Good morning, and thank you for joining us for Leading Your Group, Building Value and Scale. The webinar is being recorded, so know that we'll be sending the registrants the webinar recording and PowerPoint slides via email in the next few days. So today, our speakers joining us for this session are Andrew Colbert, Senior Managing Director with Ziegler, Andrew Wade, CEO with Ortho SC, and John Brady, who's CEO with Fox Valley Orthopedics. So now I'm going to be turning it over to Andrew Colbert to get us started. Thank you so much. Thank you so much. Really appreciate everyone joining today and looking forward to a great presentation. So I'm going to just quickly introduce, have the panelists introduce themselves. Andrew and John, would you guys mind just giving quick introductions? Morning, so I'm Andrew Wade, CEO for Ortho SC. Had the pleasure of working with orthopedic groups for about 14 years and super excited to be on a leadership journey along with the folks on this phone call, excited to learn together today. I'm John Brady. I'm the CEO of Fox Valley Orthopedics in Geneva, Illinois, the western suburbs of Chicago. I've been in healthcare for 30 plus years and have both an academic and professional interest in leadership studies and leadership development. Andrew, John, really excited to have you guys join me today. So I've had about 20 year career here in healthcare advisory services. One of the founding partners of Ziegler's Healthcare Investment Banking Group. Grew up in a family of physicians, my father and brother, both physicians. So always had the pleasure of being around healthcare and really wanting to help physicians build and grow their practices. I've had the opportunity to work on over 50 transactions, five and a half billion dollars in value. Spent a lot of time in orthopedics as well as other specialties like primary care, gastro, women's health, urology, and get to really see a wide spectrum of opportunities, helping groups think through both transformative situations like mergers and combinations as well as other growth avenues like DFAs and joint ventures and hospital affiliations and private equity transactions. So I think, you know, we're going to start today and I'm going to spend a few minutes just laying the groundwork for some of the fundamentals of leadership. And then we'll create really a discussion between John and Andrew and really excited to have the two of you here today for what I think will be a phenomenal basis for folks to really hone in and shape them. Fundamentally what is a leader? Leaders are here to set strategy, to motivate, to create a mission and build culture. But fundamentally at the end of the day, any good leader has got to create tangible results. And there's really six styles of leadership that I want to make sure we talk through. And I think as we go through the meeting today, we're going to try to find case studies and examples of how these leadership styles are used in real life and in real application. So I think some of us are familiar with the course of style. This is kind of your strongest, more direct approach. This is kind of the immediate kind of driver of compliance. Do what I tell you. I think it's a great application when there's kind of an urgency, an immediacy, kind of something needs immediate attention. But certainly isn't the highest from an impact on climate and probably the lowest ranking according to the Harvard Business School results, probably the lowest from a kind of impact on team and climate overall. This is really the most positive impact on climate. This is really the mobilization strategy. Come with me, let's lead together. Someone that really possesses the confidence, but also understands the softer side, the empathy. And this is someone that really sets forth a vision and a strategy and kind of explains the why of why you're leading and why you're building. And I think it's important as a leader, not just to kind of tell someone what to do, right, but to explain why it's important. The affiliative is always a great strategy if you've got kind of a big group of folks that you really need to build relationships. This is much more of an emotional and a harmonizing approach, certainly a positive cultural impact. One that I think is important when teams are kind of going through changes or layoffs or departures or stresses, a business that's kind of in turmoil or in transition. This is kind of a great approach when you need to kind of build camaraderie. But probably ultimately not as clear cut of a visionary, right, as someone that's kind of driving with a real clear goal and strategy. The democratic approach is something that we see a lot in physician groups. I think sometimes to a fault where it's kind of a real group think mentality. Definitely very much a collaborative, a team focused approach. Always try to build consensus and drive consensus. We see this approach, certainly if you're trying to architect, for example, a merger or a major transaction, it's very challenging to kind of just pose an idea to a group and just bring it to debate in a group setting. If someone isn't willing to kind of demonstrate the leadership and the drive and explain the why and give people kind of the understanding of why it's so important, it can take a long time to get results in a true democratic approach. Obviously, any sort of authoritative model needs to have some sort of democratic buy in. But I think can be challenging to have kind of a fully democratic approach. The pay setting approach is a great one to kind of set standards. You know, it's someone that kind of leads by example, you know, and kind of in some ways kind of gets in the trenches and does the work and kind of shows people how things need to be done. You know, the challenge here is, you know, and sometimes, you know, I find with with leaders even that I work with, it's not always the most efficient. You know, it's not always the most efficient for the leader to be kind of doing the work, if you will, as opposed to kind of managing and driving and setting goals. And, you know, ultimately, this can be helpful when you need to kind of dive in and roll up your sleeves in certain instances, but definitely not something that you want to kind of demonstrate on a regular basis. And, you know, quite candidly, I think can have a negative impact if it feels like you're kind of constantly trying to kind of look over someone's shoulder and kind of doing the work on their behalf. And then, you know, lastly, is kind of the coaching approach, which is really important, developing people for the future and developing others and helping employees improve, which is certainly great. But, you know, there's only so much that I think this can this can accomplish on its own without having a broader strategy attached to it. And so I think, you know, I think the main takeaway is, you know, there isn't one style necessarily that works always on its own, but it's a combination of these styles. And really the ultimate proof of leadership, right, is our ability to lead and influence and guide to a more desirable state. Right. Because ultimately, you know, I think a good leader is never going to be satisfied with the status quo, you know, and it's about how do we build from where we are to somewhere bigger and more valuable and fundamentally, you know, increasing shareholder value in a corporate setting. One of the key drivers of a strong leader is being able to build that consensus and build the loyalty of your following. And, you know, I think one of the things that often, you know, up and coming leaders sometimes don't always appreciate is. You really can't succeed as a leader unless you're able to bring others on board. And there's really six main principles that are important in really driving a strong following and building consensus and building, you know, a real energy and excitement behind your vision. The first is, you know, let's let's just be candid. People like those who like them, you know, and I think there's got to be a real genuineness to your leadership style. There's got to be a real sense of empathy and that you really care about your team. Secondly, you know, I think there's often not as much focus on reciprocity, you know, even small things. You know, if you are in a business setting, right, and, you know, you want an introduction from from another entity, you know, it helps to go in and make an introduction or a connection for them. And, you know, often it'll get repaid as opposed to just asking someone for for a favor. You know, the social proof is really important to, you know, kind of demonstrating not only that you talk the talk, but but kind of showing that you walk the walk. Right. And so, you know, if there are certain social cues of how to act in meetings or how to dress or how to, you know, even just, you know, showing up in the office certain days a week. Right. It's it's very challenging to kind of lead with with one set of norms for the group that that the leader isn't following him or herself. Consistency, you know, this is this is one that's also really important. Right. To be a strong leader and say to people, hey, you know, you've got to be on time to meetings. You know, you've got to be obviously demonstrating yourself that you're always going to be on time to meetings and, you know, also, you know, making those commitments that you make, making sure you follow through. Right. And so if you say to someone, hey, respond to emails and a certain amount of hours and you're not following that, obviously it's hard for others to feel the same way. You know, the authority principle is obviously an important one. But it also is important that to take an authoritarian stance, you really have to be at a lead with expertise and not just, you know, lead with emotion. And so this is one where I think it's really important as a leader. When you have the right answer, you stand up and you back it up with facts and details. But you also know how to pull in experts and pull in outsiders that can answer the question. So you're not getting ahead of yourselves. And then lastly, is just demonstrating the benefit of, you know, scarcity. Right. And, you know, just highlighting the uniqueness of capabilities that that others may not have and being able to ultimately articulate why you think, you know, your group or yourself or your team is better, right, or more more advantageous than other offerings. Right. And I think I think to me, the way I think about this is a leader always has to be articulate their value proposition and always in a very clear and concise way be able to articulate, you know, why a customer or a client should choose them over another option. And that leaves me with the goal of emotional intelligence. You know, any good leader really needs to develop a skill set around a strength of emotional intelligence. And I think this is something that's that's challenging to necessarily, you know, just teach. I think some of these skills are really kind of learned over over many years, even outside of the business world, being perceptive. You know, I think just even how you communicate. Right. And the awareness of that communication is really important, you know, particularly in a day now where, you know, everything has become so much less personal. Right. You know, it used to be every phone, every conversation was a phone call or an in-person meeting. Now, you know, it feels like 80 or 90 percent of business conversations are over email or text. So just that, you know, the the awareness, right, of of kind of how you communicate the tone of that communication, how it's going to be perceived, you know, oftentimes that, you know, we're in a rush or we're in between meetings and we send something quickly and, you know, may not always be thinking about that, that awareness, you know, just kind of the self-management. Right. And understanding, you know, people want to work and engage with folks that they can trust. And so, you know, building the trust is such an important element of leadership. You know, you can't just expect that you walk into a room or walk into a meeting and folks are going to trust you. Right. That's that's a skill that you've got to build and develop over many years. And you've got to earn that trust. The social awareness is a really important element. You know, being just aware of of your team's needs, whether it's observances, whether it's family issues, whether it's home challenges, you know, folks are going to expect that you kind of understand that. And obviously, there still needs to be a real commitment to the workplace. But folks are going to ultimately work harder and be more loyal to a leader that is aware of some of the other kind of social opportunities and needs. And then last is just, you know, having the skills to be able to communicate well. Right. And provide that forum so that folks look up to you and see your strength as a communicator, being able to drive the vision, managing the conflicts, obviously, when they come up and building on communication as really the the fundamental linchpin of what drives a successful team. So with that, I'm going to turn it over to my panelists, Andrew and John, and hopefully that set a nice framework of kind of some of the fundamentals of leadership. And now we can drive a conversation around more of the application of these leadership skills. So, you know, maybe we'll start with you, Andrew, on just walk us through the leadership style in your organization. You know, how is it organized from an executive and clinical leadership perspective? How do you guys govern and drive decision making? You guys use a team or a hierarchical style and maybe just kind of give us a flavor of how you build your leadership system. Yeah, so thank you. Great summary. And, you know, I think one of the things that stands out listening and reviewing the slides and reading through there is that, you know, trust is a key foundational component of all of it. Right. I mean, it's going to be really, really tough for people to jump on board with whatever boat we're trying to row, much less join us in doing so if they can't trust us. And so integrity is really a baseline of all of this. And that's something that you you build and maintain the same way that you build and maintain the balance of the bank account. Right. So for us in our organization, I'd say we're pretty traditional in our organization and how we're designed. But we've put a ton of emphasis and continue to put a ton of emphasis on how do we how do we build a culture of trust and how do we build a culture of taking care of each other, if you will, in the process of getting the work done, helping the practice grow, helping our physicians come together around a central theme of, all right, what are we going to do? We have tons of options, tons of things we could do, but we've got limited time, resources and expertise. And how are we going to focus that towards achieving the goals that are in front of us, knowing that they're in a constant state of flux as well? So we're set up with a dyad model for executive leadership. So we have our administrative side of our universe and then we have physician leadership who are serving in the clinical side of the world, helping us with making clinical decisions where the folks on our side, which are a bit more in the business background, don't have the training to be able to speak into how we're going to organize and how we're going to run a patient care type of an application. But beyond that, it really is the day to day marriage of those two pieces. And it really comes down to making sure that we stay connected to each other so that as we face challenges and new things that we've got to figure out how to implement, that we can deliver the best care, experience and outcome to both the patients that we're trying to serve and the team that's actually carrying out the majority of the work that's there. That's great. And how do you guys think about balancing from a clinical leadership perspective, balancing clinicians that obviously have a busy clinical day, but also have an important administrative function to play as well? You know, and that's interesting because one of the first things I was told when I was brought on board at Fox Valley, we were having a question and it was about a clinical area and it was related to salaries and something like that. And I didn't know, you know, kind of the culture yet. So I asked the president managing partner, who is my dyad partner in leadership. And I said, you know, hey, you know, what do you think of this? And he looks at me and he goes, that looks like a John Brady problem. And so I kind of established right away where we were at, you know, and I was in a difficult conversation with a, you know, owner physician just the other day. And it got very, it was one of those where business and clinical meet and it got into a question on some clinical judgment. And he was questioning clinical judgment of another provider, blah, blah, blah. And he starts going into this clinical argument with me. And I just said, I'm not that kind of doctor. You know, I'm not going to have that conversation with you. And so it's knowing where that line is. I'm never going to discuss, I mean, yeah, I'll listen to them and I'll talk about it and I'll ask questions about the medicine that they practice, but I'm never going to get into a discussion that says, you have to do it this way. I'll say, look, VSCO supplements are becoming a losing proposition business-wise. Do you think it's still the best course of action for your patients? And let the clinical drive the decision and not the money. But that's kind of how we try to balance it. It's basically anything that's business related and keeps the lights on, I kind of take the lead on. And anything that has to do with making decisions, I consult on. The clinical decisions, I provide information support and decision support and consulting for. And would you say the model, John, that you guys utilize, is it relatively similar to what Andrew described? Any differences that- It's pretty much exactly the same. We have 13 owner partners. They are the board. And then we have a medical executive committee that is four of those owner partners and myself. I have a vote with the executive committee. I don't have a board vote, but I'm responsible for creation of the agendas, running those meetings, make sure everything happens. And typically executive committee meetings are more operationally focused. Like I'm taking them the health insurance plan on Monday, just so they can sign off on it, so they know that we're doing, because we're changing providers. But like the board, it's bigger decisions. It's growth decisions. It's capital investment. It's hiring decisions. It's disciplinary decisions, stuff like that. So that's more related to their ownership and their equity. And then how does it work in terms of the executive committee or those elected positions or volunteer? Yes, voluntold. Voluntold through elections, basically. It's the same group of guys that have been doing it for a while. We merged two years ago, so we brought one of the merge doctors in to give them a voice, make them feel like they have a voice. But it's the folks that are most interested in it. Some of the more senior physicians, they've done their bit for king and country, and now they're just focused on their practice. The younger ones want to understand business. So these are people mainly mid-careerists in their 40s who are, they have the energy and the enthusiasm around it. They see a longer runway than some of the more senior physicians, and they have more experience than the junior physicians. Although it's funny, as soon as someone makes partner, they ask if they can be on MEC. And it's like, let's make sure you make your nut first, and then we'll talk about that. So that's kind of how that lays out. Yeah, I mean, and I guess that, and I think that brings up a great question, which is how do you balance the dynamic between revenue-producing activities for the clinicians, right, versus the leadership and the business-oriented, right? And I think with a lot of groups, right, there's often this resentment for clinicians that kind of spend time doing administrative work and don't obviously get any allocations for that. But that's obviously a critical component of the practice. I mean, how do you guys think about that in terms of allocating administrative time or giving people time for administrative capabilities? So for us on our side, it's a voluntold role, but we have a very, very small amount of compensation that's allocated to our partners for leadership roles. It's nowhere near worth the time that they put into it comp-wise, but it's one of the things that I've pushed them from a leadership perspective on as being critical to the success of the group. I mean, like John said, I'm here to consult, I'm gonna deliver data, and I'm a data-driven guy. I'm one of those in God we trust, but everybody else has got to bring data kind of people, but I can't make the decisions for them. It's their practice, it's their business, and so they have to stay involved. The struggle for us is really making sure that we are developing those folks, both like the mid-careers, like John just mentioned, who have the energy and who have the go-get-it mentality, but may not necessarily have a lot of the understanding built yet to be able to walk into some of those situations and navigate them well. So I would argue that's probably one of the greatest challenges that we faced is keeping a leadership pipeline of physicians in place who are willing to show up, help make those decisions, because ultimately, if they walk off, we can run the business for them, but it's very difficult to help continue producing an environment that they're going to enjoy and that they're going to be satisfied with if they don't show up and add their voice to that conversation. Yeah, I mean, my response, we don't pay a stipend for the MEC, we pay a stipend to the managing partner, and again, it's pocket change compared to what his total comp is and the amount of time he spends doing it. But he likes doing it. This is a guy who was, I mean, he's one of the, you know, in my career, I've worked with two physicians that, honestly, I can say, really get both sides of the business. They're great clinicians and they're great business leaders, and they would be great in either, and he's one of them. And, you know, he's just, he wants to run and grow, you know, a business. And these guys, I mean, these guys own this business. This is theirs. It's not mine, it's not the employees, it's theirs. So their vested interest, you know, if the organization does better, they're going to do better because of the way that we pay out, you know, the partnership every year. So I think, you know, and it's funny, you know, the gentleman that is the president managing partner, he's in, he'll be 50 next year, but he's going to be doing this for a long time. But I start thinking to myself, who in the younger ranks is next? You know, who would take his place if he won the lottery? And, you know, so we think about what do we need to do to professionally develop them? And, you know, start to get them kind of the business understanding. You know, I'm a big MHA, health administration education person, you know, to understand the balance of the business and the clinical. So trying to get these gentlemen and our one-woman partner to understand the business side is really, really important. And I had a very funny experience, not with this group, but with another group. I was in a meeting and we were talking about something and this person was presenting financials and he kept hammering EBITDA, you know, he's hammering EBITDA on and on and on and on, you know, eight X EBITDA, nine X EBITDA, blah, blah, blah, And I looked down at my phone and I get a text from this doctor from my group that's in the room. He's like, what's EBITDA? So, you know, it's like, you know, they're very smart people. I mean, if they weren't smart people, they wouldn't be doctors. They're also very curious people, but just because they graduated medical school doesn't mean they know how to run a business. It doesn't mean they know the rules of accounting or the rules of marketing or the rules of strategy, things like that. So to remind them, you know, in a non-arrogant way, it's like, look, you go do your thing and I'll do my thing so you can go do your thing. You know, I'm not, I don't put hands on patients, but that doesn't make me less of a healthcare provider because I keep the lights on and I keep the bills paid and I get the bills out and I keep the revenue coming in and the expenses down. So you can go put hands on patients. And it's that understanding. I actually said that in my interview with these guys and they all kind of looked at me and go, oh, okay, yeah, that works. So that was, that's kind of the, you know, that was the expectation I established. That's awesome. And how long did it take to kind of gain that trust? You know, cause I assume, you know, kind of you gradually worked into the ability to have more authority and more decision-making capabilities. Yeah, well, yeah. I mean, have I gained full trust? I've been there 18 months with these guys. Have I gained full trust? I don't know. I know that they like me. I think, you know, I'm pretty sure they like me and I hope they like me. God, bonus is coming. I bet they better like me. But the idea on credibility, I mean, you've talked a lot about authenticity and credibility. And I mean, that's the key to any kind of persuasion. If I don't believe the person, if I don't think the person knows what they're talking about or if I don't believe in the person, I'm not going to believe anything that comes out of their mouth. I don't care how much data they have. So I've spent the better part of my first year, I spent establishing myself, not bragging about myself, but just establishing bona fides, you know, to make sure that people knew that, yeah, I do know what I'm doing. And I feel like I'm getting to the point now where they're looking at me like, what do you think? And, you know, we'll listen to you. You know, it's your call. I'm hearing more of that language that tells me that the work that I've done, the demonstration through data, through execution, things like that, and through setting metrics and, you know, and doing all the good business stuff that they didn't have before, I think that's building my credibility up because I'm not saying, look, here's my resume. This should be enough for you to believe. I look great on paper. I really look great on paper, but am I really that good? And that's what I told them. I said, look, don't believe this. This is me selling myself. Believe what I do. And I'm trying, I mean, I still have a lot of staff that look at me with a kind of a side eye and they wonder, you know, when am I going to drop the other shoe? So I'm still working on that. And I don't see that ending anytime soon. That's an everyday thing for me is working to build credibility and trust. That's great, yeah. And I think that's well said. I find sometimes, yeah, leaders that show up in the room expecting their track record is going to just give them authority. I think struggle versus ones that actually demonstrate it through their results, right? Andrew, how do you think about your leadership style and kind of the role that you've built and as you think about those six styles that I walked through kind of which one kind of resonates with you in terms of what you feel like you gravitate towards? So personally, I really land just, you know, my natural wiring lands towards coaching. But I think the important thing there is that, you know, we have to embody all six of those leadership styles depending upon the situation that we're standing in, right? When your organization or team's facing an immediate threat, it's coercive, right? When you're in the middle of a partner's meeting and you're trying to navigate your, or help the group navigate its way through a really complex, sensitive issue, it's often democratic or authoritative. You know, in some situations it's affiliative because you can't force people to do something. You have to sell the vision and bring them along with what you're trying to accomplish. So, I mean, I'm naturally wired towards coaching. I think probably one of the worst things that happens to us is we all at some point in our career take a personality profile and learn kind of how our wiring naturally is. And, you know, if we're not careful, we assume that because that thing labeled us a hammer, everything starts to look like a nail. And we don't realize that we have to be able to shift gears depending upon whatever that situation that we're facing is to be able to deliver good leadership. Yeah, I had the third, when I worked for Northwestern Medicine, I had the third highest red on my disc score, which is basically be brief, be brilliant, be gone. So I have to fight that instinct every day. But to that question, I think Andrew makes a great point. It's very situational. And what builds authenticity in that is that the idea of transformational leadership, where you're engaging people in the larger mission and vision of the organization, they know that that housekeeper knows that by keeping those public bathrooms clean and keeping the leaves out in the fall, people see a really clean clinical environment and it makes them feel better about the care they're gonna receive. So they're gonna approach the care differently and then they're gonna have higher patient satisfaction and hopefully better outcomes because they trust the clinician who works in this clean, nice office. So when you say that to a housekeeping staff, you're like, oh, I have a role here beyond just cleaning the bathroom. I have a role to make this place look clean, clinical and comfortable. And so that type of engagement is the way that I look at it. Now, sometimes you have to coerce it, sometimes you can coach it, sometimes you can, you know, whatever, but it's making sure that people know that the work they do matters and it's not just about the dollars, it's about patient care, it's about, you know, the dollars are a side benefit to excellent patient care. One thing that I tell my, the first thing I told the team when I started working there was, I go, look, we only have one thing that we sell and the only thing we have to sell, the only product that we have to sell is time. And the value of that time comes in the clinical expertise of those people who are providing the care during that time that they're with the patient. All the other stuff we do just enhances the value of that time. So we need to make sure that we're making the most of the time that we spend in front of patients and making the most of their time. And it's kind of a different way of looking at it because it shows that it's not about the money. The money is a by-product. If you do all the value parts right for the patient, the money is gonna come and the physicians will be happy. So, and I hate that conversation about, oh, you know, we make a lot, we make more money on a knee than we do on a carpal tunnel. Well, but there's a lot of people that need carpal tunnels, so let's make sure that we're able to do it. Yeah. And I guess, what do you see as kind of the biggest leadership challenge that you have ahead of you as you think about kind of the next, you know, the next frontier for your groups? I don't know, Andrew, do you want to start on that one? Yeah, sure, sure. So I think one of the biggest challenges that we face is just the pace of change, right? The acceleration of change that's happening around us and recognizing that a lot of the times, if we're not really careful, we can be very busy in our office where it's neat and tidy and quiet so that we can focus and think. And we can lose the ability to keep our finger on the pulse of what's happening inside of our organization and outside of our organization. The pace of all of that transition and the evolution of what we do and how we do it and where we do it and who we do it for keeps changing faster and faster every year. And so I'd argue that the model that we work off of, of recognizing an issue or a challenge or an opportunity, developing an approach to it, selling that vision to our team, bringing our team along with that and executing on it is getting faster and faster as we go. And as much as that, you know, oftentimes it drives me to, all right, I just got to run faster, move quicker, decide quicker. A lot of it really comes down to making sure that I'm doing what I need to do to make sure that I can show up and deliver my best to my team. Because, you know, at the end of the day, I'm only one human being and I only have 24 hours in the day so I can only do so much, right? But if I'm focused on bringing the right leadership style to the situation and I'm focused on investing in the team around me who are really great, really smart people, they're going to be able to carry the vision that we're trying to accomplish into every unique situation that we have around us and every application of how that works from all the way from one end of the organization to the other end of the organization. Yeah, I think at a macro level, Andrew is spot on. People run around our organizations and I've worked in a lot of different healthcare environments but they run around our organizations with their hair on fire because they have this latest emergency. And what I try to tell people is, okay, let's slow down. Good baseball players are able to hit the ball because they can slow the pitch down. They don't physically slow it down but they slow down how they see it. And they know what point to look at it. And they're looking at it coming off the pitcher's hand, not as it's halfway there. We have to slow down and know where to look at things. And it's about understanding the systemic relationships that exist. So when someone comes in and they're screaming and yelling and they drop a problem on my desk, they've just made that my problem. And they may not like the direction I take with it. And I tell them that. I said, look, you come in here and you ask me what to do. I'm gonna ask a lot of questions. I'm gonna go down rabbit holes that you don't wanna go down. So help me frame the context of the situation. And I'm a huge fan of SBAR. I think the nurses got it right a long time ago with the SBAR approach, Situation Background Assessment Recommendation. So I get my management team to do it that way. When you approach me with something, you bring me an SBAR with it. And that way we can work toward it, but it slows down the problem so that we can really see it. And it forces us to think through what may have contributed to it. To the larger question that you asked about the biggest challenges we face, there is a significant cultural difference, cultural and generational difference in workers. I'm 57 years old. I'm a Gen Xer who was sent out at eight in the morning and told to come home when the streetlights come on. My daughter is 25 years old. Her approach to work and my approach to work and my wife and I's approach to work is very different. And my daughter's a very smart, effective analyst for a large insurance company. She's doing very, very well. I cannot gauge and judge how this next generation works. I have to judge them on their efficiency, not on how much they do it like I do it. And that changes the fundamentals of how we do business because people still have to go to the doctor. You don't get to remote. And yes, telehealth has risen up, but fundamentally orthopedics is about touching the patient. You can't always do that. So we have to find a way to find that happy median that yeah, you can work remote a couple of days a week, but our clinical teams can't ever work remote because they have to be there for the patients. So that cultural challenge, that generational cultural challenge is one, because what it does is you have some people say, well, I can just go work for an insurance company and work from home. So what do we do to create a culture and environment that engages them? They want to be with us, that they want to be in front of the patients, working with the patients. That to me is one of the bigger challenges that's coming down the road, but the pace of change that Andrew talked about, that's the one that keeps me up at night. Do you see the same challenge with the clinicians mindset as well, in terms of their approach to the, just the requirements of what it means to be a partner, and the interest in going out into the community and building relationships and selling their business, as opposed to just kind of showing up and expecting the business to be there for them? Yeah, that's actually a really, really good. I'm like, oh, I could tell stories, but I have one doctor who this guy is, I love this guy. He is a marketing, I mean, he's just, he came to me yesterday. He wants us to sponsor a 5k. He wants us to develop a 5k. I'm like, okay, let's slow your roller. But I have two marketing people. Yeah, we're going to do a 5k. But so, you know, I got some that are just really into it. They love speaking. They have the relationships. They do the high school medical director thing, you know, for the football teams and the soccer teams. They're all in on it. And then I've got a couple younger ones that kind of look at me and say, how come I'm not busier? I'm like, well, because you left it, you leave at four o'clock every night, you don't go to the, you know, you know, you're not, you're not having your you're having your PA come into the appointment with you instead of having your PA have their own schedule. You know, and it's, it's interesting. And I don't want to say it's generational, because I've got some older doctors like that, too. But I do see this, I don't want to work weekends, I don't want to do call, I don't want to, you know, I only want to do I'm a joint guy. And on call, I might get a hand and I don't want to do that. Or I'm a hand guy. And on call, I may get a fracture, and I don't want to do that. And it's just like, guys, this is this is the job. This is what you trained to do. You get paid very, very well, you have great lives because of this job. This is just this is just one of the elements of it. There's a lot of crap I got to do that I really hate. But, but I do it because it's part of the job. Breaking through to that mentality is when someone figures out how to do it, please call me because I want to I really want to Yeah, no, I agree. I think I mean, and that's something I mean, we see that in our business as well. I mean, there's just a fundamental change in mentalities of some of the younger generations where I think driven by some of the just the young, you know, success of these tech companies and startups, right, where where, you know, if a 20 year old can now be a billionaire, right, it just it just changes people's mindsets of kind of what they expect the path to look like, and how quickly they expect to get there. And it's not even it's not even the people that want to make a ton of money. It's like, you know, I had, I had a biller pull out a memo around that came out in April of 2020, sending them home indefinitely. And she's like, we can't come in the office because my predecessor sent this memo three years ago at the start of a global pandemic. It's like, um, okay, so we can never change that. Is that what you're telling me? You know, so that kind of breaking through those, that kind of thinking is, and this is not a young person, this is this is a person in her 40s who has kids. And I'm like, wow, you really must have had a good time working at home because you have no desire to ever come back and you know, which is fine. But how do you build? You know, how do you how do you build teams? How do you educate? How do you do those things? You got to have you still have to have your finger on it a little bit. I don't want to micromanage them. But I do want them to feel part of the team. And I do want to know them. Yeah, it's a struggle. It's a big struggle for us to I mean, I think it's a it's an ongoing challenge, because at the end of the day, we're always looking for, you know, all right, how do we keep this organization running? How do we help manage the struggles and the problems and navigate the issues that our physicians are facing. But for every employee that we have, there's an individual set of drivers and motivators that are present in them, right. And so the best leadership, the best management is figure that out and figure out how to create an application sequence that connects what they do to what drives them. The problem with that is how do you do that at scale? You know, I mean, when you're hundreds of employees, just knowing everybody is difficult, much, much less getting to know everybody individually. And so that's, like, for me, that's one of those reasons why pushing back to I've got to invest in my team so that they can invest in their team so that they can invest in their team, because we just we can't know everybody as well as we could when our, you know, when our organizations were much smaller and much more compact, and everybody worked in the same building together and walked past each other in the hallways every day. And so I mean, I don't think we've figured it out by any stretch of the imagination, but it's definitely one of those. Hey, we got to get better at this. It's funny, you know, we talk about credibility and authenticity. And we just had these Oktoberfest picnics this week, at some of our different sites. And, you know, so I go to be there to thank people and all that stuff. And I'm walking through and I have all these people, hey, John, hey, John, hey, John, and I'm like, hey, you. Because they don't have their ID on and, you know, you just feel like a fraud. But I remember back when I was a kid, and I was young, and you know, the leader walked by me and said, Hey, how are you? How's it going? Did you get enough to eat everything good? And I remember how great that made me feel. So it's not I'm not being fraudulent in not knowing their name, but but but I can still take a serious interest, even if I don't remember their name. And then I can ask somebody who that was. But um, but it's it. Andrew's so right. And we have 335 employees across 10 different sites. You know, I and then we there's no way I'm going to know all those people. But and I shouldn't I shouldn't have to. But I need to know that those people are taken care of that they're in job mean that their their goals align with the goals of their job, that their skills align with the job description. Because, you know, more often than not, the people you let go are in positions that they shouldn't be in. They're not they're not well aligned. So maybe there's a way to find something different for them. That means the manager has to be engaged, the supervisor has to be engaged. And I can influence that by being engaged with that person. So there is that, that, that that telephone line or that trail that connects, I think Andrew said it really, really well, we have to motivate, you know, the area we can and be connected to the areas that we can, so that we can be connected to the larger organization. I think one of the I totally can't remember who I stole the quote from. But one of the one of the driving things that I try to keep as foundational for me is that I can't know everybody, but I can do my best to make sure that everybody's known. And so that, you know, frontline leader to each of our individual people is my so in my organization, my site leaders are the unsung heroes of what make the place run 1000%. They're, they're on the floor with our teams, they're out in the place with our docs, they're seeing what's going on. And, you know, those are some of the best leaders that we have. And, you know, I'm, I'm a fan of my people, you know, I'm gonna be hard pressed not to find something to compliment them on, because I get to I get to work with a really incredible team. But it's fascinating to watch, you know, just like you said, you know, those points where you find yourself separating? Was it a problem with them? Or was it the problem with the situation that they were working in? Was it something where we're asking them to try to work at a job that totally grates against the flow of who they are and how they're wired? And what do you do with that again, at scale? And how do you how do you guys measure the success of that next rung of leaders? I mean, how do you typically think about, you know, kind of ranking them and assessing their capabilities? How do you measure them? Well, I, I'm not I'm not a fan of performance evaluations, I think performance. Okay, he said it, I didn't. But I think performance evaluations are our theater, and nothing more. I think setting metrics, giving people setting expectations, aligning people with, you know, so that they know what their contribution is to the larger enterprise, they understand the systemic interconnections and relationships that they're responsible for and how things work. I think that's really, really important. And that comes through active engagement. I, you know, the place I'm at now, and like Andrew, and Andrew, and I have similar educational backgrounds. So I can understand why Andrew's a data guy, because he's got an academic bent like I do. But data and metrics are everything. They don't lie. I mean, and you know, they don't tell you the whole story. But they do tell you directionally where things are going. So I want to know what my department leaders are doing, like, you know, my IT guy, you know, where are we at on, you know, give me give me percentage updates on where we're at with certain build, my call center, you know, where, you know, where are we at on, on lost calls, where are we at on missed calls, you know, we have metrics for all that stuff, and analytics to do it. And I'm building operational score, I've spent the last couple months building operational score cards and trying to socialize those across the leadership and across the partners, so that they have a better understanding of what their business is. One of the things that really surprised me when I started, because this is an organization that had just merged during the pandemic, they had a CEO leave, he checked out six months before he left. So they were kind of rudderless for about nine months, nine, 10 months. And I walked in, I started everybody I talked to had kind of a different definition of the business and success and all that stuff. I'm like, no, we have to be one Fox Valley, we have to be one set of we have to have a standard set of metrics, we have to have a standard way of looking at this stuff. You know, I'm a lean Six Sigma guy. So I wanted to eliminate waste and reduce variation as much as I could. And I'm, I'm personally disappointed in the success I've had at that. But others are saying that it's making a difference. I think we should be farther along than we are. But, you know, so I use those type of that's fascinating. So are you coming up basically with a custom scorecard for each manager effectively, and then you kind of meet with them regularly to kind of measure? No. So I operate off of kind of an operating model of four four pillar operating model, safety outcomes, access and reputation. You know, safety is the cost of entry outcomes or demonstration that we're doing things right. Access is how well people are to get to us. And that's a growth measure. And then reputation is how we're viewed in the in the in the community, patient satisfaction, stuff like that. And then that that also leads to growth. So I find metrics that fit within those four buckets across the organization. And then I say, okay, access, all right, well, this is one that fits really well with my manager for so their organizational metrics, but I take, you know, they're the metrics that are going to drive the organization forward. But I tie them and relate them to those individual departments or leaders. It doesn't mean that one person's responsible for access, it means every manager could have an access for my IT guy has an access rule. I mean, if our portals down, if my you know, my website's down, you know, so that's how I that's kind of how I that's the scorecard I'm building. That's what the model I'm moving to. That's the model I've used before and that I'm comfortable with. And what it does is it takes the guesswork out of it. Back to the point about how great performance evaluations are. You don't have to evaluate someone performance, they can see it on a dashboard, they can see it on a scorecard. But again, you can't be bottom, you can't be two numbers focused. There's also this is the situational component, the coaching component. These are people, there's relationships, there's stuff like that, that you have to take care of. And that's where the authenticity comes from. Because if I was just if I was just a data metrics guy, you know, people would see through that. And you know, they would, you know, oh, it's all about the numbers with you. Well, yes, but it's also all about, you know, people too. So we got to we got to put the people before the numbers and you don't get you don't get the numbers if you don't have the right people. But and that brings up a great point on emotional intelligence. I mean, you know, let's say you got a manager who's, you know, a super smart, phenomenal technically, but just, you know, doesn't have a thought around tone and maybe sends emails that are a bit, you know, overbearing. How do you manage that type of individual? Because clearly, they've got a skill set and a capability, but but they're lacking the emotional intelligence that that is kind of required in a business setting. You remove their ability to reply to all. I love that. What do you say, Andrew? I mean, because I feel like we all have we all have some of those right where they're just super smart, phenomenally, you know, skills, but the emotional intelligence might just not be there. So I think I would back up and say that's that's a present issue at every layer and every component of an organization, right? From the patients who walk off the elevators to the team at the front to the clinicians in the back to the surgeons to us. EQ is, I would argue in our in our universe today, where stuff just gets more complex and moves faster. And, you know, it's not as simple as it was 100 years ago, where we were, you know, industrial revolution type stuff still going on. And it was, you know, you bolt the components on in a sequence, and it works, it gets to the end of the assembly line, and we're good. Everything requires trust, everything requires interaction, you know, we're getting towards the point now where one person can't actually produce any finished product anymore. Like it's all in some way, shape or form interconnected through some kind of team. And so it's that, you know, it's not the it's not the logic of how you do that. It's the way that you carry it out. It's how the handoff between people and teams and layers in your organizations happen. And that's where you either deliver excellence or you fail. And so, particularly to your question on what do you do? I mean, I think you coach, I think you bring people along. And I think if you find yourself in a situation where you have leaders who can't make progress on that, at some point, they have to transition into a different role. Because that's just going to be a bedrock component of how that we do this in the future, you know, a little bit of emotional intelligence, the ability to walk into a situation and diagnose, all right, what am I seeing? And why? And what's the emotional temperature of this person or this group of people? You know, in our in our world today as practice leaders, I mean, it's almost never the problem that's standing in front of us, right? I mean, it's always three issues upstream that created this issue today. And if we don't fix what actually originated this problem that's standing in front of us, it's just coming back. And so, you know, pushing people, pushing people towards seeing the value, and that's tough, for one, and then helping people learn to put that in place. Because we've, I mean, we've got surgeons who are the exact same way. I mean, they ping the top of the IQ scale 1000%. Right? They just hammer that. But bedside men are struggles, because they don't understand how the emotional component of that comes across to the patients. Same thing for staff, same thing for leaders. And so I think for all of us, it's a, it's an ongoing evolutionary challenge. We got to be 1% better tomorrow than we were today at this. And some of us, I mean, we, you know, we just dip into that river and ride, we're good, right? Others, it's a bit of a struggle. But like everything else, I think that the body of research that's out there today says we can develop this, we can improve this. And so whether it's something you just eat up and run with, or whether it's something that's a struggle, you can move the needle on this. And it's absolutely necessary that we all do. That's great. Well, to bring us to closing, I'd love you guys to give some just some guidance on young leaders that are, you know, 5-10 years behind you guys. What advice would you give them to get to where you two are today? John, you want this first? Well, kids, let me tell you. I guess, you know, never stop learning. Never stop. Don't ever stop your education. Don't ever stop learning. I mean, I got my doctorate when I was 42. I became a Lean Six Sigma Black Belt when I was 45. You know, I, you know, I continue to take classes, I continue to do stuff. You know, my 25-year-old daughter is teaching me more advanced Excel skills right now. You know, just never stop learning and never stop being curious. The other thing is, if you haven't already, take a finance class, take an accounting, take a finance class, because having those basics, that's 80% of what I do. And, you know, you're looking at a guy who was a broadcasting and film major from the University of Iowa, you know, and here I am now, CEO of a large, you know, $60-plus million in revenue orthopedic group. What training did I have as an undergrad to get me here? Well, none. Other than I developed some emotional intelligence when I was in college. The self-regulation came later, the self-awareness came. But that type of stuff is really, really important. And know that your career is not a straight line. It's never going to be a straight line. And that's actually what kind of makes it fun. That's great. Andrew? So I'm going to riff on that just a little bit by saying be 1% better every day. Totally steal that from somebody else, right? But it's true. A lot of the times the person that's hardest to lead is the one that stares back at you in the mirror. And you can't expect out of your team what you're not willing to show up and give yourself. So you got to set the stone, set the tone by being better every day if you want your team to continually improve. And I think the one other thing on that is think like an owner. Learn to think like an owner in the organization that you're working in. If you understand the drivers and the thought process and what's going on behind the eyes of the physicians who own the practice, it's easier to translate between what they are hoping to have happen and what's actually functioning throughout the machinery of your organization. And in the absence of it, you can exert a lot of energy and really not move the needle. And I would add one other thing. Understand the difference between wants and needs. The think like an owner made me think of that. Owners want a lot of things. Our job is to help them understand what they need and get them there. And I say it to my management team every time we have a meeting, and you've said it a couple times, is we're going to be better tomorrow than we were today. And I love that you say that, Andrew, because that makes me feel really good because I say it all the time. So those are great points that Andrew made. I really, really like every one of those. I would say this is such a great discussion, Andrew, John. Really a pleasure to have you guys on with me today. I think we could keep going for hours. Unfortunately, I think we're getting the hook here. But this was a phenomenal conversation. I hope folks learned a lot. And Jessica, thank you so much for giving us the forum here today. Absolutely. Thank you so much for all the great wisdom that you shared and experience that you shared. This is going to be on our AAOE Learning Center after the fact. So if you have some things you want to revisit at a later time, you can always find that there. And then if there are any last-minute questions, feel free to drop them in. We can stay on for just a minute to see if anybody has any. Otherwise, we're really glad that you were able to join us this morning and look forward to seeing you the next time around. Sounds great. And folks can also feel free to just reach out to us after the webinar, too, if they have any questions. I'm sure you can find us on LinkedIn or wherever. Obviously, some things are better one-on-one. And I often think that not every question is always great for group settings. So that's okay, too. Yeah. I'm down with the social media. Sounds good. Sounds good. Well, I appreciate everyone's time. And John and Andrew, thank you again. And talk to you all soon. Thanks for having us. Thank you. Thanks, everyone.

leadership skills

healthcare organization

orthopedic practices

leadership styles

strategy

motivation

mission

culture

trust building

emotional intelligence