Achieving Autonomy in Practice

---

Today we're going to talk about how to achieve autonomy in practice. Now, what we mean by that is in business generally we have a number of places where a business can be in its lifecycle. You can think about a business as a human being, right? Or as any kind of living thing and so we have the beginning, we have the young adult, we have the adult, and we have the mature age. Autonomy is our way of saying this is maturity, this is where you can either know the business is running effectively and profitably without you being present, and/or the ability to sell the business at a multiple. So, in order to do that, we need to use a tool. Now, the reason we're not going to use a D-Map is because it is a tactical tool and it is a tool that we use when we want to solve individual problems in a specific division of the business where we've seen a stat decrease.

4Q&A is our opportunity to deal with strategic initiatives, things across divisions, where we're seeing new growth opportunities and new divisions that could be created. 4Q&A is going to be a powerful tool for that and we know that there are four things that go into our 4Q&A. The first being the problem, then the opportunity, then the difficulty, and then the approach. Now, when we talk about the problem, in this case, the problem is actually a goal. So, we're going to amend our 4Q&A a little bit. Instead of just calling it a problem, we're going to call it a goal and the goal is to achieve autonomy. However, this isn't enough. In order to accurately describe this problem/goal, we need to be very specific. In other words, in achieving autonomy, you want to be able to do what? Do you want to step out of the business? Do you want to sell the business? Let’s say, I want to achieve autonomy by not having to be present. Alright, so in this case, I'm not really looking to sell my business and I'm not looking to sell my practice, I'm looking to just achieve a place where it's profitable and I don't have to be there every day. Maybe I want to be an autonomous business or practice owner, and as the clinician I want the ability to go in and practice whenever I want but not feel like I have to be in the clinic practicing today. We need to be specific about that.

Now, if the goal was to achieve a sold business or a sold practice, then we need to be specific about achieving autonomy through selling our practice at a multiple, right? We want to be specific about that. We don't just want to sell the business because then we're going to take whatever deal comes across and I can tell you that, generally, plenty of people are going to want to buy that business. The question is, how much is it worth? So the opportunity is the next part, that's the worth. In this case, we're talking about not having to be present, so the opportunity of not being present is the profit. We can frame this in terms of time gained and this is now how we're going to calculate whether or not this opportunity is worth it. Generally, the profit is not going to change unless added by virtue of becoming autonomous you bring in someone who is responsible for growing the business, right? Initially, you're going to take a decrease in profit but your long-term goal is to increase profit by virtue of this new individual. Maybe you've put a new CEO in place of this business, and up front, the next six months or a year you're going to be losing profits in order to pay that person's salary or their commission. However you pay them, the goal is to see that they're effective and they actually not only replace their value in terms of their costs to the business but also increase your business’s value by some multiple of that.

The next thing we want to look at is the time gain. This is the most valuable thing that you can achieve in building an autonomous practice because we know that time is our most valuable asset. Money can be replaced, assets can be replaced, but time, once it's gone, it is gone forever. Therefore, the ability to gain time through achieving autonomy is really the most valuable thing that we can do. Profit is good, we can increase profit. Maybe, at the very minimum, we can maintain profitability which should be high but the time gain is the most effective thing. So what we need to assess next is, what are the difficulties in achieving this goal? Well, the real difficulty is how we are going to replace the owner hat or hats.

As an owner, what are all the things that you do in the clinic? You need to figure this out and you need to list them out. It could be treating, or it could be you might sometimes fill in at the front desk, you might sometimes fill in for the office manager, you might sometimes fill in for the biller etc. The easiest way to do this is by marking down all the divisions in the clinic and then mark down what percentage of your time is spent in each. The total should, of course, hit 100%. Ideally, let's say that most of your time is spent in the owner role so say 80%, then whatever is left in these other areas needs to be farmed out which is nice because we're only dealing with about 20% of the workload right now, right? As an owner, especially if you have a cloud-based solution or a cloud-based way of tracking statistics, you don't need to be in the clinic to access information or data. What are the things as an owner that you do today of the clinic? This is the first thing we need to figure out. What percentage of my time is spent in the owner role where I don't have to be in the clinic? It could be 80%, that means you're closer to achieving this, it could also be 30%, or it could be 10%. You're so mired in the practice and maybe 80% of your time is spent treating because you're the main treating clinician. We need to figure out how we're going to address that.

Now, let's talk about approach. In the approach, we need at least a couple of options. This is what we'd expect of our staff in these situations, so we need to take that upon ourselves. So the approach, in this case, is going to be directly related to our difficulty here because to get to the approach, we need to decide that this difficulty is worth this opportunity. We have to agree on that. If we don't agree that the opportunity outweighs the difficulties, then it doesn't make sense to come up with an approach. This 4Q&A is now tabled until it does make sense and if it does make sense, if the opportunity here is much greater than the difficulty, then we can start thinking about our approach. If I am a heavy owner and light everywhere else, then I need to buy division, we'll call this rehatting. In other words, I need to take each of the things that I do in these hats or in these divisions and successfully move them to other people. Rehat to others.

You should always do this by division, never try to do this by independent action that you'd take in the clinic. For example, you have to file paperwork or you have to make sure charts are correct. File those responsibilities under certain divisions. That way, when you hat a division or part of a division to somebody else, it's just another part of that division and you won’t get mired and lost in the details. So, by division, we either rehat to others, or another way you could solve this, and this is by no means exhaustive, add team members. The best way to do this is, one, rehat to existing people on your team. Find people in divisions who have cycles, who have open time to take over the things that you're currently doing, people that you trust. You can also bring on new team members to do that.

How does this affect our approach? Well, generally rehatting to other staff is gonna be your faster approach. Adding new team members is going to be a bit slower. Why? Because these new team members have to be trained, right? Not only do they have to be trained, but oftentimes these new team members have to gain experience and they have to be able to show loyalty. That's an important thing because even though they might be better long-term, bringing on new people is a good idea. Having a high turnover rate is a really big problem in practice and in business in general but specifically in health care. The fear in adding new team members is going to be, well, if I add two people and in six months they both quit, then I'm up a creek because now I need to do what my first approach was, right? To restart or restart the cycle again, in either case, it's going to take longer. So, when looking at these two approaches, the reality is that the first approach, rehatting, is certainly faster if the cycles are available. The second approach, adding new team members, is definitely slower and costs more, but could be more sustainable assuming revenue is increasing over time and will pay for these team members, right?

In this case, we're drawing on our profit margin in order to add people to be able to step out. So I'm taking a bit of a hit in my profit in order to gain time. If I'm rehatting to others, I may maintain my profit and gain that time. Keep in mind that sometimes when you rehat to others, if they feel that this responsibility is outside their division, they will often come back to you and they'll say, "Well, this is outside my division, you're gonna have to pay me more for that because it's not part of my established responsibilities.” In other words, this is not my jurisdiction or it's not part of the division that I act in. Therefore, establishing parameters and incentives around designated responsibilities are important and be prepared to have these types of conversations with your staff and teams. Overall, in order to achieve an optimal level of autonomy in practice, you have to achieve a certain level of success. You must have a business that runs very smoothly, very automatically, and very profitably. At that point, you can decide that the amount of profit and the amount of time gained in opportunity is more valuable than the difficulty in replacing the work that you're currently doing in each division, outside of owner roles/responsibilities. You also need to decide whether you're going to rehat those things that are left over to others that are currently in the clinic, or add new team members and spend the time training them in order to achieve that level of success.