Culture Focused Practice

Hey. Hey, Dr. Tara Vossenkemper here, and you're listening to the Culture Focused Practice podcast. Thank you for being here with me. Thank you for joining me.

Okay, let's talk numbers. I love numbers and data and scorecards metrics. Your scorecard isn't about math. I want you to just remove that from your brain right now.

Your scorecard is about meaning in e os or in any business structure that you might use. Think about your numbers as telling a story. That story is really about trust. If your team doesn't believe the scorecard reflects a reality, or if you don't actually use the scorecard to have honest conversations, you don't really have a scorecard. You have a spreadsheet graveyard.

And so think about today as basically an attempt at reframing scorecards from being about something cold and distant, like an empty number to actually being about alignment, accountability, and trust.

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Our agenda for the day, if you need some parameters, just three broad items. Number one, scorecards are for meaning making. I love meaning making, as a side note. Number two, why trust is the hidden foundation of metrics. Number three, how to build scorecards your team actually believes in.

Okay, let's do this agenda. Item number one. Scorecards are for meaning making. I am absolutely an existentialist at heart, and so meaning making is very central in my world. So of course it's only appropriate that this is gonna be the first item that we cover.

Just a few key points about this. First is that we have to start thinking about metrics as a shorthand for behaviors. So if we can look at a number, we have a very clear idea of a behavior that did or did not take place. We're not talking about context, we're not talking about nuance. We are talking about whether something occurred or didn't.

The percentage of clients that showed up for a session, the percentage of utilization for each clinician, the number of people who reach out, the number of people who schedule, the amount of money that comes into the business, all of these things are metrics.

They don't give us any details. There's nothing beyond this is a thing that took place. I have no idea. The process that client care went through with each individual person or how long it might have taken. I have no idea if my biller especially struggled in a week or not, I have no idea if she called and hounded a United healthcare because they were withholding a payment or denying a claim for something that was inaccurate. We're not getting into that. The point here is that metrics are a shorthand for behavior.

A second point here is that a scorecard without follow through is just noise. That's all that it is. It's nothing. It's useless. It's a waste of your time and energy, and it just adds bouncing around, pinballs to your head that's already full of other things. That's it. A scorecard needs follow through.

You are collecting data, therefore it should be used, not allowed to bounce around freely in your brain with nowhere for it to go.

And I'm sure I'm not alone in this, but I need less noise in my life. I don't need more.

The third key point here is that the number is just the marker for where we need to dive deeper. So think about the number as the cue and then the conversation as the point, or the number, as the flag, and the conversation as the dig.

This is where we get to have an understanding for the nuance and the context, and we get to really dive into, okay, okay, okay, I see this number, I see this percentage, but I, I need to know more. Like, why this number? What's going on? What happened or what didn't happen? What went wrong? What went right?

And this can go in the direction of good or bad metrics. And by good or bad, I simply mean above or below what your baseline or goal is for that metric. So numbers inherently aren't good or bad. There's no value ascribed to a number. It's just a number, just a digit or two, and a percentage sign or a decimal.

But when we compare that number to whatever baseline we want for that thing we're measuring. So let's say my aging over 60 days, let's say I have it set, I really wanna hit less than 2%. One and a half would be ideal, but like, let's be realistic. Shit happens. We can't control insurance companies. So we'll say 2% below 2% is good.

And I see a jump. This is something we track on a weekly basis. I see it every single week. You know, I see a jump to 3%, one week, 5%, the next 7%, the next.

Obviously that is an indicator something is wrong, and so I might reach out to my biller and start talking about, bro, like what's going on. On the flip side, if our session count is staying relatively stable and our revenue jumps. Cool. We're seeing more in revenue. I'm still gonna talk to my biller.

I don't understand why, and I need nuance and understanding for what's going on. Why is this number so much higher when our session count has remained the same?

So when I say the number is the cue, I don't mean you should just chase down numbers that you say are bad according to your baseline. I mean to say that when there is any metric that's above or below baseline in kind of a significant way and slash or for a duration of time, a three week period, for example, then you would lean into the conversation because the conversation is again, the point, while that number is just the cue.

All of these help with meaning making. They all help tell this larger story and to really grasp what's happening and why is it happening, and what needs to change, if anything.

So let's segue then to agenda item number two. Why trust is the hidden foundation of metrics. I love this. I think that people can get overwhelmed or almost like, um, scared. I don't like saying scared, but something about numbers and metrics and scorecards makes them anxious a little bit uncomfortable.

This is especially true for people who are more clinically oriented. I find that consistently that clinicians don't like looking at numbers, and I also see that that translates into. Leadership and group practice ownership until people can start to drive meaning or make meaning outta the scorecards and outta the metrics, then it becomes easier to, you know, do and maintain.

So I'm saying all of this because when we think about trust as a hidden foundation of metrics, there's a few things to keep in mind.

One is that if numbers are massaged, trust is gone. Like if you ever manipulate numbers to make them what you want them to be, and then share this with your team, for example, you have basically just eroded trust entirely, especially when that comes to light.

Conversely, if you have a team member doing this or an employee doing this and presenting you with data, that's another fucking problem. That's a huge betrayal of trust in my opinion. That's a huge betrayal of trust. Data should be data. It doesn't need to be massaged, it needs to be understood, and it needs to be seen cleanly.

So we can't manipulate numbers, and I don't think most of you do, but if you ever have the urge to, well, maybe I'll tell the team this, or maybe I'll just edit this a little bit. Don't. When numbers are massaged, if they are, trust erodes, that's one key point.

Another is that people, including you, need to really believe that the metrics are fair and relevant. So think about fair as being attainable and realistic. If I said to a clinician, I need you to hit 40 billable hours in a week, that is not attainable, that's not realistic, that's not fair.

That's a ridiculous ask from me, and that will start to leach out any trust they have in me, and it'd be the same for something like client care. If I said I want conversion rate to be at 95%, no, that's not fair. That's not a fair ask.

It's a little bit of a catch 22 here because. If you don't have any metrics to start with, like if you're not tracking any data, you don't have any metrics, you don't have any scorecards set up, you might feel like you're starting blind, like you're basically flying blind.

Uh, maybe you are. I would say if you have a group practice at all, you can backdate the data. You don't have to just start here and move forward. You can set up a scorecard or start tracking key metrics and then just go back and start to plug in some data so then you have something.

If you're entering this entirely fresh, yeah, you're not gonna have anything, so your perception of what is realistic versus not. It's like, it's a little more in flux, so to speak.

The relevant piece is that you want to make sure that people are in tune with or tracking or responsive to metrics that are appropriate for their role. So for example, client care is gonna be conversion rate. How many people coming in through the door convert into clients. Billing is gonna be aging report or revenue. Clinicians are gonna be utilization or session count. Marketing is gonna be inquiries or leads.

So, people, the employees, your people, and you, all of us have to believe that metrics are both fair and relevant.

Another key point to trust being the hidden foundation of metrics is that we can build trust by showing vulnerability and honesty with our own metrics. And by we, I mean leadership in case that's not clear.

And by this, I don't mean to say that you need to share every single metric you collect with your entire team. I don't think that's necessary unless you are adamant about radical transparency, then you do you like, that's fine.

I don't do that. That's way too much for me. That would be risky in that I think that all of the metrics would just end up feeling like noise. It would just be noise for people. They're not all relevant for the entire team, and I don't want everybody involved in all of the metrics, so I keep things clean in certain ways.

What I will say though is that we do a quarterly state of the practice meeting, and this is my quarterly meeting basically, where I go over how the practice has done in the last quarter, and i'm gonna talk to them about whether or not our rocks are on or off track, and the percentage that we completed them or not, and I'm gonna get into the why and why not. Like what we learned from this. What are the takeaways?

I'm also gonna do things like share our percentage growth, whether it's high or low, with regard to session count, inquiries, conversion rate, attendance, utilization. I'm basically gonna cover metrics that are relevant to them on a global scale.

And I'm gonna talk a little bit about what I see going on. And by that I mean I'm helping to tell a story about the numbers that are in front of us. This number is lower. Here's what we're seeing. Here's what we've done about it. Here's what we're thinking.

This number is higher. Here's why. Here's what we think. So then these, everybody who's looking at the metrics, they're not just getting a number, which they might not really make sense of in and of itself. They're getting a number in the context of this much larger picture and all of that, also, which we'll talk about in just a minute, i'm gonna connect back to our vision and reiterate why these numbers are important, how they're connected to the vision, the role that each person plays, all of those things.

I've been doing this for years now, like I've been doing a state of the practice meeting where we'll talk about growth or lack thereof for years. I found out recently that that's more rare than not, and I am surprised. I was surprised to hear that a lot of leaders will point to what they did well or what is going well, but not really also talk about what isn't going well.

I think it can seem counterintuitive because it seems like, well, if I talk about what's not going well, people aren't gonna trust me. Uh, maybe. I mean, I think, yeah, sure, that's a possibility, but I think what's more possible is that if you don't talk about what's going well and people think everything is great, but then they feel like something's off and then it comes out later that things weren't going well, that's a much larger hit on trust.

That's the erosion of trust piece. So this is why we say that trust is a hidden foundation in metrics and that. Leadership in particular, in being vulnerable and open and honest about certain metrics are enhancing trust amongst the team.

Okay, let's shift third agenda item, third and final. There's also a few key points here.

So this third item is more about how do we build scorecards your team actually believes in. I really like this. I don't like doing anything that's not relevant or meaningful. Like I don't want busy work. I don't want my people flitting about trying to answer all these metric related numbers that don't have anything to do with them.

I think that's such a waste of time and I don't wanna do it either. So why would I want somebody else to do it?

So here's what we can do. Number one, we wanna keep it simple. So there's two options with keeping it simple. I think each option lives in a different place.

One option is that every role has a number, just one number that they are in charge of. I love this for the record. I think it's very clean. I think it's really clear. I think people know exactly where they should look and what they should look at, and it removes the what I would say is a mental barrier for people in such a way that they don't have to look at five numbers and try to make sense of all of them together, which is a skill, and we can help them learn that. Sure.

But mostly I could just clean it up and give them one key number to look at, and then we could call a day. So that's the one number per role option.

Another option is that we have anywhere between five to 15 measurables with clear definitions and clear owners.

Here's what I'll say about this option is that I think that five to 15 measurables should live in a scorecard, obviously, but that scorecard should live in a departmental or leadership level meeting. So when we talk about scorecard, I think that there's both higher level scorecards where you have a scorecard for a leadership meeting that gives you a whole view of the practice health.

And then we have departmental scorecards, of course, that are much more specific to the department that they're a part of. So my ops team scorecard is gonna look different than my leadership team scorecard, for example.

And I really like scorecards for meetings and groups coming together. If it's just one person and just one role, like my clinicians for example, I just want them to have one number to look at. That's it.

So we do a blend of both of these, and again, we're talking about how to build scorecards your team actually believes in. My first point, I'm laughing at myself right now actually, because my first point is keeping it simple and I'm giving you two options and now I'm saying we do both of these things.

I see them as simple, though. I see them as it's simple. Each role does have a metric that they focus on exclusively. And at our meetings we have scorecards, which is a collection of metrics that give us a full scope view of things based on department.

A second key point here. Any scorecard that you set up, whether it's one metric or a collection of them, you have to look at it weekly. I, this is non-negotiable for me. You have to look at that number on a weekly basis. And if you say, Tara, I'm just gonna look every other week. No, don't even, don't do that.

Look every single week. Every week. It takes you all of five minutes and it is very important to do.

When you look at something on a consistent basis, you are creating reliability, you are giving yourself the opportunity to move quickly when you see an issue. If you are, for example, reviewing every two weeks, and you decide you wanna do it on Thursdays, but then most people don't work on Fridays, and then also that there's the weekend.

So then most people aren't working on the weekends, and then you get back Monday, but it's a holiday. Now it's Tuesday before you really get to address anything wrong. That's already been a two week period and the problem still hasn't been addressed.

On a weekly basis with a weekly rhythm. If you do that, at most, you're looking at a week and a half later that you're able to address something, not upwards of two and a half. So a weekly review should just be integrated into your weekly rhythm.

I would say one of the easiest ways of doing this is just baking in the review to a standing weekly meeting that you have. If you don't have a standing weekly meeting with anybody, A, you should B put 15 minutes on your calendar recurring weekly right now and start reviewing your metrics on a weekly basis.

Third key point. Every metric that you have, especially whenever you are assigning them to other people, you wanna tie it back to your vision. So it's not enough for me to just say, we wanna hit this many sessions.

Instead, I might say, this is where we're going. This is the vision. Everybody's enthused about it. This is what we wanna grow into. This is how we're trying to evolve, and in order to do that, we have to grow by this percentage, or we need to see this many sessions in a year. Are you with me? Do you wanna help create this? Are you still wanting to be a part of this?

And assuming that people say yes. Now that number is not just a number. That number is our future. We're connecting what we're doing now to where we are going and what we're going to be doing then.

It always makes me think about numbers as being enriched. Like they're kind of cold and empty on their own. They're almost lifeless, you know? When you can couch them in context or in vision or give them nuance or tell a story with them, like it's just meaningful. This is all about meaning making and trust. That's exactly what scorecards can do for us.

Okay, so last key point, and then we can wrap this up. Numbers don't just have to be about performance. As an example, I have growth goals. My group, we have growth goals, we have a vision, we have something that we are seeking to create and build out.

And within that vision there are points that force us to quantify culture. So I am not willing to grow for the sake of growth, and I'm not willing to grow if I start eroding culture.

And so, that is something that I share with everybody. That is something that should be known by all, and if it's not known by all, they can easily find the information in our vision slash traction organizer on our intra-office website.

My point here is that I would highly, highly encourage you to quantify culture to the extent that you can. This should be captured as a metric. It is not one that you can really review weekly, because I mean, sending out weekly culture surveys would feel, like, I think that would feel like a lot.

But on a quarterly basis, on a every other month basis, whatever rhythm you want, you can be seeking to quantify culture and pulling that in as a key metric. You're tying this now also in with vision, and you're saying, look, here's all these numbers about performance and how we're doing on this half. Here's all these other numbers about our culture and how we're doing as a team, how we feel with each other about the vision, about being here.

Those are equally important. I said it a second ago, I'm gonna say it again. I will not, I'm not willing. I would also say I refuse to grow a practice if my culture is not healthy and thriving, because whatever growth we achieve is gonna fucking collapse if we don't have the culture to hold it.

And on that note, my friends, let's recap.

Scorecards. Know them, use them, love them. They are not about perfect numbers. They're not gotcha techniques. They are ways to build a trust oriented, high accountability, healthy culture and to help you and your team make meaning of what's really going on, and to tell the story, to tell the story from the data, so try not to be too scared of them. Just dive in. Dive in and see what comes up.

Before we hop off, if you're really wanting help with putting tools into practice, especially with other leaders who are sort of walking that same path, make sure you sign up for the EOS Mastermind. It happens twice a year. It's a six month mastermind, so you can either get on the wait list or sign up. Go to taravossenkemper.com/eos-mastermind.

Or if you wanna something a little less mastermind-y and more do at your leisure. But with High Tara availability, join the membership inside the Living Practice Live monthly trainings with me live q and a with me. All the recordings in the portal, resources, community, et cetera. Everything is there. That's taravossenkemper.com/the membership.

Otherwise I think you know, but I'm gonna say it anyway. Thank you for being here with me. I super appreciate your time. I know how valuable time is and I am hoping this helps you to invest in your practice differently and continue to grow and evolve as a leader. Okay, I'll see you next time. Thanks. Bye.