Culture Focused Practice

Hey, hey, Dr. Tara Vossenkemper here, and you are listening to the Culture Focus Practice podcast. Thank you for being here. Thank you for joining me. Have you ever felt like you continue to solve the same problems over and over and over again? Not like I. This person keeps coming to you, but like over time, the same thing just keeps popping up.

And you question, didn't we, didn't we talk about this already? Wasn't this two weeks ago or last quarter or even a year ago, we implemented a policy? I thought we answered that already. You just, you, you keep seeing the same things happen over and over again. Today's episode in particular, we're looking at why group practice owners get stuck in repeat cycles.

What is happening is that you are getting stuck. That's that feeling that's coming up. It, it, I don't know for certain of course, but at least one probability is that you're getting stuck in a repeat cycle. And today we're gonna shift into how EOS tools can help break that loop.

We are not talking straight up theory. I love theory for the record, but what I really wanna do is, sure, maybe talk some theory, of course, but specifically focus on the tools for the problems. Real tools for real problems. Hence the title of the episode. You don't need more brainstorming. What we need, we, I would say collectively, we all need is structure in place.

So let's get into it, shall we? Before we keep going though, make sure you subscribe. If you do that because this resonates with you, then you will help this reach other people that it resonates with. So make sure you do that before we keep going.

And let's talk agenda. Four quick things. Number one, the pattern. Number two, the shift. Number three, tools with real life examples, my favorite. And number four, final thoughts. So.

I said this already, but if you've ever felt like you're doing a lot of talking about problems and not solving, you are likely stuck in the illusion of progress versus actual traction.

So when I talk about the illusion to progress, what I'm really talking about is when you leave a meeting, for example, and you feel great, you're like, man, we, we really got into it.

You know, we, we spend a lot of time grappling with this or talking about this, or brainstorming this thing or coming up with ideas or whatever, whatever it is. But then an hour goes by and you start to question like, well, what, what actually happened at that meeting?

What was my takeaway? Are there any to-dos? Was somebody taking notes? Where can I find what we talked about? And maybe you even send an email to a colleague and you're like, Hey, what did we decide about this thing? And they're like, I don't, I don't remember. I thought we said this, but you think something else, you just end up feeling confused. Maybe even more confused than you were in the first place. You know that's a possibility.

That's the illusion of progress. When you're in that meeting, you feel like you're really doing something. You're not. Not If you're having those types of meetings, that's not getting much done.

Actual traction on the other hand, is deciding. Making decisions about specific issues, assigning an owner, figuring out who's responsible for this thing, identifying relevant to-dos and tasks, documenting them, and then tracking the progress of said project or issue or what have you until it's completed.

That's traction. Feels very different than the illusion of progress. Outcome is much better, which is nice, and it's absolutely doable. There's very simple things you can implement to get into achieving traction versus feeling like you are progressing when there's probably not much that's actually progressing.

So let's talk about agenda item number one, the pattern. So this is chronic problem recycling. When we say pattern, I'm talking about chronic. I. Problem recycling. Here's some really consistent or common examples.

Uh, recurring team conflict. If you're hearing the same fucking thing over and over and over again, oh my goodness, let me beat my head against a wall. The same problems that might be coming up within your team, that's a chronic problem.

Another really common problem is inconsistent follow through where maybe one day one person is responsible for follow through and on another, there's another person, but the other person drops the ball and, or maybe you just might have a really full plate. And so this is the first thing that goes by the wayside is following through on. A certain aspect to your role or to your job.

Another is, another common example is ownership ping pong. And what this means is, you know, I might own steps A and C, and then another person owns D and D and somebody else owns B. And at the end of the day, yeah, everybody can point the finger at somebody else and say, well, I did my thing, but they didn't do their, like, it's, I'm not, I'm not responsible. It's not my responsibility.

It just consistently like, bounces around and nobody knows where it should land or who should be responsible for it. This is like a quick news flash, but if there's more than one person that owns something, it's gonna flop. Something's gonna go wrong with this.

There There needs to be just one owner for a project or a a role, especially. Just one, because at the, at the end of the day, it's that person that we go to and say, Hey, what happened? And then they get to answer. And I don't mean that in a punitive way. Like we know who to fire. Although, sure. Maybe that's it too.

I mean it in a way that we just have a very clear line of we go here, it's that person's responsibility. They're accountable. We're everyone's on the same page. Boom. Very, very straightforward, very simple, very clear.

Okay. So related to the pattern, there's a couple of key points here that I wanna bring up. And again, the pattern being chronic problem recycling, shit just keeps coming up. There's two things. One is that insight alone isn't really enough if you don't have support set up.

When I say support, I don't mean that you need a team of 15 people to support your clinical staff. I don't mean anything other than you might have insight into why something isn't working well, but if you can't build out a system, including potentially additional people to support the solution to that problem. It's gonna fail.

Because it's been failing already. And if you're the person that just is adding things onto your own plate to rectify all the issues, and you're the owner, especially, that's not really working in the direction of stepping away and being able to focus more on big picture things, for example.

If you wanna be an owner operator and you really wanna stay in the operating role, cool. I could see you making the argument that you wanna stay in an operating role. And honestly, some things you should keep in your lap, especially whether you're owner or owner operator. Some things need to stay with you, but if you are trying to move out from all of the day-to-day things, when you come to these recurring problems and you have insight, and let's say there's 10 of them and you have insight into all 10 of these problems, you shouldn't be the only structure in place to stop the continuation of these recurring problems.

That's not sustainable because now it's just all back on you and you are a very functional part of the stopping of the issue. But if you're out of the picture, then what happens? Well, it's all gonna cycle back up, which is gonna be a pain in the ass.

Additionally, and this is why I don't think you should be the person. It takes an emotional toll. And this is the second sort of additional piece that I had about the, the pattern, the chronic problem recycling. It's emotionally exhausting. It's frustrating. It can lead to burnout. You can feel resentful, especially towards your team.

If it's something related to team dynamics, for example, you keep hearing the same problems you're trying to solve it. You don't have the bandwidth to stay engaged in the actual solution. So it just keeps coming up because there's in consistent follow through

because you don't have the capacity in that moment to deal with everything happening. My point is it's exhausting. It's exhausting for everybody, for your team, but also I would say for you, period, not even just for owners, but also for leaders at the practice.

So that's the pattern. This is what we're trying to get away from. Let's go to agenda item number two, which is the shift. I love this so much. I know for myself that one of the things that helps me always in life is if I have some sort of conceptual framework. I need a map and I don't need a map that tells me exactly where to go.

I need to be able to zoom out and place myself in context. And so I can sustain a lot if I see where I am and what's happening, because from there I can make adjustments. I can make shifts, I can move forward, I can do whatever I need to do. But if I don't see myself in context, it's really fucking hard to do anything different. I can't place myself, I can't figure out where I am and what I need to do to fix whatever the feeling or problem is.

The shift from my perspective, is a conceptual shift. It's a mental shift to thinking about problems needing containers, and maybe there are some exceptions, but I would say almost every single problem has some sort of solution.

It might not be the best solution ever, but I mean, there's something that can mitigate or decrease the intensity of a problem, including getting rid of it all together. Almost always there's something,

So I'm not gonna say problems, need solutions. Uh, fucking duff, of course, problems need solutions. That's like a given. But when we're in a state where we continue to run into these like chronic problems and we're sort of feeling like, fuck what the hell is happening? We need to figure out how to organize the problems.

We need containers for, oh, okay, okay, okay. That's this sort of issue. That's this sort of issue. It go, it lives here. It goes there. If we can quickly like scan and organize, we can let go of it. It's out of our brain for that time.

Compared with if we don't have anywhere to place it, it stays in your head. If you're presented with an issue and you have nowhere to set it down, it's gonna stay with you and it's gonna bounce around in your head, which takes up precious brain power and space and time.

I don't know about you. I know I don't have that. I don't want to use any of my brain for bouncing problems, unless I want to actively grapple with them, that's a different conversation. But for something that I'm not interested in, like thinking about or giving time and energy, if I don't have a place to set it, it's gonna stay with me.

Which is a waste. It's a waste of time and energy like I just said.

So when we have containers, what we're doing for ourselves is we are getting rid of the mental clutter and chaos. We are getting rid of our realistically tendency of bringing things up more than once. So we're getting rid of duplication, basically, and we're also creating rhythms, plural.

So now, for example, when a problems comes in, we have a place to put it. So right away our rhythm is we feel a problem or we see, or we're told, we say thanks, we categorize it and let it go. So you've got a rhythm for people around you, and you've got an internal rhythm, and realistically, you're gonna have a rhythm for visiting those problems and then seeking to solve them. That's what we're gonna get into next.

So in EOS, which is, if you don't know by now, if this is the first time you've heard me talk about this, it's the Entrepreneurial Operating System. It's a concept developed by Gino Wickman, all about business structure. It's brilliant. I love it.

In EOS, there are a few key tools that we can use as containers. This is something that I've talked about and I haven't talked about it in this way before, but there's this thing that I've said to people, which is that EOS solves all of the problems. So when something comes up, there's always a place to put it. There's always a way that you can organize it.

And I'm thinking of this in terms of like containment systems or buckets or categorizations, whatever it is, whatever language you might need to give it. It allows you to deal with anything that comes your way. That's sort of the point. I'm sure there's a lot of points, but that's one of the points.

So we're gonna talk about three in particular right now. Three containers for chaos, and they are the EOS tools. One is the issues list. By far, this is my favorite one.

So on a weekly basis, if you are running level 10 style meetings or L 10 style meetings with your leadership team or with any department or group that you have, you have an issues list section on that meeting agenda.

So many issues go on this and they're all relevant for either the leadership team or the department that's having the meeting. You know, that's, you start to organize the. If something clinical comes in, I might say that's gonna go on the clinical L 10 meeting agenda. If something systems comes in, I might put it on the ops team L 10 meeting agenda. If something sort of big picture comes in, it's gonna go on leadership L 10 meeting agenda.

My point is that your issues list becomes a main, major container for chaos. So when you have these recurring problems that come up, if you don't exactly know where to put them yet, you plug them into your issues list. And so on a weekly basis, you can trust and rely this is building out that rhythm, that you're going to see that again, and then you can deal with it.

And with an issues list in particular, once you get to that section in the L 10 meeting, you pick out the three most important issues like the the three priorities. You work through those, and then you pick three more. You work through those. And however many you get to depends on how quickly you can get through things.

Some things require more time and space, you know, compared to others. So that's a side conversation. But my point is issues list is one container, probably my favorite container, honestly.

Second container for chaos is your scorecard. I love this. We'll talk more about this in a second, but your scorecard is your weekly pulse for whatever relevant number that you wanna look at.

So your leadership team scorecard, for example, is gonna be much higher level. You want your finger on the pulse of the entire practice. If you have a clinical L 10 meeting or something that's more department specific, they're gonna have different numbers on them that are relevant for that meeting and for the group of people who's, you know, in the meeting.

But regardless, the point is the same, that these are key metrics for that group that give the pulse of whatever is happening with regard to the perspective of the group that's meeting.

So. I also love the scorecard. It's relieving. It's relieving on a weekly basis to know exactly what numbers you're going to be looking at and to know why you have them on the scorecard in the first place. Very grounding.

Third thing is the accountability chart. You know, honestly, it's either gonna be this or the issues list.

For me. These are my two absolute favorite tools in all of EOS. I say that now. I could be lying on accident. Right now as I'm thinking about it, those two are my favorite.

Your accountability chart, it's not an org chart. It is a way for ensuring that each seat A makes sense. B has very clear responsibilities associated with it.

So when you go to assign a task or say, well, who owns this? You're not deciding in that moment. If somebody says to me, Tara, who owns this? I don't think about it and then say to myself, well, you know, Molly's not very busy so she can own it. Fuck no. Who owns it is based on what are the responsibilities of each of the roles.

If it's gonna be something clinical, if it's gonna be clinical program development, Molly's gonna own it 'cause she's the director of clinical operations. If it's something hr, my integrator's gonna own it because HR lives with our integrator. If it's something culture, I'm gonna own it. If it's something marketing, my marketing direct.

I mean, you get the, you get the idea, you know that the, the ownership is a result of a clear accountability chart, not in spite of, it's not what we decide, it's what the accountability chart tells us.

And again, I mean just like the other tools, this is just a relieving, grounding thing to have in place because we can all go back to it and look and say, oh, okay, cool. Yeah, it makes sense that this person take on this project or this to-do list item or this rock for the quarter or whatever. I mean, it answers a lot of questions.

Okay, let's do agenda item number three, tool walkthroughs with real life examples. I hope that this will bring it to life for you. So we're gonna talk about the issues list, the scorecard, the accountability chart. Remember, those are the three containers for chaos we just discussed.

Issues list. Here's one thing to keep in mind. Your issues list is not a dumping ground. So whenever you go, let's say you have a clinician who's not doing notes on time. Jane, good old Janie. Janie Jane isn't doing her notes on time. God, Jane, come on.

When we get to this item, let's say we do our pass through of the issues list and my DCO says, we gotta talk about Jane. And I say, cool, we highlight Jane. She's one of our first three. We get to her. Here's what doesn't happen. If Jane's not doing notes on time, I'm really frustrated with her. Yeah, she said this to me the other day in passing. Yeah. Also in supervision. She was bitching about clients instead of, um, actually processing, you know, I kept trying to redirect and it wasn't working.

What does that not have to do with? None of those things have to do with her not doing notes on time. One is drama. The opposite of that would be clarity. So Jane not doing notes on time. If that's the identified problem, like that's the one that just, you know, was thrown onto the issues list.

We're gonna walk through it using the IDS method, which is identify, discuss, and solve. That's another EOS concept. We're gonna identify what the root cause of the issue is. We're gonna discuss a variety of possible options and we'll probably even debate about what's the actual root cause and we'll, we'll get into that and then we're gonna seek to solve the problem forever.

So if we're talking about jane not doing notes on time and we realize that her schedule is three twelves and she's back to back, she's, you know, all of her clients get squished into these three days and she's averaging 33 clients a week or something.

Holy crap. No wonder she's not doing notes on time. This has everything to do with her schedule. Doesn't really seem to allow for this to get done. And so now we can talk about a solution that's a result of an actual problem rather than we're off to the races talking about one of our employees in honestly, a not very nice way.

So your issues list is by when I said not a dumping ground. I mean to say it's really twofold. One is it's not a dumping ground, meaning when you get into an issue, it's not space for you just to emote all over the place about whatever the issue is. That's not the point. The point is that we're trying to figure out what actually is wrong and solve it. That's it.

Remember the illusion of progress versus actual traction? Solving is traction. Bitching about something or just emoting consistently? That's the illusion of progress. For the record, I love emoting. I'm not anti emoting in the right context. In an L 10 style meeting, when you're talking about issues and you have 60 minutes to get through them, fuck no. That's not the point. I'm not gonna do that. That's not what it's about.

It's about solving and gaining and maintaining traction. So we will not spend it doing the illusion of progress dance. We're gonna spend it solving issues. And for the record, if you were talking about Jane and all this emotional stuff came up, what has happened in our L10 meetings is that when that happens, we'll tease it out and make it another issue. So if I say, oh goodness, okay, Molly, my DCO, Molly, it seems like you and Jane have something happening between the two of you.

I'm gonna add that to the issues list, but let's get focused back in on her not getting notes done on time. Boom. So we have captured, like I said, there's a container for the chaos. We are capturing something else that's happening between Molly and Jane and we're getting back to the problem at hand. That means that's the no dumping piece, right?

And also, again, you've a way of capturing whatever shit comes up via the issues list, via that issues list.

The second piece to the no dumping your issues list is not a catchall for every single thing that happens. This is really a process that you and your leadership team, or you and your department specific teams are gonna figure out as you go. But every three to six months, what you might do is just start to audit your issues list. And as you, as you go through and you audit and you look like, man, this has been on on here forever, I'm not sure that it fits here.

You start to notice like maybe this doesn't fit or actually that's just a to-do, or this really belongs on our Vision slash traction organizer at on our full day quarterly meeting. 'cause it's a much bigger issue. You start to get a feel for like what lives where. So the issues list is not a place to literally dump every single issue.

That comes across your desk. That's not the point, that's not the purpose. It is to put meeting specific items on there and to work through with your, again, the relevant team. So whether it's leadership or clinical or ops or whatever. This takes a little bit of practice to, to learn how to do. I will say that it took a little bit of practice for us at least.

Maybe it won't for you and your team, but that was like a process to go through and it just took a couple of meetings and like experiences of going through together before we realized like, oh shit, maybe this isn't something that belongs here. And then somehow it started where we. I wouldn't say got in the habit, but it happens consistently enough that we will question whether the item that we are going to add to the issues list belongs on the current, uh, issues list, like the current meeting issues list, or if it should live somewhere else.

I. A lot of the time we'll kick it over to a, a one-to-one, for example, or kick it over to a different department and say like, oh, actually that belongs there, but it has been some lived experience, so.

I'm gonna keep going. Let's talk scorecard next. Scorecard is that second container of chaos.

One of the things I like about the scorecard is that it removes some of the intensity of like people, I really love people, but sometimes it just makes things a little cleaner, which is nice when we're trying to solve problems. And so, let's just keep talking about Molly. If my DCO, my director of clinical ops, Molly says me, Tara, everybody is exhausted.

They're so just overly worked. They are really struggling to keep up with everything. They're just tired. That is important information to me, but it doesn't tell me anything thing.

When I look at a scorecard and these aren't necessarily numbers on our scorecard, but let's just act like they are. When I look at a scorecard and I see our utilization is like averaging 150% or something I've seen, or 125% for everybody, and when our wait list has grown by 40 and when our weekly hours average is up by 10 for the entire team and everybody has late notes. Wow, that's really important data. That sheds a different light on what my DCO was trying to tell me.

But it does it in a way that sort of like depersonalizes it and makes it digestible in a different way. So it's not that Molly was doing anything wrong by telling me, Hey, people are really overworked, but it's qualitative information without a quantitative spin. And so having both is what really highlights a full story.

So we've got, again, containers for chaos and some of the containers will, there's like a pass through almost like a filtration system that in a scorecard, which is one container, if we identify things that are problematic, boop, we just flick it over to the issues list section, which is our second container.

Okay. Last container of chaos, and we're gonna wrap this up. Uh, the accountability chart. This is again, one of my favorite things ever. I think it is the backbone of, it's sort of the basis for everything. I don't know if Gino Wickman would agree with me, but you know, tit for tit, as Dwight likes to say, accountability chart gets rid of all of the messiness around, well, who owns it?

I said this earlier, so I'm repeating myself a little bit. It's not an org chart. It really is intended to show the seat, the top five sort of major thematic responsibilities of that seat or of that role. And then it is designed to give you clarity who does what. If I have a question and I look at my accountability chart and I say. Fucking hell. Okay. We need to develop a supervision niche, like a training, sort of a developmental track in our practice.

Who does this? It's not hiring, it's kind of visionary, but ultimately I think that's a DCO thing 'cause it's a developmental niche for clinicians that is training and development for therapists. Boom, that's gonna go to the director of clinical ops.

It answers my question for me. I'm not thinking about it to an extent maybe, but I'm not like grappling or arguing or arguing with my team about who owns what it's, it's decided it's outta my hands.

This is what we have all agreed upon. This is the accountability chart that makes the most sense for our current size and will allow us to grow into it. You always wanna be also gearing up for that next leg, that next step, and that's it. It's not really up to us. This is what we decided. This is what is.

There's one additional thing about the accountability chart that I really like. There's a lot of things, but this is just one that I wanna share. I had a question the other day where somebody asked me, do you need a really big accountability chart? What about people who are just getting into EOS or who are just starting like their accountability chart process, you know, and they realize they need a huge team.

My answer is twofold. One, usually people make bigger accountability charts than what they need. I don't know if I have yet stumbled across somebody who's made one that's excessively small. They're usually much larger than they need to be, and because of that, people think they need a huge team when the reality is like, ah, no, this just needs a little bit of like reorganization and almost like shuffling around and condensing and combining.

So for example, I think I had somebody who had like three seats for marketing, and it could have all been just one. You know, it was like, that's, that's just an example.

Second, the second related piece to this is that when you have the accountability chart that's a little more concise and um, to size for your size, you also can ensure that only one person goes in the seat.

And so people will get into this I think bad habit and you know, live and learn like it. It is just live and learn. Like people dunno this until they get into it, but you should not have more than two people who are accountable for one seat. And I would go further and say, that means you should not have two people accountable for one responsibility.

So for example, if you have two people who are overseeing the intake process, what happens when there's a drop in conversions? Who do you go to? And if you say, well, I would go to this person, my question would be, is that in writing?

Do they know that you would go to person A over person B? Is it clear and concise and like very specified or written out somewhere? Is that explicit? If not. Well, I would say that's not really fair for the people doing the role, and also it's still in his brain power because they're gonna come back and say, well, I did not doing that.

Like that person works more than I do. Why are, why are you coming to me? Or they're gonna have some sort of argument for it. The reality is that if you have one person responsible for something, I hate the phrase, the buck stops here. The buck stops here, bucko, but the buck does stop with them. Where you go to them and you say, Hey, there's a drop in conversions.

Tell me what's up, what's happening? Like, what's going on? What are you noticing, et cetera. It's really hard. I don't, I would not, I don't even know if it's possible really. Unless again, you have super clean and clear systems and processes and like ownership to have more than one person in the seat. It doesn't mean you can't have the same seat twice.

So I'm, I'm gonna say that, but it does mean that if you have people who are like potentially overlapping on a process that needs to be really teased out and really clear, 'cause that's gonna get messy. Blame is gonna go around at some point. Or it needs to be hierarchical a little bit where there's one person explicitly responsible and the other is an assistant or support to that one responsible party. Then it's much clearer for everybody involved.

Having tools in place is not a way of becoming robotic. It's not intended for you to automate the hell out of everything and remove yourself entirely. Having tools in place allows for clarity and to be able to move into traction and stop staying or stop dancing around in the illusion of progress that we're talking, talking, talking, talking, basically, talking in circles and spinning around and having fun.

But shit still not getting done. That's what tools allow us to do.

They're not meant to confine or restrict, they're meant to clarify not only like expectations, but also outcomes and ownership and processes for solving issues. And that allows all of us to be able to, from my perspective, breathe a little more freely because I trust and note that shit's always gonna be captured and caught in some way and then dealt with.

And realistically, leadership is about follow through. It is about clarity and communication. It's about follow through. It's not about what you intend. So if I'm talking and I'm stuck in the illusion of progress, and I'm having all of these fucking awesome conversations and I'm telling my team, we had this great conversation, and nothing happens.

They don't care. They're gonna wanna know why nothing ever happens after these really great conversations. They're gonna be frustrated and annoyed and resentful and burned out and like, I'm not trustworthy, which I'm not, I'm not following through with anything. I just have great intentions. So.

I think that wraps us up, y'all. I think that's it. If you are interested in EOS, if you're listening to these tools and you're like, that sounds awesome. A, it is B, join the Mastermind wait list. I have one launching hella soon. So go to www.taravossenkemper.com/eos-mastermind.

Doors are legit just about to open, so you need to get your name on that list real quick. You'll get some information from me via email. Otherwise, this has been great. I hope this is helpful. It's been great seeing you. I appreciate your time. I will see you next time. Bye.