What Did Healthcare Optimize Away? The Business Case for Humanness

WEBVTT

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All right.

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Healthcare is obsessed with optimization,

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scheduling, revenue cycle, productivity,

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AI.

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We measure everything we can put on a

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dashboard.

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And Larry thinks we may have missed one.

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Maybe it is the reason a lot of

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us went to school for this.

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What if the thing healthcare actually

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needs to optimize is humanness?

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I like that word.

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And what if that's not just the soft

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stuff?

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What if it's actually a business strategy?

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Ooh, businessizing humanness.

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So Larry, let's start here.

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You open this new series by essentially

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telling a room full of healthcare

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operators, business people, hey,

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you might be optimizing the wrong thing.

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What do you think we've gotten wrong?

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Yeah,

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let me start with a little bit of

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background.

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So I presented at a national conference in

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Las Vegas about four months ago,

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I think it was.

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And these are two,

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some very stout colleagues, CEOs,

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very large private equity backed dental

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service organizations who are quite

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impressed with and have spent time

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collaborating with over the last couple of

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years.

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And so I started that out with essentially

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how I started this piece out effectively

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with a confession.

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I've sat in these rooms,

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I've led all these rooms around this,

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and I love a good dashboard as much

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as any operator.

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But every conversation that I started

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having with folks,

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I would say over the past year in

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dental,

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but also in physical therapy and

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healthcare in general,

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went to the same three places.

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optimizing our schedule,

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technology adoption, your tech stack,

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and then third, AI, which is all tech.

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All of that absolutely matters,

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but none of that is the answer.

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So if you think about it,

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for thirty years we've treated operations

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as the variable and care as the constant.

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As if the human part would just persist

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on its own while we turned everything

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around it.

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And it didn't.

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And so while we were optimizing everything

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measurable,

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and this is what I've been repeating to

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my folks all the time,

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we neglect everything memorable.

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So we optimize a visit with a patient,

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but are we really impressing and

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connecting with the patient that will

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leave them with a positive impression and

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a memorable outcome?

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So the wrong thing isn't the spreadsheet,

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it's believing that the spreadsheet is the

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strategy.

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And if you really believe as an

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organization that your future lives in

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your tech stack or your future lives in

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you being able to, you know,

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vibe code AI,

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you're building a company in our case,

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a dental company in the past,

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because no patient has ever referred a

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friend because the confirmation texts were

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punctual, right?

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Because they were efficient because they

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were optimized.

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And what I think has been getting lost

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in this is the humanness side of it.

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And James Nesbitt many, many,

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many years ago said,

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anytime you have high tech,

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you need high touch.

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But we tend to get impressed with the

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shiny objects of high tech.

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and unimpressed because it's a soft,

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almost emotional thing with high touch.

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And what I'm saying is we need to

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have better balance in how we look at

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it and a better lens from how we

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evaluate optimization, tech, and AI.

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All right.

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Well,

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then you use this phrase in your latest

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article on Substack,

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which sounds like it's in opposition,

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optimizing humanness.

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Like those two things feel like they're in

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opposition.

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That sounds almost intentionally

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contradictory.

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So how do you sort of square that

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circle?

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How do you explain optimizing humanness?

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Yeah,

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I'm glad you asked this because the

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contradiction really is the point.

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And after seeing Odysseus movie last week,

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that's the Trojan horse.

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Right.

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Operators only would take it seriously if

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it sounds like a KPI.

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So I bolted optimizing on there onto the

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one asset we've been ignoring.

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And what it actually means is take warmth,

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attention, human connection,

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the things we've been filing under soft

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skills and give them the same rigor we

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give revenue cycle management.

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Train them deliberately,

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design the patient experience around them,

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measure what they're happening,

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positive psychology,

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empathetic communication,

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intentional relationship design,

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do it as a strategy,

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not as a poster.

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in the break room or something, right?

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The science already calls things into the

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treatment modality.

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We have unbelievable good, good, good,

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good data on that.

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I'm just asking folks to run their human

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high touch side like they run their data

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side.

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You point out that a huge number of

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people actively dread going to the

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dentist.

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I mean,

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it might be in some people's top three

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of things I'd like to avoid.

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And then you write, well,

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our collective response has largely been

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better scheduling software.

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Like you mentioned a minute ago,

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people don't tell a friend about this

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experience because the text reminders were

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on time.

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So why does healthcare keep reaching for

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operational solutions to human problems?

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Yeah,

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and if you think about physical therapy

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and dentistry,

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one thing we share together is physical

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therapy has often been called pain and

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torture, PT, right?

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And while we don't really account for the

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percentage of anxiety in PT,

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there's lots of studies in dental,

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it could be as high as seventy percent.

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And so what I would say is that

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operational problems are the tools that we

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could see, you know, a scheduling gap,

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you know,

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you see that it shows up at a

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data point, it shows up in a report.

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A patient's anxiety doesn't.

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And so the operators fix what shows up,

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what gets measured and managed,

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but what doesn't get measured sort of gets

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abandoned.

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And I'm a big believer in you get

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what you emphasize.

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And so if you start emphasizing humanness,

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you'll get it.

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But there's a comfort factor too.

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An ops fix is a purchase order, right?

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A human fix is sort of a mirror.

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Only one of those can be delegated.

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So you can end up with the irony

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in this piece,

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somewhere between one and six adults and

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more than half,

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depending entirely on how you measure it,

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are dreading your product in dentistry.

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Think about that.

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They have to be consumers of it.

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And we know that forty percent of the

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American population don't even get any

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dentistry.

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And a good portion of those forty percent

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is because they dread it.

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Right.

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And so, you know, the big response

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is optimizing send them a reminder text

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keep them you know optimize all you can

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through technology and yeah some of those

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things are very very helpful but we've

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gotten world-class at efficiency of

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scheduling people into an experience that

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they don't want to be at

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That's not transformation,

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that's faster dread.

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And the no-show cancellation rates in

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dental exceed that of healthcare.

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And so why are we not trying to

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optimize the root cause,

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which in this case is dread, fear,

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anxiety,

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through better education on soft skills of

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human connections and empathetic

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communications and all of those kinds of

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things.

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It's easier to fix the techno side of

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it.

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That's my real main point,

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the lens of looking at all this.

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Yeah.

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Well, you teed up my next question.

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We're always going to go next.

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I can already hear the audience going,

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this is great.

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I believe this.

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This sounds warm.

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This sounds funny.

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Let's bring in humanness.

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They might be thinking, this sounds great,

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but I got margins.

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I have staffing problems.

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I have production targets.

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So this might sound nice,

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but how would you make the business case

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for this?

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How would you arm the person listening

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going, I believe you,

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but how do I pitch this to my

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boss?

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So where does being more human actually

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show up in the numbers that my boss

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might let me beta test this?

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Yeah,

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and let me take a minute or two

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to get there because it's a very fair

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pushback.

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I mean, I run a platform.

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I've got investors.

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I'm an investor.

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I started a high level where you have

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to fundamentally believe that part of your

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organization is a human capital talent

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management machine, is a value creator.

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And what I mean by that is just

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like you allocate dollars to buy and

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dental scanners or operatories and PT

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equipment, you know, high, low tables,

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all those kinds of things, right?

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Exercise stuff.

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That's capital equipment.

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My mentality is I want to invest in

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human capital.

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And so I allocate dollars and resources

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towards that because that's where my

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priority is.

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That's where my value is.

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That's where I do believe our mission is

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at.

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But here is more the businessy case for

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some of the things that you're saying.

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And I'll use some psychology here.

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So Kahneman's peak end rule,

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the last sixty seconds of a visit,

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disproportionately determines whether that

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patient comes back and whether they refer

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friends and family to you.

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Return and referral aren't soft numbers,

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right?

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Those are patient retention numbers.

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And your cheapest form of patient

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acquisition, what we say in Kentucky,

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milk our own cows first.

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And that really is what will get you

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a driving practice at a lower cost.

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Do you want to spend money in a

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leaky bucket of marketing leads,

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social media, digital, blah, blah, blah,

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blah, blah, blah, blah.

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Or if you do it in humanness,

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you'll get better referrals and a better

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return.

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So Jane Dutton had this thing around high

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quality connections, brief, you know,

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positive interactions that leave sort of

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both people at a better place,

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more energized, more trusting.

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In dental,

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that manifests itself as case acceptance

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and team retention in a single finding.

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Case acceptance in dental sometimes could

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be less than fifty percent.

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Well,

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if I can drive that number through better

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human connection from fifty to seventy

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five percent, guess what goes up?

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My margin, my profitability, my cash flow.

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um now flip it anxiety drives avoidance

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avoidance drives attrition and the most

00:10:34.240 --> 00:10:36.221
expensive line on your p l is the

00:10:36.322 --> 00:10:38.182
one that isn't printed on it the patient

00:10:38.202 --> 00:10:40.244
who quietly didn't rebook who didn't come

00:10:40.283 --> 00:10:42.684
back in the clinician who quit who was

00:10:42.705 --> 00:10:45.606
the quiet quitter humanness is the

00:10:45.687 --> 00:10:47.788
alternative to your margins it's the

00:10:47.827 --> 00:10:49.269
margin you haven't touched yet

00:10:49.989 --> 00:10:51.950
And the cap X is roughly zero in

00:10:51.990 --> 00:10:52.750
most companies.

00:10:53.451 --> 00:10:53.892
So you see,

00:10:53.932 --> 00:10:56.592
if I can take a measurement like treatment

00:10:56.633 --> 00:10:58.735
case acceptance, retention,

00:11:00.995 --> 00:11:03.638
and no-show cancellation,

00:11:03.778 --> 00:11:05.719
and flip it from a metric that is

00:11:05.759 --> 00:11:07.660
a very hard metric to what can I

00:11:07.740 --> 00:11:10.403
do through human connectedness, empathy,

00:11:10.462 --> 00:11:12.703
peak end effect to drive it,

00:11:13.625 --> 00:11:15.306
you can make a strong business case for

00:11:15.326 --> 00:11:15.365
it.

00:11:17.705 --> 00:11:19.306
uh let's go the other route tell me

00:11:19.326 --> 00:11:21.447
about maria in the article that you just

00:11:21.486 --> 00:11:25.727
wrote what did she understand about one

00:11:25.827 --> 00:11:30.429
patient that had some anxiety that a

00:11:30.509 --> 00:11:34.192
perfectly optimized workflow might miss it

00:11:34.211 --> 00:11:36.393
would never show up there yeah it's

00:11:36.452 --> 00:11:38.333
interesting i gave i do these amazing

00:11:38.374 --> 00:11:40.394
coins once a month that are based on

00:11:40.433 --> 00:11:41.235
nominations

00:11:42.347 --> 00:11:44.590
And so many of them are these patient

00:11:44.629 --> 00:11:45.510
testimonials.

00:11:45.551 --> 00:11:48.052
So when I use a case like Maria,

00:11:48.173 --> 00:11:49.092
it's a real case.

00:11:49.553 --> 00:11:50.855
The names may be changed,

00:11:50.914 --> 00:11:52.096
but it's exactly,

00:11:52.135 --> 00:11:53.616
and sometimes people get there by just

00:11:53.636 --> 00:11:55.477
kind of a natural tendency towards this,

00:11:56.158 --> 00:11:58.760
or they're just really, really good at it.

00:11:59.400 --> 00:12:01.822
And other times,

00:12:02.244 --> 00:12:03.784
my belief is you can train for it.

00:12:03.804 --> 00:12:05.645
So Maria is a dental assistant in one

00:12:05.666 --> 00:12:06.366
of our practice,

00:12:06.386 --> 00:12:07.988
an elderly patient comes in,

00:12:08.128 --> 00:12:09.048
they're very anxious.

00:12:09.448 --> 00:12:11.029
a lot of times people have shame in

00:12:11.070 --> 00:12:12.770
dentistry too they're shamed of their

00:12:12.811 --> 00:12:14.513
teeth you know you have that working plus

00:12:14.533 --> 00:12:16.354
anxiety and they both manifest itself they

00:12:16.394 --> 00:12:18.735
haven't seen a dentist in years you know

00:12:18.794 --> 00:12:21.856
so the optimized workflow says intake is

00:12:21.897 --> 00:12:25.120
running long keep it moving right you know

00:12:25.360 --> 00:12:27.841
but maria pulled her chair up close sat

00:12:27.861 --> 00:12:29.342
at an eye level and asked one question

00:12:29.383 --> 00:12:30.803
how you doing how you really doing

00:12:31.690 --> 00:12:33.030
And that's the actual skill.

00:12:33.051 --> 00:12:34.610
It's the connection skill where both

00:12:34.630 --> 00:12:36.152
people are left better off.

00:12:36.172 --> 00:12:37.312
She didn't redirect.

00:12:37.371 --> 00:12:40.153
The patient talked about her husband's,

00:12:40.332 --> 00:12:42.114
you know, illnesses, her worries.

00:12:42.514 --> 00:12:44.455
Why'd she be putting off her own care?

00:12:45.034 --> 00:12:45.335
You know,

00:12:45.634 --> 00:12:47.375
but she left with a treatment plan and

00:12:47.395 --> 00:12:49.336
a commitment to return all because of

00:12:49.375 --> 00:12:50.177
human connection.

00:12:50.956 --> 00:12:52.538
And here is what the Maria's of the

00:12:52.577 --> 00:12:55.239
world understand that the workflow misses.

00:12:55.278 --> 00:12:57.499
The anxiety was the chief complaint,

00:12:58.480 --> 00:12:59.279
not their teeth.

00:13:00.318 --> 00:13:01.120
They didn't come,

00:13:01.159 --> 00:13:02.221
they have fair avoidance.

00:13:02.260 --> 00:13:03.861
We know this in physical therapy on

00:13:03.902 --> 00:13:05.683
patients that have back injuries, right?

00:13:05.803 --> 00:13:06.924
That's the condition.

00:13:08.086 --> 00:13:10.207
The dentistry is downstream of it.

00:13:10.227 --> 00:13:12.190
The physical therapy is downstream of that

00:13:12.230 --> 00:13:12.971
low back pain.

00:13:13.650 --> 00:13:16.072
A perfect workflow would have processed

00:13:16.113 --> 00:13:17.894
the intake right on schedule and the

00:13:17.934 --> 00:13:19.155
patient wouldn't have come back with a

00:13:19.456 --> 00:13:19.897
commitment.

00:13:21.006 --> 00:13:22.707
So Maria wasn't running a referral

00:13:22.748 --> 00:13:25.830
program, she was revealing one.

00:13:26.530 --> 00:13:27.572
Who does the patient tell?

00:13:27.591 --> 00:13:28.772
Her family, her friends,

00:13:28.892 --> 00:13:30.332
everyone that she loves.

00:13:31.173 --> 00:13:33.355
And so you have these downstream effects

00:13:33.475 --> 00:13:34.296
of humanness.

00:13:35.017 --> 00:13:38.178
And you can calculate them if you use

00:13:38.239 --> 00:13:40.120
the right metrics that are sometimes

00:13:40.159 --> 00:13:41.701
directly or indirect.

00:13:42.160 --> 00:13:44.062
It's also the relationship between

00:13:44.102 --> 00:13:46.024
qualitative and quantitative metrics.

00:13:46.565 --> 00:13:48.206
And these things are really palpable

00:13:49.203 --> 00:13:51.884
And I think the difference maker in an

00:13:51.945 --> 00:13:53.664
environment where everybody has been so

00:13:53.705 --> 00:13:57.285
busy optimizing the mechanizing, you know,

00:13:57.346 --> 00:13:59.167
commodity-driven way we've looked at

00:13:59.187 --> 00:14:01.687
healthcare and dentistry.

00:14:01.927 --> 00:14:04.948
You go on to argue that warmth, attention,

00:14:05.548 --> 00:14:07.969
connection aren't merely soft skills.

00:14:08.048 --> 00:14:08.389
And again,

00:14:08.690 --> 00:14:10.330
we should probably do a little marketing

00:14:10.370 --> 00:14:12.010
work on soft skills because it makes it

00:14:12.030 --> 00:14:13.390
sound like it's not as valuable.

00:14:14.171 --> 00:14:15.432
But they're part of the treatment.

00:14:15.491 --> 00:14:16.451
If that's true...

00:14:17.714 --> 00:14:20.677
Why don't we train and measure them with

00:14:20.717 --> 00:14:23.961
the same seriousness that we give clinical

00:14:24.003 --> 00:14:26.285
competency?

00:14:26.686 --> 00:14:27.967
Yeah, we should.

00:14:28.427 --> 00:14:29.750
And honestly, we don't.

00:14:30.291 --> 00:14:31.412
Clinical competency,

00:14:31.452 --> 00:14:32.274
if you think about it,

00:14:32.293 --> 00:14:33.936
that gets your boards, your licensure,

00:14:33.956 --> 00:14:35.258
your CE requirements,

00:14:35.278 --> 00:14:35.357
your

00:14:36.499 --> 00:14:37.440
Your calibration,

00:14:37.500 --> 00:14:39.682
it's decades of sort of infrastructure.

00:14:40.201 --> 00:14:42.823
Connection gets one slide in orientation.

00:14:42.903 --> 00:14:43.563
Smile.

00:14:44.225 --> 00:14:45.205
Good luck out there.

00:14:46.365 --> 00:14:48.648
Underneath that is bad assumption that

00:14:48.727 --> 00:14:51.769
warmth is a trait you hire for rather

00:14:51.789 --> 00:14:53.150
than a skill you build.

00:14:53.530 --> 00:14:54.711
And I like the statement,

00:14:55.091 --> 00:14:57.232
soft skills are the new hard skills.

00:14:58.833 --> 00:15:01.196
I love all the emphasis that people are

00:15:01.235 --> 00:15:02.677
placing on them, but unfortunately,

00:15:02.736 --> 00:15:05.097
I don't see a lot of companies delivering

00:15:05.219 --> 00:15:05.458
on it.

00:15:06.239 --> 00:15:09.623
um the research says by the way what

00:15:09.663 --> 00:15:11.423
it says empathetic communication is

00:15:11.484 --> 00:15:14.027
trainable responding well to people is

00:15:14.086 --> 00:15:16.649
trainable we just have never really built

00:15:16.688 --> 00:15:19.172
the curriculum because we file it under

00:15:19.432 --> 00:15:22.254
you know personality you know what we're

00:15:22.274 --> 00:15:24.937
doing at dca i i turned it into

00:15:25.037 --> 00:15:27.318
call to care into an actual provider

00:15:27.359 --> 00:15:27.759
course

00:15:28.597 --> 00:15:30.259
that we hold people accountable to,

00:15:30.720 --> 00:15:34.182
that's got modules, that has tests,

00:15:34.562 --> 00:15:35.583
that has practice,

00:15:35.604 --> 00:15:37.485
that has knowledge checks,

00:15:37.504 --> 00:15:39.846
that almost it's a mentoring kind of thing

00:15:39.907 --> 00:15:40.408
as well.

00:15:40.847 --> 00:15:43.110
We give that the same seriousness we give

00:15:43.149 --> 00:15:44.270
any clinical program.

00:15:44.591 --> 00:15:46.513
So when we train dentists and we upskill

00:15:46.533 --> 00:15:46.753
them,

00:15:47.033 --> 00:15:49.154
they're getting upskilled not in hands in

00:15:49.174 --> 00:15:50.015
the mouth skills,

00:15:50.275 --> 00:15:52.297
but mouth skills outside of the mouth

00:15:52.317 --> 00:15:52.677
skills.

00:15:53.918 --> 00:15:55.801
And measuring it isn't mysterious.

00:15:56.881 --> 00:15:57.081
You know,

00:15:57.182 --> 00:15:59.745
audit the last sixty seconds of the visits

00:16:00.546 --> 00:16:02.388
and you'll see whether that's trainable or

00:16:02.427 --> 00:16:02.648
not.

00:16:03.008 --> 00:16:04.769
Read what patients actually write in

00:16:04.809 --> 00:16:05.390
reviews,

00:16:05.451 --> 00:16:07.293
not what they punch on a five star

00:16:07.332 --> 00:16:07.712
system.

00:16:10.095 --> 00:16:12.076
Nobody has ever come in and said, boy,

00:16:12.115 --> 00:16:14.177
that intraoral scanner that you've got

00:16:14.236 --> 00:16:15.418
these wellness checks now,

00:16:15.437 --> 00:16:16.217
that is amazing.

00:16:16.697 --> 00:16:18.298
What they do though is they name people.

00:16:19.038 --> 00:16:21.080
And that's what you see in reviews.

00:16:21.139 --> 00:16:23.020
And so for naming people in all of

00:16:23.041 --> 00:16:24.422
these qualitative checks,

00:16:24.442 --> 00:16:27.043
why aren't we training people to do the

00:16:27.062 --> 00:16:27.263
same?

00:16:27.929 --> 00:16:29.551
I had a really simple exercise I

00:16:29.610 --> 00:16:30.091
suggested.

00:16:30.130 --> 00:16:32.851
You've got data out there hiding in plain

00:16:32.892 --> 00:16:33.192
sight.

00:16:33.412 --> 00:16:35.332
I suggested that business owners go to

00:16:35.352 --> 00:16:37.352
their Google reviews, copy all,

00:16:38.052 --> 00:16:39.514
run it through your favorite AI and just

00:16:39.614 --> 00:16:40.953
ask, what are the patterns?

00:16:41.174 --> 00:16:42.774
And what I've seen with a couple just

00:16:42.815 --> 00:16:44.916
doing this superficially,

00:16:45.535 --> 00:16:47.557
front office staff or clinical staff that

00:16:47.576 --> 00:16:48.897
get mentioned over and over,

00:16:49.576 --> 00:16:51.238
that's a signal that your audience is

00:16:51.317 --> 00:16:52.118
telling you something.

00:16:52.138 --> 00:16:53.399
So something you just mentioned there.

00:16:54.298 --> 00:16:56.279
Is there something uncomfortable buried in

00:16:56.320 --> 00:16:57.000
what you're saying?

00:16:57.080 --> 00:16:57.220
Like,

00:16:58.386 --> 00:17:01.750
Could an extremely efficient healthcare

00:17:01.830 --> 00:17:04.291
organization actually be getting worse at

00:17:04.352 --> 00:17:05.292
caring for people?

00:17:05.913 --> 00:17:07.075
You've said this before.

00:17:07.275 --> 00:17:09.175
Are we optimizing the wrong thing?

00:17:09.215 --> 00:17:10.458
So I guess this would be like a

00:17:10.498 --> 00:17:11.959
similar question.

00:17:12.598 --> 00:17:13.460
But this is a little deeper.

00:17:14.040 --> 00:17:16.143
If by optimizing these things,

00:17:16.182 --> 00:17:17.784
are we actually getting worse at the thing

00:17:17.804 --> 00:17:18.605
that we're there to do?

00:17:20.224 --> 00:17:22.665
hundred percent and that's exactly the

00:17:22.705 --> 00:17:24.446
uncomfortable part of this the whole good

00:17:24.487 --> 00:17:26.448
hearts law if you remember we talked a

00:17:26.488 --> 00:17:28.108
lot about that when a measure becomes a

00:17:28.148 --> 00:17:30.450
target it stops being a good measure when

00:17:30.630 --> 00:17:32.851
when return over retention rate of your

00:17:32.891 --> 00:17:36.192
therapist is the measure and you're buying

00:17:36.272 --> 00:17:40.394
it through compensation or through other

00:17:40.414 --> 00:17:42.556
means to affect the measure rather than

00:17:42.576 --> 00:17:43.777
what you're really aiming for

00:17:44.557 --> 00:17:45.817
It no longer is a good measure.

00:17:46.098 --> 00:17:48.681
You can hit every KPI and hollow out

00:17:49.221 --> 00:17:51.763
the very visits that those KPIs were built

00:17:51.844 --> 00:17:52.224
on, right?

00:17:52.505 --> 00:17:54.547
Tighter blocks, scripted interactions,

00:17:54.646 --> 00:17:56.008
check out in five seconds.

00:17:56.048 --> 00:17:56.828
Congratulations,

00:17:56.868 --> 00:18:00.211
you've optimized every moment where trust

00:18:00.231 --> 00:18:01.653
could have been formed.

00:18:02.594 --> 00:18:02.914
You know,

00:18:03.674 --> 00:18:05.895
you've limited the human connection in

00:18:05.976 --> 00:18:06.477
time.

00:18:06.997 --> 00:18:08.298
Every dashboard is green,

00:18:08.337 --> 00:18:10.058
but the patients leave and they're

00:18:10.138 --> 00:18:10.778
unattached.

00:18:10.818 --> 00:18:12.480
They have not built emotional connection

00:18:12.500 --> 00:18:13.840
with your clinic.

00:18:13.861 --> 00:18:14.540
And how do you know that?

00:18:15.001 --> 00:18:16.782
Look what the dashboards don't show.

00:18:17.623 --> 00:18:18.663
Patients don't cancel.

00:18:18.683 --> 00:18:19.864
They just never rebook.

00:18:20.223 --> 00:18:21.984
Treatment case acceptance in dental goes

00:18:22.025 --> 00:18:22.305
down.

00:18:22.384 --> 00:18:23.705
Most groups don't run that report.

00:18:23.726 --> 00:18:23.925
You know,

00:18:23.965 --> 00:18:25.326
one of the interesting things about dental

00:18:25.346 --> 00:18:26.708
that's very different than PT,

00:18:27.127 --> 00:18:28.188
in physical therapy,

00:18:28.448 --> 00:18:29.969
the first visit is usually the most

00:18:30.028 --> 00:18:31.349
lucrative because you've got the initial

00:18:31.369 --> 00:18:32.009
evaluation.

00:18:32.029 --> 00:18:33.010
That's a higher charge.

00:18:33.550 --> 00:18:34.250
In dental,

00:18:34.570 --> 00:18:36.192
the second visit is the most lucrative

00:18:36.231 --> 00:18:37.673
because that's typically when they accept

00:18:37.692 --> 00:18:39.294
or start their treatment case acceptance.

00:18:40.173 --> 00:18:40.855
Very different.

00:18:41.355 --> 00:18:42.797
But in physical therapy, if you remember,

00:18:42.836 --> 00:18:44.557
we had a lot of conversations about this.

00:18:44.577 --> 00:18:46.881
I'm getting ready to do a talk in

00:18:46.941 --> 00:18:48.561
Nashville at one of these private practice

00:18:48.582 --> 00:18:49.282
summits coming up.

00:18:49.343 --> 00:18:50.223
I think it's in September.

00:18:50.903 --> 00:18:52.645
And I've got some really interesting data

00:18:52.685 --> 00:18:54.248
that you and I have chatted about called

00:18:54.268 --> 00:18:54.847
the cliff.

00:18:55.249 --> 00:18:56.829
They don't even realize that their drop

00:18:56.970 --> 00:18:59.071
off is occurring between patients two and

00:18:59.112 --> 00:18:59.353
three.

00:19:00.439 --> 00:19:02.359
significant numbers don't come back

00:19:02.380 --> 00:19:03.721
between visits two and three,

00:19:03.740 --> 00:19:04.922
that retention.

00:19:05.442 --> 00:19:06.883
And most practices aren't even measuring

00:19:06.923 --> 00:19:07.223
that.

00:19:07.384 --> 00:19:09.265
And that's a humanness kind of proxy,

00:19:09.625 --> 00:19:09.805
right?

00:19:09.825 --> 00:19:11.246
They're failed to make the real connection

00:19:11.266 --> 00:19:12.247
to the physical therapist.

00:19:13.428 --> 00:19:15.048
So in dental,

00:19:15.068 --> 00:19:16.349
there's a lot of overlap to this.

00:19:16.369 --> 00:19:16.630
You know,

00:19:16.869 --> 00:19:18.250
what did the exit interview say on a

00:19:18.270 --> 00:19:18.570
patient?

00:19:18.590 --> 00:19:20.251
There's a walk the floor test that,

00:19:20.332 --> 00:19:20.573
you know,

00:19:20.712 --> 00:19:22.334
standing in your practice the last sixty

00:19:22.354 --> 00:19:23.114
minutes and look,

00:19:23.173 --> 00:19:25.756
this three visit test I use in PT,

00:19:26.215 --> 00:19:27.596
that's the data point I want to know

00:19:27.616 --> 00:19:28.438
in due diligence,

00:19:28.478 --> 00:19:29.659
how many of your patients are leaving at

00:19:29.679 --> 00:19:30.118
that time.

00:19:30.798 --> 00:19:31.858
And most patients in PT,

00:19:31.939 --> 00:19:32.460
as you well know,

00:19:32.480 --> 00:19:34.759
don't even complete their treatment care

00:19:34.779 --> 00:19:35.059
plan.

00:19:36.340 --> 00:19:37.921
But you have to have a caring audit,

00:19:38.121 --> 00:19:40.402
you know, no dashboard at all covers it.

00:19:40.862 --> 00:19:41.922
Yep.

00:19:41.961 --> 00:19:44.042
You take this from the floor,

00:19:44.083 --> 00:19:45.682
the treatment floor, the treatment room,

00:19:46.242 --> 00:19:48.203
and up the ladder into leadership.

00:19:48.683 --> 00:19:50.565
If we're so serious about optimizing

00:19:50.625 --> 00:19:52.464
humanness, again, love that phrase,

00:19:52.505 --> 00:19:53.786
that needs to be on a t-shirt somewhere.

00:19:54.226 --> 00:19:56.365
Does that mean we've also been promoting

00:19:56.425 --> 00:19:58.826
and selecting the wrong kinds of leaders?

00:20:00.338 --> 00:20:02.319
Yeah, I mean, I'll say it pretty clearly.

00:20:02.359 --> 00:20:04.641
We've been hiring resumes and hoping for

00:20:04.681 --> 00:20:06.182
leaders.

00:20:06.261 --> 00:20:08.201
Pedigree tells someone can do the right

00:20:08.241 --> 00:20:08.923
thing.

00:20:08.942 --> 00:20:10.584
That's part of this whole Peter Drucker

00:20:10.624 --> 00:20:11.923
thing about efficiency.

00:20:12.183 --> 00:20:14.305
But it tells you nothing about whether a

00:20:14.404 --> 00:20:16.865
scared new assistant will speak up in the

00:20:16.986 --> 00:20:19.007
operatory, at least in dental.

00:20:19.227 --> 00:20:21.567
There's that whole Amy Edmondson

00:20:21.607 --> 00:20:22.969
psychological safety.

00:20:23.509 --> 00:20:25.089
And it's one of the strongest predictors

00:20:25.130 --> 00:20:26.530
of team performance we have.

00:20:26.570 --> 00:20:26.711
I mean,

00:20:26.730 --> 00:20:28.811
the Google researchers did all that a few

00:20:28.852 --> 00:20:29.491
years back.

00:20:30.131 --> 00:20:32.372
The profile of the future really is

00:20:32.432 --> 00:20:34.173
emotional intelligence, resilience,

00:20:34.212 --> 00:20:35.012
adaptability,

00:20:35.252 --> 00:20:36.894
the ability to build safety in your

00:20:36.933 --> 00:20:40.035
clinical team, not instead of competence.

00:20:40.075 --> 00:20:41.855
Competence is table stakes, right?

00:20:41.875 --> 00:20:43.395
We assume people have good clinical

00:20:43.435 --> 00:20:43.816
skills,

00:20:44.215 --> 00:20:46.957
but the tiebreaker amongst competent

00:20:46.997 --> 00:20:47.377
people,

00:20:47.678 --> 00:20:49.298
which is where every hiring decision

00:20:49.357 --> 00:20:50.098
actually lives.

00:20:50.699 --> 00:20:52.900
I remember a long time ago,

00:20:52.940 --> 00:20:54.480
the John Maxwell leadership book,

00:20:54.500 --> 00:20:55.580
where he called it the law of the

00:20:55.641 --> 00:20:55.901
lid.

00:20:56.661 --> 00:20:57.682
basically a team.

00:20:57.721 --> 00:20:59.603
The concept is a team never outgrows its

00:20:59.702 --> 00:21:00.063
leader.

00:21:00.763 --> 00:21:02.845
Every practice culture I've walked into

00:21:02.904 --> 00:21:05.446
that is the shadow of the of the

00:21:05.487 --> 00:21:05.767
leader.

00:21:05.807 --> 00:21:06.086
Right.

00:21:06.508 --> 00:21:07.969
And so, yes, different profile,

00:21:08.249 --> 00:21:10.210
higher people who can lift lids,

00:21:10.230 --> 00:21:12.270
who can take you to the next level.

00:21:12.872 --> 00:21:14.553
And that involves a little bit of

00:21:14.653 --> 00:21:16.253
normalizing discomfort and taking you

00:21:16.273 --> 00:21:17.994
where places that you need to go,

00:21:18.015 --> 00:21:20.436
which you won't go there on their own.

00:21:20.576 --> 00:21:20.676
Yeah.

00:21:20.717 --> 00:21:22.057
Here's one of the lines that felt like

00:21:22.117 --> 00:21:23.759
sort of the thesis or the through line

00:21:23.778 --> 00:21:24.740
of the whole article.

00:21:25.700 --> 00:21:28.862
need to stop optimizing the humanness away

00:21:29.582 --> 00:21:31.262
like almost like it's something to get rid

00:21:31.303 --> 00:21:32.964
of so where do you see organizations

00:21:33.244 --> 00:21:35.586
accidentally doing that today and maybe a

00:21:36.086 --> 00:21:37.586
key or two on how we can stop

00:21:37.646 --> 00:21:40.769
doing that everywhere and it's always with

00:21:40.788 --> 00:21:43.030
the best of intentions and that's what

00:21:43.070 --> 00:21:46.313
makes it you know invisible right um each

00:21:46.393 --> 00:21:48.973
cut on each sort of cut is defensible

00:21:49.074 --> 00:21:52.195
on its own but collectively they remove

00:21:52.316 --> 00:21:54.077
every moment where a connection could

00:21:54.097 --> 00:21:54.357
occur

00:21:55.151 --> 00:21:57.413
You get to an end of the visit,

00:21:57.452 --> 00:21:59.193
you hand a piece of paperwork to somebody

00:21:59.213 --> 00:22:01.316
and go to a payment terminal.

00:22:01.355 --> 00:22:02.276
Daniel Kahneman, again,

00:22:02.296 --> 00:22:03.978
says that's the most valuable clinical

00:22:04.018 --> 00:22:05.479
minute of the appointment and we give it

00:22:05.519 --> 00:22:09.280
to a card reader or a scheduler.

00:22:09.320 --> 00:22:11.522
Schedule the minute of the appointment and

00:22:11.742 --> 00:22:11.982
schedule

00:22:12.943 --> 00:22:15.228
There's no slack for a Maria moment.

00:22:15.307 --> 00:22:17.612
Her conversation doesn't fit a ten-minute

00:22:17.752 --> 00:22:19.536
intake block, so the block wins.

00:22:20.277 --> 00:22:22.140
Scripts that are so rigid,

00:22:22.200 --> 00:22:24.042
they turn a warm human being into a

00:22:24.104 --> 00:22:25.346
phone tree with legs.

00:22:27.076 --> 00:22:27.317
you know,

00:22:27.457 --> 00:22:29.718
a dental hygienist measured purely on

00:22:29.798 --> 00:22:32.137
chair time units or production,

00:22:33.038 --> 00:22:36.019
not return of patients with scheduled

00:22:36.038 --> 00:22:37.298
within the next six months.

00:22:37.318 --> 00:22:39.118
That's just a, you know, a KPI.

00:22:39.798 --> 00:22:41.440
And the newest one that I hear about

00:22:41.500 --> 00:22:44.339
is AI answering the phone for an anxious

00:22:44.420 --> 00:22:46.420
patient who took three weeks to take the

00:22:46.480 --> 00:22:48.181
nervousness up to even make a call to

00:22:48.221 --> 00:22:49.280
a dentist to begin with.

00:22:49.780 --> 00:22:51.320
Not one of those decisions is done,

00:22:51.340 --> 00:22:53.382
but nobody's watching for the sum parts of

00:22:53.422 --> 00:22:53.602
that.

00:22:53.642 --> 00:22:54.821
The sum is the practice.

00:22:55.915 --> 00:22:58.797
where everything is optimized and no one

00:22:58.836 --> 00:23:00.617
is cared for.

00:23:00.678 --> 00:23:00.877
All right,

00:23:00.938 --> 00:23:03.057
so here's the operational question I'll

00:23:03.157 --> 00:23:03.298
ask.

00:23:03.338 --> 00:23:05.598
If I gave you control of a Seventy

00:23:05.638 --> 00:23:07.660
Clinic healthcare platform tomorrow and

00:23:07.700 --> 00:23:09.780
said, optimize humanness,

00:23:09.820 --> 00:23:11.980
you are the humanness czar,

00:23:12.682 --> 00:23:14.662
what's the first thing you'd actually do

00:23:14.761 --> 00:23:15.942
on Monday morning?

00:23:15.962 --> 00:23:17.903
How do you begin that process?

00:23:18.443 --> 00:23:20.884
Well, Jimmy, my first reaction is,

00:23:22.204 --> 00:23:22.984
a few hundreds?

00:23:23.704 --> 00:23:24.165
Seventy?

00:23:26.112 --> 00:23:27.794
monday that sounds like a vacation you

00:23:27.814 --> 00:23:29.055
know what i actually do i run about

00:23:29.095 --> 00:23:31.156
four hundred of them you know and notice

00:23:31.196 --> 00:23:33.077
that none of it requires a committee a

00:23:33.357 --> 00:23:36.942
consultant or a dollar of of pure capex

00:23:37.001 --> 00:23:40.644
but you know no culture initiative no logo

00:23:40.724 --> 00:23:42.926
no launch event the moment culture gets a

00:23:42.967 --> 00:23:45.048
logo it's already sort of on the shelf

00:23:45.068 --> 00:23:47.090
so i would do i think i think

00:23:47.111 --> 00:23:50.554
about it as a design uh roughly three

00:23:50.594 --> 00:23:52.414
moves you redesign

00:23:53.435 --> 00:23:56.278
the last sixty seconds of every visit and

00:23:56.298 --> 00:23:58.378
you measure that and monitor it.

00:23:59.240 --> 00:24:00.721
Make sure that's memorable.

00:24:00.861 --> 00:24:02.561
The end belongs to a human,

00:24:02.582 --> 00:24:05.743
not a payment terminal, right?

00:24:05.884 --> 00:24:07.265
That's the Kahneman minute.

00:24:07.285 --> 00:24:09.086
That's the cheapest clinical intervention

00:24:09.125 --> 00:24:11.508
in health care is the peak end effect.

00:24:11.587 --> 00:24:12.509
How you end it.

00:24:13.588 --> 00:24:15.369
The second thing is you find your Maria's.

00:24:16.010 --> 00:24:17.471
Every clinic has one or two.

00:24:18.653 --> 00:24:20.273
They're the names patients write in

00:24:20.314 --> 00:24:20.753
reviews.

00:24:20.913 --> 00:24:21.634
Study them.

00:24:22.355 --> 00:24:24.298
You know, I call it positive deviancy.

00:24:24.357 --> 00:24:25.839
Take those who are the most positive

00:24:25.880 --> 00:24:27.582
deviants, learn about them,

00:24:27.803 --> 00:24:29.424
celebrate them, highlight them.

00:24:29.464 --> 00:24:30.707
They are your exemplars.

00:24:31.367 --> 00:24:32.710
Make them the curriculum.

00:24:32.769 --> 00:24:33.069
Right.

00:24:33.750 --> 00:24:35.814
And then I think the third thing you

00:24:35.854 --> 00:24:37.336
do is you got to change the hiring

00:24:37.355 --> 00:24:38.096
interview a bit.

00:24:38.755 --> 00:24:38.994
You know,

00:24:39.035 --> 00:24:40.595
you got to look at and measure

00:24:40.674 --> 00:24:42.355
accessibility, adaptability,

00:24:42.375 --> 00:24:43.635
emotional intelligence.

00:24:44.855 --> 00:24:45.297
You know,

00:24:45.317 --> 00:24:46.777
what do they understand about

00:24:46.836 --> 00:24:48.037
psychological safety?

00:24:49.597 --> 00:24:50.298
For every, you know,

00:24:50.317 --> 00:24:51.438
look at it in terms of for every

00:24:51.498 --> 00:24:52.758
hour on their resume, right?

00:24:52.798 --> 00:24:54.278
The measure, you know,

00:24:54.298 --> 00:24:56.398
we tend to measure the boring lag numbers,

00:24:56.499 --> 00:24:59.140
rebooking, reactivation, turnover.

00:25:01.059 --> 00:25:02.000
But be the patient.

00:25:02.040 --> 00:25:05.862
Culture compounds and nothing compounds

00:25:05.902 --> 00:25:07.041
faster than culture.

00:25:07.998 --> 00:25:11.821
But you have to combine the rigor and

00:25:11.842 --> 00:25:14.965
the discipline of metrics and KPI to

00:25:15.026 --> 00:25:16.326
humanness and culture.

00:25:17.127 --> 00:25:18.910
And so in our organization,

00:25:18.930 --> 00:25:21.834
it manifests itself with our mission

00:25:21.874 --> 00:25:23.836
vision that we not just put on a

00:25:23.895 --> 00:25:24.476
tagline,

00:25:24.496 --> 00:25:24.797
but we

00:25:25.336 --> 00:25:27.156
build into their job description and

00:25:27.176 --> 00:25:29.258
they're measured and they're valued by it.

00:25:29.778 --> 00:25:32.059
It's based on our amazing customer service

00:25:32.079 --> 00:25:32.420
system.

00:25:32.460 --> 00:25:34.181
It's made to provide our call to care,

00:25:34.201 --> 00:25:35.981
which is system means it's defined,

00:25:36.021 --> 00:25:37.162
it's taught, it's monitored,

00:25:37.221 --> 00:25:38.942
it's rewarded, it's re-engineered.

00:25:39.503 --> 00:25:42.065
You get in business, which you emphasize,

00:25:42.105 --> 00:25:43.665
it's emphasized constantly.

00:25:44.486 --> 00:25:46.567
And then we look at how it has

00:25:46.626 --> 00:25:47.968
impacted the results,

00:25:48.188 --> 00:25:49.368
treatment case acceptance,

00:25:49.469 --> 00:25:50.970
no-show cancellation rates.

00:25:51.630 --> 00:25:53.030
retention rates of dentists,

00:25:53.911 --> 00:25:55.711
how long the dentists are staying in your

00:25:55.832 --> 00:25:56.751
organization,

00:25:57.813 --> 00:25:59.673
and where they become clinically

00:25:59.913 --> 00:26:03.555
autonomous, master, purposeful clinicians,

00:26:03.875 --> 00:26:05.816
but also good leaders and good managers

00:26:05.836 --> 00:26:07.596
and good operators if that's where life

00:26:07.616 --> 00:26:08.037
takes them.

00:26:08.076 --> 00:26:10.838
So you can make these changes in company.

00:26:10.858 --> 00:26:12.659
There's a great Eric...

00:26:14.200 --> 00:26:16.020
reese book that just came out i think

00:26:16.060 --> 00:26:17.961
in may this year jimmy that would be

00:26:18.102 --> 00:26:20.523
uh well he'd be a great he's the

00:26:20.544 --> 00:26:22.125
one who wrote the lean startup and he

00:26:22.144 --> 00:26:24.546
wrote a another book called incorruptible

00:26:24.586 --> 00:26:26.727
and it's about how great companies go bad

00:26:27.488 --> 00:26:31.049
and and uh um not surprisingly when you

00:26:31.069 --> 00:26:33.911
look at uh many of them whole foods

00:26:33.990 --> 00:26:35.711
price warehouse he goes through a whole

00:26:35.751 --> 00:26:36.492
litany of them

00:26:37.133 --> 00:26:38.555
They dropped the cultural elements.

00:26:39.556 --> 00:26:39.676
Yep.

00:26:39.696 --> 00:26:41.138
They sold out the cultural elements.

00:26:41.219 --> 00:26:43.821
And we learn these lessons over and over

00:26:43.882 --> 00:26:44.242
again.

00:26:44.282 --> 00:26:46.306
And yet we never really, you know,

00:26:46.346 --> 00:26:47.688
we never really learn.

00:26:48.228 --> 00:26:49.569
Who knew that history was actually a

00:26:49.589 --> 00:26:50.050
really important.

00:26:50.211 --> 00:26:51.292
It wasn't just fun stories.

00:26:51.894 --> 00:26:52.374
Exactly.

00:26:52.493 --> 00:26:52.734
Yeah.

00:26:53.214 --> 00:26:54.176
Curveball question then.

00:26:55.224 --> 00:26:56.806
If connection drives retention and

00:26:56.826 --> 00:26:57.567
referrals,

00:26:58.047 --> 00:27:00.528
should clinicians actually be compensated

00:27:00.669 --> 00:27:01.990
for being great at it?

00:27:02.049 --> 00:27:03.751
You're saying change the hiring sort of

00:27:03.791 --> 00:27:05.992
rubric and bring people in who are better

00:27:06.034 --> 00:27:07.654
at these soft skills.

00:27:08.115 --> 00:27:11.317
So if we know that that leads to

00:27:11.377 --> 00:27:12.898
retention and referrals,

00:27:13.819 --> 00:27:16.741
would it be good to compensate clinicians

00:27:16.981 --> 00:27:17.923
for being great at it?

00:27:18.282 --> 00:27:19.143
Yeah, a hundred percent.

00:27:19.282 --> 00:27:19.903
You know, I mean,

00:27:19.923 --> 00:27:21.523
it's pretty straightforward in dentistry.

00:27:21.564 --> 00:27:23.345
They are rewarded for it because they get

00:27:23.365 --> 00:27:25.046
a percentage of what they,

00:27:25.445 --> 00:27:26.385
of what they collect.

00:27:27.086 --> 00:27:29.507
And so it's, you know,

00:27:29.547 --> 00:27:32.107
what's their best business move to supply

00:27:32.127 --> 00:27:33.568
a lot of, you know,

00:27:34.489 --> 00:27:35.730
dish out a lot of coffee to a

00:27:35.769 --> 00:27:36.411
lot of patients.

00:27:36.431 --> 00:27:37.652
Well, you do that over time,

00:27:37.672 --> 00:27:38.893
you're not gonna have many patients

00:27:38.932 --> 00:27:39.653
wanting coffee.

00:27:40.073 --> 00:27:42.335
But if you are kind and courteous to

00:27:42.355 --> 00:27:42.875
your patients,

00:27:42.895 --> 00:27:44.457
you drive good empathy and good human

00:27:44.517 --> 00:27:45.438
connection to them,

00:27:45.778 --> 00:27:47.378
they're the ones that drive more referrals

00:27:47.419 --> 00:27:47.818
to you.

00:27:48.200 --> 00:27:52.442
So this isn't just a good for life,

00:27:52.502 --> 00:27:54.463
good for emotion, it's good for business.

00:27:55.744 --> 00:27:58.886
And it drives the training on their

00:27:58.926 --> 00:28:00.548
competency, upskills them.

00:28:00.909 --> 00:28:02.730
So now they're doing bridges rather than

00:28:02.789 --> 00:28:04.951
teeth cleanings, or they're pulling teeth,

00:28:05.010 --> 00:28:06.392
or they're doing restorative work,

00:28:06.451 --> 00:28:07.732
or they're doing orthodontia.

00:28:08.433 --> 00:28:09.855
And they're also having patients who

00:28:09.875 --> 00:28:11.675
they've had good human connection with.

00:28:12.542 --> 00:28:14.144
referring more patients to them,

00:28:14.483 --> 00:28:15.344
friends and family.

00:28:15.765 --> 00:28:16.525
So they go together.

00:28:17.464 --> 00:28:19.767
And you could look at what is,

00:28:20.007 --> 00:28:21.386
if you look in the last fifteen years

00:28:21.426 --> 00:28:22.807
in dentistry, they've actually taken us,

00:28:23.127 --> 00:28:26.170
like physical therapy, cost for inflation,

00:28:26.930 --> 00:28:28.270
their salaries have been reduced.

00:28:29.070 --> 00:28:30.592
But you can reverse that.

00:28:31.172 --> 00:28:33.073
And the way you reduce it is upskilling

00:28:33.252 --> 00:28:35.193
in both clinical skills and human

00:28:35.253 --> 00:28:37.974
compassion, empathy skills as well.

00:28:38.496 --> 00:28:39.016
And guess what?

00:28:39.036 --> 00:28:40.757
You also have providers who are less

00:28:40.797 --> 00:28:41.196
burned out.

00:28:42.304 --> 00:28:43.744
Oh, no.

00:28:43.825 --> 00:28:44.746
Oh, Larry, you knew.

00:28:44.766 --> 00:28:46.105
So maybe healthcare doesn't need another

00:28:46.227 --> 00:28:47.426
optimization strategy.

00:28:47.487 --> 00:28:48.788
Maybe we need to look at what thirty

00:28:48.827 --> 00:28:50.849
years of optimization has actually

00:28:51.170 --> 00:28:51.509
removed.

00:28:51.829 --> 00:28:54.211
What have we optimized and scrubbed away?

00:28:54.932 --> 00:28:56.432
Because it looks like the company of the

00:28:56.472 --> 00:28:58.354
future might not win by becoming less

00:28:58.614 --> 00:28:58.954
human.

00:28:59.015 --> 00:29:00.435
It might win by finally realizing

00:29:00.536 --> 00:29:02.396
humanness, again, love that term,

00:29:02.757 --> 00:29:05.138
was an operating advantage all along.

00:29:05.419 --> 00:29:05.519
Now,

00:29:05.538 --> 00:29:08.000
this is part one of Larry's new five-part

00:29:08.040 --> 00:29:09.480
series, Inside a Platform.

00:29:09.500 --> 00:29:11.041
Make sure to subscribe to The Operator on

00:29:11.182 --> 00:29:11.682
Substack.

00:29:12.223 --> 00:29:13.790
so you don't miss part two and the

00:29:13.830 --> 00:29:14.693
rest of the series.

00:29:14.914 --> 00:29:16.702
Until next time, keep operating.