Latest / The Operator | Healthcare Business / Good Intentions Are Not a Mentoring Program: How Healthcare Builds People Who Stay

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Good Intentions Are Not a Mentoring Program: How Healthcare Builds People Who Stay · The Operator | Healthcare Business

0:04
There it is.
0:04
Big fancy intro.
0:05
It's official here on the operator
0:07
podcast.
0:09
This week, Larry dives into this.
0:12
Every health care organization says they
0:14
have great mentorship.
0:15
It's the M word.
0:16
It's on the career page.
0:18
It's in the job posting.
0:19
It's something every new grad looks for
0:22
and hears during the interview.
0:24
The latest article on the operator asks a
0:26
simple question.
0:27
How do you know?
0:28
How do you know?
0:29
Because assigning someone a mentor isn't
0:31
the same as having a mentoring program.
0:34
Those are two different things.
0:37
So Larry, let's start here.
0:39
You open by saying every healthcare
0:41
organization promises mentorship.
0:45
Why do you think so many organizations,
0:47
they genuinely believe or at least say
0:50
they're delivering it,
0:51
but why is that a disconnect?
0:54
Yeah,
0:54
I think it's because nobody ever checks.
0:56
I mean, if you think about, you know,
0:58
I think if you check your benefits,
1:00
you got health insurance, well,
1:01
you got to get a health insurance card,
1:03
right?
1:04
And it's just the most common lie that
1:07
I see in operations,
1:09
maybe not a deliberate one.
1:11
Because mentoring, on the one hand,
1:13
is supposed to be unstructured.
1:14
But on the other hand,
1:15
if it's not structured enough,
1:16
it won't exist.
1:18
But it's a thing that everybody believes
1:20
is happening,
1:20
but nobody's really verifying it.
1:24
And the promise during recruiting is
1:26
somewhat sincere.
1:28
But like any other system,
1:29
it has to have checks in it and
1:30
accountability to make sure that it's
1:32
happening.
1:35
Maybe they paired somebody on day one,
1:37
but from that moment forward,
1:39
nobody measures it, nobody owns it,
1:40
nobody calendars it.
1:42
And the only person who really fills the
1:44
gap between the promise and the delivery
1:47
is the new hire.
1:48
And she or he is not going to
1:50
name it because they're polite and they're
1:52
new.
1:53
And, you know,
1:55
so it starts to unwind and evolve.
1:57
And eventually it's probably the reason
2:00
why a lot of people leave.
2:04
You know, you're assigned a mentor,
2:06
you're introduced by email on week one,
2:08
you have coffee on week two,
2:10
by week six,
2:11
you were planning on meeting again.
2:13
The intention was there, but as you said,
2:15
there's no structure.
2:16
I think the title says a lot.
2:17
Everybody has mentoring,
2:18
almost nobody has a mentoring program.
2:22
You sort of covered that a second ago
2:24
there, right,
2:24
about the difference between that is one
2:26
is a promise, the other is a process,
2:28
right?
2:28
No, that's right.
2:29
It has to have structure.
2:31
It has to be systematic.
2:33
And when something is systematic, Jimmy,
2:36
it's defined, it's taught, it's lived,
2:39
it's monitored, it's re-engineered,
2:41
it's held accountable, it's rewarded.
2:45
Everybody has mentoring,
2:46
two people paired up, good intentions,
2:48
maybe even an occasional coffee.
2:51
But the program has four things the
2:53
brochure skips.
2:55
It has to have milestones and a
2:56
curriculum.
2:57
Number one, number two,
2:58
it has to have a written development plan.
3:01
You have to have mentors who are trained.
3:03
Would you train a therapist to be a
3:06
clinical supervisor for a student?
3:08
Of course you would.
3:09
In fact,
3:09
the APTA has a credential for it.
3:12
You ought to do the same with mentorship
3:14
and it has to have obviously bilateral
3:17
accountability.
3:18
And here's the part people really get
3:20
wrong.
3:21
Structure isn't the boring part of
3:23
mentoring.
3:24
It is the whole thing.
3:25
Yeah,
3:27
assigning a mentor is not a mentoring
3:29
program any more than buying a gym
3:30
membership as a workout, right?
3:32
Both are real, both are well intentioned,
3:34
but both produce exactly nothing without a
3:37
formalized structure that turns, you know,
3:40
intention into repetition,
3:43
and then repetition into, you know,
3:45
what you're really looking for is outcomes
3:46
and results.
3:47
Yeah,
3:47
you want to change or you want to,
3:49
you know, you're selling structure.
3:52
And if it lacks to be there,
3:53
everybody gets cheated.
3:55
You mentioned this,
3:56
something you call the recruiting
3:57
brochure.
3:59
I've said this phrase before, you know,
4:01
you're in the middle of something like
4:01
this was not on the brochure.
4:03
You know,
4:03
I didn't see I didn't see this one.
4:04
I didn't think this was happening when I
4:05
signed up.
4:06
That felt just painfully familiar.
4:08
So how does mentorship become something
4:10
that's great for recruiting,
4:11
looks awesome on the brochure with some
4:13
stock images and some people smiling,
4:15
but quietly disappears after day one?
4:18
Yeah, and if you look,
4:20
you'd be hard-pressed to find a physical
4:22
therapy company or a healthcare company
4:25
that doesn't promise mentorship.
4:28
So it's built as a recruiting asset,
4:30
but it's not an operating commitment with
4:33
intentionality.
4:35
um it's really one of the one of
4:37
the two or three things that a clinician
4:39
is sold on you know schedule you'll have
4:42
some flexibility uh you'll hours or eight
4:45
to whatever and money um and we're going
4:49
to mentor you we have a strong commitment
4:51
to it so it's so sick the closure
4:54
right then the investment ends the moment
4:57
they sign no curriculum like i said is
4:59
behind the sentence
5:01
uh no protected time no one no one's
5:04
job it is to make it real i
5:05
will tell you that a lot of companies
5:08
started substituting mentorship for
5:10
formalized residency and there is some
5:13
truth to that right i mean you know
5:15
because then the apta approved clinical or
5:18
abpts approved clinical residencies abt
5:21
ref whatever the name of that is the
5:23
initials are um you have to have so
5:25
many mentoring hours that's a requirement
5:28
although they've gotten pretty
5:30
lackadaisical is that remote is that what
5:32
does that really mean so i think for
5:35
a while that started to be the substitute
5:37
but you really should have both because
5:39
mentoring involves clinical and
5:40
non-clinical the the the socialization the
5:43
you know other support services you know
5:46
we had mentoring when i was in the
5:48
military and that was somebody who helped
5:51
guide you to the socialized lifestyle of a
5:53
military person, how to access services,
5:56
who to know,
5:58
sort of the informal networking, all that.
6:01
Now, in a company, though,
6:02
you could spot this stuff out in a
6:03
minute.
6:05
The mentorship appears,
6:06
and it's oftentimes even in the offer
6:09
letter, right, or on the career page.
6:12
But it's not in anybody's job description.
6:15
If you're an experienced therapist and
6:17
your job description doesn't have that
6:19
you're
6:20
supposed to be a mentor,
6:21
you don't get somewhat rewarded for it.
6:23
You know, in dental, it's interesting.
6:24
We actually pay our dentists to be mentors
6:27
because they go out of their way.
6:28
It can actually decrease their
6:29
productivity and their productivity is
6:31
their income.
6:32
And so we actually backed that commitment
6:34
out with a little different, you know,
6:36
it's why we have so many dental directors
6:38
and I think PT should go to that
6:40
model.
6:40
I think PT should have PT, you know,
6:43
directors, not clinical directors,
6:46
not businessy, but on the purely on the,
6:48
on the clinical side that rewards them for
6:51
going out of the way and being mentors,
6:52
you know, otherwise what, what, you know,
6:54
show me an incentive and I'll show you
6:55
an outcome and it's just not going to
6:57
be done.
6:59
Yep.
6:59
You mentioned that coffee chat that I just
7:02
sort of alluded to a second ago.
7:03
Two people meeting up, good intentions,
7:07
no structure,
7:08
both sort of waiting for magic to happen.
7:11
Why is that model almost always guaranteed
7:14
to fail?
7:15
Yeah,
7:15
it's guaranteed to fail on the clinical
7:18
side.
7:19
because really that model runs on
7:22
friendship, and friendship's a good thing,
7:24
but friendship's not a development system.
7:27
How many of your friends sit down with
7:29
you and guide you, Jimmy?
7:30
They don't, and so there's no milestones.
7:32
There's no way to know if anyone's
7:33
progressing, no curriculum.
7:35
Content is whatever top of mind that week.
7:38
There's really no plan.
7:39
Some people have a journal club and they
7:41
call that mentoring.
7:42
Journal club is certainly a function for
7:44
it, but that's not mentoring.
7:47
And the other thing is the mentors always
7:48
get busy because they're getting beeped by
7:51
their BI tool about their productivity and
7:53
units per visit.
7:54
And the reality is your best clinicians
7:59
are really busy and they're probably some
8:01
of your best mentors,
8:02
which is why exactly their schedule is
8:04
full.
8:05
But here's the reality to tell.
8:08
We would never run clinical training this
8:10
way.
8:10
Spend time with patients,
8:12
you'll pick it up, right?
8:14
We would never do that.
8:15
We define the competencies,
8:17
we sequence them,
8:18
and we check whether they're reached.
8:20
That's what we do with student interns
8:22
that are on their clinicals.
8:24
Mentoring deserves the same discipline.
8:27
The question isn't whether it feels good,
8:29
it's whether anyone is really measuring
8:32
measurably better for it.
8:34
We used various systems over the years,
8:37
but checklists and skill checklists and
8:39
making sure that people understood the
8:41
clinical prediction rule or understood a
8:43
certain manual therapy technique.
8:47
And that level of accountability is a good
8:49
thing.
8:50
And if done right,
8:51
it helps a therapist progress to mastery
8:55
and to board certification,
8:56
which is sort of the ultimate,
8:58
which is what you want.
9:00
Yeah,
9:01
one of the biggest ideas that I didn't
9:02
think about because I've been on the
9:05
receiving end of this recruiting brochure
9:07
is that mentoring isn't disappearing
9:09
because people don't care.
9:10
They're not qualified or they're not
9:11
there.
9:12
Simply, it's because nobody owns it.
9:15
So that accountability is the missing
9:17
ingredient, it seems like.
9:19
yeah absolutely um you know you get what
9:22
you measure and what you reward and in
9:24
really most platforms mentoring doesn't
9:27
show up in a metric doesn't show up
9:29
in a board deck unless they're trying to
9:31
impress somebody there's no incentives
9:33
there's no review it's it's purely a
9:35
discretionary effort
9:37
laid on top of a full clinic load.
9:39
Like I said,
9:39
I think you have to reward clinicians for
9:41
that.
9:43
I had a meritocracy system where maybe
9:46
didn't pay them extra for the mentoring
9:49
time,
9:50
but those time counted towards
9:53
a classification system that moved them up
9:56
the ladder where they did get paid more
9:58
money and or more paid time off it
10:00
was a combination of both or in some
10:02
cases a one-time bonus you know
10:04
discretionary effort is the first thing
10:06
that we cut when we're under pressure you
10:08
know right units per visit visits and you
10:10
know all these all these things happening
10:12
um and all that stuff really happens and
10:15
the mentoring just slides and it's it's
10:17
the same lesson the ninety day rule
10:19
teaches that work isn't a role
10:22
is the work that disappears the moment
10:24
someone gets busy.
10:26
The work that isn't a role, I mean.
10:27
So when somebody gets busy,
10:30
what gets shortchanged?
10:31
Mentorship is that kind of thing.
10:35
And you cannot run retention on favors or
10:38
promises.
10:38
You just can't.
10:40
No, no.
10:41
OK,
10:41
so if I'm a clinic director or an
10:43
owner listening,
10:44
what's the smallest thing I could do?
10:45
I mean,
10:45
you describe what a really good mentoring
10:47
program
10:49
Should actually look like.
10:50
So if someone's listening,
10:51
what's the smallest thing they could do
10:52
and implement tomorrow that would move
10:55
them from, you know,
10:56
wishes and good intentions toward a real
10:59
program?
11:01
Yeah,
11:01
I think there there's a couple moves you
11:03
can make in sort of one day's work.
11:05
First thing I would do is write down
11:07
what you believe the milestones are.
11:09
what your new clinician should be able to
11:11
do at thirty days, ninety days,
11:13
six months.
11:14
And I like monthly checkpoints and
11:16
checklists.
11:18
And you can certainly make them all
11:19
electronic now and everything.
11:20
But you could also now use A.I.
11:22
and say, you know,
11:23
all those kinds of things to protect it.
11:26
That single act converts that coffee chat
11:29
we talked about into something with a with
11:31
a spine because progress becomes visible
11:34
and really stalls when it's
11:36
You know, when it's not detectable,
11:38
that's the first thing you could do.
11:39
Milestones, objective things, calendar,
11:42
checklist.
11:43
The second, if you'll do it,
11:46
is put mentoring in the job description
11:49
and the review of the therapist.
11:52
And in that case,
11:52
it holds them accountable to their annual
11:54
review or to the review moment.
11:56
The moment it counts towards how a senior
11:58
clinician is evaluated,
12:00
it's no longer discretionary, right?
12:02
It is what you're supposed to do.
12:04
Now,
12:05
you have to organizationally have a
12:06
commitment to it.
12:09
Interesting, you know,
12:10
I did a post on this,
12:12
I guess about a year ago,
12:13
maybe a little over a year ago now,
12:15
and I had a niece graduate from PT
12:17
school.
12:18
She said,
12:18
what are the questions that I should be
12:20
asking in my interview?
12:22
And that's one of the things I pointed
12:24
to,
12:24
show me
12:26
verifiably how you hold your mentoring
12:28
accountable and that it's a formal
12:30
program.
12:31
Because I do believe that applicants have
12:35
every bit of right to evaluate your
12:36
mentoring program as they do your
12:38
healthcare insurance or your dental
12:40
insurance or your life insurance.
12:42
The cheapest version of a program is the
12:44
one you write down before the best mentor
12:46
leaves and takes the whole thing out the
12:47
door in his or her hand.
12:50
The most expensive one is the one where
12:52
you contribute effort and energy and
12:54
resources to it.
12:57
As you well know, exit interviews,
13:00
oftentimes don't mention mentoring,
13:02
but if you really drill down,
13:04
it does get to that as a really
13:07
significant portion as to why young
13:09
therapists change jobs very often.
13:11
You know,
13:11
keep in mind the average therapist
13:12
changes,
13:14
doesn't last on their first job less than
13:15
a year.
13:16
Yeah.
13:17
You've got an almost stunningly simple
13:21
diagnostic to figure out if there's a
13:23
mentorship program in place.
13:24
And it seems like it's two questions,
13:26
like walk us through that.
13:29
yeah so the you know the clinician you
13:32
know asked what are you working on with
13:33
your mentor this month and what would you
13:35
know if it happened um you know that
13:38
that's it structure can answer it and
13:41
fondness or you know pleasantry can't
13:43
right if the answer comes back in one
13:45
clean sentence with a name and a
13:47
checkpoint i'm working on x and we review
13:49
it at our monthly
13:51
You have program.
13:52
This actually harkens back,
13:54
if you remember, Jimmy,
13:54
to the series we did on meetings and
13:56
why they're important and why they should
13:59
also be structured.
14:01
If it's a pause or we just kind
14:02
of check on it or it's a warm
14:04
story with nothing measurable in it,
14:07
you can have a coffee chat at best
14:09
and you have something on a brochure.
14:12
The fondness in the answer isn't the
14:14
signal.
14:14
The structure, really the formality,
14:17
the backbone is.
14:19
It's really an engagement detector.
14:22
If you look at Gallup, for example,
14:24
they predict whether someone stays with a
14:28
key question.
14:29
It's a Gallup question.
14:30
It goes something like,
14:31
I have somebody at work that encourages my
14:33
development.
14:35
They have another question that says,
14:37
I have someone at work that cares about
14:40
me.
14:41
I have something at work that gives me
14:44
the opportunity to grow and develop.
14:47
For a new clinician, that's most of it.
14:51
I would teach my managers that in addition
14:54
to those three questions,
14:57
do I have somebody that gives me the
15:01
tools and resources to maximize or to
15:03
optimize my job?
15:05
And am I proud of the company?
15:09
So, you know,
15:09
you take those kind of things and you
15:11
boil them down to some level of simplicity
15:14
and you realize that the mentoring has
15:17
sort of the intended consequences,
15:19
but it has a lot of unintended
15:20
consequences.
15:21
It really drives engagement because it
15:23
holds people accountable to each other's
15:26
development.
15:27
And, you know, it all goes back,
15:29
Stephen Covey, to learn, to live,
15:31
to leave a legacy.
15:32
You know, people want to grow and develop.
15:36
It's oftentimes an unstated driver.
15:39
And, you know,
15:39
are you an organization that drives people
15:42
to grow, to maturity,
15:44
to master clinician level?
15:47
you know,
15:47
what is the legacy that you have here?
15:50
And I think ultimately,
15:51
ultimately that's how companies end up
15:54
being judged because that all converts to
15:57
the downstream effect of better EBITDA or
15:59
better cash flow.
16:01
Yeah, it does touch the big scoreboard.
16:02
It feels fluffy and fuzzy and warm and,
16:05
and a little emotional,
16:07
but if the people leave,
16:08
that does affect your bottom line.
16:10
So the people are the thing actually in
16:12
these professions delivering the service.
16:14
So let's imagine.
16:15
By the way,
16:16
to that point on people leave, you know,
16:17
one of the things that's been, you know,
16:19
I'm going to do some writing on this
16:20
is that we have this bad habit in
16:23
health care service businesses
16:25
Of commoditizing our therapists.
16:28
So, oh,
16:29
we brought forty five new therapists on
16:31
this month and we lost forty three.
16:33
Therefore,
16:33
we're a net gain of two therapists.
16:35
Right.
16:36
Well,
16:37
the problem with that is tell me about
16:39
the forty three that you lost.
16:41
Were they your best people?
16:43
Are they regrettable leaves to where
16:45
they're billing and they're they're
16:47
mentoring?
16:49
You can't replace that with another PT,
16:50
at least not right away.
16:51
Right.
16:51
Right.
16:51
Yeah, it's important.
16:55
So five years from now,
16:56
a health care organization becomes known
16:58
as the place new clinicians want to build
17:00
a career.
17:01
I know several of those in the country.
17:02
And it's almost like you can spot them.
17:05
But from across the street,
17:08
you might not be able to until you
17:09
start to look into why that is.
17:12
So what's true about their mentoring
17:14
program,
17:14
the place that people know as the great
17:16
place to start?
17:17
What's true about their mentoring program
17:19
that isn't true about other places?
17:23
What's true about their mentoring program
17:25
is the consequence of being a destination
17:27
employer.
17:28
Where do new grads want to go?
17:30
They want to go where people have
17:31
graduated from there.
17:34
and have either spent their careers there
17:39
or a good portion of their career and
17:40
they came out better for it.
17:42
When they came out better,
17:43
they opened a practice or they in turn
17:44
mentored other people.
17:47
You develop this legacy reputation and you
17:51
develop a reputation as a destination
17:53
employer.
17:55
When you do that,
17:56
your recruitment costs are less,
17:58
your turnover is less,
17:59
your production is more,
18:01
everything benefits from it.
18:04
This is a real difficult times for
18:06
healthcare service platforms because we've
18:08
had this post COVID hiccup of decreased
18:11
payments, headwinds around all of that.
18:13
You have headwinds around shortages,
18:15
you have headwinds around inflation.
18:17
My gosh,
18:17
we thought we were getting rid of
18:18
inflation actually got worse.
18:21
And now all of a sudden,
18:24
what can you do to get margin back?
18:27
And it's really, really difficult,
18:29
but some of the things you can do
18:30
as an organization
18:33
is to be that destination employer because
18:35
you'll have less costs going out the door
18:37
for recruitment.
18:38
You'll have less costs going out for
18:40
replacement.
18:41
And the difficulty with that is we tend
18:45
to,
18:45
at least in the healthcare services
18:47
business,
18:47
think of capital expense as I'm going to
18:50
open up a de novo.
18:51
I'm going to buy a machine.
18:53
I'm going to name an asset, right?
18:56
What we have to think about is how
18:59
much can I invest in human capital?
19:02
And so my investment in mentoring,
19:03
my investment in talent creation,
19:05
my investment in an academy that upskills,
19:09
in our case,
19:09
dentists for what I'm doing now,
19:11
that commitment takes real capital.
19:14
It has to be budgeted.
19:15
It has to be prioritized,
19:16
and it has to be part of your
19:18
value creation strategy.
19:20
And when you do that effectively,
19:22
everything else benefits from it.
19:23
But if you're waking up and saying,
19:25
what new de novo am I doing?
19:26
What new piece of equipment do I want?
19:29
What do I want to spend money on?
19:31
And you're not waking up thinking of how
19:34
can I make human capital my number one
19:36
investment?
19:38
Healthcare service platform companies are
19:39
gonna be rewarded by the best operators.
19:42
And as you know,
19:42
from several talks that you and I have
19:44
had,
19:44
operations become secondary or tertiary to
19:48
leadership and management.
19:50
But now we have to really focus on
19:52
operational excellence and pride in that.
19:54
And the companies that do that well will
19:56
be rewarded.
19:57
And the companies that do that well,
19:58
certainly mentoring is a key hub of their
20:00
talent, management,
20:02
human capital perspective.
20:04
Yeah.
20:04
Well, if I took anything away from this,
20:06
I would say mentor doesn't fail because
20:07
people don't care.
20:08
It fails because good intentions are not a
20:11
system.
20:12
And unless you put those things in place,
20:16
it doesn't have a return for the people.
20:18
And we know what that can lead to.
20:19
Yeah.
20:20
It's tough to manage because you have to
20:22
have a lot of systems, right?
20:24
But ultimately,
20:26
your systems are your priorities,
20:28
your priorities are your values,
20:29
your values are your strategies.
20:32
And mentoring and human capital,
20:36
all of those things
20:39
really should be integral to companies
20:44
because that is what's going to allow them
20:46
to have sustainable growth,
20:48
sustainable profits, you know,
20:51
just success in the marketplace and
20:52
ultimately get the benefit of being a
20:54
destination employer who's highly focused
20:56
on nurturing and developing their people.
20:59
if this conversation made you rethink the
21:01
difference between culture and structure
21:04
maybe go deeper in the article subscribe
21:05
to the operator on substack until next
21:07
time larry keep operating thank you buddy