4 Major Concepts to Uplevel Your Practice

Align Your Practice podcast with Dr. Cliff Fisher where your best practice and life awaits you. Are you tired of running a practice on your own? We want to come alongside you with experts to help you create your dream practice in your dream life. Here is your host.

All right tribe. Welcome back. I'm super excited last time, we made it all the way through all the different ceilings in chiropractic. And so today, what we'd like to do is really sum up and talk about like, after we went through that, like I had a couple of takeaways, Dr. Joe, I know you had a couple takeaways. So I guess like for we talked about it, but what were your two favorite takeaways of everything on how to go from each level, because we talked about level two level two level, but there's also this thin red line that kind of keeps everything tracked. And it was like the same thing. It's just different up leveling, do whatever your two favorites.

So I think yeah, a lot of it was granular data. But overall, as a premise, going from launch, to build or build to scale, those three stages, my number one thing I think that has to happen is it has to be an up leveling of the planet, the maturity of a planning, time you spend on planning. And I know you're gonna go down the road of people, and teams, so important, but I feel if you don't plan adequately, as you go through the stages, you're going to get in, you're going to get in trouble. My second one would be budgeting, maturity and the way you budget money. Because as you grow, and there's more money coming in as more people to be paid, and it's more goals and deliverables, you got to get more mature in your budgeting, what would be your chip.

So my two, just like you alluded to, number one would be hiring and onboarding, like getting the right people and making sure the right persons in the right seat on the bus. And then the other one was training and equipping. And so and super,

don't realize that onboarding, training. That's important. Yeah.

Yeah, so tell me about planning. So what's your thought? Like? What do you feel like people should be planning because I think that's a huge blind spot for people. Yeah, it's

interesting, because when you're the owner, operator, everything's based around your energy. When there's adversity, it's cleaned up quick, when there's a morale issue, the your energy will help you resolve that fast, your energy is such a, you don't realize it. But if you're an owner operator, the power of your energy is intoxicating. your passion, your energy, your commitment, your conviction, your purpose, your philosophy is intoxicating for the team for the patients for everything. So things just seem to flow and move better, even if it's in a chaotic, chaotic state because of the energy of the owner operator. So what I realized, and I realized this in hiring a manager and seasoned Manager with 1015 years experience in healthcare, I didn't feel I needed to train the manager because they were so experience. So I brought them on and like, Well, you do your thing, here's what our goals are. But I realized they didn't know our core values or mission or vision or purpose. And they took the business in their direction versus the direction that we set. And what that taught me was that not only when you go for onboarding, that's, that's a lesson I never validating your point. But it is, you know, when you're a CA, you should plan about 5% of your day as high as 10%. But let's say a 5%, your week, so it's 40 hours a week. 10% of the time, it's only four hours. So if you spend one hour on Monday, planning the week and a half an hour every morning, getting ready for your day, that's 10% of your time, if you really think about and CA's need to level up that time to plan their day. Now, if you're a manager, like an office manager, it should be about 20% of your time spent planning, not just planning the day planning, staff reviews, planning, quarterly strategic sessions, planning a review of the rocks of the deliverables, there's a lot of planning that goes on. If you're now moving from, let's say, launch, which is, again, chaotic crisis management, you're trying to get this thing off the ground and you go to build. Now you gotta plan like you. Like you preach to the Align life clinics, you want at least a quarter head and your marketing count. Like you have one marketing calendar for 90 days and you have another marketing calendar for the next 90 days. And a list of what the campaigns and the events are most likely for a full year. So it's way different than launch right? So that's build when you get to scale it means you're don't have this Although in your hand, you're not digging a ditch, you don't have the screwdriver. You're not tweaking things. You're out being a visionary, and a stretch strategic leader. So that takes 30% of your time. And that's the hard part. And when we had this discussion, Cliff, I love what you said, the anxiety of not doing the work and doing it right, right.

Yeah, cuz I mean, when I had to shift to planning, I felt like I was being lazy, because I'm like, Oh, I'm just sitting in front of this, I'm not bringing any money into the clinic, I'm not doing any work, real work, it was tough. It's,

there's a guilt associated. So take this point by Cliff, really, strongly take a note of that, because you're gonna feel that once you step out, but if you don't step out in scale, scale is leveraged scale is what everyone wants, when they own a business, there's two parts of scale, you either stepping a little bit out of your clinic here, you're not the main practitioner, or you're opening another facility. Either way, planning is gotta go up significantly. So just set that in state, about 30% of your time planning, put it in your calendar. And I know, Cliff you and I, we have an area of strategic planning, we have an area for planning, you have a thinking chair in your office of when you think planning is, is so essential. So that would be my take left for for my number one.

That was funny, because I'm bringing up mine, I'm like, man, so hiring is also planning because you can't like when we were talking about your two and my two as like, my two are interrelated. Like they come together like this. It's not like anything separated. So it has to be like a system that functions and so hiring and onboarding. So one thing with hiring, hiring, for me is like the foundation. And I think my tendency when I first started was to hire people I liked. So I had a whole bunch of people that were like me. And so I had no diversity on my team. And so there was a lot of exposed areas and a lot of weaknesses that I couldn't compensate for, because I didn't have the right team member on our team. And so we don't have to be good at everything. But we have to have a team that's good at everything. And so we were really like our whole team was relational. And, you know, it really created a bunch of gaps for us that we had to rectify later that we didn't even really see. And then now starting to build new offices. I'll go ahead, Joe.

Well, I think when you stepped out, and you have a good story, which we'll talk about another podcast, but you stepped out fully where you weren't in the clinic, you weren't around the clinic eventually. I mean, you went back and forth. Yeah. But eventually weren't there. Those holes probably became more glaring, easy to see. And scary, right? First, when you were in your energy, you didn't even smell it. See, it tasted as much, right?

Yep. And you could rectify it faster when you're present. When you're a present owner, it's definitely a different game. Yeah. But when you're a non present owner, like, you know, you have to use the data, you have to use the stats, you have to make sure you have the right people who are going to drive it because like I had one office where we put in a caregiver doctor, and we're trying to build the practice, and he was the only doctor there. And it really struggled. And then now we put in practice builder and the office is just taken off. So making sure you have those right hires. And then onboarding is a 90 day process, the worst thing you can do is when you hire somebody, just like you talked about with your office manager, I would hire somebody, I'm like, oh, man, they get it. I would just, I got other things to do versus nope, pour into them for 90 days, Dr. France, and he taught me that it's like, just keep pouring into him for 90 days. And you know, that'll pay off for three years or 10 years.

So yeah, the point in onboarding is, like they have to understand deeply your core values. And here's the good point is, when you're stepping out of the main office, let's say you open a second or third or fourth office, and you have a manager hiring. If the manager hires without understanding that values, which are the blinders or the direction, or the decisions or the culture of an organization, it's the energetic expression of the organization. And they don't know the essence of the values, I think, no, I don't think I know, you're going to start to derail the clinic with new hires, because they're going to be hired under a premise that only the office manager knows. And you'll see this with companies and the owners of Infusionsoft, which I talked about in the book scaling up, and a company I've used for 20 years. I was with him when they started and I watched their growth. They had said once managers started hiring middle managers without the owners, the founders influence the company's morale and culture changed. And they had to spend five years cleaning up because they had a middle management level, let's say 5080 people that didn't understand the vision of the founders. So that was a really shocked me and it made me and then what they did is they moved for a facility that was like a football field. Have, and then their values on AWS, they have their values everywhere, they uplevel so much to offset the damage that was caused. So for those of you in the owner operator looking at moving from build to scale, and you're making that decision, put a stake in the ground, and you're like, I'm going to leverage the value of my experience. And I leverage my time, I'm going to leverage my knowledge. And I'm going to now have more people doing more under my, my direction, but I'm not exchanging time for money anymore. That's the power of scale. And when you go into that, you have to be humble, there has to be a little humility, because when you're the owner, operator, you solved everything. And there were no problems like Cliff said, if there were six staff that were all like you, you just made it happen. When you step out of that, it's going to be glaring. So have humility before you make that step and just do a check on the team to make sure that you have those spots fully, like Cliff mentioned. Okay, so that's to us. That's one of my top ones, one of yours. And it's interesting when you said all of them, because my next one's budgeting. And I think I'll end with that. Maybe you do this next, but they're all planner. Right? That's all.

Yeah, it's all planning, right? Yeah, I totally agree. And I think like a couple things are back on the hiring, right. So if you hire the wrong person, it's going to cost your company three to five times their annual income. If you lose the right person, it costs you 10 times their salary, in lost production,

rehire, if you've imagined, let's say paying 40,000 a year, and they're not the great greatest hire, and you got to rehire and re onboard, and retrained, go through all that the time that you're going to spend, instead of focus on growth on training, that leader is going to be 120,000, minimum, up to $200,000. In value, resource time, effort, lost income, is going to be $200,000. So that's something to think about guys. Because don't hire on a whim because you're desperate and just take whatever comes, you hire slow, fire fast, really important to know. So and then plus that if it's Rockstar, if it's someone that's grown your business, ready to three exited in a couple of years, which you didn't do before this team player, and you lose that player to find and get someone to that level clip is saying you're gonna lose 10 times that person's income. If they're paying 4050 grand, that's like 400 or $500,000. Clip? Yeah, that's big. I think that's from top grading maybe. Yep. Which is one of the most notable, hiring training systems out there. So that puts some credence on that number, that scary clip, and it makes me sit back and be like, you know, we got to make better decisions, right?

Yeah, it's definitely a place to slow down to speed up, hire slow, just like you said. And then, you know, fire fast like, and you alluded to it earlier on the core values. And like, why that onboarding so important, because they need to know what the core values aren't. I know how I am. When we bring people into our offices, I'm like, Okay, here's our core values. This is what you can expect from me in our entire team. And this is what we expect from you. This is also what we hire and fire based on. And so I do that on there. Day one.

Yeah, well, I learned this in great detail from pain of hiring. Remember, I hired two people for a line like corporate office, or for the franchise, I had at the same time we started with I did an hour and a half or two hour lecture to these two, and my team. And one of them lean forward in the chair, jaw, open eyebrows raised, taking notes, and, you know, asking questions that relate to our children and our mom, her neighbor, like, Oh, my goodness, and the other one was looking at her nails. I saw an eye roll once a big Huff puff, looked away. And it was so easy, is so easy when you speak your mission, your purpose, to read energy. And I don't know why this isn't taught at the entry level hiring, right? I mean, if we all just did that, then you know if they're on purpose or not, if I that person decided not to take the position, right before I told them, they're not right for the position, I went up to the table to tell her and she goes, You know what, and we both had the same message. That's before we even started. Most people be six months in trying to force that person. And in view, and this is key guys, what we do is we start lightening up our our purpose or our mission, because we don't want to make them uncomfortable. So we soften our mission to appease people as we love people, just because of the wrong seat and bus. You know what I mean? I mean that that does happen.

Yeah. 100% And I think if anything we've learned from COVID It's like lean into your principles, not away from them because as soon as you take a stand, you're just going to attract your tribe and the people that are like you and want to be around you.

And that's is not in our top four here. But that's something to take note on, is, make sure you stand stronger for your principles. When you go from launch to Bill, like put a line in the sand and strengthen your belief systems on what you convicted on what you believe, when you go from Bill to scale, and now you're, you're not the operator, you're the visionary and the strategic planning partner, or leader, you've got to level up that conviction, because you're going to be a step further away from the energy of the operation. So I think that's a good point.

Yeah. So my next one is, you know, so after you onboard them, then how do you keep a player so it's just it's training, and there's just certain things you have to have, you have to have certain rhythms, you have to have certain. Like, we have scorecards inside of a line life that you know, are awesome, and they help us keep our team member on track, because one of the worst things is you get an A player, and they don't know what winning looks like. And so with a scorecard, they know, am I doing well? Or am I not doing well, having clear job descriptions, so many people don't even know what they're supposed to be doing in some of these offices. Like, I know, I was working with the other business. And I'm like, Cool. Let me see your org chart. They're like, well, we don't have one. I'm like, Oh, okay. Any job descriptions? Not like, and he's like, Well, why people are underperforming. I'm like, they have no idea what to do. And he was blaming, like, they were blaming them versus like, okay, cool, like, help me get that. And so I think that's a huge foundational piece, like having those basic things. They seem fundamental, or they seem basic, but they're actually fundamental.

Yes. So onboarding is about understanding the purpose, mission vision of the company, the core values, and understanding their job detail, the behaviors that they're expected to do the resources, they're supposed to use, the software, the tools, the processes, the online infrastructure, the forms that the system, right, that's training is where you're refining their communication, you are refining the way they behave, how they relate with other, they got to come out of a position you call non existence, which means they just plopped into a facility or a clinic. They don't know who they don't know the person they report to. They don't know who reports to them. They don't have relationships, these people, they don't know what their strengths are, they're non existent. So what they their first move is to come out of non existence by building relationships with people finding out the accountability that each person has on a team, including themselves before they start the job, like what is your role? What is it? What are you accountable to, and then like Cliff said, you go to the org board. But if you're in build going to scale, it's important that you go back to the job descriptions, and make sure what they're doing is watching the job description. Because once you step out, open the second clip, it's like hitting that golf ball. If you put it and it's off by a little bit, you may still hit the hole. If you are drive it, and you're off a little bit, you could be 100 feet off the great. And I'm not a golfer, but

now you would mind.

Because it's swinging the club, I learned that quickly. So that's, that's finally important. I want to I want to say something about the scorecard verse job description. When we hire an online life. We're constantly refining job description, while we're learning through adversity and success. And the job description is really a set of behaviors that you're direct. That sir, I changed language, from your direct report to your direct support, your direct support person is giving you a framework of behaviors, that's going to give you the best chance of success. But it's just a framework of behaviors, your scorecard is the outcomes that your job is supposed to produce. So you use the job descriptions to understand behaviors, to create the outcomes that you have to accomplish on the scorecard. But it's really only about the scorecard. The job is about the outcome. If you find a behavior that may work better than what's in the job description, then you talk to your direct support. And you say, I want to try these things, you have a meaningful conversation. And you may shift a little bit of behavior to create the outcome on your scorecard. I know that may or may be confused, you may have enlightened somebody. To me, there's confusion between those two, and you got to know what they are. When you change your behavior, then you go back to your direct support person, and they may change the job description say this behavior. So it's a dynamic moving, beautiful process with the scorecard and job description, all attached to the org board that you mentioned. Saving Yep.

100%. So then for me hiring is about competency. A hiring onboarding is about competency training and equipping is about mastery. And so that's why those two for me are such a big deal. And I think that leads right into budgeting because if you don't have any money, you can't hire anybody. You can't do any of the things we want to do. And so tell me more about the budgeting Joe.

So So budgeting, budgeting is not just expenses. Budgeting is also budgeting growth. So the first thing you want to do is look at your income verticals and refine those in more detail and separate them. The more your business grows, the more granular data gets. So when you start out, you're like, let's say lead gen. How many would it cost for us to get a new patient? cost $200 For an average new patient, okay. When you go to the next level of business, you're like, what, how much does it cost for me to get a digital marketing lead in the office, first, an internal lead versus an external lead. That's the next step of the business. The third step of the business is how much for getting the lead from Google verse Tiktok, first Facebook verse, SEO through the website, each one has a different cost per acquisition. So data becomes more granular as you have more dollars and more people because there's more risk. So all you're doing is getting, and really, it's all about awareness, everything in business, that's why I love business, is because it drives my personal self awareness of me as a human and my consciousness through my life. So really, that's the beauty for me, is I learn about my own self awareness through business. Because as you get more granular in numbers, you get more granular in your own behaviors, your own thoughts, and how it impacts people that you do business with. And it's all measurable. So if it's off, you see it, I'm favorite. So, so in budgeting, you want to start getting granular, not granular when you get to scale in your first office. But when you get your fourth fifth office, you better start looking at cost of acquisition on a real refined basis on what your costs are. So when we're looking at top line revenue coming in, you may have chiropractic and align life. We have chiropractic, we have nutrition, we have weight loss, we have different services with the major piece being chiropractic. Now in chiropractic, we have x ray, when you get so busy and practice, you stop react train, when you get so busy, stop doing exams. What that does is not only affect quality of care and retention, but also revenue. And you have to see it on paper in a trend. When I'm doing budgeting I'm not looking at. And I know that our good friends, Steven Francis always talks about one number being a stat two numbers being a story. I don't want to numbers, I want a trendline I want to see month over month, what is the behaviors being initiated by the team creating in a trend? I'm looking at a percentage growth? Is it empower a 30%? incline? Is it in growth, a 20% increase? Is it stagnated? Or is it decreasing? That has to change behavior. So I'm looking at trends of numbers to assess behavior. So top line revenue, we're looking at X ray verse exam, first adjustment, right. And then we're looking at other services like weight loss and whatnot, every one of those should be growing, because the natural state of any business is growth. And if there's lack of attention, you're going to have an issue. Then when we get to the expense side of things, we have to put expenses in categories and apply percentages to them. So we can ensure at the end of the day, we have net profit, that's the green pieces of paper that you collect, put in your pocket and walk home to your family and put it on the table and say, I got food for the family, I got money for college, I got money for a new house, that green stuff has to be dropped to the bottom line by holding percentages in categories in your budget. And the last piece of the whole thing and budgeting where I was at a loss for over a decade. And when I learned this, it really changed all the businesses that I've been associated with, which is when you budget your growth, let's say you want to grow your chiropractic clinic, and you're a half a million dollar business and you want to grow to a million dollar business. You have to say the average spend in marketing is eight to 12%. Let's say let's say 10%. You're half $1,000,000.10 percent is $50,000. If you want to go to a million dollars, how much should you spend in marketing? You may say half 1,000,010% $50,000. So 50,000 divided by 12 months is 4000 a month. But you said you want to go to a million dollar clinic. So your budget of marketing is 10% of the future money. $1,000,000.10 percent of a million dollars is 100,000. If you budget 50,000 Because that was your budget at half a million and you want to get to a million you won't get there. You have to save 100,000 So what does that mean? You need savings. You need to plan for your future growth by having net profit enough to keep the car offers for with enough money, or your credit, your income to debt ratio, your books have to be clean enough that there's a nice person at a building down the road that has a lot of money in a safe called a bank that thinks that you're worthy to give you some of that to grow your business. So you may have 50 and get another 50 from the bank. So your marketing budgets 100,000. So again, the end point there is the budget is on the future number you want to hit not on your current member. And that will level up your business faster than anything, if you follow what Cliff said, you cannot miss the the hiring, onboarding, you can't miss that you can't miss training, equipping. And overall, all this is around, right and planning. So

yeah. Great wrap up, Joe. So this is definitely one of my favorite thoughts just as far as wrapping everything up. And so the four things we talked about was planning, hiring, training, and equipping and budgeting. And, you know, one of the things that came up for me in budgeting was the profit versus top line revenue. Everybody talks about top line revenue. But what's really sexy, is that bottom line, what you take home, what you take home to your family, where you are able to invest, and just being able to have that planning and because what I see with doctors is they start to earn more, and then they increase their lifestyle versus like, go two or three years like don't let your lifestyle increase as much as you do let your business like invest in your business for the first three years

are counting from that works with franchises around the country gave us a compliment and said it's weird. You guys had a line line focus on net profit with the clinics, when most companies are, you know, that's doing service like we do or focus on top line revenue, like how much money comes in. And I said, you know, our line life has grown to this day, just by referrals and word of mouth, not so much by marketing, which we're going to start more aggressively because we look at making sure the doctor has money at the end of that sheet of paper which is net profit. We have to teach people how to do that because I know many doctors that run a multimillion dollar clinic that do not make money that guys are making a half a million dollar clinic because they're not budgeting right to make sure they get that so line life culturally focus on making sure doctors take home the money

Awesome. All right, you guys. I am excited about our next episode. Dr. Joe is gonna actually be talking about how to exit a business because now we've talked about okay, you spend your whole life building a practice and we don't want your practice to die with you. And so where as you exit not that you're passing away but so next episode will be on exit. Thank you guys so much for being here. I'm super excited for the next episode. Have an awesome day. Awesome.