Scaling Your Practice Deep Dive - Part 3: Communication and Team

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.

Alright, tribe welcome back. I'm super excited to continue our conversation on scale. I'm here with Dr. Joseph Esposito. I just I really love this conversation, as far as like, going through the three different phases. Last time, we talked a little bit about procedure, or we talked last time about procedure and flow. And this time, we're gonna jump into communication and team. So what were some of your quick takeaways, Joe?

Yeah, I'm excited about this stage. Because like we mentioned last time, most people get stuck in build, and they don't really gain the value of owning a business, which is the scale component. So I think this is where a lot of doctors need to really listen up. Because moving from build to scale is really the point of leverage, it's really the reason to go into business, when we talked about the heavy lift of launch, that's a lot of work to get that rocket off the ground. And the built in is where the doctor, the owner is putting a lot of effort in to get some, you know, some, some momentum in the practice. And then the beauty, the leverage, the opportunity to reason for opening the business, to own it and go through all of that work is to scale. And I think these podcasts that we're doing can create some awareness for people to make that move from build to scale, and enjoy the fruits of that opportunity.

Yeah, when you're talking about like getting that, you know, rocket off the ground, I always think of that space shuttle, they use all that fuel just to get off the ground. That's the launch bill. When you're talking about build, I really feel like this is a space where the leadership has to develop for the doctor because they got to train the team, and there's a whole shift in mentality for them. And that's where I think they get stuck, because it's just easy seeing patients being the superhero being the, you know, everything kind of falls on their back. That's easy and hard, like,

distinction for me is that in build, it's very energetic, because the doctors, and everything moves around this energy source of the chief energy officer, that person that's there adjusting, and like, everyone flows, doctors, on the teams on the doctors on purpose teams on purpose, the doctors, you know, efficient, the team's efficient, and it's like, the energy of that leader is so powerful, and you get to scale. If you have other practitioners there, and maybe you're off in Europe for a month, and your business is still running. If you're all the energy with lower level systems, lower level, accountability lower, you're going to showcase that very painfully and very quickly. And that scar tissue that you may not want to gain, maybe experience verse, gaining your own scar tissue, because I don't know if I know you felt it, I believe because I know I felt it. When I went from owner operator. I felt like a king. I felt unstoppable adversity, I could handle any adversity I was there. My finger was on the pulse. And then when I opened the second clinic, I felt like a kindergartner again, I did not understand how that other clinic couldn't sustain what I was doing. Because I'm still the leader. I just wasn't there. And that really knocked me over. And I It hurts me to see doctors who start to question their own value or ability, whether they're stepping out of their own clinic for two weeks on a vacation or whether opening a second clinic and they're not present, right. I mean, that's the pain. really strengthen the doctor with accountability structure, and systems and training. So that they don't question their capability because now we know they're an entrepreneur, we know they're a leader, right? Because they built a successful clinic. They're not right, they have the props, but they might not have the skills. So the difference, right

100% And I think that's where I learned it too. Like we did great with one office and we open two offices. And what I found was my first office was actually supporting on some level, the second office and then the other problem with the second office is the second office felt like almost like the redheaded stepchild where it was like it wasn't good enough. It wasn't like oh, you you guys are seeing this and you know, they're just starting so they shouldn't have that same expectations but the team like I thought it would inspire but it actually you know deflated them sometimes.

It definitely and and then you start thinking their capabilities only X when really it's x times 10 But in our minds like let me just put that effort in the main office because because you start to categorize the offense, that that can be emotionally destructive for your ability to build. So all of these scar tissues we're talking about, we can kind of offset by what we're going to finish teaching today. And I'm really excited about wrapping it up next time by the key concepts in going from one stage to the next.

Yeah, so awesome. So let's dive into this, I'm going to share my screen. So again, the PDFs attached to this below. So if you guys want to see what we're talking about, if you're not watching us on video, the PDFs below and so the two that I have up is our launch build scale. So the whole thing, so again, zero to 150s, launch build is 150 to 300. And then scalings, 300. and above. And so if we go right, jump right into the scale one, we talked about process procedures and flow. This time, we're gonna go into communications and team. And so what I find in communication, Jonah, I don't know what you found, I think we found similar things. But this is a space where before, like in build, it was really doctor to team now what we're really focusing on is the team communicating with the patient better, because we really need to start educating the patient more. So they're more on board. So they're more like understandings or ambassadors versus, like, still learning or not knowing. And so but that was where my big piece was, was. In build, I felt like I was the one who had to communicate everything where as we grew bigger, it was actually everybody had to communicate with the patient,

saying the transition is the teacher is the team, not the doctor. So like the way it's a group teaching event. And when you see a seasoned practice, you see the front desk, literally educating the patient about why their child should be checked with with very articulate means and a lot of conviction. Or you have a tech ca taking the X ray and expressing you know how decay is silent and you don't feel it, you don't know. And then we're going to show you on the X ray and bringing intrigue. And then one of the other staff members running that better results faster the actual workshop. And they're educating people. So it's like, if you walk through that office, the doctor is just providing a service like adjusting patients, but the magics happening with the team. So you got to if you're listening to this podcast right now, I think it'd be good to close your eyes and vision that of education happening at the front, in the extra room, in the lecture area, in the rehab area, not just at the table with the doctor and I visualization I have is when I look at the same type of thing, like when you look at a, like a regular department store or electronics store, and you see a line of four people checking out, right, and it's like, I gotta wait five minutes to check out. Or you look at an Apple store. And you see about 30, Apple representatives, all with a checkout in their hand, you can buy on the spot, and there's 30 transactions happening at the exact same time in one room. And I'm like, Huh, that's kind of what you're saying. Right? The Apple checkout first, the casual.

Yeah, right. I mean, because everybody has an opportunity. And everybody has a different story. And everybody has a different perspective. And so one of my favorite things that I always did was when I was educating in the back of the room, and somebody told me a great story or a testimonial, I'd be like, Oh, my gosh, that's such a great story. Joe, why don't could you go up to the front and tell them because, you know, they don't get to hear those stories, like I get to hear all all the time. And so then they would go out there and they would communicate and the whole room would hear it. And then our front desk of here. So it inspire everybody. So also just encouraging the patients to speak, you know, share their story more to the team and other people.

So if we were to inspire that team to patient, what you just said is one step. Share the stories from the adjuster room to the front. What's another one? Yeah, bring a testimonial online to the weekly meeting, have your front desk or one of your staff member find the best one we got this week, printed off and just read it after meeting. That's a second one. So you start creating inspiration around the team. educating the patient, as Cliff mentioned is number one on this chart. We just gave you to take some notes, try to figure out what would be a third, fourth fifth way to start getting a team geared up to help educate the patient. I love it. That's a great number whitecliff

Yeah, and I think in huddle, like that's the other space I always saw like morning huddle, like just starting off the day like going around the room because everybody hears the miracle stories. What are you hearing or you know, have that person come with a story? I think is a great way to do that because it just kicks the day off right?

I agree. Bye. Number two DCS

number two, DC the DC patient care management so So we ended up having four to six doctors in one office. And where we broke down, honestly, was somebody being a primary doctor for a patient. So we were like up there seeing him up there seeing him. So we had this going on, where people were like, they didn't know who was their primary doctor, because they were seeing all the different doctors. And so we lost a lot in retention, because we weren't doing exams on time we weren't doing the different follow ups like measuring, we were just taking care of people.

So what's your lessons learned at that? Would you keep the primary doctor concept? What would you change that? What's the lesson?

So for me, the lesson was that every patient had a primary doctor, they could see whoever they wanted. But it was more of an internal thing, because the patients honestly thought they had a primary doctor, like you'd ask them, they're like, Oh, my primary doctor is right, but or cliff or, you know, Rick, but then at the end of the day, they were like, they didn't, we didn't, we weren't tracking that. So we missed on our progress exams, we exams and read reports. And so we're just a little bit of a leaky bucket.

And I guess that goes to our conversation we're gonna have on the next episode, which is accountability. Yes, who's accountable to people accountable, no one's accountable so that I kind of liked that. So the lesson learned there guys is having a primary doctor that makes sure that that ideal patient lifecycle is honored that they're getting taken through the cycle. That's a great, great point. Yeah. And any other thoughts around that topic? I think that clearly denotes the value there. And then you can, you can have a doctor's clinical meeting with doctors get together, and you may share insights I we did that when we have three doctors is, you know, it was once a month, I thought I could have done it once a week. But where are we pulling cases and saying, Oh, you saw Michelle, she's going for surgery, or she needs this rehab or, and you kind of leveling up everyone that may share patients real quickly going through cases?

Yeah, I think that's a great point. I we did that. And then we also did weekly trainings with the doctors were, you know, we had our training curriculum, but then we had technique X ray, and wherever one of the doctor strengths was, they would actually lead that so then they would uplevel all of us. And so that was a great way to do like that DC to DC training.

I think that is so valuable, because sometimes we get so caught up in the protocol and the flow and we step away from clinical, we used to do it on everything from nutrient integration, to understand the impact that certain common drugs are having on the physiology, we would do X ray reviews, like you were mentioning. And then we'd actually if we were the primary doc over the case, like you remember, we saw blank and then blank and then blank, we walk through the case. And some of that was really not only lessons learned clinically, but it was inspiring for us to continue that, you know, continue to serve.

And it was also awesome, it like brought us together, like we're all on a common mission. So it kind of rolls right into, like team in that space like, and just I just want to do one clarification on this, the primary doctor, um, they're responsible for the patients having the experience that supposed to be having doesn't mean that they don't have to always see that person. Where I think where we missed it was it was just it was off. We just we saw people to see people, but we definitely got lost. So that was a big deal. Sorry, I don't know how to double click on that. But I just wanted to double clicking. And I think I said pretty much the same thing.

No, no, but that's important. Because it's something that you overlooked. It's something that you don't you don't feel you need to put the attention on. So no, I think it's very important. Okay, the third one.

So team Table Talk, and we kind of already wrapped that in as far as like everybody having the same topics are toxic. I know we had one of our offices in a line life, they, you know, Raymond's bringing all these things into his office like tires. And tell me about that and bring in paperclips like he's bringing these different things to start a conversation. So the patient's thinking about their health. So making table team Table Talk fun, and not that it just always falls on the doctor the clinical side. So

let's break that down a little bit. So Table Talk, and you hear the word check. Some chiropractors don't know what that really means. Tick is a little bit of chiropractic. So we just call it tick. So you're not taking a fire hose and jamming it down the throat of a patient trying to teach him who DD Palmer was in the whole history of the profession on day one. That's the fire hose approach where we're so excited about our profession and our deliverable that we put a fire hose but the tick is just a little tiny bit, but you do it every single visit. And we'll close talking about is moving that not just tableside with the doctor but to the whole team and pretty much cliff. Your layout here Communication is all about that migration from doctor to team on this journey. So they're all kind of a feeling of that. And the middle one is about doctor to doctor, which I love. But the book ends of white. And it's really, how do we get the team behind us. So team Table Talk, your example, you gave his Raymond Adeline life was using props, your teammate love props, you have a warm tire where one side is really worn really bad, and you have to replace the tire. And the other side of the tread on the tire is beautiful. It looks like a brand new tire. But unfortunately wear it out. Same thing with this fine, you could have a perfect spine of 15 vertebra, but nine of them are a worn out and you got a bad spine. Right? It's not? Yeah, it's good. And I liked that analogy. So you can do those things. You can also have the boards in all the rooms like we used to have right in front of the adjusting, we've got instead it sit in a chair and get scoped and they be staring at a board. And the board would say, the Golden Gate Bridge, they will I think we will ever Well, when they finish painting the bridge, the painters go back to the beginning and start over because it takes so many years to paint. And by the time they're done, they need to repaint, like really well, the same thing with the spine is we continually maintain the spine. So that would be the message. But we would haven't written all the rules, not just the doctors adjusting them. But if you're in rehab, even if you're a front desk, there's a message that we're all kind of talking about. And then you can have you know little tricks where you put a tick next to the if you have a travel card, you can put a tick next to it. If you're the one handled the story, the Golden Gate Bridge, you don't need to tell it six times. But it's not just the doctor, it's whoever gets to it does in a software, you may have a click on it on a tag for the day and a tag is thick. So you got to figure your way of seeing who talks, especially if you're opening up communication for the team. So you're not redundant. But make it fun and take the opportunity to educate under that day's premise or props or whatever. What are your thoughts?

Yeah, and I love it like having an idea. But also don't be afraid to be redundant. I think we're so scared to be redundant that we don't tell the story enough. So like I know, I've heard some things it takes me 1015 times. And every time I hear it, I hear it from a different space. But if you do it from more of a Socratic space of asking them questions. Okay, so the topic today was the Golden Gate Bridge. And I know Doc talk to you about what was your takeaway on it. So then, again, it gets him in that rhythm of both them being able to share the story, but also then them being able to really understand it better, because when they teach it, it's different than when they hear

a great point. Because let's say even my Golden Gate Bridge story, you know, there's a bridge out there that is rusted, that has to be taken down because it wasn't painted. And it's going to cost 34 million, and it's going to maybe bankrupt a little town that has this bridge, and you may have another story. So it doesn't have to be the same story. Maybe when we prepare for the talk of the day, we do a little, you know, three second research on Google like wait, there's a little more embellishment around the story. And really what we're trying to get is we're trying to gain the values of what we believe in the chiropractic lifestyle, embedded in the synapse of their brain. So when they think and teach their children or act or behave or live their life, they're just making a little shift. So it's like, my daughter has a glass of water versus a drug. Let's get it. Let's get the spine check. And you're just looking at little shift in their behavior pattern. And the way to do that is to constantly teaching the same premise in many different ways, right? I mean, that's the whole essence of Yeah,

yeah, I know, like in online life, we have 10 principles that they need to learn. And then two more to get them on mission and referring, but there's 10 things that every patient needs to know, for them to do better with their health, not just in our office. And one of the big ones for me is that for them to recognize that modern life is unnaturally stressful. So if they get that then they get regular maintenance, chiropractic care, if they don't get that they don't understand that feel like we're more of a carwash. I grew up, I have a problem, we fix it up. I'm good again. So it's just it's so important to get these basic fundamentals. Foundational,

that's a good point on the line life that we have this list of these tenants that the patient should know just for their own well being and the family's well being in every single adjusting room. Like it's just, it's just right, because we ought to be going on the same terms. So that's the thing you can do in your office, is you have those tenants in the adjusting room. No matter if you have one, three adjustments, five offices. Every room is is set up correctly. Alright. Yeah, work the last

last session. Okay, so team like I think this one just like, as we're going through this, the doctor really shifts from running the office to leading the office. And then they have an office manager that runs the office. And so thinks just, that was just an important one, to start to understand the distinction that all of a sudden the roles start to get divided out. So

you're saying the office manager now runs the clinic. So that that distinction to me is the accountabilities to the manager now, not the leader, the leader is holding vision and strategy. But the manager is holding accountability. So now you're on vacation in Europe for three weeks, you can still run vision, and you can still do strategy. And you can do a zoom call if you need, but the day to day checklist, deliverables, quality control, and making sure flow systems and outcomes is done. That's the manager. So that's a, that's probably one of the biggest cultural shifts for me is when I had to step away and allow the manager to shine. First, I hired the wrong manager. I hired another visionary was my mistake, I didn't hire a manager. Because I liked visionaries, because I'm a visionary. So I hired that was one of the first then another, and I hate this concept. They're gonna mistakes, but our scar tissues is the beauty of the next generations. Success without the pain, right? So yeah, one was that the second is onboarding, I thought they were seasoned manager, they know how to manage, I would take less time to onboard than I would have ca. And I should have put three times the amount of time when my first manager, I learned the lesson. And the next time, I had the the manager, not only go through our purpose, mission, vision, core values, but I had a more at the front desk, and then work X ray and then work and I put them through like Zappos does with selling shoes is the accountant is using biases for a month before they get to be an accountant for the company. I mean, that concept.

Yeah, 100% huge. Yeah, so I think that's a, it is a big shift. And Joe, you talked about it, you know, hiring the right person, there is a certain person whose DNA is meant to be a manager, and there's a certain person who's not, and there's a bunch of people who are not. And so, you know, I know, inside of our system, we have ways for you to identify who that should be. And, you know, and then the other parts, we talked about how to onboard them how to train them, like we have checklists, and we have all these spaces so that they come on board, and have the right philosophy or the same philosophy, and have the same understanding,

we used a PDP profile inside of a line life as one of the tools. And I want to give a plug to to two different companies. One is Cairo matchmakers, who allows you guys to use this tool PDP which you can call them and get trained and learn how to use it. The other one is the dream leader Institute clip that you run, which is a little more elaborate of a understanding of people, and how to truly evaluate and build value for an individual, yourself, your team or whatnot. So I think those are two things for people to, to look into. Okay.

And then the two is easy that it's a team driven training. So the the manager runs the training, the leader steps up, does a 510 minute introduction starts with a why the heart gets them, you know why this is so important. And then the manager then will come in and run it like, and run the meeting and get the data and really shift that and one of the big things and that is to have a curriculum and a schedule. And so I know that's something we have inside of a line life. You know, we have an annual schedule that we get to lapse through everything. So no matter where a team member onboards we're not restarting our schedule, they're just getting looped in. But every six months, we get a second run through of that,

you're basically saying number one, and number two is we're shifting the management who's running the organization. And then the training done by the team first the doctor, so the doctors letting go of management and training. That's a huge, huge, huge, huge and but think about that Doc's if you're listening this, if you gonna go into Scale, that means that you're leveraging a team and you're not having to be there. And if you try to still hold all management, all training, and then you're not there, it's going to fall apart. So I think handing that off is it's tough. But I think this is truly leveraging the business. That's a good point, the last one office culture.

So for me, like office culture, just recognizing what that is, when you bring people in that they know your culture, they know your core values, they know the mission. Because so often, by this point, when you're on scale, we're so far on the other side of what, you know, we've told the story, you know, 1000s of times, we're like, oh, man, I gotta tell it again. But we feel like that's over. You know, like if I keep repeating the same things, but people need to hear that and so creating that inspiration and And also that you're creating a culture that it's data driven, you know, two parts of data one part gut because and launch and build a can be more around the, you know, gut where as you're starting to scale it has, we have to start to shift that data perspective. And honestly, you have to have data throughout, but you can definitely do launch and build with, you know, without

wrapping this up this session, Cliff goes back to how I initiate it is that if your office culture is not understood, when the doctor is not there, that that energy that holds everything together, that belief that that one person had that carried everyone along is not present, and there's some lack of clarity or conviction around the culture or the the values of that clinic, then it becomes to get damaged very quickly. So what happens is, if that manager hires, but doesn't hire to the values of the company, or respect the purpose or doesn't know the purpose, you watered down the vision of this company as it expands. So you really, really have to be careful in refining that vision, so my my opinion is when you start moving towards that two to four week vacation here, these things are in place beforehand, you're like, Okay, let me make sure the culture is set, three months, six months of work here, guys, kidding. The the manager, onboarding, the manager, letting the managers take over training, sitting in and watching the training as the manager runs a trainer, and you're just quiet, listening and taking notes, and how you can help refine, but stop stepping in and taking everything over, be a listener, be be a guide, and be in the background, taking notes and empowering them. Don't step in with your energy and take everything over all the time. Because that's not what's gonna happen when you are not in the office. I mean, that those are my final thoughts cliff, what are yours?

Yeah, I love it. I think it's a great way to wrap it up. It's so true. get smaller, like in the organization, allow your people to be in their roles do their job. And Joe, I think the one thing too is this is a process, it's six to 12 months, really to bring on a manager who's then can run the meetings at the same level you can. But if you never step away from it, you'll never really grow. And I think that's why so many people get stuck in that build is because they don't have the patience and time because most of us are Clydesdales. We just like throw it on our back and let's go to work. But as you shift you have to shift from like taking that 30,000 foot view of your business.

Yeah, last thought is that the scale is not just stepping out of your clinic or leveraging it, but it could be opening a second clinic. But before you open the second one, in your first one, you should be giving up the training and giving up the management so you can free up to be able to oversee the launch of the new one, right? Sometimes they think well I'll just keep this and then open the other one and I'll keep doing what I'm doing. You got to free up time for that second one. If you don't, you're gonna have a redheaded stepchild that's not going to produce as well because they're still caught in the first one. So

awesome. Yeah. So next. So great episode. Next episode we will we'll wrap up all three of them into one episode, we'll tell you our biggest takeaways as we're going through this process. And so I'm super excited to see you guys at the next one. So thank you, Dr. Joe.