so that is something that gives me a bit of energy.

PTO 156 | Leadership Development
Spend the time and effort finding out what's important to you, figuring out exactly what you value, what your ethical and moral fibers are that you want to bring into your company.

Also, it gave us an opportunity to not point the finger. It was like, “I should have done this. I could have done that.” In our debrief, if something did not quite go wrong, like, “That was my fault. That was something that I could have done better. I could have put a little bit more attention on that.” We’re winning together, but we were also going through some of the mucks together as well. It made you feel like a part of something bigger than yourself again and it wasn’t all of the weight of everything on your shoulders.

I know we’re going into your next point here, but to do that, it is imperative that you write down what is weighing you down. What are you working on that you need to delegate? This is how I abdicated responsibility. When I was a young owner, I would interview people and I’d say, “Your job is to do anything I asked you to do.” I literally said that. I do not know how many times. Of course, they were waiting for me to tell them what to do.

I was upset because they did not like to see a garbage can that was full and not dump it. I told him at the very beginning, “Your job is to do what I tell you to do.” They’re waiting for me to tell them to do that. That was my fault as a young owner. What I learned with coaching and consulting is the dirty work. The grind of an owner or any leader as you are developing a leadership team is to write down what someone else’s responsibilities are going to be, what your expectations are, and have those conversations about, “This is what I expect you to do and here’s a manual on how to do it as well. This is how we do things in your position to obtain your product and to keep stats high.” Writing all that up is imperative but it is a grind and that we do not talk about a lot.

It can be very cumbersome, which is why I think what you said is important. Leverage the team members that are doing something well. This is our job description, coursepacks, training manuals, your playbooks, or your hat packs, owever you want to name them. This is essentially the outline of your company's successful actions, how they’re done, and the steps to get them accomplished. This was something that took us quite a bit of time to develop and it was always in a revision state like, "How can we improve this even better?” It was never fully done.

I remember having a number of different packs that we had not only for the CEO, VPO, PT, or PTA, but we had a leadership hat. It outlined all the books we wanted you to read. It had all of those different ways of doing it. We have what we called our all-rise hat or an all-employee hat that went through the purpose product and key set of every single team member. Not only did I know what my responsibility was, I knew what everybody else’s responsibility was, so then I could support in whatever capacity I could to help them also get their product. Outlining all of that is important because it takes the pressure off of the owner.

I would love to survey your audience like, “How many of you were the primary accountability holders? How many of you are the primary holders of all of the crucial conversations? How many of you are in charge of hiring? Which ones of you are the primary holders of key relationships? How many of you are still out there doing all the marketing?” All these different things initially fall on the owner. When you start, you are it. You are popping upshot if you are doing everything on your own. There has to be a time where you are relinquishing that.

As you are hiring value-aligned team members, they are getting a rhythm. You are marking those that have a desire and a potential to be the leaders, and you see people doing things well. Ask them to write it down. “How do you have a successful day?” “Every single day, I come in, I look at the schedule, and I earmark all of my patients that are going to be either high risk for falls.” You are planning out. That is a successful action that maybe we know how to do for ourselves, but maybe that needs to be written down to be shared and put in those course packs or those playbooks for everybody to now know.

That is crucial in leveraging your team on how they do that like, “Tell me the steps of how you go about as an aid tech. How do you go about cleaning the clinic? What is your process?” All those things can be a little bit cumbersome but are essential because then it is not, “What does Nathan say? What does Michelle say or this owner say? What is the handbook saying?” That is how we do it. Everybody has a uniform way of doing it, especially if you are going to be in multiple clinics. You have to have a uniform way of doing things.

For any owner that has aspirations for multiple clinics, there has to be a common playbook between clinics or there is going to be chaos. It is going to be impossible to manage everything and handle all the things happening at once because everyone is running their own place at the same time. I remember I had a PT student who had spent ten years being attacked at some clinic in the past. I said, “If I paid you $250, would you write up what it takes to be a tech and what do they have to know?” She was like, “Sure. It is $250. I will take that.” I used that for years to train all my techs after that. I was like, “Here’s what you have got to do. Do that. Learn this. I will quiz you on it later, but these are our expectations.” It had exercises, anatomy, cleaning routines, and all that stuff. It is all in there. That was gold for me because I was able to use it over and over again.

As you said, for those owners who are reading who do not have any of this stuff in place, it is going to take some time. If you have anybody on your team, you could say, “They are a rockstar technician, front desk person, and physical therapist on my team.” Asking them how to do what they do and take fifteen minutes if you could. How do you get patient buy-in? How do you get a good arrival rate? How do you collect collections over the counter so well and get 100% every day? What do you have to do to get that done? Having them do some of that will be powerful and is a good place to start. As you take time away from treating patients, you can start writing up some of the things you will eventually want to delegate to somebody else.

Honestly, being that teammate and being like, "You hear me and see me doing good work and you want to leverage what I know. I feel seen, heard, and important. Now, I have more ownership like I'm part of the handbook." That is pretty cool. I'm not only coming to a place of work and being told what to do. I'm being asked what I do well. It is ownership, not only in the company but also validation for that person that you are working with.

Great producers don’t necessarily make great leaders. Click To Tweet

It can be huge. The fallback we have as owners are, “It is going to land on me. I’m going to have to do it all.” Hopefully, what they get out of this conversation is, number one, not only is it valuable to write up all this stuff. Number two, you do not have to do it all. There’s a significant portion that you may have to do. You are going to be ultimately responsible and organizing things initially. Try to find others, if you can, to do some of that work for you.

Have them do some of the write-up and you can put it together in the way that suits you and your company, then continual revision. It takes time. You do not have to do it alone, but it is a valuable way to grow your practice.

This goes to your final point, which is to communicate what your vision is like, “I want to eventually have a 2nd or 3rd clinic. I know that to do that successfully, I'm going to have to have a policy and procedures in place that are replicable over and over again.” While you teach those people who come on board, what were the expectations? Holding that communication line is important.

I think all of these things come together but also the regular communication, daily, weekly, monthly, quarterly, communication rhythm, and a meeting rhythm for the team. They know exactly what’s going on. You are bringing them behind the curtain. After a strategic planning session, now we’re delivering and cascading that information down to the team. They’re not, again, only on marching orders. They’re a part of something. This is your impact on how to move this clinic and these clinics together towards our ultimate goal for the company as a whole. Those are ways that we can bring communication into our team. Get their buy-in. Get their ownership in that as well.

Not only that, they have a uniform time each day, week, month, however you set it up. They know they’re going to go over their values. They’re going to highlight things, present their stats and answer the questions, but they’re also going to be there holding that meeting and being heard. They’re part of the team and part of something bigger. Once you have that regular rhythm, that also breathes into the culture. You have a uniform way of communicating information. You know when you can bring things to the table when you can’t bring things to the table. It also relieves the owner and the leadership as a whole because you do not have like, “Do you got a minute? Can I catch you for a minute?” You know our regular meeting rhythm. Maybe you have office hours, a private conversation, or put that on the parking lot.

That is something that we can bring up to the entire team because if you have that question, there might be other people within the company who have that same question, have that same desire to do something, change something, or work something out. It is a uniform place for everybody to communicate, be heard or be seen. Also, speaking of our values, see the company's greater vision and see how they can be impactful in that.

If there is no consistent communication, people are going to blurt out in the middle of patient care without raising their hand and say, “What is going to happen on Christmas?” That has happened to me in the past. I’m working on somebody, someone comes up to me and asking me about paid time off. “I’m with the patient. Right now is not the best time.” If they know that there’s a consistent communication method and way an oral communication line, they can bring up those questions and concerns, and there is some structure to it. The consistency of communication also provides opportunities for the leaders to shine because you can see them either leading out in discussions when there’s a group discussion as an owner.

The worst feeling in the world is, “How are we going to improve our arrival rate this next week," and then get crickets. You want those leaders to step up and start talking during some of those conversations or if you probe them a little more, they have more depth, have a little more insight, and are also willing to take responsibility. When you have those communication opportunities, that is when some of your leaders are going to step up.

We’ve seen it time and time again. We’re bringing some people on no matter what the position PT, PTA, tech or a PCC sometimes. You are like, “That was a valued well comment.” That is something that I did not consider because sometimes, even as owners and people with big visions and strategic planning, we can get a tunnel vision of something around certain items. To hear perspective from other people that maybe have been new to our industry or not even a part of our industry and coming in, and saying like, “We’ve attacked with something similar to this. I’m not sure if it works.” It is like, “That is gold. I love that.” Seeing that pop up during those team meetings is important but regular consistency is key.

I have also witnessed, unfortunately, in certain times where you set a meeting structure but then the volume of the clinic goes up. All of a sudden, the meetings drop off of the schedule then it becomes something that is not necessarily conducive to building that culture and open line of communication. It is something that wasn’t valuable for somebody to put on our parking lot or wanted to bring up for discussion is now tabled for another week or something like that. It is defeating. You have to stick with them. Sometimes it is difficult because it does.

It could potentially take away from patient care hours, but I will tell you that time will make up for its weight in gold. You will have more streamlined communication. You are not having one-off conversations throughout the week. You have a specific, dedicated time for all team members to hear the same information in the same unit of time. It saves you a lot of work as an owner or as a leader.

PTO 156 | Leadership Development
When you pull them behind the curtain and share those visions and values, they get to be a part of them, and they feel like you want to hear from them.

This is also an opportunity if you are having those meetings for people who are getting training to take responsibility. You are having accountability meetings or maybe they're not necessarily disciplinary in nature, but you are having a monthly or quarterly one-on-one with your team members. If you have someone who's in training, they can sit in on those meetings as long as the other person is comfortable with it. Give them the opportunity to see what that looks like from a leader's perspective. Even though they've been part of that in the past, you can be a part of that planning and assessing after the fact with that person to help them train and communicate how that coaching session went or how that accountability meeting went. There are opportunities galore within that structure to have potential leaders step up and get trained.

I love that you brought that up. It is not always disciplinary. Some people think of accountability as a dirty word. It is like, “I’m going to be held accountable.” It is one of my favorite values and I love it when teams have it as one of their values in their company because I see it as an opportunity for improvement. I care about you enough. I love you enough that I’m not going to let you continue to make the same mistake. I’m going to coach you in a direction that will help you be a better service to the company, but it is also going to improve you personally. That is how I see the accountabilities.

We’ve done that in the past too. If I’m the company's primary owner and holder of all the accountability conversations, you bring your number two in with you and they watch you do it once. The second time, you are still in there and you are seeing them do it, so then you can give some coach points and say, “This is where you could have improved in that or you knocked that out of the park. You are ready to fly on your own.” You are then gradually working yourself out of that picture and maybe you are not in the next one. It depends on the leader and how they’re going, but it is a good rhythm of how to work yourself out of that responsibility.

I can imagine most young owners or newer owners are going to look at those meetings and be like, "How can those happen without me being there?" They still go. There's going to be some trepidation initially, but that is where you develop them. You get them to the point that they have gone through the processes we've talked about. They have worked on themselves, shared that with others, develop strong purpose and values, made the right hires, developed write-ups and hats that these people have followed, trained, done well, and producing well in their positions and responsibilities.

You have given them a little tidbit of responsibility, but that one thing, the one-on-one interaction where the door's closed and you are not present, as the owner, can be one spot where you'd be like, "I hope that goes well." There are opportunities there in training your team and your leaders to do that with you and do it a number of times if you have to so they get it right. You feel comfortable or spontaneously sit in on a few if you want to make sure things are still going well. They can happen without you if you are intentional about the training of the leadership team that is going to take over that responsibility.

Taking all those steps that we talked about makes those conversations a lot less sticky. They’re not emotionally based, value-based, and objectively based. There are so many things that, “This is not in alignment with our purpose, and this is not an alignment with our values.” These metrics are out of whack like, “What’s happening? Let’s take a look at your sub stats.” It makes the conversation far easier. Oftentimes, what I have found in our previous working career together is people are already coming in there knowing exactly what we’re going to have a conversation about. It makes it less like a confrontation or an issue for the owner or the leader to have to do because it is like, “I know my stats are down and XYZ has a reason. This is what I’m going to do to make sure that that is not the case next week.” It is like, “Great. I’m so glad I can count on you. Thanks for coming in prepared,” it makes it a lot easier.

The goal for most owners is to get to a point where they can trust other people to carry out their purpose, vision, growth and goals of the company, so all the burden is not on you. There is some shared lifting. There's so much joy when you can create an environment in which others align with you and work on getting together towards a cause. It is fulfilling in that regard.

It is legit magic.

One question for you. We had a number of consultants and coaches during our time working together and you got some individual coaching from them. I'm sure a lot of that was valuable. Would you say it is imperative to have a third party like that provide you some coaching that is not directly coming from owners?

I personally think so because it is somebody that can see from an outside perspective and maybe look at it from a different angle. They're not fully immersed in the company and all the things that are day-to-day operations. They can help you look at the bigger and wider degree, things and other considerations that can be brought to the table. I thought it is invaluable that people outside of our company were added to our mix.

Did you feel like you could say things to them or talk about things with them that you couldn't talk about with the owners, whatever that might be?

We’re winning together, but we’re also going through some of the mucks together. Click To Tweet

To a certain degree, yes. You felt like you could go a little bit deeper with our relationships and the owners. We created such a safe space that you did not necessarily hold back too much, but maybe there were certain areas that you are like, “This is an expectation and I do not necessarily agree with that. How do I handle that? How do I bring up the point?”

You can talk that out with a coach. It is like, “These are the expectations. I see where they’re coming from, but this is my angle and my view. How can I make that clear to them? How can I have that conversation in an appropriate and respectful manner but come to a position where we’re getting a conversation on the table of something that has currently been a program or a policy?” It is helpful to get that outside perspective of how to even address conversations with your owner or other leadership team members. Not every single day is a rainbow and sunshine. There’s tough stuff that gets done behind the wall.

So much of what I talked about on the show is about owners getting coaching, which is imperative. 99.9% of the people who are successful that I talked to have had some coaching and consulting in the past. After having this conversation, I recognize that I haven't stressed much about having the owners get coaches and consultants for their leadership. That is coming to light to me as we're talking. We provided coaching. Not only we got coaching for ourselves, but we also got coaching for our leadership teams, then thinking about the development of the leadership team that we had. You guys got a ton of value from coaches helping you out and not only straight from the owners.

As we even grew and developed, we had our middle management people involved in our strategic planning. We’re getting directors on our two days off sites together quarterly. We would have directors with us one day and they would go back to their clinics, then the executive team would stay for an additional day. We got insight from the people that are in the clinics doing the work. We had even more and I have gold. Now they are behind those decisions and it is not marching orders. They’re going into the clinic being like, “No, they heard us. They listened to us. They want to do this. We are a part of that. This is what we came to a decision about.” It was important and getting them exposure to those types of thought leaders and people and that way of thinking. Not only like, “I needed to see my new patients.” It was great.

How did it feel then as a leader for us to present to you as owners like, "You are going to get some individualized coaching from someone who coaches us?”

I was giddy. I was like, “Yes, please. Whatever I can do.” It was part of our culture too. We always looked at our primary customers. Every single person on the org board and the communication line had a primary customer. For me, that was our owners. Eventually, I became a partner and people were doing that for me, but my job was to offload my upline. If I had the coaching, I had the capability and I got to service my leaders in that way by having the coaching that you were giving me the opportunity to participate in. I was overjoyed to be able to be a part of that.

PTO 156 | Leadership Development
We have a desired impact that we want to create within our team members and also our community. And that has to be carried by the entire team. Not one person can do it, not one leader, not one rehab coach or tech or aid or PCC or PT.

It is something that I thought about as we were talking about this. It is something that I haven't pushed on the show before or shared a lot. Many owners have leadership teams that could do well to allow their leadership teams to get some one-on-one coaching as well.

It doesn't necessarily have to be at the same rhythm that the owners are doing, especially if we're empowering them to do some of it. I think it is valuable. It should be a part of the path to offloading yourself and getting your leadership some individualized training.

Anything else you want to share about leadership development? At this time, we covered a ton of ground. I want to give you the chance to share anything that you might have thought about during the discussion.

We covered a lot. It is a true passion of mine. I love to see the light bulb click on for leaders, helping go through that coaching process, and see people get to a position where they make decisions and feel confident about it. That is part of that coaching and training process as we go through as coaches and consultants. I’m here to be of service to people just as you are. I hope people found value out of this episode. It is an absolute joy to be on here with you. Thank you.

 If people want to reach out and get in touch with you, how would they do that?

You can reach me on my email. It is I'd be happy to have a conversation around your needs and wants and see where we can meet that.

That would be awesome. Thank you so much for taking the time, Michelle. I appreciate it.

Likewise, it's always a joy.

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About Michelle Bambenek

Michelle Bambenek, PT, DPT has spent years as a successful leader and developer of leaders within the physical therapy space. In this episode she breaks down the critical components of leadership development - granting team members opportunities to grow and live out their purposes. This aspect of ownership is essential for the expansion of the business. The owner can't do it all and must rely on others to follow successful patterns in order to grow. If you're looking to expand your PT practice consider these 5 steps first.


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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.

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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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An organization needs to adhere to its values in order for growth to thrive. Stephen Rapposelli's turning point in his clinic came when decided to implement some structure and identify what his company stood for and how they got things done. As you'll hear in his story, once he and his team decided to clarify their core values and begin working, hiring, firing, evaluating, and championing their values, the productivity, culture, and profits significantly increased. It's never too soon to introduce, implement, and live by the values you crystallize with your team. What this does for you is it gives you and your team an automatic decision matrix by which they can make their own judgment calls without you and be right 90% of the time. In this episode, Stephen details exactly how to decide on your company values, how to utilize them going forward, and how to hold your company accountable to them. Discover these great, fundamental wisdom for business owners to obtain your goals in business.


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Business Fundamentals: Identifying And Living Your Core Values with Stephen Rapposelli, PT

I've got physical therapist Stephen Rapposelli out of Delaware. Stephen owns a number of PT clinics. He is also the Vice President of the Delaware Physical Therapists Association. I came across Stephen because he wrote an article in July 2019’s Impact Magazine about team building via identifying core values. I've talked a number of times about values here and there in the show, in parts of discussions but never had an episode dedicated specifically to that and more specifically how to create and maintain/work-by values that we have in our company. Stephen was awesome in his article in that he broke down exactly what he did to create values for his company.

He and I might agree that it’s probably many years too late. He and I would agree that we should have identified values in our companies much earlier than we did and start hiring, firing, promoting and developing a culture around those values. The transformation that can take place after implementing them and living by your values is transformational and empowering to the employees. You get people who are aligned with you and your purpose. You also weed out those people who aren't aligned. There's nothing wrong with that. That's okay if they don't align. Let's just make sure they are not on our bus and they move on. To be able to select like that can be powerful and puts you in a powerful position, nonetheless, we talk about some of the details of what he did to create the values.

I'll share a little bit about what I did to create values for our company and also how we maintain those values going forward so that it wasn't just a one-time talking piece or once in a while we throw value out or painted on our walls but never discuss it. How do we live and breathe the values is something that was cool that we got into during the course of the interview. Let's get to the interview and talk to Stephen about values and the importance of them.


I've got Stephen Rapposelli, CEO of Performance PT and Fitness out of Delaware. He’s also the VP of the Delaware Physical Therapy Association. I’ve read his article in Impact Magazine regarding values as it pertains to our physical therapy clinics. I thought this was invaluable. I needed to have him on to share his story and also talk a little bit about values and the importance of them in our clinics. Stephen, thanks for joining me. I appreciate it.

It's a pleasure to be on your show. I've listened to your podcast already and I love what you're doing so far.

Thank you. I appreciate that. If you don't mind sharing with the audience a little bit about yourself, your professional experience, what got you to where you are at this point? I'm sure along the way, we're going to hit heavy into values and the importance of them.

Back in the Middle Ages, I was working for a private practice in Delaware. I was 25 years old at the time and I was working hard and I said, “I'm ambitious and I'd like to maybe one day buy into your practice.” He looked at me and he said, “That's not going to happen. The owners are not going to sell to you and you can't afford it anyway.” That's one of those times where you realized that your life is going to go in a different direction. A few months later, I had my own business. It didn't take long. At that point, I remember talking to the guy who's building an office and I said, “I want you to build me the smallest possible office because I am out of business and bankrupt.” The guy knew what he was doing. He chuckled and he knew that I didn't know anything about anything. He was kind enough to build me a little 1,100 square foot office. That's how I started at the age of 26. My first employee was my mother. She was my receptionist and biller. She brought me lunch and she provided motivational speeches when needed. That's how we got started.

That's awesome because one of my first employees was my mom as well.

You can't mess with a mother because nobody is going to rip off their babies. She was an advocate for me in the beginning and a good person to have and also all mothers.

They got your back and they want to see you succeed. She would go around and talk to my patients. She would walk around motherly like, “How are you doing?” She brought a great atmosphere to the environment.

I'm surprised in the beginning she didn't run over people to get patients because mothers will do that.

How long ago was this?

PTO 60 | Living Your Core Values
Living Your Core Values: Success comes down to you as a professional and how you treat people.

That was a long time and you’re going strong. That's amazing.

One of the takeaways that I tell people is every phase in the physical therapy industry, there are storm clouds on the horizon whether it's DRGs or this is going to happen or this is going to spell the end. You survive it. If you treat everybody special, there will always be a place for you. Whether you go cash-based or not, whether you do this model or not, whether you do that or not, it doesn't matter. It comes down to as a profession, how we treat people. That was one of the main takeaways for being in the business for almost many years.

You started with a 1,100 square-foot clinic. Where are you at now? Do you still have one clinic or do you have multiple clinics? What are you doing now?

We have three offices. We’ll probably be going to have a fourth. Part of the reason we grew, because most PTs who start out you can have one office and have a great job for the rest of your life. We added offices primarily because we had great staff members who said, “I want to be a clinic manager one day.” For years I'm like, “I'm the clinic manager so that's all you can go.” To provide an upside of a career ladder and an opportunity for growth is one of the reasons why we added offices.

You definitely had the opportunity maybe more so in the staff that you employed. The Jim Collins principle in Good to Great, “First who then what.” You had someone who was aligned with your values and provide an opportunity.

If you can surround yourself with people that are better than you, you're going to be successful. Click to Tweet

I was lucky enough to hire as a partner a guy who went to high school. We're like an old married couple. We know what each other is thinking without having to say it. Every now and then you can hook up with somebody truly special and this guy certainly is. He's better than me. If you can surround yourself with people that are better than you, you're going to be successful. I was lucky enough to be able to do that almost every step of the way.

What's his name, your partner?

John Bradley, the best guy I've ever met. He's almost Christ-like. I'm surprised three sheep aren't following him because he can have a following.

What would you tell your younger owner self many years ago? What would you tell him about now with the experience that you have?

I wish I had a mentor. I didn't have a mentor and I didn't go out to find them. I remember I lived in a community that has these giant corporate businesses. In Delaware, there's DuPont, whichever is a household name. I remember a guy who was a consultant for them and who was a patient of mine. He said, “Tell me about your business.” I said, “I've got this one office and I'm happy the way I am. I don't want to get bigger. I'm going to stay the way I am for the next many years.” He goes, “That's not going to happen.” I'm like, “No, it will be fine. I will stay the way I am.” That is God's honest truth. In any business, you're either going to get bigger or smaller whether you wanted to or not. Hooking up with a good mentor that can help you grow professionally and personally is the number-one success tactic that a younger PT should and must do. They are out there.

How do you recommend they go about doing that? I've heard the same thing and I've heard Tim Ferriss recommend it and how he recommended going about doing it. How did you go about it? How do you recommend people go about finding a mentor?

PTO 60 | Living Your Core Values
Living Your Core Values: You need to have your mind expanded. You need a coach and a mentor.

I didn't have a mentor. I didn't have anybody to bounce any ideas off of. I stunted my own growth significantly because I was happy doing what I was doing. I didn't force myself because I was truly ignorant to look ahead and beyond myself. Mentors come in many different forms. I do think if you're talking specifically for physical therapists, you need a physical therapist mentor and you need a business coach mentor. Those can be two different things because I now surround myself with coaches and mentors. It's okay to have more than one and you should have more than one because if you're a physical therapist, you quickly realize that there are people out there who don't think like you. That's a good thing. As physical therapists, we think in a certain way and sometimes that's not good.

It can definitely be to our detriment.

Have you ever met someone who's in business that's not yours and you speak to them in a mastermind group and you're like, “I did not even think like that, I didn't even know that type of thought process existed?” As you're doing that and coming to that realization, you're expanding your skills and your abilities and that's what it comes down to.

Sometimes I'd be in a mastermind group and I recommend the same thing, a mentor, a coach, a mastermind group. That's why my mantra is, “Step out, reach out and network.” Reach out means reach out to someone else, whether that's a coach or consultant or mentor in this case. Networking definitely needs to be part of a mastermind group of some others so you can have a different perspective. I would sit in mastermind groups and tell them the issues that I'm having with physical therapy. As I'm describing the issues and recognizing they're coming from a different perspective, I’m thinking, “This is a stupid mindset.” It is a mindset or it's a story that I was telling myself and was so ingrained that I believe it. I could tell from their faces and the way they were looking at me like, “Why do you do that way? Why are you thinking like that? There's no reason you have to do it like that.” It's something that becomes ingrained.

Those are limiting beliefs that you don't even realize. You talked to a guy who's a dry cleaner or does home repairs. He's like, “This is how we acquire customers A, B, C and D.” You're like, “We could never do it that way.” Maybe you should do it that way. Maybe it's okay to do it that way. You need to have your mind expanded. You probably need a coach and a mentor and it's okay to have one for one specific thing. Maybe I don't know anything about Facebook ads. Go with a coach who does Facebook ads and teaches you all you need to know about that or business processes that are different or contracts that's different. It's okay to cut and paste and get different coaches and mentors so that single piece of advice would push people forward much more than you can do yourself. I found mentors in books and I'm a firm believer that reading books is probably the gold standard for all of us. Any question that you want to have answers is in a book. Someone wrote a book for it, whether it's how to think better, how to invest better, how to open up a business, how to close a business. Anything you want to do, someone's written a book on it.

I'm huge into books. The one thing that I would say about books, they have a ton of knowledge. There are people out there though that will gain knowledge without converting that to action. That's where the benefit of a mentor and a coach comes from. Now you're personally accountable if the mentor or coach is doing their job. You need someone to hold your hand.

If you treat everybody special, there will always be a place for you. Click To Tweet

Books provide us with ideas and then you have to execute. One of the tips that I give people is I have the Amazon app on my phone. Whenever I'm out networking with people, I will ask them the same question, “Tell me a book that you absolutely love.” Whenever they tell me, I open up that app and I buy it right there without question. You slowly add that to your own personal library, which your personal library should only be filled with books that you have already read. I threw out my entire Encyclopedia Britannica that I had never read. I decided to throw them all out and go with books that I've read. You can buy those books used.

It's $10 to $20.

If you get one idea out of that book, wasn't the $10 worth it?

To go back to where we’re focusing on in values, is that something that you got out of a book? You had your clinic for many years. Where along the process did you decide, “I need to install some values in my clinic and the way we do things?”

A few years ago, my partner and I were like, “We're busy. We're seeing all these patients but we're not making money. What's wrong with this?” That was the same time that my then office manager said to me, “I looked at the Department of Labor statistics and you're underpaying me by about $15,000 a year.” I said, “We're doing the best we can, but my income went down by 50%.” She looked at me with a straight face and said, “That's not my problem.” That's the other day that changes your life. I went, “I am no longer going to live this way.” I hired a consultant who came out. I paid him a lot of money and besides him saying, “You have to fire your office manager,” which I did, he started making me look at processes.

I realized all the things that I was doing wrong as a business owner or things that I wasn't doing. When you're a physical therapist, you figure, “I'm great at physical therapy. If I treat people, everything's going to be a success afterward.” That's not necessarily the case. I picked up a book called Traction by Gino Wickman, which I recommend everybody to buy. It talked about establishing values. I'm like, “Let's skip that part. Let's go into the tactics. What can I do to make more money than I did last year?” I force myself to go through the boring hard work of creating the foundation for my business, which starts with values. It sounds boring and stupid. Why do I have to identify what my values are? I know my values. My values are great. My values are my values. “Tell me what they are.” “Do good work, that's not it.”

PTO 60 | Living Your Core Values
Traction: Get A Grip On Your Business

We decided to get the staff together and have a staff meeting. I put a whiteboard up at the front of the office and I said, “In your mind, think of the best employee that you've ever seen here. You don't have to tell me who it is. I don't care if that's not me. Think of who is the best person that is the heart of this business. When you got that person in your mind, I want you to tell me some words that you describe that person.” For the first three minutes, everybody just sat there. In my mind I'm going, “I don't care how long it takes. I don't care how uncomfortable the silence is. Someone is going to say something.” You give people the eye-roll, you give people a look and sooner or later somebody says, “She was friendly.” “What else?” “She was good with patients.” “What does that mean she was good with patients?” “She treated them like family.” “What does that mean?” “When people come in, she was always honest.” “Tell me more.” We came up with sixteen words. I said, “We have sixteen words, now we're going to come up with four.” We start eliminating words. What is truly the non-negotiable must-have quality of that person that says they are the Performance Physical Therapy or they are our brand? We came up with six values: honesty, integrity, respect, treat people like family, treat people with enthusiasm and teamwork.

Now we have these six words. What are we supposed to do with that? As it turns out, you do everything with those words. Everything you do comes from those words. It means that I can't be everywhere. I can't be in all three offices. I can't be there from 6:30 in the morning to 8:00 at night. Somebody is going to be there without me and they're going to have to make a decision. How do they know if they're doing the right thing? Whatever decision is in front of them, if they say, “Am I being honest? Am I respectful? Am I treating somebody with integrity? Am I treating somebody like family? Am I treating them enthusiastically?” Whatever decision is in front of that employee, if they run it through that filter and it comes up yes, 99 times out of 100, they're doing the right thing. The opposite is also true. If they're about to make a decision and it's against one of those values, they're probably not doing the right thing.

When you have to hire somebody, you hire them through those values. When you fire somebody because there's somebody, “I’ve got to let Jane go. I’ve got to fire Jane. Jane does not fit in here.” You can't just say that. You have to be able to come up with some reason why. When they don't embody one of those values that helps you as a manager to say, “This time you did this and it wasn't honest. This time you did this, it was disrespectful. This time you didn't work as a team and here are the examples.” It allows you to make all these decisions for the betterment of your company and make sure that you're course-correcting. It's almost infallible.

It's fundamental and it gives you so much power to be able to fire somebody according to the values, to hold people accountable according to the values, to do performance evaluations according to the values. Probably the most important is to be able to hire according to the values. As you're sitting there, sometimes we would do group interviews and we would talk about our values. We'd ask them what they thought about those words and you watch the body language. The people who weren't comfortable in that space talking about values, those were the people that we weren't too excited about hiring in the first place. As we would evaluate people, we'd evaluate them according to the values and how well they were representing those values.

Have you ever made a mistake hiring somebody, Nathan?

Yes, of course.

Your customers and your patients should know what you stand for, and that guides all your actions after that. Click To Tweet

In retrospect, you try to evaluate that and say, “How did this person fool me? How did they get through? How did they get here with me not knowing it?” People can fool you in the hiring process. That's probably one of the single most important things that a business can do is hire the right people. Those values allow you a clear, common, easily reproducible set of metrics to evaluate a potential employee. You and your staff are called to develop an assessment tool to evaluate that. How do you assess whether someone's honest? How do you assess if somebody has integrity? How do you assess if someone's a team player? How can you assess that objectively? One way we assess if someone's a team player is if they've played on a team. In your entrance exam for your business, do you play sports? What sports have you played? Do you volunteer? Those are simple questions that can help filter out the people that that need to sit for the face-to-face interview and those who should self-delete out of the mix.

We should have done it so much earlier in our careers, especially as owners. It would have made things so much easier. Sometimes you think you're so small that you're like, “What does it matter?” You've got to take the long view there, get a little bit bigger perspective. As you're developing your foundation, it would make things so much easier if you hired according to your values, even if it was yourself. Maybe it's you and your mom back in the day.

The exercise that my business partner and I did was very similar to yours. We didn't bring in our whole company and reading your experience, maybe we should have but anyway, that's here or there. We did the same thing. We said, “What characteristics do we highly value in people that we revere and respect? What are some of those characteristics that we expect out of ourselves or out of our company?” We made a list of twenty. Some of them were very similar and so they eliminated each other. Maybe you could use a different word to describe them better and started narrowing them down. It’s the same thing. It’s a cool process. We enjoyed it.

We came up with Professionalism, Accountability, Growth and Empathy. That was an easy acronym to remember, PAGE was our acronym. Eventually as we rebranded along the way, we came up with some cultural values as well. We wanted our company to be known for family, fun and freedom, the three F's. A lot of the things that we did around developing the culture revolved around those three things about family, fun and freedom. We took this but didn't ingrain it into our company until we started using them more. We talked about using the values to hire, fire and evaluate employees. Do you bring up values at other times during the weeks or months in between all those activities? Tell me about those.

You think that's gimmicky, the three F’s. The value of that is you are setting very clearly and simply the expectation in your company. You should promote that to customers as well. Your customers, your patients should know what you stand for and that guides all our actions after that.

What are some of the things that you're doing to incorporate values into the discussions between those events?

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We have weekly and quarterly leadership meetings as well as staff meetings. We identify what those values are. We take one of those values and talk about it and we give examples. That's huge. What you do is you reinforce it every single time. One of my morning rituals as a CEO is I go onto Google and I look for Google reviews. When someone writes a Google review, that instantly gets copied and pasted and goes company-wide. The subject line is, “A great way to start my Monday or guess who got a five-star review? See who got a shout out.” That reinforces those values as well. It comes up time and time again. The more you talk about those values, the more it becomes part of your company's cultural dialogue and vocabulary almost to the point where it's like an inside joke to people, where you can look at another staff member and go, “You people like family.” They get that and they dig it. It only happens with repetition like anything else. That's true personally as well because you can't talk about professional development unless you talk about personal development. That's part of that personal ritual that we all go through. Atomic Habits is a great book by James Clear about how to develop these personal and professional habits on a day-to-day basis to get more out of your day productivity-wise.

We got a lot of traction out of the values when we started talking about them weekly in our team meetings at each clinic. We would highlight one maybe and then ask if someone had exemplified that during the course of the week or recently. We brought that up significantly in our quarterly events. We would shut down the clinics one Friday afternoon a quarter. We would have a subject that we wanted to talk about that pertains to everybody. What everyone loved the most was when it’s almost like a religious meeting where people were standing up and we'd ask them to share who exemplified what value sometime during the course. People were emotional and they were in tears. They were excited and proud of their coworkers. They were excited to be part of such a team.

We call those shout-outs. We carve out time in that staff meeting. A staff member stands up and gives a shout-out to somebody else, “I noticed that Anthony went outside last week in the rain and picked up our flags so they didn't get ruined. His pants got all wet. Thanks, Anthony. That's great.” You’d think that's dumb. That is some of the best use of the time you can do because it tells the employees what you value and that they're being recognized by not just me but by each other. That's a big deal. Going back to values, when you go to our website and you go to the staff page, we have each physical therapist do a video on one of our values. We've got an extraordinary amount of feedback, not only from patients but also from potential employees who said, “I saw those videos and that resonated with me, that spoke to me. I appreciate that,” or from a patient that said, “All physical therapy places are not the same. You feel like family to me because I watched you.” That's a tip for your audience. If you do that one thing, that will 10X your results.

How engaging that is to have video posted on each value. You've ingrained it into your company. What has changed in your company since you had cemented values a few years ago?

That next year after starting that process, our profits went up 96% in one year. It's that difference. It’s that much of a change because what you find is that the people who do not belong on your bus, get the idea fast that, “This is probably not the place for me.” It also makes those conversations easier if it gets down to it. If they don't get it, if they don't want it, if they don't have the capacity for it, they realize it and they take themselves out. They find it uncomfortable to be around that environment where they're not congruent and they take themselves out and they leave.

I would imagine a year later the ease at which you obtained that 96% profit growth was significantly greater. It was so much easier and the environment and culture changed.

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What happens is then you're like a forced coupler. Everybody knows what they're supposed to be doing when they're supposed to be doing it. As the owner, you wind up having to talk less. You now can concentrate on shoring up your processes, being more efficient, being more effective and documenting things, which none of us does.

We all need to get down to the dirty work and do that because it's an ongoing process. What the values did for you is exactly what you're talking about. It gave you some freedom and independence. It allowed the employees to take on more responsibility, to be sovereign and give you the freedom to then work on those things. It allowed you to be the leader of your own ship, to be up at the helm looking forward instead of looking backward.

My late father who was a very smart man but I didn't realize it at the time. One of the things he said to me is, “Your biggest job as an executive is to think.” I'm like, “Dad, that's stupid. I don't have time to think. I’ve got to do all this stuff. I’ve got patients to see, I’ve got to write checks, I’ve got to meet doctors.” My dad was right, the most valuable thing that we can all do as executives is think. You take uninterrupted time to think, give me two hours to think and I will come up with something good. What most of us do is you're running and gunning, you're hacking and chocking, you're bobbing and weaving. You don't have time to do anything and you wind up doing crisis management all day versus being the smith of your own fortune, planning ahead and then executing on it. That's the difference between having a job and growing your business.

It makes all the difference when you can have a bedrock of shared purpose and values and with those people come in alignment as to how things get done, then it's an unstoppable force. The weeding-out process can be painful but in the end, it’s so amazingly better once you go through all that. Things become easier.

Identifying those values does it for you. You should always stress testing, meaning that in January when we have our two-day leadership retreat, you say, “Is this what we value? Let's take each one of those. Are we about being honest with ourselves, our employees, our physicians and our patients? Do we want to be honest? Is that a value?” We stress test it. We argue about it and we'd go back and forth. If it needs to change, then we change it. If it stays the same, then we're on board.

What a great exercise for you. I'd be surprised if your values change all that often, but what I'd imagine happens is how are we not being honest and what do we need to do to correct it? Is it picking one value?

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Yes, that's exactly right. You have to have the fortitude to be able to test your beliefs. One of the other powerful things that we do and it's emotionally exhausting to do this, but we go around the room with each leader and say, “What do I need to do more of and what do I need to do less of?” That is one heck of an exercise. Even if you only have two people in your leadership, even if it's just you and your mom, “Mom, what should I be doing more of? What should I be doing less of?” You have to be able to trust each other. My leadership team, I'm sure they were sweating bullets but they let me have it when they went around the room. One of the things they said was, “You've got to be less distracted. You're being pulled in all different directions. You're going after the next shiny thing. You're checking your phone. You've got to be less distracted.” That was embarrassing to hear that. I was the CEO. I was supposed to be the knower of everything, the perfect one. They're telling me what I needed to hear, not what I wanted to hear. It changed my behavior. That is the mark of a real awake executive to be able to have that feedback and then to try to implement it.

In that setting, you're becoming vulnerable. Initially, when you described the exercise, I thought like, “I'm coming up with it myself. This is what I need to do better at,” but they're telling you. You can get in an uncomfortable position. You set yourself up for a lot of vulnerability and emotion to come up but what does that do for your team? I can't imagine the trust and the cohesiveness that comes after a hard exercise like that.

That’s the prerequisite for that exercise is to be able to establish that there's trust and then there’s safety in this group. It doesn't matter that there's are fifteen or there are five or there are three. You carved time out of your day off to get together and better yourselves personally in the profession. Once you set that stage, then you can be vulnerable and say, “What is the number one thing I can do to help myself this year coming up? What do I need to do more of? What do I need to do less of?” It’s those two simple questions. It's almost not as valuable if you do it to yourself in your own head because I can fool myself easily. I can tell myself anything I want to hear but getting that feedback and as a CEO or as an executive, you don't get that very often. They’re not going to tell you.

I love what you're doing with values. You've got to be proud of the company that you’ve built after going through the structuring process, the hard times and also this focus that you've put on the last few years.

It's never over.

It’s much more enjoyable.

You think, “What else can we do? What else can we tear apart and rebuild and make it better?” It's also very easy to look back and be like, “Was I a dope?” You're right. You were a dope. Everybody's a dope. My only competition is the man that I was yesterday. Don't worry, that person's not even here anymore, just keep moving forward. How’s that for advice?

This is a great conversation. We've covered a ton and we nailed some of the important topics that I think of when it comes to values. Is there anything else you want to share?

Try to always better what you're doing no matter what. Nobody has the answers. I know that I don't and I'm always looking for the next teacher. Everybody has something to teach you. Be open, be willing, do it without ego, do it with humility. You're a better person for it because time is short. None of us has as much time as we think we do.

That’s great advice. I'm shaking my head because I agree with everything that you went through and felt like we've gone down a similar path.

You should also probably tell your audience more of your story because you have an incredible story to aspire to, from having a practice in Arizona, selling it and moving to Alaska. That's pretty bold and it's very impressive that you do that.

It's hard for me to self-promote. It's difficult to do that. I know I need to get that story out there, that's for sure. I'm sure I will here in the coming months.

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I told you that I think somebody should interview you for your own podcast.

I will have to do that. I did it with my business partner, Will Humphreys, a few episodes ago. It didn't get into our story. I'm glad you said that because I think I'm going to try to get Will on again and talk about our story a little bit and how we got to where we’re at. It's an intriguing story and worthy of note.

Some of those lessons, you've got some gold in there. You’ve got some nuggets that are valuable to people that they can benefit because as a PT owner, especially if you're a one-man show or one-office show, you think you're the only person. You think you're out on an island somewhere. For years and years, I’ve felt that way. I didn't realize that there’s a whole community out there of people that you can connect with and resonate with and say, “When this happens, then I feel like this. Do you ever feel that way?” They're like, “Yeah,” and then we all get better for it. That collaboration with peers is vital. The private practice section is doing a great job. They have the peer-to-peer network that they promote that I'm part of that is very valuable. I benefit from it and about every practice owner can benefit from it as well. There are resources out there, you just have to reach out and ask for it.

That's why my mantra is, “Step out, reach out and network,” because it's out there. As independent business owners, we can get stuck in our little bubble, our 1,100 square-foot space or 2,500 square-foot space and think that's our world. Our thoughts become realities and we get self-limiting beliefs. It's important that we got to step out of that. We’ve got to stop treating full-time. You've got to reach out to get a coach and mentor as we discussed and you've got to network. That's where growth occurs. There are resources out there to help you.

Another common problem is you go to these networking events or you go to a conference and you think, “Everybody is more successful than me. Everybody knows more than me. Everybody has gone down to that path and I don't. I'm just a mess.” That's probably not the case. Everybody has wisdom inside them. It's a matter of having the opportunity to share ideas. You have an incredible amount of knowledge that you should be spreading to other practice owners and I look forward to hearing more of your show because that's very good.

Thank you. I appreciate the comments. Thanks for coming on. Thanks for taking the time. I appreciate you sharing your experience, Stephen. It's a great resource and I hope more and more PT owners take this specific lesson to heart. It's invaluable and I appreciate it.

Rock on with your mission because you're doing great work and it's a pleasure to be here. You've got nothing to sell but everything to give.

I appreciate it, Stephen.

Thank you.

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