Monthly Archives: April 2014

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What does the Hedgehog say?

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One of the most elegant and useful concepts from Jim Collins’ Good to Great study is the Hedgehog Concept.

The Fox knows many things, but the hedgehog knows one big thing - Archilochus

In his famous essay “The Hedgehog and the Fox“, Isaiah Berlin divides people into two groups: foxes that see the world in all its complexity and pursue many ends at the same time vs. hedgehogs that condense concepts and reduce challenges into simpler ideas. The parable would have the crafty fox attack the hedgehog with a variety of clever strategies, to be repeatedly beaten by the hedgehog’s simple, but powerful strategy - roll into a ball so the pointy parts are facing out. While the fox is crafty and nimble, the hedgehog is focused, determined and stays the course.

The companies that went from good to great discovered and then had the discipline to stay within a foundational hedgehog concept that kept them from being distracted from their core business. In contrast, the comparison companies that never made the leap to greatness often lost focus and took opportunities that were outside of their strengths.

A hedgehog concept is found at the intersection of three dimensions:

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  • What you can be the best in the world at.
  • What drives your economic engine.
  • What you are deeply passionate about.

The good to great companies (compared to comparison companies) were disciplined enough to understand and stick to their Hedgehog concept despite the temptation to chase after increased profits or ‘once in a lifetime opportunities’.

In the medical field we see some great examples of finding and sticking to a hedgehog concept. One local example is a practice called Sullivan Physical Therapy. This practice has a niche - women’s health - that they are great at. Another is Balance 360 that focuses on balance and vestibular disorders. In these cases, these practices don’t try to be all things to all people - they have a concept that they can be the best at, that drives their economic engine and that they are passionate about.

I don’t think that the hedgehog concept applies only to practice niches, though. At Texas Physical Therapy Specialists, we can be the best in the world at developing clinical specialists and team leaders. This is where our passion lies and the team it produces drives our economic engine. By understanding and sticking to our hedgehog concept, we have the potential to be the best in the world. We have to have the discipline to avoid ‘once in a lifetime opportunities’ that don’t fit within our concept and we have to have the discipline to stay the course when it seems like jumping to a different strategy might be more effective.

What’s yours?

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Jobs Applied: Know Both the Big Picture and The Details

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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.14866993_m

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’.

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Jobs Applied: Engage Face to Face

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“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:

  1. 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′.
  2. Monthly - face to face 121s between leaders and those they lead.
  3. Quarterly - Summits with key leaders meeting to share results, insights and progress toward meeting goals.
  4. 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