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Your Meetings Are Filtering Out the Truth · The Operator | Healthcare Business

0:01
All right.
0:01
Everybody says healthcare has two
0:02
meetings.
0:03
I feel like too many meetings.
0:04
I feel like every industry has too many
0:06
meetings, right?
0:07
I mean,
0:07
how many times have we muttered this
0:09
meeting could have been an email?
0:10
And in fact, you say at some point,
0:12
this meeting should have been an email.
0:15
In your latest article,
0:15
you say the problem isn't meetings.
0:17
The problem is the meeting stack.
0:20
And when I first read that sort of
0:21
in the beginning of the article,
0:22
I was like, huh.
0:24
I don't even know what my own meeting
0:25
stack is, which is part of the problem.
0:27
And you say somewhere inside a lot of
0:28
growing healthcare platforms,
0:31
you've said this before,
0:32
dashboards are green,
0:33
board decks always look great,
0:35
acquisitions are closing while clinicians
0:38
or these people that are providing the
0:40
care are quietly leaving.
0:42
culture's eroding and nobody in leadership
0:44
sees it until it's in the rear view
0:46
mirror.
0:47
So today we'll look at this thing that
0:49
should be all about culture,
0:51
coming together, a meeting,
0:52
and why the architecture,
0:54
never thought I'd put those two words
0:55
together, meeting architecture,
0:58
inside organizations may be one of the
1:01
most overlooked operating system failures
1:04
or potential failures in multi-site
1:06
growth.
1:07
So you open this article with a regional
1:10
leader who technically isn't lying.
1:13
They're telling the truth,
1:15
but also isn't telling the truth at the
1:17
same time.
1:18
How often do healthcare platforms operate
1:21
inside this gap with what they think
1:23
they're doing, think what is happening,
1:26
but it actually isn't?
1:28
Yeah, before I get to that question,
1:30
which is a key question,
1:32
I want to give you some insights as
1:33
to how I got to this topic of
1:35
meetings.
1:36
For a long time,
1:39
most companies have followed a structure
1:41
and a format to their meetings.
1:43
Pat Linsoni's Five Dysfunctions and Death
1:47
by Meeting,
1:47
those kind of books have led people to
1:50
a structure that is somewhat consistent
1:52
across organizations.
1:53
However,
1:54
The big thing that was thrown at them,
1:58
the curve, was COVID and the pandemic.
2:01
And then what happened to remote work
2:02
environment?
2:03
I know we're going to get into that
2:04
a bit.
2:05
But what I started to see in healthcare
2:06
platforms I was working with or part of
2:09
was the inclusivity in meetings.
2:12
Way too many people,
2:13
way too many meetings,
2:15
and the inefficiency of them.
2:16
And I started then looking in the research
2:18
and saying...
2:20
Has there been any research since the
2:22
pandemic on remote work and meetings and
2:26
meetings in general?
2:27
And man, there's a lot of data.
2:29
So that's what brought me to what I'm
2:31
doing now, which is a series of meetings,
2:33
not only to report on it and what
2:35
the research has to say,
2:36
but also to help improve organizations
2:38
that I'm associated with, for-profits,
2:40
nonprofits, and the like.
2:42
But now you get to the question about
2:44
the regional director who technically
2:45
isn't lying and how often do healthcare
2:48
platforms operate within that gap.
2:50
And the honest answer is every week.
2:53
And almost every multi-site platform that
2:55
I've looked at or visited, that gap,
2:58
technically true but functionally false is
3:00
the default operating state it's not
3:03
malicious it's it's really structural the
3:05
regional vp in the article isn't lying
3:08
she's adapting to a meeting that wasn't
3:11
built to surface what the truth was in
3:13
other words it truth isn't coming out
3:15
because the meeting wasn't structured that
3:16
way she reads the metrics but the meeting
3:20
Because the meeting, what does it do?
3:21
It asks for metrics.
3:22
She doesn't raise the rotting acquisition
3:24
because the meeting hasn't asked her to,
3:27
and there's no clean place for that in
3:29
the agenda in any real material way.
3:31
Now multiply that by twelve regional
3:34
managers, fifty-two weeks a year,
3:36
and you've got a leadership team making
3:37
decisions on information that is mostly
3:40
accurate at the surface,
3:42
but very wrong underneath.
3:44
And meetings are meant to detect what's
3:46
going on underneath.
3:48
The thing that should worry operators is
3:50
not that this happens occasionally,
3:52
It's that it's the steady state or the
3:55
operational infrastructure already going
3:58
on.
3:58
The meeting is the system.
4:00
If the system isn't asking for the truth,
4:02
the truth is what the system stops
4:06
getting.
4:07
Yeah, but it feels comfortable, right?
4:10
I've accomplished this meeting.
4:11
I spent that time.
4:13
So you actually further on,
4:15
you argue meetings are actually the
4:16
operating system.
4:17
You said that before.
4:18
For situational awareness,
4:21
most people think the dashboards are for
4:24
situational awareness.
4:25
So why are dashboards insufficient and
4:28
what should be sort of happening in these
4:29
meetings?
4:31
Yeah,
4:31
I would boil it down to three reasons.
4:33
First,
4:33
the dashboard measures what already
4:36
happened.
4:36
In most cases,
4:37
they're lag measures by design.
4:39
By the time a metric shows up red,
4:41
the bad thing it's measuring has already
4:43
happened, often weeks afterwards.
4:45
Your dashboard will tell you that Mrs.
4:47
Jenkins didn't show up.
4:48
It will not tell you that for four
4:50
more Mrs.
4:51
Jenkins that didn't book this morning,
4:53
you're about to have a no-show problem you
4:54
didn't see.
4:56
Second,
4:56
dashboards have no social enterprise to
5:00
them, no social dimension.
5:02
A clinician in one of the operatories will
5:05
never log her real concern into a
5:07
dashboard.
5:08
She might say it out loud in the
5:09
meeting to the right leader at the right
5:11
moment in a room where she feels safe
5:12
saying it.
5:12
And that's what psychological safety and
5:15
trust,
5:16
which is the core foundation of every
5:17
company, at least what it should be.
5:19
So meetings when they work are how weak
5:21
signals get turned into actionable
5:23
information.
5:25
Dashboards are passive consumptions.
5:28
Meetings are active surfacing.
5:30
What you're trying to do in a meeting
5:31
is create what I call creative abrasion,
5:34
difficult conversations, conflicts,
5:36
things that are not pointed at people,
5:39
but they're situational events.
5:40
In order to do that effectively,
5:42
you have to have a foundation of
5:44
psychological safety.
5:46
Third,
5:46
and this is the one operators very rarely
5:48
think about,
5:49
is that dashboards only show what
5:52
companies have decided to measure by
5:54
virtue of their decisions to measure.
5:56
They tell you exactly nothing about the
5:58
things you didn't know to measure.
5:59
The meeting stack is your only mechanism
6:02
for finding out and surfacing things that
6:04
you didn't know to measure.
6:05
That's what meetings really are
6:06
functionally for.
6:08
most platforms have broken their you know
6:10
have been broken theirs to the point where
6:12
they no longer surface the information
6:15
that you're trying to surface that's what
6:17
the function of a meeting is not to
6:19
tell you what you already know not to
6:20
read a powerpoint not to read a dashboard
6:22
but to unearth things problems grow in
6:26
water like weeds and your job as a
6:30
manager
6:31
is to get the water out of that
6:34
weed so they stop growing.
6:35
The only way you can do it is
6:36
not to pick them from the top,
6:37
but to pick them at the bottom.
6:39
So a dashboard cannot replace a
6:40
conversation.
6:42
It usually replaces it instead.
6:46
And that's what you don't want.
6:49
You make a point about health care in
6:52
a different way that I hadn't thought of
6:53
before,
6:53
which is the floor never went remote.
6:57
We're talking about twenty twenty twenty
6:58
twenty one.
6:59
The floor never went remote,
7:00
but leadership did.
7:02
So did health care accidentally create
7:04
this leadership clinician disconnect
7:06
during covid that also never got repaired?
7:10
We didn't go back.
7:12
Yes, and it has not yet repaired.
7:15
If you think of the most enlightened
7:16
companies in the United States,
7:18
they've all gone back to in-office.
7:20
They may allow you to work from home
7:22
a day or two a week,
7:24
some less than that.
7:26
And then, oddly enough,
7:27
in healthcare platforms, DSOs,
7:30
behavioral health, dermatology,
7:32
ophthalmology,
7:33
the leadership in the front office went
7:36
remote.
7:37
I think that's symbolically wrong.
7:39
I don't like it.
7:40
I've worked in both environments,
7:41
and my personal belief is if the
7:43
clinician's got to be in the clinic,
7:44
so do the officers,
7:46
and so do those around.
7:49
And so it hasn't repaired.
7:50
The math is simple.
7:52
The floor never did go remote.
7:53
Patients still show up.
7:55
Clinicians are still gowning up,
7:58
putting their stuff on,
8:00
and the front desk is there.
8:03
The corporate, regional,
8:03
and operational backbone largely did not.
8:06
I mean,
8:06
Cleveland Clinic alone is something like,
8:08
I don't know,
8:09
eighty-one hundred non-clinical employees
8:11
classified as remote or hybrid.
8:13
Most multi-site platforms, dental,
8:15
primary care run a similar split.
8:18
So you have, and by the way,
8:20
it's very difficult to uncrack that egg.
8:23
Financial service companies, others did,
8:26
but for whatever reason,
8:27
healthcare platforms have it.
8:28
So what you have is the most consequential
8:30
structural shift in healthcare leadership
8:33
in over fifty years.
8:34
And it happened by accident in a pandemic.
8:37
It's a hangover.
8:38
or an effect from the pandemic,
8:40
nobody designed for it.
8:42
So this disconnect doesn't show up in the
8:44
kind of metrics that reach boards.
8:46
It shows up in turnover intentions,
8:48
in the energy of clinical leadership
8:50
pipelines,
8:51
in young folks not getting appropriate
8:53
bump around factor in mentoring.
8:55
And it's how you're trying to recruit.
8:58
The nursing research out of a journal
9:01
called OJIN names visibility as the single
9:04
biggest barrier remote leaders create for
9:07
clinical staff.
9:08
The floor is not asking for a fully
9:10
co-located leader.
9:11
The floor is asking for a leader who
9:13
shows up like the work matters.
9:15
In most healthcare platforms,
9:17
the signal is not being sent and the
9:19
cultural debt is compounding every quarter
9:22
we don't fix it.
9:23
There was recently an unpublished study,
9:26
but largely making its way through the
9:27
circles,
9:28
where remote revenue cycle management
9:31
workers,
9:31
once software was put on their keyboard,
9:34
is showing that they're only working about
9:35
fifty percent of the time.
9:37
We've now taking the luxury of flexibility
9:41
as the priority for your workforce rather
9:43
than getting things done.
9:45
You talk about something that people
9:47
notice and maybe have never said out loud,
9:50
but you see it when it's there.
9:53
Camera off,
9:54
someone clearly multitasking during a
9:57
meeting,
9:58
someone checking their watch or checking
10:00
that clock.
10:00
We all know where the clock is,
10:02
top right corner on a computer.
10:06
What are clinicians reading and feeling
10:10
when leadership shows up,
10:12
we'll say poorly in meetings, which is,
10:15
Is the goal of the meeting to get
10:16
it done or is it to achieve something?
10:19
A lot of times I feel like clinicians
10:21
read it's to get it done.
10:22
So what are they reading?
10:25
Yeah,
10:26
they are reading a few specific things and
10:27
they're reading them faster than
10:29
leadership knows.
10:30
They're reading,
10:31
this person doesn't know what Wednesday
10:33
afternoon in operatory three is actually
10:35
looking like.
10:36
They're reading,
10:37
this leader is multitasking,
10:38
which means this work is not important to
10:40
them.
10:41
They're reading,
10:41
my concerns are not going to be heard,
10:43
so why raise them?
10:44
And they are reading the medium itself.
10:47
They could not even be bothered to drive
10:49
here.
10:49
So when you have hybrid meetings with
10:51
clinicians and non-clinicians in a remote
10:53
work environment, it is really,
10:55
really difficult.
10:56
Now,
10:56
there are some ways you can mitigate that.
10:59
I believe human beings are now sort of,
11:01
you know, task to multitask.
11:04
If you're going to multitask,
11:06
have it benefit everybody.
11:07
And so while somebody is speaking,
11:09
it's okay to have ongoing chat going on
11:13
because you're adding to the value of
11:15
everybody.
11:16
If you're not having ongoing chat,
11:18
you're on your own chat on your own
11:19
phone texting.
11:21
And that is bad.
11:23
So use multitasking to benefit folks,
11:26
not to distract them.
11:28
And another point,
11:29
when you're reading these,
11:31
people are seeing what you're doing in
11:33
meetings, which is not paying attention,
11:36
these signals are actually occurring
11:38
consciously.
11:39
It's not in an explicit way,
11:44
but in a global sense,
11:45
this leadership it's saying is not serious
11:49
about clinical work.
11:50
And once that is formed,
11:51
it's almost impossible to undo.
11:54
So the clinician who's in OPT-IV who has
11:56
never met the COO in person has already
11:58
formed an opinion.
12:00
They are distanced.
12:01
There's a latency here.
12:03
And by the way,
12:03
most of these opinions are correct.
12:05
Almost none of them are flattering.
12:08
so this is the cost of brokley meeting
12:11
cadence is in a multi-site platform one of
12:13
the things i do is i have my
12:19
ai of choice geared up to be an
12:21
expert in executive coaching time
12:24
management efficiency and based in steeped
12:28
in research what is the most effective
12:30
schedule for a ceo in an organization
12:34
And they are constantly scanning my
12:36
calendar four weeks in a rare,
12:38
one day in a rare, three weeks forward,
12:40
two weeks forward, two days forward,
12:42
and then giving me real-time updates daily
12:46
whether I'm spending time effectively,
12:48
not efficiently, but effectively.
12:51
And what I found when I started doing
12:53
this is that most of the time I
12:55
was being incredibly inefficient.
12:56
And why?
12:57
Too many meetings with too many people
12:59
about too many things that don't matter
13:01
and that don't move the needle.
13:03
So you were using that tool,
13:04
and it was scanning with the purpose of
13:05
the meeting, who was there,
13:07
and it was looking backwards to say,
13:09
did what we do four weeks ago accomplish
13:12
what the goal was?
13:13
And it's able to give you real-time or
13:15
in-time recommendations of what to do
13:17
forward.
13:18
Absolutely.
13:18
It's a daily report I get.
13:20
Wow.
13:21
All right,
13:21
so a lot of operators are doing this,
13:23
though.
13:23
If they're not using a tool like that,
13:25
they're adding dashboards because if
13:28
something's broken, add something to it.
13:30
They're adding meetings or wiping them off
13:33
the schedule altogether.
13:35
Why are all three of those usually wrong?
13:39
Yeah, so the way I look at it,
13:40
all three of those are symptoms that the
13:43
meeting stack is broken and they're red
13:46
herrings.
13:47
They're not fixes for it.
13:49
Adding dashboard,
13:50
the assumption is that the problem is data
13:53
visibility.
13:54
The problem, by the way,
13:54
isn't data anymore.
13:56
We used to say, oh,
13:56
we need more data.
13:57
We need more.
13:57
We have plenty of data now.
13:58
We have too much data.
14:00
What we need is insights.
14:02
And then we need actions from those
14:04
insights.
14:05
The problem was never about data
14:07
visibility.
14:08
The data was visible.
14:09
But what was missing was the conversation
14:12
about what the data meant in a room
14:14
full of people who act on it.
14:16
A new dashboard doesn't create that
14:18
conversation.
14:18
And most platform, it displaces it.
14:22
Adding meetings.
14:23
Now you're at forty five hours of meetings
14:25
a week.
14:25
The same metrics are being walked through
14:27
five different ways and nobody can tell
14:29
you what a single meeting is for.
14:31
How many times if you ever worked in
14:33
an office at any point during your career,
14:35
did a meeting start on a half hour
14:36
and on a half hour and a new
14:38
meeting started immediately with no time
14:40
in between to chat with people or to
14:42
talk with people?
14:43
never happens.
14:45
And so Microsoft's data, by the way,
14:46
on this is what they call the infinite
14:48
workday.
14:49
I love this concept that Microsoft came up
14:51
with.
14:51
Meetings have tripled.
14:53
Since two thousand twenty triple
14:55
executives at nineteen plus hours of weeks
14:58
of meetings,
14:59
the workforce interrupted an average of
15:01
every two minutes.
15:03
How are they interrupted?
15:04
Slack, chat, text,
15:07
all of these ways that bombard you.
15:09
That's a chart for failure at industrial
15:12
scale,
15:13
which is what health care platforms are
15:14
at.
15:15
cutting meetings,
15:16
the platform feels lighter for about a
15:18
quarter, then the decision,
15:20
stop getting made cleanly accountability
15:23
erodes and the truth stops surfacing
15:25
because you decided to deleted venues
15:27
where it could be said,
15:28
now you're running a multi site platform.
15:31
on a hundred and fifty-three Teams
15:32
messages or Slack channels,
15:34
and a hundred and seventeen emails per day
15:36
per leader.
15:37
And also Microsoft's numbers, by the way,
15:40
with no shared room in which any of
15:42
those threads are ever resolved in
15:43
decision.
15:44
Microsoft's data,
15:44
a hundred and fifty-three Teams messages,
15:46
hundred and seventeen emails per day per
15:48
leader.
15:49
The actual fix, by the way,
15:50
is none of them.
15:50
It's redesigning the meeting stack so that
15:53
each meeting has one specific job and is
15:57
held accountable for one specific job.
16:00
And a lot of that specific job is
16:01
unearthing things that's harder than any
16:04
of the three reactions above,
16:06
which have been the default operating mode
16:09
since we've been in the recovery post
16:11
pandemic.
16:12
So you say most platforms are doing this.
16:14
They're running the same meeting four ways
16:17
and thinking they're getting four things,
16:18
but they're not.
16:19
What does a broken meeting stack actually
16:21
look like in healthcare?
16:25
Some examples.
16:26
A broken stack looks at four different
16:28
meetings with four different audiences all
16:30
doing the one job, reviewing,
16:32
trailing financial metrics, which,
16:34
by the way,
16:35
could be done on a three-minute Loom video
16:37
recording or a stream on Microsoft or
16:39
something like that.
16:41
The daily huddle,
16:42
instead of being a huddle,
16:43
becomes a metrics dump.
16:44
This much cancellation,
16:45
this many patients are scheduled.
16:47
This is what's going on here.
16:48
The weekly tactical becomes a dashboard
16:50
recital.
16:51
You're just reciting data.
16:53
The monthly strategic becomes a slide deck
16:55
parade where decisions are pre-baked from
17:00
the one-on-one somebody ran with each
17:01
board member earlier that week.
17:03
And the beauty now, we have tools.
17:05
We can take our recorded meetings and we
17:07
could put them in a database and have
17:09
it give us feedback on how we're
17:10
performing in those meetings.
17:12
Not as a way to monitor,
17:13
but as a way to instruct to make
17:15
things more effective at unearthing
17:17
conversations.
17:19
So four meetings,
17:20
one job performed at four different
17:21
production values.
17:23
All of those things really are not
17:25
supposed to be that way.
17:27
And here's what they're supposed to be
17:28
like.
17:28
Here's what each tier is.
17:30
So you have the daily huddle.
17:31
The job of the daily huddle is situational
17:34
awareness.
17:36
You know, what is going on?
17:37
Where am I at in space?
17:39
If I'm a pilot, you know,
17:41
what is my altitude?
17:43
It's the only meeting where the floor can
17:45
talk back.
17:46
Think about that.
17:46
You have a daily huddle at the floor.
17:48
It's the only one where they get to
17:49
provide feedback.
17:51
And the single question that should be
17:53
answered every morning is,
17:54
what does anyone in this room know that
17:57
we need to know,
17:58
that I don't know as a leader,
18:00
that I need to know before we open
18:02
the clinic.
18:02
Tell me things where my blind spots are.
18:06
What aren't we seeing that we should be
18:07
seeing and addressing?
18:09
That's a really good question.
18:10
And it's not the question that people ask
18:13
because it's easier to recite data.
18:15
The weekly tactical would be the second
18:17
meeting.
18:18
This is for week to week execution.
18:21
In Lansoni's framework,
18:23
it's a forty five to ninety minute
18:25
meeting,
18:25
a lightning round of leadership
18:27
priorities,
18:28
four to six leading indicators,
18:30
then a real time agenda built in the
18:32
room.
18:33
If there's not an agenda,
18:34
don't build it there.
18:35
Strategic topics get parked.
18:37
They get put on a shelf for the
18:39
later meeting.
18:40
Decisions walk out.
18:41
That's the weekly tactical meeting.
18:43
A barometer of sorts.
18:45
Execution.
18:46
What do you need support in?
18:48
What are you doing that we need to
18:50
know about?
18:50
That's what a tactical is.
18:52
Then you have a monthly strategic.
18:54
This is the third meeting.
18:55
Remember, we had the daily huddle.
18:56
weekly tactical the monthly strategic
18:59
where the platform's hardest questions get
19:01
debated creative abrasion two or three
19:04
topics don't do any more than that written
19:07
narrative memos not slide decks you know
19:10
not death by powerpoint real conflict real
19:13
uncomfortable conversation that's where
19:16
real decisions get made they're not
19:18
pre-baked that gets you to consensus and
19:21
commitment
19:22
whether that decision was made in your
19:24
favor or not is irrespective.
19:27
You stated your point,
19:29
made a decision and went on with it.
19:32
And then the fourth meeting is, you know,
19:35
you call it a lot of things.
19:36
Most people now call it in all hands.
19:38
That's a culture meeting.
19:39
That's a transmission meeting.
19:41
At least a quarter of the meetings in
19:43
real Q and A. In other words,
19:44
your culture meeting is allowing your
19:47
people in a town hall to ask questions,
19:49
not pre-screened questions.
19:51
real questions with honest answers that
19:54
are hard questions where they see
19:55
vulnerability and they see emotion and
19:57
they see reactions it's not necessarily
20:00
audience approved content this is not a
20:02
g-rated you know meeting it's clinical
20:04
issues for clinicians and operational
20:06
issues for operators
20:08
If each meeting does its specific job
20:10
within that framework of that stack of
20:12
four meetings, it works.
20:14
If any one meeting is doing trying to
20:16
accomplish what another meeting's tactical
20:19
intention is,
20:20
then you're degrading all four.
20:23
You introduced this napkin test.
20:25
So here's a fun exercise.
20:27
If someone listening right now paused this
20:30
episode right now and audited their
20:32
calendar for tomorrow,
20:34
what would or what should scare them on
20:37
their calendar?
20:38
Yeah,
20:38
the thing that would scare them is how
20:40
few meetings that they attend on their
20:42
calendar pass all four questions.
20:45
The test runs like this.
20:46
For every recurring meeting,
20:48
you answer four questions.
20:50
What is this meeting for?
20:52
What does it decide?
20:55
What would specifically not be discussed
20:58
there?
20:58
In other words,
20:59
what rabbit trails are you not going to
21:01
go down?
21:02
What would happen if the meeting didn't
21:04
exist?
21:05
The first question, what is it for?
21:08
Most operators can answer at the service.
21:10
It's the ops review.
21:11
But push hard on the specific job and
21:15
those answers blur.
21:17
Situational awareness, tactical execution,
21:19
strategic deliberation,
21:21
often two or three of those at once,
21:23
which means the meeting is failing at all
21:26
of them.
21:27
One other question about that first
21:29
question I like to answer is,
21:30
are decisions being made at its most local
21:32
level?
21:33
If it's an operating clinical decision at
21:36
a local clinic,
21:38
is a question trying to be answered by
21:40
the executive team?
21:41
If so,
21:41
that is transmitted and escalated to a
21:44
level that on the surface does not make
21:47
any sense.
21:48
The second question, what does it decide,
21:51
is really where it gets uncomfortable.
21:53
Most recurring meetings don't decide
21:55
anything.
21:55
They just discuss things.
21:56
They align.
21:57
They review.
21:57
They don't decide.
21:59
A meeting that doesn't decide anything is
22:01
a status broadcast meeting.
22:03
It's a pretender.
22:05
It's just pretending to be a meeting.
22:07
The third question,
22:08
what specifically should not be discussed
22:10
here is the idea that you don't go
22:11
down rabbit holes.
22:12
It's contextual separation.
22:15
You can't name what doesn't belong.
22:17
You haven't separated it from the other
22:18
meetings in the stack.
22:20
And then the fourth question is the one
22:22
that produces the most uncomfortable
22:24
answers.
22:25
For a startling number of recurring
22:27
meetings,
22:27
the honest answer to what happens if this
22:30
meeting didn't exist.
22:32
If the honest answer is nothing,
22:35
or would people be relieved,
22:36
or the conversation would happen anyhow
22:38
between the two people who actually needed
22:40
to talk, then you don't need the meeting.
22:42
And so if an operator runs that exercise
22:45
on tomorrow's calendar,
22:46
those four questions, that napkin test,
22:48
you'll find that most of their week is
22:50
operated in a fog.
22:51
It's dressed up in not operational
22:54
discipline,
22:54
but in meetings that just consume
22:56
calendars, and it's just scary.
22:58
The good news, though,
22:59
and the good news is it's fixable.
23:01
Hire a meeting czar.
23:04
Assign one person per each one of those
23:06
meetings to stay on track of those
23:08
meetings.
23:09
A benevolent dictator.
23:10
And when they get off track,
23:12
they have full authority and power,
23:13
regardless of their title or where they're
23:15
at on the bureaucratic hierarchy,
23:19
to intervene and stop it.
23:21
And that's what good companies do.
23:23
Final hard question.
23:25
Can a platform scale faster than its
23:28
meeting stack?
23:30
Could the meeting stack possibly be a
23:32
limiting factor?
23:33
No,
23:33
and this is one of the most important
23:35
things I've come to believe about
23:38
multi-site platforms.
23:39
The meeting stack is the platform's eyes
23:42
and ears.
23:43
It is a system by which leadership knows
23:46
what's happening across a footprint that
23:48
they can't personally cover.
23:51
If you grow from twenty sites to eighty
23:53
without redesigning the stack,
23:55
you're running an eighty site platform
23:57
with twenty site nervous system.
23:59
You can't see anymore.
24:00
You're operating blind.
24:01
And so if you have a hundred clinics,
24:02
you should have a hundred daily huddles,
24:04
right?
24:05
And a lot of times that discipline, well,
24:07
we'll just, you know,
24:08
not have these new clinics do the daily
24:10
huddle for a while.
24:11
We won't have, you know,
24:12
the leader of that clinic,
24:13
the clinic manager, the doctor show up.
24:17
No, that's absolutely wrong.
24:18
You absolutely have to have the
24:20
discipline.
24:21
around that.
24:22
A PE-backed healthcare would have a
24:27
specific version of this problem,
24:30
especially when you're buying clinics
24:31
faster than you can do it.
24:33
And it becomes crazy because you start to
24:36
say integration doesn't go well.
24:38
Well,
24:39
integration oftentimes doesn't go well
24:40
because you don't have a meeting stack
24:42
that supports integration.
24:44
You're integrating payroll,
24:45
you're integrating all kinds of things,
24:46
but nobody is sitting back trying to
24:48
unearth.
24:48
and trying to get to its most local
24:50
level to provide feedback.
24:52
A good useful rule,
24:53
which I've not seen anyone in healthcare
24:55
write down is every time your site count
24:57
crosses a meaningful threshold,
24:59
twenty-five sites, fifty sites, a hundred,
25:01
whatever that number is,
25:03
you redesign the meeting stack.
25:06
not adjust it you redesign it you have
25:08
the huddle architecture you have the
25:10
tactical meeting you have the four types
25:12
of meetings but you redesign them meaning
25:14
that you're finding out which people
25:16
really need to be that them and you
25:18
and you ask them not to take it
25:19
personally if they're not attending
25:21
certain meetings anymore you have to
25:23
rebuild those stacks at each and every
25:27
threshold this is the most expensive
25:30
accidental loss
25:32
in multi-site operation it's also the
25:34
easiest to fix if you're willing to admit
25:37
and have discipline and rigor around your
25:39
meeting stack the meeting stack is the
25:42
operating system that you typically have
25:44
never really designed for so it sounds
25:46
like the takeaway isn't just have fewer
25:48
meetings it's ask yourself if your
25:50
meetings are either transmitting truth
25:52
filtering it or just performative
25:55
Yeah, they become, you know,
25:57
what ends up happening in my experience.
25:59
And by the way, I've just, you know,
26:02
I've lived every one of these
26:03
dysfunctions, you know,
26:04
throughout my career.
26:05
And, you know,
26:06
you have to go back and constantly learn
26:08
it.
26:08
That's what really motivated me to go back
26:10
to the literature post-pandemic here.
26:12
And you have to have some really good
26:14
discipline about meetings.
26:15
Otherwise, they become perfunctory.
26:16
I show up, I drink coffee.
26:18
In the old days,
26:19
I would eat a donut that somebody brought
26:21
in and then you'd leave.
26:23
But you have to really now,
26:25
in a remote environment in particular,
26:27
be more adamant around that.
26:30
Simple thing you could do,
26:31
record the meeting on one of the AI
26:32
things of choice,
26:34
run it through a very good thing and
26:36
ask them,
26:37
did this meeting accomplish what it was
26:38
supposed to?
26:39
Ask those questions based on the recording
26:42
of them, not just...
26:44
Most people are using AI in meetings to
26:45
record it and then just recapitulate it or
26:48
these are the tasks that were assigned to
26:49
each person.
26:51
Ask AI to effectively rate your meeting on
26:54
how its ability to answer those discipline
26:57
questions on why you even had the meeting
26:59
in the first place.
27:01
If your growth story is or you'd like
27:03
it to be real,
27:04
the meetings sounds like should reveal
27:06
problems early and if they don't,
27:09
the dashboard might be the last place you
27:11
find out that something's wrong and it's
27:12
going to be a lag indicator anyway.
27:16
You can go deeper into Larry's article
27:18
this week on Substack and if it made
27:20
you a little uncomfortable, it's good.
27:23
That's the point.
27:24
Thanks for this, Larry.
27:26
Awesome.
27:26
Thanks, buddy.
27:28
I've got to run, Jimmy.
27:29
I've got to get in this other meeting.
27:30
I'll reach out to you.
27:30
You're the best.