0:00:02 - Mark Henderson Leary

Welcome to Practice Freedom. What if you could hang out with owners and founders from all sorts of healthcare private practices, having rich conversations about their successes and their failures, and then take an insight or two to inspire your own growth? Each week on Practice Freedom, we take an in-depth look at how to get the most out of both the clinical side and the business side of the practice, get the most out of your people and, most of all, how to live the healthy life that you deserve. I'm Mark Henderson Leary. I'm a business coach and an entrepreneurial operating system implementer. I have a passion that everyone should feel in control of their life, and so what I do is I help you get control of your business. Part of how I do that is by letting you listen in on these conversations in order to make the biggest impact in your practice and, ultimately, live your best life. Let's get started. Welcome back, practice leaders. 

Welcome back to another rant on practice freedom with me, mark, and today's topic is what I call high value individual contributors, and as I talked about that, I thought I wonder if that even makes sense to the person listening. So what is it? What is a high value individual contributor? That is, people in your organization who, like lawyers, like lawyers, litigators, doctors, really technical people, consultants, architects, people who do very expensive, high value work and therefore may be treated differently. What do you do with them? How do you manage them, how to think of them differently? They're very problematic and if you do not address them, address their existence properly, you will have problems. So let's talk about that in a second. But, of course, don't them, address their existence properly, you will have problems. So let's talk about that in a second. But, of course, don't forget, if this is useful, send this to your friends, make sure people are getting this stuff. We need the feedback, we need to share. We got to share the word and the excitement and the enthusiasm and the passion for entrepreneurial healthcare leadership and all the things that go with that. But if, for some reason, you know the reason we're here, the reason that I'm doing this is to make is to really I want to touch a thousand individual businesses over the next 10 years and I want each of those organizations to find themselves in control, to be in control, to create a great, high value organization that they love to be a part of, that really manifests their dreams, that leaves a legacy of pride and value and health and improvement with a great culture. If you're stuck in that process, though, or if you know somebody who's stuck in that process who doesn't know where to start or what the next step is, please don't stay stuck. Please reach out and let's have a quick conversation to see what the first step or the next step could be for you to be on that path to practice freedom and check me out, or just check me out, check me out, reach out at practicefreedomcom. Slash schedule. 

So the topic individual, high value individual contributors. What are they? Well, other ways to describe them. They might be the leaders. They might be the mavens. They might be the influential personalities. They might be the status of the organization. They might be the resumes, the CVvens. They might be the influential personalities. They might be the status of the organization. They might be the resumes, the CVs. They might be the faces all over the website that give you clout and credential and the ability to make money. Very often, maybe, it might be the economic engine of your entire organization. 

And why do I call them high value individual contributors? The high value part probably speaks for itself, but individual contributors why does that matter? Well, because individual contributor is the sort of opposing term, counter opposite, not opposite of, but certainly the alternative. That's what I'm looking for, alternative to a manager in terms of a group leader. And what's the difference? Well, an individual contributor contributes high values through their individual work, their craft, their hands-on production or creativity, work output. In many ways, the visionary of the organization could be seen as an individual contributor, but that's a whole other topic. But there's a lot of common DNA there. So it's not non-linear value necessarily, but a manager in my definition, a people manager is somebody who delivers their value primarily not through their individual handiwork, but through the multiplying value of others, through the production of the team that they cultivate and keep healthy and aligned and clear on their objectives, and so the mode through which you operate is very different, and so this is really important. So what's the difference? 

If we have a high value individual contributor, what are some things that you need to know? First, most of the time, these people are not managers. They're not good at getting a lot out of people. They are good at getting a lot out of themselves. And so why does that matter? Because people, as they, perform better, left to cultural expectations and norms, the default most people think they need to be managers or be in charge of a group of people to be seen as successful, to be seen as valuable or move to the next level, and that, as a leader, you can move people through your leadership, by your thought leadership, your sharing ideas, and that's fine. 

That's not what I'm talking about. I'm talking about the manager. The manager is the person who is accountable to the success of the team, and so I want to slow a tiny bit down on that, because there's a lot of equivocation between leadership and management. Let's just be. My version is anybody can lead, anybody should lead. You should lead the group that you're with. You should lead yourself. You should be in charge of a vision of where we're going, and I want people to be cultivating themselves as leaders at all times. That's fine, that's great, that's healthy. Manager, on the other hand, we need to be crystal clear Are you the manager of the team? Are you the people manager? Are you the boss of these people? 

High value individual contributors are generally terrible at this. They're not good people builder uppers, they're not good cultivator coaches, they're not great at moving accountability. They're not good at taking a step back and cultivating growth through mistakes and lessons, and this is probably a whole other topic. So let's just say that a really great plastic surgeon who works on a human being is not a people. Person there's individual contributors are better with things than with people. And let's be clear when a person is having their, is having surgery done, they're not a person. 

There's no conversation happening. They're out like a light, they're a thing and that's the way we want it. That's the way we need it. People, you couldn't do this. You had a conversation. How does this feel? What are you worried about right now? That wouldn't work. We got to turn them into things and that's how the process works. But that's also great, right? We just the people who design amazing things, like Eames, who designed that chair? I'm I don't know, I'm assuming probably not a great manager, great designer, that amazing chair that we've all seen, even if you don't know the name, you've seen the chair. These great plastic surgeons, these great individual contributors, the great attorneys in the world who have left marks on our world through the great cases they've won and the things they've done. Individual contributors through their craft. 

So the first step of this is to disassociate ego and status with management, because that's why we're doing this. We got to start to change the language and start to change the thinking of what's good and what's not. Another reason we need to talk about this is that everybody in our organization, especially those with influence, need to be led Right. They're leaders and they need to be led by the leader of the organization, or at least a leader in the organization, so they can all be on the same page in doing the right things and be clear on what's right and what's wrong. There's always in every organization, going to be right and wrong. There's going to be core values and cultural norms and things we can and can't do, and process and procedure and God forbid productivity and production and certain levels of expectation around that and those have to be managed and met. 

And if you're starting to feel uncomfortable in this conversation, like how am I going to manage and drive productivity around my high value individual contributors, that just means you're normal. But give it a hot second and you'll realize that sooner or later it's sort of fundamentally true. It's immutable that this is true. You're uncomfortable leading your organization with this feeling of like, but I don't really have influence over some of these people. It's not good and it is ultimately unacceptable and as your organization scales, you will have to solve for it, and the sooner the better. 100%, for lots of reasons, and we can talk about this. Let's just say put a spoiler on this that the longer you wait with wrong fits, the harder it is to get rid of them, which means you got to start when you hire them. So if you have a bunch of high value individual contributors, you didn't screen very well for culture and value and commitment to be led through your follow procedure and be bought in to what your organization stands for, and then, yes, you have some problems. Good news is you can solve for it. Just take some time, take some patience, but you can get there, but it is real. 

So a couple of things you want to be thinking of here. First thing is when they're not managing, what does that mean? Just, you know, in a medical environment, you can apply this to all high value individual contributors, but this is the easiest for me to describe in the healthcare environment. You've got a surgeon, you've got a doctor and they've got some support staff that help them. You've got medical assistants, surgical assistants, nurses and other folks, and so the logical mindset is like well, I guess the nurses. I guess these surgical assistants kind of report to these doctors and let me tell you, no, they don't. That is not good. That doesn't mean they don't serve them, though. So let's slow this concept down, because I really want you to envision how this works down, because I really want you to envision how this works. How this works is it's a customer mindset, it's a service mindset. 

A surgical assistant is set up to succeed by being prepared with tools, training, management, coaching to go serve the surgeons in surgery and that surgeon, a lot of surges going on. I've got to slow that down so I don't mumble. They have an objective and in the operating room, are these folks going to be good managers? Like, well, let me coach you through this, let's slow this down. No, they're going to be impatient, they need things to happen right now and they're going to work as a team in a different capacity and maybe in a short-tempered, high emotional capacity, where things are said and things happen and things go well. Things go bumpy, that's okay. 

When the dust settles, what are we going to do with this? Do we think that that surgical assistant or that nurse wants to sit down with this highly emotional, very high standards of excellence, individual and sort of be treated as their you know it was a boss subordinate relationship. Is that going to go great? Well, it's not. It's not going to go great. What would work better? Well, if they have a manager of their own, if there is a manager of the surgical assistants or the support staff or the mid-levels or whatever however you structure this. So creating a structure in your organization where all of the support people have an actual manager, somebody who understands empathy, who can understand process and productivity and professionalism and all those things to help prepare them for going back into the OR and providing what they need. And so, as a surgical assistant, you now have a boss to go to. Hey, that didn't go great or it went great. This is what we need to do. And now we can sort of consciously and maturely and rationally fix the process. And if there needs to be more communication, let's go talk to the surgeons about what's going on wrong. Are their expectations wrong? They're expecting things to be different, they don't normally work here and our office is set up differently, and we can move this back through the process through proper channels. So what that means is, from the first step of this, we got to get the support staff a proper manager and that's sort of the shared services, internal services organization and this works. It works really well. The harder part doesn't work any less well is when we go back to that. 

The doctor side, the healthcare provider side it could be NPs, it could be any kind of mid-level, it could be anywhere where you've got like this high value. They're going to need a leader, manager, somebody who can say this is okay, this is not okay, you're doing great, you're not doing great. And by not doing great we got to put you on plan to get to be great. And if you're sort of wondering like, how does this work? It starts with defining roles and we know from healthcare is the worst at defining roles. We say I need a doctor, what's the job description? What's the job description? Doctor, please, just doctor for me. 

And that is not workable. You have to be much more clear than that. Are you in surgery for these hours, these types of surgeries and these type of cases and this kind of turnaround is that are you doing? Are you a diagnostician or are you only working with these specific types of cases? You've got to be way more clear on that. Are you junior, are you senior if you're senior, do junior, are you senior? If you're senior, do you have different performance expectations than if you're a junior, and all the things that go with that. So, getting the roles clear and then there has to be a manager over that. 

Now this is where the nuance comes into place. You've got to have some time, hopefully. Hopefully, depending on your organization. Maybe you're like the light bulb's going on oh great, I'm the boss of the surgeons, I'm the boss of the doctors, the healers, or maybe not. Maybe you're like well, we're going to have to elevate somebody who I think has got some management skills into this seat and that's fine. Either one works Absolutely. If you're thinking doctors don't want to be led by somebody who doesn't share their status, that might be true, might not be true. It depends. I mean, I see a lot of ways this is solved, for Sometimes it's those you know, in certain organizations, a good manager just has the right demeanor to talk about what matters most. 

You're going to have to. When you look at that management role and you look at those roles of each of those healer, physician, healthcare providers, the providers you're going to have to understand exactly what you need from them, healthcare providers, the providers you're going to have to understand exactly what you need from them. Is it a certain amount of productivity or production, customer service, sales, upsell, cross-sell education, what is it? You got to be clear on that. And so that manager has to be the right person who can coach that and I've seen really everything under the sun from somebody who really just is in that seat to manage the process, to coach these providers what productivity looks like, how to optimize their schedule, what conversations to have, how to do it, how to look at the checklist for productivity and they don't necessarily have to be super high status to do that, just got to be credible. In that. That's one way. 

The other way is the opposite. We've got massive amounts of ego and we got to put a physician type person who's a senior and got that right affability and has got the credibility through their outcomes and years and seniority, and the role ends up being a little more around, less around productivity and more about like success of doctors, like what has to be true for the doctors in the organization to be successful, and education and possibly outcomes and possibly just skills even, and the craft itself and creating a nice space for these doctors to have some community which creates a great space to talk about culture and what's right and what's wrong and allows us to sort of align around the core values. And that's a great place to sort of red flag on people who don't fit in the core values. And in that scenario sometimes we've got to be really nuanced in figuring out how much direct, clear accountability can we have. My hope is that you just put somebody in that seat and then we have real clarity. This is the leader of the providers and when people don't perform or they're not a fit, we can just get them out. 

But if your organization is struggling with that and you have to kind of figure out, what bite of the apple can we take? Can we put a manager in front of productivity and that'll work. Or can we put a manager in front of outcomes and craft and healthcare as a science and an art and start there? That's a good place to start and maybe you've got to have a more formal process that if somebody is written up it goes to HR and there's a committee to fire somebody. But whatever, you have to have to have to be working towards a sense of accountability and consequence. You have to be able to tell people this is not acceptable. And if we made a mistake and brought you into this environment where you're not fit, that may be our fault but that's not going to change the outcome. You're going to have to move to an organization where you're a better fit, which is not here. You have to have to have that consequence. You have to lead. That's the immutable part of this. There has to be leadership and management to accountability, which leads to, I think, ultimately you having to work through those elements. 

So to kind of recap this, to get clear on this, you want to remove the status, association with management and say it's great to be an individual contributor and your art, your gift, your leadership is valuable, but you're not managing people and that would be a waste of your talent, those people that support them. They need to be managed by a real manager who can take care of them and communicate and cross-functionally communicate with the peer managers, ultimately the leader, manager of those providers, which you will have to get clear on the roles, like if you've got a senior surgeon, if you've got a nurse practitioner role, what exactly are those roles? What are those accountabilities? And putting somebody in charge of what matters most and you're going to have to decide what are we managing to first? Is it about productivity? Is it about patient outcomes? Is it about a customer experience? Is it about whatever it is about? 

And really taking a bite out of that and making sure that somewhere in your process and hopefully very close and early in that management journey for you is that real accountability, that we can reward high performers and we will remove non-performers and non-fits with love. We're definitely going to have to do it with love and we're going to do it in a timeframe that makes sense for us. I'm not concerned that if you have somebody today who doesn't feel like a fit, it's going to take you six to nine months to remove them. I care that if you're never going to do it, you might be in an organization where you only get a shot at bringing on new healthcare providers once a year based on the classes that you're working through. Hopefully not because you find yourself held hostage for long periods of time, and that's in that case. But whatever it is, as long as you commit to a timeframe and replacing those wrong people with the right people that's the commitment I'm looking for for you. So hopefully that's helpful. Hopefully you understand that we really want to create those separate organizations, the leadership, the management, and take the burden off these high value individual contributors as from being managers, and let them just be great leaders in the culture and great producers and let those other folks also have great managers and have accountability and clarity for all. Hope that's helpful. 

Give us some feedback. If it's not, if that's confusing which I think it's possible I've got some visuals I could share. Just reach out to me and I'll get those to you. Get some time with me. Let's get you unstuck. If you're struggling with any of this stuff at all, practicefreedomcom slash schedule to get a few minutes with me, we'll talk through With that. That's the end of today. That's our time. Give us some feedback, love to be contributing to your world of entrepreneurial health and we'll see you next time on Practice Freedom with me. Mark Henderson Leary. 

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