Monthly Archives: March 2014

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Jobs Applied: Tolerate Only ‘A’ Players

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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.26325920_s

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
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Jobs Applied: Push for Perfection

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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?

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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:

  1. The therapist is very knowledgeable.
  2. The instructions from the therapist were very clear.
  3. Appointments are on time, with a minimum wait time to see a therapist.
  4. All the staff is very friendly.
  5. 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
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Jobs Applied: Bend Reality

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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.

“The foundation of changing behavior is linking rewards to performance and making the linkages transparent.”

- Larry Bossidy

Execution: The Discipline of Getting Things Done
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Jobs Applied: “Don’t be a Slave to Focus Groups”

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Steve Jobs was famous for the strange duality of his relationship with his customers. From one perspective, he cared very deeply about the customer’s experience. However, he thought that this was different than asking them what they wanted. He is quoted as saying to his design team:

“Customers don’t know what they want until we’ve shown them” - Steve Jobs

This lesson from Steve Jobs has been much on my mind lately. In Nov 2013, Larry Benz and I presented the results of a university led, privately funded research project into ‘what patient’s really want’. The service features that this study delivered as being the most important included these as the top 3: ‘The therapist is very knowledgeable’, ‘The instructions were very clear’ and ‘appointments are on time, with a minimum wait to see a therapist’. Watch for a webinar coming soon where Larry and I will present the full findings of this study.

While presenting and then discussing this topic over the past several months, this leadership lesson has come to mind frequently. Giving the patient these features they tell us they desire is a worthwhile exercise and I think the foundation of an excellent service strategy.11268773_m

That said - what if we could figure out what the patient craves, but can’t tell us? Here are a few things I think might make a big difference but would be difficult to pull out of patients in a focus group:

  • A warm voice on the telephone when answering the first phone call.
  • Staff members that remember the patient’s name.
  • Therapists that notice when a patient doesn’t make it and are concerned instead of irritated.
  • Therapists that listen more than they talk.
  • Employees that enjoy each other and the patients.
  • A ‘positive vibe’.

Perhaps for Steve Jobs not being a slave to focus groups was about innovation and giving customers a computer they never knew was possible. For physical therapy practices I think it is about that indefinable feeling that only exists in a practice where the staff is highly engaged in the business of creating powerful, healing connections with patients. Our healthcare system is so broken that the patient’s don’t remember to include ’the therapist cares about me’ as their first priority. Perhaps we can make sure that we deliver it anyway.