From COVID Collapse to Record Profit and a Bigger MSK Vision | with Bruno de Jongh, BOAC #61

0:00I had a video gaming addiction and I'm 45 now and I've been playing games for at least 40 years. Before I had children, six years ago, I would easily play for eight hours straight. So I use that as a coping mechanism to address my anxiety and also bury my head in the sand and not look at what's happening in the business, not look at what's happening with my marriage. plus since then it's been three years with the program I'm one of the coaches now at Thrive as well two months ago we hit record revenue since forever last month we had record profit since forever most people they don't have fear of failure they have fear of being successful one of the biggest inspirations for me to run my business is my mom and my dad because they they're on their 70s now.

0:56Dad goes to the gym. He's 75. He's nonstop. You know, he's never been sick all his life. So for me, having a Pilates studio attached to CBR clinics means that we can provide clients with a continuation of care. Hi, everyone. This is Jared, co-founder at Coherent Healthcare. We're back for another shorter episode of Business of a Clinic. Today, I'm very excited to have Bruno, who is the director founder of CBR Clinics. So I'll share a bit about his story, but this should be a very interesting one because of the journey that Bruno has been on. So Bruno, maybe obviously we've had a chance to get to know each other.

1:32Other folks don't know much about you. Maybe some of them do. Can you take us on the two minute version of how you got from home to this chair in terms of your career experience that led you to be in the position that you're in right now? I started like most people start as a sole trader without having a clue of what I was doing because you don't learn how to run a business in university. You just learn to be a physio, in my case. And slowly, as the years went by, built my team, mostly of self-employed people. And it was all very great for a long time until COVID hit. And because I think what happened with COVID was that it showed through a lot of business owners, if the business had a good model, it was strong or not, and because mine was a bit of a shambles and I was still making profit, but somehow, but I didn't have a great system at all, then it really crumbled.

2:32And it took me, after COVID, probably another three years to finally ask for help because we were going to crash. And then I engaged with Thrive Business Coaching and from Katie Bell. And since then, I think it still took another year and a half for things to really change for me to work on my mindset and implement everything I wanted to implement. But since then, now it's been three years with the program. I'm one of the coaches now at Thrive as well. And last few, two months ago, we hit revenue. We have record revenue since forever. Last month, we had record profit since forever. So yeah, things are just happening now.

3:17Yeah, and boom. Yeah. So first of all, thank you for being so honest, because I think it's very easy to only talk about the good days and you're talking about the bad days. I imagine that also coming from a background in clinic operations, clinic leadership, the bad days really hurt. I would say that one of the great things about being a healthcare provider is that people have to come and see you. You're not going to be wiped off the face of the map by AI. There's something very real. But the worst part is that you also have rent and you have staff and you have these things. They hurt when they hurt.

3:51Yeah. Thinking about the bad days. What's the emotional intellectual? What does it feel every day? People like empathize with that. I certainly empathize with that. I sympathize with that. What do the bad days feel like? How do you even know you're having bad days? How do you say, hold on a minute, something? Yeah. So the bad day always felt like a lot of anxiety, which means then I wasn't sleeping well. I had a video gaming addiction, which I've had when I'm 45 now, and I've been playing games for at least 40 years. And I hid a lot behind video games. And before I had children, six years ago, I would easily play for eight hours straight.

4:39and that so i use that as a coping mechanism to address my anxiety and also bury my hand in the sand and not look at what's happening in the business not look at what's happening with my marriage so that was a big thing for me to then admit to myself and then take steps to overcome Um, so a bad day would look like trying to play some gaming to soothe my brain and cope on a day-to-day basis. But at the same time, still having anxiety because I wasn't addressing what needs to be addressed. Not sleeping well, worrying about money coming in. Yeah. And then just always looking, always thinking of worst case, oh, it's going to happen.

5:28I think in two months, we're going to crash. Now, maybe it's going to be in six months. Yeah. So you're going through this period of, I don't know how long, prolonged, I'm going to use the word prolonged. Extended, ongoing anxiety, self-soothing, you're self-soothing with video gaming, which actually sounds healthy compared to other ways that you might, that people might self-soothe, but still you're self-soothing, you're wearing your head in the sand, which all sound like indicators. Then you reach this moment where you say, okay, I, something's going to change. And you go find this program you mentioned already, Thrive Coaching Program, Katie Bell.

6:00And that seems to have been the beginning of the transformation. I'm wondering if you think of the curve, the bottom was down here. You've just given us a flavor for that. What were the stages? What started to change between that point on the line now to here? You're having record revenue, record profit, improved work-life balance, happier at home. They didn't all happen at once. No. So what happened first? What happened next? What were the chapters of that transformation? I think the first thing I did was probably start going through this checklist that you get from coaching programs, right? And started implementing a few things.

6:42But the big thing with Thrive is that they have a mindset coach as well. so i was doing that but so i was implementing stuff but i wasn't quite engaging with my mindset and i was still quite stuck into old patterns and still catastrophizing still very anxious still not quite believing in it and there's a big difference when you start believing in it and taking action because then you start seeing results because you might implement exactly the same strategy they implemented at a time that you didn't have a great mindset you weren't a great place if I implement it now it's going to have different results just because I'm in a different place mindset wise but I think the first thing I did was with the coaching was just trying to go into the checklist and then I think I started addressing a bit of the mindset and when I got really close to a breakthrough I tried to leave and they and I said so I sent them an email and I said, thank you very much.

7:44You've been very helpful. I'm off because this is too scary. And they were like, you're not going anywhere. You're going to stay because we can see there's a lot of potential. And they said they were very loving and compassionate. They said, look, if you want to go, you go. But we think there's... Come on. Come on. You're about to... You're about to... Yeah, you're about to hit transformation. Just stick with it. Are you attending these meetings? Are you attending those meetings? I was like, no, I'm not attending anything. I was like, how about you start attending them? For then I started attending them and turning up and asking more questions.

8:21And I think it was, there was one day that I was having a chat with Katie in this group, online group. She just put me against the wall. She just said to me, and she basically said, Bruno, I want you to do one thing for the next week. Every single day, you're going to do a gratitude list. Because my biggest problem back then was self-worth. and when you have self-worth, you don't see the good stuff around you. So then she said, crush it. I want you to write on the group chats, our WhatsApp group chat that we have, 10 things you're grateful for every single day and they can't be the same. And you have to do that for seven days.

8:55That's a lot of zahht. Well, on the first day, I'll be like three things. I was like, there's nothing else. But then I will fight. And by the seventh day, something had changed in me. Something there. And I started feeling more this self-worth. Yeah, that was the big breakthrough for me, to work on the self-worth. It's so interesting. I'm not a coach. We don't do coaching at Coherent. I've been the beneficiary of great coaching before. And I've experienced dynamics that you're describing, that real change in the way that you see experience interact with a thing, an event, a place, a business, a team member, whatever it is.

9:34What I think is so interesting is that if I think about the time that we spend with clinic odors, which is much more in a provider-supplier capacity, a huge amount of the work that we do bumps into this idea of willingness to change because the idea of following up with your patients is not new. It's not rocket science, but the belief or the open-mindedness to the fact that maybe it's not working well is a huge change. So many clinic leaders that we speak to, all the way from 90, 100 side groups down to two, three sides, down to a single practitioner, their first response will be, we ready to do that.

10:20Yeah. That would have worked for us. That would have worked for us. Yeah. I've got someone that does that. Okay. We're done. Like, I got nothing. Yeah. You can't. That's a mindset thing. Yeah. That is a mindset. Is revenue trending positively? Do you know what your patient retention looks like? No. Okay. We can't have more. So it's interesting to hear that. And it sounds like the beginning of your change was tactical checklist. But actually, it sounds like the first gear to second gear movement was actually, yeah, this comes first. Yes, definitely. And this is something that we see and thrive a lot these days, which is for Casey or whatever coach will do a presentation, will present, oh, this is a strategy that you guys could implement.

11:07And a lot of people will come and say, oh, this wouldn't work for me. It's a lot of time people just don't have a growth mindset. And it comes down to that. And it's just blocks that they're putting on their own way. because sometimes they're so resistant to being successful. It's not... Most people, they don't have fear of failure. They have fear of being successful. Because what would it mean to be successful? It means that they might be going against what they heard their parents saying about people who are wealthy. Because a lot of people, they grew up hearing that money is bad and that rich people are evil, they're the evil in the world, that's why there's only so many percent of them.

11:58A lot of people grew up hearing those things, so for some people to go against their parents' beliefs is almost like a betrayal, so they won't do it. So this is just one example. It's interesting that you talk about you were in school and you trained to be a physiotherapist and they don't teach you about the business, which makes sense. They also don't teach you about the mindset. So they're giving the, I guess, the formality of becoming a healthcare operator, which you are. There are different ways into that journey. One of them is a clinician up. One of them is operational and up. One of them is investor down.

12:37I'm sure there are a lot of different pathways, but it sounds like the threads that you're pulling on to be successful and to continue finding success in your work are really around three things. Number one, the tactical and the operational, plus the clinical and the scientific, plus the mindset and the behavior. And it sounds, for what you're saying, those are the three pillars that you need to be constantly challenging, reinforcing, developing. Is that true of your day-to-day? Yeah, definitely, definitely. I think the implementation, the strategy and the mindset definitely are two big things.

13:12And I think what you said that the clinical execution, there is probably more about having the right team around you. And this is something that I've worked diligently over the last three years. And actually, since I started working with Thrive, since I've been a client of Thrive, only one person of my team is still the same. Everyone else is new. Wow. Everyone's changed. And we have a team of seven with me as eight. so there's only one person who survived the change yeah so she was in she was i showed her yeah i showed her this is where we go like okay let's go but everyone else either they left because they saw that it's not where they want to go or we had to get rid of them because they just weren't it's entering the i'm recalling a conversation i had recently with a group leader actually in the U.S.

14:08big footprint, not an MSK in dentistry. And he was saying something very similar, which is that when they started acquiring practices and building the group, oftentimes people will focus on the systems integration, the get consistency in the process. And he said, all that is total nonsense. It's all second and third priority. The first priority is that make sure the team you're absorbing is aligned. The mindset is aligned. the leadership of that clinic is aligned, the clinic management, the operator, the principal practitioners, mindset, mindset, everything else come for free if that's aligned.

14:44Yes. Because if you see that differently, then you will battle tooth, nail, blood, sweat, tears to try and get that share of conviction. And it sounds like that's been your experience as well. It's having the right people in the right seats. It's hard. Yeah, it's really hard. I'm curious. So it sounds like one of the big changes on that journey from bottom to up. It doesn't sound like we're at the top yet. It sounds like we're coming up. It sounds like we're coming up. It sounds like we're coming up. Has been the team. And I know we spoke before about the fact that you have a, almost a, maybe it sounds like a personal specialty in finding other people who are not part of the core team, suppliers, partner services.

15:27And that's your full team. Your full team is the full-time team plus the expertise here and providers there. how do you think about building that team of in-house and outhouse how do you think about getting that to work well together it's hard to do it's hard to have a sort of part in part out i think people are often very anxious about that i'm often anxious about that what has been your secret sauce so i've been burned in the past like everybody that's burned in the past by providers that didn't align with my core values and the business core values. And I think since that happened, I've been a lot more selective as to who I work with.

16:14And what I always look for, and this is across my team who is employed, my contractors and the providers, is always transparency. This is the first thing that I'm looking at. Are they going to be transparent? And you can see these days I've trained myself to spot it and to ask the right questions to see if there is going to be transparency or not. So these days it takes me a while to engage with a provider rather than just jumping straight on it, which I would do in the past, because there's several conversations that need to happen for me to really see, yeah, okay, I think this is, they align with our core values.

17:02So I think as long as you're clear what your core values are, then it's just seeing if people fit and asking the right questions around that or asking to see some data from some evidence. So show me some evidence of what you're saying is actually going to happen, that the return you're saying that I'm going to have is like, and then people show me, okay, here we go. We've been working with this and this client. we started they started like this this is where they are now and i looked them up but they're all real people so i think you guys have been one and then the other one splatch the marketing agency that we engaged with the other one zephra that we worked with as well so very transparent very clear nice people easy to talk to not big-headed or we know it all like there are some all there yeah i think that the all needs to align so for whoever's watching whoever's listening i think this is it what are your core values and then how do you what what questions can you ask to try and determine if the provider engagement share those core values yeah it's interesting i think oftentimes people even myself i think about running clinic you always think about values or typically think about values as an internal measure of alignment are the people that i'm recruiting to my team aligned it's interesting to think about actually can i take that exact same set of expectations and let them be external oh yeah and filtering as well well why not it makes perfect sense and and i can also attest to the fact that you do take your time when it's about who to work with because we probably spoke five times over the course of six months or something.

18:47Yeah. Very lot. And eventually, so we found our way to work together. So I think I can confirm that what you're saying is true and not just what you're saying. I guess the, the, so following that line of thinking where we've now been working together for a few months. Yeah. I know you're doing many things to improve your business. It delights me to hear that the last few months have been particularly good months and it also delights We won't take all the credit for that, obviously, but it's nice to know that we've in some way contributed to that. And one of the things that we always want to understand is what's changed in the business.

19:27We're working well together. We think we're working well together. We enjoy working with you guys. I was saying over lunch, the team that we work with most closely day to day are really switched on, really on it. Very open, easy, open dialogue. We don't have to go chasing for things. So the dynamics, it works well on both sides. It's not a burden for us. It's a joy for us. How has that shown up in your business, the experience of working together? What's changed? What does the future look like? Help me understand. So I think in terms of how that's been working, I think it's because one of the reasons that it works, it's been working well.

20:02One is because we speak the same language and we're looking at the same measurables. Like you were saying that sometimes you go to a clinical and say, oh, do you know your retention rate? Do you know your rupert? And people are like, don't know that. Well, we know everything that there is to know and we keep digging. Every Monday's a new thing that Marcel digs out of. We should start looking into this as well. And you guys are very thorough. I think when we do the monthly meetings, there's about 15 graphs of different stuff that you show us. So you're very thorough on the KPI measuring. And so we speak the same language.

20:39And then one thing that's massively made a difference was having people who are really competent doing recalls. Because until then, we had a software doing emails, SMS, which clearly wasn't enough. Because since you guys came in, a lot of people started coming back to us, people from four years ago. And also we had some therapists doing some outreach sometimes, but they're not wired to do that. They are wired to deliver a treatment plan and engage with the client in clinic, not be calling. It was not part of their job. And also because they were doing some of that before, it was just taking part of their admin time.

21:23So that's freed up their diary a bit. And because we have competent people doing the recalls now, then it just works. Clients come back a lot more. and yeah i think the financial aspect of the revenue i think last on the first month it was an extra four thousand pounds that we you guys generated to us so i have this great return and this is it when i think when there's alignment of values when there's people in the right seat because when i engage with the providers i almost think it's almost like each provider is an employee who's providing a service, but of course it's a group of people behind that and they're not working 40 hours a week for us, but it doesn't need to be because there's all this alignment and then there's people in the right sense of coherent health is in the right seat for doing recalls and the outreach as a specialist on that.

22:24Then it works. So when you hire specialist people to do the job, or providers to do the job, it just works. It's interesting. So thank you for sharing that. I think one of the things that I'm always interested in and would be curious to understand from the inner of the business, in MSK specifically, more so than in a lot of the other healthcare verticals that we work in, there seems to be an expectation that the practitioners will do the follow-up. We don't see this in dentistry and medical aesthetics, dermatology, but yet in MSK, somewhere along the way, I guess it became the assumption that the practitioner would be the person checking in.

23:06And I understand why. If you saw someone and you touched them yesterday, you want to see how they're doing, it makes sense. Our belief is, not as MSK providers, but our belief is that's not a good place for people to spend their time. And I'm happy to hear that has opened up time for the team to do other more specialist, mission-critical, clinically relevant things. but it is still a change and I'm curious as a practice leader how does how did you think about that that fact that someone or something would be doing some of that patient relationship management outside of the immediate purview of the practitioner how did that sit with you because we often find that some practitioners say I'm a little uncomfortable with that I understand why I'm curious, how did you think about that?

23:57I think the way that I saw that and the way that I see engagement providers these days is that it's always an investment. Because it's the same with marketing, right? I could be doing my Google AdWords myself. Or I could get one of my team, each of the cities. And they're going to do a half-baked job because they're not really enjoying it. It's not in the bag. but so i think i see these days more as investment when i hire a marketing team because they're gonna produce the results and it needs to be measurable right so with my marketing with clutch they measure everything they go into clinical they see which leads have converted and how much have they spent and then they show me okay so you spend this much with us and go outwards, but this is how much you sold because of that.

24:55So it's okay. It's an investment. There's no, no brainer. Yeah. And with you guys, again, it's very similar. It's, it has to be, it has to be measurable. So when you measure and you see what we're, so, and I think a lot of clinical, especially small businesses, sometimes when they're really small, there is a problem with cash flow. There is a problem. They can't afford it yet. short that's fine so then they get the therapist to do it because it's cheap it's the it's paid for already right it's filling up the diary especially when they are new to the team so i was running one of the coaching sessions yes and this is one of the questions that one of the clinic owners said is hiring her first employee and then she's how do i fill up her time because she's going to have some clients but it's going half of that is going to be empty i'll get her on the phone, making some calls.

25:49Sure. It's probably the right thing to do for that cynic size, but there comes to a point where it's gonna, if you keep your team doing a lot of the admin that they're not wired to do, it's going to prevent you from growing because they're just going to be a bit demotivated to do it. They're not going to do it. And then you're just going to come up in a meeting. They're all X and Y is that person. They're not doing the follow-up calls. of guests have a meeting with them then and then it's a half an hour or an hour meeting with each one of them it's a whole lot of time wasted it's interesting we work with a very large msk group dozens of sites and we're in this process right now of trying to move that follow-up burden and i was trying to understand what was the motivation speaking to the ceo there what was the motivation and it was very interesting because she said forget return on investment for a minute in terms of appointments and efficiency and consistency and all those things.

26:49Let's just talk about staff retention. This is something that our practitioners don't like to do. This could be a recruiting tool for us. We can now recruit practitioners who don't have to do all this stuff and they just get to do the thing that they signed up to do. And that for her was a huge motivation was actually, it's hugely painful, expensive, time-consuming, and efficient to recruit new people and train new people. And I'm thinking about that because of what you're saying in management time. That's the hidden cost. 30 minutes of your time and 30 minutes of a practitioner time is a very expensive hour.

27:23It's a very expensive hour, which you don't, when you're doing the math, you don't necessarily add those minutes up and it can be very expensive. Yeah. And then it becomes little issues that can fill up your diary every week, which are not going to move the needle. are just good. They might improve a little bit here and there, but because they're not wired for it, that problem is going to come, it's going to surface again in two, three months time. And then again, you're having those conversations. So you might as well just give it to someone who is just... Wait, because I'm done with it. That's all I'm going to do.

27:57Every day. Exactly. Yeah. I'm curious. So you're now, going back to your graph of the down and the up, it's now going up. Yep. If we were to sit down in 24 months, Yeah. 60 months, I mean, you pick the amount of time, however many, two months, what is the future look like what is the vision you mentioned earlier in the leadership of your business you have vision and you have integration implementation wearing the hat of visionary wearing the hat of the future where what would you if i sat down with you in 60 months i said how are things going yeah what would where would we be would we be in more sites the same time would be in America or Brazil or what does the future hold?

28:39So we have plans of opening a flagship site in January. And I'm talking about and I'm viewing some places in this new site. It will be a new site. It's not going to replace any, but it's going to be a brand new site. It's still between Waterloo and Canary Wharf, which is our two existing sites. but this flagship site we're going to have the idea is to have a glasses studio and to have a rehab room with sort of a jungle gym because so for me one of the biggest inspirations for me to running my business is my mom and my dad because they they're on their 70s now they exercise at least three times a week they're strong they're healthy they can climb stairs they can lift stuff my dad morphs my mom has some help usually three pilates three times a week and my dad goes to the gym three times he's 75 he's non-stop that's great he's never been sick yeah always live and for me this is a secret one of the things you can do to improve your quality of life and to ensure that you're living you're just not living a long life but you're living a life through lots of quality right at the end.

30:01And you can travel, you can do whatever you want, right? You're 70, you're 90. So for me, having a Pilates studio attached to CVR clinics means that we can provide clients with a continuation of care, which we know is going to make a huge impact in the long term for the lives. That's a very exciting... Yeah. It's amazing. Next milestone. It's doable. It's totally doable. And there's a market for it. And lots of clients. We have a really strong marketing team. And the clinical team now is fantastic as well. The infrastructure is there. The infrastructure is there. Everything I feel like over the last three years, I have been fixing one thing at a time.

30:45And I think up to April, there's always things to fix. In April, we did another little overhaul on this one thing. Let's fix it. And then June already, massive result in July. Revenue records. because we're always trying to look where the leaky buckets in the business. So that's a coherent outcome to do as well. We do like a leaky bucket. We do like a leaky bucket. Yes. That's great. Thank you, Bruno, so much for sharing. I think we have a lot of different people who join us to talk about their experiences. And I think I always try to say, what am I taking away from this? For me, one of the things I'm taking away is, I think this is the first time that mindset has come up in any conversation.

31:25There's a lot of talk about clinical excellence. There's a lot of talk about operational excellence. I think sometimes people will hit on culture, DNA, which maybe is in and around mindset, but you're saying actually this is a pillar in and to itself. This is a thing that needs active thinking, investment, development, just like the rest of the business. And I imagine that is, I know that is true all the way up. Tiny first solo practitioner through to massive multi-site international group. No matter how you look at it, there's a mindset component, a growth mindset component. That's one of the things I'm taking away.

31:56The second thing I'm taking away is that whether they say it or not, most people have had those really dark days. The part that you said on that upswing was actually you got to a place where you said, I'm good, thank you. And it was actually through that. Yeah. That was the crossing of the threshold. The crossing of the chasm was going through that. And I don't know even at Coherent, we have those moments of, ah, we fixed it. But actually, if we just push a bit more. A little bit more. Usually when it's least comfortable. that's it this is usually where that happens and then I think the third thing is from what you're saying it sounds like wearing the vision hat you are thinking about the evolution of your business as living well longer and in that vision it didn't describe you mentioned a new facility but it seems like that facility is in service of the vision as opposed to we're going to open four more sites or we're going to open whatever it is actually the pursuit was this is the big thing and all Pilates studio or five more sites or no more sites.

32:59It's all ultimately the how of delivering against that. And I find myself wondering, even thinking back to when I was running practice, I don't know that I would have been able to articulate as clearly everything we do is in service of helping people live well longer, whenever the version of that is. And so sometimes you get lost in the mess and actually having that hop line. So thank you for sharing for those interested, visit Bruno in London or visit Bruno's team because Bruno's not in the clinic anymore himself, but thank you so much for joining. And Bruno, thank you so much for joining as well.

33:26Thanks for having me. Pleasure.