PTO 167 Avi Zinn | Leadership Development

We have been following the journey of Avi Zinn, PT, DPT of Druid Hills PT in Atlanta, GA, for two years, tracking his growth as a newer clinic owner. At this stage, Avi is out of treatment completely and continues to grow his business. Since the last time Avi has been on the show, he's made some changes for the better – hiring another front desk person, implementing weekly team meetings, and planning for a leadership team. In this episode, Avi discusses with Nathan Shields how he's handled these issues and gives us a peek at what he's looking forward to in 2022.

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Reality Episode #6 With Avi Zinn, PT, DPT: Moving Up In Ownership - Meetings, Leadership Development, Marketing Strategies

In this episode, we have returning guest, Avi Zinn. We’re doing Reality Episode #6. Over the past few years, we followed Avi’s progress as a relatively new PT owner and we're on the sixth episode following along in his progress as an owner. Avi, thanks for joining me again.

Thanks. I'm so glad to be back. It has been months since we've done this. I've been waiting to get back in touch with you.

It's good to have you on again. I can't believe it has been that long. It doesn't seem like it was months ago but we've tracked you over time since November 2019. We're almost into 2022 now so we tracked you over two years of your growth. If you haven't read the previous episodes with Avi, you can see what we've been talking about and his growth as an owner starting back in 2019. At the time, how long had you been an owner?

I started in 2017 so that was about two years in when we started talking.

Can you share what kind of growth has your company seen since 2019? Where were you in 2019 to where you are now maybe in terms of weekly visits? Maybe that's a good metric.

We can start with that. 2020 was COVID or at least we're still dealing with that stuff. It’s hard to look at numbers. I would imagine that’s for everyone but for us because we were so new and young, looking at the numbers before 2020, it was sometimes hard to track progress but visits-wise before COVID, around when we started, we were probably on average about 150 more a month than when we were in 2019.

In the last episode, we talked quite a bit about you changing to a new EMR prompt. You had taken on a billing company, In The Black, doing collections with Will Humphreys and you had changed out a front office person. Now, bring us up to speed on maybe what's worked for you over the few months and maybe even more interesting, if you have that experience, what hasn't worked for you over the past couple of months?

The last time we were talking, I was in the process of hiring a new PT. I hired him and he got started in June 2021. We were already pretty integrated with Prompt and the billing company. Both of those, I started around the same time. Prompt was new and the billing company had never used Prompt. We were in the middle of trying to have this three-way communication between all three parties and trying to get our processes and everything down. We've come a long way.

We have some really good communication between all three between our front desk, the billing company and Prompt. We've got that down pretty well. There are still some things that happen here and there but mainly positive things only because Prompt does upgrade and update their software. Every now and then, they do an update and it refines and improves some of the billing stuff so we have to come up with new ways of using that new system. That has been pretty good and has been a great upgrade to the company.

We brought on a new front desk and that was a result of our previous one going off to school. She was able to come on before the other one left so she got some good training with the previous front desk before she left. That was great. She was onboarded pretty smoothly. Since then, we have hired another support front desk to help out. We were getting a little busier and we needed help with some backend stuff like authorizations and following up with patients so we've created a whole back office position for this. Not even back office but support helping out with the front desk.

She's also doing some patient experience stuff where she's following up with certain things with the patients and sending out surveys. We've been sending out postcards after the first visit to welcome them and giving them handwritten, “Welcome to Druid Hills. We can't wait to be a part of your team or be a part of your recovery.” That seems to be going pretty well.

What made you decide that you needed some extra help at the front desk? I think that could be an easy metric to follow for a physical therapist to say, “I know how many appointment slots we have and we're filling up 85, 90 or 95% of those appointments slots. I don't have room to get these patients in at the frequency I want them to. There are no extra spots so we need to hire another PT.” That’s not so obvious sometimes for the front desk. Was there a metric that you followed or what was it that made you decide you need to bring on someone else and I'm assuming you brought this person on part-time or full-time?

It was part-time. There wasn't an exact metric because the front desk was just busy. It wasn't exactly following the metric but she wasn't able to do all the things that she was supposed to do efficiently in calling and following up with authorizations and the lost patients and calling patients to make sure everything is in order for their first visit. Those all do fall into some metrics, like the lost patients. We can get a sense of who's following up with their plans of care or not. We realized that she couldn't do it all so we brought her on to do those other things, which are to make all the callbacks for all the lost patients and to make sure they're scheduled for the next week and to help out with authorizations.

We've developed a whole bunch of other things in that same arena of calling. We made that her responsibility. She does all the calls. She'll call doctors to make sure we get the plan of care signed and to make sure we have all their contact information and the right fax numbers to send to. She's already calling everyone so we threw that into her. That is her responsibility.

It's those kinds of tasks that you don't want the front desk doing and thus, missing an opportunity to reschedule a patient or get them in the frequency that they want to get in because they're on the phone with an insurance company or a doctor's office and not collecting a copay because they're busy or not giving that new patient the proper welcome and explanation of what to expect. You don't want them to miss out on that so I think it's great that you recognized that there was a bottleneck there at the front desk.

You want that to be the best experience possible for the patient because that's the first experience that they have come into your clinic. We recognized it was somewhere around the 125 visits per week that maybe you could stretch them out to 150 before you had to get that second person. I don't know if those were the numbers that you were seeing at that time but when they're getting to that 125 mark, they start to be getting stretched thin, especially if they're doing any insurance verifications and authorizations.

I would say not looking at the numbers in front of me that it probably was about almost like what you are saying. It was once we got around to 125 a week. Knowing our average monthly now, that is probably what it was but that is exactly why we brought someone on. We had that bottleneck and she was missing check copays or missing scheduling someone because she was on the phone and they would walk out of the office because they didn't want to bother her. I think that made a huge difference and then also adding in some of the other patient experience things have upgraded the patient experience.

Meetings are important in any business or organization. Click To Tweet

I think that might be hesitation as to why owners might not bring on that other front desk person is because they're simply looking at the authorizations task and say, “If I just give her authorizations, that's not worthy of a part-time job. That doesn't get her twenty hours a week,” but think greater like you're doing, what more can be added to your business by bringing on this extra person to improve the patient and front desk experience?

What can you do to make them more efficient? What can you do to improve patient arrival rates, decrease cancellations and make sure that no unauthorized visits are seen? There are a lot of things that you can do to add to their plate to fill out part-time and pretty soon probably a full-time position for the support of that front desk.

It happened backwards. The biggest obstacle we were having was the authorizations and when she came on, I think it was right around the Delta spike of COVID so things slowed down quite a bit. There was this month period where we didn't have to have all this extra work for the authorizations, which is when I started focusing on all this patient experience stuff and we figured out other ways to increase that experience and send out the surveys and postcards and then once we started building back up again, it was cool because she already had all that stuff that she had systems for.

She was able to go back to doing all the other front desk authorizations. It was cool how it worked out because I didn’t know that I would've thought to do all that stuff. It was more of a result where I brought her on and then all of a sudden, we have a little extra time and I was thinking, “Now I have this time and I brought her on, what can I use this time for?” That's when I started all this patient experience stuff.

In that regard, it was a blessing.

It was cool. It allowed me to do it. Otherwise, it would have been hard to make that jump. People might have a hard time justifying bringing someone on because they might not think of things that they're going to be able to do and just for authorizations is not worth bringing someone on.

You're not in the office five days a week. You're running the business remotely from what I recall, right?

Yeah. I go in more than I did during 2020 but I'm not there all the time. I’ll do stuff from home. I live close to the office so I'll go back and forth.

What keeps you busy most of these days?

The big thing that we were talking about from what I recall from the last time we spoke is you had asked me if I was developing any leaders. I believe we were talking about that. What keeps me busy is trying to grow the company, strategize and have a vision of where we're taking this and trying to implement it.

To answer that question with also the question you asked before about of what hasn't been going well sometimes efficiencies and communications were not happening the way I thought they should be. One of the things I was working on was establishing a meeting rhythm where we would start implementing our weekly meetings and we hadn't done that.

I don't know if we were doing it yet the last time we had spoken but I have implemented that. Whether or not that was me working on it at home or there, it was about coming up with how we're going to do it and when we were going to implement it. Since then, we've started these weekly meetings which have helped our communication.

It’s creating a team culture where everyone's voice is heard and gives us a space that we can all come together as a team. I think that that's what has allowed the team to realize that their voice is important and so then, they're maybe taking a little bit more of an active role in following up with these communications.

When you're talking about meeting rhythms is the weekly all-staff meeting the meeting rhythm that you're talking about or did you also implement others?

That's the main one. Trying to connect it to the leadership, I've been at the same time trying to find a Clinic Director. The meeting rhythms that we have now is a weekly meeting with the team but what I want ultimately to be able to happen is where the clinic director could probably lead these meetings and then I would have some type of rhythm also where I meet with the director or maybe some of the other PTs so there’s a whole system of meetings.

Let's go back even a little bit. Was there some hesitancy in pulling the team together for 1 hour or 1.5 hours or however long you have? Was there some hesitancy initially to do that on your part?

PTO 167 Avi Zinn | Leadership Development
Leadership and Self-Deception: Getting Out of the Box

Looking back at it, I started looking at the numbers and I was like, “That's four hours with the four PTs every week. Add that up times 52, that's 200 hours that we're sacrificing to not get patients,” and then I realized that first of all, we're not at 100% capacity anyways. Even if we stick the meetings on, there's still going to be those slots somewhere else. That was an easy way for me to realize that we're not using the entire schedule anyways.

That was the first hesitancy and then it was trying to figure out when to do it and does it make sense or how does that mess with the schedule? That was the hesitation but once it started, I realized that this has to be done. I maybe should even be having more meetings. It's so important and so powerful to have this communication with everyone that you can't not have it. At this point, I can't imagine not having these meetings.

I love that you're sharing this because I've had coaching clients that express the same thing that they didn't have weekly meetings or maybe they adjusted them a little bit based on my recommendations. Now as they're having them, they can't imagine not having them. They also are saying things like, “We're getting more done now in the past few months of having weekly meetings than we've done in ten years because we're actually having communication and talking about where the issues are and where things are getting stuck and how to improve workflow. Things that we've been complaining about for years, we're finally addressing those items in our weekly meetings and we're making significant progress. It's great. I can't imagine not having these meetings.” It's cool to hear that you're having that same experience.

Some of them are exactly that. We had a meeting about the plan of care, who faxes them, who's following up with them. That's ultimately where we had the support front, desk person. She became in charge of following up with the unsigned docents but it was because we all came together in the meeting and said, “We have this issue. Some of the plans of care are getting lost, not getting signed and not getting followed up. Sometimes the front desk doesn't know that the plan of care is ready to be faxed out.”

I asked everyone what made the most sense and we came up with the plan. The solution was that the PTs fax it and then we have this other person who then follows up with them from then on. It was a simple and easy process that could have been done but because we all never got together and talked about it, it never happened.

Another cool example of not even necessarily something that we are struggling with but we came together to talk about some of our social media stuff. I think the last time we talked, I was telling you about how I was doing a little bit more social media because we didn’t have a strong presence. We started wanting to have a weekly patient feature where one PT would feature one patient every week and we'd post it on Instagram.

In the meeting we talked about, “Does it make sense? Does everyone think it's realistic that we could get one done?” We all agreed and then we set the expectation right then like, “Everybody, that’s one time a month and Abby who's the support front desk person is going to follow up with you and make sure you get the thing and she's going to post on Instagram.” We all agreed on it and we all set the expectation. It just has happened every week since then and it was because everyone was a part of that decision and created it. It wasn't me coming and saying, “This is what everyone is expected to do,” and there were no questions. It was a joint decision.

You facilitated some discussion and it wasn't you saying, “This is how we're going to do it going forward,” but rather, “Here's the problem. Let's talk about it and come up with a solution.” You probably had some ideas in your head about how things could maybe go best but you were open to having the discussion and letting them come up with the solution. When they do that, they have greater engagement and buy-in.

That's what I'm saying. It's very powerful. That's why I can't imagine not having these meetings.

Did you purposefully go in with that mindset or did you get a little bit of coaching ahead of time to not come in and say, “This is what we're doing going forward.”

I'm working with Will Humphreys. I try to be able to make my own decisions when I can but with most things, I run it by Will to get a sense of, “Maybe this is what I think should be done and it's going with my gut but is there a good, better or best way that I can approach it, how I speak about it, how I get team buy-in and how I get everyone to work with it?” I don't remember exactly if it happened but I would imagine I spoke to the coach and got some good ideas on how to approach it.

It sounds like you're just getting started with these weekly team meetings. You even mentioned it yourself that you're starting to see the formulation of culture coming about like, “This is how we get things done.” Are you starting to get a vibe and a culture around your clinic?

I do. I think that there's a stronger team culture where the team is starting to do things on their own. Not that they wouldn't but because we get together and have the space to talk about things. It's promoting that if I bring something up in a meeting, it can happen at any point and if you have an idea, let's all talk about it. I think that everyone is now comfortable bringing up ideas and trying to act on them and can come together. I think the culture has been greatly upgraded because of these meetings.

Are you starting to see some people stand out a little bit? I say that because we talked in the last episode about developing leaders and you mentioned it now that you’re looking for that next clinic director. Do you see some members of the team stand out a little bit more than others as you do some of these things or were you already going down a path with one of your team members already?

Everyone is standing out in certain ways but not in the way of the clinic director. I did let the entire team know that I was going to start advertising and looking for a clinic director. At the same time, I let everyone know that I'm going to offer it internally as well but based on some of the different situations and schedules, it wasn't something that anyone that was there was wanting.

One of them was not a full-time person and this was a full-time position so it couldn't work out. Whatever the situation was, it didn't work out. As far as the director goes, I did advertise it and I did hire someone. She applied to be a PT but ultimately has the interest in becoming the director. We talked about it and came up with a plan for her to be a director but we are bringing her on just as a PT first to make sure she comes in and gets comfortable. She is a team member first and then looking down the road if it makes sense and everything looks as it should then move her over to the director. That should be happening.

She’ll be our fifth PT and then she's going to essentially become the director. Everyone is stepping up in a lot of ways. Do I think it's from these meetings? I don't know but I can't imagine it's not helping. The team culture is becoming so strong and I think because of that, it's creating this team accountability where people are maybe wanting to do a little bit more for the company than for themselves.

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It's interesting that you hired from the outside to bring a clinic director in. That's not typical but it's not atypical either. Usually, you grow someone from within but what's clear is that as you're developing this leader, they didn't come in and just get the title. The same should be said for anyone that you are bringing up from within the company. They don't get the title and then get some training. They need to show that they're value-aligned.

They maybe do some small leadership tasks to see how well they are able to organize, how to be responsible, how to get other people involved and then if they show competence, especially do a good job in those tasks and are value-aligned, now you can turn over responsibilities related to the clinic directorship and then “give them the title that.” It takes time. You don't ever want to just give them the title and then do the training. You want to do some training. They have to show that they're capable and then you can move them into that position.

What we're trying to do is exactly what you said. We're trying to bring her on, make sure she settles in and first of all, make sure she builds up her caseload and does her roles and responsibilities of a regular PT. You see normally a lot of times people hire from within.

I did hire her with the intention of the director even though we have these stages that we're going to go through but at the same time, what we're going to do is even though she's going to be “just a PT” for the first three months, we're going to start having conversations. I'm going to give her some books to read about leadership and try to at least get some alignment in that so when she enters into the training then she'll already be ready for it.

That was something that we had our leadership team do is read some of the books that Will and I had read that were influential in our thought processes so they could understand why we do some of the things that we do and where that came from. It wasn't us simply thinking up great ideas or coming up with stuff out of the clear blue but rather, here were some of the books that were influential that changed our minds regarding leadership and why we do some of the things that we do. I think it's important to have that library of books to help train other leaders on your team.

I talked to Will about which book he would recommend. The first book he recommended for any director is Leadership and Self-Deception and then the other one was The Five Dysfunctions of a Team.

Those are great. If they want to learn more about leadership and ownership some of those other books are Good to Great and The E-Myth Revisited. Those are all great books that we referenced quite often in our leadership team meetings.

I have not read The Five Dysfunctions of a Team, which apparently is one of those must-reads.

It's a great one, especially with your team. Once you get your leadership team, it's fun to read it together and share thoughts about different aspects of it. It's a great place to start. You've been a PT owner for years. Is there anything that looking back from where you are now you would say, “I would have done something differently?” What would you have told your younger own self?

A lot of things.

Like what?

I always say I got lucky in a lot of ways. I didn't necessarily plan everything or do all the research for some of the important things that you would think you should do as far as looking up what your reimbursement rate might be when you start or if you're going to take insurance. I think the thing that I would have done automatically from what I know now is I would have started with a coach automatically. I think that would have allowed me to skip a lot of the guessing.

I learned and got lucky by doing things and learning as I did it but having a coach probably would have fast-tracked me a little bit more. I say that and then I realized though at the same time, having to make those decisions even if you don't know for sure if it's the right one or wrong one because, without the coach for the first two years, I was just making decisions.

Having to do that was very important for my development as an owner it's hard to make a decision. It's exhausting. It's challenging. It's hard to know if what you're choosing to do is aligning with what your values are and I guess ultimately, what are my values? I think going through all those was important for me but it also could have been done a little bit more efficiently or maybe a little better had I had a coach.

One thing that I was thinking about that if I had done differently and although it hasn't affected me too much I was aware of it during the big decrease in caseload during COVID, was that I've always historically relied a lot on, at least in the beginning, these paid directly to consumer Google ads that have been very successful for me.

We still use them but I would say now, we don't use them as much because we've been around, we've built up a reputation and people are coming back. Our first patient ever back in 2017 came back again this 2021. It's her sixth time that she's come back already. We're having return patients but we're still using the Google ads but what I never did a great job of was relationship marketing and developing doctor's referrals.

I think early on, I tried unsuccessfully and that's when I started looking into these Google ads and I gave up when the ads started working but I realized during COVID that you can't just rely on one thing because there was a time when the ads not performing as well as others. It pointed out that you can't rely on that one thing.

PTO 167 Avi Zinn | Leadership Development
The Five Dysfunctions of a Team: A Leadership Fable

Had I gone back, I would've continued this whole time to try to develop those relationships. We've developed a few relationships with some local docs. None of them are part of hospital systems. They're all independent. It's hard to make those relationships so I think for sure starting from the beginning, I would have kept up with that.

Since you brought it up, do you foresee bringing on even a part-time marketer to help you with some of that stuff?

I've been thinking about it and I don't know. It might be a good idea to bring someone on to do marketing and brand awareness to get a more cohesive marketing strategy. I've thought about it but I don't know who to speak to about that. I think it could be powerful. I can't imagine it would hurt.

The beauty of it is you're doing so much on the organizational side of things yourself. You're the visionary, the leader and you’re holding people accountable that if it's not something that brings you a lot of energy and joy then marketing is something that falls off until the numbers start to dip and then when the numbers dip, you're thinking, “We've got to rev up the marketing machine again.” The beauty of having someone who that is their sole responsibility is that there's the attention paid to marketing all the time so it minimizes the rollercoaster ring and allows someone to pay attention to the entire marketing strategy that you might take your eyes off of every week or two until you go back and say, “We need to redo our Google ad,” or, “We haven't seen that doctor in a while. We need to go see them again,” whereas when you have that person who's dedicated to it, of course, they can concentrate on that effort and make sure the social media is getting taken care of.

They're looking at the four buckets. They're focused on physician relationships, looking past patients and how they can get them back in the office, making sure that everyone's asking for referrals from the current patients and then also talking directly to the community either via social media or the Google ads like you were talking about. Having someone dedicated like that helps maintain the marketing efforts and can increase your numbers in general. That's a conversation that we've had in our masterminds the last couple of months because people are starting to bring on these part-time marketing people and seeing some great results from it.

Everything that you said, I relate to, especially with that roller coaster of like, “The numbers are dipping a little bit. Let me see what doctors I haven't texted in the last three weeks.” That's interesting. As part of the new front desk person, Abby, I also labeled her the patient success manager. She was doing some of the follow-up calls and she's been the one posting stuff on Instagram but I think having someone designated their full responsibility to marketing makes a lot of sense and that's something that I will take away from this episode.

My best marketer was an assistant to a physical therapist. She was a great marketer. Her name’s Stacy Sullivan. She was one of my first employees and she did a great job. She loved it too. It's amazing because I don't know about you but I hate seeing doctors. I hate the marketing stuff and to recognize that there are people out there that love that stuff, if you can find that type of person, use them for sure because that's what they want to do. They want to go see doctors, they want to get new patients in the door, they believe in physical therapy and what you're doing at Druid Hills and they’ll market and promote you all day long. It's great to have that person on your team.

I don't hate going to doctors or at least the ones I already have a relationship with but there are some things that I could see that I just do because I've always done it. I think that’s a lot of the stuff that I'm learning from having a business and with coaching is that if it doesn't bring you a lot of energy then it should be someone else doing it.

You should focus on the things that you like doing and that's where you're going to see the most return on. I could see how that could be something that I'm doing but I'm not giving it my all because it's not something that I love doing or maybe I don't know how to do it either and there are people that are better at it.

You don't have to find a person with a marketing degree or someone that’s going to school for marketing. Some of the people that are getting hired by members of my mastermind are stay-at-home moms whose kids are in school and they want to do something for a few hours since they have the time now. If they've got the personality and the energy and you can show them what to do and tell them what metrics you're expecting them to generate then they can work.

I'll have to add that to my list now, to start hiring a part-time marketer.

As you're looking forward to 2022, when do you start looking forward to the next year and planning for it?

In 2020, I did a budget with my coach and that was the first time I had done that. We probably did it right around now to get ready to start looking at the next year. I haven't done that yet but it was something I'm planning on doing because it was super valuable to do that and to project. We had talked about it in one of the episodes. I don't remember if I said 30% or I used a number and the way I chose that number was based on the actual physical space that we had and then we work backward and that's how we decided how to set the budget. If we were going to fill our space, then we can have six FTEs and then work backward from there.

Even though we didn't end up meeting all of those numbers, we weren't too far off. It was amazing to have a budget where I looked at the numbers for every month or for every quarter and to know ahead of time that if we want to get to this point, I already had it worked out, “This is what we'll need. We need these many visits.” I can look week by week or month by month to see, we can increase our marketing efforts, hold back our marketing efforts or we need to focus on these things so that way, we can hit our numbers. It was super powerful to do that in 2020 and that’s something that I was planning on doing pretty soon getting ready for 2022.

We have to let everyone know that your business coach is also a CPA so it's easy for him to generate these kinds of performance and budgets.

I'm not working with him anymore. I had two coaches that I was working with and it was getting a little too much. They were giving me too much stuff to do. It was all valuable but it was overwhelming sometimes where I would be looking at my homework from the coaches and then I’m like, “This is too much for me to handle. I don't want to do that much. Slow down a little bit.” I took a break from that coach but yes, he was a CPA. That's in his wheelhouse to look at the numbers that way so it was helpful. Now, I think I have a pretty good sense of how to go into QuickBooks, pull out my P&L, look at our numbers and project, look at our metrics and analytics from our EMR and then go from there.

That’s pretty impressive that you're able to read the P&L yourself and maybe even generate a budget yourself if you wanted to in QuickBooks. Is that something that someone had trained you here in the last few years or is that something that you knew how to do beforehand?

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I have no clue how to do that beforehand. I think it was a combination of that coach but from the beginning when I started, I had a bookkeeper where we would meet every week or so and he would send me a PDF of the P&L and we would go over it and we would look at the balance sheet. He would explain it. After the first year of doing that every week, I got a good sense of how to interpret it and then I'm able to now go into QuickBooks and I can pull up a P&L and I know where I can separate it quarterly, do it monthly or select the time. Now, I'm able to go in and generate that.

That's impressive because I went maybe ten years without reading a single P&L for my business. I didn't know how to do it before. I finally recognized that I need to know what's happening with the financials of my company because a patient asked me one time what my cashflow is like and he was also a business owner. I just looked at him blank and staring. I had no clue. He laughed and was like, “I guess things are going fine for you,” and I was like, “Yeah,” but that's embarrassing as a business owner that I don't know my financials well enough so I asked my CPA at the time, I said, “I want to meet with you monthly and you're going to show me how to read a P&L and balance sheet. I need to know what my financials are. I want to do this monthly going forward.”

I highly recommend all of my clients and even the audience who are reading, meet with your CPA monthly and pay him the extra hourly wage to sit with you and show you how to read your financials because it's powerful to know where your money's going. You should know if you're spending more in a certain category this month compared to last month or this year over last year.

You should know what your breakeven points are both in terms of dollar amounts and per visit amounts, which I'm sure you're able to do now that you have Prompt EMR up and at the same time, QuickBooks. You should know how to generate those reports and look through them and review the numbers monthly. That's a fundamental number maybe 3, 4 or 5 in being a small business owner.

Once I got comfortable with it, I can glance at it here and there. It's so helpful to be able to look at it to know where you are and you can see where you're at, at that point. That way, you know what the numbers are. It's like in that situation where the business owner or your patient was like, “What's your cashflow?” To be able to know that you know the answer is powerful.

It is powerful because as you look at those numbers or your management numbers from your EMR, you cannot only see what has happened in the past but you can also project what to expect going forward based on the historical data that you have. It’s powerful to know like, “We saw so many visits in the month of October. That means we can expect this kind of revenue in November. If it's good then that's great. We should expect that number and expect that out of our billing company but if it's not, what do we need to do now in order to cut back expenses or rev up the marketing engine again depending on which way we're going?” We can project going forward and not guess what we're going to do in the coming month. There is a lot of power in that.

It’s also what I was alluding to a little bit earlier about 2019 and then 2020 being COVID. It’s hard to look at our numbers and compare them to 2020 and then to 2019 because of the stage of the business that I was in and then COVID. It's hard for me to do that now to look back and say, “Last November, we were this number,” but last November was also still a little different because it was 2020.

However, it is still the same and not have the budget like I did last 2020 for 2021. It did allow me to do that exact thing which I can look at quarter three and expect that we're going to be here, which means we're going to be bringing in this much and we’re going to be this much profitable. We'll also have this many visits, which means that we'll probably need to be hiring. “I need to start looking for someone and hire them now,” instead of waiting until we see those numbers happen and then say, “Now we need to hire,” which can take an extra three months.

I had some clients who put together a budget going forward and they did it in some Apple spreadsheet. They made targets for when they were going to hire their next physical therapists. I thought, “You guys are pretty ambitious here,” and they're like, “We're just going to put some goals here with the numbers.” Lo and behold, they started hitting those targets, hiring those therapists and the numbers followed suit. It's almost like as you put it out there into the universe, things work in your favor.

PTO 167 Avi Zinn | Leadership Development
Good to Great: Why Some Companies Make the Leap and Others Don't

Before we started recording, we were talking about one of your coaching clients that she stopped treating and she hired some more patients. Because of that, all of a sudden, she was seeing more patients per week than she's ever had before. It's not exactly projecting but she put it out there. She created the space for it and then it happened. I think that's also what I see a lot of times too. You look at these numbers, you think about it, you put it out there and then it happens.

It’s not because you just sit there and let it happen but because you have some intention behind it and your actions follow suit. You're looking at this like, “I want to meet this goal or these are the things that I'm expecting my business to perform and to do.” Your actions along with the help of the universe somehow work in your favor and things go the right way once you put it out there. It's great to see.

I have to acknowledge all the work that I do because a lot of times I just say, “It happened that way. I was lucky,” but it takes a lot of intention. You can set those goals but there are a lot of things that you have to do. Sometimes, it's making a big decision and that can take a lot of time and energy to come up with the right decision to move forward with.

To wrap up this episode, maybe we've already discussed it of the things that we've discussed but is there one thing that stands out that you've learned over the past few months as an owner?

Number one, in terms of the meeting rhythm and communication, I think the more clarity there is around everything, the better it's going to happen. When we can have clarity on the process, why we're doing it, what the expectation is, it's going to happen versus I come out and I send an email saying, “This is what we're doing,” and then it never happens.

When we have a meeting, we all talk about it and everyone lends their voice and everyone agrees on it and it’s clear why we're doing it and how it aligns with our purpose, vision and values then I can see how much more everyone is involved. That has a lot to do with clarity. I think that has been cool to see. Most PTs, I would hope, at this point are coming out of school and are good PTs, if maybe they're not the best. I want our clinic to focus so much on the patient experience that the PTs don't have to worry about any of that and they could just do their job.

I'm so surprised at how much it makes a difference when we give the patients an experience of not even about the actual treatment itself but it's about making sure that we explain every single thing to them before they come in. Make sure that we treat them with respect by explaining the financials and the insurance stuff and then going an extra step and sending out a survey and a postcard. That makes the experience so much better and we're seeing that in our patients’ reviews, in what they say and in their responses. They say that it's an amazing PT experience compared to any of the other places they've been to and it’s because we're putting so much effort into the patient.

It’s not even so much on the actual treatment. Obviously, that's important and that’s why they're coming. It's surprising how that's even almost more important than the PT itself in getting them successful. If they don't have that trust, if they don't love the experience for whatever reason or if they were told the wrong insurance information then it comes back differently, they're going to stop coming, because they feel something is wrong. They're not going to ever be able to finish their PT but if we get them to buy-in and trust from the beginning because we go out of our way to do that, they're going to be so much more successful in finishing their plan of care. It’s so crazy how much it has almost nothing to do with the PT itself.

PTO 167 Avi Zinn | Leadership Development
The E-Myth Revisited: Why Most Small Businesses Don't Work and What to Do About It

I discussed that in length with Jerry Durham. I think he has a podcast now as well but he talks a lot about the patient experience and what he shared on the episode was to sketch out the patient life cycle from the very first point of communication with that patient all the way to the point of their balance is zero with your clinic. At each of those touchpoints, how can we improve the patient experience with our clinic?

If one of the first touchpoints might be your website, how can we make that a better experience for the patient? What would they want to improve that experience with your clinic's website? If it's a phone call, what can we do on our phone calls to make that a better patient experience? As they come into the front office on their very first visit, how can we make the waiting room a better patient experience? You can take each one of those. You could take a full day and talk about your patient's life cycle, how you can improve it and if you did so. I shared this in the previous episode, I think your marketing efforts would significantly increase. They'd probably double or triple.

I completely agree. It's stuff that I'm so surprised at how much it makes a difference and I think because of that, I am being conscious of some of our marketing and trying to think of it through the patient experience. Does it match up to our website? Does it match up to what we're saying and the language we're using when we talk to them? Does it connect to the email that we send them out?

That goes back to what you asked about the marketing person. I think in that patient experience, there could be more cohesive brand awareness or just your marketing and when they're all saying the same message, that's going to completely increase that experience. I think to be able to do that, it's a lot of work but I can understand how that makes a huge difference.

Is there anything else you want to share with us?

I like when I do these with you because it's almost a free coaching session for me because I got to answer these questions and you ask questions that I haven't necessarily thought about, like the marketing person. I think last time, you were asking me if I had an onboarding system and I was like, “Not really but I should probably do that.” I don't have anything else to share other than I do appreciate you keep having me on. I still tune in to your show and I think maybe other than Eric Miller, I might be out there for some of the shows that you’ve had.

That's right. If you've tuned in to my show, you know that Eric Miller has been a frequent flyer. Will Humphreys has been on here a number of times but you're probably second behind Eric. That's for sure.

I wouldn't say that I'm adding as much value as some of the other people but hopefully, the other owners out there or people who are aspiring to be an owner can at least learn from my experiences. Hopefully, it's helping other people.

Thanks for sharing your experience. I appreciate it. We'll be in touch again.

Thank you so much.

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About Avi Zinn

PTO 167 Avi Zinn | Leadership Development

Dr. Avi Zinn, PT, DPT, OCS is the owner of Druid Hills Physical Therapy in Atlanta, Georgia. He opened his practice at the end of 2017 and has slowly built it up—transitioning from a staff of one (himself) to a team of administrative staff and treating therapists. He continues to grow the practice gradually. Avi’s main mission for Druid Hills PT is to provide high-quality, personalized care to each and every one of his patients.
Avi has his doctorate in physical therapy from Touro College, and is a Certified Orthopedic Clinical Specialist. He lives with his wife and three children in Atlanta.

PTO 122 | Sustained Growth And Success

Brandon Buehler, PT is routinely asked, "What is the secret to your success, especially in a difficult PT market like California?” To that question, he responds that he keeps his focus on truly living their practice’s purpose and values, and infuses those into discussions and staff meetings. He joins Nathan Shields to explain how this enabled them to establish a team culture that has grown from within to establish seven clinics in southern California. Brandon admits it takes a lot of hard work, but the added effort to establish solid and living purpose and values is what makes it fun and fulfilling.

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Listen to the podcast here:

The Secret Sauce For Sustained Growth And Success With Brandon Buehler, PT

I've got a guest on that I've wanted to have for a long time. He's part of the network that Will and I were a part of as we grew our clinics over time. He was in a group with other people on my show that I've had before like Vinod and Blaine. I still haven't had the girls on from Magnolia, Amy and Lisa but these were all people that we looked up to. Brandon Buehler, who is the President and Founder of Coury & Buehler Physical Therapy in California. He’s one of those people I'm excited to have on. Finally, after a couple of years of doing the show, I've got him on. Brandon, thanks for joining me. I appreciate it.

It’s my pleasure. Thank you so much for inviting me.

I'm excited to bring you on because you guys have been successful especially in a difficult area of the country in California. I think when we knew you back in the day, you had maybe 2, 3 clinics and now you guys are up to seven. You've been successful in your model and I've always looked up to you guys because you've always been well-founded. That's a lot of what I want to talk about with you because I know that's the basis of your success. Before we get into a lot of that, do you mind sharing with us a little bit about how you guys got to where you are? A little bit of the story of Coury & Buehler Physical Therapy and what's made you guys successful?

I'll show you a little bit about how I got into physical therapy and then how that led into the birth of Coury & Buehler Physical Therapy. My route to becoming a physical therapist was a circuitous one. Initially, I had no idea what I wanted to do. I went to UCI and it was an engineering major. I was good at math and science so I figured engineering sounds right. I started in that and I did well. I enjoyed it but towards the end of my first year in college, I got in a bad car accident and suffered a bad back injury. I had pain for months and when I saw multiple doctors and MRI. I was referred to different specialists and medications thrown at me like crazy.

It wasn't getting better. I'm like, “This is crazy.” A friend of mine said, “Have you tried physical therapy?” I said, “What is physical therapy?” I had no idea what it was. I went to physical therapy and within one week, I was already starting to feel better. Within three weeks, I said, “This is what I want to do with my life. I can be an engineer of the body instead of an engineer for other things.” That's led me down the path. That's one of the reasons that I'm passionate about our profession. We can help people naturally that we don't have to be spun in this web for months or years of pain until they find me getting physical therapy as we hear it all the time.

A patient had five years of headaches within about a month of treatment with us, the headaches gone and tears rolling down her eyes. She asked me a common question we hear from a lot of people, “Why didn't I get it earlier?” That's a good question. It is something that us, as a physical therapy community need to solve. Why few people getting into us? Why are they seeing specialists, MRI, surgery and medication only to often fail that and then come to us?

We fall short in that regard. The marketing efforts of physical therapists over the years have been so focused on, “Talk to the doctor and get that referral from the physician,” that we've failed as a profession to market what we do to the communities at large. Even nowadays, I've been a therapist for many years, the question continues to come up like, “What makes you different than a chiropractor? Are you a massage therapist? What do you guys do?” Many people don't know and that's a failure on our part.

One of the sad aspects of our profession is we all feel like we're competitors. It's a crazy thing. In my world, we see such a small percentage of our community. We're always worried more about our competitor down the street doing the fact that 99% of the people in the community aren't getting into either one of us. We work to band together. We couldn't handle the business we have, instead our patients are going to a chiro or getting MRIs, medication, surgery and seeing specialists. It is something we can work on. What you're doing, Nathan, is you're working on that. You're trying to bring people together and through consulting, networking and these types of podcasts. Other people who've been here like me are sharing some similar ideas.

That's a lot of what the pandemic has led owners to do is to not focus on physicians because that physician pipeline essentially got cut off in a lot of places. How are we marketing now to get those referrals in the door, to get those patients in the door and see them because people are still getting injured, whether we have lockdown or shutdowns? It doesn't matter. They still need physical therapy. A lot of my shows have been about how to use social media, how to do the direct to consumer marketing route and spread our message so that we don't necessarily rely on physicians to also get it out to the people that physical therapy is available to them.

PTO 122 | Sustained Growth And Success
If we combined our efforts and promoted our profession, that alone would have a dramatic influence on all of our business.

Imagine if our profession, all of us, whether they're next door or the next city over, if we combined our efforts and promoted our profession. That alone would have a dramatic influence on all of our business. The concept of rising tide would in full effect on that. That’s my story about becoming a physical therapist in terms of how Coury & Buehler Physical Therapy started. My founding partner Rich Coury, we met as I was doing internships at a place and we became instant friends. He was maybe a couple of years ahead of me. We weren't far apart in age. We clicked and connected as friends. I finished up there and started working somewhere else and he was working somewhere. We would hang out a lot.

We would grab drinks or lunch. He came over and hang out with my wife and me. We were friends, but we also were both passionate about the profession. We would spend many evenings talking and dreaming about, “What if physical therapy could do this? What would it be like if the place we worked at providing this type of care? Is this constant dreaming envisioning of the ultimate physical therapy company? What would the dream vision of a physical therapy company look like?” We talked and talked. I remember one night my wife saying, “Are you guys going to keep talking about this or are going to maybe follow up on these dreams? You seem like you have the passion about it.”

Rich and I met one day and said, “This is the time. We have this vision. The physical therapy model that we think is better and will provide better outcomes and results for patients. Let's do it. What do we have to lose, my house? That's about it. Let's move forward.” It's been a fun ride. Since then we've grown since day one and that was about many years ago. During the first couple of years, we found that to be a challenging time but we grew quickly early on I think just because of our good looks and our charisma with treating.

We hit this wall where we're kept. We felt like we're limited in what we could do. We didn't know what to do and how to get to the next step. That's where we started luckily to meant that we needed help. At that point, we got some consulting. We started networking with incredible physical therapists like yourself, Will, Vinod, Lisa and Beth and all these great therapists. Getting help from different people, talking and reading books, taking on the posture from that day forward of being a learner in terms of not as a physical therapist, but as a business owner and practice owner who wants to improve the profession.

That's something that I've always loved about you is that you've always come from a place of so much wisdom. I've read books that you've recommended to me during the course of conversation. I don't even know if you remember that you've recommended books to me, but you've been someone who's always been looking for more information. You are a learner trying to absorb as much as possible to improve yourself, not just professionally, but also personally. That's kudos to you and it goes to the typical pattern of a successful physical therapy owner that I've seen in 99.5% or 100% of the successful PT owners I interview. They recognize that they need help.

We didn't learn any business things in physical therapy school essentially, so we need to get some business acumen. Networking is huge in that regard and helping you know that, “I'm not in this boat alone. There are other people who have done some successful actions that they're willing to share.” The networking alone can be a huge aspect of it. There are always books that can give you inspiration, insight, and that stuff. I'm reading one called Grit by Angela Duckworth.

It's an awesome book. I haven't read about the topic that we're going to discuss but in the course of our discussions prior to this interview, you told me that other owners and younger owners might come to you and say on occasion, “What do you guys do? What makes you successful?” I thought it was great that you came back to we really live our purpose and our values. That's where I want to take this because we've discussed this on the show before not you and I, but other guests about how to establish a purpose. How to establish values and exercises you can take your teams through and how important it is? I know that you guys live that stuff. You guys reference back to it. You use your purpose and values as a filtration system for the choices and directions that you go to and your physical therapy ownership. Tell me a little bit about that. What was the Genesis of finding your purpose and values? Then we can get into, what are you doing to keep it alive and well?

I appreciate you bringing this up because this is something I'm passionate about. It is funny. We have people come up to us often either calling us in PT network meetings or wherever like, “What is your secret sauce or what tricks you got? What are you doing?” Everyone thinks we have some magic thing that we're hiding behind the scenes for our success. Everyone's looking for that one answer. What's that one book that turned it for us or that one marketing guru we're following? We all want that in life. We want the pill that'll make us lose weight. We want the one exercise that'll give us big biceps.

We all know that it's much more than that. It's more complicated than that, but the reality is my answer to everyone is that it's our commitment to our purpose and values. I know it can sound commonplace for people to say that or to throw that out there. For our company, it's been true. I told you about the story of how Rich and I started the company and his dream, but a lot of our dreaming and visioning is starting to talk about our purpose, vision and values. Back then, we had no business training. We were young therapists. We didn't know what it meant to create a purpose statement and core values, but we were smart enough to know that those things mattered.

In a small business that experiences ups and downs, having a stable and lived purpose and values is like a lighthouse in a storm. Click To Tweet

We started talking a bit about it. We didn't necessarily use the word purpose and values, but we would talk about what we wanted to be about. We talked about how we wanted the company to operate and the type of people we wanted. We started in those early days formulating our purpose and values and the same concepts from day one before we started the company. I was telling people, I started the company about 1.5 years before the company started. It started with Rich and me talking about it and dreaming, visioning and creating these fundamentals. Once the company started after one year or so, we decided to get real fancy and write the things down we talked about. Put it on the wall.

It's a piece of paper. It was a rudimentary version of what we came up with. Those things evolved a bit as we started to find out more. When you're at a company, it's like you go from being a teenager to an adult. Your company evolves and develops. Over time, our values did not change, they matured. What happened maybe about many years ago is our company growing. We also have grown a leadership team, which is phenomenal. We decided to sit down as a leadership team and to relook in a new union of time. We call it our vision statements, purpose, values and BHAG.

We spent a whole day, maybe two days offsite, just looking at that. What we did is we didn't add to it, we simplified it. We looked at every single one and said, “This is too complex. Let's be real with who we are, our purpose and values. Those two are great, but that's not us. Maybe we liked it, we agree with it, but let's focus on what we know we will die for.” We went from maybe 8 or 9 to 6 core values. We refined some of our other statements that we have what we call team creed. We have our BHAG. We have a care statement. We took what we've always had, and we refined it. That's become the foundation. If you want to know what our process for success, it would be those things.

What I want to highlight is you thought it's important that you guys took two full days, one would be enough for me, to focus on this.

Two full days after already having stuff in. We've already met years formulating and refining it. We decided to take two days to refine it on the stage for the next many years to reach our BHAG.

Purpose and values shouldn't necessarily be changed all that much. Maybe they get altered a little bit. As you said, you mature and you change a little bit because life and business environment change over time but you took things and simplified it that sparked a memory in our ownership. We recognize that we spent too many hours in meetings. We simplified and became more efficient in that regard. The same thing, we had these values, but we didn't have any definitions behind them. We took the time to come down to some concise phrases that weren't more than a sentence that describes those values to be more concise and clear about what they meant to the company.

Even though we all had our own individual definitions, we felt it necessary to define what those values meant in our company. What that look like? How does that show up? We also had some other things. We had cultural values as well, that was separate from our core values. The fact that you took much time and were that specific and intentional about it, could you say after doing something like that many years ago, it provided more clarity and maybe even a better foundation, a jumping-off point for continued expansion and growth?

We've always focused on them and made them part of our organization. At that point, it was another turning point in the company where we decided to more fully commit to our purpose and values than ever. At that point, we got more committed to making sure that every part of the organization was ran based on those values or reflect those values. We committed to instilling that more in the company and found other creative ways to make those alive in our organization.

Let's get a little bit deeper into this specific. What are some of the action items you take to have your purpose and value lived through each individual in the clink? How does it get from the owners and distilled down into the everyday actions that even someone at the front desk? If you use technicians to get down to the technician, what are some of those things that keep it alive and don't collect dust on the show?

PTO 122 | Sustained Growth And Success
Sustained Growth And Success: Your company evolves and develops over time. Your values evolve a bit as you start to find out more.

One thing is interesting is you hear a lot of people talk about, “I've done that. I got that.” Most of my friends not in physical therapy, I try to connect with a lot of my friends who have businesses outside of our industry. I love learning from people outside of our industry, but I find the majority of people I know who have done this, it's something they put on the wall. It's like, “We got it in the break room or it's in a policy manual,” which means everyone read at once and then forgot about it. It's a mistake a lot of us make. Purpose, values and vision statements, those only have an effect on the company if they are ingrained in the fabric of the company.

We talk a lot about Pinocchio at some point became human because he got a soul. We talk about our company is not human until it has its purpose and values breathed into it. Another way to say it is that the personality of our company is based on our purpose and value statements. It's the person that's who we are as a company. We have to be lived and breathed. There are multiple ways we do that. Starting with, first of all, recruiting and hiring. The first entry point of the company starts with measuring every single purpose to our purpose and our values. We use some statements that even our recruitment ads about our company because we want to try to track people who are attracted to that. When we do our interviews, the first questions are all against our core values and our core competencies for that position. Right off the bat, we're asking questions based on each of our values because we try not to take generalizations or trying to get specifics on how they maybe align with the value of teamwork.

You can say you do, but tell me how and what that means to you and describe it. Based on the initial screening interview, you can get an idea if someone aligns with their values and if they don't, it doesn't mean they're bad or were bad. This is who we are. We sell maturity and growth to do, but we know who we are. We know the type of people we need to bring on. Our companies not for everybody without a doubt. We know who we're for. We are for a certain type of people who align with us and the people who do aligned with our values or our track, they do well in our company. The first thing we do is we hire based on that.

We did the same thing. We've listed our values. This is our purpose. This is how we do things in our company. It's interesting as you do more interviews, I don't know if you're still doing a lot of the interviews, but as we were doing the interviews, you watch body language. As you're starting to talk about values and the people who are bought in start leaning forward a little bit more and they light up a little bit. The people who aren't bought in, you could tell in their body language. They don't care as much. I agree. It starts there. You start discussing those at the forefront and so that they recognize that these are important to us and you can find those people that work well with you. It's easier to do as you do more and more of those interviews.

What's hard in our clinic or with my coaching clients is we'll talk about purpose and values at the beginning. I think a lot of companies go through this and that the owners get this bright idea that, “We're going to establish purpose and values.” Two to three months down the road, it was like, “Did we talk about that one time? I forgot.” It has some initial momentum and then falls off. I know you guys do more about that and you're going to share a little bit more with us. I just want to interject a little bit, but go ahead.

Once we hire someone based on our purpose and values and someone we think is aligned to that. The first thing they do is go through a training course on that. It takes them several hours. They could read the purpose and values, but we created a several multi-hour course that takes into the reach component and goes in-depth on what that looks like. We even have some fun video examples. We'll read. We're trying to impress that into them. It's one thing to say teamwork, but what does that mean? What does that look like? We try to press that into them and then have them answer questions. Not just like ABC, but some essays. They got to think about it and write it down because we want people to process these things.

That's the next thing. They go through that and during their onboarding, we're making sure that they understand and agree with it. There have been times where maybe we brought someone on and then during the training we realized, “I don't think they're a good fit. We're finding maybe they don't align with these values.” That's the initial thing we do. During their onboarding, the first few months, their managers are continually watching and making sure this person is the best fit. They continue to match this person to who we want to our purpose. This person agrees with our purpose, this person agrees on these values. Can they live at our team creed? If they don't, they're not bad. We're not bad. It's like, “You are probably not a good fit. This is who we know we need and I don't think you align best with this. You'd better in a different setting.”

Those are some of the easiest firings, aren't they? When you do a value-based firing like those actions that you're doing or performing aren't living up to this value. You're not exemplifying teamwork when you act in this manner. If professionalism was one of your values, it's not professional and we can't tolerate people who come in late consistently. That goes against professionalism. We're going to have to let you go. You're not a bad person. We don't tolerate people who don't align with the values.

Most of our hiring are more based on values these days. Those are the big things. Beyond that though, the question is how do you make it a day-to-day part of the organization? It’s because it has to be and if not, it'll become that type of thing where like, “What did we want to talk about? Isn't it on the wall in the break room?” There are multiple ways we do this and different things we experiment, try and have fun with. I'll go through some of the different ideas. One, we have a display. It's displayed everywhere. It's on our website. We don't hide it. It's in every one of our clinics. It’s somewhere were patients could see it. It's in different admin areas or breaks rooms. It's displayed to remind people. During our weekly meetings, we try to focus on a different value each week that we were cycling through them to continue to drill through. Maybe every couple of months, they're getting back through the cycle.

The secret sauce to our success? It's our commitment to our purpose and values. Click To Tweet

You're talking about and maybe, “Have a short couple minute discussion about a particular value.”

A real quick and maybe a minute or two. This is the night of the week. You talked about it. Maybe share a win based on it. Maybe we'll take a couple of minutes and camp on that and have a quick discussion about it or bring up a patient experience on that and things like that. We do a weekly email from one of the founders, Rich or I. Every email we always try to highlight or one of the values of the week and talk a little bit about that or maybe share a story about that trying to interject that into it. Our HR manager sends out a weekly value of the week award winner. Another great way to promote either a purpose, one of the values or one of our vision statements. Somebody who's living out one of those aspects. They're getting recognized and sharing a fun story about them. It's a sneaky way to remind people of that value because we'll get your coworker to live this out. Remember, it's one of our core values and that's part of our purpose.

We did the same thing. We didn't do it anything weekly like that, but at our annual parties, we would have a value award for a particular employee and highlight some of the things they did over the course of that year that exemplified that value. I'm sure your HR person is doing that same thing but on a weekly basis. This person exemplified blank because they did blank, that exemplifies this value. I think that's great. That recognition brings that to people's minds, especially the receiver of the award.

Our leadership team met and we are starting to finalize our awards for our annual Christmas party. One of the big aspects of our awards is our value awards and we give out awards based on each value. I worked on that and coming close. That's another way to do it. Those are some of the main ways we do that. Each manager during reviews or the reviews are off that's part of the route integrated into the review process as well. We're always finding fun ways to interject that in or sometimes we'll send out a random story or video to remind people of something.

We did the same thing with our reviews. It was not only value-based recruiting and hiring and value-based firing and value-based reviews. In our reviews, to get a little bit more specific, we would have the person that we're reviewing fill out essentially the same sheet that the supervisor would fill out. That was here are the values. What did you do in the past year, six months or whatever the timeframe was to exemplify those values and maybe even give yourself a score or maybe on some other things? The person who was being reviewed would say, “These are some of the things that I did.” The supervisor would say, “These are some of the things that I've seen you do and how can you improve on some of those values, live those even better and more fully in the company.” I love that you brought that up. It reminded me that you take values into recruiting, hiring, firing and exemplify on a regular basis, but also bring it into things that might have pertained to a salary increase or a promotion. You want to promote those people and you want to give salary increases to people who live out those values.

One of the best byproducts of this is culture it helps create. We're very protective of our culture. You probably have read Good to Great by Jim Collins. There's one part of his book that stuck out to me. It's one of the most memorable quotes from a business book I've read. He talks about your goal is to have your values infused into your company. He says, “Your culture is so strong. You have a cult-like culture.” Anyone who joins the organization either gets swept up into these values or they stand out like a sore thumb and get injected like a virus.

I'm like, “That's a powerful analogy or description of what it should look like.” You can create such a strong culture in your company based on your values and your purpose where people who joined the team get swept up in it or they stand out. There's no in-between. The people who stand out, it's like that group pressure where you better join and get out. We're not perfect at that, but we see that at times. When we're doing well, you see that and it’s a good place to be. Culture is everything. Your team depends on having been working in a great place, a place they love and believe in. No one wants the drama. No one wants the other stuff.

It takes some years and some intentional effort to get to that point but I know that over time we can develop that culture, such that people have finally gotten to the point where the purpose where they're waking up knowing how they're going to fulfill that purpose that day. Not that they're waking up and going to a job and punching the clock. It elevates things to another level for the people that buy-in once you establish a strong culture like that. These are people that will stay with you through thick and thin, work hard and maybe even for less than where they would get other places because they buy into exactly what you are fulfilling in them and as a company. It creates so much strength.

COVID is a tough time for people. You see everyone handling it differently. Now more than ever, our teams need a North Star, a guiding light. They need to have something to look to. There are a lot of confusion and chaos in our offices. There are frustrations. Everyone's a little bit have difficulties outside of here. There's this challenge and reminding, “I know things are harder. I know we have more in tribulation in our offices, but this is who we are. Focus on this.” We’re headed towards that goal. We just get to look up. I know this stuff stinks, but remember, this is what we're about. We're about changing people's lives. The other stuff settles down a little bit, it’s like, “Compared to that, this stuff's not as important.” People are sick or different things going on because of COVID, but if we can continue to focus on a purpose, it helps people be aligned.

PTO 122 | Sustained Growth And Success
Sustained Growth And Success: Our purpose, values, and vision statements only have an effect on the company if they are ingrained in the fabric of the company.

Has that been a stable thing for you as you've gone through the COVID experience these several months? You have seven clinics and you're a successful guy, but you got bruised, battered and hit like every other PT on are out there. Did you find yourself reflecting back to the purpose and values and may be either shifting them a little bit or relying on them more in order to get through it?

As a company, we decided to close down for three weeks. We decided to mostly because we wanted to regroup. We wanted to decide as a leadership team on how do we run the company? What do we do? We want to provide care but in the safest manner. We took time, but Rich and I were back in day one. We came back to the office and felt like it had to be here. The very first thing we started talking about is, “Let's remember what we're about.” We can sit here, cry, complain and get frustrated. There are all these things we could talk about, but we know what our purpose is. We know what we need to do and let's focus on that.

Sometimes we talk about our purpose being like a lighthouse. You're in a storm and lost at sea, which direction do you go in? You see the lighthouse, you’re like, “I know where to go.” There are many times in our company history for ourselves and our team that that's been the case. It’s like, “We know where the lighthouse is. Let's go in that direction.” We were all bummed out. Seeing our company closed down brought tears to my eyes, but that didn't last very long. Within minutes I'm like, “I'm not going to cry about it. I'm going to focus on what we need to do because I know the purposes. That purpose includes what we need to do for patients and our team.” We started moving forward.

I can imagine that your weekly newsletters over this period of time in 2020 have had to focus more on the bigger picture perspective, why we're doing this? These are the decisions that we're making and this is why and how it relates to where we're going. Did you find that you had to reflect back on that a lot?

Yes.

Especially with the decisions that you were making, were there some things that you changed in your workplace due to the pandemic? Maybe you let some people go or you changed some things around on how you treat but still, you bounce those things and filtered them through the purpose and values.

We did have to make some changes. The biggest change was changing our treatment model to have less people in the office at one time. Administratively spacing people out. We have a lot of moms, we had to support them. Some couldn't come back to work yet. Some needed to work from home. Shifting things around. We're often comparing things and decisions against the purpose, but this is a time where we at it continually do that and remind ourselves of this is what we're about. This is not best for the business, but this is who we are as a company. This is our hardest decision based on revenue, but this is who we are as a company. We need to make this decision.

When you first established your purpose and as you've refined it over time, I wonder how you defined it. As I'm working with my coaching clients and I asked them their purpose which has something to do with, we provide great physical therapy care to the residents of blank. I want to tell them, “That's what you do. That's your job as a person and as a company,” but it's more about the why. I'm wondering if that's how you've thought about your purpose over time and came upon it. It was like, “You do physical therapy, but for what purpose?” It goes back to a higher purpose which I talked about with a 30-minute key and that is helping people live pain-free. If that was your higher purpose or support the surrounding community so they're healthier. How you go about doing it is you provide physical therapy. How do you define purpose and how it helped you clarify what your purpose was?

We're on the same page. We have always seen purposes as the most important question. The purpose for us is the, “Why.” That is the first and foremost, question decision that any business makes to help make all the decisions under that. You see a lot of businesses in our industry and not in our industry, start a business and they haven't made this decision and they're making these decisions. The problem is these decisions can be right or wrong. If they're not, they don't know they don't figure out the why. When we came up with a purpose, that was the thing we were talking about, like, “Why do we exist? Why are we here? Why are we doing what we're doing?”

Those are the overarching type of theme. What we also decided is we felt like our purpose needed to transcend our industry. I feel like your purpose is in your industry. It’s not as bad. Our purpose is to help people out of pain and that’s awesome but we felt like, “Maybe our purpose should be bigger than that,” because it takes us out of the industry and is more important in our industry. Our purpose is to enhance the lives of people in our community. Our focus is helping our patients get out of pain, this includes our team and the people around that you work with even vendors. Vendors come in to enhance our lives. Whoever we're dealing with. The neighbors in our building, let's enhance their lives. It gives us a little bit of a different perspective on what we do overall.

The personality of our company is based on our purpose and value statements. Click To Tweet

As people start defining their purpose, it becomes less about the physical therapy they provide and what they can do for other people's lives and broadens the influence to not just the patients. As business owners, we want our team members to feel a certain way, to have a certain experience and experience a certain culture. We want to be the ones that establish that culture to better their lives as if we were working on a patient one-on-one. We want to enhance their lives and we want to enhance the patient's lives and thus affect the community in multiples. As you establish that purpose, it becomes less about the physical therapy itself and the care that you provide, not less about that, but to also include the workers, the people who are supporting you and the people that you interact with in helping the vendors, the workers at the physician's offices to include everybody that you come in contact with. It expands to more and more people.

Everyone in the team and what our position is can be part of that purpose. It's bigger than just helping patients in pain. Enhancing lives may look different for each person in our company but we can all be a part of that.

Were there some books that were influential to you in regard to purpose? You mentioned Good to Great but were there others that guided you along in that regard?

All of the Jim Collins books touch on that. Simon Sinek’s Start With Why and the Scaling Up book as well. There are others, but those helped formulate some of our thinking.

Is there anything else you want to share in regards to the purpose and how you guys live it and breathe it in Coury & Buehler?

It affects and influences most of our decisions. In terms of how we run the company on a day to day basis. Big decisions we're making in terms of a standard to measure our company with. Rich and I, when we meet, sometimes we check each other on this. We'll be talking about things and be like, “Remember this is our value. Does that align with that? We talked about this, we know what we're about.” We check each other all the time. If we didn't have that, we'd be making dumb decisions.

One of the things I'm most proud of is our company is, it's not Rich and I, we have a team of partners. That came out of Rich and I, when we were going through our purpose and values realizing that there are a couple of values that compelled us to expand the ownership team. We had some incredible physical therapists that we felt like based on what our purpose, our values and some of the things that we want our culture that we needed to provide that opportunity for them. That stemmed out of the purpose and values that we’re going through.

That's the easiest route to expansion is to find those people in your company that you've not only vetted but figured out they align with you. There's a great Jim Collins phrase, “You find those people who are truly aligned with you.” It's to expand when you have those people on your team and open up other clinics, grow or provide them leadership opportunities. It makes growth so much easier and fulfilling.

It's fun to see them grow and reach their dreams.

PTO 122 | Sustained Growth And Success
Sustained Growth And Success: The people who align with your values will do well in your company.

You provide that foundation from which they can build off. It's not there unless you have those purpose and values and have them well-stated because they've been with your company for a period of time. They align with you through all the decisions that you've made with them over time. To help them expand and start up a satellite clinic and get the next clinic going. They're simply living those purposes and values. You don't have to train that up all over again. They continue the cycle all over again. That makes it so much easier.

We've never brought someone from outside for a higher position. Everyone starts in a position. Anyone in management or above has grown up in the company. They are moved up in our system.

Thanks for your time, Brandon. It was great to have you on, you've got a wealth of knowledge and wisdom. I finally got you on the show so you could share that.

Thanks for having me.

Do you have any contact information you can share or a website people can go to check out your clinics?

My email is BBuehler@CBPhysicalTheraphy.com. My cell is (714) 345-0426.

You've grown a ton. It's impressive. You've always been someone that we looked up to. I'm glad that we could tap into some of your wisdom. Good luck with everything. 2020 has been a tough one but I know you guys are in a great position to withstand it and grow going forward.

I appreciate what you're doing for our profession. I love your podcast. I love that you're helping coach and consult for other physical therapists because our profession needs that. Kudos to you for what you're doing for our profession and for all the help you're providing for physical therapy private practices out there.

That's nice of you. I appreciate that. Coming from you, that's a huge compliment. Thanks.

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About Brandon Buehler

PTO 122 | Sustained Growth And SuccessBrandon decided to become a physical therapist after being involved in a car accident and had to go through months of treatment in order to return to playing soccer in college. After experiencing how physical therapy helped him return to his normal activities, Brandon decided that this was the career that he wanted to pursue. He has a passion for helping people return to their sport or daily activity without pain or limitations.
Brandon has extensive training in orthopedics and manual therapy through the Institute of Physical Art. He places high value in continuing education and training at CBPT. Brandon emphasizes the importance of quality and personalized care with one-on-one treatment for every patient.
Brandon is also the co-founder of POISE (Prevention of Injury and Sports Enhancement), Richard Coury, MPT, assisting athletes in preventing injuries, helping them in full recovery to their sport and improving performance on the field or short.
In his spare time Brandon enjoys spending time with his wife and kids, running, working out, hiking kayaking & paddleboarding.

He enjoys spending time with his close friends, especially enjoying a meal from his barbeque.

As a native Philadelphia, Brandon is always on the way to pizza.

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PTO 122 | Sustained Growth And Success

Brandon Buehler, PT is routinely asked, "What is the secret to your success, especially in a difficult PT market like California?” To that question, he responds that he keeps his focus on truly living their practice’s purpose and values, and infuses those into discussions and staff meetings. He joins Nathan Shields to explain how this enabled them to establish a team culture that has grown from within to establish seven clinics in southern California. Brandon admits it takes a lot of hard work, but the added effort to establish solid and living purpose and values is what makes it fun and fulfilling.

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Listen to the podcast here:

The Secret Sauce For Sustained Growth And Success With Brandon Buehler, PT

I've got a guest on that I've wanted to have for a long time. He's part of the network that Will and I were a part of as we grew our clinics over time. He was in a group with other people on my show that I've had before like Vinod and Blaine. I still haven't had the girls on from Magnolia, Amy and Lisa but these were all people that we looked up to. Brandon Buehler, who is the President and Founder of Coury & Buehler Physical Therapy in California. He’s one of those people I'm excited to have on. Finally, after a couple of years of doing the show, I've got him on. Brandon, thanks for joining me. I appreciate it.

It’s my pleasure. Thank you so much for inviting me.

I'm excited to bring you on because you guys have been successful especially in a difficult area of the country in California. I think when we knew you back in the day, you had maybe 2, 3 clinics and now you guys are up to seven. You've been successful in your model and I've always looked up to you guys because you've always been well-founded. That's a lot of what I want to talk about with you because I know that's the basis of your success. Before we get into a lot of that, do you mind sharing with us a little bit about how you guys got to where you are? A little bit of the story of Coury & Buehler Physical Therapy and what's made you guys successful?

I'll show you a little bit about how I got into physical therapy and then how that led into the birth of Coury & Buehler Physical Therapy. My route to becoming a physical therapist was a circuitous one. Initially, I had no idea what I wanted to do. I went to UCI and it was an engineering major. I was good at math and science so I figured engineering sounds right. I started in that and I did well. I enjoyed it but towards the end of my first year in college, I got in a bad car accident and suffered a bad back injury. I had pain for months and when I saw multiple doctors and MRI. I was referred to different specialists and medications thrown at me like crazy.

It wasn't getting better. I'm like, “This is crazy.” A friend of mine said, “Have you tried physical therapy?” I said, “What is physical therapy?” I had no idea what it was. I went to physical therapy and within one week, I was already starting to feel better. Within three weeks, I said, “This is what I want to do with my life. I can be an engineer of the body instead of an engineer for other things.” That's led me down the path. That's one of the reasons that I'm passionate about our profession. We can help people naturally that we don't have to be spun in this web for months or years of pain until they find me getting physical therapy as we hear it all the time.

A patient had five years of headaches within about a month of treatment with us, the headaches gone and tears rolling down her eyes. She asked me a common question we hear from a lot of people, “Why didn't I get it earlier?” That's a good question. It is something that us, as a physical therapy community need to solve. Why few people getting into us? Why are they seeing specialists, MRI, surgery and medication only to often fail that and then come to us?

We fall short in that regard. The marketing efforts of physical therapists over the years have been so focused on, “Talk to the doctor and get that referral from the physician,” that we've failed as a profession to market what we do to the communities at large. Even nowadays, I've been a therapist for many years, the question continues to come up like, “What makes you different than a chiropractor? Are you a massage therapist? What do you guys do?” Many people don't know and that's a failure on our part.

One of the sad aspects of our profession is we all feel like we're competitors. It's a crazy thing. In my world, we see such a small percentage of our community. We're always worried more about our competitor down the street doing the fact that 99% of the people in the community aren't getting into either one of us. We work to band together. We couldn't handle the business we have, instead our patients are going to a chiro or getting MRIs, medication, surgery and seeing specialists. It is something we can work on. What you're doing, Nathan, is you're working on that. You're trying to bring people together and through consulting, networking and these types of podcasts. Other people who've been here like me are sharing some similar ideas.

That's a lot of what the pandemic has led owners to do is to not focus on physicians because that physician pipeline essentially got cut off in a lot of places. How are we marketing now to get those referrals in the door, to get those patients in the door and see them because people are still getting injured, whether we have lockdown or shutdowns? It doesn't matter. They still need physical therapy. A lot of my shows have been about how to use social media, how to do the direct to consumer marketing route and spread our message so that we don't necessarily rely on physicians to also get it out to the people that physical therapy is available to them.

PTO 122 | Sustained Growth And Success
If we combined our efforts and promoted our profession, that alone would have a dramatic influence on all of our business.

Imagine if our profession, all of us, whether they're next door or the next city over, if we combined our efforts and promoted our profession. That alone would have a dramatic influence on all of our business. The concept of rising tide would in full effect on that. That’s my story about becoming a physical therapist in terms of how Coury & Buehler Physical Therapy started. My founding partner Rich Coury, we met as I was doing internships at a place and we became instant friends. He was maybe a couple of years ahead of me. We weren't far apart in age. We clicked and connected as friends. I finished up there and started working somewhere else and he was working somewhere. We would hang out a lot.

We would grab drinks or lunch. He came over and hang out with my wife and me. We were friends, but we also were both passionate about the profession. We would spend many evenings talking and dreaming about, “What if physical therapy could do this? What would it be like if the place we worked at providing this type of care? Is this constant dreaming envisioning of the ultimate physical therapy company? What would the dream vision of a physical therapy company look like?” We talked and talked. I remember one night my wife saying, “Are you guys going to keep talking about this or are going to maybe follow up on these dreams? You seem like you have the passion about it.”

Rich and I met one day and said, “This is the time. We have this vision. The physical therapy model that we think is better and will provide better outcomes and results for patients. Let's do it. What do we have to lose, my house? That's about it. Let's move forward.” It's been a fun ride. Since then we've grown since day one and that was about many years ago. During the first couple of years, we found that to be a challenging time but we grew quickly early on I think just because of our good looks and our charisma with treating.

We hit this wall where we're kept. We felt like we're limited in what we could do. We didn't know what to do and how to get to the next step. That's where we started luckily to meant that we needed help. At that point, we got some consulting. We started networking with incredible physical therapists like yourself, Will, Vinod, Lisa and Beth and all these great therapists. Getting help from different people, talking and reading books, taking on the posture from that day forward of being a learner in terms of not as a physical therapist, but as a business owner and practice owner who wants to improve the profession.

That's something that I've always loved about you is that you've always come from a place of so much wisdom. I've read books that you've recommended to me during the course of conversation. I don't even know if you remember that you've recommended books to me, but you've been someone who's always been looking for more information. You are a learner trying to absorb as much as possible to improve yourself, not just professionally, but also personally. That's kudos to you and it goes to the typical pattern of a successful physical therapy owner that I've seen in 99.5% or 100% of the successful PT owners I interview. They recognize that they need help.

We didn't learn any business things in physical therapy school essentially, so we need to get some business acumen. Networking is huge in that regard and helping you know that, “I'm not in this boat alone. There are other people who have done some successful actions that they're willing to share.” The networking alone can be a huge aspect of it. There are always books that can give you inspiration, insight, and that stuff. I'm reading one called Grit by Angela Duckworth.

It's an awesome book. I haven't read about the topic that we're going to discuss but in the course of our discussions prior to this interview, you told me that other owners and younger owners might come to you and say on occasion, “What do you guys do? What makes you successful?” I thought it was great that you came back to we really live our purpose and our values. That's where I want to take this because we've discussed this on the show before not you and I, but other guests about how to establish a purpose. How to establish values and exercises you can take your teams through and how important it is? I know that you guys live that stuff. You guys reference back to it. You use your purpose and values as a filtration system for the choices and directions that you go to and your physical therapy ownership. Tell me a little bit about that. What was the Genesis of finding your purpose and values? Then we can get into, what are you doing to keep it alive and well?

I appreciate you bringing this up because this is something I'm passionate about. It is funny. We have people come up to us often either calling us in PT network meetings or wherever like, “What is your secret sauce or what tricks you got? What are you doing?” Everyone thinks we have some magic thing that we're hiding behind the scenes for our success. Everyone's looking for that one answer. What's that one book that turned it for us or that one marketing guru we're following? We all want that in life. We want the pill that'll make us lose weight. We want the one exercise that'll give us big biceps.

We all know that it's much more than that. It's more complicated than that, but the reality is my answer to everyone is that it's our commitment to our purpose and values. I know it can sound commonplace for people to say that or to throw that out there. For our company, it's been true. I told you about the story of how Rich and I started the company and his dream, but a lot of our dreaming and visioning is starting to talk about our purpose, vision and values. Back then, we had no business training. We were young therapists. We didn't know what it meant to create a purpose statement and core values, but we were smart enough to know that those things mattered.

In a small business that experiences ups and downs, having a stable and lived purpose and values is like a lighthouse in a storm. Click To Tweet

We started talking a bit about it. We didn't necessarily use the word purpose and values, but we would talk about what we wanted to be about. We talked about how we wanted the company to operate and the type of people we wanted. We started in those early days formulating our purpose and values and the same concepts from day one before we started the company. I was telling people, I started the company about 1.5 years before the company started. It started with Rich and me talking about it and dreaming, visioning and creating these fundamentals. Once the company started after one year or so, we decided to get real fancy and write the things down we talked about. Put it on the wall.

It's a piece of paper. It was a rudimentary version of what we came up with. Those things evolved a bit as we started to find out more. When you're at a company, it's like you go from being a teenager to an adult. Your company evolves and develops. Over time, our values did not change, they matured. What happened maybe about many years ago is our company growing. We also have grown a leadership team, which is phenomenal. We decided to sit down as a leadership team and to relook in a new union of time. We call it our vision statements, purpose, values and BHAG.

We spent a whole day, maybe two days offsite, just looking at that. What we did is we didn't add to it, we simplified it. We looked at every single one and said, “This is too complex. Let's be real with who we are, our purpose and values. Those two are great, but that's not us. Maybe we liked it, we agree with it, but let's focus on what we know we will die for.” We went from maybe 8 or 9 to 6 core values. We refined some of our other statements that we have what we call team creed. We have our BHAG. We have a care statement. We took what we've always had, and we refined it. That's become the foundation. If you want to know what our process for success, it would be those things.

What I want to highlight is you thought it's important that you guys took two full days, one would be enough for me, to focus on this.

Two full days after already having stuff in. We've already met years formulating and refining it. We decided to take two days to refine it on the stage for the next many years to reach our BHAG.

Purpose and values shouldn't necessarily be changed all that much. Maybe they get altered a little bit. As you said, you mature and you change a little bit because life and business environment change over time but you took things and simplified it that sparked a memory in our ownership. We recognize that we spent too many hours in meetings. We simplified and became more efficient in that regard. The same thing, we had these values, but we didn't have any definitions behind them. We took the time to come down to some concise phrases that weren't more than a sentence that describes those values to be more concise and clear about what they meant to the company.

Even though we all had our own individual definitions, we felt it necessary to define what those values meant in our company. What that look like? How does that show up? We also had some other things. We had cultural values as well, that was separate from our core values. The fact that you took much time and were that specific and intentional about it, could you say after doing something like that many years ago, it provided more clarity and maybe even a better foundation, a jumping-off point for continued expansion and growth?

We've always focused on them and made them part of our organization. At that point, it was another turning point in the company where we decided to more fully commit to our purpose and values than ever. At that point, we got more committed to making sure that every part of the organization was ran based on those values or reflect those values. We committed to instilling that more in the company and found other creative ways to make those alive in our organization.

Let's get a little bit deeper into this specific. What are some of the action items you take to have your purpose and value lived through each individual in the clink? How does it get from the owners and distilled down into the everyday actions that even someone at the front desk? If you use technicians to get down to the technician, what are some of those things that keep it alive and don't collect dust on the show?

PTO 122 | Sustained Growth And Success
Sustained Growth And Success: Your company evolves and develops over time. Your values evolve a bit as you start to find out more.

One thing is interesting is you hear a lot of people talk about, “I've done that. I got that.” Most of my friends not in physical therapy, I try to connect with a lot of my friends who have businesses outside of our industry. I love learning from people outside of our industry, but I find the majority of people I know who have done this, it's something they put on the wall. It's like, “We got it in the break room or it's in a policy manual,” which means everyone read at once and then forgot about it. It's a mistake a lot of us make. Purpose, values and vision statements, those only have an effect on the company if they are ingrained in the fabric of the company.

We talk a lot about Pinocchio at some point became human because he got a soul. We talk about our company is not human until it has its purpose and values breathed into it. Another way to say it is that the personality of our company is based on our purpose and value statements. It's the person that's who we are as a company. We have to be lived and breathed. There are multiple ways we do that. Starting with, first of all, recruiting and hiring. The first entry point of the company starts with measuring every single purpose to our purpose and our values. We use some statements that even our recruitment ads about our company because we want to try to track people who are attracted to that. When we do our interviews, the first questions are all against our core values and our core competencies for that position. Right off the bat, we're asking questions based on each of our values because we try not to take generalizations or trying to get specifics on how they maybe align with the value of teamwork.

You can say you do, but tell me how and what that means to you and describe it. Based on the initial screening interview, you can get an idea if someone aligns with their values and if they don't, it doesn't mean they're bad or were bad. This is who we are. We sell maturity and growth to do, but we know who we are. We know the type of people we need to bring on. Our companies not for everybody without a doubt. We know who we're for. We are for a certain type of people who align with us and the people who do aligned with our values or our track, they do well in our company. The first thing we do is we hire based on that.

We did the same thing. We've listed our values. This is our purpose. This is how we do things in our company. It's interesting as you do more interviews, I don't know if you're still doing a lot of the interviews, but as we were doing the interviews, you watch body language. As you're starting to talk about values and the people who are bought in start leaning forward a little bit more and they light up a little bit. The people who aren't bought in, you could tell in their body language. They don't care as much. I agree. It starts there. You start discussing those at the forefront and so that they recognize that these are important to us and you can find those people that work well with you. It's easier to do as you do more and more of those interviews.

What's hard in our clinic or with my coaching clients is we'll talk about purpose and values at the beginning. I think a lot of companies go through this and that the owners get this bright idea that, “We're going to establish purpose and values.” Two to three months down the road, it was like, “Did we talk about that one time? I forgot.” It has some initial momentum and then falls off. I know you guys do more about that and you're going to share a little bit more with us. I just want to interject a little bit, but go ahead.

Once we hire someone based on our purpose and values and someone we think is aligned to that. The first thing they do is go through a training course on that. It takes them several hours. They could read the purpose and values, but we created a several multi-hour course that takes into the reach component and goes in-depth on what that looks like. We even have some fun video examples. We'll read. We're trying to impress that into them. It's one thing to say teamwork, but what does that mean? What does that look like? We try to press that into them and then have them answer questions. Not just like ABC, but some essays. They got to think about it and write it down because we want people to process these things.

That's the next thing. They go through that and during their onboarding, we're making sure that they understand and agree with it. There have been times where maybe we brought someone on and then during the training we realized, “I don't think they're a good fit. We're finding maybe they don't align with these values.” That's the initial thing we do. During their onboarding, the first few months, their managers are continually watching and making sure this person is the best fit. They continue to match this person to who we want to our purpose. This person agrees with our purpose, this person agrees on these values. Can they live at our team creed? If they don't, they're not bad. We're not bad. It's like, “You are probably not a good fit. This is who we know we need and I don't think you align best with this. You'd better in a different setting.”

Those are some of the easiest firings, aren't they? When you do a value-based firing like those actions that you're doing or performing aren't living up to this value. You're not exemplifying teamwork when you act in this manner. If professionalism was one of your values, it's not professional and we can't tolerate people who come in late consistently. That goes against professionalism. We're going to have to let you go. You're not a bad person. We don't tolerate people who don't align with the values.

Most of our hiring are more based on values these days. Those are the big things. Beyond that though, the question is how do you make it a day-to-day part of the organization? It’s because it has to be and if not, it'll become that type of thing where like, “What did we want to talk about? Isn't it on the wall in the break room?” There are multiple ways we do this and different things we experiment, try and have fun with. I'll go through some of the different ideas. One, we have a display. It's displayed everywhere. It's on our website. We don't hide it. It's in every one of our clinics. It’s somewhere were patients could see it. It's in different admin areas or breaks rooms. It's displayed to remind people. During our weekly meetings, we try to focus on a different value each week that we were cycling through them to continue to drill through. Maybe every couple of months, they're getting back through the cycle.

The secret sauce to our success? It's our commitment to our purpose and values. Click To Tweet

You're talking about and maybe, “Have a short couple minute discussion about a particular value.”

A real quick and maybe a minute or two. This is the night of the week. You talked about it. Maybe share a win based on it. Maybe we'll take a couple of minutes and camp on that and have a quick discussion about it or bring up a patient experience on that and things like that. We do a weekly email from one of the founders, Rich or I. Every email we always try to highlight or one of the values of the week and talk a little bit about that or maybe share a story about that trying to interject that into it. Our HR manager sends out a weekly value of the week award winner. Another great way to promote either a purpose, one of the values or one of our vision statements. Somebody who's living out one of those aspects. They're getting recognized and sharing a fun story about them. It's a sneaky way to remind people of that value because we'll get your coworker to live this out. Remember, it's one of our core values and that's part of our purpose.

We did the same thing. We didn't do it anything weekly like that, but at our annual parties, we would have a value award for a particular employee and highlight some of the things they did over the course of that year that exemplified that value. I'm sure your HR person is doing that same thing but on a weekly basis. This person exemplified blank because they did blank, that exemplifies this value. I think that's great. That recognition brings that to people's minds, especially the receiver of the award.

Our leadership team met and we are starting to finalize our awards for our annual Christmas party. One of the big aspects of our awards is our value awards and we give out awards based on each value. I worked on that and coming close. That's another way to do it. Those are some of the main ways we do that. Each manager during reviews or the reviews are off that's part of the route integrated into the review process as well. We're always finding fun ways to interject that in or sometimes we'll send out a random story or video to remind people of something.

We did the same thing with our reviews. It was not only value-based recruiting and hiring and value-based firing and value-based reviews. In our reviews, to get a little bit more specific, we would have the person that we're reviewing fill out essentially the same sheet that the supervisor would fill out. That was here are the values. What did you do in the past year, six months or whatever the timeframe was to exemplify those values and maybe even give yourself a score or maybe on some other things? The person who was being reviewed would say, “These are some of the things that I did.” The supervisor would say, “These are some of the things that I've seen you do and how can you improve on some of those values, live those even better and more fully in the company.” I love that you brought that up. It reminded me that you take values into recruiting, hiring, firing and exemplify on a regular basis, but also bring it into things that might have pertained to a salary increase or a promotion. You want to promote those people and you want to give salary increases to people who live out those values.

One of the best byproducts of this is culture it helps create. We're very protective of our culture. You probably have read Good to Great by Jim Collins. There's one part of his book that stuck out to me. It's one of the most memorable quotes from a business book I've read. He talks about your goal is to have your values infused into your company. He says, “Your culture is so strong. You have a cult-like culture.” Anyone who joins the organization either gets swept up into these values or they stand out like a sore thumb and get injected like a virus.

I'm like, “That's a powerful analogy or description of what it should look like.” You can create such a strong culture in your company based on your values and your purpose where people who joined the team get swept up in it or they stand out. There's no in-between. The people who stand out, it's like that group pressure where you better join and get out. We're not perfect at that, but we see that at times. When we're doing well, you see that and it’s a good place to be. Culture is everything. Your team depends on having been working in a great place, a place they love and believe in. No one wants the drama. No one wants the other stuff.

It takes some years and some intentional effort to get to that point but I know that over time we can develop that culture, such that people have finally gotten to the point where the purpose where they're waking up knowing how they're going to fulfill that purpose that day. Not that they're waking up and going to a job and punching the clock. It elevates things to another level for the people that buy-in once you establish a strong culture like that. These are people that will stay with you through thick and thin, work hard and maybe even for less than where they would get other places because they buy into exactly what you are fulfilling in them and as a company. It creates so much strength.

COVID is a tough time for people. You see everyone handling it differently. Now more than ever, our teams need a North Star, a guiding light. They need to have something to look to. There are a lot of confusion and chaos in our offices. There are frustrations. Everyone's a little bit have difficulties outside of here. There's this challenge and reminding, “I know things are harder. I know we have more in tribulation in our offices, but this is who we are. Focus on this.” We’re headed towards that goal. We just get to look up. I know this stuff stinks, but remember, this is what we're about. We're about changing people's lives. The other stuff settles down a little bit, it’s like, “Compared to that, this stuff's not as important.” People are sick or different things going on because of COVID, but if we can continue to focus on a purpose, it helps people be aligned.

PTO 122 | Sustained Growth And Success
Sustained Growth And Success: Our purpose, values, and vision statements only have an effect on the company if they are ingrained in the fabric of the company.

Has that been a stable thing for you as you've gone through the COVID experience these several months? You have seven clinics and you're a successful guy, but you got bruised, battered and hit like every other PT on are out there. Did you find yourself reflecting back to the purpose and values and may be either shifting them a little bit or relying on them more in order to get through it?

As a company, we decided to close down for three weeks. We decided to mostly because we wanted to regroup. We wanted to decide as a leadership team on how do we run the company? What do we do? We want to provide care but in the safest manner. We took time, but Rich and I were back in day one. We came back to the office and felt like it had to be here. The very first thing we started talking about is, “Let's remember what we're about.” We can sit here, cry, complain and get frustrated. There are all these things we could talk about, but we know what our purpose is. We know what we need to do and let's focus on that.

Sometimes we talk about our purpose being like a lighthouse. You're in a storm and lost at sea, which direction do you go in? You see the lighthouse, you’re like, “I know where to go.” There are many times in our company history for ourselves and our team that that's been the case. It’s like, “We know where the lighthouse is. Let's go in that direction.” We were all bummed out. Seeing our company closed down brought tears to my eyes, but that didn't last very long. Within minutes I'm like, “I'm not going to cry about it. I'm going to focus on what we need to do because I know the purposes. That purpose includes what we need to do for patients and our team.” We started moving forward.

I can imagine that your weekly newsletters over this period of time in 2020 have had to focus more on the bigger picture perspective, why we're doing this? These are the decisions that we're making and this is why and how it relates to where we're going. Did you find that you had to reflect back on that a lot?

Yes.

Especially with the decisions that you were making, were there some things that you changed in your workplace due to the pandemic? Maybe you let some people go or you changed some things around on how you treat but still, you bounce those things and filtered them through the purpose and values.

We did have to make some changes. The biggest change was changing our treatment model to have less people in the office at one time. Administratively spacing people out. We have a lot of moms, we had to support them. Some couldn't come back to work yet. Some needed to work from home. Shifting things around. We're often comparing things and decisions against the purpose, but this is a time where we at it continually do that and remind ourselves of this is what we're about. This is not best for the business, but this is who we are as a company. This is our hardest decision based on revenue, but this is who we are as a company. We need to make this decision.

When you first established your purpose and as you've refined it over time, I wonder how you defined it. As I'm working with my coaching clients and I asked them their purpose which has something to do with, we provide great physical therapy care to the residents of blank. I want to tell them, “That's what you do. That's your job as a person and as a company,” but it's more about the why. I'm wondering if that's how you've thought about your purpose over time and came upon it. It was like, “You do physical therapy, but for what purpose?” It goes back to a higher purpose which I talked about with a 30-minute key and that is helping people live pain-free. If that was your higher purpose or support the surrounding community so they're healthier. How you go about doing it is you provide physical therapy. How do you define purpose and how it helped you clarify what your purpose was?

We're on the same page. We have always seen purposes as the most important question. The purpose for us is the, “Why.” That is the first and foremost, question decision that any business makes to help make all the decisions under that. You see a lot of businesses in our industry and not in our industry, start a business and they haven't made this decision and they're making these decisions. The problem is these decisions can be right or wrong. If they're not, they don't know they don't figure out the why. When we came up with a purpose, that was the thing we were talking about, like, “Why do we exist? Why are we here? Why are we doing what we're doing?”

Those are the overarching type of theme. What we also decided is we felt like our purpose needed to transcend our industry. I feel like your purpose is in your industry. It’s not as bad. Our purpose is to help people out of pain and that’s awesome but we felt like, “Maybe our purpose should be bigger than that,” because it takes us out of the industry and is more important in our industry. Our purpose is to enhance the lives of people in our community. Our focus is helping our patients get out of pain, this includes our team and the people around that you work with even vendors. Vendors come in to enhance our lives. Whoever we're dealing with. The neighbors in our building, let's enhance their lives. It gives us a little bit of a different perspective on what we do overall.

The personality of our company is based on our purpose and value statements. Click To Tweet

As people start defining their purpose, it becomes less about the physical therapy they provide and what they can do for other people's lives and broadens the influence to not just the patients. As business owners, we want our team members to feel a certain way, to have a certain experience and experience a certain culture. We want to be the ones that establish that culture to better their lives as if we were working on a patient one-on-one. We want to enhance their lives and we want to enhance the patient's lives and thus affect the community in multiples. As you establish that purpose, it becomes less about the physical therapy itself and the care that you provide, not less about that, but to also include the workers, the people who are supporting you and the people that you interact with in helping the vendors, the workers at the physician's offices to include everybody that you come in contact with. It expands to more and more people.

Everyone in the team and what our position is can be part of that purpose. It's bigger than just helping patients in pain. Enhancing lives may look different for each person in our company but we can all be a part of that.

Were there some books that were influential to you in regard to purpose? You mentioned Good to Great but were there others that guided you along in that regard?

All of the Jim Collins books touch on that. Simon Sinek’s Start With Why and the Scaling Up book as well. There are others, but those helped formulate some of our thinking.

Is there anything else you want to share in regards to the purpose and how you guys live it and breathe it in Coury & Buehler?

It affects and influences most of our decisions. In terms of how we run the company on a day to day basis. Big decisions we're making in terms of a standard to measure our company with. Rich and I, when we meet, sometimes we check each other on this. We'll be talking about things and be like, “Remember this is our value. Does that align with that? We talked about this, we know what we're about.” We check each other all the time. If we didn't have that, we'd be making dumb decisions.

One of the things I'm most proud of is our company is, it's not Rich and I, we have a team of partners. That came out of Rich and I, when we were going through our purpose and values realizing that there are a couple of values that compelled us to expand the ownership team. We had some incredible physical therapists that we felt like based on what our purpose, our values and some of the things that we want our culture that we needed to provide that opportunity for them. That stemmed out of the purpose and values that we’re going through.

That's the easiest route to expansion is to find those people in your company that you've not only vetted but figured out they align with you. There's a great Jim Collins phrase, “You find those people who are truly aligned with you.” It's to expand when you have those people on your team and open up other clinics, grow or provide them leadership opportunities. It makes growth so much easier and fulfilling.

It's fun to see them grow and reach their dreams.

PTO 122 | Sustained Growth And Success
Sustained Growth And Success: The people who align with your values will do well in your company.

You provide that foundation from which they can build off. It's not there unless you have those purpose and values and have them well-stated because they've been with your company for a period of time. They align with you through all the decisions that you've made with them over time. To help them expand and start up a satellite clinic and get the next clinic going. They're simply living those purposes and values. You don't have to train that up all over again. They continue the cycle all over again. That makes it so much easier.

We've never brought someone from outside for a higher position. Everyone starts in a position. Anyone in management or above has grown up in the company. They are moved up in our system.

Thanks for your time, Brandon. It was great to have you on, you've got a wealth of knowledge and wisdom. I finally got you on the show so you could share that.

Thanks for having me.

Do you have any contact information you can share or a website people can go to check out your clinics?

My email is BBuehler@CBPhysicalTheraphy.com. My cell is (714) 345-0426.

You've grown a ton. It's impressive. You've always been someone that we looked up to. I'm glad that we could tap into some of your wisdom. Good luck with everything. 2020 has been a tough one but I know you guys are in a great position to withstand it and grow going forward.

I appreciate what you're doing for our profession. I love your podcast. I love that you're helping coach and consult for other physical therapists because our profession needs that. Kudos to you for what you're doing for our profession and for all the help you're providing for physical therapy private practices out there.

That's nice of you. I appreciate that. Coming from you, that's a huge compliment. Thanks.

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About Brandon Buehler

PTO 122 | Sustained Growth And SuccessBrandon decided to become a physical therapist after being involved in a car accident and had to go through months of treatment in order to return to playing soccer in college. After experiencing how physical therapy helped him return to his normal activities, Brandon decided that this was the career that he wanted to pursue. He has a passion for helping people return to their sport or daily activity without pain or limitations.
Brandon has extensive training in orthopedics and manual therapy through the Institute of Physical Art. He places high value in continuing education and training at CBPT. Brandon emphasizes the importance of quality and personalized care with one-on-one treatment for every patient.
Brandon is also the co-founder of POISE (Prevention of Injury and Sports Enhancement), Richard Coury, MPT, assisting athletes in preventing injuries, helping them in full recovery to their sport and improving performance on the field or short.
In his spare time Brandon enjoys spending time with his wife and kids, running, working out, hiking kayaking & paddleboarding.

He enjoys spending time with his close friends, especially enjoying a meal from his barbeque.

As a native Philadelphia, Brandon is always on the way to pizza.

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