Culture Focused Practice

 Hey there, Dr. Tara Vossenkemper here, and you are listening to the Culture Focused Practice Podcast. Thank you for being here with me. We're gonna get straight into it.

This episode is for all of my people who realize in those quiet moments that they are the problem. If this hasn't happened to you yet, it will. I say it will. It might. If you are a standard group practice owner, it's likely going to happen to you at some point.

So let's say you've built systems, you've hired all the great people, and you have even implemented some sort of structure. In our case, it's e os, but maybe in your case it's something else, but you keep hitting a log jam.

Like it just keeps happening and it almost always comes back to you. At the top. And so you're stopping everything from flowing around and beneath you and in every direction of the practice that it needs to flow.

So today's own room episode is all about the feelings associated with being a bottleneck, good and bad, and hopefully some insight not only for myself. 'cause as I talk through these riffs, I often find myself coming to realizations in real time. But also maybe for you that that would be the goal.

Before I forget, and before we go further, make sure you subscribe to the podcast. In doing so, you are ensuring that like-minded people can also find and listen and enjoy, hopefully, enjoy the experience.

There's two items on the agenda. This is not a listicle type podcast. These are not talking points. The agenda items are getting to, I'm gonna do five questions today. That's one. And then the second piece is going through a scenario. So I will read a scenario, it's a really brief little snippet, and then I'll just talk through how I might handle that situation. Alright? Again, when you are the bottleneck and you know it, welcome to the owner's room.

Question number one, how do you justify bottlenecking to yourself? For example, it's faster if I do it. They'll drop the ball. How do you justify bottlenecking to yourself? How do I justify that to myself?

I think the justification for me comes from the weight of teaching somebody else how to do something. That's what it is.

I know there are some things that I'm not good at, and honestly, some things that I don't wanna do, so. Of course that's a sweet spot if you have something that you're not good at and you don't wanna do. Ideally those are the things we offload right away. But there's some things that I'm not good at and I, I do want to do.

Let's say there's a concept or like an idea that I have and I am in the process of trying to make sense of it. You know, I'm like grappling with it. Okay, well how would that fit and who would do what and how would we integrate it or implement it? And how would the current structure we have hold the smaller structure within? You know, like where does it live?

I'm sort of like going through a series of questions, you know, and so. That process, like the grappling process of like bringing something to life. It's really hard for me to not do that before I hand something off because I don't think, and, and I think this is actual, I don't think that, I'm just saying this.

And I think that maybe this is even unique to being a group practice owner and not even on leadership team, or not one of the, you know, providers or someone on the ops team, for example.

There's such a unique set of responsibilities, like internal responsibilities that I have to the practice, and so if there's some like concept that I wanna bring to life, part of bringing it to life is walking around the entire outside of it to make sense of all of the questions that I ask. Like, well, okay, where would this live and who would do what and how would that change their role? And how does that fit with culture? And you know, of course there's like, let's

say HR perspective and then in the process of walking around this thing, when I can see it clearly then. I'm like, I'm good to be like, okay, cool.

I'm absolutely a bottleneck there. And the justification then, as I'm talking, I'm realizing the justification is I don't know if people are gonna ask all of the questions that I couldn't even tell you what I ask.

I just do it internally and so it ends up being, this is actually ties into what I think I just said, that it's so much more labor to have to capture like the questions that I have about bringing a concept to life than it is just to do it. Because if you were to ask me, what are you thinking about, I would tell you like, I don't fucking know.

Like I don't have any idea. But if you gave me a concept, then I would just start like walking around it and sort of poking and prodding at it.

But the practice of documenting what's happening in my head and like getting it down onto paper, I hate it. I'm, I hate it so much. It is just so much effort and I feel like I never actually capture the essence of what I'm trying to do.

So I feel like when I go to, like, put it down on paper. Maybe I've got some of the questions right, but they're also weighted in my mind, you know, like, you like take a test and you've weighted questions, for example, the question or weighted scores. I'm sorry.

So depending on the concept, you know, one question is gonna be a heavier weight. There's gonna be more, um, importance assigned to it than another. But I don't know in advance what that's gonna be. I have to know what the thing is that I'm grappling with first, and then like the weightiness of the questions will organically show up.

It just happens like, oh, okay, cool. So this is gonna be most important, or this is gonna be more important.

This is, this is literally, as I'm talking, I'm really, this is me justifying being a bottleneck, which is just really fucking funny and ridiculous. So, yeah, I just, I don't know if anybody else can do it in the same way that I can. And I also don't know how to teach that thing. That's not to say that I'm the only one that's good at everything. I don't wanna come across as dismissing the value that other people bring to the table because absolutely my leadership team each brings like very distinct strengths to the table. That's why they're on the leadership team.

So in real time you've just heard the justification for being a bottleneck. There you go. That's what happens, man. That's helpful actually to know. You know, what I might do is take it to chat GPT. I might have it prompt me with the scenario and then I will voice memo back, all of the questions that come up for me.

And then I will say to chat. Why am I asking these questions? Draw out the themes for me? Because if you can do that, I could pass that along to my leadership team. That would be a way of removing myself from the bottleneck. And also I would have it do a couple scenarios. This is how I would work through it.

I would have it do a couple of scenarios, just vastly different scenario as different as possible, you know? And then I would do the thing where I'm generating the questions and I would talk out loud about, well, I would do this first for this reason. I would do blah, blah, blah. And then maybe it could generate, like I said, the themes and maybe the types of questions that I'm asking, and when one type of question is more important than another, for example.

Yeah, that's actually what I'm gonna do. I'm really happy that I'm talking about this right now because I just realized I could rely on some of the tools I have around me to like write down, get it outta my head and onto paper, and then I could share that with my team, so then I can remove myself from being the bottleneck.

Perfect. Okay. I'm gonna keep going. I think I've answered that question enough by justifying myself being the bottleneck.

Okay. Question two. Where do you fear things will fall apart if you loosen control? Man, I like this question. I don't know if I fear that they will fall apart in any specific place, but I heard or read recently something about, there's a principle I think in physics where entities tend towards disorganization.

And so I don't think there's a fear that things will fall apart in a certain area. There is a fear, and fear is a strong word that this thing. Very well could start to come sort of undone at the edges, and that would be a slow unfolding of all of the structure and layering in and intentionality all the way to the middle of the organism of the practice, which is an organism.

So it's not any one specific area, it's just this sort of thought like, Ooh, if we do stop paying attention to the practice, things will start to fray and unravel. That's the, we'll say fear, but I, again, I don't think that's exactly the right word, and I do think this is justifiable. If I'm stealing a word from riff number one, I do feel like this is justifiable. If we know that entities tend towards disorganization, wouldn't it be the same in our case? Like wouldn't it also be the same, that if we don't have feedback and communication and sort of clarity and accountability, all of this stuff in place to maintain a system and help it scale and evolve and grow, then it's gonna unravel. Like you know, you hear these stories about people scaling too fast and shit just bottoms out, or people not being able to scale at all because their infrastructure is shitty.

You know, it's just not high quality and it's not intentional. And so I think that there's something to be said for paying attention to all of the areas of your practice.

You being the sole person doing it is not, that's bottleneck stuff. So if you are the only one who's sort of assessing the entire practice organism, you know you're gonna slow yourself down. You're gonna get in your own way. It's gonna be too much at some point, and you're not gonna be able to do anything else. You're gonna gonna be straight up assessing all the time.

So I think that there's a possibility of becoming a bottleneck if you think I'm the only one that can do this thing. If you build in feedback to the structure, then you don't have to worry as much about things falling apart because you have every indication of when shit starts to go sideways based on the feedback that you have set up.

number three, riff number three. Question number three, how do you tell the difference between high standards and micromanagement? Ooh, I like this question. I do have high standards, not probably in life in general, like with what other people do. I don't feel controlling of others, but if there's something directly connected to me, I know that I want it to look and feel a certain way.

And so to me, micromanagement is gonna be telling somebody exactly how to do the thing, period. I think a high standard in contrast would be me saying, Hey, this is a project needs to be done by this time.

This is the look and feel that I want. This is what we needed to do. Having high standards and wanting something to be a certain way is not the same thing as every single step of the way, i'm looking over someone's shoulder.

So my marketing director, this, this is a great example actually. I might tell her, you know, we need, this is a simple example too, but we need a flyer. We need a flyer for this thing. Like we need some, you know, visuals. She'll say, okay, and so what goes on there? And I'll say, I don't know.

I think something about, like something about. If we're hiring something about the location we're hiring for the, you know, licensure type. Here's a position description so you can pull, you know, what's important to us out of this, pull some stuff outta here. And then she left and she went off to work on this thing and she came back and showed me, here I have three here.

What do you think? And from there, the first draft is never the final draft. From there, it's almost always where I say, okay, I like this. I don't like this. I can't tell you why. Maybe it's the color. This one's really text heavy. I think I want less text. I. And she'll say, okay, and then she leaves again, and then she comes back with another draft and I'll say, Hmm, you know what?

I actually like this, this design better, but I like that amount of text better. And then I like, could you do something like combining these and then she'll leave again and go away, and then she'll come back and present something. She does not feel micromanaged in that process.

She wants to make sure that the end product is what I want it to be because the eyes of the practice, you know, how it looks and how it comes across that is mine to own. She will bring it to life for me. She's so great at it too , but she and I both know I want final eyes on the visual products.

If every single step of the way I was sitting with her where I said, Hey, let's pull it up right now and we're gonna start editing together. I wanna watch you do this, and I'm gonna tell you yes, no, don't do that. Yes, do this. That's micromanagement. She doesn't need to be, she's a fucking designer. Like she doesn't need to be told what to do.

She needs to get feedback on what she has developed and then she can take and run with it. I think I have wrung all of the water out of this sponge of a question, so I'm gonna keep going.

Question number four, what would it mean to stop being quote, essential end quote to every outcome? I absolutely don't feel essential to every outcome, so I'm gonna say that right off the bat. I don't feel essential to every outcome.

If I was, I just feel like my body tighten up with tension, I would feel relieved. I would feel immense relief to not be essential to every single outcome. That's how I would feel.

What would it mean? And this for me is a positive thing. It would mean that I was freed up to do other things. It would mean I would be able to spend time working on things that I wanted to develop for the group, working on ideas or concepts or future-focused things, or even culture oriented things in the moment, getting feedback from people about how things are going, you know, whatever it might be, would mean I would have free space. I could spend time in the area and ways in which I wanted to spend time.

I'll say, let me just like place myself, you know, pick myself up and place myself back five years ago or something, even four years ago maybe, to not be essential to every outcome then would have been much scarier. And I think part of why that is, is because I didn't have the right people in place.

So I, I was essential to every outcome, every final decision, every outcome. I didn't have an accountability chart. I didn't have clarity in the same way that I do now. And so if I went back then and I was asking myself this question, and you might be in that space, if you're listening, you might think, well, fuck I, I am essential to every outcome.

Take heart. Because if you can clean up your accountability chart, if you can clarify roles and responsibilities, and then you get in the habit of practicing, letting things go, I think that delegation project delegation in particular, letting things go, it's like a, it's a practice. It has to become a practice.

It's not something that people who start their own business and, and evolve it and grow it. It's not something that comes naturally to us. And so it was having the right people. It was practicing delegation, practicing letting go of things, even voicing out loud, I would say to my team sometimes, once I started to get the right people in place.

I'm actively removing myself and I'm, it's really hard to do, but I'm just, I'm not gonna say anything. I'm, I'm literally like, I'm removing myself. I just want a voice that it's difficult for me in this moment, but I'm still gonna do it because you can do this, and my feelings are about me and not reflective of you.

What else would it mean to stop being essential to every outcome? I'm just realizing as I'm talking, I think it would mean that you have successfully built a group. You've done what you set out to do. Isn't that what this whole thing is about? It's crazy to even say that loud.

'cause I'm realizing holy fucking shit. Like, oh my God, my group is incredible. That's what it would mean for you, then that means that's what it means for me, which is super cool, but it means that you have done what you set out to do, which is celebratory celebratable.

Is that a word? It should be. If it's not, that is something to be celebrated. How about that? So kudos to you, my friend. Kudos to me, also.

Let's do question five. Let's keep going.

Question number five, what part of your identity is wrapped up in being the problem solver? I love this question. Uh, let's do short version answer. My nutshell answer is, none. I think. Okay, hang on. Let's define problem solver. So if you're saying the one who literally fixes the problem, probably none. Minimal. Minimal part of my identity.

Sometimes I get the urge to scratch that itch. Like I just wanna get something done. Sort of like, uh, that's where I turn into that dog with a bone piece. A lot of times this shows up when I'm doing something with like a dashboard or like a Google sheet and I'm trying to, I wanna do something very specific and I can't figure out how to do it in the simplest way.

So then I end up spending, you know, two hours talking to Chat G PT or Googling, how would you do this? And going to YouTube videos and watching somebody do something. And then I tried the formula and then it doesn't work. So then I go back and I watch again, and.

That aside, I'm more interested in understanding the problem. And I think from understanding comes an obvious answer or an obvious solution. Implementing the solution, I may or may not want any part of.

Like if it's not related to my role, I'm probably not gonna do it. If it's related to somebody else's role, then perfect. Like they have an answer in accordance. In accordance with the actual, I think that's the right way of saying that, right? They have an answer related to the problem and so they'll solve it , but they're not solving the thing that maybe came across their desk. They are digging into it to really understand the nuance and the actual problem before seeking to solve it.

I think maybe another piece to this, like the part of my identity that's wrapped up in being the problem solver. I would say that there is a strong internal part of me that really likes to understand systems.

I will vacillate between zooming out big and like getting super fine grained and then zooming out big and then zooming back into fine grain. Like I want to understand. Whatever system I'm a part of at every single level. I want it to make sense. I want to get it.

I wanna understand how all of the pieces of the system intersect and interact with one another.

And I think probably the flip side of that part, I think there's either, maybe it's two parts. You know, maybe it's like this part that is seeking to understand and then the, the yin to that yang is gonna be the part of me that's just really curious.

Like, I'm curious about things I want to understand as much as possible, almost like I wanna gorge myself on life, like I wanna live it to the fullest. I wanna understand it as much as I can. I wanna learn as much as I can, and I'm incessantly curious, so I'm gonna be a question asker.

I'm gonna be that student in class that you really, can you shut the fuck up please? I'm gonna be that student that's like, wait, wait, wait. I have a question. I don't, I don't have any qualms about asking questions in public either. So like I'm always the one with the questions, you know, although in my defense I think I'll ask the questions and a lot of people are like, I was thinking the same thing, but I'm glad you asked 'cause I was afraid to, I'm not afraid to ask questions.

So I have a lot of curiosity and I like to seek to understand things and I think from there you get problem solving. But I don't have a strong part of my identity that's wrapped up in doing the problem solving. I do have a strong part of me that is wrapped up in the grappling with a problem to seek to understand it.

This actually makes me interested in your perspective of yourself with regard to problem solving. You know, what is it about you or is there something in, uh, you know, a part or like a part of your identity that feels, enmeshed, let's say, really wrapped up in being the one who solves the problem.

Sort of like the one who swoops in and saves the day. Is there something about being a savior or maybe something about, maybe it's a little bit martyr, you know, like nobody else can, can bear this weight.

Or is there something around just having to be the smartest in the room? Is there something around like, I need to be the one to solve this so that everybody sees me in a respectful way? Is there something about maybe historically being the one that everyone turned to to get an answer and you just, you are the one that has all the answers, everybody needs to come to you. You know, it's sort of like ingrained like, well, I need to have all the answers then.

I think this maybe is worth a reflection because if you are somebody who needs to be the problem solver, I'm thinking if that is the case, then you're also the bottleneck. You know, being the problem solver. The problem solver, one of the exclusive ones for your group, or maybe one of two problem solvers for your group basically sets you up to be the bottleneck.

You and that one other person, you are the bottlenecks for your group, then. That's what will happen if it hasn't already. And so I think it's worth it to think about this and to ask yourself, do I have any part of my identity that's wrapped up in being the problem solver?

Because if you do, then you can address that part of your identity and start to work through it so that you don't put yourself in a position to be and remain the bottleneck. 'cause that's not gonna help your practice evolve and grow and develop.

Okay, let's do this. Let's do scenario now, shall we?

All right. A practice owner has successfully implemented EOS. They have a clear accountability chart, weekly l 10s, and even traction with rocks. They're striving for traction with rocks. I should say it like that, but decisions still funnel through them. They say they want a self-led team, but they're editing emails, redoing spreadsheets, and being CC'd on every damn thing.

What is actually going on here for them? What would letting go really look like? How can they hold people accountable without being included in everything?

You know, I actually feel sad about this. I feel sad thinking about a person who is probably wanting, like they're wanting to step away and something is happening so intensely inside of them that they're not able to. And so what this brings up for me is, weirdly enough, it brings up trauma.

It brings up complex trauma. For me, the idea that somebody with a more secure style of attachment, let's say, is going to trust people around them. And if they have a little bit of skepticism, after some exposures and like healthy exchanges and, you know, um, trust building experiences with the people around them, the skepticism might go away relatively quickly.

Where they're like, oh no, this person has followed through. They're great. We have a good relationship. We've had some honest conversations and dialogue, and so I trust they're here. They're here with me. Got it. And then they can continue in that direction.

if you have gone through, you grew up in like emotionally mature households, neglectful parents, if you experience abandonment, if there's gaslighting as a child, you know, um, children of alcoholics. I mean, there's just so many ways in which people can go through complex trauma or live it for a long time.

So what is coming up for me is that.

Like I would think that for somebody like this who has got all the systems in place and they've done all the right moves and people are, let's say their team is performing well and they still can't let go, that would indicate something much deeper and I would say, from my perspective, that's a therapeutic need. You probably need to go talk to somebody about this.

Like this is beyond your team. It's beyond the structure. This organism is relatively healthy and you still can't let go. Maybe you go do some therapy, maybe you go do some neurofeedback, maybe you go do some EMDR, maybe you go do some somatic experiencing, maybe you go whatever it is that you wanna do. That's where therapy actually comes into play for me, where I think this person needs more than the structure and the system and the healthy people around them.

So that's my first sort of thought about like, okay, what is actually going on?

So another option is that this is just a person who has let's say higher than average levels of emotionality, or we can say neuroticism. I, I don't know why people think neuroticism is, there's like judgment about that word. I don't feel any judgment. I know I can be neurotic sometimes. I don't think anything's wrong with it.

My point is, let's just say this person, you know, maybe they're like two standard deviations above the mean, or something like that. So a little bit higher than average levels of neuroticism or emotionality.

That could just be it. It could literally be, okay, so this person needs a little more in terms of repeated exposures of things going well in this area. I don't think there's anything wrong with that. My thought is just fucking voice it.

If you're that person where you're like, no, it's actually, it's not complex trauma, it's just really hard for me to let go, I get really, really anxious, and I'm, I am high on neuroticism or you know, I am high on emotionality.

Cool. Then why don't you share that with your team and let them know, I'm gonna be working through this. It's really hard for me to do. I'll probably never be low in neuroticism or emotionality. Totally fine. This is what I love about people is that they're all different, and I really wanna try to a balance with you, leadership team in particular with you, about how I can respect you and your role and try to regulate myself in those moments, but I also just need you to know that I might always be a little bit more high strung about certain things.

So my point is that you could take something like a Big Five or a Hexaco or whatever. I love the Hexaco. As a side note, if you take something like that and you see high levels of emotionality.

Then I would just fucking bring it back to the team and talk and say, here's how this shows up between us. What I love about stuff like that is people who work with you, they already know you, bro.

Like they already know you. They work with you, they see you. So in saying this thing out loud, you're not saying anything that they don't already know. Like I could say to my team, I really have to grapple with concepts they fucking know. And I have said that. And they've said, yeah, we, we know like you're good.

it's that simple, you can just make it known and then try to make it work for you and your team. It doesn't need to look a certain way. I don't think I would ever wanna tell somebody it needs to look like this. Not fucking doesn't. It needs to work for you. That's what it needs to do.

And so if you need some level of being CC'd on emails. Cool. Maybe the communication to your team doesn't need to be, remove me. Don't ever CC me again. I'm gonna get rid of this thing. Maybe it's that you and your team discuss. What are the most important emails that you actually do need to be CC'd on?

Or maybe it's something like, I want to be CC'd on every email, but I know that that feels like micromanagement, so can we please collaborate on how I can stay in the know with things without you feeling micromanaged?

My other thought even about like going through and editing emails. When somebody's new in a role and they are in leadership, I want to know how they're saying things and what they're saying. And I coach people. I absolutely have coached people.

And I'll still have, sometimes my DCO will sometimes shoot me an email and she just wants eyes on it of her record for the record, not because I want her to. But when we talk and meet, unless she specifically asked me to edit, I'm not gonna touch her text.

I'm gonna give her feedback on it. And then I'm gonna give it back to her. And so part of your team also, I think there's maybe something that might be missing is this notion that we have to coach people and then they have to learn how to do it still. Like I could tell my son how to ride a bike, but he has to literally get on the bike and ride it.

I could talk all day. It's not the same thing as doing. So in those moments too, it might be that you're coaching somebody, but instead of fixing, you also are allowing them to fix it.

And I would say further still, they are gonna have a unique relationship with the team. They are not you, so you don't need to tell them what to do. You need to help them find their own voice in doing it. And then also hold the space of your leadership manifesto, and ensure that they're operating from the song sheet.

So I'm thinking like you're sort of giving them a theory to root into a leadership theory, so to speak, but you're allowing them the practice of doing it on their own.

I think that wraps us up, folks. I value time so much, so I really appreciate you spending some with me.

If you have feedback or want want a certain owner's room scenario, that would be fucking sick. I would love if you sent me a scenario. And I could plug that in. I would de-identify it of course, but then I would plug it in and I would go from there. Ah, that would be so awesome.

So if you have something, send it to me. And if you don't, that's cool too. I will just plan on seeing you next time. Thank you for being here with me and have a great day. See ya. Bye.