A Great Clinician Can Still Build a Bad Clinic, with Jared Aron & Sally Eugenia Schwartz, E54

0:00Jared Aron: You can't walk more than 20 minutes in central London without hitting some form of aesthetic or medical aesthetics injectable practice. How do I extend clinical excellence to the other 3 ,650 days where the patient is not physically there? How do I proactively advise them about how to maintain and practice and point blank so people don't want to talk on the phone? There's been 15 to 20k in marketing a month. And there's this wonderful thing called cross-domain tracking where if you drive your lead intent to a webpage, As soon as you click book now, you redirect to the practice management software booking flow.

0:32Jared Aron: The data disappears. And when you think about engagement and retention as a data problem, you go out and you hire a data-driven marketer, or you go and you hire a data scientist. You don't go out and hire a clinic manager who has run some life cycle marketing campaigns. You're not Netflix. You're not meta. You don't have unlimited resources to pay people$5 million a year to be an all singing, all dancing unicorn. You've got 50 grand budget to spend on two roles and you need them to be all singing, all dancing unicorns. It's not going to happen. That transformation, that full coverage, every patient, every time, as if you were doing it as the clinic owner.

1:04Jared Aron: Like it was you. You have infinite hours. You can message everybody. You can stand on top of everybody as if it was you. It's not a human problem unless you're going to go out and hire a thousand versions of you. Good luck.

1:19Sally Eugenia Schwartz: so i actually want to start with a question i've had for quite a while um which is why the elephant that's a good question uh so when we were we were starting

1:32Jared Aron: coherent as the name implies we wanted a symbol that felt wholesome felt grounded felt trustworthy and in some cultures also symbolizes wealth and prosperity and we were trying to think how do you communicate that sort of accessibility and friendliness

1:59Jared Aron: married with the fact that if you go to a healthcare conference and you walk down an aisle of conference booths you will struggle to find more than one logo that doesn't have some kind of healthcare cross or doctor script or something else that looks and feels like everything else and so we we thought animals are lovable totally and accessible and warm and people generally hold in similar regard types of animals you don't usually have a hundred people look at an elephant and they all feel something very different they think oh there's an elephant it's a big elephant i feel safe because it's not an aggressive animal i depending where I am in the world, I might look at an elephant and think, oh, this is a positive token for the future.

2:50Jared Aron: This is pointing to something that ultimately is beneficial to me and to the people around me. And so we thought everyone loves an elephant. And actually, a former colleague was the one who really championed the elephant. Elephant champion. No, they really did. And And I think she was right. She was absolutely right in the fact that people see it. And when it pops up on their WhatsApp or when it pops up on their email or if they see someone wearing a T-shirt, there's nothing else that looks like that. And so it becomes instantly recognizable. And in some ways, we actually have customers who have sort of given the elephant a bit of a personality.

3:31Jared Aron: And they often will say things like, I'm waiting for my elephant's stuffed animal or I'm waiting for my elephant's cupcake. So I think really that was the motivation. It was to give people that sense of security and that warmth, but also to look different enough that when people saw it, they could connect with it in a way that stood out.

3:48Sally Eugenia Schwartz: It's really interesting, actually, because it's how are you differentiating, I guess, right within health care. And when I think about the clinics that we speak about, they're all trying to do that. How can they get different? How can they be recognized and things? And I was wondering, you know, I feel like we've been speaking to a lot of them and they have marketing people now. They have sales people. They have different kind of business related elements. And I was wondering what your thoughts are on that.

4:23Jared Aron: Yeah. So I think health care, particularly in private health care, is changing very quickly. So we have a consultant that we work with who set up his practice probably 15, 20 years ago. He's a single consultant that doesn't own a retail premise. He splits his time between NHS and private. And I remember asking him what's been the biggest change over the last 15, 20 years. And he said, 15, 20 years ago, you just needed a pulse to be in business. As a private practitioner, there was nothing. There were the online points of access, finding practitioners. It was easy. There were not a lot of practitioners in private practice.

5:03Jared Aron: You know, certain healthcare verticals, maybe, you know, dentistry, which was a more mature market earlier in the private healthcare space. Maybe that was slightly more developed, but you didn't have to do much. And you still could stand out. You could stand out on the basis of your clinical merits. And over the last 15, 20 years, that has changed dramatically because now there are a lot of people in private practice, solo consultants, larger hospital players, big groups, single clinics. And if you walk down the high street, you see this for yourself. You can't walk more than 20 minutes in London, in central London, without hitting some form of aesthetic or medical aesthetics injectable practice.

5:44Jared Aron: You can't walk more than 20 minutes in London without hitting some form of musculoskeletal MSK, chiropractic physiotherapy practice. It is increasingly in demand because people at a consumer level are more thoughtful about their health, their longevity, their wellness. And so if you're a clinic and you're saying, that person going across the street over there can come here, it's very hard to train on clinical foundations. It's very hard to say, oh, my doctor-led clinic has an extra two years of experience compared to the person over on that side of the street. I don't think that's enough. People don't really respond to two years of clinical difference.

6:21Jared Aron: And so you need to start thinking about what do you do to genuinely look and feel different. Now, part of that is a branding exercise, but I think a lot of it is also a values exercise. some practices play techno music for people walking down the high street and like that's the vibe right it's it's loud it's shouty it's instagram centric it's basically a a consumer phenomena dressed up as a dental practice if that works for you works for you that's that's your positioning it's fine other practices will say you know what we are we are fully all in no questions asked on clinical excellence. And so that's the thing that will be the pillar of everything that we do will come back to clinical excellence.

7:08Jared Aron: And I think as a practice today, given the competition, given how expensive it is to trade and to acquire and to retain patients who have a lot of choices, that point of connection, that stickiness is really important. You go back to the elephant for us, customers don't stay with us because we have a playful elephant as a logo. Of course not. In a similar way they wouldn't stay with the dental practice. But for us, it is meant to be yet another point of connection that people ideally see and become familiar with, which is why all of our emails, and this is something we took a decision on very early on, every single employee, their email icon is an elephant.

7:47Jared Aron: So when it lands in someone's inbox, it's an elephant. It doesn't matter who sends it. We're trying to use that as a way of establishing emotional connection. Brand logo is not why people pay us money in a similar way that brand logo is not why a patient shows up to a dental practice. But it is yet another thing that starts to make its way into your customer, your patient's life. And so I think as a practice today, when you think about brand, when you think about service delivery, it is increasingly a story of relationship. It is increasingly a story of how do we maintain, how do we remain very front and center for our patients emotionally?

8:23Jared Aron: so that when they're not physically there, they still think about it. They still feel about it. It's not like, oh, I don't need to worry about my teeth anymore because my dentist is not in front of me. No, it's, you know, my dentist looks after me. I care about my dentist. They care about me. I'm going to be proactive in thinking about my dental program. When they reach out to me to see how I'm doing, I'm going to engage with them. I'm not going to fall away. I'm not going to disconnect. That relationship forms the basis of care today. And it's also what forms the basis of profitability and durability as a business.

8:52Sally Eugenia Schwartz: A hundred percent. I think it's so true. I mean, after working at Coherent for, I guess, two months now, almost three, it's been so life-changing because it's like every street I walk down, one, two, three clinics, they're all next to each other. MSK, aesthetics, dental, you name it. And there's this kind of this bombardment of choice and this bombardment of things. And I think it actually, you raised a few points there I want to speak about, one of which be kind of this clinical excellence. And what you said, clinicians said the other week on the podcast, which is you could just be a fabulous clinician.

9:36Sally Eugenia Schwartz: And that was enough. What are your thoughts on that? It seems kind of interesting to me how you go from being a fabulous clinician to having a fabulous practice. and also I guess sometimes when practice can take over actually clinical excellence and wear those downsides. I was wondering if you've come across that at all. Yeah. So I think there's a bit of a challenge with trading on clinical merit alone.

10:05Jared Aron: We're talking about just now around brand, et cetera. A lot of people can claim that. But I think also when you think about the service you're delivering, the relationship with your patient in most cases, at least in the cases where we work, the healthcare parts of the market that we work, you have relationships with your customers, with your patients for, in some cases, 20 years. In some cases, you have multi-generational relationships. In many cases, you have five-year relationships, 10-year relationships. And so when you think about that relationship, call it a 10-year relationship, that's 3 ,650 days.

10:45Jared Aron: 365 days a year, 10 years, 3 ,650 days. Now, if you're trading on the clinical experience alone, of 3 ,650 days, in total, if you are a dentist, that patient is in front of you for maybe one day total, probably not even. You don't spend 24 hours at the dentist over 10 years. You probably spend half of that. Call it an hour a year. So now you've got one day out of 3 ,650 days where you are able to actually develop that relationship, cultivate that relationship, and reinforce clinical excellence. That's not enough. That doesn't do it. It is forgotten. It's a drop in the ocean. So the question becomes, if I'm going to trade on clinical excellence, how do I extend clinical excellence to the other 3 ,650 days minus one where the patient is not physically there?

11:40Jared Aron: How do I proactively advise them about how to maintain and practice oral hygiene? How do I proactively engage, reach out to support, check in on the patient? How do I ensure that when there are these potential moments of drop-off, disengagement, oral decay, that we show up first and that the patient knows we're thinking about them? You've got 3 ,600 plus days of reinforcing clinical excellence, if that's your thing. It's very different from a practice that's all about, using the one I explained earlier, all about the Instagram vibes, where it's more likely the fact that if you are about the place where people go to have fun while they're going to the dentist, which it's not really what I go to my dentist for, but it is what some people go to the dentist for, then the way in which your customer, your patient is engaging and that relationship is being nurtured is most likely through your social and through your ad spend and your marketing, your brand, your events.

12:40Jared Aron: and that might feel more aligned to that brand. But if your brand is clinical excellence and many practices will still trade on clinical excellence, you need to reinforce clinical excellence 364 days of the year when the patient is not physically there. Because more often than not, the patient is not there. Welcome to outpatient healthcare. It's a different experience.

13:03Sally Eugenia Schwartz: Totally. And I think one problem truly is if you're an excellent clinician, does that mean that you have an excellent team of clinicians do they have the same care that you have what's happening with that and i think i was wondering what your opinion on that is or any time we've seen or maybe you've seen recently that type of struggle or heard anything from

13:26Jared Aron: clinics we've spoken to yeah so principal practitioners they have a love for their work that others just won't. That's not a judgment, it's just a reality. When it is your business, you think of every patient as yours, even though you may not see them. And we will often hear from practice leaders who set up a site and initially they are the only practitioner. And so all of their customers, all of their patients go to them. And then eventually they hire the second one, they hire the third one, they hire the fourth one. And then suddenly you've got 10, 15, 20, 25 practitioners and you don't even recognize most people's names that come through the door unless they come and see you because they've been with you for 10 years.

14:10Jared Aron: One of your foremost challenges is do the other practitioners care as much, not about delivering great care in clinic, because more often than not, a great practitioner will care about providing great care in clinic. What they may not care about is what happens next. And so you have this reality where a practice owner, practice leader, you as an individual might be doing the follow-up. You might be doing the extra 10 minutes a day, the extra 10 hours a week, the extra 100 hours a month to make sure that every patient is followed up with, that questions are being handled quickly, that any inquiry is being escalated to the right point of care.

14:49Jared Aron: It's more likely than not the case that your practitioners are not. Again, not because they're bad people. It's just the reality. They don't have that same connection to the practice. We have a clinic that we work with. They have many, many sites and they will often say we have incredible physiotherapists. We have absolutely incredible physiotherapists. But if someone cancels in the middle of the day, the practitioner will use that opportunity to get a coffee. And by the way, is that a bad thing? I don't think so. It's a good thing. You want your practitioners rested and caffeinated and relaxed.

15:24Jared Aron: It's a good thing. So you want to create an environment where if a practitioner ends up with 30 minutes free in an eight hour day of being hands on with patients all day, totally, that's great. But if that is the culture you want to build a place, which is genuinely happy, comfortable, convenient for the clinic to work and for the clinicians to work, then you need to offload that burden from them. And the only way you can offload that burden from them is, is by doing it a different way. And then the question becomes, what is that way? Now you have to start getting into the software, the team that you need, the tech that you need, the practitioner.

15:57Jared Aron: It becomes a question of sticking together lots of things to try and deliver the outcome that in an ideal world the practitioner is doing. But it's amazing to me. We speak to group leaders all the time. We speak to practice leaders all the time. And we will ask them point blank. What happens next when a patient cancels? What happens next? Oh, our practitioner calls them. Great. What happens next? I don't know.

16:20Sally Eugenia Schwartz: It's so true. They even say, I don't even know if they call them. I don't even know if they call them.

16:25Jared Aron: Well, if you don't know and they can't prove it to you. And by the way, even if you call, the odds are that the person didn't answer. Totally. So you're tracking the calls, but the calls don't matter. It's completely irrelevant if you call them.

16:38Sally Eugenia Schwartz: Right. Because it's not like they're recording it or have a whole, you know, telephony system around that. I mean, I know that when I'm in the middle of my workday, I can't answer the phone. That's the reality. I have a number from some number. And if it's important, I feel like they'll email me or WhatsApp me or I'll WhatsApp them. But, you know, it's really hard these days to connect.

17:01Jared Aron: Absolutely. We have a practice that we've been working with for a while. We do payments with them. We also do patient recall retention with them and soon cancellation support as well for patients who are dropping off in journey. And I remember asking the practitioner. He's been practicing now for probably 25 years. he opened his practice a long time ago. It's a very, very successful practice. And I said to him, if you thought about the patient journey, the patient interaction, what is one of the biggest changes that you've seen over the last two decades? And point blank, said people don't want to talk on the phone.

17:31Jared Aron: People do not want to talk on the phone. They don't want to call you. They don't want to be called. 100%. It's not, I mean, it's not a surprise. You look at other industries, you look at the way people interact and they're behaving. This is not a surprise. Healthcare has to keep up. It is so far behind in so many things. It's, you know, the things that are exciting in healthcare were exciting 20 years ago in most other industries. The idea that you could book something online in healthcare was radical, you know, in the last five years. Wow, online booking. And the online booking experiences in most practices are terrible.

18:07Jared Aron: So bad. So bad that people will be in the middle of an online booking process and say, you know what? I just can't do this anymore. I'm just going to call you.

18:15Sally Eugenia Schwartz: It happens to me all the time. And the more complex of a service line you have, the more impossible it is. It's like, I don't know what exact, the 30, the 60-minute injection. What are you talking about?

18:26Jared Aron: The way that online booking flows are built, it's like you expect your patient to be the practitioner.

18:34Sally Eugenia Schwartz: A hundred percent. No, it's crazy.

18:37Jared Aron: It's absolutely crazy. And the practice management software, bless the practice management software, bless the EMR, the HR. It's really good at many things. Conversion ain't one of them. There's no way to cut that. And so you have this ridiculous problem. Here's an example of the problem. And this, you know, healthcare clinics, not, you know, not necessarily connecting all the dots all the time. So you spent a lot of marketing, we speak to a practice right now, that's spending 15 to 20 grand on marketing a month. That is a big number.

19:04Sally Eugenia Schwartz: It's huge. I mean, like, I can't even imagine what they're spending it on. It's a huge number. To get an actual ROI.

19:12Jared Aron: Well, that's exactly. So there's spending 15 to 20K on marketing a month. And there's this wonderful thing called cross-domain tracking, where if you drive your lead intent to a web page and the patient reads, consumes information and says, you know what? I think I'm going to book. They press that big, beautiful book now button on the top right of the page. Everyone says you should put a book now button there. as soon as you click book now you redirect to the practice management software booking flow yep and at that moment the data disappears it go come poof so now you're saying oh i know how to i know how to optimize all my marketing spend to get people to press book now but i have no clue what happens after they press book now so here's an example what happens if everyone's pressing book now and then just stopping.

20:06Jared Aron: So now you're optimizing the marketing spend to get people to press book now and then stop. So you've got no ability to see. Here's another example. You're getting all these people to press book now. Let's assume they all actually go through to a consultation. Never happens. Let's say that they do. Do they go on beyond the consultation? So now maybe you're optimizing your marketing spend for people who only show up once. Totally. And it's absolutely crazy. We work with another clinic group where they're spending on marketing, very, very tight budget, couple hundred pounds a month, meta. Huge amount of the patient inquiries that are coming off of this ad spend think the clinic is somewhere else.

20:44Jared Aron: Yep. They're saying, I'm based up here, five hours away. That's a huge waste of money. Huge. Huge waste of money. Waste of money, waste of time, distracting. The CEO doesn't have the visibility inside because they're not in the marketing data. They don't see that the patient is asking a question. oh, are you based in Manchester? No, we're based in London. So all of this way, this goes back to the idea of being a great clinician, but not necessarily having a great clinic. You can't see these things as a clinic owner because the tools that you're using and the team that you have, and it is very much both of those things, it is very much a combination of the team that you have and the tools that you're using, are not designed to give you the visibility, the data, the intelligence to make good decisions.

21:33Jared Aron: So it's not like you can't make good decisions. It's that you're trying to make decisions with someone holding their fingers in front of your eyes. You're saying, which way would you like to go? And oftentimes as a clinic leader, I remember this from being in clinic, you sort of do this. Totally. And you hope you picked the right one because you just don't know.

21:49Sally Eugenia Schwartz: Totally. I mean, on that point even, it's not even that they're blinding you. The reality is about data, it's actually quite complicated. And you can have different definitions for different things. I can say the word cancellations, you can say the word cancellations and the data could be two different things. I can say a booking attribution, you could say a booking attribution, it's two different things. And especially when you go cross platform, that gets 10X worse and 10X messier. And so I think it can be very hard for all of us, for everyone in the world, actually, to make data-driven decisions because you're intrinsically assuming that the data you have at play is accurate because it's data and we trust data the data can be anything you know you don't know what the data is actually saying and so it's a hundred percent that

22:38Jared Aron: and um it's quite we speak to uh actually we did this call together we're speaking to a a practice recently and and we're going through you know we have the data playback where we're showing them their own numbers they hear your numbers this is what's going on in your own house and we ask the question we often ask the question is this new to you did you did you know that the you know if it's your own house did you know that the bathroom was upstairs not downstairs did you know that the kitchen has a leak in it did you know that the bedroom actually is painted pink not painted blue so we say do you I mean what do you think I mean we're not there we don't know the practice does this look right to you and it's really interesting because the feedback from from one person on the call was we actually can't see this information this is really helpful and then the other person on the call says uh yeah yeah we have this and so you sort of stop and you say well what exactly do you have is that oh we have we have spreadsheets with these numbers like okay so that's that's the same i have a i have a ford and i have a ferrari i've got a car right it's the same it's the same thing right i can no it's not

23:48Sally Eugenia Schwartz: But 100 %? No, and it's also one of these things, I guess, going back to it and stuff and going back to this idea of wanting to improve, right? You hire these, these clinicians are hiring these business people. And I was wondering kind of what you've seen in the marketer, how you've perceived that to either help or hinder that experience.

24:11Jared Aron: Yeah, look, we work with a lot of clinic leaders. We don't work closely with their operational and business teams, so I can't comment on them. What I can say is that when I was running clinic, we came to terms with the fact that most people that we tried to hire for commercial roles in our practice environment with background in commercial roles in other healthcare environments didn't get there. When I say didn't get there, here's what I mean. They would bring the playbook from the past clinic. that playbook was not good enough. We had to go outside of industry, very far outside of industry. So when we're thinking about patient engagement retention, we went to companies like HelloFresh, who are doing engagement and retention for millions and millions and millions of people, and who understand that engagement and retention is ultimately a data problem.

25:11Jared Aron: And when you think about engagement and retention as a data problem, you go out and you hire a data-driven marketer, or you go and you hire a data scientist. You don't go out and hire a clinic manager who has run some life cycle marketing campaigns. There's a group in the UK, it absolutely blows my mind, there's a group in the UK, it's actually a US-based group, I think there's a hundred sites or something in the US, massive, huge organization. And they're building out their European presence right now, and they hire a life cycle marketer. Okay, you know, who's the person? So they meet the person, I look at LinkedIn, I see their background.

25:53I don't think the person has ever touched a quantitative data-driven role ever.

26:00Jared Aron: So now you've got someone who's bringing the brand and the vibes and the feel, and they're using GoHighLevel. Believe me when I say that the founders of GoHighLevel and the engineering team at GoHighLevel have never spent a day in a clinic, full stop. So you're using a tool that was built for agency performance. You're hiring someone who like knows how to do premium life cycle marketing. And you're saying, here, here's your tool. You've got the skills, go. And what you end up with is really nice looking email campaigns. Totally. That nobody opens and nobody engages with. and you're over the moon when you get 15 % open rate and 10 % click through on your Black Friday campaign in November.

26:49Jared Aron: This is the gold standard. There are so many things that are wrong about that. But again, as a practice, unless you are pumped full of cash, and we were a venture-backed clinic. And so we had the resources to retain and recruit talent that were drawing salaries that you don't see in a clinical environment. Unless you have the resources to do that, you can't hire the right people to do the job, not one-to-one. And your clinic alone is probably not big enough to justify a full-time role. So how do you get that talent, that know-how, into the practice? You just can't. There's this massive drop-off.

27:31Jared Aron: And it's true in most SME environments. You can't go out and recruit a C-suite management team with loads of experience, deeply specialized. So you end up with generalists who can kind of do lots of things. And those generalists who can kind of do lots of things is exactly the problem. Not because they're bad. It's just that they're doing 14 different things and they're doing all of them kind of well, okay enough to keep the wheels turning, but they're not changing the game. They're not moving the practice forward in the way that you need them to, to unlock that next chapter of growth.

28:06Sally Eugenia Schwartz: Makes a lot of sense. And I think you said something interesting there in terms of looking elsewhere. Do you think it's a situation where a lot of times people or clinic owners don't necessarily know what excellent looks like within these domains? So they're okay with what's happening, whether it be, you know, people spending hundreds of thousands of dollars on marketing for a small clinic or even a medium-sized clinic still there are a lot of companies out there that are much larger that do not have that type of budget able to be spent on marketing or whether it be kind of this kind of operational management of services of follow-ups etc and they're using a clinic practice do you think this situation is not having that repertoire of what is out there and what those standards can be before um before we started coherent i was

29:00Jared Aron: personally doing a consulting project for a uh a very well-regarded plastic surgeon

29:07Sally Eugenia Schwartz: who was opening her first own premise uh and and her own demise and it was branded and it was all

29:14Jared Aron: these things and so she needed someone to help her set up shop and do the stuff and coordinated working with her in that capacity. And we're coming to the end of the engagement and we're talking about continuity. How do you keep the business side running? How do you do that? And I said to her, listen, you have incredible expertise. You have a very clear vision. You need an operator to sit alongside you. And, you know, do you know anyone? And she said, yes, I know someone from the hospital that I used to work in. They were a facility man, whatever, or whatever. And I think they'd be great. And they're very affordable.

29:54Jared Aron: I said, interesting, can you share, like send me their CV? I'm just curious. Look at the CV. Facilities management, IT management, you know, compliance, CQC. None of these things are growth drivers for the clinic. They're all compliance, operational back office, which you do need, but these are not the things that move the revenue line. They are things that compress risk. But when you're starting out, your risk is only so big. So I connected her with a headhunter who has never worked in healthcare, who only recruits for tech for companies like Uber, WeWork, businesses that have grown and seen scale and build playbooks and think about data, et cetera.

30:37Jared Aron: And I remember having a conversation with both of them saying, listen, I think what this consultant needs, this surgeon needs, is a 27-year-old-ish, late 20s, a few years of experience, comes from a very structured commercial background. Maybe they spent one or two years in consulting or banking. They moved into a tech startup. They can move really quickly. They're digitally native. They can think about how to build a business, and they'll work 18 hours a day, and they will sit next to you, and they will help you realize the vision. You need to pay them X per year and give them 5 % upside in the business.

31:11Jared Aron: If it really goes on to be successful, they're basically a junior partner. That's the person I think you need to hire. They're going to run the show for you. And that way you can focus on the vision. And it was oil and water. I mean, this practitioner who was probably, you know, preeminent number five in the country for the work that she was doing had never, never come into contact with that kind of operator, never under just different walks of life. They've been a surgeon. So I don't think it's a question of not necessarily knowing what great looks like. Cause I think oftentimes healthcare practitioners practitioners, the best healthcare practitioners have a very high standard for excellence, but in their progression in that journey, they haven't come up against or seen or interacted with that kind of operator.

31:57Jared Aron: So what ends up happening is you hire the people that you recognize, you hire the people that you are, that you're familiar with. And so you go to the same places, you recruit the same people. They bring the same broken systems from over there. They put it in your clinic. Now you've got broken systems. They're new, but they're broken systems. you need to go outside of that very almost bubble community of they were a practice manager over there. I'm going to hire them. That just means they're going to bring the stuff from there that's not working and bring it over here. Oftentimes you need to think these things through from first principles.

32:33Jared Aron: You don't need to think through your compliance things from first principles. Compliance things, there's a way to do it. You do it, get someone who knows how to do it. They do it every time. You don't have to worry about it. You sleep easily at night. When you think about growing, when you think about brand, when you think about customer experience, you think about patient experience, you want someone who can think about it differently because building that today is very different than the 20-year-old practice manager veteran who's been around for a long time, who built it once 20 years ago. And that playbook from 20 years ago was really good then.

33:03Jared Aron: It's not good now. So there is a disconnect in talent ecosystems where you go out and you recruit from the same places over and over and over again and you expect different results. You're not going to get them. It's not going to happen.

33:17Sally Eugenia Schwartz: Yeah, I think it's really, it's a hard mental shift to make though, especially in such an environment as healthcare where you really care about patient excellence. You believe for good reason that there needs to be extra care and extra work around it. It's really hard to be in regulated industries and have the belief that someone could come and learn enough of it, but bring their own unique expertise to come in and get jumped up.

33:44Jared Aron: Completely agree. I think it's, if I think about the best hires, one of the best hires that we made when I was running clinic was our clinic manager who came from Soho House. So cool. She'd never been in healthcare. Never stepped in a healthcare environment. Had such an eye for hospitality. Was so obsessed with guest experience. Was so like a dog with a bone. Even one person was unhappy. That was her North Star. Everything else, the clinical communication, the treatment, all that stuff was just enabling the vision of this is what it means to deliver not five-star, 10-star customer, guest, patient experience.

34:32Jared Aron: She didn't care who it was. She didn't care if it was a customer. She didn't care if it was a guest. She didn't care if it was a patient. It just needed to be 10-star. She transformed the way that clinic operated. When she left, the experience fell off a cliff.

34:45Sally Eugenia Schwartz: It fell off a cliff. I mean, that actually leads to another really great point. When you have someone who's great, who set up a great thing, how do you make sure that's actually set up to last? That it doesn't go away with the person, whether that be a clinician and they take away the patients, or whether that be this wonderful person from Soho House who took away the magic of the experience. What can you do about that? Or what lessons did you learn from it?

35:11Jared Aron: I think so much of the business of a clinic, the operations of a clinic, live in people's heads. undocumented we're speaking with a practice earlier today incredible practice phenomenal phenomenal run you know with such integrity so much quality so much it should be the standard of other practices but most things are written down by their own admission right and so when you have this we'll call it context this context exists in people's brains so step one is to take Take it out of your brain and put it on paper. Step two is how do you get it from paper into reality? And this is usually where good practices will go from paper, from brain to paper.

36:01Jared Aron: Excellent practices will go from paper to reality. Paper to reality is extremely, extremely, extremely hard. It's very hard. It's hard for many reasons. It's hard because people go on sick leave. It's hard because people turn over, they leave. It's hard because some people come in and they're not good enough. It's hard because when you're scaling fast, things being written down and things being done doesn't always work. And so the leveling up is turning that paperwork into system. System that runs all the time. Whether you're away on holiday, whether you're asleep, it should run unless the building blows up.

36:38Jared Aron: It's done. And it should just keep running. And if you look at even the best performing practices, most of them, if you've got three or four people, for example, in your client care team or your patient relationship team, your head office, your call center, front desk, if you've got 20 % of people who have a holiday, things start to feel very shaky. And the reality is in healthcare frontline, and literally 10 to 20 % of people are like in and out, they're weekend cover, they're away, they're late for this, they're sick one day, their kid's out sick, they go on holiday, they're on parental leave.

37:18Jared Aron: So you're constantly turning over that frontline. And every time you turn over that frontline, it gets the process that you think exists on paper, 10 % of it changes. A hundred percent. Every time it's like broken telephone. The word is strawberry. The next person, they hear berry. Next person hears very. Next person hears cherry. And then you get to the end and you say, hold on a minute, like we said we were going to say strawberry. And then the person at the end says, that's not what I'm saying. I'm saying cherry. Now imagine that all over your healthcare practice. We said, when someone cancels, we're going to call them in 24 hours.

37:58Jared Aron: Then we're going to email them. Then we're going to send them a WhatsApp message. The next person comes in and says, Ooh, I don't know how to send the WhatsApp message. So I'll just do the email on the phone call. Next person says, I don't know how to do the phone call. I'll just do the email. Next person comes in and says, I don't have time to do the email. I'm not going to do anything. Bye-bye cancellation process. Out the door. It's gone. 100%.

38:14Sally Eugenia Schwartz: You know, and it's funny because the other thing going back to the data, and not to say that the data is the elephant in the room, because, you know, we are coherent in any way. But what I found really interesting as well is you think you have a process, but I have not come across one clinic who can say this is how we track and verify that that process exists, that it's followed and complied to, that these are the results of that process, that this is our performance metrics against those processes. And it's because the data is not tracked in that organized and coherent capacity to enable those types of insights.

38:56Sally Eugenia Schwartz: And so I think in addition to what you're saying about things living in people's brains and then the game of telephone, then there's the game of did it actually happen and what was the result of the thing that we did and how can we improve it, which is a really hard thing to actually come to grips with. As is the fact that process, to really have the discipline, I think that's why it's really great when you see these kind of exemplary practitioners who are, you know, very detail-oriented and really on it to get away from, well, it depends. Oh, it depends. Like, everyone's an individual. And really figure out the way to systematize that individual care at scale for the entire practice.

39:45Jared Aron: it's funny we work with a um we're with a practice in canada and we've said this to them many times the practice manager in that in that practice is a machine is an absolute machine to a point where usually when we go through onboarding and we ask for sops we we brace for impact we say here come the voice notes and the spreadsheets and the word document and the emails from six years ago they're just going to throw it at us and then we're going to have to you know untangle the nest of snakes to try and make this thing sensible and we were onboarding this practice we said you know would you mind sending your sops and you know within five minutes came a thing that felt heavenly granted it was still a word documents but here's how we do this here's how we do that here's how we oh yeah this how we do that when except when this happens then we do that way and it's amazing And you say this person, this person, and it's very known by the clinic leaders as well, this person, this is what we call the hero operator.

40:51Jared Aron: This is a person who has come in and because of who they are, because of their unique abilities, their unique commitment, their unique integrity in their work is going to lose sleep to get it done the right way. very very few people operate that way very very we work with another multi-site msk over in kelmsford uh in in the uk they've got a person like this as well where does not miss a beat does not miss a beat the problem is they're still human right which means when they're on holiday or when they leave or when they move to spain or when they whatever you have a problem Totally. Because that likelihood of getting that person again is like you playing.

41:41Jared Aron: It's a unicorn. It's a dancing, singing unicorn. And I think that if you're building a practice based on dancing, singing unicorns, you will hit your ceiling. Your ceiling will be how many dancing, singing unicorns can I get into practice? And, you know, with all due respect, you're not Netflix. You're not Meta. You don't have unlimited resources to pay people$5 million a year to be an all-singing, all-dancing unicorn. You've got 50 grand budget to spend on two roles, and you need them to be all-singing, all-dancing unicorns. It's not going to happen. Unicorns are more expensive. So you either get lucky or you're stuck in this perpetual, we can only go as fast as we as individuals can go.

42:24Jared Aron: and we also need to deliver the care and we also need to maintain the site and we also need to be worried about these 20 things and by the way, that patient isn't feeling very well and all this other stuff that becomes a rate limiter and a rate limiter and a rate limiter. You need to free the practice, the team of those things. You have to pull it away. You got to get it off the front desk. You got to get it away from the practitioners. You can't ask your physiotherapists or your injectors or your dentists to go and do follow-up. You just can't do it. They've got a limited number of hours of the day.

42:55Jared Aron: They are your revenue engine. They need to be seeing people, seeing people, seeing people, seeing people, resting, seeing people. And by the way, being happy. Totally. Because when they leave, you got to go find another unicorn. And that's slow and it's hard. And then the new person can't retain people. So your marketing budget gets hit. You need to protect the integrity of the treatment room. The best way to protect the integrity of the treatment room is to have extremely happy, very satisfied, very work-life balance, or whatever else you want for your practitioners who go home at the end of the day and they say, thank goodness I work here because everywhere else would have me do this garbage stuff that I don't want to do.

43:30Jared Aron: Then you have to build it that way.

43:32Sally Eugenia Schwartz: You got to. I mean, and it's really interesting because going back to that, even if you have the unicorn of a front of house staff member who is making all those documents, you know, we have a whole saying in tech and product and stuff that people don't read. So that's great context for us who are coding and building the thing to be exactly and precisely what they want. Is your physio going to read it? Like your clinician to read exactly, precisely how they should email exactly the patient on exactly this day after they've canceled on exactly this type, et cetera, and every single Alice, Alice, Alice?

44:13Sally Eugenia Schwartz: No, that's for the engine. That's for the machine. So therefore, you already have a degradation of quality and service there, because even though she's doing her best job, and that is amazing for us, who's going to fall away? Like, it's too much. It's actually too much context. People are going to be like, oh, God, no, I can't read that. Whatever. You're lucky if I even sends me. But secondly, second of all, you have that those SOP documents for one moment in time, the minute she leaves and there's no one to be updating. Read first, read all of those documents and understand exactly where to update and what.

44:51Sally Eugenia Schwartz: And then to have the self-discipline to be updating them and updating and updating and cleansing and making sure they're to date, you know even the best of the best it's exhausting you forget to do it you you're not disciplined you know it can happen we're all human as you said so we work with a a multi-site group

45:09Jared Aron: here in the uk dermatology aesthetics very fast growing huge amounts of football incredible brand very um very aware of really connected to their to their customer to their patient in a way that I think most healthcare practitioners and practices rarely are, we get stuff from them every week. We get an email every week. Now we do this this way. Now we do this this way. We've just introduced a new service line. We're doing this at, uh, now the price point is up 25 pounds. This new thing is that way that practitioners, the, the volume and speed of those changes of those adaptations to your point makes your document dead, totally on dead on, dead on arrival.

45:50Jared Aron: it's it's immediately dead so now you've got a problem where the context is the latest email the last thing that was sent now no wonder you can't build the machine off of the latest email because if you weren't on that email thread you're out of the loop right and a lot of it's a lot of people aren't on the email thread so you've got this this immediate it was instant disconnect and it's funny we work with a different practice in dentistry where they're really uh on the ball connected to the work, very, very thoughtful about the patient journey. And the clinic owner almost takes a different approach, which is that if everyone doesn't know, if everyone's not in the lube, then the change is not.

46:32Jared Aron: It's a totally different approach. One of them is fast, fiery fireworks, you know, microwave style. The other one is total rice cooker. It takes a long time, slow, very methodical. Both okay. You've got problems on both ends of the spectrum. You've got the accuracy and the diligence of moving slowly, moving methodically, but you're just constantly moving through quicksand and it's like being a sloth. And the clinic down the street is a cheetah. And you're just sitting there watching that thing go and saying, hold on a minute, what about us? What's going on here? It's because you're moving at that pace.

47:03Jared Aron: On the other hand, you know, if you're fast and fiery, you've got compliance issues, you've got inconsistency, you've got service level gaps, you've got care gaps. The challenge is how do you get the speed and the hygiene. How do you bring those two things together so you can move quickly, but also maintain the consistency in the service delivery? And as soon as you try and pair those two things, you realize, again, it's not a human job. It's not a problem that one more receptionist, one more booking coordinator, three more call center agents, they don't suddenly give you that transformation, that transformation, that full coverage, every patient, every time, as if you were doing it, as the clinic owner.

47:46Jared Aron: Like it was you. You have infinite hours. You can message everybody. You can stand on top of everybody as if it was you. It's not a human problem unless you're going to go out and hire a thousand versions of you. Good luck. Let me know when you find them.

47:57Sally Eugenia Schwartz: It's not human. It's not human. Because you can't, because they all need to read the same SOP and have that all consistency. You all of a sudden add even more operational mess and noise and chaos to what should be a seamless problem.

48:11Jared Aron: 100%. 100%.