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 another episode for you.

I had a great conversation with John Gallagher, who is a lot like me but different, and he's a coach, works a lot more with individuals. I tend to work with more leadership teams, but it's kind of the same thing in that we share a passion for growing people and particularly, he's an executive coach, performance consultant, advisor to some of the world's leading organizations and is founder and CEO of Growing Champions Coaching and Consulting. He's served dozens of renowned global entities and their top leaders, at places like IBM, mitsubishi Electric, eden Corporation, harvard University and several billion dollar plus healthcare systems. John specializes in achieving exceptional results in the area of people development, productivity improvement and profitability and growth, and so he and I talked a bunch and he's a storyteller, so I let him invite him to tell a little story and it starts off really talking about impetus for change and the pain required to do that and how we kind of get lulled into mediocrity and kind of what that's like, and so the whole conversation really talks a little bit about that. And I think the theme of the whole conversation is what does it take to change patterns? Who are the coaches in your life? I mean, we come from a coaching perspective and so that's obviously the perspective we come from, but how are you getting feedback on what needs change and are you honoring your failures for what they are and what are the options?

I think we finished. We kind of get excited about a bunch of topics that could go much, much further near the end, but I think it's sort of this idea of what are the possibilities, what are the options in the world that we could be doing if we weren't stuck in the rut. So with that, I want to invite you to listen to John, but before I do that, just don't forget if you're stuck that's ridiculous you don't need to stay stuck Reach out If you're imagining a super high value culture where it's a super high value organization, where everybody loves what they do and you love what you do and you're living the life that you deserve. But you're in some ways stuck, don't know what to do next. Please reach out. Schedule a little time with me. Practicefreedomcom slash schedule. So with that, with no further ado, john Gallagher.

Well, good morning John. Happy to have you on the show. Mark, how are you? I'm really well. I'm excited because you and I are trading shows and I am happy to give you the gift of kind of doing your thing, because what I?

learned. I watched this on Oprah. Actually, I watched Oprah as an interviewer and I watched her be so kind of innocent in her questioning of these experts and she always seemed like fangirl on these things. And then I saw her interviewed and it was like total role reversal. It's like, oh no, she is really smart, listens to everything and she's just really good at asking questions and it really belies the amount of information she has been exposed to. And so I've. I love hosting, I love asking questions, but when I'm a guest it's like, well, I can just do my thing. So I love this opportunity. I want to give you a little gift, john. Tell us a story.

0:04:06 - John Gallagher

Sure, absolutely. I mean well, stories, right, I just started up with stories. So when I think about some of the things that I've been through on my journey and some of the topics we'll get a chance to touch base on today, one of the ones that even just hit me pretty recently and the power of the metaphor of change, and it's something that, again, sometimes people make these things up and whatever they are. But this one actually happened to me and I can imagine some of your listeners can feel the experience with this. But I was comfy in my bed about 2.30 in the morning and the infamous smoke alarm battery detector that will go off not at 10, 1030 in the morning, when you're already ready and alert and ready to go change it out, whatever you need to do, but goes off at 230 in the morning and starts to chirp inside of our house and my wife kind of gives me the elbow to make a change and I kind of ignore the elbow, hoping that that won't happen, and the dog starts to get nervous and I'm still. I'm like I think I can tolerate this pain of listening to this chirp for a couple more hours before the alarm clock goes off and I'll get up then and make the change. And sure enough, that chirp started to get louder and that elbow started to get a little sharper and even the dog started to get more worked up. So ultimately it was choosing to leave the warmth of the covers, and even here in Myrtle Beach, south Carolina, I'm sure it happens right in the wintertime as well, when it gets down into the 40s and 50s at night. But it became a metaphor as I was standing on the ladder at 2.30 in the morning to change the battery out, unplug it.

I know that people will change when the pain of remaining the same is greater than the pain of the change itself. And that just became a metaphor and something I've used in a presentation the smoke detector. Because each time those things happen, the smoke detector is going to go off at the most inopportune time. As leaders, the problems we're going to have are going to happen at the most inopportune time, as running our business, when things are going okay, we've got to make that decision of is staying the same at that point in time where we want to be or we want to grow, and we got to make a decision to get out of our comfort zone and make a change.

So I think that story, whether it's overly simplistic or not, is a metaphor for whether it's in the entrepreneurial world or, frankly, in some of the larger businesses that will ultimately stay in their comfort zone, be okay with mediocre performance rather than making the change to choose excellence and what they have to do to make change. That's even in our personal lives. If we want to lose weight or want to become more healthy, we've got to make a change to a decision to not enjoy the cheeseburgers every night and stop eating french fries. So I don't know, that's a story. To get started, change is something that, as a consultant, as a coach, I've got to work with leaders and organizations to get out of their own comfort zone.

0:06:54 - Mark Henderson Leary

That's the story that I use pretty often well, there's actually a lot in that story and it reminds me, it kind of hits a nerve on a couple things. One of those is, you know, like I get a picture in my mind of what the outcome can be. I talk to somebody and I see what their business and their life could look like, and then they stop or they don't take the step forward. And I'm so confused and what I'm always humbled by is there's a lot more to the story than what I see. What I see as pain may not be pain relative to what else is going on in their world. What I see as pain may not be pain relative to what else is going on in their world. What other family politics, business politics, personal crises, addictions, family issues and things, who knows? And so really humbling myself to understand. You know, pain is all relative In your situation.

How sleepy are you? That's a factor Like I haven't slept in five days. I'm sleeping through this. Or, you know, what conversations have you had with your wife? Has she really been irritated with you the last three days? And now's the time to really move on that Everything, everything has a different valence depending on a whole bunch of factors.

0:07:57 - John Gallagher

Well, and you touch on it too. I mean cause. Ultimately, after the conversation, after you go through that is okay what is the system I can put in place to make sure this doesn't happen again and again? I think about relating that back to healthcare is that what are the same, and healthcare practices and it's that you serve the population that you have that listens into this podcast. Is that? How many times do we allow that to happen? Because I could have just changed the battery out, or I could have done something very simple and said Alexa, remind me in nine months to change out the batteries again so I can change them out during the day, versus waiting for it to chirp. How many times do we wait for the problem to occur rather than preventing it from occurring in the same place? I think it's a dilemma that healthcare faces all over in our communities, in our country and, frankly, in the world as well, with how we practice medicine.

0:08:43 - Mark Henderson Leary

Yeah, so that's a great point. So let's dive right into that and I'm trying to avoid some distractions because I could really go back into that story a couple of different ways and I might later. But one of the things that has always attracted me to healthcare is opportunity to serve. I say this all the time that the least valuable healthcare organization that I work with, who does the least contribution, is healing people for a living. That's a high value, getting people back into their life, giving them back something of the most precious value. That should be very valuable in the marketplace.

At the same time, the dysfunction and the ignorance and I don't mean that in the pejorative, I mean that in the objective sense of like there is so little management and leadership, information and knowledge and role modeling in there, and I think largely it has to do because the value gap is so high you can afford a lot of collateral waste, and so as time goes on, that tolerance gap is diminished, which is why so many people think the business is terrible now. It's because, like, you actually have to be good, but you can be great. Now the opportunity is massive. Like well, I know how to help somebody run a great business. Really well, like I really know how to do that with proven systems, without magic, with really reliable.

So why don't more healthcare organizations just immediately flip the switch? I think of a lot of that is what you're saying. It's like well, I hear the beep. You know regulation. You know hiring people sucks. You know it's hard to get good people. It's a regulated business. It's how we are. Everybody knows morale is going to be terrible. Everybody knows we can't be transparent with financials in the organization because the doctors make too much money and everybody else makes too little, and so we can't do these things, even though we've proven a million times over it.

0:10:30 - John Gallagher

All this stuff is totally possible, absolutely. And it kind of even takes a story of how I ended up getting into that healthcare space. I mean, I was an engineer by background. I worked in manufacturing space for 20 years and really learned the Toyota production system or lean as a part of a manufacturing concept. It came from Toyota making cars, however you want to look at that, and I spent a few years in real estate trying to work on that as well and I said I want to get back into operations again.

So I started connecting with the people that were in my previous space and they're like wants to be a consultant? And I'm like gosh, I don't know, this whole consultant thing is not necessarily anything that really interests me. Travel, trying to get folks to do things. I mean I appreciated the space of manufacturing, maybe the differences, but it just didn't encourage me and they kept nudging me and the third time they called me back. They said, well, what about doing it in healthcare? I'm like healthcare, what do you mean? Like in clinics and hospitals and utilizing that toilet production system? I said yeah, and it was something that clicked to me. I said I was kind of. You know if you will naive enough to believe after I'd experienced some things on the side of being the patient through a healthcare system, through the clinic, through the hospital, but being naive enough to believe that I might be able to make a difference inside of that space. So I said I'll try it out, let's see how it goes. I'd do it for a couple of years and then get back into operations again, and that was 2009 when I got started into it and I'm still in that space. I started out with a consulting organization, worked my way up Through acquisitions, we worked our way up to being ultimately acquired by IBM. So it became from 140 employee organization to 400,000 employee organization still working in healthcare, and then now I'm a single individual entrepreneur working in healthcare.

Many different ways, though the system, regardless of what you use needed in healthcare. You mentioned that the gap between profitability and cost has been so wide for so long. The opportunity to put the waste in the system is easy to do. The Institute of Medicine, a study probably 10 years ago or so, maybe even longer now, 15 years ago, said that at best, a healthcare system, whether it's a clinic or a hospital, is operating at about 70% efficient or 30% of the activity that they do is non-value-added, redundant, over-processing, over-producing, over-prescribing, whatever those things are driving some of the cost up in our system. And that became the opportunity really for us as an organization, for me as an individual, to both coach the executives inside of that space but also help them put the systems and processes that they needed to reduce that waste in their system as well. So I love talking about that journey inside of healthcare and what's possible, and even when I talk to practitioners of healthcare they get a little bit nervous about it, but I think it's something that needs to continuously improve, no doubt.

0:13:20 - Mark Henderson Leary

What do they get nervous about?

0:13:21 - John Gallagher

Well, back to that change word, right? So I'm, you know, asking them to do something different than they did for the past 30 years. And you know, john, you don't understand. We're not making cars here, we're treating patients, and it's just not the same thing, right? But you know. So, getting through to that, it's a highly intelligent mindset. That is the physician, the physician leader, and I understand that completely, and they've been trained for a long time to do things a certain way, but they aren't trained in leadership and they aren't trained how to run a business to be successful as well. And so, bringing some of that in to play, you've got to work many times with egos to get them back to the smoke detector, to get them to realize that that chirp in their ear, if it's a consultant, has some good things to say and they need to make changes in how they do things.

0:14:08 - Mark Henderson Leary

Yeah. So one of the things that I see a lot is ideological friction, because it's a very easy thing to say, I think, for a doctor that you're not a doctor, you don't get it, and I have come to honor that because I'm not a doctor and I work with a lot of doctors. That's right and I believe them. The trick is we speak English, both parties but we don't communicate in terms of you have medical magic, that needs a space and we have to improve effectiveness. We can do greater good together and we can create a culture. We can find a better way as a group and we can get clear, we can get specific, we can drive accountability, we can set clear expectations and we can do great things in a capitalist economy. And hopefully you'll understand that, doctor, because I think what I do is understandable.

I think I can prove to you and I'm fine with you saying that, look, you're a man, you'll never notice like to have a baby and so, since you're not a doctor, you'll never understand Like. I'm fine to keep that, but how do you find getting us on the same page to be possible?

0:15:28 - John Gallagher

Well, you know the methodology, what's in it for them. So if I were to have to change what really is in it for me and I think about this, stephen Klaska was one. The Jefferson College Population Health CEO of a large system in Philadelphia talked about this. With regards to improving is about we need them to be doing what they are best at doing, to be the empathetic figure they need to be with the patient, looking the patient in the eye and really trying to learn some of the challenges that the patient is facing.

But when I've got the physician behind the computer typing into the system, or I've got the physician trying to figure out in the paperwork if they had their blood pressure or their last colonoscopy completed and not focusing their time and energy that limited time and energy they have on that patient, then those distractions and that noise make it very difficult for them to build that patient-physician relationship that they really were trained to do.

And so what I really try to talk about is how can we work together to pull some of those distractions, some of those non-value added activities, off of your plate so that you can focus your attention on being the physician that you are ultimately trained to be? And I think that sometimes works for them, because I really, truly believe that's what they want. They were trained to help, they were trained to heal, and many of the systems you talked about regulations we could go into so many different paths payment models, technology all these things are just noise in the world of making it easier for insurance companies and finance departments to collect their money for the visit, versus the physician being the doctor they were trained to be. So I try to work on the heartstrings a little bit to understand that I'm not here to tell you how to do your job as a physician. I'm here to tell you that the things you are doing are not what you were trained to do, and we want to get those off your plate.

0:17:24 - Mark Henderson Leary

Yeah, one of the things is lucky, though, the entrepreneurs I work with tend to entrepreneurial healthcare leaders will say right away, like hey, I'm in this business, I'm leading this, but I was trained as a doctor, as a healthcare provider in some capacity, and I was not trained on this leadership management. That's right, and so there's usually some degree of humility At this stage. I encountered them so early on. I suspect there is not, and I've definitely talked to those people who, at least from the veneer, you know, hey, I'm smart enough to be a doctor, I'm smart enough to do everything else, but most of the doctor leaders come to me like this is not working great, or it worked well enough until now, and it's about to be a real problem because it worked so well.

The stakes are super high, and I find that very inspiring and hopeful, but there's a little bit of the sort of question of so, I know, the bucket's empty of management and leadership knowledge, and actually let me slow that down a little bit, because I think, when we talk about leadership, we put a lot of things in that bucket, and I think most of what's missing isn't necessarily the leadership, although we can oftentimes get better at that it's definitely, though, the management it is.

You know, how do you coach, measure, regulate, set expectations, how do you monitor the performance of a group of people collectively, and how do you adjust to that? That is a set of skills that is rarely naturally acquired, and even less rarely naturally acquired with someone who has a tremendous individual skill, like being a surgeon or something like that. Those people can often lead very well because they know high standards of excellence. They can, at least at a high level, model things and teach to some extent, and so I'll give them a lot of leadership, but I'm like that's not the missing ingredient when we start getting a group of people working together and needing to get them on the same page. And so what do you tell people in that spot who are like, hey, I'm trying to figure out my identity of like I'm kind of in this pile of stuff. I'm a doctor, I'm a leader, I'm a manager, and it's a stew that doesn't taste that great.

0:19:27 - John Gallagher

You know it's funny, you said because, as I was listening to you describe it and going back to some of the physicians that I work with, I mean going all the way back to their education again, back into middle school, high school they were. You know, most of those physicians were deemed as the smartest people in their school. They were valedictorians, they were competing. So at that point they were competing to get to the best universities. And then, when they're in the university, they're competing to get into best medical school, right, and then even at a medical school, they're then competing for the best residency. It's all individual, based in terms of how they compete. For that. They've been rewarded for their individual intelligence for so long. And then we bring them into the world of healthcare and we ask them to be good leaders as well, and so I love the idea in terms of what you're saying with regards to the humility and I think many of them have that it just takes a while to get into the space. I'll never forget you can tell me a story having a conversation with a internal medicine physician who was a deputy CMO at the time and had been coaching here for about six months, and she said I want you to give me a grade so far as to how I've done. I said no, you don't, you really don't, I don't think you want a grade. She said no, no, no, I really. What do you think in terms of how I've done so far? I said C plus is where I put you and tears rolled down her cheeks. She's like her cheeks. She's like I've never had a B in my life, let alone a C. And you've just told me that I am not satisfactory in my leadership and my growth. And at times you have to be that rough, balancing the consultant, coach and inspiring and directive and all those things. And I said that's okay. So what? I mean, it's a C plus. Now what are you going to do? Because what you're really seeking from me was an A, but I'm just identifying that there's still a gap to where you want to get to to be an A. And I want to, in essence, inspire you to say no, I'm not satisfied with that C plus, I want to get better.

There are ways, with those assessments, to really start to listen in. I mean, I spend a good deal of time building the relationship. John Maxwell wrote a book, the Five Levels of a Leader and oftentimes you know I go into these new client relationships and I have to start out at level one. I'm there because I am the consultant in that space, but I want to really get to. He defines level two as permission. They follow you or listen to you because they want to, ultimately getting to level four about they follow you because of who you are and what you represent and you know you go through those phases. But I work to get to that phase pretty quickly with the leadership skills that I want them to emulate, that I want them to model in terms of how we treat them and things like that, because I know it's difficult.

I'd been while I hadn't been a physician leader before. I had been a new leader before in the space that I didn't know how to spell leadership. So I felt like in many instances, from a leadership standpoint, I was perfectly positioned to help them because I was once there as a new leader and so the not just the knowledge of being an engineer, but the wisdom of the experiences that I had gone through and failures in my leadership development and successes that I was able to communicate to them. So I just think that was really important. I'll never, and I probably ramble here a little.

Another story I remember the very first improvement event that I went into to help the healthcare system improve and it was on the diabetes protocol they were using to care and follow up with their diabetic patients. And I didn't know how to spell protocol when I walked into that room. But I knew what process improvement is and I walked in this room. It was like 12 white coats sitting around the table physicians. I'm like whoa, I'm way outclassed from an intelligence standpoint, but I think I can work with them and get them to care about what the outcome is going to be and I have a process that they can follow to make improvement. Look, they're trained to diagnose, they're trained to fix and solve problems, but they're not trained to kind of look at it from the standpoint of where am I today and where I want to go. So that was intimidating for me, but I found by the end of the week that was very intimidating for them as well. So we worked well together.

0:23:34 - Mark Henderson Leary

Yeah, I think that that's the essence of this, I think, is vulnerability, this ego thing. Doctors don't spend money, doctors are all egotists, they're not to listen to anybody Totally, totally overstated. There are evidence, it pops up. But I recently did an event and a small intimate dinner. I've done all kinds of talks, workshops over the last decade, but I just got more focused and I was like I'm just we're just gonna have a small intimate dinner for physician physician-led type organizations and we're gonna teach the system. And I talked to a lot of people along the way and a lot of the opinions leading into this were like you know, it's a tough business, it's like ethics aren't great, you know it's scarcity mindset, everybody's, you know, just sort of down on this. I can't, why would you do this? Which? I get that kind of noise periodically and I'm always fighting it off, but it was when I was driving towards this event. I was particularly susceptible to this negative feedback Like this is a terrible idea, and so so what I ended up with was a small group of people, largely physicians, and absolute vulnerability and excitement and optimism about learning more, creating more. There's never been a better time to be in health care, despite the challenges, and it comes from of just this openness of you know what? I don't know that many things about this, but everybody in this room seems willing to share and if we do this together it's going to be great. And that is such the opposite of the past.

And I think the people who hold on to that scarcity mindset hey, you come out, you hang a shingle, you're already fully baked, you don't need any more learning. Those people are dying on the vine and that's a rough way to go. You're sort of drying out, you're just desiccating and withering away. And those people who are like you know what we discovered. We don't know how to run businesses and you know what, if we embrace the C, which in some of us is an F, it's like we embrace the F and turn the business side. You allow all these things in that just completely flood you with optimism and opportunity and choices and ways to make a huge difference. And it's just a total reversal of seeing that C as a failure and going, no, it could have been an F if I hadn't been on the journey at all, and I have a way to an A that other people who are not open to this don't have.

0:25:52 - John Gallagher

I love the word you use vulnerability, I think, is a great word. There's a space for that inside of health care, because they've got teams around them that can help them be really successful. So, learning how to use them oftentimes like I don't want to show weakness, I don't want to show that I have vulnerability or that I make mistakes, but they already know yeah, I mean, this is something that that exists. They already know that you make mistakes, they already know that you're human and so you know.

It's not the lack of vulnerability I see inside of that space, but it's the awareness of it. I think there's a level that I would experience working with them directly says I have to be this way and so you know, helping them be aware of. No, you really don't. You just have to be open to learning, open to learning something new that you haven't done before, and know that you can't be the best in everything. They literally want to be the best in everything that they do, but sometimes they got to delegate to others who can be better than they can be in that space.

0:26:50 - Mark Henderson Leary

Yeah, the leadership role reversal is you get out of school having been packed full of answers and so you're the answer person. And you go through your rotations and internships, all the whole residency and all that kind of thing and, like you're beat into you, you're the answer person. And then, if you find yourself in a leadership management role, it's the opposite You're the questioner. I don't know what the answers are. I start with absolute no information or some hypotheses. And we've got to go get to the truth and we know right now that it didn't go as well as it could have and I don't yet know what would make it better. And that's the opposite formula and it's the key success criteria.

0:27:30 - John Gallagher

Well, that's why they get quote paid so much and I always have empathy for them when people talk like that as well, because the number of hours that they work with regards to positions, executives, even running small practices often the pajama time that's required to get the other things done that they can't get done because they're trying to see 34 patients over the course of a day in 10 minute intervals. They don't have time to go to the restroom, let alone document their visits to let folks know what's happening. So I have some empathy in that space for them. But when I think about those that are really successful, it is those individuals who recognize that if I'm going to get better, I'm going to need help to get there.

That was a conversation for me as a leader one time when I got a performance review. It's pretty similar to that C plus. I had to be vulnerable and be open and say I need help, and it was the first time I was introduced to having a coach. I just think it can be so powerful to have those other voices in the mentors and coaches and others that can help consultants that can help them get to a space that they want to go to.

0:28:31 - Mark Henderson Leary

Yeah, and I think that's a lot of the essence of the coach is to be able to pattern, interrupt around these things that don't feel right and have somebody kind of increase the, magnify the failures a little bit and it's like, hey, this really isn't that great from my perspective. Are you okay with that? And that's a large element of coaching, I think, is walking that fine line between look, you signed up with me and I have a certain standard of excellence of who I work with and I'm just going to assume that you want that too, and I think that's important. But there's also, like I noticed this Is this a big deal to you or not? Your people are afraid of you. Is that a big deal to you or not? Is that how you want to run your culture? No, it's not. And then that's.

Let me go a little deeper on that. I've never met anybody, I've never worked with anybody, who, more than a fit of like frustration holds on to they're supposed to be afraid of me. It more than a fit of like frustration holds on to they're supposed to be afraid of me. It's like you know, maybe it's like I was, I'm really well, they should have known better. And it's like, okay, when the, when the calm down happens, it's like do you really think that it's good that they don't, that they're afraid of you? No, I don't. Do them to grow. Do you want them to feel safe making mistakes? Yes, I do, and so that is that the behavior you're doing. No, it's not Okay. So is it worth it to talk about ways to make that change? And let's move some people around the leadership team. Let's put people in places, including you, and giving them ways to make that happen.

But I think that, back to the initial story. A lot of toxic behavior, a lot of counterproductive, inefficient, frustrated behavior just gets normalized. It's the ringing in your ears and it's not working, and you know it because you hit the ceiling. You get to a certain spot, it's working pretty well, and then the key person leaves or something happens that just kind of puts you back and you're back in this repetitive cycle of like I thought I was past this, you're not past this until you make significant change and getting that reflection on, what kind of culture are we trying to create here?

Do we want to preserve healing as the highest priority? Well, yeah, probably you do, and so let's make sure we have that throughout the entire organization and let's make sure that everybody grows in the organization, from the front office coordinator all the way to your partner surgeons. They all should be growing in a way that makes sense for them, in alignment with where this organization is going, and you may have to break some patterns and learn a lot of things that you were never taught but won't be that hard to learn. Once you learn to break the patterns, it can get there and it's just so important just to have that self-awareness like, hey, this is Groundhog Day.

0:31:19 - John Gallagher

Well and I think I've read a little bit of your background as well, you talked about this in your journey is the silver bullet that we're looking for, and I'll use the general term. Healthcare loves to look for silver bullets, whether it's robot technology to be sexy in surgery or building these new buildings, or even a software program that's going to help them become really good at tracking their patients. Look, that is all good stuff, but if you lay those technologies on top of bad processes that already exist, including leadership processes, you're just becoming more frustrated. So you want to fix some of those processes, including through awareness of saying what are the disciplines I need to do to be a better leader, just like the disciplines that are required to improve your faith and read the Bible every day, or improve your fitness by exercising three times a week and eating less. Leadership requires that same intentionality change behaviors and exercising new ways to become better.

0:32:19 - Mark Henderson Leary

Yeah. So, at the risk of going a little deeper and longer on that subject, one of the things I like to say is there's no such thing as a life-changing workout, like you don't head up to the gym for an hour and a half and life changed. There is a life-changing workout routine. There is a life-changing commitment to health through working out and diets and things like that. It's a collection of repetitive behaviors and along that line I think that humanity has evolved over millennia, not through just genetics and just learning things that stay learned Like oh, we now know that two plus two is four, like that's been great.

There are a lot of disciplines that are not natural. I don't think to humanity. We don't automatically think long game, we automatically think short game. And so, as civilization and humanity evolves, we look around and say you know what? We have observed that these behaviors really serve us better if we do X. And we say you know what? We have observed that these behaviors really serve us better if we do X and we go. You know what? That's right, that makes a lot of sense and we get back to our daily lives and that habit's not being natural to us, doesn't just it? It it wane, it evaporates a little bit. So there are things in our lives, like spirituality, I think, that require us to go back to the well on a regular basis to be reminded.

Yes, and I think leadership is like that as well. We're trying to do things, but we get scarcity minded again. You know, everything was going great until something got a little dicey and we started going to our old habits. And that doesn't make us bad people. It doesn't make us like super flawed people. It just means that we're just natural, normal human beings driving towards natural tendencies for more immediate gratification and sort of shortest path to things. And we need some help with systems thinking, long game thinking, so understanding.

Where do we find that leadership could be? In coaching could be in using systems as a part of the ecosystem. It could be in faith. It could be in whatever could be in using systems as a part of the ecosystem. It could be in faith. It could be in whatever your spirituality is. You're grounding your other practices in your world and I think everybody can do this. If everybody takes five minutes, think about what practices in your life don't just take care of themselves without careful tending and maintenance, and certainly the leadership of your practice evolves and needs that. Return to principles, return to comparison. You lose relativity very easily. Sure.

0:34:41 - John Gallagher

Well, I had a CEO in healthcare who was a physician leader, kind of through the ranks, and I'd been coaching him for about a year and it was one of the things is like, you know, what this really feels like is it has to become a reflex, like bending our elbow to pick up our coffee cup and take a drink. We don't have to think about it or work our way through it, and so some of those habits, while they're tough to get going on the front end, they really become part of who we are. They've already done that as physicians and how they think about diagnosing sickness. Now they need to think about that. What's the prescription, if you will, for improving their leadership? That they need to develop and go on forward and change those habits so that they become a reflex in their daily walk, if you will, in the practice or outside of the practice. Absolutely.

0:35:25 - Mark Henderson Leary

Yeah, and I think there certainly are habits we learn. Once we learn that move, once you learn that joint flexibility. You know, like Bruce Lee, you know once you've practiced this so much, it happens automatically. That's a certain discipline, but that's a part of the hierarchy of this. It's learning new habits, but then new ways to use the habit, new forces for good.

And you talked about levels of leadership, the maturity and this path we're on in life. And you know, there is certainly, I think, a call to act or to ask yourself what's enough. That's a whole other topic, but let's just kind of put what's enough is a very important question for entrepreneurs, because if not, you can go your whole life just going more and more and more realizing you went way past the finish line and forgot to like, enjoy it. That is a real thing. But I think that's a great sort of call to like okay, well, I hit the finish line on leg one of my journey, or leg 10 or wherever I'm seeing this. Should I reevaluate where I'm going up the mountain from here?

Because life is not a, you know, a check box. It is an infinite journey towards an infinite number of opportunities that evolve and make a difference. And I think, as you go through, it requires greater and greater discernment of all. Right, I'm here now. Now what? And I see so many practice owners and business owners really, I mean, we go through the process, we teach them the system. It's inevitable. At some point there's a little bit of like hey, like it's not so urgent anymore, like I spent 15 years firefighting and like I don't know what to do now that there's not a fire.

0:36:58 - John Gallagher

I'm uncomfortable. All right, exactly.

0:37:01 - Mark Henderson Leary

And do I walk more in the mornings? Do I spend time with a lot more time? I'm already spending a lot more time with my wife, but at some point I think I'm spending too much time with my wife and she's looking. So what do I do? And that's a great question to have. But you know another topic entirely 15 years of well actually it ties back into this thing. You go through medical school. 10, 15 years of your life you learn to let go of self-direction. You're on the railroad tracks. You're not thinking for yourself at all. You're learning this stuff. Okay, now phase shift. Now you're into building a practice. Now you're in the struggle. Do that five, 10, 15 years. You start checking out of autonomy and agency. Like you're asking the question what do you want? And it's not uncommon for somebody between their 50s and 60s I ask you what you want.

0:37:58 - John Gallagher

And you're saying everything you've heard and I'm not buying any of it because you're just copying your buddies Absolutely. Talk about a different podcast. Just the industry in general and the education reform that could be more powerful inside of that space and utilizing technology that exists and changing the payment model, all these things that I don't know that. I'd want to be a private practice provider right now unless I could run something like a concierge medicine practice, dealing with all the regulations and having and all the different things that go on inside of that space right now. It's hard to keep up with.

So I know the fact that you've chosen that as an issue in your businesses is to be commended, because they need a lot of help from a system, from a leadership development standpoint. And again, that need sounds like it's kind of being a hero, but it's really that awareness of like I just did this for 30 years and I turned around, look what I have and I got a couple of cars and a couple of houses and things like that. But what do I really have? I'm just burnt out.

0:38:48 - Mark Henderson Leary

Yeah, well, I mean again another podcast. But the answer to that question of you know why now, why optimistic? Why is it so difficult? Or would it be so difficult? Would it be so terrible? And the answer is not so terrible because private practices for the last hundred years have not been run as businesses.

They've been almost like, almost socialized. It's like you know, we get our leads through credentialing. We get, you know, insurance. Some of the value chain is sort of assumed that you know, the referral model is just sort of flowed what other businesses would call leads, you know. So that's how that works. But that's getting harder and harder.

But what we've never done is figured out who our best customer is, and we've never done is figured out who our best customer is and we've never marketed to them and we have never figured out how to add value to them in a way that they really would want that we're efficiently set up to provide. And so when you start saying, hey, just run this practice like a business, identify your best customer, your best patient, figure out how to build processes to support them and nobody else, and deliver a great service for a specified niche market, it totally works. But it's so foreign where the hard part is there's very few models by comparison. There's a bunch more out there, but it's not the same. That's not the same thing as a mature market where you just sort of copy a model, where you cause, right now you're like, well, I don't know, are we going up to fitness, are we going after the moms? Are we going after the families? We're going lower income, middle income, upper income, concierge, and all these options are on the table, and so choosing ends up being the hard part, and but it's really hard because we haven't been taught how to do that. So it takes some time, takes some iteration, you make some mistakes, you go after a customer or target market that doesn't actually work for you. Your processes, processes aren't set up for that. You've got to convert your entire culture from this like we do everything for everybody mindset to like, hey, this is really not our best customer patient thing and all of my staff are confused. So there's a lot of change management that goes with that, and so I definitely don't want to understate how difficult that can be. But the opportunity is huge.

Just to be a good business, like just with the basic principles that every dry cleaner, every well, that's not true. Dry cleaners don't do that well, everybody who's really successful in entrepreneurship is historically in other industries. The principles you know know your customer. Do one thing Be very specific. Know your differentiation, you know. Build a brand around a small set of things Very, very proven concepts, brand new to healthcare. But things like concierge are doing great for that reason, the ones that do that well, because they're like we're figuring out two things we can build a brand and we don't have to serve everybody, and so we can do that.

Oh, and this is the, I think, the mind blowing, the biggest mind blowing thing in healthcare right now is that we think that you have to be paid. Not everybody the dentistry knows this and optometry is getting this very clear the only way to get paid is through reimbursement. Well, no, it's not Like. People have credit cards, right, so what can you sell them that they want and what price would you have to price it at for you to make money? And we're finding that like it's very affordable If you just charge them what you need to make money on this and you cut the insurance out of this. You know, like direct primary care and things like that. Well, you just how about we just charge you. Why don't we just forget about this? Insurance for a thing? And it's like you know what 99 bucks a month, that's actually very reasonable, I'll pay that. And so I think there's this absolute mind blowing transformation of if we just forget the old model and go right to free market, capitalist economy, what happens, and it's pretty miraculous.

0:42:23 - John Gallagher

I think there's a lot there in what you're saying. Again, another podcast episode just to talk about that in terms of moving it as well from treating sickness to preventing sickness. I think you get a better chance to do that inside of. You mentioned that private practice and the data that's available. You know these little things that sit on our wrist that our physicians generally inside of these large systems never see, they don't trust the data, they don't want to see them Like. That's like gold in terms of how you know heart rate and heart rate variability and how I sleep. All those things are so powerful, making that data available, that unstructured data available to them to help make decisions.

0:42:59 - Mark Henderson Leary

Goodness gracious, yeah, I mean, I'm having the hardest time ending this conversation, I know, right, but the case in point is the total real thing, and I didn't realize how real People talk. Oh, this data is not being used. So I was wearing CGM continuous glucose monitor and I, as a pre-diabetic, non-diabetic, wanted to learn some things about that, and there's some stuff I didn't understand. And so I was like you know what? I would love to have a doctor walk me through this, and I'm not a diabetic. There are no doctors who will do that for me. It's not a thing like I. I said please look at nope, no, you're not, you're not sick enough yet. And so it was.

It was really what happened I and oh no, I and I am. I asked my primary care doctor, ask around, like no, I've asked three people until they can code for you. They won't see you, they don't, and there's no a, there's no data to compare to. So I get that the institution is based on like I'm not going to subjectively interpret what I'm looking at. I need, I need the studies, I need the data, I need all this stuff, and and then they also can't bill for it. So it's absolutely real. And so what we're finding is that somebody says you know, do you want to pay money to be more healthy, even though the previous healthcare quote unquote healthcare system has never done that, people say, well, yeah, how much? And it's a real thing. And it's a brand new thing that we can finally do outside of the old system. You just go right to market and who wants to buy it? And it turns out a lot of people want to do that.

0:44:19 - John Gallagher

Well, look, man, we've covered a lot. We could cover a million more things.

0:44:22 - Mark Henderson Leary

Anything you feel like we missed?

0:44:23 - John Gallagher

Yeah, not really a miss here. I mean, I just think about all With regards to identifying the gaps in the system, the gaps in leadership, the gaps in the overall payment or being able to make money inside this space as well. And here's what I think we've come to believe whether it's the EOS, whether it's a Toyota production system, whatever it is in terms of process, I do believe that excellence only happens on purpose and we've got to be intentional in developing those disciplines, looking at our calendars and saying what has happened, because I believe excellence. Really the result is a good practicing business. But for me, the greatest story ever told is on the very end of that.

There's going to be a time when somebody's going to be sitting around and asking a question and saying, hey, who's someone who's had a positive impact on your life, and when somebody writes your name on that list, I just believe that's the greatest story ever told. You may never know that, but if we're going to reach that point in terms of our leadership, we're going to reach that point in terms of impact in our communities and our homes, we've got to be intentional. We can't just let it happen, and I think what you're doing is so important in terms of working with those physicians, those physician entrepreneurs, to be successful, not just in their business, but looking at that greatest story ever told at the end. It's just so important. So I appreciate the opportunity to have the conversation with you, Mark. It's been really cool.

0:45:40 - Mark Henderson Leary

Awesome. Thanks so much, John. We've covered so much. It's a real pleasure. What's your passionate plea to entrepreneurial leaders right now?

0:45:48 - John Gallagher

Yeah, I mean, I think about that in terms of looking out in the future and understanding who you want to be in that space, and that excellence does it. If you want to get to that point, you're going to have to make a change and be very intentional about getting there, and so that's my plea. Another piece of what I look for and I have in group with regards to accountability is you know the people that we are with, the people that we surround ourselves with in our businesses, in our homes and communities. You know, I truly believe, that we become those individuals that are around us the most. So, if you're going to be in those books, raise the average of the group that you're inside as well. Be great, make them better as well. Awesome.

0:46:27 - Mark Henderson Leary

Thank you so much. Great time together. We'll have to do this again. There's obviously lots to talk about. If somebody wants to keep up with you, though, how do they find you? What's the simplest way? We'll put some stuff in the show notes, but if there's something, no, I appreciate that.

0:46:38 - John Gallagher

I mean. The easiest way to get in touch with me is to coachjohngallaghercom. That's my website. It's got an opportunity on there that you can do that. And social media LinkedIn is the place that I hang out the most, so that's a place to find me as well. Love it.

0:46:56 - Mark Henderson Leary

Well, thank you, john Gallagher. We'll talk to you in the future, for sure. So that's our time. So, wrapping this up, of course, the whole point of this conversation was making a difference and maybe changing the pattern, and I love the theme of that. And so, if you're listening to this and thinking, I can envision a world where my practice is running better, my business is running better, and it would be amazing if we were adding super high value and I loved my work. But you're stuck. That's kind of the point of this. That's what John does, that's what I do.

If you're looking for individual coaching conversations, certainly check out John's stuff. If you don't know what a first step looks like, though, never hesitate to get on the calendars practicefreedomcom slash schedule. We'll figure out what it looks like to get you unstuck, whatever that looks like, because it's so important that what you're doing is maximizing the value and giving you the life you deserve as part of that. It shouldn't be sucking the life out of you. You're giving so much, and so that's our time. We will see you next time on Practice Freedom with me, mark Henderson Leary.

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