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What Did Healthcare Optimize Away? The Business Case for Humanness · The Operator | Healthcare Business

0:05
All right.
0:06
Healthcare is obsessed with optimization,
0:09
scheduling, revenue cycle, productivity,
0:11
AI.
0:12
We measure everything we can put on a
0:14
dashboard.
0:15
And Larry thinks we may have missed one.
0:18
Maybe it is the reason a lot of
0:19
us went to school for this.
0:21
What if the thing healthcare actually
0:23
needs to optimize is humanness?
0:27
I like that word.
0:28
And what if that's not just the soft
0:31
stuff?
0:32
What if it's actually a business strategy?
0:34
Ooh, businessizing humanness.
0:37
So Larry, let's start here.
0:38
You open this new series by essentially
0:41
telling a room full of healthcare
0:43
operators, business people, hey,
0:45
you might be optimizing the wrong thing.
0:48
What do you think we've gotten wrong?
0:50
Yeah,
0:51
let me start with a little bit of
0:52
background.
0:53
So I presented at a national conference in
0:56
Las Vegas about four months ago,
0:59
I think it was.
1:01
And these are two,
1:02
some very stout colleagues, CEOs,
1:06
very large private equity backed dental
1:09
service organizations who are quite
1:12
impressed with and have spent time
1:14
collaborating with over the last couple of
1:16
years.
1:18
And so I started that out with essentially
1:21
how I started this piece out effectively
1:24
with a confession.
1:26
I've sat in these rooms,
1:27
I've led all these rooms around this,
1:30
and I love a good dashboard as much
1:32
as any operator.
1:34
But every conversation that I started
1:36
having with folks,
1:38
I would say over the past year in
1:40
dental,
1:41
but also in physical therapy and
1:42
healthcare in general,
1:44
went to the same three places.
1:47
optimizing our schedule,
1:49
technology adoption, your tech stack,
1:53
and then third, AI, which is all tech.
1:57
All of that absolutely matters,
2:00
but none of that is the answer.
2:02
So if you think about it,
2:03
for thirty years we've treated operations
2:06
as the variable and care as the constant.
2:10
As if the human part would just persist
2:12
on its own while we turned everything
2:14
around it.
2:15
And it didn't.
2:16
And so while we were optimizing everything
2:19
measurable,
2:20
and this is what I've been repeating to
2:21
my folks all the time,
2:23
we neglect everything memorable.
2:27
So we optimize a visit with a patient,
2:29
but are we really impressing and
2:31
connecting with the patient that will
2:33
leave them with a positive impression and
2:36
a memorable outcome?
2:38
So the wrong thing isn't the spreadsheet,
2:40
it's believing that the spreadsheet is the
2:42
strategy.
2:44
And if you really believe as an
2:45
organization that your future lives in
2:47
your tech stack or your future lives in
2:50
you being able to, you know,
2:52
vibe code AI,
2:54
you're building a company in our case,
2:56
a dental company in the past,
2:58
because no patient has ever referred a
3:00
friend because the confirmation texts were
3:03
punctual, right?
3:04
Because they were efficient because they
3:06
were optimized.
3:07
And what I think has been getting lost
3:10
in this is the humanness side of it.
3:13
And James Nesbitt many, many,
3:15
many years ago said,
3:16
anytime you have high tech,
3:18
you need high touch.
3:20
But we tend to get impressed with the
3:22
shiny objects of high tech.
3:24
and unimpressed because it's a soft,
3:26
almost emotional thing with high touch.
3:30
And what I'm saying is we need to
3:33
have better balance in how we look at
3:35
it and a better lens from how we
3:37
evaluate optimization, tech, and AI.
3:41
All right.
3:41
Well,
3:42
then you use this phrase in your latest
3:43
article on Substack,
3:45
which sounds like it's in opposition,
3:47
optimizing humanness.
3:49
Like those two things feel like they're in
3:52
opposition.
3:52
That sounds almost intentionally
3:54
contradictory.
3:55
So how do you sort of square that
3:57
circle?
3:57
How do you explain optimizing humanness?
4:00
Yeah,
4:01
I'm glad you asked this because the
4:02
contradiction really is the point.
4:04
And after seeing Odysseus movie last week,
4:09
that's the Trojan horse.
4:10
Right.
4:12
Operators only would take it seriously if
4:15
it sounds like a KPI.
4:16
So I bolted optimizing on there onto the
4:20
one asset we've been ignoring.
4:22
And what it actually means is take warmth,
4:25
attention, human connection,
4:27
the things we've been filing under soft
4:29
skills and give them the same rigor we
4:31
give revenue cycle management.
4:34
Train them deliberately,
4:35
design the patient experience around them,
4:38
measure what they're happening,
4:40
positive psychology,
4:41
empathetic communication,
4:43
intentional relationship design,
4:45
do it as a strategy,
4:48
not as a poster.
4:50
in the break room or something, right?
4:51
The science already calls things into the
4:54
treatment modality.
4:55
We have unbelievable good, good, good,
4:58
good data on that.
4:59
I'm just asking folks to run their human
5:02
high touch side like they run their data
5:06
side.
5:08
You point out that a huge number of
5:09
people actively dread going to the
5:13
dentist.
5:13
I mean,
5:13
it might be in some people's top three
5:15
of things I'd like to avoid.
5:18
And then you write, well,
5:19
our collective response has largely been
5:22
better scheduling software.
5:24
Like you mentioned a minute ago,
5:26
people don't tell a friend about this
5:28
experience because the text reminders were
5:31
on time.
5:32
So why does healthcare keep reaching for
5:34
operational solutions to human problems?
5:39
Yeah,
5:40
and if you think about physical therapy
5:42
and dentistry,
5:43
one thing we share together is physical
5:46
therapy has often been called pain and
5:48
torture, PT, right?
5:50
And while we don't really account for the
5:51
percentage of anxiety in PT,
5:54
there's lots of studies in dental,
5:55
it could be as high as seventy percent.
5:58
And so what I would say is that
6:00
operational problems are the tools that we
6:03
could see, you know, a scheduling gap,
6:05
you know,
6:06
you see that it shows up at a
6:07
data point, it shows up in a report.
6:09
A patient's anxiety doesn't.
6:11
And so the operators fix what shows up,
6:15
what gets measured and managed,
6:16
but what doesn't get measured sort of gets
6:18
abandoned.
6:19
And I'm a big believer in you get
6:21
what you emphasize.
6:22
And so if you start emphasizing humanness,
6:24
you'll get it.
6:25
But there's a comfort factor too.
6:27
An ops fix is a purchase order, right?
6:31
A human fix is sort of a mirror.
6:34
Only one of those can be delegated.
6:36
So you can end up with the irony
6:38
in this piece,
6:39
somewhere between one and six adults and
6:41
more than half,
6:42
depending entirely on how you measure it,
6:44
are dreading your product in dentistry.
6:47
Think about that.
6:48
They have to be consumers of it.
6:50
And we know that forty percent of the
6:51
American population don't even get any
6:53
dentistry.
6:54
And a good portion of those forty percent
6:55
is because they dread it.
6:57
Right.
6:58
And so, you know, the big response
7:02
is optimizing send them a reminder text
7:04
keep them you know optimize all you can
7:06
through technology and yeah some of those
7:08
things are very very helpful but we've
7:10
gotten world-class at efficiency of
7:12
scheduling people into an experience that
7:15
they don't want to be at
7:17
That's not transformation,
7:19
that's faster dread.
7:21
And the no-show cancellation rates in
7:23
dental exceed that of healthcare.
7:26
And so why are we not trying to
7:28
optimize the root cause,
7:30
which in this case is dread, fear,
7:32
anxiety,
7:34
through better education on soft skills of
7:36
human connections and empathetic
7:38
communications and all of those kinds of
7:40
things.
7:43
It's easier to fix the techno side of
7:45
it.
7:46
That's my real main point,
7:48
the lens of looking at all this.
7:49
Yeah.
7:50
Well, you teed up my next question.
7:51
We're always going to go next.
7:52
I can already hear the audience going,
7:53
this is great.
7:54
I believe this.
7:55
This sounds warm.
7:56
This sounds funny.
7:58
Let's bring in humanness.
8:00
They might be thinking, this sounds great,
8:01
but I got margins.
8:03
I have staffing problems.
8:04
I have production targets.
8:06
So this might sound nice,
8:07
but how would you make the business case
8:10
for this?
8:10
How would you arm the person listening
8:12
going, I believe you,
8:13
but how do I pitch this to my
8:15
boss?
8:16
So where does being more human actually
8:18
show up in the numbers that my boss
8:20
might let me beta test this?
8:23
Yeah,
8:24
and let me take a minute or two
8:25
to get there because it's a very fair
8:27
pushback.
8:28
I mean, I run a platform.
8:29
I've got investors.
8:30
I'm an investor.
8:34
I started a high level where you have
8:36
to fundamentally believe that part of your
8:39
organization is a human capital talent
8:41
management machine, is a value creator.
8:44
And what I mean by that is just
8:45
like you allocate dollars to buy and
8:47
dental scanners or operatories and PT
8:50
equipment, you know, high, low tables,
8:54
all those kinds of things, right?
8:55
Exercise stuff.
8:56
That's capital equipment.
8:58
My mentality is I want to invest in
9:02
human capital.
9:02
And so I allocate dollars and resources
9:05
towards that because that's where my
9:06
priority is.
9:07
That's where my value is.
9:08
That's where I do believe our mission is
9:11
at.
9:12
But here is more the businessy case for
9:16
some of the things that you're saying.
9:18
And I'll use some psychology here.
9:19
So Kahneman's peak end rule,
9:21
the last sixty seconds of a visit,
9:24
disproportionately determines whether that
9:26
patient comes back and whether they refer
9:29
friends and family to you.
9:31
Return and referral aren't soft numbers,
9:33
right?
9:34
Those are patient retention numbers.
9:37
And your cheapest form of patient
9:38
acquisition, what we say in Kentucky,
9:40
milk our own cows first.
9:44
And that really is what will get you
9:46
a driving practice at a lower cost.
9:48
Do you want to spend money in a
9:49
leaky bucket of marketing leads,
9:52
social media, digital, blah, blah, blah,
9:54
blah, blah, blah, blah.
9:55
Or if you do it in humanness,
9:56
you'll get better referrals and a better
9:58
return.
9:59
So Jane Dutton had this thing around high
10:01
quality connections, brief, you know,
10:03
positive interactions that leave sort of
10:05
both people at a better place,
10:06
more energized, more trusting.
10:08
In dental,
10:09
that manifests itself as case acceptance
10:12
and team retention in a single finding.
10:14
Case acceptance in dental sometimes could
10:16
be less than fifty percent.
10:18
Well,
10:18
if I can drive that number through better
10:20
human connection from fifty to seventy
10:22
five percent, guess what goes up?
10:23
My margin, my profitability, my cash flow.
10:27
um now flip it anxiety drives avoidance
10:31
avoidance drives attrition and the most
10:34
expensive line on your p l is the
10:36
one that isn't printed on it the patient
10:38
who quietly didn't rebook who didn't come
10:40
back in the clinician who quit who was
10:42
the quiet quitter humanness is the
10:45
alternative to your margins it's the
10:47
margin you haven't touched yet
10:49
And the cap X is roughly zero in
10:51
most companies.
10:53
So you see,
10:53
if I can take a measurement like treatment
10:56
case acceptance, retention,
11:00
and no-show cancellation,
11:03
and flip it from a metric that is
11:05
a very hard metric to what can I
11:07
do through human connectedness, empathy,
11:10
peak end effect to drive it,
11:13
you can make a strong business case for
11:15
it.
11:17
uh let's go the other route tell me
11:19
about maria in the article that you just
11:21
wrote what did she understand about one
11:25
patient that had some anxiety that a
11:30
perfectly optimized workflow might miss it
11:34
would never show up there yeah it's
11:36
interesting i gave i do these amazing
11:38
coins once a month that are based on
11:40
nominations
11:42
And so many of them are these patient
11:44
testimonials.
11:45
So when I use a case like Maria,
11:48
it's a real case.
11:49
The names may be changed,
11:50
but it's exactly,
11:52
and sometimes people get there by just
11:53
kind of a natural tendency towards this,
11:56
or they're just really, really good at it.
11:59
And other times,
12:02
my belief is you can train for it.
12:03
So Maria is a dental assistant in one
12:05
of our practice,
12:06
an elderly patient comes in,
12:08
they're very anxious.
12:09
a lot of times people have shame in
12:11
dentistry too they're shamed of their
12:12
teeth you know you have that working plus
12:14
anxiety and they both manifest itself they
12:16
haven't seen a dentist in years you know
12:18
so the optimized workflow says intake is
12:21
running long keep it moving right you know
12:25
but maria pulled her chair up close sat
12:27
at an eye level and asked one question
12:29
how you doing how you really doing
12:31
And that's the actual skill.
12:33
It's the connection skill where both
12:34
people are left better off.
12:36
She didn't redirect.
12:37
The patient talked about her husband's,
12:40
you know, illnesses, her worries.
12:42
Why'd she be putting off her own care?
12:45
You know,
12:45
but she left with a treatment plan and
12:47
a commitment to return all because of
12:49
human connection.
12:50
And here is what the Maria's of the
12:52
world understand that the workflow misses.
12:55
The anxiety was the chief complaint,
12:58
not their teeth.
13:00
They didn't come,
13:01
they have fair avoidance.
13:02
We know this in physical therapy on
13:03
patients that have back injuries, right?
13:05
That's the condition.
13:08
The dentistry is downstream of it.
13:10
The physical therapy is downstream of that
13:12
low back pain.
13:13
A perfect workflow would have processed
13:16
the intake right on schedule and the
13:17
patient wouldn't have come back with a
13:19
commitment.
13:21
So Maria wasn't running a referral
13:22
program, she was revealing one.
13:26
Who does the patient tell?
13:27
Her family, her friends,
13:28
everyone that she loves.
13:31
And so you have these downstream effects
13:33
of humanness.
13:35
And you can calculate them if you use
13:38
the right metrics that are sometimes
13:40
directly or indirect.
13:42
It's also the relationship between
13:44
qualitative and quantitative metrics.
13:46
And these things are really palpable
13:49
And I think the difference maker in an
13:51
environment where everybody has been so
13:53
busy optimizing the mechanizing, you know,
13:57
commodity-driven way we've looked at
13:59
healthcare and dentistry.
14:01
You go on to argue that warmth, attention,
14:05
connection aren't merely soft skills.
14:08
And again,
14:08
we should probably do a little marketing
14:10
work on soft skills because it makes it
14:12
sound like it's not as valuable.
14:14
But they're part of the treatment.
14:15
If that's true...
14:17
Why don't we train and measure them with
14:20
the same seriousness that we give clinical
14:24
competency?
14:26
Yeah, we should.
14:28
And honestly, we don't.
14:30
Clinical competency,
14:31
if you think about it,
14:32
that gets your boards, your licensure,
14:33
your CE requirements,
14:35
your
14:36
Your calibration,
14:37
it's decades of sort of infrastructure.
14:40
Connection gets one slide in orientation.
14:42
Smile.
14:44
Good luck out there.
14:46
Underneath that is bad assumption that
14:48
warmth is a trait you hire for rather
14:51
than a skill you build.
14:53
And I like the statement,
14:55
soft skills are the new hard skills.
14:58
I love all the emphasis that people are
15:01
placing on them, but unfortunately,
15:02
I don't see a lot of companies delivering
15:05
on it.
15:06
um the research says by the way what
15:09
it says empathetic communication is
15:11
trainable responding well to people is
15:14
trainable we just have never really built
15:16
the curriculum because we file it under
15:19
you know personality you know what we're
15:22
doing at dca i i turned it into
15:25
call to care into an actual provider
15:27
course
15:28
that we hold people accountable to,
15:30
that's got modules, that has tests,
15:34
that has practice,
15:35
that has knowledge checks,
15:37
that almost it's a mentoring kind of thing
15:39
as well.
15:40
We give that the same seriousness we give
15:43
any clinical program.
15:44
So when we train dentists and we upskill
15:46
them,
15:47
they're getting upskilled not in hands in
15:49
the mouth skills,
15:50
but mouth skills outside of the mouth
15:52
skills.
15:53
And measuring it isn't mysterious.
15:56
You know,
15:57
audit the last sixty seconds of the visits
16:00
and you'll see whether that's trainable or
16:02
not.
16:03
Read what patients actually write in
16:04
reviews,
16:05
not what they punch on a five star
16:07
system.
16:10
Nobody has ever come in and said, boy,
16:12
that intraoral scanner that you've got
16:14
these wellness checks now,
16:15
that is amazing.
16:16
What they do though is they name people.
16:19
And that's what you see in reviews.
16:21
And so for naming people in all of
16:23
these qualitative checks,
16:24
why aren't we training people to do the
16:27
same?
16:27
I had a really simple exercise I
16:29
suggested.
16:30
You've got data out there hiding in plain
16:32
sight.
16:33
I suggested that business owners go to
16:35
their Google reviews, copy all,
16:38
run it through your favorite AI and just
16:39
ask, what are the patterns?
16:41
And what I've seen with a couple just
16:42
doing this superficially,
16:45
front office staff or clinical staff that
16:47
get mentioned over and over,
16:49
that's a signal that your audience is
16:51
telling you something.
16:52
So something you just mentioned there.
16:54
Is there something uncomfortable buried in
16:56
what you're saying?
16:57
Like,
16:58
Could an extremely efficient healthcare
17:01
organization actually be getting worse at
17:04
caring for people?
17:05
You've said this before.
17:07
Are we optimizing the wrong thing?
17:09
So I guess this would be like a
17:10
similar question.
17:12
But this is a little deeper.
17:14
If by optimizing these things,
17:16
are we actually getting worse at the thing
17:17
that we're there to do?
17:20
hundred percent and that's exactly the
17:22
uncomfortable part of this the whole good
17:24
hearts law if you remember we talked a
17:26
lot about that when a measure becomes a
17:28
target it stops being a good measure when
17:30
when return over retention rate of your
17:32
therapist is the measure and you're buying
17:36
it through compensation or through other
17:40
means to affect the measure rather than
17:42
what you're really aiming for
17:44
It no longer is a good measure.
17:46
You can hit every KPI and hollow out
17:49
the very visits that those KPIs were built
17:51
on, right?
17:52
Tighter blocks, scripted interactions,
17:54
check out in five seconds.
17:56
Congratulations,
17:56
you've optimized every moment where trust
18:00
could have been formed.
18:02
You know,
18:03
you've limited the human connection in
18:05
time.
18:06
Every dashboard is green,
18:08
but the patients leave and they're
18:10
unattached.
18:10
They have not built emotional connection
18:12
with your clinic.
18:13
And how do you know that?
18:15
Look what the dashboards don't show.
18:17
Patients don't cancel.
18:18
They just never rebook.
18:20
Treatment case acceptance in dental goes
18:22
down.
18:22
Most groups don't run that report.
18:23
You know,
18:23
one of the interesting things about dental
18:25
that's very different than PT,
18:27
in physical therapy,
18:28
the first visit is usually the most
18:30
lucrative because you've got the initial
18:31
evaluation.
18:32
That's a higher charge.
18:33
In dental,
18:34
the second visit is the most lucrative
18:36
because that's typically when they accept
18:37
or start their treatment case acceptance.
18:40
Very different.
18:41
But in physical therapy, if you remember,
18:42
we had a lot of conversations about this.
18:44
I'm getting ready to do a talk in
18:46
Nashville at one of these private practice
18:48
summits coming up.
18:49
I think it's in September.
18:50
And I've got some really interesting data
18:52
that you and I have chatted about called
18:54
the cliff.
18:55
They don't even realize that their drop
18:56
off is occurring between patients two and
18:59
three.
19:00
significant numbers don't come back
19:02
between visits two and three,
19:03
that retention.
19:05
And most practices aren't even measuring
19:06
that.
19:07
And that's a humanness kind of proxy,
19:09
right?
19:09
They're failed to make the real connection
19:11
to the physical therapist.
19:13
So in dental,
19:15
there's a lot of overlap to this.
19:16
You know,
19:16
what did the exit interview say on a
19:18
patient?
19:18
There's a walk the floor test that,
19:20
you know,
19:20
standing in your practice the last sixty
19:22
minutes and look,
19:23
this three visit test I use in PT,
19:26
that's the data point I want to know
19:27
in due diligence,
19:28
how many of your patients are leaving at
19:29
that time.
19:30
And most patients in PT,
19:31
as you well know,
19:32
don't even complete their treatment care
19:34
plan.
19:36
But you have to have a caring audit,
19:38
you know, no dashboard at all covers it.
19:40
Yep.
19:41
You take this from the floor,
19:44
the treatment floor, the treatment room,
19:46
and up the ladder into leadership.
19:48
If we're so serious about optimizing
19:50
humanness, again, love that phrase,
19:52
that needs to be on a t-shirt somewhere.
19:54
Does that mean we've also been promoting
19:56
and selecting the wrong kinds of leaders?
20:00
Yeah, I mean, I'll say it pretty clearly.
20:02
We've been hiring resumes and hoping for
20:04
leaders.
20:06
Pedigree tells someone can do the right
20:08
thing.
20:08
That's part of this whole Peter Drucker
20:10
thing about efficiency.
20:12
But it tells you nothing about whether a
20:14
scared new assistant will speak up in the
20:16
operatory, at least in dental.
20:19
There's that whole Amy Edmondson
20:21
psychological safety.
20:23
And it's one of the strongest predictors
20:25
of team performance we have.
20:26
I mean,
20:26
the Google researchers did all that a few
20:28
years back.
20:30
The profile of the future really is
20:32
emotional intelligence, resilience,
20:34
adaptability,
20:35
the ability to build safety in your
20:36
clinical team, not instead of competence.
20:40
Competence is table stakes, right?
20:41
We assume people have good clinical
20:43
skills,
20:44
but the tiebreaker amongst competent
20:46
people,
20:47
which is where every hiring decision
20:49
actually lives.
20:50
I remember a long time ago,
20:52
the John Maxwell leadership book,
20:54
where he called it the law of the
20:55
lid.
20:56
basically a team.
20:57
The concept is a team never outgrows its
20:59
leader.
21:00
Every practice culture I've walked into
21:02
that is the shadow of the of the
21:05
leader.
21:05
Right.
21:06
And so, yes, different profile,
21:08
higher people who can lift lids,
21:10
who can take you to the next level.
21:12
And that involves a little bit of
21:14
normalizing discomfort and taking you
21:16
where places that you need to go,
21:18
which you won't go there on their own.
21:20
Yeah.
21:20
Here's one of the lines that felt like
21:22
sort of the thesis or the through line
21:23
of the whole article.
21:25
need to stop optimizing the humanness away
21:29
like almost like it's something to get rid
21:31
of so where do you see organizations
21:33
accidentally doing that today and maybe a
21:36
key or two on how we can stop
21:37
doing that everywhere and it's always with
21:40
the best of intentions and that's what
21:43
makes it you know invisible right um each
21:46
cut on each sort of cut is defensible
21:49
on its own but collectively they remove
21:52
every moment where a connection could
21:54
occur
21:55
You get to an end of the visit,
21:57
you hand a piece of paperwork to somebody
21:59
and go to a payment terminal.
22:01
Daniel Kahneman, again,
22:02
says that's the most valuable clinical
22:04
minute of the appointment and we give it
22:05
to a card reader or a scheduler.
22:09
Schedule the minute of the appointment and
22:11
schedule
22:12
There's no slack for a Maria moment.
22:15
Her conversation doesn't fit a ten-minute
22:17
intake block, so the block wins.
22:20
Scripts that are so rigid,
22:22
they turn a warm human being into a
22:24
phone tree with legs.
22:27
you know,
22:27
a dental hygienist measured purely on
22:29
chair time units or production,
22:33
not return of patients with scheduled
22:36
within the next six months.
22:37
That's just a, you know, a KPI.
22:39
And the newest one that I hear about
22:41
is AI answering the phone for an anxious
22:44
patient who took three weeks to take the
22:46
nervousness up to even make a call to
22:48
a dentist to begin with.
22:49
Not one of those decisions is done,
22:51
but nobody's watching for the sum parts of
22:53
that.
22:53
The sum is the practice.
22:55
where everything is optimized and no one
22:58
is cared for.
23:00
All right,
23:00
so here's the operational question I'll
23:03
ask.
23:03
If I gave you control of a Seventy
23:05
Clinic healthcare platform tomorrow and
23:07
said, optimize humanness,
23:09
you are the humanness czar,
23:12
what's the first thing you'd actually do
23:14
on Monday morning?
23:15
How do you begin that process?
23:18
Well, Jimmy, my first reaction is,
23:22
a few hundreds?
23:23
Seventy?
23:26
monday that sounds like a vacation you
23:27
know what i actually do i run about
23:29
four hundred of them you know and notice
23:31
that none of it requires a committee a
23:33
consultant or a dollar of of pure capex
23:37
but you know no culture initiative no logo
23:40
no launch event the moment culture gets a
23:42
logo it's already sort of on the shelf
23:45
so i would do i think i think
23:47
about it as a design uh roughly three
23:50
moves you redesign
23:53
the last sixty seconds of every visit and
23:56
you measure that and monitor it.
23:59
Make sure that's memorable.
24:00
The end belongs to a human,
24:02
not a payment terminal, right?
24:05
That's the Kahneman minute.
24:07
That's the cheapest clinical intervention
24:09
in health care is the peak end effect.
24:11
How you end it.
24:13
The second thing is you find your Maria's.
24:16
Every clinic has one or two.
24:18
They're the names patients write in
24:20
reviews.
24:20
Study them.
24:22
You know, I call it positive deviancy.
24:24
Take those who are the most positive
24:25
deviants, learn about them,
24:27
celebrate them, highlight them.
24:29
They are your exemplars.
24:31
Make them the curriculum.
24:32
Right.
24:33
And then I think the third thing you
24:35
do is you got to change the hiring
24:37
interview a bit.
24:38
You know,
24:39
you got to look at and measure
24:40
accessibility, adaptability,
24:42
emotional intelligence.
24:44
You know,
24:45
what do they understand about
24:46
psychological safety?
24:49
For every, you know,
24:50
look at it in terms of for every
24:51
hour on their resume, right?
24:52
The measure, you know,
24:54
we tend to measure the boring lag numbers,
24:56
rebooking, reactivation, turnover.
25:01
But be the patient.
25:02
Culture compounds and nothing compounds
25:05
faster than culture.
25:07
But you have to combine the rigor and
25:11
the discipline of metrics and KPI to
25:15
humanness and culture.
25:17
And so in our organization,
25:18
it manifests itself with our mission
25:21
vision that we not just put on a
25:23
tagline,
25:24
but we
25:25
build into their job description and
25:27
they're measured and they're valued by it.
25:29
It's based on our amazing customer service
25:32
system.
25:32
It's made to provide our call to care,
25:34
which is system means it's defined,
25:36
it's taught, it's monitored,
25:37
it's rewarded, it's re-engineered.
25:39
You get in business, which you emphasize,
25:42
it's emphasized constantly.
25:44
And then we look at how it has
25:46
impacted the results,
25:48
treatment case acceptance,
25:49
no-show cancellation rates.
25:51
retention rates of dentists,
25:53
how long the dentists are staying in your
25:55
organization,
25:57
and where they become clinically
25:59
autonomous, master, purposeful clinicians,
26:03
but also good leaders and good managers
26:05
and good operators if that's where life
26:07
takes them.
26:08
So you can make these changes in company.
26:10
There's a great Eric...
26:14
reese book that just came out i think
26:16
in may this year jimmy that would be
26:18
uh well he'd be a great he's the
26:20
one who wrote the lean startup and he
26:22
wrote a another book called incorruptible
26:24
and it's about how great companies go bad
26:27
and and uh um not surprisingly when you
26:31
look at uh many of them whole foods
26:33
price warehouse he goes through a whole
26:35
litany of them
26:37
They dropped the cultural elements.
26:39
Yep.
26:39
They sold out the cultural elements.
26:41
And we learn these lessons over and over
26:43
again.
26:44
And yet we never really, you know,
26:46
we never really learn.
26:48
Who knew that history was actually a
26:49
really important.
26:50
It wasn't just fun stories.
26:51
Exactly.
26:52
Yeah.
26:53
Curveball question then.
26:55
If connection drives retention and
26:56
referrals,
26:58
should clinicians actually be compensated
27:00
for being great at it?
27:02
You're saying change the hiring sort of
27:03
rubric and bring people in who are better
27:06
at these soft skills.
27:08
So if we know that that leads to
27:11
retention and referrals,
27:13
would it be good to compensate clinicians
27:16
for being great at it?
27:18
Yeah, a hundred percent.
27:19
You know, I mean,
27:19
it's pretty straightforward in dentistry.
27:21
They are rewarded for it because they get
27:23
a percentage of what they,
27:25
of what they collect.
27:27
And so it's, you know,
27:29
what's their best business move to supply
27:32
a lot of, you know,
27:34
dish out a lot of coffee to a
27:35
lot of patients.
27:36
Well, you do that over time,
27:37
you're not gonna have many patients
27:38
wanting coffee.
27:40
But if you are kind and courteous to
27:42
your patients,
27:42
you drive good empathy and good human
27:44
connection to them,
27:45
they're the ones that drive more referrals
27:47
to you.
27:48
So this isn't just a good for life,
27:52
good for emotion, it's good for business.
27:55
And it drives the training on their
27:58
competency, upskills them.
28:00
So now they're doing bridges rather than
28:02
teeth cleanings, or they're pulling teeth,
28:05
or they're doing restorative work,
28:06
or they're doing orthodontia.
28:08
And they're also having patients who
28:09
they've had good human connection with.
28:12
referring more patients to them,
28:14
friends and family.
28:15
So they go together.
28:17
And you could look at what is,
28:20
if you look in the last fifteen years
28:21
in dentistry, they've actually taken us,
28:23
like physical therapy, cost for inflation,
28:26
their salaries have been reduced.
28:29
But you can reverse that.
28:31
And the way you reduce it is upskilling
28:33
in both clinical skills and human
28:35
compassion, empathy skills as well.
28:38
And guess what?
28:39
You also have providers who are less
28:40
burned out.
28:42
Oh, no.
28:43
Oh, Larry, you knew.
28:44
So maybe healthcare doesn't need another
28:46
optimization strategy.
28:47
Maybe we need to look at what thirty
28:48
years of optimization has actually
28:51
removed.
28:51
What have we optimized and scrubbed away?
28:54
Because it looks like the company of the
28:56
future might not win by becoming less
28:58
human.
28:59
It might win by finally realizing
29:00
humanness, again, love that term,
29:02
was an operating advantage all along.
29:05
Now,
29:05
this is part one of Larry's new five-part
29:08
series, Inside a Platform.
29:09
Make sure to subscribe to The Operator on
29:11
Substack.
29:12
so you don't miss part two and the
29:13
rest of the series.
29:14
Until next time, keep operating.