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 Got a fun topic for you guys today the concept of the accountability chart. 

If you are familiar with EOS, you've heard the term. If you're not familiar with EOS, you might be thinking of the org chart, and I have a serious bone to pick with the org chart and the damage it does to your organization why you should kill it and leave it to die Before we do that, of course, if this topic resonates with you, if you feel stuck, before we do that, of course, if this topic resonates with you, if you feel stuck, if you're trying to build this amazing high value, high morale culture that you love, that's high value in the marketplace, driving patient or client or customer value, however, you see it with a lot of loyalty that you love to participate in or just proud of it. But if you're stuck, you don't know what to do. Please don't stay stuck. Please reach out. Practicefreedomcom slash schedule, just so we can take a couple minutes and see what a first or next step could look like for you to get unstuck. 

But anyway, this topic, the accountability chart. What's the difference? First of all, it looks very similar and so it gets very confusing and I see a lot of organizations that just kind of build an org chart. So fundamentally, let me just compare the two. So an org chart if you've ever worked with one, you may recall the familiar discussions about the people and what their skills are and what they could do and who they could report to, who could bring the best out in them. 

Who needs to have these people based on their title, their seniority, their compensation level has a factor here. This is a lot of large company thinking, and I'm not here to say that we can completely dispense with status, comp levels, seniority, valuable titles to people's careers, maybe even to the organization. Sometimes it's very important that your CTO is the former head of product from Microsoft and we need to document that somewhere. It might also be notable in your organization that they have been promoted three times and they're now vice president or something like that. I understand that sometimes there's a need for that. However, what we're doing with an org chart is trying to do another function a lot of times, and that is create a clear sense of who do I talk to when things are not working and who do I talk to when things are working, how do I give credit, how do I adjust? And so the way I describe the flow of an org chart is actually totally counter to the efficiency and clarity. We need to know what to change and who to talk to about changing it. 

So the accountability chart is what we teach in EOS, and we're not the only ones that have this approach of sort of function first, but that is the idea to look at the business, not look at the people. Now, we care about the people. We're going to put right people in the right seats down the line. But in order to get the right person into a seat where they're really high value, they love it and they're adding maximum contribution, we have to first establish whether or not we need it, and so we have to do the hard work and say you know, how many seats do we have? What are the functions that really are important? And so this is a mindset approach of taking everybody out of the room. You can perform this exercise at the departmental level. You can at the team level. 

Certainly, we always start with the leadership team, the very senior leadership team. We start there and ask the question functionally in this organization, without regard to the needs of people, this business, this organization, has to be good at a few things. Three to seven you'll hear me say that a lot. Three to seven, hopefully closer to three significant major functions in the organization. Why is that? Because complexity is expensive and it's very unreliable and it's very risky, and so if we're going to add complexity, it had better be very, very valuable for us, and the rule is generally three to seven. That's why phone numbers were seven digits until they were 10. And then we had to memorize area codes in a different way. That really messed with our brain. But three to seven is about all a human can handle. 

And so when we're looking at these functions and I'm not going to dive really into the technique and the way we get this down there are ways that you figure out some of the functions of the business, or combination functions that roll up a bunch of different things. It could be like an administrative function or a finance function that has a whole bunch of things reporting up into it and if that makes sense for your business, but if it doesn't make sense for your business or your organization, you break it out into what does, all the while just committing to three to seven, hopefully closer to three. So why does this matter what we're trying to create? We call it the accountability chart for a reason. So we start at that leadership team level and every team below that we're going to have. You know, if they say there's a finance team, there's going to be three to seven functions under finance. Let's go over to sales, let's go over to patient intake, let's go over to clinical care, let's go over to surgical operations or directive nursing or whatever. Your function is Three to seven under each of those typically, and as we get further and further down the organization, it gets closer and closer to three until ultimately it's just people who are responsible to do work, which is a good entree into RACI, r-a-c-i. 

This is not an EOS tool. This is a tool I teach extensively. It is a project management mindset that explains any given individual's relationship to a project or an initiative. Look it up R-A-C-I, raci, and there's lots of explanations, lots of graphics for it. You don't need that from me, but look it up R-A-C-I. And R stands for responsible, a stands for accountable. You'll notice that that is thematically consistent, that we're accountable. Consulted is the C and the I stands for informed. Why do I share this? Well, it can be a little primer on racy, and then we'll go back to the A in accountability, in responsibility and accountability. If you have never thought before about the difference, today is the day. They are very different. 

Think about responsible parties, responders. If a fire breaks out in your city, who are the first responders to a fire and what are they doing? Well, imagine the firefighters rolling trucks, and how many? Oh lots as many as there need to be, and they respond and they go get their hands dirty and they go put the fire out, actually themselves. If, however, after the fire is put out, we look around and we think the fire was not put out very well. There was a shortage of trucks or people or hoses. There was some confusion about how things need to be done. This is when we move to the accountable person. This is the person who takes account of the situation and they are the ones who are going to fix this. Even if they did not get in a truck and go out there this is perhaps your fire chief and they take account of person who is accountable. 

So I hope you're starting to see here that this is not the thinking we apply to an org chart. I'm not saying we can't, you don't need to track some of that stuff, but I want you to start thinking wow, this isn't going to work for driving accountability. We need to have a small number of accountable parties. Why? Because we need to know what's working and we know what's not, and we need to ask the person who is accountable to it to solve it. And if they're not the right person. We got to make a change and so we're looking for these three to seven functions to end up with teams of, like you know, four to eight. Four to eight teams. If you've got a manager and three or seven functions, that's about eight people at the high side. So we're thinking small teams here, accountable teams who can make clear decisions and take account of those things. Now I want to drive some subtle points here, because that would be enough what I just described for you, if you build your accountability chart around the accountability of these functions and you put leaders in charge of them, because that's the second step structure first, people second. 

Now you've got the right person in the right seats. You've really asked the question. We can talk about the tools in EOS. We call it GWC, gets it, wants it and has the capacity to do it. So if the person GWC is that seat as we described this is the fire chief seats and they get it, they understand what it is to put fires out efficiently, they want it, they're excited to do that work. They're not just willing, they just really want to do that work. They're not just willing, they want to do it, which means they're going to try real hard and that passion is going to produce great results and capacity. They actually have the skills, the training, the certifications, the background, the physical strength, the ability of their home life schedule to work the hours that are needed. They have the capacity. Have all three of those, then you got the right person in the right seat. If you can do that, that's so powerful. 

I want to go a little further, because there's some confusion oftentimes in accountability chart because we've got the R and the C and the I. Still what do we do with those? And so a lot of times I see people start expanding this accountability chart more to org chart because we're going to start to create community and communication and do all these things. And whoa, yes, yes, we need to do these things, but that's not what the accountability chart does. And so I do want you thinking that when we build this accountability chart, it is where the bosses are discovered and known. So those direct reports absolutely that's the boss, but that is not the end of our communication. There's lots of other things we need to communicate on and can, and using that racy theme or theme of that methodology to spur some thoughts on exactly what we need to communicate. 

So if you're the fire chief and you have firefighters, obviously there's probably a hierarchy to this, but let's keep it. It's a very small town, so the fire chief has got a couple of firefighters to report directly to the fire chief, and so those responsible parties maybe they've got a meeting, maybe they've got a weekly meeting or a monthly meeting, something that makes sense to keep that clear on their responsibilities, because that would be the sort of extent of the downline on the chart. It's just the fire chief and the firefighters and that's it. However, sometimes other organizations much more layers, and so if we think about those responsible parties, usually it's still the same thinking applies. That's possibly departmental meeting, but not always. 

Sometimes we create functional teams and we ask for help and we give help and we supply it throughout the organization. And there's lots of ways that we can be clear on this. The number one way we do that is through process, and so hopefully these are light bulbs are going on right now. How do we manage all this cross-functional communication? Well, hopefully there's some repetition, and if there's not, we got to address that. But we do start. We always start with process. So your number one tool for addressing responsibility communication is through process, so people know what has to happen and they know who they need to hand information off to and from throughout the organization. That's your number one tool. So don't try to build in every piece of responsibility into the accountability chart. Process should really do the heavy lifting of that and your accountability can stay on the accountability chart unfettered and uncluttered with a bunch of dotted lines and things like that. 

Let's move on to C. What do we do with C? Again, these meetings are really powerful for that. So C is the. We haven't talked about what C is. C is consulted. This is what happens when you've got a fire chief who is really going to get fired if fires are not taken care of. However, there are people outside the organization who could share a lot of valuable information. So you go consult with these people. Right, of course, there might be the mayor to go talk to. Well, tell me about what you've experienced. You've been in the city a lot longer than I have. Let's go get some consultation from experts. Let's go talk to the senior firefighters and other people and anybody in an organization can be consulted with to get their feedback and it's a dialogue. 

But the distinction is the accountability stays with the accountable party on the accountability chart. We have to be crystal clear on that. Just because we talk to somebody more senior than us doesn't mean that they steal our accountability or that we give it up. We don't. We make sure we know who's accountable, we know who's going to get fired and we know who's going to take credit, because this is the clarity that we need to know what to change or who to talk to along the way. Back to this clarity of measurement, the predictions and the ownership. We have to be crystal clear on that and if we clutter that, it doesn't work. So just bear in mind in consultation, you can consult with anybody in the organization. It's your prerogative and you can use your meetings, your regular weekly meetings, to have these conversations as well, and people can offer feedback and give feedback and you can totally take your badges and status off and have these conversations and then, when the conversation's over and we're making a decision, the accountable party owns the decision and knows it's on them and they can say you know. 

Thank you everybody for your feedback. I appreciated what you three said and what you two said. However, I'm going this way Thank you for the feedback. I'm going to take the accountability for how it turns out. I hope this is making sense Now, of course. The last one is I informed. We want to inform people and especially if your culture is a very peer-oriented, community, consensus-based culture, we certainly don't want to take away from that. But that doesn't mean that we can give up clarity of accountability. So we keep this accountability chart crystal clear with these three to seven rules, with downlines to three to seven functions. I said roles, but I mean functions and major functions all the way down to the smaller functions, ultimately to these responsible individuals. 

But if we have some information we need to share and maybe even some consultation, so other information, how do we share information? I'll go back to some other thoughts in a second. Of course we've got to send out newsletters. We've got to have cascading messages out of our meeting. We got to have town halls, we got to have some briefings, we got to have things like daily huddles. Now, everything I just said is optional. Right, I'm not suggesting you do those, but these are, these are tools you bring to bear. 

Once you've got accountability crystal clear, you've got a great meeting pulse with those accountable parties and so those teams. If you've got the fire department and have a fire team meeting, and then they've got other subordinate meetings and those are running great, fantastic. But now there's still this need, of course, quarterly state of the company meetings. You're gonna have to have those anyway and you should be doing those for everybody in the organization. But if that's not enough, if you're not getting enough consultation with the entire organization, enough information flowing to everybody, then make sure you have some way to do that. Maybe it's breakfast, lunch and learns I guess you'd breakfast and learn or lunch and learns. You get what I'm saying. Some way to share this information. 

But understand the objective. When we have these larger meetings and these town halls, we're not there to make decisions and to choose the priorities for the year or choose the priorities for the next 90 days. We might be collecting information and having conversations and consulting, but when we go back, those leadership teams need to be in those small groups to say all right, we are well-informed and we are going to make some choices and we are not going to be ruled by consensus, because you aren't going to get there from here. You're going to have to tell somebody that you're going to disappoint some people along the way and so we have to solve for all these R-A-C-I things separately, understanding that the discipline that is so commonly missing is that A, and the reason I've kind of gone down this whole rant is that once I teach that accountability piece, sometimes we lose a little sight of the responsible, the consultative and the informed. But you had to have them all. 

So, focusing on accountability because it really drives this clarity of who's in charge, who's accountable, who's making the choices and where do we go, fix this and then figure out other ways. So, like I said, through responsibility, let's make sure we got all the process, and you can sense it in my voice. I'm wrapping this up. So the summary on this is the accountability chart is different from the org chart because it focuses on the true accountability of the core functions, of the major functions of the business and what it needs to a small number of people three to seven people with a leader, small number of people who are taking accountability and making the decisions. 

Responsibility needs to be handled mostly through process and some through meetings. Certainly, make sure that process is doing the heavy lifting, consultation, make sure those meetings if you do a good work with the accountability, you're going to have really good peers in there who can share information and you can get that feedback with sort of the badges and the status taken off of your taking your badges off and no egos and sharing that information. And then going back to that accountability I understand what you've shared with me and I'm going to take the accountability for whether it goes well or not. And then, of course, information make sure we're having great town halls, making sure we're sending emails on a regular basis If we need to send newsletters, we're having those state of the company meetings and sharing that information and figuring out the pulse of the organization and when we have those meetings we're setting objectives crystal clear so we're not misleading people to think that, hey, we've got everybody together to decide the priorities for the year or the quarter. 

That is not what that meeting is about. It's about to get information and be transparent and share what's going on and put that pressure frankly on the accountable teams to know it's their job to make the decisions. Take the accountability right or wrong. Learn as you go not to take the failing hard. That's not what I'm saying at all. We just need to make sure that you've got crystal clear experimentation going on so that people know what works and what doesn't. And if you need to make major changes, you can. But you've got your eye on the ball for execution. 

And so the last point I'll say on that when you build an accountability chart, you're building it around functions. It might be the fire department, it might be sales department, it might be patient outcomes, it might be the patient acquisition, it might be marketing. And I want you to take those status type titles out of there. Don't put them in there. If it's a senior chief, something or other, if it's a vice president of something else, it's a director on there, then people are not seeing these as accountabilities. They're seeing them as status, as trophies, as accomplishments, and you don't want that. You can't have that and have accountability at the same time. It will distract you, it will distract them. You'll feel like you're messing with somebody's career. You might be that you've got to put that off to the side and handle it some other way. Make sure these functions are just boring functions. You're in charge of revenue. You're in charge of patient outcomes, you're in charge of revenue cycle, you're in charge of financing activities, and the right person will think that's amazing and the wrong person will not be trying to achieve status through that seat. 

Anyway, hope that's useful. Accountability chart is the way to go through this and I want you just to kill those org charts and put them out the pasture. They're not helpful. Track status and comp somewhere else. Let everybody understand the value of their function and the right people in the right seats, so people can move through your organization and do the job that they're meant to do and you can get the result that you deserve. Again, if you need any help, if you're stuck, please reach out. Practicefreedomcom. Slash schedule. Love to talk you through anything I said that left you confused or any place you're stuck. We'll see you next time on Practice Freedom with me, mark Henderson Leary.

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