AI Won't Replace Your Front Desk. It Will Change Who You Hire

0:00Does not replace human AI augments human. So if you're looking at a remote front office team or remote reception, and you're saying, okay, I'm currently staffing 20 people there. The question is not, how do I go from 20 to zero? The question is, how do I go from 20 to 10? Because by the way, going from 20 to 10, but maintaining or arguably even improving the quality of what you're doing, that's where you see P &L level transformation. But it means one thing, and this is the really important thing for healthcare providers in particular, the bar just went up. The bar on who you keep in the room just went up.

0:34You need to think about AI in the context of a talent strategy, not a technology strategy. It's not about the software you replace. It's about how you rebuild your team around this capability. Listening to the patient voice, letting the patient surface their specific problem, the thing that really didn't work for them. That is gold. When you get to scale, when you are an executive decision maker and you personally have not seen a patient in five years, now you have a problem. Now you have no line of sight into what's happening in the room. And those micro decisions, we always say it coherent, transformation is a million small steps.

1:11You cannot show up with a butter knife to carve a steak. You just can't do it. You need something that's chiseled differently. It needs to have different purpose.

1:27Before we get started, this episode of the Business of a Clinic is sponsored by Virillo. Virillo is the trusted marketplace for clinic owners looking to sell and groups and clinic buyers looking to acquire high-performing clinics. There are very few specialized marketplaces in the UK that focus on this transition for clinic operators. Virillo is one of them. Learn more at virillo.co.uk. Now on to the episode. did you listen to the clip that i sent you from daria of the ceo talking about steven's friend who's the ceo of klarna there was a bit of a drama where they fired a whole lot of people and they hired them back and in the media yeah that's what he was saying in the media it was oh we couldn't do it and then we had to hire them back i remember reading the headline klarna fires 2 ,000 people or whatever it was.

2:18And I remember at the time, it wasn't that long ago, this is 12, 24 months ago, whatever it was. This was right around the time that they, I think they were talking about their IPO. And then there were concerns about revenue and they were in the news quite a lot. There were a lot of headlines about it. And I remember specifically the head count reduction. This was one of many articles that came out at the time, I think, Block in the US, formerly Square had another one, head count, AI story. We've seen a lot of this. And I remember with Klarna, there was then another piece, which is customer service levels have dropped X amount.

2:52And so now there's a hiring spree to bring people back, which obviously the media will portray things in a very inflammatory way. I think it's an interesting journey, and I think it is exactly the window into what's coming. And that window is that AI does not replace human, AI augments human. And I think more and more, the market is moving in that direction. So there is an expectation that a certain kind of task is absolutely doable hands-free, but it really is task dependent. And it also is very much connected to the quality of service that the business wants to provide. So even though, as a simple example, an ultra high net wealth individual probably could book a flight using an AI agent if you're paying$50 ,000 for a travel agent so that you don't have to think about planning your holiday, just because it can be done that way doesn't mean it should be done that way.

3:51the human layer is increasingly premium and it reflects the value that you're trying to put in front of your customer. And so I think in the case of something like Klarna, it's wonderful to see that they have automated a large number of low complexity support tickets, but it's also great to see, and it's important that they can maintain that human in the loop, the human addressing the work that is more challenging or that needs a bit more hand-holding. And I think in healthcare, we're seeing the same kind of shift. We're seeing a lot of healthcare providers initially gravitate toward the appeal of AI.

4:32For example, AI receptionists. Oh, great, I can use AI receptions instead of my own reception. I have yet to meet a single healthcare provider, and I would absolutely love to meet this person. I've yet to meet a single healthcare provider who has reduced their front office headcount as a result of adding an AI receptionist, because ultimately the AI receptionist is very good at handling a certain kind of task, but is not necessarily capable of supporting all patients uniformly across the care continuum. And so for us at Coherent and what we expect in healthcare is that if you're looking for augmentation, then AI only might make sense.

5:13The problem is that when you look for augmentation, you pay for augmentation. So now it's an and. It's an additional thing you pay for. Whereas if you're looking for a replacement, you need to actually solve the augmentation piece and the what happens if the augmentation fails. You need both parts of the sandwich. And so I think what's interesting here, and Klarna being a really good example, is they said, okay, I can use the tech piece to get rid of some of this inefficiency, but I still have to have a support team. I still have to have humans doing some of the work. And we have a very similar view at Coherent About Healthcare, front office operations.

5:50You need to have technology doing some of the heavy lifting, and then you need to have people to do the rest of it. And it's a really interesting balance, because when you look at it through that lens as a healthcare provider, you should stop thinking about where you can get rid of departments and you should start thinking about how you can make a department much more efficient. So if you're looking at a call center or if you're looking at a remote front office team or remote reception and you're saying, okay, I'm currently staffing 20 people there. The question is not how do I go from 20 to zero?

6:23The question is how do I go from 20 to 10? Because by the way, going from 20 to 10, but maintaining or arguably even improving the quality of what you're doing, that's where you see P &L level transformation. That's where you see EBITDA start to change. And so what we always will advocate to healthcare providers that we work with is we don't want to be a technology that you press a button and bolt on in a similar way that when Klarna tried to get rid of their support function or grossly downsize their support function, they overcut. And they maybe didn't cut the right things, but now they probably have built that understanding to say, this is what we can genuinely automate and make more efficient.

7:01And this is where we need to maintain the human in the loop, the human layer. But it means one thing. And this is the really important thing for healthcare providers in particular. The bar just went up. The bar on who you keep in the room just went up. Because if you can genuinely build a front office team, where 50 % of the work making up the number, 50 % of the work can be done by technology, then the other 50 % of the people who are still in the room need to be really good. You can't carry that weight anymore. And I think it means the same thing for front office employees and clinic managers.

7:34Having a body there to pick up the phone, having a body there to send a message, that's not the job anymore. The job has fundamentally changed. It's now a strategic job. It's about quality. It's about service. It's about empathy. It's about humanity. Those are much harder things to hire for. They're much harder things to train. They're much harder things to retain. And so you need to think about AI in the context of a talent strategy, not a technology strategy. It's not about the software you replace. It's about how you rebuild your team around this capability. And I think we're seeing that in Klarna.

8:06We're seeing that in a lot of the bigger industries, but it's not yet in the main flow of healthcare. People are still trying to figure out what that balancing act is. You've been having investor conversation for a very long time. And throughout the history of VC, the journey of raising capital across the startup landscape, everybody would have different vision that they invested in, or as a startup operator, a different kind of vision fundamentally to build towards. So one example, the Uber building like a completely streamlined ride hailing process 15 years ago, it might be a complete pipe dream, but now it's happening, right?

8:45But that's, that happened over a very long scale of timeframe. So in this healthcare context, there seems to be, at least based on the current market dynamic, there seems to be two kind of vision that people are betting on. One is a far from now futuristic vision where all doctors are AI across a consultative hands-on sort of practice, but there is also a more kind of medium-term safety-oriented, safety-driven sort of, oh, we can't just bet on the far distant future where AGI is not here yet. You need to sort out the one step first and making sure that no one dies or no one get hurt throughout that process, right?

9:24And that kind of leads to this topic that you've been having, also having different guests that you've been speaking with in recent weeks. For example, you and Lane discussed about patients going around AI receptionists, try to speak with a real person. And then they're also an alternative way of managing their expectations so that they don't get disappointed when they speak with an AI, but they will be okay, right? They're okay with speaking with an AI if their expectation was managed. What was your impression on what's been happening after you've been speaking with all these healthcare providers who's trying to or have been adopting AI or like you mentioned, many of them got burned.

10:05What was the data that you collected and what is going to happen inevitably in the future. I think people in and outside of healthcare, everyone's excited about the idea that building software is free and fast now and you can just ship whatever you want. Now you've got doctors who are building their own AI receptionist and their own payment plan software, et cetera, et cetera. Let's put aside the safety and security and reliability issues with that. Just leave that aside for a minute. I think what people maybe don't think about enough, particularly in a healthcare context, is that when you buy software, you're not just buying a capability.

10:39You're buying infrastructure. You're buying learning, expertise, support. You're buying more than the buttons you click. And I say that because just because you can build it doesn't mean you should build it. And we had this conversation, I had this conversation with Lane, where he said they have a very rigorous way of thinking about buy versus build. They're going to build stuff that is about internal efficiency. He was talking about building micro apps for learning and development for new employees. He was talking about building a sort of company brain so that every email and every call transcript and every team meeting is feeding into this intelligence for the organization.

11:22so they're going to build things that allow them to move faster but when they think about putting something in front of a patient now there's a different kind of pressure it's not only to build it and maintain it it's also to optimize it and make sure that it's secure and that it's safe and that it's reliable you carry a market-facing risk that you don't carry when you build internal tools and so we were talking about the ai receptionist example and he said yeah we try to roll out of ai receptionist, what we found is that patients would call in, AI receptionist would answer. They would figure out if an AI receptionist patient would hang up, try and call back in, hang up, try and call back in.

11:58I spoke to a leading plastic surgeon recently based out in California, who's just opened up another practice. And he said that he was pitched recently on an AI receptionist, all singing, all dancing. And their big thing was, oh, if we get you one more person than you're currently missing, it'll pay for itself because plastic surgery is$10 ,000, or$20 ,000 per engagement. And he said, yeah, but what about the three people that you piss off along the way? So it's great. You gave me the one more, but what about the three that I lose? What about the three where there's now an issue because you've automated, but you've lost some of that soft handling?

12:30So I think when you're in a healthcare provider setting, I think the question really needs to become, what do you want to make really efficient? And what do you actually want to keep very humid. And that's a choice. It's now a choice in a way that it wasn't a choice in the past. In the past, you had software, you bought software, you had a user, you had the software, that decision was made for you. Now you need to make that decision. You need to actively say, these are the things that I don't think are material in the patient experience. These are the things that if they're automated, actually no one's the worst for it.

13:07And these are the things that I really want to keep soft touch. These are the things that are really important to maintain human, to maintain that empathy. And I'll give you a simple example. We work with a dental clinic up in Sheffield. It's a great clinic. I think 400 five-star reviews, one of the crazy positive feedback. And you look at the reviews and it's not just, I had a great experience. It's the team is amazing. I go there for my birthdays. It's like, they really love the clinic. And what I think is really interesting about their approach is they tried, I think before we started working with them, they tried an AI singing octopus thing that does it all.

13:43And they said, listen, it worked, but it also got some stuff wrong. And as soon as it started getting stuff wrong, we couldn't fix it. It wasn't easy to fix because we had to tell the provider that it was wrong. Then they had to go and do something. And then they, it still wasn't right because, hey, AI is not necessarily deterministic. So it's not like you have a bug in your software that if you change one thing, it works. there isn't that reliability that consistency and the changing is really hard the ability to actually go in turn some knobs and get it to work it's not that easy it's not that easy to just say oh yeah if i just change it this way it'll work every time life's not that good so when we started working with them what they said is they knew there were going to be some issues they were okay with that but actually addressing those issues was really hard because the company they were working with.

14:30They were supporting hundreds of practices. And to get one use case tweaked for this one clinic, hey, it wasn't a priority. So when you buy tech, when you make a decision to purchase tech now, when you're buying intelligent tech, you need to be thinking about not only how do I buy the capabilities, but how do I buy the certainty? How do I buy the change, the ability to adapt? What happens when you change your SOPs? What happens when you change your pricing menu? What happened when you hire five new practitioners and you fire five other practitioners? How quickly is that information going to show up in the AI receptionist?

15:08And the answer is often not as quickly as it needs to. So I think when you're making that buy build decision or when you're buying in tech more generally, this is what Leigh and I were talking about. You need to really know what you're trying to solve for. And in the past, it used to be make a process faster. It's not necessarily what you're buying right now. You're buying, it's almost like thinking about it like you're writing a job description. That's how you should be buying some of these tools. What is the job I'm hiring this tech to do? It's I'm hiring it to buy things, to answer things, to check on things, to send messages.

15:42Whatever the thing that you're paying for it to do, that's how you need to assess it, much like you would assess an intern who comes in to do that job as well. It's a completely different way of thinking about technology. And this is also when we were talking about competitive advantage of the new high street or non-high street clinic types. Like you mentioned just now, the bar is much higher and the expectation from the patients are much higher. Once you experience the white gloves service or relationship oriented service, you can't go back anymore. And if the clinics next to you offer something better, and then if you're offering something worse, it's not going to be good for any growth-oriented clinic owners because ultimately taking a step back, zooming out from the forest, from the tree, looking at the forest as a whole, the reason why many of these clinic owners, especially multi-site clinic owners, their goal is to build valuable assets, right?

16:37In order to do that, they have to deliver a much more exceptional patient experience or customer relationship. And AI obviously is a bit too early for that to deliver guaranteed or reliable, high quality, high end, obviously depending on the clinics, the type of clinic or the, you know, if you're a Tesco of the clinic positioning map, then maybe that doesn't matter. But it really depends on what kind of clinic owners you are, what kind of strategic decision you're making for your clinic group in terms on your growth trend, right? What do you look at? How do you look at the competitive advantage?

17:12Because We actually saw a clip from a while back with the conversation you had with Joao, who's one of Coherence's clinic partners. And then throughout her words, it was pretty clear that she was trying to deliver. Her mission with her clinic groups was to deliver an exceptional patient experience, right? just so that they can stand out, they can differentiate themselves from the injectable clinics next door, flooded across London or maybe New York very soon. What are your thoughts on that particular point in terms of building an asset, creating the competitive advantage as a clinic owners on developing a chain or group?

17:56I think it's a really interesting question because being competitive right now in multi-site clinic operations, I think it is a different animal. first of all, there's just more competition. But I think equally, if you're thinking about building value, you've got a lot of levers to pull. One of them is more revenue. One of them is less cost. One of them is patient experience, which obviously connects to those two things. One of them is headcount efficiency. There are a lot of ways you can create value. And I think one of the things that we'll often hear from clinic leaders, like the one you referenced, like at Injectual, is that they are trying to unpick some of the assumptions.

18:32some of the old ways, some of the things that were just assumed about what it takes and what it should look like to run a healthcare operation, those things are being challenged very aggressively. How they challenge varies enormously by the type of provider, but in the case of the clinic we're talking about, there's an appetite to make the non-clinical experience, the hospitality experience, feel very rich around the actual clinical care. And I think that is one version of the future of high street, in this case, aesthetics, dermatology. We have another group CEO in dentistry that we spoke with and his view was that actually, I think he was calling it conservative dentistry.

19:18Conservative dentistry is the thing that they are going to hang their hat on, but actually around conservative dentistry in terms of the operational efficiency and the client care, that's going to feel very modern and forward looking. But actually, when you're in the clinical room, you're going to get a very conservative dentistry based approach. So it's totally fine for each health care provider to have a different spine. And actually, you'd hope that they do, because if they don't, then they're going to get lost in the sea. So I think having those things that are really special to your practice, to your group, they really move the needle.

19:51But when you look at how that shows up in other parts of the business, maybe businesses that are not market-facing, that don't touch the patient, that you can't see on the website. What do those things look like? Because that's really the lights and clockwork. That's really the engine room stuff. And I'm thinking of a different conversation we had where the CEO, previously COO, said a huge part of their value creation and transformation is about patient voice. Up until recently, the patient voice was in a feedback form set by Google or Microsoft forms six months after someone's last visit. That was how they figured out the customer.

20:28They asked explicitly in a very bad, inefficient way, and then they hoped that what came back was representative. If you look at any other business, Amazon, there's no shortage of Jeff Bezos saying in front of camera, customer obsession. There's that great interview where someone says, oh, you took all this big warehouse space. Isn't that a problem? It's going to be very expensive. Can you maintain that? And his answer is on a long-term basis, we want to be close to the customer because we want to be customer obsessed. We want to deliver that value to the customer. The only way you can deliver the value to the customer is if you listen, if you actively listen, which is why so many clinics are really good at going from zero to a million or zero to two million or zero to three million in a single site.

21:12The reason that they're good at it is because the decision maker is seeing the patient. They're listening to the patient. They have that anecdotal insight into what the patient is saying. They make decisions based on those conversations. When you get into multi-site operations, when you get into group leadership, you're not in the room anymore. How do you listen to the customer? You can't. You don't have a way of seeing, connecting, hearing what the customer has to say. I'll give you an example. We work with a multi-site medical aesthetics group. Great group, growing very quickly, incredible leadership, really forward-thinking leadership.

21:46There was a change that happened in one of the clinics. I don't know why the change happened, but for some reason, there was a bit of volatility in the practitioner rota. And a few patients had their appointments canceled multiple times in quick succession with no near-term appointment made available to them. And they said by response, listen, I can't have this from a provider that I'm using. I'm going elsewhere. Now, that's three clients or four clients to walk out. They're not coming back. Those are regular patients. So you're looking at 5 or 10K in annualized value in one site that's just gone.

22:20Now, the leadership and head office didn't know. No visibility. The practitioners didn't tell them. If they did tell them, the leadership didn't understand the consequence of that happening. They didn't realize that, oh, hold on. The patient is saying something is wrong here. The customer is saying something is wrong here. And I think in the healthcare world, we are over-indexed to listening to patients as patients. We actively seek their clinical feedback. We actively want to know, is the leg still hurting? Are you happy with your results? Are your teeth in better shape? We're actively looking for clinical information to come back.

22:56We need to do much more to actively look for customer feedback. What's the customer saying about their experience? Did they have a good experience? Was it convenient? Were the service levels satisfactory? Those are the things that allow you to genuinely drive better outcomes as a business, not as a doctor's office, not as a clinical point of care, but as a business, you have to listen to the feedback of the patient. And that feedback happens organically through conversation. It doesn't happen in Microsoft forms. And so I think when you're talking about value creation as an asset, yes, add more revenue.

23:27Yes, this is all table stakes stuff. You can chat GPT your way to an answer. but listening to the patient voice, letting the patient surface their specific problem, the thing that really didn't work for them. That is gold. It's absolute gold. We have another clinic that we work with. Half of the correspondence that we see for that clinic is about people dropping out of the online booking flow. They write in, I tried booking online. I wasn't sure how to do it. Those are the people who really want to go ahead. What about all the people who got that far had the same problem and said, you know what, I'm going down the block.

24:01I don't have to deal with this. This is too complex. Figuring out that there's a lot of friction in your online booking flow is an$100 ,000 solution. Literally, in value, marketing money, you're driving to an online form that otherwise gets thrown into the toilet. That insight, you only hear that when people, in this case, patients, customers actually say something. And in healthcare, I think we have a feedback problem. And this is a huge part of what we're trying to do at Coherent. We're trying to say, listen, you've got 50 ,000 patients that you see every week. Are you listening to them? No.

24:32Let us help you build direct points of connection to that patient body so that when they say, hey, I had a bad experience, you're on the front foot. Three weeks later, three hours later, not three months later, three years later, when the next CEO comes in and says, oh yeah, I need to do it differently now. You want to be on the front foot for customer feedback, which is very different than being on the front foot for clinical feedback. And the keyword is at scale, right? at scale. Anyone can do this in a single practice. We used to work with a pediatrician. We no longer work with him. It was a single practitioner in one room.

25:04Could we help? Yes. Did he need it? Not really. Why? Because he had every single one of his patients in WhatsApp, literally in WhatsApp. They were writing to him. There was no complexity. He was a one-person practitioner. When you get to scale, when you are an executive decision maker and you personally have not seen a patient in five years, now you have a problem. Now you have no line of sight into what's happening in the room. And those micro decisions, we always say coherent transformation is a million small steps. You don't put in place one piece of technology and suddenly it all changes. If you want to invoke genuine change, it's a million small steps.

25:42First, it's this part of the journey. Then it's that part of the journey. Then it's that part of the journey. But listening and identifying what those parts of the journey are. That's a hard thing to do. That is not a human problem. Now a quick break to tell you a little bit about Coherent Healthcare, the company behind the business of a clinic. Coherent helps fast-growing healthcare providers engage, support, retain, and nurture their patients from intake to discharge. As you get bigger, your patient body grows enormously, and it becomes much more than just another hire, just another front office team member.

26:13It's no longer a people problem. You need technology that can scale with you. Coherent helps you do that by keeping every patient on track. In short, we're the agentic CRM and patient support platform for outpatient hands-on healthcare. To learn more, visit us at coherenthq.com. Now back to the episode. And something you mentioned just now, a keyword was if you haven't seen the patient for something like five years, right? But it's fascinating now these days, how many clinics across dental, aesthetic, and MSK, the leader of a group, multi-site group, and not clinician. They want dentist, they want physio.

26:52Many of them are, of course. You have a multi-site clinic across London and New York. You want an aesthetic professional. You had no idea how to remove a tattoo other than learning the things later on, right? But you are a business operator. It's fascinating to me, at least, how many non-clinician-led business operators now taking over and running multi-site clinic groups across dental aesthetics and MSK, right? That is particularly interesting because they never had to communicate with their patients one-on-one, unlike clinician-led clinic groups, right? This seems to be a much bigger problem if you've never, as a business leader, as a CEO, if you've never really spoken to patients because you weren't a clinician.

27:39You are never going to be someone's chiropractic or doing injectable for a customer, i.e. patients of yours. So this seems to be a much bigger problem for them. If you have never had an experience where you are responsible for that patient feedback, it's hard to understand what it looks and sounds like. But I think there's something else going on here. If you look at leading consumer brands, particularly premium consumer brands. And I think there's an important distinction because non-premium consumer brands that are operating at scale are consciously providing a level of support that matches the price point.

28:15When you are providing a premium service at scale for customers, and I think about things like travel, hospitality, dining, there's an expectation that justifies the price. And that expectation needs plumbing, I've been a better word. You need to build that expectation on top of a set of capabilities. There's a great example. I've used these guys before and I think they're increasingly known. NecoHealth, which is founded by the gentleman who set up Spotify together with another entrepreneur. They are now, I think, in their 10th site. They've got thousands, tens of thousands. They're running an at-scale operation and it's early days for them.

28:52So there's going to be many more tens of thousands, hundreds of thousands of patients going to the Neco Health assembly line, they are very aware of the fact that patient support, i.e. customer support, is an important thing, which is exactly why they went out and they purchased Zendesk. And I know that they purchased Zendesk because I went to one of their health scans and I wrote in with a question and I got a thing back at the bottom of the email. It said, powered by Zendesk. So I know they use Zendesk, but I'll tell you something, the people at Zendesk, the good people at Zendesk, they have never stepped foot in a healthcare clinic.

29:22Not with the intention of building technology, not with the intention of serving the healthcare industry. They have thought about consumer e-commerce solving ticket support at scale. That's a fundamentally different environment than healthcare. And I know this because even when I reached out to Neco Health and I got powered by Zendesk on the way back out, it didn't solve my problem. So you have to think about how you want to deliver the experience and then the tools that you need to deliver that experience. And it's a very different thing. I always use the example of the practice management software, electronic medical record.

29:50Why do you use a practice management software, electronic medical record, EMREHR? Why? because you need to provide clinically compliant, high-quality healthcare. You need a scheduling thing, a patient record thing. Now you've got all kinds of ambient scribes in there. They can write up the conversations. You're providing a clinical service, but you're also providing a customer service. And it turns out that the good people at Epic and the good people at all of the other healthcare, EMR, EHR, PMSs in the world that are doing the core booking flow, turns out that their DNA, the thing they're really good at is the clinical journey.

30:22It's fundamentally different than the customer journey. and the customer support that you need to provide. And we know it's fundamentally different because oftentimes when we start working with practices, we come in and we say, how do you do this thing? How do you follow up with patients that haven't rebooked an appointment they canceled yesterday? Tell me what happens. They say, oh, we've got a really good process. Go ahead. What is that process? We send an SMS. Then what happens? Then we send another SMS. Then what happens? Then someone calls them. Then what happens? If they answer and they rebook, it's done.

30:53and if they don't answer, then we call them again. Okay, then what happens? That's it. How many people actually rebook? We don't know. We can't tell you. We just know we do that process. What's that great saying? Insanity is the definition of people doing the same thing over and over again and expecting a different outcome. This is what mostly happens in a clinic and environment when you're trying to use your PMS EHR to provide a customer function. It's let me try and twist this thing into some kind of misshapen Frankenstein workflow, connect six different tools and kind of get them to do the one thing that I want.

31:24The number of times I've heard clinics, in my old clinic, we had this, where we had a practice management software. We had a CRM. We had a customer support tool. We had a voice dialing tool. And our practice management software, who I won't name, they kept saying, we have all these capabilities. It's all inside ours, just use ours. And we kept saying to them, yours sucks. Your thing is really good at one thing. It's like being the calendar and making sure people show up and put the medical notes in there and capture the consent. That's what you're good at. you don't have a whole team obsessing over this one thing that also needs to be done.

31:57So it works when you're tiny scale, when you're a single practitioner, one room, five rooms, you can live inside of one tool, but very quickly you come to learn that tool has a limit. That tool has a finite ceiling that allows you to do the things you want to do. And if you're looking to build a customer-centric operation, a customer-centric healthcare provider operation, as opposed to a clinically centric healthcare provider operation. You need different tools. You cannot show up with a butter knife to carve a steak. You just can't do it. You need something that's chiseled differently. It needs to have different purpose.

32:32And this over and over again becomes the fundamentals of the conversation we have with clinics, which is what do you find to achieve? But wouldn't you say a butter knife can be turned into a Swiss army knife? Why a PMS can't turn themselves of adding another blade that does a different function in parallel with the existing blade? Why can't APMS create a customer-centric extension or parallel function? Is there some sort of intrinsic blocker, category blocker? I think you have to look at the roots, right? Very rarely, if you look at the roots of a tree, can you come to discover that it's actually not a tree, it's a flower.

33:16The roots of the tree tell you how the thing is built, how it's thought of. When you look at a practice mentor software, EMR, EHR, the foundation of everything is the clinical appointment. It's a clinical event. And everything wires through that architecture. When you're thinking about a customer, you're trying to achieve a very different set of things. You want a different kind of flexibility, a different way of communicating. The number of practice mentor and software that I have seen use myself and hear from others that only allow, as an example, one-way SMS. What are you going to do with one-way SMS?

33:48On purpose, right? For a reason. It's an appointment reminder. You don't need two-way SMS in a appointment reminder. Fine. But one-way and the number of messages I have received from healthcare providers say, here's some update. If you want to discuss this, call us. Here's number to call us. On what planet would someone receive an SMS from a number that they will then go and call instead of writing back. It's like people will talk about patient access. It's like we're trying to make it hard as an industry. It's like we're actively trying to get patients not to talk to us. It's a crazy thing. It's really crazy.

34:29I have a very good friend right now, very good friend, very close to me, who's going through a healthcare journey. And she described a situation where she went to private GP. She went to private GP to do bloods. She went and she did her bloods. went home. They send results through some weird triple gated thing that need four access codes to get your own data, but fine. It's blood. So let's assume it's good enough. But only some of the bloods are shared. Only some of the results. The other results will come in three weeks. So what do they say to her? They send her a message. This is the first result.

34:59The second results come in three weeks. Three weeks go by. They send load. Your second results are now available to be viewed. Now, three weeks have passed since this person accessed this place where the secret bloods are held. Three weeks have passed. Every piece of modern software of the planet, if you log out of something and you press log in, it remembers everything for you or it logs you right back in. You don't have to think about it. What does she need to do? Oh, she doesn't remember the code to get into the thing. So she has to request it. But then she doesn't get it right away. So she has to wait four days later this is her blood this is not it's like a health issue it's not software that she's trying to send an email out of this is a mission critical life critical stuff baseline of the the hierarchy of needs you can't have that much friction you just can't if a software that you use at work created that much friction you would just stop using it they would it would be in the big graveyard of software that you no longer use if there was that much friction around getting in.

36:01There are entire teams that are paid tens of millions of dollars a year and big companies to make sure people can get back in. So I think you ask the question, why can't the PMS do it? In theory, anyone can do anything. Amazon can go open its own restaurants, right? Anyone can do anything. But what is your core business? With all due respect to practice management software, EMR, EHR, even the biggest ones, the multi-billion dollar companies, There's such a thing as inertia. If a big company that had been building this from ground zero had made this a priority, then they would be a very different company.

36:34You wouldn't have this problem. You wouldn't have the frustration of, did I follow up with them? Did they have a problem? Was I able to rebook them? What did my front of house actually do? There's an entire workflow around those jobs that just doesn't live in the practice management software, not because the PMS is bad. It's a butter knife. You need a steak knife. You've got a big piece of steak. You need a different kind of tool. So you have to marry the business objective with the tooling, just like you have to marry the business objectives of the team. If your business objective is, I want to open a new line of service, I want to offer aesthetics at my physio practice because I have a big captive audience and they keep talking about wanting to look and feel their best.

37:11So let's say that's your business objective. You don't train your physios to do instables. You go out and you hire an aesthetics injector because that's a tool. It's a tool to achieve your business objective. You need the same kind of tooling in your technology stack. You need a tool to achieve the thing you're trying to achieve. And I think this goes back to what we were talking about earlier. And what I keep hearing time and again from group leaders in dentistry, in MSK, in medical aesthetics, what's the business objective? The business objective cannot be, I want to be AI first. The business objective has to be, I want to reduce my client care team from 12 to 6, from 15 to 7.

37:48I want to increase my patient retention by 3%. and reduce my marketing spend by 4%. Those are specific measurable objectives at a business level that fortunately we are able to help groups achieve. But equally, you then have common language to look at it and say, hey, has it been achieved? Has this actually moved the needle? Not theoretically, does an AI receptionist maybe answer more calls out of hours and that actually might increase bookings. It's like actual numbers, numbers help. I think it's a good segue when you talk so much about PMS and the difference from PMS and with other type of CRM or patient relationship management categories that Coherent trying to work on.

38:32You've probably heard a lot or on many occasions across sales calls and customer calls about PMS migration. And that conversation come up quite regularly. Is that related to what you were just saying? For example, a clinic owner was expecting PMS to do more or do different things. And then they get promised by the PMS provider that they could do these things with the tool, but eventually they realize that it didn't work. They keep playing this music chair game until they see that this is the end of the story. What happened there? Why so many clinic owners wanting to change PMS? I was speaking recently with a clinic owner who's going through some challenging times in her practices right now.

39:15And we were talking about the extent to which changing the PMS would be the thing that changes the game. And what I said to her, which is the same thing I'll say now, is that the answer is always no. Why is it always no? It's very unlikely that your business fundamentals are broken because you don't have the exact automation that you want from the PMS. It's very unlikely that the feature that you really want is the one thing holding back your business. Totally different if you're on pen and paper, right? Yes, of course, then you probably will see dramatic gains. But more often than not, and we hear this from PMS providers themselves, people will change over, they'll get really excited, they'll spend some time setting it up, and then it will just regress.

39:56It will regress to the least complicated version of itself. It will go backwards to low complexity because the team will change and people will use it differently. And eventually all things will cascade down to the simplest actions that a person can take. So is the PMS bad? No, it's a phenomenal piece of software. Mission critical has to be there, but it also serves a singular purpose. And when we see clinics migrating or looking to migrate their PMS, the question I always ask first is when you do this, what will be different? You're in system A, you're moving to system B, what will be different?

40:32And when they say at a high level, oh, it'll be this and we'll automate that. And I like have fun. That's it. I know the conversation needs to end. Rarely does someone respond with these five things. number one we have this integration which cuts out 20 hours of someone's time a week and as a result we can blah blah blah that's one thing that changes the second thing that changes is that we will we we anticipated 25 uplift in new conversion of initial inquiry because the booking flow is that much better okay when you have five things that are deeply measurable and specific to that transition you're setting yourself up for success i'll give you another example we spoke with a group recently who are looking at a new multi-site MSK practice management software, and they're looking at different options.

41:17And I said, how are you assessing these options? Very impressively, they send a very long list, an Excel sheet, red, yellow, green, which is already ahead of the game. And I looked at it and I said, this one looks really good. Looks like by your definitions, there's a whole lot of green here. Why aren't you using this one? It looks like it meets all your requirements they said oh the sales presentation didn't go very well okay so the tech seemed fine but the way the person pitched it to you wasn't very that's a problem obviously in terms of the company but it looks like the tool does the thing that you wanted to do and they said yeah but we couldn't get the team excited because the pitch was so bad it's like wow it must have really been a bad pitch how about this one this is second best what's wrong with this one this one's got a lot of green next to it also can we use this one oh this one doesn't let you do group holds for break time.

42:08Hold on a minute. Group holds for break time. Like, where's that showing up in the requirements of the practice management software? Group holds for break time. Everything else was good, but it fell down on group holds for break time. That was the decision. Something that's completely irrelevant in terms of what you're trying to achieve in your patient service. So I think the practice management migration story is usually driven by feature wars, often very poorly understood by the people making that decision. I know this. I've made this mistake. When I was running clinic, we started in one practice management software and the course of two years, we changed three times.

42:43Nothing changed. A little bit more automation, a bit easier to handle. Did the fundamental business performance change? No. I spoke with a different group leader recently and I said, oh, you're acquiring these clinics. Are you forcing them to migrate to a single practice management software? He said, no. I was like, oh, that's interesting. Why not? He said, that's a fool's game. Go on. Why is it a fool game. He said it's a fool game because you get a little bit more efficiency, maybe by standardizing across Linux. You might get a small improvement, but you piss off a lot of people because they've spent 15 years learning how to do something in one system.

43:17And so for a little bit of efficiency, you create a lot of chaos, a lot of headache. So the creation story is usually an emotional one. One person got upset about something. One person had a great sales call. One person feels really excited about a new feature. Very rarely is it thought through and decisioned in a way that justifies the change you're about to make. Thank you so much for joining us on this episode of The Business of a Clinic. We hope you had a good time. We hope it was helpful. If you can think of anyone who should join the conversation, feel free to nominate them, send them our way.

43:46We'd love to invite them to participate. If you like what you saw, give us a like, share, comment. We hope we'll see you again next time. Thanks so much.