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Never Give Up

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Last weekend, I had the pleasure of listening to Diana Nyad speak at the 2014 TeamBeachBody Coach Summit. This amazing lady shared the story of her lifelong goal of swimming from Cuba to Florida, which she achieved at age 64. I vaguely remembered seeing this on the news last year, but I failed to realize just how impossible this swim is.

103 miles in the open ocean, through waters teeming with sharks and jellyfish. In the 30 years since she failed the first time (still setting a world record by swimming to the Bahamas instead) nobody had broken her record. To be honest, part of me thought that wanting to do this in the first place must be a special kind of insanity. Then she said this:

It’s not about what you get, it’s about who you become

This really struck me. What if I could apply the mindset of arguably the world’s toughest athlete to my own life and endeavors?

Its easy for me to stay in my comfort zone and to complete my daily work without ever really stretching myself. I’ve always wanted to write a book. Its a scary proposition, though… what if nobody wanted to read it? What if I put all that work into it and then it didn’t go anywhere? Its always seemed like an impossible goal.

Diana told us that achieving her goal wasn’t what made the difference… striving for the goal defined her, fulfilled her and allowed her to build a tremendous resilience. She failed and failed and failed until she finally succeeded. The most important thing she did was to try.

I think I’ll take that little quote, put it in my journal and try to be a person that fails at massive goals. After all, that’s exactly who Diana was when she started her fifth and final try at that impossible swim.

Do you have an impossible goal?

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…and fire quickly.

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I have never met a leader or a practice owner that regretted firing somebody that was a poor fit for their team. While I have not had to let many of my teammates ‘find other, more suitable employment’ one example comes to mind.

DOFIStacy (not her real name) was a pretty good DOFI. DOFI stands for ‘Director of First Impressions’, a title shared by all of our front desk personnel. All the patients loved her and she took care of the data entry and scheduling portion of her job well enough. The downside was that she was often late and her ‘sick days’ tended to fall on the Friday before a 3-day weekend. I must have put up with a half-dozen ‘throat hurting’ and family emergencies (I think her grandmother died twice) and way too much aggravation before she finally pushed me over the edge. After a very dramatic sick call, she posted some great pics from the lake on Facebook! We let her go the next day, only to find out that she had been stealing co-pays from patients for on and off for over a year.

Lesson learned! I should have let her go as soon as I figured out that she had an integrity problem. Here are a couple of relevant quotes to help us remember to make the decision to remove people from our team more quickly. I find that it helps to think of ‘firing’ as rectifying my own mistake in hiring the wrong person.

“The moment you feel the need to tightly manage someone, you’ve made a hiring mistake” (Jim Collins)

“Don’t beat yourself up if you get hiring wrong some of the time. Just remember, the mistake is yours to fix.” (Jack Welch)

So if you find yourself tightly managing someone or smelling a culture mismatch, move into addressing the problem without delaying to see if it will rectify itself. If its a problem with competence, you should be able to address it and see improvement. Chris McChesney of Franklin Covey said it best:

“If they can’t do it, they are in the wrong seat. If they won’t do it, they are in the wrong organization”.

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Hire slowly…

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One of the most important decisions in building a great practice comes whenever we are hiring people. Likewise, one of the surest ways to destroy a great culture and derail growth is to pick the wrong people for your team.

“The old adage people are your most important asset turns out to be wrong. People are NOT your most important asset. The right people are.” - Jim Collins, Good to Great.

This principle from ‘Good to Great’ has been useful lately as we go through a round of hires at Texas Physical Therapy Specialists. Whenever we find ourselves in a position of needing to hire, inevitably the growth or circumstances that necessitates the hire pushes on us to accomplish it quickly to remove the pressure. The challenge is that this is the best time to slow down and be disciplined and rigorous. Its painful (just ask my directors waiting for help!) but it pays to put in the energy up front and hire the right person.26325920_s

Here are 4 of my favorite rules to help us make this important decision:

  1. Cast a broad net. You want to make sure that you capture a large pool of applicants, rather than a sample of convenience. Sometimes a ‘good’ applicant appears fortuitously - making the path of least resistance a quick hire without much need for rigor. What if the 5th or 10th applicant would have been somebody great?
  2. Don’t compromise. The surest way to build a mediocre team is to hire mediocre people. Deal with the short term pain of the search and hire the very best you can find. The long term pain of a mediocre hire is worth avoiding.
  3. Hire for attitude, over aptitude. Unfortunately, we don’t always have the luxury of waiting for that perfect candidate to come along or we have to choose between two great people. When we do have to choose, we should give attitude and fit within our culture greater weight than competence and skill set.
  4. Do more than an old school interview. There are alot of tools out there to help you dig into who a person is. Consider using tools like the Omnia profile, Emotional IQ, Strengthsfinder or the VIA character strengths profile to give you a window into your candidate. Using this type of tool (don’t try to use them all) will make you slow down and think deeply about who you are hiring and their fit within your team.

party-busPackard’s Law captures why getting the right people on the bus is so important:

“No company can grow revenues consistently faster than its ability to get enough of the right people to implement that growth and still become a great company”. - Jim Collins, How the Mighty Fall.

Take the time to hire slowly…. and the second half of that adage is … fire quickly. We’ll talk about kicking people off the bus next time.

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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
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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.