How to Have Difficult Conversations With Your Team

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So go get your audiobook now. Www.entremd.com 7Figurebook. And let's rewrite the narrative for physicians starting today. Hi docs. Welcome to the Entre MD podcast where it's all about helping amazing physicians just like you embrace entrepreneurship so you can have the freedom to live life and practice medicine on your terms. I'm your host, Dr. Una. All right, welcome back to another episode of the entremde podcast. Today we are going to be talking about something that I avoided for a long time as an entrepreneur, mostly because I am phlegmatic at my core. And so what that means is I would do my best to avoid conflict. But as an entrepreneur, what you do is you solve problems. You solve problems for your clients, you solve problems for your team, you solve problems in the industry, you are a problem solver. And what that means is you run towards conflict, painful as it may sound. And so I had a doc post a question about needing to talk to a doctor who has had outstanding charts for a long time and stuff like that. And that's something that comes up a lot. And I figured I would share how I would would handle that and hopefully you get some pointers that you can use to go through through that process where you end up with the solution that works for both parties. Okay, so we're going to be talking about how to have difficult conversations. Okay, so let's make up a scenario here. So let's say that we have a doctor who owns a private practice, and as I talk a lot about this, that private practice is a low ticket, high volume model. Right? Okay. So this person has a private practice and she has a physician who's working with her who has charts that are charts from a month ago, charts from 90 days ago that are still undone. Okay? And so let's say that there are 120 outstanding charts and she has to have a conversation. She doesn't want to be mean. Right? And let's make this person a pediatrician. So she's a pediatrician. We're very nice people. We don't want to be mean. Okay, so, so we have a pediatrician, practice owner, has a doc working with her, is 90 days behind on charts, has 120 charts outstanding, doesn't want to be mean, but outstanding charts also means that we're not billing for these charts, which means we're not getting paid. So we saw patients, but it mattered to the patient, but it didn't matter to the practice because we didn't get paid and stuff like that. Right? Like, so this is the scenario, this is what we need to work. So we need to have a quote unquote difficult conversation. And I really want to start off by saying we want to reframe the way we think about these conversations. These are necessary as entrepreneurs. And the more you grow in your leadership, the more you grow in the kind of the size of the business you're leading, the more you grow, the number of businesses you're leading, the better you're going to need to get at this. So this is a muscle. We want to build it when we have opportunities to use it. We want to use it because we're going to need the upgraded version of it later. Right? Okay, so what do we do? Okay, so number one is, is to address it head on. We're not going to run away from it. We're not going to wish it away. We're not going to be passive aggressive and just drop hints here and there. We're going to address it, right? Like that's the first thing, is a decision. I am going to address this. And so what that looks like is scheduling a meeting, right? So we schedule a meeting. Like, hey, what would like for us to do some reviews here? Schedule a meeting. Okay? So. So that's the first thing. And this is one of the things you may think about a lot, your heart may race and all of those things, but understand that you're doing something that you're not really good at yet. And so it's okay for it to be. For it to make you nervous, right? The same way you felt Nervous when you did your first IV or your first spinal tap or your first knee replacement or your first intubation of a preemie baby, like, it's okay. Okay, so that's number one. Now, at that meeting, at that meeting, what you are going to do is you want to create a situation where you and the person, you and the employee are on the same page. And so you want to paint a picture, okay? Because you're looking at it from the angle of, oh, my goodness, we have all these outstanding charts. Maybe there's risk there, maybe there. There's payments. That's not happening, and all of these kind of things. That's what you' seeing. The employee, on the other hand, may be seen, whatever the reason for that is. Okay? So I struggle to do my notes. I feel like I see too many patients. I have this thing going on at home and all of those things. So both of you are looking at one situation, but you're seeing it differently. For you guys to come on the same page, then we're going to need to paint pictures and ask questions. Okay? So the first part of it is you're painting a picture, and you're painting a picture of what this situation means. Okay? Hey, Dr. X, I'm so glad that we get to meet today. And all of these stuff, you can do a little small talk, but small talk, right? Because you don't want to use small talk as procrastination and not have the conversation you really need to have. And so you're like, okay, so there's something that's come to my nose that I want us to walk around. I'm going to share what that means from my perspective, and then let's talk about it so we can get to a solution that works for both of us. Okay? And then so you're like, okay, so we have these notes and all of these things. And the reason why I'm bringing it up is because there are implications. I want to show you what those are. Right? Like, so first of all, when the companies look at the fact that this patient was seen on. Seen in March and then the notes were not done till July, then the question is, do you even know what you're talking about? Do you even remember what patient that is? If someone were to come in and audit our notes, it's like, none of these notes are done. If there's malpractice, then, I mean, like, everything is timestamped, right? Because it's all computerized now. And so the risk is putting the practice, the whole practice at risk. Right. Okay. So that's one piece. The second piece is with the model that we work in. This is. Is very trying times for private practices. We're talking about 11,000 practices, I think in 2021 alone that either went out of business or sold out to private equity. And cash flow was a big problem with the hyperinflation with the UP because of COVID all of those kind of things. Like, we're in a point where I'm happy that we can continue to run this practice and continue to meet payroll and continue to be in a financially stable place. But it does require certain things. So when with all these things that are outstanding, we can't bill for any of them. Right. And so we're needing to pay you, but we're paying you off of the work that the other doctors are doing because we're not able to generate all this stuff from the patients that you are seeing. Right. And then for me, I am concerned about the work life balance, if you will, of my employees. I will also say, and I cannot imagine how it must feel to have these number of undone notes. Right. And so what that means is this could put you in a position where you're not on your A, you're not playing, you're not. You're not playing your A game, you're stressed out and all of these kind of things. And you're thinking about my practice when you're at home, when you should be with your family, and all of those kind of things. So when I look at this, I see it as something that is an emergency, I think see it as something that is a really big problem that I would like for us to fix and all of that. So talk to me about. So this is the third part. So you've painted the picture. So the next thing is talk to me about, like, what do you think is going on? How can we resolve this? I want you to be able to finish work at work, close your computer, say, hasta la vista, go home and, and be with your family. Right. And come back and think of us at work. But when you're at home, be with your family. Right? Okay. And so that gives the opportunity for you to see a little bit of that person's picture. Oh, something happened with my family. I'm on it, like, and so I kind of been falling apart, Blah, blah, blah. I'm glad we're having this conversation. Or it may be around a perception, like a perception that I can't just handle. Work is just too stressful. But, you know, that Work didn't necessarily change and stuff like that. But you'll hear, right? Because you want to hear if that connect you. Because you guys are collaborating, right? To create a solution, if you will. So you want to listen to what that is. It may be someone who's always struggled with notes. So it may be a person who is doing a lot more work than is actually required. Maybe they're spending most of their time doing portal messages, or they're spending most of their time answering calls when another team member can take care of it or whatever. You're going to hear a lot of things, okay? So you've scheduled a meeting, you've painted the picture, you've asked the person for their perspective on how they think this can be resolved, right? They may say things like, I would like to see less patience. Or they may see say things like, I would like to have more admin type or whatever it is. Or they may say, I would like a charting coach. Or it could be anything, right? Like I don't know what it would be. It could be anything. But at least you've heard. Both sides have been heard. Okay? Now the next thing is to kind of work through the solutions. Okay? I have had people tell me, I would like to have hour long visits and then that way I can do everything you want me to do. Okay? Now as we work through those, there's nothing that there's no decision, that's a vacuum. Okay? So when I say work through them, what I mean by that is, okay, so let's make the assumption that we are making $100 per patient. And if you want to see a patient an hour, that means you're seeing eight patients a day. And that means you're bringing in $800. And in this practice, overhead is about 50%, which is not unusual for a private practice. And so that means at the end of the day, what is left is $400 to pay you and $400 for there to be some profit for the practice to make it worth it for the owner. And so even if we gave you the entire $400 that was left, that will put you at 400 times 20. So that's $8,000. And for the year, that will put you at $96,000. And so the question is, are you okay with earning a percentage of $96,000? Now, you don't have to do the entire math, but what I'm saying is you have to paint the picture that while that would be great, the model that we have, that does not work, right? We are a low ticket, high volume model. Do you see what I'm saying? And so in that conversation, okay, what can we do as you work through it? The ones that are not feasible, because remember, you have to take the decision and weigh it against all the other things that exist. The overhead, support staff that need to be there, blah, blah, blah, blah, blah, right? Like so you can't just take solutions in a vacuum and implement them, right? And so you want to think through those and make decisions. So, okay, if I wanted to get a scribe, you have to check, do the numbers work? Right? So if the numbers work where the margin is such that, yeah, we can put on it, we can add on a scribe, add on an extra patient a day and we'll be good. And then, okay, we do describe, fantastic, problem solved. Or you can say, well, maybe what we need is a charting coach so we can learn how to use our time strategies to chart all that kind of stuff. Now there's AI, right? So you can use AI and all of that. So there's so many things, right, that could be done. And so you work through those and then come up with a solution. It does not have to happen at that meeting. The meeting, what is important is you've painted the picture, you've heard what the other person has to say, so you can develop solutions. It may be very obvious where it can happen at the meeting, but if you need to think about it does not have to happen during the meeting. You are running a business and you need to make strategic decisions. So it's fine to think about them. Right? Okay. And so then after that, maybe you have a second meeting. You're like, okay, this is what we've come up with. Blah, blah, blah, blah, blah, blah, blah. And you guys are on the same page. You get it done. Now when you're done with that, the next thing that needs to happen is there needs to be some kind of accountability built in which could look like this, okay? And now remember, this is hypothetical, so we're all making this all up. But if you think about it, that you can use it for a lot of difficult conversations, okay? So it could look like this. So going forward, all our notes are going to be done within 24 hours. If that's what your metric is, if you guys aren't a week. But 24 hours is so good. Okay, so 24 hours, right? You're like, so from now on, we are going to get the notes done within 24 hours. And for the backlog, we are doing five extra whatever a day till we get through all of those or 10x whatever the number is, Right. We're doing that till we get through the backlog. So that way you can then have weekly follow ups like, this is where we are. This is where we are. This is where we are. Okay. Because that's kind of the way those things work. Things that are not inspected don't get done. People do what you inspect, not what you expect. Right. So you want to put some kind of accountability metric in place and you want some kind of cadence to follow up, whether that's a meaning or whether that's just an observation and a text saying, good job, this is happening, this is where we are, or email, whichever. So you want to pick that and pick the cadence. Now, when it comes to that, chances are it's not going to work out exactly the way you want it to. Right? So in the example that we're using, well, maybe the doc is keeping up every 24 hours, but maybe instead of five charts, five extra charts every day, they're doing four extra charts every day. And you want to be sure to celebrate and celebrate and correct. Right. We don't want to do just one. We don't want to just celebrate and not say, but this is not working. And we don't want to say, this is not working and not celebrate. Right? Okay. So to say, hey, great work. I see that you're keeping up with your notes. For the last two weeks, you've completed your notes within 24 hours. That is amazing. I have noticed that they're like, for the outstanding ones, we are getting four done, which is great. But to be on track for where we want to go, we really need for it to be five. What can we do to bring it up to five? Right? Like, how can I support you so you can get it up to five? Or what do you need to do to bring it up to five and stuff like that. And then keep going with the cadence. Right. And so what will end up happening is chances are you would have supported the doc, the doc would have felt supported. The doc will be in a place where they can complete their notes in a timely manner. You didn't have to feel like a tyrant. And it's a win win situation. Okay. Now we would hope everything would play out that way. Sometimes there may be people who. It may just not play out that way. Right. And then we just troubleshoot those and go. But I guess the point of this conversation is to put us in a position where we don't run away from those kind of conversations because we're going to need to have them, we're going to need to have a lot of them, we're going to need to have them with higher capacity people and we want to develop that as a skill so we're not bent out of shape every time that we have to do it. Okay, so let me kind of summarize this here in a way of thinking about it. So you have to have a difficult conversation. Number one, make the decision to have it and AKA schedule it. You know what I mean? Number two, at that meeting, paint a picture of your side of the thing and then ask questions, right? So you understand what exactly is going on, how the person perceives it can be solved and all of that. Number three is work through the solutions that come up. Don't just take any. You cannot just implement any solution at random. You have to take it, you have to plug it into the entire strategy and all that stuff and say, okay, this will work. You have to run the numbers. This will work. Right? Okay, so, so work through the solutions and then decide on a solution. Number four is decide on your accountability metrics. So you've put the solution in place. What are the metrics we're going to be measuring? How often are we going to be meeting to talk about those metrics or how often will I be following up with an email or with another team member? Be following up with an email to give you data on how you're doing on the metrics. And then number five, when you have those meetings or emails or whatever those are to follow up on on the metrics, you want to make sure you're celebrating and correcting. You need to correct anything, but you're celebrating and correcting. You're doing both. So that, that way, because if you're only celebrating, then there's no accountability and so things are just not going to get done. But if you're only correcting, then it does make it seem like you don't see any good that the person is doing. And it's actually really discouraging. It's not empowering at all. So you want to do both. Okay, all right, so I guess, you know, what you could do is right now, if there is a difficult conversation that is overdue, then maybe now is the time to have it. And you may say, well, I don't have one in my business, which look really hard though, make sure you don't have one in your business. But if you don't have one in your business, then it could be one that you need to have somewhere else in your life or whatever. But when you have your next opportunity, which may already exist right now to have a difficult conversation, have it, okay? Have it. And start growing that muscle. Because the price for greatness, my husband puts it this way. The price for greatness is pain, right? There are, for instance, this is a painful. We would rather not do this. At least, I would rather not do this. But the thing is, if you are going to be great, you're going to do this a lot. You're going to have so many opportunities to do this, because that means you're going to be somebody who has a vision. You're going to need to learn to have people see the vision. You're going to have to course correct. If people are not doing what will line up with the vision? I mean, like, you're going to do this a lot, right? So embrace the pain or discomfort of doing this, okay? And it will absolutely rock your world. And when I watch basketball games, one of the things that always fascinates me till this day is when people, they get into it on the court from opposing sides and they rough themselves up a little, and at the end of the game, they have a conversation, they're cool. I'm like, wait, what? Because I'm going like, wait a minute. Like, if it were me, I'd probably have thoughts about it. I'd think about it for a while. I'll be annoyed about by it for a while. I'll do all. But they're cool. They're completely cool. They're champions. That's what champions do, right? So imagine being in a position where you have to have difficult conversations and all those things and you're not going to be excited about it. You're not a psychopath. But you can go through it without getting bent out of shape, without it ruining your day, without you avoiding it and allowing things go wrong in your company. If you have doc who's not turning their notes, I mean, like, and you're not billing for those, you could go under. Like, you can legit go under because you're not willing to have a difficult conversation, right? So think about you being in a position where you have these and you're comfortable. When the, when the opportunity presents itself, you're like, okay, I know I'm going to need to do this. You make a decision, you schedule the meeting, you get it done. Boom, done. Imagine being able to do that. Like, I would love that for you. I would love that. It will change your life. It will really change your life, and it will make your business so much better because you're not afraid to be the leader and you're not afraid to have hard conversations. So give this Share this episode like just copy the link. Share with another doc in your life. They'll thank you for a long time. Because we're docs. We're nice people. We don't like to do stuff like this, but we need to. And I'll see you on the next episode of the ontremd podcast. Hey, if you love listening to the ontremd podcast, I want to invite you to join ontremd On Demand. It is my signature subscription program that gives you access to a library of business courses designed to help you do one thing as a physician entrepreneur, and that is to thrive. Just head out to entremd.com ondemand and I'd love to have you join us. See you on the inside.