Culture Focused Practice

Hey. Hey, Dr. Tara Vossenkemper here, and you are listening to the Culture Focused Practice Podcast. Thank you for being here with me as per usual.

Okay. Today is my favorite type of episode, it's the owner's room. Basically, think of the space as the messy middle. Like there's no answer. There's no teachable content. It's just a series of five questions and one scenario that I ask myself without really thinking about it in advance of hitting record and starting talking.

So it goes wherever it needs to go. And where that is, your guest is as good as mine.

Okay. So the theme of today's owner's room is when the data tells you what you don't wanna hear. So I know you have had that moment in the same way that I have. You've got metrics in front of you and you do not like what they say. Maybe you have an increase in no-shows, or maybe revenue doesn't match projections or maybe client turnover, like your churn rate is really horrific, or your employee turnover is really bad, worse than what you thought it was.

I wanna spend this time sitting and grappling with that discomfort because even if a scorecard is about trust, trusting the truth that we are getting from it is arguably the hardest part.

Of course. Before we go further, please make sure you subscribe, that way you don't miss out on any of the owner's room episodes and people who need this message are more likely to get it.

Here we go. Five questions.

Question number one, am I ignoring data or hoping it's self-correct?

Hmm. Am I ignoring data or hoping itself corrects? That is a good question. My answer is no. No, my answer is no. I think it's a little bit nuanced.

So I think that recently it probably looked like we were ignoring data because our session count was low and our revenue of course, then was low. However, there were two clinicians out on maternity leave.

So if somebody were stepping into a meeting and they saw us having an L 10 meeting, a leadership L 10 meeting, they might say, why are they not addressing gross or why are they not addressing session count?

And the reality is that we were actively in the process of hiring and we had two people out on maternity leave. And so there was very little else that could be done or that we could think of to do. Maybe there was other things and we just have no idea what they were.

But that's an example of the data isn't being ignored, it's trying to be tended to, and we are not getting the outcome that we want yet.

As an aside, I absolutely have now learned that if we have people going on leave, we are hiring well in advance of them leaving. That's a side note.

I think if I took that same example though, and I said that we have two people out on maternity leave, our revenue's down, our session count is down, but we are not doing anything except biding our time, waiting for those clinicians to return. I think that would've been us waiting or hoping for it to self-correct.

Us actively trying to hire, reviewing our onboarding, reviewing our position descriptions, looking at our pipeline, that would indicate not ignoring data and not just hoping that itself corrects. But if we were just sitting by and waiting, I think that would be something like ignoring the data or hoping that itself corrects.

By nature of how we operate, just using EOS and looking at scorecards on a weekly basis, we don't really have the luxury of ignoring data. Like we don't, we don't have the ability to feign ignorance because we see everything. It's right in front of us every single week and every single week we say, what's off track and what do we need to talk further about?

So no, to answer that question. I don't think I'm ignoring data and I am not hoping anything self-corrects. Honestly. I'm too like neurotic for that. I can't just let something self-correct. I'm too pushy for that. How about that. I'm much more grab the bull by the horns rather than sit back and wait for it to rectify itself.

Cool. I think that's question one. I think that's good enough.

Question two. Do my feelings about the numbers, oh, this is a good one, reflect fear of failure, or fear of being seen. Hmm.

Oh my God. Do my feelings about the numbers reflect fear of failure, or fear of being seen. Wow. Let me feel into this. Okay. I don't think fear of being seen is it. So I would say no. My feelings about numbers do not reflect fear of being seen.

I'm not really sure that I think failure is the right word either. There's something about fear of doing enough or being enough, or there's something about worth that's tied up in it all, but it's also not all the numbers, it's just certain numbers.

So for me, shame and finances are very interwoven.

You know, it almost makes me think of a mangrove tree, where you obviously see this tree, but if you look down at the root system, which is very visible, you see all of these like individual roots, it's not, you know, these roots are not underground like most trees.

But there's something about like finances and shame. Are all these individual roots, but it ended up growing together. So it's this long ass fucking process of trying to extricate shame from finances and like worth or enoughness, all of that stuff.

For me, that ties in with financial metrics. The other metrics, everything else we track. I don't think I have any feelings about fear of failure or fear of being seen or shame around other numbers. I think it can be vulnerable to like share those numbers with others.

But I don't necessarily think that they reflect anything about me. I think that they are data, like metrics are data. It tells us what we can do, what we should do, what we need to do. It just gives us information about what's going on at the practice and where we need to move next.

I also think that's the constant evolution of an organism, of a living practice that's alive, which is if we're constantly seeking to grow towards our vision, for example, then the metrics that we have for ourselves, the bar that we set for ourselves, it's going to constantly be changing.

And so we will, and we won't hit the numbers that we're seeking to in any given week. So I think to me, that just feels like the process. So aside from shame worth enoughness tied up, up with finances. I would say not really any other strong feelings about being seen or failure or anything like that.

Okay. Question three, what conversations am I avoiding because of these numbers? Oh my gosh. What conversations am I avoiding because of these numbers? Mm mm mm mm.

Well, you know, this is kind of moot at this point, but I'll talk about it anyway. I think what can happen sometimes with numbers, at least for me. I'm gonna assume for other people as well, and maybe not in every instance, but in some instances and with some numbers.

Even when you have data in front of you. For me, sometimes it can still be hard to see the story and there are some stories that are harder to see than others.

So when it comes to clinical data, that story is crystal clear. I feel like I see the edges. I see the interior, I see the divisions. I see the lines. I see the details. It's sharp focus. When it comes to client care, I feel the same way. It's very, very clear.

When it comes to finances, for example. It kind of clear, but like a little less so. And even if it's clear, I still have shame wrapped up. So the shame is not about the lack of clarity, there's just shame wrapped up in finances.

But something that is really hard for me or has historically been difficult for me in terms of clarity with metrics and the story is marketing.

So I can tell you about a conceptual stance on marketing. I can tell you about strategy and creating content. I can tell you how to throw spaghetti at the wall, like I understand how marketing works and all of these roads leading to Rome. Got it. Totally makes sense. However, what I hate about marketing metrics is that you don't see an immediate impact.

So whatever the thing is that you might be doing, you have to then be able to track, did my effort have the impact and the outcome that I wanted? And so when we had a marketing person in place who I adore, for the record, this was also not a strength of hers. Her strength was in graphic design and social media stuff. You know, it was not in tech heavy, back end metrics oriented marketing.

Given that that was the first time we had a marketing role at the practice, it was sort of like this, I slash we are actively trying to build this out as we need it and we are doing trial and error as we go.

So what I didn't know then, and what feels more clear now, is how to have a conversation about numbers, because I didn't feel clear on what specific numbers to track. Sure. I had a sense for some lag measures, especially, but the lead measures were the ones where I was feeling a little bit unclear, unsure, not quite certain, and I think she was feeling similar because again, her strength was elsewhere.

And so there's this sense that something is off, but I can't articulate it because I don't exactly know what it is.

So I feel like I was avoiding a conversation but not because I'm trying to avoid the conversation more because I'm not sure how to have this conversation. I know something is off, but I just don't know what it is. And then when I bring that up, my person also wasn't sure what it was.

And so it's this weird like dance, like we're, we need to do something different, maybe let's try this. We need to do something different, maybe let's try this.

I think ultimately what would've been beneficial is a person who was very clear about these are the metrics that we need to tend to, with regard to marketing. Here are the specific things we need to do. And of course now I feel much more clear on what those things are and what the metrics are, and I didn't for a long time, which stinks and is, you know, what are you gonna do? Live and learn. Honestly, that's what I'm gonna do.

So, yeah, not actively avoiding a conversation because of numbers, but unable to have conversations that I need to because of lack of clarity around certain concepts. Yeah. So, okay, keeping going.

Question four, how do I separate the story in my head from what's on paper? Hmm. I don't actually think I have an issue doing this because I don't entirely develop stories in my head without what's on paper.

So for me, the story is created from the data, like that's where the story lives, the start of the story, the bare bones of the story, and then the meat and the potatoes of the story live in the conversations that need to be had because of the data.

So if I see something off, for example, if we're, you know, again, I'm thinking leadership. 'Cause we review scorecard on a weekly basis. If I see something off in a leadership team meeting where we're reviewing scorecard, what we typically say is, okay, well let's drop this number down to the issues list. We get to the issues list, we highlight it, we start talking through it, and that's where we either dig into context to figure out what's going on with this number or we assign a to-do item to the appropriate role for further investigation.

And that's it. And then we have not only the data from the, the metrics, the data, the scorecard, et cetera, but now we're also getting the qualitative information to fill in the gaps.

Last episode, I talk about this a little bit. If you go back and listen, there's something about seeing your scorecard, seeing your metrics as a starting point, but then the conversation is actually the main point. So if you're thinking about the metric as a flag in the ground, the conversation is you digging. That's the difference between the two.

Okay, last question. Number five. What does my team need from me when the numbers look bad? Fuck. I think they need honesty. I think they need to grapple with it in the same way that I do. I think they need as much transparency as possible. I think they need context as to why the numbers look bad.

I think they need hope and a plan for what we're gonna do moving forward. I think they just need candor, honestly. They need you to be upfront with them.

For me, that's like the piece with leadership. I don't need to know all of the answers. I don't need to know everything. I don't need to know exactly what we're gonna do at exactly this right time and exactly it's gonna end up this way.

I just need to be real with my people and keep us pointed in the right direction and moving forward toward a shared goal. That's it. And if we look at these numbers together and I say, man, y'all this quarter fucking sucked. Like this was a rough quarter.

I don't just stop there. Then I say, here's what we think happened. Here's what we think is going on. Here's what we think was going wrong, and here's what we're gonna do differently next quarter. Here's how we're going to address some of the problems that we have identified.

For me, that's the beauty in the numbers, that if you are looking at data in front of you and then you gather this context and you have this deeper conversation about what's really going on. As a freaking byproduct of doing that, you have a path forward.

Now you know exactly, maybe not exactly, now you know precisely what problem you need to solve. You might not have the exact answer to solve it yet, but you know, oh my gosh, that's the problem. Okay, we need to do this. We need to do this thing moving forward. So you've got a solution. And you can't get that solution unless you dive into the numbers and you make sense of them.

So I think that's what my team needs. I think that they need to know that we have dove in, dived in, dove in. I wish Dove in was a word. We have leapt into the numbers and the data. We have grappled with it. We have made as much sense of it as possible. We have pulled these themes out from what went well and what didn't go well. Here's what we're gonna do moving forward. Boom.

That instills ideally some hope in them, some confidence, some oh relief that this is being taken care of. Some trust. And I think also I can speak for myself, but I would say broadly speaking, people like you to be candid with them. They want to know what's actually going on. They don't wanna be fed bullshit from you. They want to know the truth as much as possible.

Boom. Those are our questions.

Okay, let's move on to scenarios. I was debating on doing one or two. I think I'm gonna do both and I'll try to do them quickly. I don't wanna keep you on here forever. Actually you have full agency you can start listening or stop listening whenever you want to. So nevermind.

Scenario number one. Your client retention numbers start dropping quarter over quarter. You've been telling yourself it's seasonal or that it's just a couple of tough matches, but the scorecard says otherwise. Facing, it means asking hard questions about therapist fit intake systems, and maybe even your own leadership clarity.

Ooh, I think probably most of us have been here. Or a lot of us have been here. You know the funny thing about numbers is that your perception of them before you start tracking them is usually wildly different from what they actually tell you.

I can't tell you the number of times I've had conversations with people where they say, well, this thing is great, and I say, cool. Does your data back that up? And they're like, well, no, but it's good. I'm like, okay, that's fine. How about you start tracking data and they do, and then they come back and it's like, oh my God, this is not as good as I thought.

Yeah, that's the point. That's why we look at data because it either supports what we think or it disproves what we think, and then we get to go from there either, direction.

Okay, so if client retention numbers are dropping quarter over quarter. You have been telling yourself it's seasonal or it's just a couple of tough matches, but the scorecard says otherwise, what would I do?

Yeah, so here's the route I would go first and foremost. I would try to figure out through the data if this was global or if it was specific.

Are there specific clinicians that are not retaining clients, and if so, who? If that's the case, at what point are they mostly losing them? Are they losing them between that first and fourth session, or are they losing them around session six or seven?

Because if they're losing them around one through four, my approach to working with them might be different versus if they're losing them in sessions five, six, or seven.

If it's global, I might start looking at the intake systems. I might start figuring out, okay, are we clear about what this is? Is our marketing accurate? Is our intake process? Clean. Are we not saying something in the process that we should be? Are we saying way too much and people don't know what they're stepping into?

Are we sending appointment reminders? Are we billing accurately? Like I'm gonna start looking at our systems to figure out what is happening in this process that people are leaving soon.

Depending on what we can ascertain from that, I might also, and I don't mean me specifically but like I might have this happen, might also reach out to some people who have left to try to get a feel for, hey, we see that you left after your third session. Can we get some feedback as to why? Because we want people to have a good experience with us and we can't do better if we don't have feedback.

That feedback would be incredible if you could get it. So. If you're seeing these numbers dip over and over, then you also could go to the clients and ask them directly, or former clients I should say, and try to ask them directly.

You're not gonna be able to do this with everybody and not everybody's going to answer you, but to get some data would be really great.

And then lastly, I think the leadership function here is stepping in sooner. So if you're noticing something, this kind of goes back to the first question about, um, avoiding or ignoring data or trying to let solve itself or something. If you're noticing numbers drop and you're not actively trying to figure out why they're dropping or what to do about it. Then you are ignoring the data, like you're ignoring something that's playing out in front of you.

If you're feeling unsure about where to start, I think you could start by setting a time limit for yourself. You know, if you've let something go on for two quarters, that's too long of a time. Instead, you might say, okay, I'm gonna let this go on for three weeks. I will let a number be off track for three weeks before I really start to dig into it.

And then that's what you do. You give yourself a time limit and you might not feel like you wanna address it or you might not feel like you wanna dive into it at that point in time. But it kind of doesn't matter because if a number is off for three weeks, that's patterned now, that's not a one-off experience. That is a consistent and recurring pattern that you can then step in to address.

I think the last piece to this is that if you have a leadership team and you're all doing the same dance of avoidance, that's a conversation to have as a team. Like I would be bringing that up now as a team saying, this number's been off for this long, and we have all ignored it. We need to figure out what happened and how not to do this in the future. And I think that's it for that question.

Let's do scenario two now. So you realize your revenue projections aren't lining up and despite working harder, you are not closing the gap. The scorecard is showing stagnation, but naming it out loud feels like admitting you're failing as the visionary. The truth is, this is the truth. The data is a signal, not a sentence, but sitting with it feels like exposure.

I love this. I mean, I hate when this happens, but I like this example. I think that there's something about revenue in particular that's personally. Hard, although not hard for everybody.

So there's a couple thoughts that come up for me. First and foremost is if you have a scorecard and you have a leadership team, if you're using anything like EOS, gross revenue should be on that scorecard. And so then it's one, immediately forcing yourself into a somewhat vulnerable position. If you are a person who feels uncomfortable with that, it's almost like this forced vulnerability, which is not necessarily a bad thing in this case, because then we're immediately stepping in to combat some of the shame around it.

Two, what we're also doing is we are relieving just ourselves from carrying the weight of identifying it as a problem, voicing it, and then attempting to solve it. So in having a team and in having a group approach to looking at scorecard numbers especially, and including something like revenue, we're sort of sharing that weight of responsibility, of course, not the liability. I mean that's gonna be on the owner and likely the visionary, meaning the visionary is probably the owner and it still helps alleviate some of the weight of carrying it.

I think what also stands out to me in this scenario is this notion of despite working harder, you're not closing the gap. What I really like about scorecards and metrics and leadership teams honestly, is that seeing a problem doesn't mean that you need to work harder to solve it.

When there's a problem, what we really need to do is understand what the problem is. And so if we're thinking of data as a marker, just a signal like, Hey, this is off. That is a problem, but it is likely not the problem. So any marker that we see, any data that we see, almost always, it's not going to be the problem. It's going to be a sign or a signal that there is another problem that needs to be addressed.

And so we're using it as a stepping stone. We're using it as, again, a flag in the ground to indicate we need to start digging in right here. And in doing so, then we can unbury, okay, what's actually going on? What is the problem? What do we need to do about it? How do we fix this? How do we solve it so that it goes away for good, which is a EOS concept.

So solving the problem period, honestly might not have anything to do with you.

So it could be something like your director of clinical ops needs to double down on owning clinician utilization, or we need to pull a hiring trigger and we missed it three months ago. And so now your integrator or your HR person is gonna start moving towards shit, we need to get somebody in the door, maybe two people in the door. We need new hires, stat.

So in having that conversation and identifying the root cause, we are able to then ideally solve the problem or work towards solving the problem, which may not equal you need to work harder to close the gap.

I think also there's something in all of this just about growth cycles. I don't actually know if this is true, but I, I just keep thinking about my doctoral advisor. Her name was Susan. I just love her so much.

When we talked about research though, initially, like when I was doing my dissertation, I remember her saying something like, you know, you're gonna start narrow and then your research is gonna expand big, and then you're gonna whittle it back down, and then it's gonna expand big again, and then it's gonna come in and so almost like this, this process of like expansion and then contraction and expansion and then contraction, and that through that process you're getting closer and closer to the end.

Like in doing this, you are not only saturating yourself in the research. But also more clearly identifying where you need to go next, or what you need to dive into next, or what the writing needs to reflect or you know, whatever.

My point is the same. I wonder if there's something about practice growth where there is also this maybe expansion, contraction process. You know, if I think about a practice as a living organism, as a living practice, which I do, then why wouldn't it pulse? Why wouldn't it also breathe, where there's an inhale and an exhale. There's expansion and contraction.

And If that is the case, then it's also the case that there's gonna be these moments of quiet, these moments of we've been pushing hard to grow, now we need to slow down, and then we're gonna have this other cycle of growth, and then we're gonna bring it back down. Expansion, contraction.

So I'm saying that because if a scorecard is showing stagnation, one, maybe it is a problem. So I'm not saying that this isn't a problem if, if you stagnate, that's not a problem at all. I, I don't know. It could be a problem, but I also just wanna put out the possibility that maybe it's a sign of a fall into winter season or a sign of an exhale or a sign of pruning, that also can be true.

And I'm saying that because I think that separates then this stagnation from us, failing from visionaries failing, or from leadership failing. Ironically, I don't do winter and fall well, I feel like I'm dying when it happens. I feel like I am dying on the inside when it comes to slowing down. Going dormant, slowing down, deepening my roots elicits a visceral reaction from me, and still is true. Like it still needs to happen even if I have a very strong reaction to it. So.

It's funny too 'cause I feel that way and I still see data as a signal. Like I see it as a sign, you know? So it's like, uh, I don't know. The, and both of leadership, it's almost always and both, isn't it?

Okay. I think that's it for today. I think that that does wrap up my scenario two.

I'll say again, if this resonates with you, if you wanna stay up on owner's room episodes, if you think of a friend who needs this, if you love the content, subscribe and slash or share with a friend. Share an episode with a friend, if you think like, Ooh, they need to hear this too.

And lastly, as per usual, thank you for being here with me. I super appreciate your time. I know how valuable it is, and I will see you next time. Thanks. Bye.