Steve Jobs had a penchant for dreaming big. His far-reaching vision brought personal computers into the home, revolutionized the music industry and contributed to the advent of today’s world of cloud computing. Yet at the same time, he also kept his hands in the nitty-gritty details of the products Apple was producing. He set not only the destination of Apple, but he paid attention to every turn along the way. This ability to ‘zoom out’ to the big picture and ‘zoom in’ to focus on details is part of what made him so effective.
Small business owners, particularly in service industries like physical therapy, are often pulled in a thousand directions. We have to make decisions on a grand scale – ‘Do I buy this building?’, ‘How big do I want to grow?’, ‘should I participate in this ACO?’. However, we also have an overwhelming flood of details to oversee. ’who has the best price on theraband?’, do I have time to put another patient in my 2:30 slot?, ‘should I give my technician a $.25 raise?’.
“Details matter, it’s worth waiting to get it right.” – Steve Jobs
Focusing in on just the big picture can create problems. In today’s challenging payment environment, the margin is often found in our management of expense details and avoiding unnecessary costs. It takes almost $1.25 of revenue growth to equal $1.00 of cost savings. This means that controlling costs is often an underutilized mechanism for improving performance. The success of our teams often also happens due to paying attention to details. Getting the right people on the bus and making sure that we only tolerate A players has everything to do with careful selection of every member of our team.
However, focusing only on the details stifles innovation. Strategic thinking, big picture goal setting and innovation are necessary ingredients for a vibrant culture and practice growth. We have to have a vision and a strategic plan for reaching that vision. As Vince Lombardi said “hope is not a strategy.” As leaders in healthcare, we have to be part of the nationwide conversation going on right now. We need to be involved in coming up with the ideas that guide our changing healthcare system, and we will need to be ready to adapt to the new reality that is coming.
“I want to put a ding in the Universe” – Steve Jobs
To grow and to be successful we have to know both the big picture and the details.
This Jobs Applied lesson reminds me of one of my favorite principles from Jim Collins. My next #Browdering series will apply this principle and several others from ‘Good to Great’, ‘Great by Choice’ and ‘How the Mighty Fall’ to our world of physical therapy management and leadership. I hope you will join me next week as we discuss ‘The Stockdale Paradox’.
“There’s a temptation in our networked age to think that ideas can be developed by e-mail… that’s crazy. Creativity comes from spontaneous meetings, from random discussions.” - Steve Jobs
While he valued face to face engagements and meetings, Jobs had nothing but disdain for the typical corporate ‘death by powerpoint’ session. What he looked for was live engagement and problem solving.
The hectic pace of physical therapy, with what sometimes seems like every moment taken by scheduled patient care makes it difficult to create time for face to face engagement. While we occasionally make time for clinical education activities like journal clubs, it is easy to replace face to face engagement for leadership activities with phone or email communication.
Creating regular face to face engagement is difficult in organizations like our private practice, with 17 facilities spread across a few hundred miles. In even larger companies with hundreds of facilities, face to face engagement between executives and local team leaders is even more rare. My short stint working with US Physical Therapy (we were temporarily partners after an acquisition) showed me the reality of this. The executive I reported to had about 260 direct reports. We met face to face perhaps twice each year.
Face to face engagement… which we affectionately term 121s (one to ones) between a leader and those they lead is a key leadership task. In my opinion it is a key component of the cadence of accountability we should try to maintain with our teams. One of the most difficult but most rewarding activities we have undertaken as our practice has grown has been to maintain a regular regimen of contacts between our leaders and those they lead. Here is an example cadence that has worked well for me:
- Weekly – small group, very focused video teleconference focused on activities being completed to meet our most important goals. We do 3 of them to allow small groups so they take no more than 20′.
- Monthly – face to face 121s between leaders and those they lead.
- Quarterly – Summits with key leaders meeting to share results, insights and progress toward meeting goals.
- Annually – Strategic planning with a small, focused group and then subsequent meetings to share aspirations and strategies with the entire team.
I believe that your average ‘meeting’ is a great way to avoid working. That said, focused face to face engagement and communication between leaders and those they lead is essential to building a great team.
Focus is a natural principle. The sun’s scattered rays are too weak to start a fire, but once you focus them with a magnifying glass they will bring paper to flame in seconds. The same is true of human beings—once their collective energy is focused on a challenge, there is little they can’t accomplish.
- Chris McChesney
The 4 Disciplines of Execution
Steve Jobs, despite all of his redeeming features, was famously ‘impatient, petulant and tough with the people around him”. He also delivered results, while maintaining a loyal cadre of high achievers that stayed with him much longer than was typical of the computer industry at the time.
“CEOs who study Jobs and decide to emulate his toughness without understanding his ability to generate loyalty make a dangerous mistake”. – Walter Isaacson
Jobs believed that part of his job was to unfailingly deliver the brutal truth, rather than sugar coat failures. His belief was that many organizations employ managers who are so polite and forgiving as to become ineffective, allowing mediocre employees to feel comfortable and thus encouraging them to stay.
Jack Welch, famed CEO of GE had a similar style and philosophy when it came to an intolerance for mediocrity. Indeed, Jim Collins, in ‘Good to Great‘ found that one of the key features of great companies is that they were good at ‘getting the right people on the bus’. Along with that inevitably comes the need to get the wrong people off of the bus. GE famously utilized a performance feedback system that systematically ensured that the bottom 10% of employees were terminated or rehabilitated… slowly raising the bar for all employees.
Leaders and managers in physical therapy practices attempt to hire the strongest clinicians, with an attitude that lends itself great customer service and teamwork. This gets more difficult in tight job markets or when timing limits our choices. The adage of ‘hire slow, fire fast‘ is often harder to do than we like, and it goes without saying that the best time to ensure we have the right people on the bus is during the hiring process. We occasionally hire someone that isn’t a good fit (a C or D player). These are difficult enough to deal with. Even harder than the obviously insufficient are those that are ‘OK’, the B players.
By tolerating ‘B players’ we prevent the opportunity for an A player to join our team. True – we can develop B players into A players… but when you determine that they are a B player with no potential, they can set the bar for everyone around them. A team member’s status as a A or B or C doesn’t have to be defined only by phenomenal clinical skills, or amazing personality or steadfast work ethic… although it could mean any or all of those things. We should employ good clinicians with great empathy and a strong work ethic. We should employ great clinicians with good customer service skills and great ability to teach others. We should employ resilient, gritty grinders that never complain and make sure that the work gets done. But we should never tolerate mediocre clinicians with an OK attitude that give us no reason to complain.
How we deal with professionals that ‘meet standards’ or are ‘good enough’ determines whether our practice is doomed to mediocrity or if it has the capacity to be great. Tolerate only A players.
“The best leaders are the ones who show their true colors not during the banner years but during times of struggle.”
- Shawn Achor
The Happiness Advantage: The Seven Principles of Positive Psychology that Fuel Success and Performance at Work
Steve Jobs was a famous perfectionist – often delaying the release of a product until a minor issue could be reworked, or even totally scrapping and reworking a design that didn’t feel right. A famous example is the design of the Apple retail stores. He famously delayed the initial openings several months to reorganize the layouts around activities instead of product categories.
Successful physical therapy practices are constantly working to improve the patient’s outcomes and overall experience. In order to provide consistent services efficiently, countless processes have to be accomplished behind the scenes. We should always be looking for places to improve – striving for perfection in the areas that are most important to our customers. However, we can’t be perfect at everything – down that path lies a lack of focus and likely mediocrity at everything. How do we decide where we should focus?
In Nov 2013, Larry Benz and I presented the results of a conjoint analysis of ‘what patients really want’ to well over 500 passionate attendees of the Private Practice Section annual conference. This was a University performed, privately funded study that surveyed almost 500 patients, from 3 companies with 31 outpatient facilities.
This is was patients told us they value the most in their physical therapy experience:
- The therapist is very knowledgeable.
- The instructions from the therapist were very clear.
- Appointments are on time, with a minimum wait time to see a therapist.
- All the staff is very friendly.
- A doctor recommended this clinic.
These are the things that we should strive continually to improve upon, even at the cost of not improving in other areas. Focusing on these areas with the laser-like focus and dedication that Steve Jobs exemplifies will allow us to push for perfection in the most important areas for our practice.
“When [what you are deeply passionate about, what you can be best in the world at and what drives your economic engine] come together, not only does your work move toward greatness, but so does your life. For, in the end, it is impossible to have a great life unless it is a meaningful life. And it is very difficult to have a meaningful life without meaningful work. Perhaps, then, you might gain that rare tranquility that comes from knowing that you’ve had a hand in creating something of intrinsic excellence that makes a contribution. Indeed, you might even gain that deepest of all satisfactions: knowing that your short time here on this earth has been well spent, and that it mattered.”
- Jim Collins
Good to Great: Why Some CompaniesMake the Leap... And Others Don't
His staff called it the ‘Reality Distortion Field’. I can almost imagine the super-geek (no offense intended) hallways of Apple ringing with the mythical storytelling that had to surround Steve Jobs as he pushed people to go beyond what they thought they could accomplish. Steve Jobs would set what I would call BHAGs (Big Hairy Audacious Goals) such as creating the iPad – which was essentially impossible until it came out.
“People that want the future to be different don’t accept the status quo – they push against it” – Steve Jobs
The coming period of transition in healthcare is going to force us to rethink how we do things. What things do we think are impossible now that we could make happen if we had to? I think this is a very useful exercise and can help us to position ourselves to adapt to the changes in our own marketplace. Here are some examples:
- Could you fill a schedule with patients paying $200 cash?
- Could you provide services if the most you could be paid per visit was $55?
- Could you take care of 24 patients in a day if you were the only therapist?
- Could you see 15 new patients every day in a walk-in clinic?
- Could you provide excellent clinical care to 3 patients at the same time?
- Could you base your income on your outcomes?
I don’t know which of these things you will need to be able to do in the future… but I believe they are all possible. In order to create the future we want, we may need to bend reality. What do you think of the examples above? What do you think your personal distortion field might need to create in order for you to succeed in the future of physical therapy? Bring on the discussion below, post it on Facebook on my page or throw it on twitter – use the hashtag #browdering.
“Only through focus can you do world-class things, no matter how capable you are.”
“The foundation of changing behavior is linking rewards to performance and making the linkages transparent.”
- Larry Bossidy
Execution: The Discipline of Getting Things Done