Your Meetings Are Filtering Out the Truth

WEBVTT

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All right.

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Everybody says healthcare has two

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meetings.

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I feel like too many meetings.

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I feel like every industry has too many

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meetings, right?

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I mean,

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how many times have we muttered this

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meeting could have been an email?

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And in fact, you say at some point,

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this meeting should have been an email.

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In your latest article,

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you say the problem isn't meetings.

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The problem is the meeting stack.

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And when I first read that sort of

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in the beginning of the article,

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I was like, huh.

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I don't even know what my own meeting

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stack is, which is part of the problem.

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And you say somewhere inside a lot of

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growing healthcare platforms,

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you've said this before,

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dashboards are green,

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board decks always look great,

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acquisitions are closing while clinicians

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or these people that are providing the

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care are quietly leaving.

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culture's eroding and nobody in leadership

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sees it until it's in the rear view

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mirror.

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So today we'll look at this thing that

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should be all about culture,

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coming together, a meeting,

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and why the architecture,

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never thought I'd put those two words

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together, meeting architecture,

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inside organizations may be one of the

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most overlooked operating system failures

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or potential failures in multi-site

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growth.

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So you open this article with a regional

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leader who technically isn't lying.

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They're telling the truth,

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but also isn't telling the truth at the

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same time.

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How often do healthcare platforms operate

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inside this gap with what they think

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they're doing, think what is happening,

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but it actually isn't?

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Yeah, before I get to that question,

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which is a key question,

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I want to give you some insights as

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to how I got to this topic of

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meetings.

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For a long time,

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most companies have followed a structure

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and a format to their meetings.

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Pat Linsoni's Five Dysfunctions and Death

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by Meeting,

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those kind of books have led people to

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a structure that is somewhat consistent

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across organizations.

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However,

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The big thing that was thrown at them,

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the curve, was COVID and the pandemic.

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And then what happened to remote work

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environment?

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I know we're going to get into that

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a bit.

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But what I started to see in healthcare

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platforms I was working with or part of

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was the inclusivity in meetings.

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Way too many people,

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way too many meetings,

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and the inefficiency of them.

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And I started then looking in the research

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and saying...

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Has there been any research since the

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pandemic on remote work and meetings and

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meetings in general?

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And man, there's a lot of data.

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So that's what brought me to what I'm

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doing now, which is a series of meetings,

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not only to report on it and what

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the research has to say,

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but also to help improve organizations

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that I'm associated with, for-profits,

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nonprofits, and the like.

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But now you get to the question about

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the regional director who technically

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isn't lying and how often do healthcare

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platforms operate within that gap.

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And the honest answer is every week.

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And almost every multi-site platform that

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I've looked at or visited, that gap,

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technically true but functionally false is

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the default operating state it's not

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malicious it's it's really structural the

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regional vp in the article isn't lying

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she's adapting to a meeting that wasn't

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built to surface what the truth was in

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other words it truth isn't coming out

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because the meeting wasn't structured that

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way she reads the metrics but the meeting

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Because the meeting, what does it do?

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It asks for metrics.

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She doesn't raise the rotting acquisition

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because the meeting hasn't asked her to,

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and there's no clean place for that in

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the agenda in any real material way.

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Now multiply that by twelve regional

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managers, fifty-two weeks a year,

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and you've got a leadership team making

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decisions on information that is mostly

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accurate at the surface,

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but very wrong underneath.

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And meetings are meant to detect what's

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going on underneath.

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The thing that should worry operators is

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not that this happens occasionally,

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It's that it's the steady state or the

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operational infrastructure already going

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on.

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The meeting is the system.

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If the system isn't asking for the truth,

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the truth is what the system stops

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getting.

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Yeah, but it feels comfortable, right?

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I've accomplished this meeting.

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I spent that time.

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So you actually further on,

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you argue meetings are actually the

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operating system.

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You said that before.

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For situational awareness,

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most people think the dashboards are for

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situational awareness.

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So why are dashboards insufficient and

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what should be sort of happening in these

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meetings?

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Yeah,

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I would boil it down to three reasons.

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First,

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the dashboard measures what already

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happened.

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In most cases,

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they're lag measures by design.

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By the time a metric shows up red,

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the bad thing it's measuring has already

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happened, often weeks afterwards.

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Your dashboard will tell you that Mrs.

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Jenkins didn't show up.

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It will not tell you that for four

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more Mrs.

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Jenkins that didn't book this morning,

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you're about to have a no-show problem you

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didn't see.

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Second,

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dashboards have no social enterprise to

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them, no social dimension.

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A clinician in one of the operatories will

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never log her real concern into a

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dashboard.

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She might say it out loud in the

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meeting to the right leader at the right

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moment in a room where she feels safe

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saying it.

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And that's what psychological safety and

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trust,

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which is the core foundation of every

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company, at least what it should be.

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So meetings when they work are how weak

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signals get turned into actionable

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information.

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Dashboards are passive consumptions.

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Meetings are active surfacing.

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What you're trying to do in a meeting

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is create what I call creative abrasion,

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difficult conversations, conflicts,

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things that are not pointed at people,

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but they're situational events.

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In order to do that effectively,

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you have to have a foundation of

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psychological safety.

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Third,

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and this is the one operators very rarely

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think about,

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is that dashboards only show what

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companies have decided to measure by

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virtue of their decisions to measure.

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They tell you exactly nothing about the

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things you didn't know to measure.

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The meeting stack is your only mechanism

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for finding out and surfacing things that

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you didn't know to measure.

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That's what meetings really are

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functionally for.

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most platforms have broken their you know

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have been broken theirs to the point where

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they no longer surface the information

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that you're trying to surface that's what

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the function of a meeting is not to

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tell you what you already know not to

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read a powerpoint not to read a dashboard

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but to unearth things problems grow in

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water like weeds and your job as a

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manager

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is to get the water out of that

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weed so they stop growing.

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The only way you can do it is

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not to pick them from the top,

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but to pick them at the bottom.

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So a dashboard cannot replace a

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conversation.

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It usually replaces it instead.

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And that's what you don't want.

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You make a point about health care in

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a different way that I hadn't thought of

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before,

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which is the floor never went remote.

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We're talking about twenty twenty twenty

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twenty one.

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The floor never went remote,

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but leadership did.

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So did health care accidentally create

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this leadership clinician disconnect

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during covid that also never got repaired?

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We didn't go back.

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Yes, and it has not yet repaired.

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If you think of the most enlightened

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companies in the United States,

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they've all gone back to in-office.

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They may allow you to work from home

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a day or two a week,

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some less than that.

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And then, oddly enough,

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in healthcare platforms, DSOs,

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behavioral health, dermatology,

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ophthalmology,

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the leadership in the front office went

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remote.

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I think that's symbolically wrong.

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I don't like it.

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I've worked in both environments,

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and my personal belief is if the

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clinician's got to be in the clinic,

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so do the officers,

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and so do those around.

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And so it hasn't repaired.

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The math is simple.

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The floor never did go remote.

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Patients still show up.

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Clinicians are still gowning up,

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putting their stuff on,

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and the front desk is there.

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The corporate, regional,

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and operational backbone largely did not.

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I mean,

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Cleveland Clinic alone is something like,

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I don't know,

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eighty-one hundred non-clinical employees

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classified as remote or hybrid.

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Most multi-site platforms, dental,

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primary care run a similar split.

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So you have, and by the way,

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it's very difficult to uncrack that egg.

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Financial service companies, others did,

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but for whatever reason,

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healthcare platforms have it.

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So what you have is the most consequential

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structural shift in healthcare leadership

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in over fifty years.

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And it happened by accident in a pandemic.

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It's a hangover.

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or an effect from the pandemic,

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nobody designed for it.

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So this disconnect doesn't show up in the

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kind of metrics that reach boards.

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It shows up in turnover intentions,

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in the energy of clinical leadership

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pipelines,

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in young folks not getting appropriate

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bump around factor in mentoring.

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And it's how you're trying to recruit.

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The nursing research out of a journal

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called OJIN names visibility as the single

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biggest barrier remote leaders create for

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clinical staff.

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The floor is not asking for a fully

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co-located leader.

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The floor is asking for a leader who

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shows up like the work matters.

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In most healthcare platforms,

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the signal is not being sent and the

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cultural debt is compounding every quarter

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we don't fix it.

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There was recently an unpublished study,

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but largely making its way through the

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circles,

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where remote revenue cycle management

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workers,

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once software was put on their keyboard,

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is showing that they're only working about

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fifty percent of the time.

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We've now taking the luxury of flexibility

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as the priority for your workforce rather

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than getting things done.

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You talk about something that people

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notice and maybe have never said out loud,

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but you see it when it's there.

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Camera off,

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someone clearly multitasking during a

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meeting,

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someone checking their watch or checking

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that clock.

00:10:00.922 --> 00:10:01.981
We all know where the clock is,

00:10:02.522 --> 00:10:05.082
top right corner on a computer.

00:10:06.942 --> 00:10:09.583
What are clinicians reading and feeling

00:10:10.464 --> 00:10:11.984
when leadership shows up,

00:10:12.104 --> 00:10:14.065
we'll say poorly in meetings, which is,

00:10:15.453 --> 00:10:16.815
Is the goal of the meeting to get

00:10:16.835 --> 00:10:19.154
it done or is it to achieve something?

00:10:19.174 --> 00:10:21.096
A lot of times I feel like clinicians

00:10:21.196 --> 00:10:22.677
read it's to get it done.

00:10:22.876 --> 00:10:24.517
So what are they reading?

00:10:25.298 --> 00:10:25.518
Yeah,

00:10:26.238 --> 00:10:27.977
they are reading a few specific things and

00:10:27.998 --> 00:10:29.438
they're reading them faster than

00:10:29.499 --> 00:10:30.438
leadership knows.

00:10:30.458 --> 00:10:31.038
They're reading,

00:10:31.078 --> 00:10:33.220
this person doesn't know what Wednesday

00:10:33.360 --> 00:10:35.681
afternoon in operatory three is actually

00:10:35.701 --> 00:10:36.260
looking like.

00:10:36.280 --> 00:10:36.780
They're reading,

00:10:37.142 --> 00:10:38.721
this leader is multitasking,

00:10:38.741 --> 00:10:40.582
which means this work is not important to

00:10:40.623 --> 00:10:40.802
them.

00:10:41.363 --> 00:10:41.863
They're reading,

00:10:41.903 --> 00:10:43.904
my concerns are not going to be heard,

00:10:43.965 --> 00:10:44.785
so why raise them?

00:10:44.826 --> 00:10:47.107
And they are reading the medium itself.

00:10:47.128 --> 00:10:49.409
They could not even be bothered to drive

00:10:49.450 --> 00:10:49.669
here.

00:10:49.990 --> 00:10:51.691
So when you have hybrid meetings with

00:10:51.730 --> 00:10:53.773
clinicians and non-clinicians in a remote

00:10:53.812 --> 00:10:55.674
work environment, it is really,

00:10:55.715 --> 00:10:56.495
really difficult.

00:10:56.554 --> 00:10:56.676
Now,

00:10:56.716 --> 00:10:58.996
there are some ways you can mitigate that.

00:10:59.957 --> 00:11:01.839
I believe human beings are now sort of,

00:11:01.999 --> 00:11:04.480
you know, task to multitask.

00:11:04.940 --> 00:11:06.039
If you're going to multitask,

00:11:06.080 --> 00:11:07.461
have it benefit everybody.

00:11:07.921 --> 00:11:09.662
And so while somebody is speaking,

00:11:09.802 --> 00:11:12.383
it's okay to have ongoing chat going on

00:11:13.182 --> 00:11:15.504
because you're adding to the value of

00:11:15.563 --> 00:11:16.163
everybody.

00:11:16.443 --> 00:11:18.044
If you're not having ongoing chat,

00:11:18.085 --> 00:11:19.825
you're on your own chat on your own

00:11:19.846 --> 00:11:20.745
phone texting.

00:11:21.721 --> 00:11:23.001
And that is bad.

00:11:23.022 --> 00:11:26.082
So use multitasking to benefit folks,

00:11:26.143 --> 00:11:27.462
not to distract them.

00:11:28.082 --> 00:11:29.004
And another point,

00:11:29.344 --> 00:11:30.443
when you're reading these,

00:11:31.644 --> 00:11:33.706
people are seeing what you're doing in

00:11:33.785 --> 00:11:36.046
meetings, which is not paying attention,

00:11:36.366 --> 00:11:38.827
these signals are actually occurring

00:11:38.888 --> 00:11:39.528
consciously.

00:11:39.788 --> 00:11:43.369
It's not in an explicit way,

00:11:44.409 --> 00:11:45.669
but in a global sense,

00:11:45.970 --> 00:11:49.071
this leadership it's saying is not serious

00:11:49.211 --> 00:11:50.152
about clinical work.

00:11:50.652 --> 00:11:51.812
And once that is formed,

00:11:51.832 --> 00:11:53.894
it's almost impossible to undo.

00:11:54.475 --> 00:11:56.557
So the clinician who's in OPT-IV who has

00:11:56.618 --> 00:11:58.879
never met the COO in person has already

00:11:58.940 --> 00:11:59.880
formed an opinion.

00:12:00.201 --> 00:12:01.283
They are distanced.

00:12:01.342 --> 00:12:02.543
There's a latency here.

00:12:03.105 --> 00:12:03.565
And by the way,

00:12:03.605 --> 00:12:05.466
most of these opinions are correct.

00:12:05.527 --> 00:12:07.048
Almost none of them are flattering.

00:12:08.509 --> 00:12:10.611
so this is the cost of brokley meeting

00:12:11.072 --> 00:12:13.833
cadence is in a multi-site platform one of

00:12:13.854 --> 00:12:18.397
the things i do is i have my

00:12:19.017 --> 00:12:21.678
ai of choice geared up to be an

00:12:21.859 --> 00:12:24.620
expert in executive coaching time

00:12:24.660 --> 00:12:27.984
management efficiency and based in steeped

00:12:28.024 --> 00:12:30.345
in research what is the most effective

00:12:30.686 --> 00:12:33.668
schedule for a ceo in an organization

00:12:34.187 --> 00:12:36.188
And they are constantly scanning my

00:12:36.249 --> 00:12:37.909
calendar four weeks in a rare,

00:12:38.070 --> 00:12:40.009
one day in a rare, three weeks forward,

00:12:40.049 --> 00:12:41.990
two weeks forward, two days forward,

00:12:42.551 --> 00:12:45.591
and then giving me real-time updates daily

00:12:46.072 --> 00:12:48.793
whether I'm spending time effectively,

00:12:48.874 --> 00:12:50.793
not efficiently, but effectively.

00:12:51.294 --> 00:12:53.054
And what I found when I started doing

00:12:53.095 --> 00:12:55.275
this is that most of the time I

00:12:55.296 --> 00:12:56.937
was being incredibly inefficient.

00:12:56.956 --> 00:12:57.456
And why?

00:12:57.677 --> 00:12:59.418
Too many meetings with too many people

00:12:59.697 --> 00:13:01.317
about too many things that don't matter

00:13:01.519 --> 00:13:02.558
and that don't move the needle.

00:13:03.222 --> 00:13:04.224
So you were using that tool,

00:13:04.244 --> 00:13:05.504
and it was scanning with the purpose of

00:13:05.524 --> 00:13:06.787
the meeting, who was there,

00:13:07.206 --> 00:13:09.089
and it was looking backwards to say,

00:13:09.629 --> 00:13:11.630
did what we do four weeks ago accomplish

00:13:12.011 --> 00:13:12.932
what the goal was?

00:13:13.052 --> 00:13:15.355
And it's able to give you real-time or

00:13:15.615 --> 00:13:17.017
in-time recommendations of what to do

00:13:17.177 --> 00:13:17.758
forward.

00:13:18.217 --> 00:13:18.759
Absolutely.

00:13:18.778 --> 00:13:20.299
It's a daily report I get.

00:13:20.399 --> 00:13:20.701
Wow.

00:13:21.437 --> 00:13:21.616
All right,

00:13:21.657 --> 00:13:23.618
so a lot of operators are doing this,

00:13:23.658 --> 00:13:23.837
though.

00:13:23.878 --> 00:13:25.339
If they're not using a tool like that,

00:13:25.739 --> 00:13:28.139
they're adding dashboards because if

00:13:28.200 --> 00:13:29.980
something's broken, add something to it.

00:13:30.221 --> 00:13:33.142
They're adding meetings or wiping them off

00:13:33.162 --> 00:13:34.861
the schedule altogether.

00:13:35.383 --> 00:13:38.203
Why are all three of those usually wrong?

00:13:39.303 --> 00:13:40.684
Yeah, so the way I look at it,

00:13:40.804 --> 00:13:42.946
all three of those are symptoms that the

00:13:43.426 --> 00:13:46.267
meeting stack is broken and they're red

00:13:46.307 --> 00:13:46.846
herrings.

00:13:47.086 --> 00:13:48.488
They're not fixes for it.

00:13:49.607 --> 00:13:50.589
Adding dashboard,

00:13:50.629 --> 00:13:52.951
the assumption is that the problem is data

00:13:53.110 --> 00:13:53.971
visibility.

00:13:54.030 --> 00:13:54.871
The problem, by the way,

00:13:54.892 --> 00:13:56.013
isn't data anymore.

00:13:56.052 --> 00:13:56.613
We used to say, oh,

00:13:56.633 --> 00:13:57.313
we need more data.

00:13:57.333 --> 00:13:57.813
We need more.

00:13:57.854 --> 00:13:58.955
We have plenty of data now.

00:13:58.975 --> 00:13:59.895
We have too much data.

00:14:00.395 --> 00:14:01.636
What we need is insights.

00:14:02.177 --> 00:14:04.239
And then we need actions from those

00:14:04.298 --> 00:14:04.778
insights.

00:14:05.220 --> 00:14:07.260
The problem was never about data

00:14:07.301 --> 00:14:08.081
visibility.

00:14:08.601 --> 00:14:09.702
The data was visible.

00:14:09.743 --> 00:14:12.164
But what was missing was the conversation

00:14:12.304 --> 00:14:14.407
about what the data meant in a room

00:14:14.447 --> 00:14:15.927
full of people who act on it.

00:14:16.427 --> 00:14:18.208
A new dashboard doesn't create that

00:14:18.249 --> 00:14:18.950
conversation.

00:14:18.970 --> 00:14:21.530
And most platform, it displaces it.

00:14:22.491 --> 00:14:23.292
Adding meetings.

00:14:23.371 --> 00:14:25.212
Now you're at forty five hours of meetings

00:14:25.253 --> 00:14:25.533
a week.

00:14:25.573 --> 00:14:27.375
The same metrics are being walked through

00:14:27.434 --> 00:14:29.735
five different ways and nobody can tell

00:14:29.755 --> 00:14:31.116
you what a single meeting is for.

00:14:31.397 --> 00:14:33.038
How many times if you ever worked in

00:14:33.077 --> 00:14:35.119
an office at any point during your career,

00:14:35.158 --> 00:14:36.740
did a meeting start on a half hour

00:14:36.860 --> 00:14:38.061
and on a half hour and a new

00:14:38.100 --> 00:14:40.422
meeting started immediately with no time

00:14:40.482 --> 00:14:42.102
in between to chat with people or to

00:14:42.163 --> 00:14:42.903
talk with people?

00:14:43.663 --> 00:14:44.485
never happens.

00:14:45.085 --> 00:14:46.807
And so Microsoft's data, by the way,

00:14:46.826 --> 00:14:48.548
on this is what they call the infinite

00:14:48.589 --> 00:14:48.928
workday.

00:14:49.009 --> 00:14:50.990
I love this concept that Microsoft came up

00:14:51.010 --> 00:14:51.150
with.

00:14:51.630 --> 00:14:52.792
Meetings have tripled.

00:14:53.590 --> 00:14:55.451
Since two thousand twenty triple

00:14:55.971 --> 00:14:58.292
executives at nineteen plus hours of weeks

00:14:58.412 --> 00:14:59.011
of meetings,

00:14:59.491 --> 00:15:01.472
the workforce interrupted an average of

00:15:01.592 --> 00:15:02.552
every two minutes.

00:15:03.092 --> 00:15:04.114
How are they interrupted?

00:15:04.274 --> 00:15:06.774
Slack, chat, text,

00:15:07.235 --> 00:15:09.176
all of these ways that bombard you.

00:15:09.615 --> 00:15:12.236
That's a chart for failure at industrial

00:15:12.557 --> 00:15:13.057
scale,

00:15:13.157 --> 00:15:14.778
which is what health care platforms are

00:15:14.878 --> 00:15:14.998
at.

00:15:15.658 --> 00:15:16.558
cutting meetings,

00:15:16.818 --> 00:15:18.779
the platform feels lighter for about a

00:15:18.820 --> 00:15:20.221
quarter, then the decision,

00:15:20.900 --> 00:15:23.263
stop getting made cleanly accountability

00:15:23.342 --> 00:15:25.303
erodes and the truth stops surfacing

00:15:25.344 --> 00:15:27.664
because you decided to deleted venues

00:15:27.705 --> 00:15:28.525
where it could be said,

00:15:28.946 --> 00:15:30.787
now you're running a multi site platform.

00:15:31.206 --> 00:15:32.629
on a hundred and fifty-three Teams

00:15:32.688 --> 00:15:34.591
messages or Slack channels,

00:15:34.650 --> 00:15:36.453
and a hundred and seventeen emails per day

00:15:36.494 --> 00:15:37.014
per leader.

00:15:37.754 --> 00:15:40.097
And also Microsoft's numbers, by the way,

00:15:40.138 --> 00:15:42.000
with no shared room in which any of

00:15:42.039 --> 00:15:43.481
those threads are ever resolved in

00:15:43.522 --> 00:15:44.003
decision.

00:15:44.102 --> 00:15:44.923
Microsoft's data,

00:15:44.964 --> 00:15:46.546
a hundred and fifty-three Teams messages,

00:15:46.846 --> 00:15:48.566
hundred and seventeen emails per day per

00:15:48.586 --> 00:15:48.826
leader.

00:15:49.167 --> 00:15:50.346
The actual fix, by the way,

00:15:50.366 --> 00:15:50.907
is none of them.

00:15:50.947 --> 00:15:53.748
It's redesigning the meeting stack so that

00:15:53.868 --> 00:15:57.149
each meeting has one specific job and is

00:15:57.188 --> 00:15:59.809
held accountable for one specific job.

00:16:00.210 --> 00:16:01.750
And a lot of that specific job is

00:16:01.950 --> 00:16:04.591
unearthing things that's harder than any

00:16:04.630 --> 00:16:06.731
of the three reactions above,

00:16:06.751 --> 00:16:08.711
which have been the default operating mode

00:16:09.032 --> 00:16:11.432
since we've been in the recovery post

00:16:11.472 --> 00:16:11.952
pandemic.

00:16:12.437 --> 00:16:14.058
So you say most platforms are doing this.

00:16:14.078 --> 00:16:17.100
They're running the same meeting four ways

00:16:17.162 --> 00:16:18.302
and thinking they're getting four things,

00:16:18.322 --> 00:16:18.783
but they're not.

00:16:19.182 --> 00:16:21.904
What does a broken meeting stack actually

00:16:21.924 --> 00:16:25.528
look like in healthcare?

00:16:25.567 --> 00:16:26.227
Some examples.

00:16:26.307 --> 00:16:28.330
A broken stack looks at four different

00:16:28.350 --> 00:16:30.571
meetings with four different audiences all

00:16:30.610 --> 00:16:32.352
doing the one job, reviewing,

00:16:32.692 --> 00:16:34.634
trailing financial metrics, which,

00:16:34.673 --> 00:16:35.075
by the way,

00:16:35.115 --> 00:16:37.437
could be done on a three-minute Loom video

00:16:37.476 --> 00:16:39.538
recording or a stream on Microsoft or

00:16:39.597 --> 00:16:40.298
something like that.

00:16:41.363 --> 00:16:42.344
The daily huddle,

00:16:42.484 --> 00:16:43.445
instead of being a huddle,

00:16:43.485 --> 00:16:44.826
becomes a metrics dump.

00:16:44.865 --> 00:16:45.886
This much cancellation,

00:16:45.907 --> 00:16:47.207
this many patients are scheduled.

00:16:47.227 --> 00:16:48.408
This is what's going on here.

00:16:48.668 --> 00:16:50.870
The weekly tactical becomes a dashboard

00:16:50.929 --> 00:16:51.471
recital.

00:16:51.850 --> 00:16:53.211
You're just reciting data.

00:16:53.552 --> 00:16:55.874
The monthly strategic becomes a slide deck

00:16:55.913 --> 00:17:00.057
parade where decisions are pre-baked from

00:17:00.097 --> 00:17:01.678
the one-on-one somebody ran with each

00:17:01.719 --> 00:17:03.100
board member earlier that week.

00:17:03.320 --> 00:17:04.980
And the beauty now, we have tools.

00:17:05.280 --> 00:17:07.582
We can take our recorded meetings and we

00:17:07.622 --> 00:17:09.201
could put them in a database and have

00:17:09.241 --> 00:17:10.623
it give us feedback on how we're

00:17:10.663 --> 00:17:11.643
performing in those meetings.

00:17:12.022 --> 00:17:13.223
Not as a way to monitor,

00:17:13.544 --> 00:17:15.763
but as a way to instruct to make

00:17:15.804 --> 00:17:17.644
things more effective at unearthing

00:17:17.704 --> 00:17:18.545
conversations.

00:17:19.006 --> 00:17:19.925
So four meetings,

00:17:20.046 --> 00:17:21.586
one job performed at four different

00:17:21.605 --> 00:17:22.606
production values.

00:17:23.027 --> 00:17:25.228
All of those things really are not

00:17:25.268 --> 00:17:26.708
supposed to be that way.

00:17:27.188 --> 00:17:28.588
And here's what they're supposed to be

00:17:28.628 --> 00:17:28.788
like.

00:17:28.808 --> 00:17:30.048
Here's what each tier is.

00:17:30.128 --> 00:17:31.329
So you have the daily huddle.

00:17:31.809 --> 00:17:34.872
The job of the daily huddle is situational

00:17:34.932 --> 00:17:35.511
awareness.

00:17:36.011 --> 00:17:37.413
You know, what is going on?

00:17:37.492 --> 00:17:39.594
Where am I at in space?

00:17:39.634 --> 00:17:41.234
If I'm a pilot, you know,

00:17:41.255 --> 00:17:43.154
what is my altitude?

00:17:43.476 --> 00:17:45.036
It's the only meeting where the floor can

00:17:45.076 --> 00:17:45.757
talk back.

00:17:46.136 --> 00:17:46.797
Think about that.

00:17:46.896 --> 00:17:48.438
You have a daily huddle at the floor.

00:17:48.478 --> 00:17:49.838
It's the only one where they get to

00:17:49.858 --> 00:17:50.878
provide feedback.

00:17:51.219 --> 00:17:53.119
And the single question that should be

00:17:53.259 --> 00:17:54.500
answered every morning is,

00:17:54.800 --> 00:17:57.082
what does anyone in this room know that

00:17:57.853 --> 00:17:58.693
we need to know,

00:17:58.794 --> 00:18:00.195
that I don't know as a leader,

00:18:00.455 --> 00:18:02.038
that I need to know before we open

00:18:02.057 --> 00:18:02.518
the clinic.

00:18:02.577 --> 00:18:05.541
Tell me things where my blind spots are.

00:18:06.088 --> 00:18:07.670
What aren't we seeing that we should be

00:18:07.730 --> 00:18:08.829
seeing and addressing?

00:18:09.170 --> 00:18:10.590
That's a really good question.

00:18:10.951 --> 00:18:13.031
And it's not the question that people ask

00:18:13.071 --> 00:18:15.032
because it's easier to recite data.

00:18:15.593 --> 00:18:17.594
The weekly tactical would be the second

00:18:17.614 --> 00:18:17.913
meeting.

00:18:18.454 --> 00:18:21.536
This is for week to week execution.

00:18:21.675 --> 00:18:23.156
In Lansoni's framework,

00:18:23.217 --> 00:18:24.896
it's a forty five to ninety minute

00:18:25.337 --> 00:18:25.657
meeting,

00:18:25.817 --> 00:18:27.378
a lightning round of leadership

00:18:27.419 --> 00:18:28.078
priorities,

00:18:28.179 --> 00:18:29.859
four to six leading indicators,

00:18:30.319 --> 00:18:32.260
then a real time agenda built in the

00:18:32.300 --> 00:18:32.580
room.

00:18:33.020 --> 00:18:34.061
If there's not an agenda,

00:18:34.102 --> 00:18:34.942
don't build it there.

00:18:35.262 --> 00:18:37.644
Strategic topics get parked.

00:18:37.785 --> 00:18:39.267
They get put on a shelf for the

00:18:39.307 --> 00:18:39.987
later meeting.

00:18:40.327 --> 00:18:41.469
Decisions walk out.

00:18:41.509 --> 00:18:43.349
That's the weekly tactical meeting.

00:18:43.750 --> 00:18:45.071
A barometer of sorts.

00:18:45.291 --> 00:18:46.232
Execution.

00:18:46.833 --> 00:18:48.154
What do you need support in?

00:18:48.555 --> 00:18:50.056
What are you doing that we need to

00:18:50.135 --> 00:18:50.737
know about?

00:18:50.797 --> 00:18:52.038
That's what a tactical is.

00:18:52.438 --> 00:18:54.119
Then you have a monthly strategic.

00:18:54.160 --> 00:18:55.121
This is the third meeting.

00:18:55.141 --> 00:18:56.261
Remember, we had the daily huddle.

00:18:56.622 --> 00:18:59.023
weekly tactical the monthly strategic

00:18:59.064 --> 00:19:01.185
where the platform's hardest questions get

00:19:01.246 --> 00:19:04.548
debated creative abrasion two or three

00:19:04.587 --> 00:19:07.430
topics don't do any more than that written

00:19:07.490 --> 00:19:10.432
narrative memos not slide decks you know

00:19:10.512 --> 00:19:13.494
not death by powerpoint real conflict real

00:19:13.634 --> 00:19:15.936
uncomfortable conversation that's where

00:19:16.017 --> 00:19:18.419
real decisions get made they're not

00:19:18.479 --> 00:19:21.361
pre-baked that gets you to consensus and

00:19:21.401 --> 00:19:21.981
commitment

00:19:22.846 --> 00:19:24.887
whether that decision was made in your

00:19:24.928 --> 00:19:26.907
favor or not is irrespective.

00:19:27.469 --> 00:19:28.808
You stated your point,

00:19:29.848 --> 00:19:31.809
made a decision and went on with it.

00:19:32.569 --> 00:19:35.030
And then the fourth meeting is, you know,

00:19:35.050 --> 00:19:36.092
you call it a lot of things.

00:19:36.172 --> 00:19:37.832
Most people now call it in all hands.

00:19:38.092 --> 00:19:39.292
That's a culture meeting.

00:19:39.492 --> 00:19:40.853
That's a transmission meeting.

00:19:41.673 --> 00:19:43.094
At least a quarter of the meetings in

00:19:43.153 --> 00:19:44.795
real Q and A. In other words,

00:19:44.815 --> 00:19:47.096
your culture meeting is allowing your

00:19:47.135 --> 00:19:48.996
people in a town hall to ask questions,

00:19:49.375 --> 00:19:50.836
not pre-screened questions.

00:19:51.497 --> 00:19:53.980
real questions with honest answers that

00:19:54.019 --> 00:19:55.441
are hard questions where they see

00:19:55.500 --> 00:19:57.442
vulnerability and they see emotion and

00:19:57.462 --> 00:19:59.986
they see reactions it's not necessarily

00:20:00.165 --> 00:20:01.968
audience approved content this is not a

00:20:02.028 --> 00:20:04.529
g-rated you know meeting it's clinical

00:20:04.589 --> 00:20:06.471
issues for clinicians and operational

00:20:06.551 --> 00:20:07.712
issues for operators

00:20:08.334 --> 00:20:10.434
If each meeting does its specific job

00:20:10.474 --> 00:20:12.395
within that framework of that stack of

00:20:12.435 --> 00:20:14.257
four meetings, it works.

00:20:14.297 --> 00:20:16.097
If any one meeting is doing trying to

00:20:16.498 --> 00:20:18.919
accomplish what another meeting's tactical

00:20:19.138 --> 00:20:19.920
intention is,

00:20:20.420 --> 00:20:21.681
then you're degrading all four.

00:20:23.201 --> 00:20:24.821
You introduced this napkin test.

00:20:25.803 --> 00:20:27.564
So here's a fun exercise.

00:20:27.644 --> 00:20:30.125
If someone listening right now paused this

00:20:30.244 --> 00:20:32.846
episode right now and audited their

00:20:32.885 --> 00:20:34.126
calendar for tomorrow,

00:20:34.666 --> 00:20:37.348
what would or what should scare them on

00:20:37.368 --> 00:20:37.929
their calendar?

00:20:38.237 --> 00:20:38.457
Yeah,

00:20:38.477 --> 00:20:40.137
the thing that would scare them is how

00:20:40.218 --> 00:20:42.078
few meetings that they attend on their

00:20:42.119 --> 00:20:44.500
calendar pass all four questions.

00:20:45.201 --> 00:20:46.501
The test runs like this.

00:20:46.541 --> 00:20:48.503
For every recurring meeting,

00:20:48.523 --> 00:20:49.864
you answer four questions.

00:20:50.565 --> 00:20:51.746
What is this meeting for?

00:20:52.885 --> 00:20:54.067
What does it decide?

00:20:55.307 --> 00:20:58.390
What would specifically not be discussed

00:20:58.430 --> 00:20:58.670
there?

00:20:58.710 --> 00:20:59.069
In other words,

00:20:59.109 --> 00:21:01.112
what rabbit trails are you not going to

00:21:01.152 --> 00:21:01.612
go down?

00:21:02.031 --> 00:21:03.732
What would happen if the meeting didn't

00:21:04.034 --> 00:21:04.594
exist?

00:21:05.454 --> 00:21:07.076
The first question, what is it for?

00:21:08.156 --> 00:21:10.598
Most operators can answer at the service.

00:21:10.719 --> 00:21:11.700
It's the ops review.

00:21:11.960 --> 00:21:15.282
But push hard on the specific job and

00:21:15.324 --> 00:21:16.644
those answers blur.

00:21:17.125 --> 00:21:19.807
Situational awareness, tactical execution,

00:21:19.847 --> 00:21:21.249
strategic deliberation,

00:21:21.729 --> 00:21:23.971
often two or three of those at once,

00:21:23.990 --> 00:21:26.713
which means the meeting is failing at all

00:21:26.753 --> 00:21:27.153
of them.

00:21:27.694 --> 00:21:29.115
One other question about that first

00:21:29.155 --> 00:21:30.237
question I like to answer is,

00:21:30.356 --> 00:21:32.598
are decisions being made at its most local

00:21:32.659 --> 00:21:32.898
level?

00:21:33.779 --> 00:21:36.561
If it's an operating clinical decision at

00:21:36.582 --> 00:21:37.642
a local clinic,

00:21:38.423 --> 00:21:40.083
is a question trying to be answered by

00:21:40.123 --> 00:21:41.144
the executive team?

00:21:41.284 --> 00:21:41.784
If so,

00:21:41.864 --> 00:21:44.746
that is transmitted and escalated to a

00:21:44.806 --> 00:21:47.106
level that on the surface does not make

00:21:47.146 --> 00:21:48.048
any sense.

00:21:48.907 --> 00:21:50.750
The second question, what does it decide,

00:21:51.151 --> 00:21:53.373
is really where it gets uncomfortable.

00:21:53.492 --> 00:21:55.015
Most recurring meetings don't decide

00:21:55.075 --> 00:21:55.455
anything.

00:21:55.655 --> 00:21:56.817
They just discuss things.

00:21:56.856 --> 00:21:57.397
They align.

00:21:57.417 --> 00:21:57.939
They review.

00:21:57.979 --> 00:21:58.759
They don't decide.

00:21:59.279 --> 00:22:00.922
A meeting that doesn't decide anything is

00:22:01.001 --> 00:22:02.983
a status broadcast meeting.

00:22:03.545 --> 00:22:05.027
It's a pretender.

00:22:05.047 --> 00:22:06.489
It's just pretending to be a meeting.

00:22:07.317 --> 00:22:08.278
The third question,

00:22:08.317 --> 00:22:10.298
what specifically should not be discussed

00:22:10.318 --> 00:22:11.720
here is the idea that you don't go

00:22:11.740 --> 00:22:12.680
down rabbit holes.

00:22:12.720 --> 00:22:15.540
It's contextual separation.

00:22:15.601 --> 00:22:16.981
You can't name what doesn't belong.

00:22:17.021 --> 00:22:18.882
You haven't separated it from the other

00:22:18.902 --> 00:22:20.343
meetings in the stack.

00:22:20.363 --> 00:22:22.403
And then the fourth question is the one

00:22:22.423 --> 00:22:24.384
that produces the most uncomfortable

00:22:24.584 --> 00:22:25.025
answers.

00:22:25.585 --> 00:22:27.204
For a startling number of recurring

00:22:27.244 --> 00:22:27.605
meetings,

00:22:27.625 --> 00:22:30.226
the honest answer to what happens if this

00:22:30.286 --> 00:22:31.787
meeting didn't exist.

00:22:32.247 --> 00:22:34.347
If the honest answer is nothing,

00:22:35.410 --> 00:22:36.891
or would people be relieved,

00:22:36.991 --> 00:22:38.853
or the conversation would happen anyhow

00:22:38.873 --> 00:22:40.555
between the two people who actually needed

00:22:40.595 --> 00:22:41.955
to talk, then you don't need the meeting.

00:22:42.836 --> 00:22:44.979
And so if an operator runs that exercise

00:22:45.118 --> 00:22:46.140
on tomorrow's calendar,

00:22:46.160 --> 00:22:48.362
those four questions, that napkin test,

00:22:48.663 --> 00:22:50.023
you'll find that most of their week is

00:22:50.183 --> 00:22:51.365
operated in a fog.

00:22:51.925 --> 00:22:54.067
It's dressed up in not operational

00:22:54.127 --> 00:22:54.688
discipline,

00:22:54.728 --> 00:22:56.869
but in meetings that just consume

00:22:56.910 --> 00:22:58.070
calendars, and it's just scary.

00:22:58.771 --> 00:22:59.771
The good news, though,

00:22:59.852 --> 00:23:01.593
and the good news is it's fixable.

00:23:01.992 --> 00:23:03.732
Hire a meeting czar.

00:23:04.053 --> 00:23:06.354
Assign one person per each one of those

00:23:06.394 --> 00:23:08.233
meetings to stay on track of those

00:23:08.294 --> 00:23:08.713
meetings.

00:23:09.013 --> 00:23:10.294
A benevolent dictator.

00:23:10.574 --> 00:23:11.815
And when they get off track,

00:23:12.015 --> 00:23:13.775
they have full authority and power,

00:23:13.815 --> 00:23:15.474
regardless of their title or where they're

00:23:15.535 --> 00:23:18.976
at on the bureaucratic hierarchy,

00:23:19.375 --> 00:23:21.176
to intervene and stop it.

00:23:21.497 --> 00:23:22.876
And that's what good companies do.

00:23:23.887 --> 00:23:24.768
Final hard question.

00:23:25.587 --> 00:23:28.068
Can a platform scale faster than its

00:23:28.148 --> 00:23:30.148
meeting stack?

00:23:30.209 --> 00:23:32.109
Could the meeting stack possibly be a

00:23:32.170 --> 00:23:32.890
limiting factor?

00:23:33.750 --> 00:23:33.970
No,

00:23:33.990 --> 00:23:35.371
and this is one of the most important

00:23:35.411 --> 00:23:37.671
things I've come to believe about

00:23:38.050 --> 00:23:39.310
multi-site platforms.

00:23:39.750 --> 00:23:42.832
The meeting stack is the platform's eyes

00:23:42.852 --> 00:23:43.291
and ears.

00:23:43.672 --> 00:23:45.992
It is a system by which leadership knows

00:23:46.032 --> 00:23:48.853
what's happening across a footprint that

00:23:48.873 --> 00:23:50.913
they can't personally cover.

00:23:51.413 --> 00:23:53.034
If you grow from twenty sites to eighty

00:23:53.054 --> 00:23:54.654
without redesigning the stack,

00:23:55.115 --> 00:23:57.255
you're running an eighty site platform

00:23:57.275 --> 00:23:59.016
with twenty site nervous system.

00:23:59.355 --> 00:24:00.195
You can't see anymore.

00:24:00.236 --> 00:24:01.256
You're operating blind.

00:24:01.296 --> 00:24:02.557
And so if you have a hundred clinics,

00:24:02.576 --> 00:24:04.037
you should have a hundred daily huddles,

00:24:04.656 --> 00:24:04.916
right?

00:24:05.396 --> 00:24:07.837
And a lot of times that discipline, well,

00:24:07.857 --> 00:24:08.678
we'll just, you know,

00:24:08.738 --> 00:24:10.459
not have these new clinics do the daily

00:24:10.499 --> 00:24:11.239
huddle for a while.

00:24:11.519 --> 00:24:12.499
We won't have, you know,

00:24:12.538 --> 00:24:13.679
the leader of that clinic,

00:24:13.719 --> 00:24:16.740
the clinic manager, the doctor show up.

00:24:17.099 --> 00:24:18.619
No, that's absolutely wrong.

00:24:18.660 --> 00:24:20.040
You absolutely have to have the

00:24:20.101 --> 00:24:20.621
discipline.

00:24:21.060 --> 00:24:21.701
around that.

00:24:22.402 --> 00:24:27.445
A PE-backed healthcare would have a

00:24:27.506 --> 00:24:29.688
specific version of this problem,

00:24:30.107 --> 00:24:31.348
especially when you're buying clinics

00:24:31.388 --> 00:24:32.609
faster than you can do it.

00:24:33.211 --> 00:24:36.673
And it becomes crazy because you start to

00:24:36.712 --> 00:24:38.815
say integration doesn't go well.

00:24:38.855 --> 00:24:39.075
Well,

00:24:39.154 --> 00:24:40.717
integration oftentimes doesn't go well

00:24:40.737 --> 00:24:42.218
because you don't have a meeting stack

00:24:42.258 --> 00:24:43.979
that supports integration.

00:24:44.318 --> 00:24:45.380
You're integrating payroll,

00:24:45.400 --> 00:24:46.681
you're integrating all kinds of things,

00:24:46.701 --> 00:24:48.102
but nobody is sitting back trying to

00:24:48.222 --> 00:24:48.583
unearth.

00:24:48.883 --> 00:24:50.483
and trying to get to its most local

00:24:50.523 --> 00:24:51.743
level to provide feedback.

00:24:52.403 --> 00:24:53.503
A good useful rule,

00:24:53.544 --> 00:24:55.785
which I've not seen anyone in healthcare

00:24:55.805 --> 00:24:57.925
write down is every time your site count

00:24:57.965 --> 00:24:59.625
crosses a meaningful threshold,

00:24:59.685 --> 00:25:01.606
twenty-five sites, fifty sites, a hundred,

00:25:01.626 --> 00:25:03.227
whatever that number is,

00:25:03.686 --> 00:25:05.567
you redesign the meeting stack.

00:25:06.473 --> 00:25:08.494
not adjust it you redesign it you have

00:25:08.535 --> 00:25:10.436
the huddle architecture you have the

00:25:10.477 --> 00:25:12.898
tactical meeting you have the four types

00:25:12.959 --> 00:25:14.920
of meetings but you redesign them meaning

00:25:14.960 --> 00:25:16.901
that you're finding out which people

00:25:16.941 --> 00:25:18.481
really need to be that them and you

00:25:18.663 --> 00:25:19.823
and you ask them not to take it

00:25:19.883 --> 00:25:21.545
personally if they're not attending

00:25:21.625 --> 00:25:23.546
certain meetings anymore you have to

00:25:23.586 --> 00:25:27.268
rebuild those stacks at each and every

00:25:27.308 --> 00:25:30.009
threshold this is the most expensive

00:25:30.691 --> 00:25:31.692
accidental loss

00:25:32.432 --> 00:25:34.512
in multi-site operation it's also the

00:25:34.614 --> 00:25:36.934
easiest to fix if you're willing to admit

00:25:37.414 --> 00:25:39.576
and have discipline and rigor around your

00:25:39.616 --> 00:25:41.978
meeting stack the meeting stack is the

00:25:42.057 --> 00:25:44.240
operating system that you typically have

00:25:44.299 --> 00:25:46.922
never really designed for so it sounds

00:25:46.942 --> 00:25:48.702
like the takeaway isn't just have fewer

00:25:48.742 --> 00:25:50.723
meetings it's ask yourself if your

00:25:50.743 --> 00:25:52.464
meetings are either transmitting truth

00:25:52.525 --> 00:25:55.047
filtering it or just performative

00:25:55.663 --> 00:25:57.123
Yeah, they become, you know,

00:25:57.163 --> 00:25:58.943
what ends up happening in my experience.

00:25:59.703 --> 00:26:02.265
And by the way, I've just, you know,

00:26:02.285 --> 00:26:03.384
I've lived every one of these

00:26:03.424 --> 00:26:04.825
dysfunctions, you know,

00:26:04.845 --> 00:26:05.746
throughout my career.

00:26:05.806 --> 00:26:06.705
And, you know,

00:26:06.766 --> 00:26:08.405
you have to go back and constantly learn

00:26:08.425 --> 00:26:08.486
it.

00:26:08.526 --> 00:26:10.146
That's what really motivated me to go back

00:26:10.186 --> 00:26:11.826
to the literature post-pandemic here.

00:26:12.527 --> 00:26:14.188
And you have to have some really good

00:26:14.248 --> 00:26:15.307
discipline about meetings.

00:26:15.347 --> 00:26:16.688
Otherwise, they become perfunctory.

00:26:16.867 --> 00:26:18.088
I show up, I drink coffee.

00:26:18.909 --> 00:26:19.469
In the old days,

00:26:19.509 --> 00:26:21.150
I would eat a donut that somebody brought

00:26:21.230 --> 00:26:22.769
in and then you'd leave.

00:26:23.384 --> 00:26:24.865
But you have to really now,

00:26:25.165 --> 00:26:27.048
in a remote environment in particular,

00:26:27.387 --> 00:26:29.249
be more adamant around that.

00:26:30.029 --> 00:26:30.990
Simple thing you could do,

00:26:31.069 --> 00:26:32.830
record the meeting on one of the AI

00:26:32.892 --> 00:26:33.711
things of choice,

00:26:34.231 --> 00:26:36.354
run it through a very good thing and

00:26:36.473 --> 00:26:37.013
ask them,

00:26:37.233 --> 00:26:38.674
did this meeting accomplish what it was

00:26:38.694 --> 00:26:39.215
supposed to?

00:26:39.395 --> 00:26:42.057
Ask those questions based on the recording

00:26:42.097 --> 00:26:43.298
of them, not just...

00:26:44.019 --> 00:26:45.720
Most people are using AI in meetings to

00:26:45.759 --> 00:26:48.201
record it and then just recapitulate it or

00:26:48.342 --> 00:26:49.803
these are the tasks that were assigned to

00:26:49.883 --> 00:26:50.483
each person.

00:26:51.223 --> 00:26:54.626
Ask AI to effectively rate your meeting on

00:26:54.666 --> 00:26:57.449
how its ability to answer those discipline

00:26:57.489 --> 00:26:59.730
questions on why you even had the meeting

00:26:59.769 --> 00:27:00.810
in the first place.

00:27:01.991 --> 00:27:03.553
If your growth story is or you'd like

00:27:03.573 --> 00:27:04.253
it to be real,

00:27:04.713 --> 00:27:06.595
the meetings sounds like should reveal

00:27:06.654 --> 00:27:08.576
problems early and if they don't,

00:27:09.284 --> 00:27:11.144
the dashboard might be the last place you

00:27:11.184 --> 00:27:12.746
find out that something's wrong and it's

00:27:12.766 --> 00:27:14.587
going to be a lag indicator anyway.

00:27:16.368 --> 00:27:18.210
You can go deeper into Larry's article

00:27:18.250 --> 00:27:20.250
this week on Substack and if it made

00:27:20.270 --> 00:27:22.833
you a little uncomfortable, it's good.

00:27:23.212 --> 00:27:24.334
That's the point.

00:27:24.974 --> 00:27:25.694
Thanks for this, Larry.

00:27:26.276 --> 00:27:26.796
Awesome.

00:27:26.816 --> 00:27:27.276
Thanks, buddy.

00:27:28.237 --> 00:27:28.997
I've got to run, Jimmy.

00:27:29.037 --> 00:27:30.117
I've got to get in this other meeting.

00:27:30.317 --> 00:27:30.919
I'll reach out to you.

00:27:30.939 --> 00:27:31.439
You're the best.