Culture Focused Practice

Hey, Dr. Tara, Vossenkemper here, and you are listening to the Culture Focused Practice podcast. Welcome back. Glad to see you. Here you are. I almost said lucky enough, but I guess that's TBD. You are here with me and the third episode of my miniseries regarding, EOS foundation's for group practices.

Here's the thing. This is an owner's room special. So the owner's room is a space where I don't teach you necessarily. I queue up a couple prompts and I just riff off of those prompts and questions.

The focus for today is really about a different kind of leadership tension, so this is the one that might show up when your systems are strong and your team is solid, and technically in a lot of ways things are good, but that pressure that you might feel, whether it's to keep growing or scaling or expanding, it just doesn't let up.

So it could be internal pressure, you know, expectations, ambition, drive, et cetera. And also it could be external pressure. So market, industry, your bank account, financial pressure, et cetera,

Whatever it is, regardless of what the pressure is, the reality is that being in a strong place, like feeling good about where you are, doesn't just automatically quiet.

The pressure that you are probably used to feeling or have felt at some point in your group practice ownership or leadership experience. I would even go so far as to say that sometimes doing well can ramp up that pressure before we can sort of tamp it down.

And I don't mean tamp it down, like snuff it out and act like it doesn't exist. I mean, sort of form a new relationship with it, have a different understanding of it.

So today we're basically talking all about what it feels like to want to grow from a stable foundation, but how different that pressure feels compared to like early scrappy days.

Prompt number one, what personal expectations are driving my pressure to keep growing even when the foundation is solid. Not salad, like the salad you eat, but solid. Like a solid or a gas. So again, what personal expectations are driving my pressure to keep growing even when the foundation is solid?

Ugh. Hit myself with a good question, didn't I? So I think there's a few different things here. For me, there's a few different things. One is internal drive. I just have it. I don't force myself to want to do things. I don't work hard to have grit or to be driven or to have ambition. It just, there is a ball of energy inside of my body and it needs a fucking outlet.

Honestly. It feels existential in that I wanna savor every moment of life that I can. I know that I'm walking towards death. We all are basically marching towards our own demise, and I want to gorge myself on my life with as much as possible.

I want to gorge myself on the things that are meaningful and valuable and in alignment with my own values and integrity. And I wanna surround myself with people who are fucking awesome. And so it's like all of these things sort of coalesce together with my practice where there's bombass people where I feel so integrity driven and so like purely cleanly focused on being of service and of value through the lens of my core focus and of our core values.

It's hard not to want to inflate that a little bit more. I don't mean inflate like in a superficial inflation way. I mean like literally expand it so that it takes up more space to the extent that it can sustain it.

I don't ever want something to grow past the point of being able to maintain integrity. That is just not, I'm not willing to do that at all, but my, like the drive, my personal expectations, like what, what is that stuff? It's not anything other than I, I love building out systems. I have a lot of ambition and drive and sort of fortitude and tenacity and I think also there's a need for creative expression in a very unique way.

I like to bring concepts to life. There's something that is like a creative expression with this, where I have to look at it from a bunch of different angles, like the user experience and the business experience and the employee experience and philosophically, what does this do? Like big picture, how does this fit with who we are?

There's some sort of like creativity in building something out and being able to move it around and mold it in a way that really maintain integrity and alignment with values and serve people and, you know, all of those things altogether matter to me.

It doesn't feel like expectation as much as it does energetic output, like I need output.

What I will say is that it is hard to shift out of something I know well into something I don't know as well, and I don't have as clear a concept of. So for example, if I'm shifting from my group practice to consulting for example, it has taken me literal years of thinking about, talking about, processing, being in, grappling with consulting to really get a sense for what is it that:

A, I can actually be of value to others about or with.

B. What really speaks to me, like what's really valuable and signif significant for me as a person.

C, how do I build something that that isn't just more of the same?

D, how does this all fit together? Not only sure the offers that I have. The core values that I have, but also like big picture, what does this mean in 1, 3, 5, 10 years? What is it that I'm seeking to build?

And so when I talk about liking this like sort of creative output, that's kind of what I mean that when I'm creating something, I don't wanna just create a thing. That's easy. It's easy just to say, here's a course, I'm just gonna create this. Yeah, fucking fine. That's, that's fine.

I can't just do that though. If I'm creating something, I need it to fit inside of a really large like ecosystem and framework. And if I don't have a framework, it's hard for me to sustain something.

I just have one more story. When I was really early days in my group practice ownership, I was part of a little mastermind and I was doing everything. Of course, I'm always doing everything, but I was doing everything like I was teaching and I was supervising for state licensure and I had interns and I was wanting to build out some courses and I had clients and I was trying to grow group practice and I had a baby and I was dissertating. God, I was nuts. I still am probably.

And somebody said to me, you know, what do you wanna do? Like, what is it? What do you wanna do? What is it that you're running from? I was like, oh God, I wanna do everything. And I'm not running from anything. I'm running towards the things that I want. So that's always my problem.

It's like running towards things and then, oh God, like deciding what things and how do I focus and where do they live. And then trying to again, creative creatively build out this big framework and ecosystem for where things can live and where they stay grounded, and how they can further develop, et cetera.

So. That's actually a great segue to prompt number two, which is when does growth feel exciting and when does it start to feel compulsory?

I feel like I've learned this the hard way. Growth always feels exciting for me at the inception. An abstract concept, figuring out how it fits and where it lives, and who does what and how we bring it to life.

Initially I would try to do all of the things when I was the one in all of the roles, especially earlier on in my group practice. Um, I would try to be the one to do all of the things and then I would just lose steam quickly and if something wasn't a priority to get done, sort of, you know, I was more in reactive mode than proactive and I was trying to do 10 things in a quarter instead of maybe isolating that down to one or two.

It would just fall flat. It just, things weren't actually sustainable the way that I was doing that.

It's very easy for things to feel compulsory to me. I think because I'm more of a Kolbe Quickstart, I'm more of a abstract visionary type. I like. Building out concepts and ideas. I do not like the maintenance of anything. So if I have to be the one that's consistently involved in the maintenance of a system, I am so fucking over it.

Just almost immediately, like I feel like my insides are filled with cement, drying, cement, just sludge. I can't move my body. I'm not excited. I don't want to do this. I just, uh, that's how it feels. Just that noise. Uh, don't care. Don't want anything to do with it. So for me, the compulsory piece is when I have to be involved in the maintenance of something because I fucking hate it.

The exciting piece is the creation of things and the, even the troubleshooting, the initial phases of something, but the minute that it's stabilized and then there needs to be routine maintenance for it, I'm out. I'm out now. I used to not be out because I didn't, well, maybe because I didn't know that about myself to the extent that I know it now, but also because I didn't have the right people in place based on size, but also just based on knowledge about accountability charts and, you know, uh, organizational structure, so to speak.

At this point. I know. Everybody knows around me. My leadership team knows I know. I can't be involved in ongoing maintenance of stuff because I will drop the ball. I just have zero interest in doing it, and it's not where my strength is. I don't do it well. I forget shit. I'm uninterested, I just, it does not work well.

So some of you might be listening and thinking, I can't believe Tara, like she doesn't even stay involved in her routine maintenance. I had a colleague question something related to how I. I ran my business once with regard to, I think it was billing. They said something about they wanna be involved in all aspects of billing, and I was like, Ugh.

And it kind of felt shame-y, the way that they brought it up. And my response was, one, I don't wanna be involved in all aspects of billing. Two, I'm not a biller. My biller knows how to call all the insurance places and handle them. She knows what to ask. She knows the language to use. She understands all of the ins and outs of the coding and the, you know, specialization types and the, like, the add-on codes, you know.

She knows so much more than I ever want to know about billing. Why would I even venture down that path when I'm not good at routine detailed maintenance of things and my time is best served visioning.

My time is literally most valuable when I'm in my own, like mm-hmm. I don't like the language genius, but like zone of genius, so to speak. I'm good at this stuff, let me be here. Which serves a practice. Big picture, so it's a little bit of a tangent related to growth, feeling exciting and versus when it starts to feel compulsory.

But my short answer is exciting in conception. Getting it going. Working through initial issues. Compulsory in maintenance. Ugh. Always.

Let's continue this, shall we? This is prompt number three. If nothing changed for the next six to 12 months, would I actually be unhappy or just uncomfortable? Hmm. That's a really interesting question.

I would be dissatisfied. I don't think I would be unhappy, and I don't necessarily think I would be uncomfortable. I think I would feel dissatisfied. I. The goal for the business is not to remain the same, and so if we're not doing anything different, if nothing changes in six to 12 months, to me, that's problematic.

One, I would feel dissatisfied about nothing changing. It just feels kind of stagnant. Two, the entire business is set up in such a way that we are consistently evolving and growing and working through issues. So for me. That would point to a major fucking problem in how things were being run. That's what it would really mean.

I would feel dissatisfied and I would really be concerned that there were significant issues happening. I wouldn't be concerned. I would be sure that there were significant issues happening that nothing is getting done. That's a big problem. So not unhappy, not uncomfortable, dissatisfied and concerned about the health of the practice based on shit not getting done that should be.

The three questions and prompts I just asked were way more internal facing. These next three are gonna be more external facing, meaning external pressures, you know, coming in.

So question four is our first external pressure prompt, and it is, in what ways have financial realities like cashflow, profitability, personal income, created real or perceived urgency around growth?

I mean. They always create urgency, not, uh, wait, hang on. Let me think about that. I would say they're always a factor. I don't necessarily know if I would say they create a sense of urgency, although I will say when the systems are set up to support a 15 clinician team or a 20 clinician team, meaning like operations and the number of support staff we have and then our clinician count dwindles down to 12.

Yeah, there's absolutely a sense of urgency because your operating expenses and your admin expenses remain the same, but your revenue decreases, which means from a P and L perspective, a profit and loss statement perspective, the percentage of money being allocated to ops, operating expenses, admin, et cetera, increases.

It either dips into profitability in such a way that you are now bleeding, or it just decreases profitability to the extent that it's down to basically zero.

For me, profitability is not about lining your pockets. It is about sustainability of the business. If your business isn't profitable, it's not sustainable.

There are months where, especially if there's three pay periods in a month, we're definitely in the negative. Like there's no way we are gonna sustain profitability in the two months out of the year where there are three pay periods. I pay biweekly for the record.

That means all my other months need to be profitable in order to counter that negative and ensure that there is a sustainability for the practice, that money is probably gonna go into cash reserve so that if something like Covid happens again, I'm set, I'm set for a little bit, at least.

I have horror stories of friends who have blown through. A lot of money, thank God they had cash reserves or people who have had to take out business lines of credit in order to pay their people.

That's no shade or judgment that anybody who's done that, because anybody who runs a small business knows that's absolutely a reality that a lot of people have to go through.

But what I will say is. Profitability, cash flow, income, all of these things are part of the discussion with regard to growth.

Even in our V/TO, our vision traction organizer. When we talk about a, you know, three year, uh, three year picture and a 10 year target and a one year plan, profitability percentage is on those measureables. Not just gross revenue, but also what's the profitability, because you could have a $5 million practice and if your net, if your profit is 0.02%, well why? I mean, what's the point? That's a huge gross revenue amount and a minuscule profit amount.

So yeah, I think it's always, the financial realities are a component of. They should be considered and paid attention to.

I don't think they should be the driving force for running a business or for making decisions, but they should be an equal factor when you're also looking at things like your vision and leaving out your values and the way that you wanna see your practice grow.

If you know you wanna set gross revenue in a set profit percentage that bleeds over into then what do operating expenses need to look like and how many clinicians do we have at what, you know, what full-time equivalent ratio? It helps you figure out what needs to be in place, which, so vision and finances for me, they all tie together.

So definitely real variables and factors. I would not necessarily say that they all relate to, or they all feed into a, a sense of urgency. Sometimes. Sometimes I might feel a sense of anxiety and a little bit of frantic energy around, fuck we need to hire. And that's not a, that's not an all the time thing.

That's like a, when I'm looking at numbers, how are things shaking out thing.

Prompt number five, what is the difference between healthy growth and forced growth for my practice? Super interesting. Hmm.

Healthy growth is organic. It's an organic evolution of what is, I always think about bamboo, you know, where the roots of bamboo grow for, in some cases, I'm sure there's a variety of strains, but in some cases, the roots grow for years at a time before you even see bamboo break ground.

And so I think about that with my own practice. What are the ways in which I can deepen my roots, even if we're not breaking ground in a really significant way yet?

And. What might that look like in 1, 3, 5, 10 years? What do we want this to look like? And along the way, what we're doing is we're assessing for whether or not things continue to fit. Are things in alignment with our focus? Are they in accordance with our core values? Do they make us excited in a sort of sustainable excitement way, not like a frenetic, exciting, let's do a thousand things, not like that sort of way, but in a holy shit, this would be a fucking awesome place in three years if it looked like this, if it felt like this, if we had these things in place.

So I think healthy growth for me is really organic, even if it's planned. It's an organic evolution, organic reflection of where we are and where we're headed.

Forced growth would be you are gunning for one specific thing, and that's it. Regardless of as you're going, you're not assessing how it feels or whether it fits or if you still feel in alignment with it, you're just going for it come hell or high water. That is forced growth for me.

I've never been somebody who can do that. I just, mm-hmm. I'm a person. I know that I need to be in something. So I would say I am pretty experiential in that I need to be in and experienced before I really have a sense for how I feel about it. I also know that once I'm in an experience, I'm immediately, I think probably all of us we're immediately sort of taking stock of how we feel, what we like, what we could change, what could evolve.

That is a constant happening at my practice. Whether it's a function of how I show up, it's sort of a trickle down of leadership, or it's built in because of EOS and it sort of forces us on a quarterly basis for sure to assess where we're going if we're all on the same page, and still in alignment and still excited, and what might need to change in that process.

Okay. Question six, last prompt slash question. How do I give myself permission to grow intentionally without defaulting back to more, faster, bigger as the only metric of success? This might be a cop out question. I don't think I can do anything without intention. Like once it's in the mix, it's hard for me to let go of.

Even when I was in the very early stages of my practice, I remember a refrain that I would say to my team is that I wanna be the best. I think I still say that I want to be the best, period. I don't need to be the biggest. We don't need to grow the fastest. We don't need to do more for the sake of doing more.

I wanna be the best. I wanna have a strong reputation, do high fucking quality work, have integrity, be in alignment with our values, and if we grow from there, which we have plans to grow, that's what I want. That thing.

I don't like growth for the sake of growth. It has to be grounded and it has to come from a, it just has to come from a deeply rooted place.

So that might be a cop out question because I think all of our growth is intentional. We are only ever seeking to grow intentionally. Even I'm thinking about some of the biannuals I've had, some of the conversations I've had with my team where, you know, they voice concerns about, I don't wanna grow, I don't want it to turn it into the last place I was.

And I'll say, yes, same. I'm not willing to disregard the culture for growth or disregard our values for growth for some fucking number. I don't give a fuck what that number is.

I wanna grow, of course, we're seeking to hit these marks, and that doesn't mean we're just gonna bring anybody on to hit the clinician count.

That doesn't mean we're gonna run a sort of a clinician mill of therapists in order to hit our revenue goals like. We can be focused on growth with intention and not lose the focus on culture at the practice. I would, I don't think I could ever do that. I wouldn't be here if that's the way that it started evolving. I would be gone.

I think probably the takeaway, I really do think about growth as a depth. I don't think about it as more necessarily. I think about it as depth of alignment, depth of clarity, depth of systems, depth of leadership, depth of accuracy with roles. I mean, I think that that kind of ties in with leadership and clarity, depth of marketing, sort of the framework for marketing and how we go about doing this.

If you are in a stable place and you still feel pressure, I think one thing I would say is, man, welcome to the club. Like, yeah, I do also still feel pressure, but the second thing I'll say is that might mean that it's time to redefine what growth really means to you. What I'll add onto that is if you really want a place to explore meaningful growth, meaningful growth, not just bigger, faster, stronger, but better, higher quality, more integrity, more alignment, more values oriented, more culture focus.

All of that is done through the EOS Mastermind. This is where we're headed. So the wait list is open right now at www.taravossenkemper.com. Hover over work with me. There's an EOS mastermind. Join the wait list. You'll get all the deets and dates coming up, and the doors close officially for the Mastermind on June 2nd.

So we are talking about this a little bit early because I know that spots are going to fill it pretty fast. It's, uh, it's an incredible experience.

I hope this was helpful in some way that it spoke to you, that it resonated with you and otherwise, thanks for being here, I appreciate it and I will see you next time. See ya.