From Running Pubs to Running an Aesthetics Clinic: A Nurse’s Story | with Joolia Gilvey, BOAC #75

0:00You're talking like 90 grand, got the hyperbaric oxygen pod. I would like to upgrade that to one of the hard shell chambers. So sometimes you have to stop yourself. Just think, I'm going to want that for myself. So it's a slow and steady climb of acquiring these different devices that promise the world. But you need to be sensible and you've got to make sure that you've got the demand for it. You've got to follow trends a little bit, but you've just got to be a bit sensible with your decisions and just sit back sometimes and think, okay, is this going to work? Have we got any evidence? I've worked for different companies and then you get paid but you're thinking what's really in that for me apart from a pat on the back I would rather be working on my own business for the day than working on somebody else's business but I don't really now want to be affiliated with any one particular brand because that's not going to benefit me you have a lot of reps that come in to see you and they go what can we do for you and I go nothing but then you have to say what can you do for me when you start asking the reps what they can do they go oh I can do this I can do that I can offer you this business support, I can offer that.

1:00For 10 years, I used to give you coffee and you used to come to my clinic and I never used to ask you. I didn't even know you could do that.

1:14Julia's going to do it. Okay. I'm going to do this. Do you want to do the thing? Okay. What do I have to say? You just snap it. Do you want? Let's go. And then he will start. One second. Three, two.

1:26There you go. It is fun.

1:31Hi, everyone. This is Jared, one of the co-founders at Coherent Healthcare. We're back for another episode of The Business of a Clinic, this time with Julia, who is a nurse prescriber and clinic leader. Thank you so much for joining. Thank you for having me. Yeah, absolutely. I have had the opportunity to read about and learn about your background, so I think I wouldn't say I'm up to speed, but I'm getting up to speed. I think others, maybe less so maybe do you mind starting with the two inadvertent yeah tell us the origin take us to the beginning where we started originally i'm from a place called norwich in england and i started off actually running pubs that's what i did as my first career and i did that for several years and eventually had two children got married two children and i thought oh this is not working out so well running the pubs late nights two small children and i thought so what should i do what I do and I had a friend who worked at the hospital and she said come work at the hospital there's loads of jobs you can just do all sorts of things so applied for a few different jobs ended up getting a job on a medicine for the elderly ward and I was doing sort of the caring role then and I just thought gee I can do this it's like it's changing your customers at the pub for your patients you're looking after people it's a service you're making people happy and so I did that for a while and I kept looking at the nurses and I kept thinking I reckon I could do that I reckon I could do that but it's I had to go back to university and obviously I've got two small children so that's quite a big thing to do isn't it anyway I did it the rest is history I started working on a thoracic ward and then I was about 40 actually by the time I'd qualified get a little bit older starting to have some treatments and I thought as a nurse that did my treatments I thought I think I could probably do that so then it just one thing leads to another and then I started doing some courses and started to enjoy the aesthetic side of things as well as staying within the NHS.

3:23So that's where it all started. This is intentionally just to poke the question. Yeah. You said similarities to being in pub management, looking after customers, looking after people. I completely agree with that. I think so because it's about giving a service and looking after people and making sure people are happy. So I guess that's where I came from. And I think that's where I've done quite well in my career, because I think sometimes people who aren't thinking about customer service, they don't, if they come from healthcare, they've never had to do that. So they've never been in sales. They've never had to upsell.

3:59Would you like a larger glass or would you like this with that? And I've never had to run around doing lots and lots of things at lots of times as well, looking after lots of people and trying to be doing everything, but looking quite calm on the outside. So maybe the question I'd love to start with then is when you think about the skills you picked up you just mentioned some of them supporting the customer thinking about the customer very customer centric yeah when you think about the skills that you had going into practice leadership yeah because of your non-health care background how would you lay those out what were the sort of the ingredients that let you make that transition very successfully I think it's just basically you come from a place of wanting to please don't you so i think if you want to please then you're going to have to create all the skills that you need to do that so in whatever your environment is if you want to make people happy make people feel comfortable whether that's in a restaurant environment or whether that's when someone's in a lot of pain or they're nervous before an operation it's just about focusing in on that person and making that person feel special and i think that's probably what i'm quite good at and why is that because you alluded to it earlier and these are my words not yours You didn't say no one who comes from health care has that background.

5:07Many people do have that. But sometimes there is that tension where people who come from a very clinical... People don't, they just don't have the skills to think about the other person maybe as much as themselves. I don't know. Is it a sort of lack of empathy in the room or is it an overcommitment to the clinical, do you think? Yeah, I think it's probably a little bit of both really, isn't it? Yeah. Okay, so now you're running your practice. Yeah. The vision is coming to life. You have a bigger team. It's growing. If I'm a patient of yours, does that focus on empathy, on the customer experience?

5:42How does that show up? Yeah, I think with all of us in the team, what's really nice actually about being able to pick your own team rather than be forced to work with people that you didn't choose to, is you can judge people's personalities and just make sure that they're the right fit for the team. so all of us at the clinic we all want the best so you know when the door opens we're standing up people are coming in we'll always smile they get a really nice coffee or a really nice drink so the service starts from the minute they walk through the door it isn't just about when they come to see me or when they go to see one of the other nurses it's right from the front desk and it's also right from the phone call when they or they might drop an email so it's about trying to give that service first I think give them a little bit of luxury as well make everything look nice and give them extras, little extra things as well, add-ons and things that they wouldn't get somewhere else.

6:30It makes it special. It's interesting because what you're describing, and you've used the word a few times, service, service, service, key coming up. And I think when we, other folks I've spoken to on the show, what we will often see is, I wouldn't say a bright red line down the middle, but there's definitely this split of people who say, I am in the business of treating patients as opposed to I'm in the business of serving customers. and obviously everyone's doing a bit of both but it sounds like yours yeah I guess so that's probably from my history though isn't it I guess I had 30 years non-medical first of my life and then 10 years so it's really only been the last 15 years it's been medical so I guess you'd always go back to your history wouldn't you so if you had to if you were sitting down I'm not a doctor unfortunately or fortunately depending right if you were sitting down with a clinical a person whose background is from the more traditionally clinical side of the house.

7:24And you were trying to help them think about bringing a service-based mentality to their work, to their team's work, to the way they want to deliver for their patients. What would you say to them? I think you've got to be really able to speak to everybody on all levels as well. So simplify things as well for the patients. So anyone who's coming through, they need to understand the treatments that you're doing. You've got to educate them in a way that they understand. So you've got to read the room as well a lot, haven't you? But I guess that's a skill that can be transferred. How does that show up in how you, for example, train your staff?

8:01So you want that ethos to carry? Normally, the girls will come in with me if they can. Sometimes we're too busy, and sometimes it's not appropriate, depending on the patient. But I think, for me, I'm learning as I go along as well. So I don't really know sometimes what I'm doing. I'm just, everything's new for me as well. I'm trying to help the girls as much as I can and I've got new staff members coming in so we've spent some money on communication, teamwork sort of sessions as well so that's quite nice to do that. So it's bringing everybody in, making sure everyone feels included and then they all understand the vision that we're trying to have so that everyone's on the same sort of page really so I think that's been helpful.

8:40Those teamwork-y sort of things. I was curious, you You used the word vision. Obviously, you've already, the business has grown considerably since you opened the doors. What is the forward looking? What are you trying to rally the team behind in terms of seeing what comes next? We've got a really beautiful building. It's a listed, like a grade two listed building and it's really beautiful, but there isn't that much space. But at the moment, we've got three rooms, which are useful for clinical rooms. So at the moment, it's just trying to make sure the rooms are busy and the rooms are full and we've got the nurses coming on board.

9:12so obviously you have to invest in a bit of marketing to get busier, invest in the right devices as well. So for me it's about getting the place really buzzy because the days when the three nurses in, it's really good, it's a really nice vibe as well. So on the days when sometimes someone's got a day off or it might just be me and reception, I'm a bit like, oh, it's a bit flat today. So I suppose it's about getting the building busy, working it as much as we can and then we see where we go from there. It's interesting, you use the word vibe and the idea of atmosphere, I think that, again, this is that sort of tension where a lot of people don't necessarily, I don't agree with this, I agree with you, I don't necessarily agree with it, but a lot of people don't think about atmosphere, atmosphere, you think about restaurants, hotel, hospitality.

9:57So we've got really nice fragrance in the clinic, we've got really luxury soaps, we've got perfumes in the clinic for people to try, top brand of things, We have music always, like Ibiza Chilout music going, so it's a little bit vivy. So it's not medical, it's not clinical. Everybody, I think everybody really enjoys coming to see us and it's very friendly as well. Do you think that has... People always come early. They always come early. Just to sit and spend time in the space. Yeah, exactly. And they never leave. And then they just get a little chocolate and then get some gifties and stuff and have a little squirt of perfume and then they come in.

10:33And there's a lot of stuff going on, So it just makes it feel really luxurious and nice. Where did that come from for you? Why was that an important thing to me? I think I just really like nice things around me anyway. So if I'm at work all day, I just want to be surrounded by nice things. So why have them at home when I can have some nice... Patients will enjoy it. Yeah, exactly. So it's a space that you'll enjoy being. Exactly. And so most likely it's a place that... And I've been to many a doctor's office or a healthcare facility where I think... We've always got fresh flowers. Just always looks really nice.

11:07And the detail around that experience. Exactly, yeah. Do you think that, is that new to appreciating that the industry has evolved a lot? But when I was working in the medical aesthetics, dermatology space, I think that it was only just starting this sort of splitting. It's a difference between sort of a luxury hotel and a spa and a medispa. And now we're amalgamating into the same sort of thing, aren't we? but it's an experience it's not just a treatment and is it do you think that's how your customers that you see is that are they they're coming to you for i think so yeah yeah interesting and if you're going to be charging sort of high end for my area it's not london prices obviously then you've got to give them something that someone else isn't and that's not so is it going beyond the treatment itself the whole like i said the minute you come into the door to the minute you leave you want to feel special you want to feel part of the team part of the I don't like using the word family but there's a togetherness we've got a membership scheme we offer sort of rewards we give people birthday vouchers so we include them in the sort of clinic sort of a membership really one of the things I'm interested in so we work with people who I guess are more on the or clinics or providers that are more on the hospitality side and then all the way to the other under the spectrum is neurologists and the rest.

12:27There's a huge range. And I think there's always, there is always a little bit of tension between, amongst leadership, where some people, I think, fall down more on the side of, we want to build an experience that happens to have healthcare inside. And others are, we want to provide a healthcare service for patients. And then if They have a good experience. That's good too. Sometimes they're very tied, I think. So I'm not CQC registered, but if you are CQC registered, then you have to follow specific guidelines as well. So I think I have a little bit of a degree of flexibility because I'm not quite so registered.

13:06For example, the reception staff can have nail varnish on at my clinic, but you wouldn't have that if you were CQC registered. Just very small sort of clinical things. Certain hand washes wouldn't be allowed. Perhaps we wouldn't be allowed to have fresh flowers in the room so there's a lot of things that you can't have sometimes if you are really clinical so actually I think just I'm just stepping under that a little bit how does that show up for one of the things I'm always interested in I think about back to being in an environment more regularly that was patient facing even when patients came back for second visit third visit fourth visit there was always a little bit of there's some nerves you're going to for us it was non-invasive it was laser-based but you're going to have some kind of treatment something's going to be touching you even if you've been there you know it there's still a little bit of the you know yeah people do get nervous some people say to me all the time oh i feel a bit loud it's just that they're about to get on the couch usually and but i think part of my nursing background is calming people down making sure they feel okay and then you can help to alleviate those nerves but also say that just that is normal to feel nervous i'd be worried if you didn't feel nervous and I'm going to be doing a procedure that involves needles, you know it's going to hurt a little bit.

14:19It's like going to the dentist, isn't it? So it's, you know, something's going to be happening. There is an element of risk always. So people will feel nervous, but you just have to, I think having a calming environment, they could come in and have a coffee, speak to reception, see the other nurses milling around and it's not too busy and it's quite an intimate space as well so it's not too big it's not too vacant looking so I think they feel special we work with some I think that is interesting here to say we're safe because this this is what I was just thinking we work with some dental practices dental groups where we will see in the patient correspondence yeah patients very clearly saying I'm I'm or worried and or uncomfortable with coming back to the dentist even though I might have a thing and I think oftentimes the things you're describing, because of your background as a nurse, that focus on the comfort level of the patient, that sense of safety helps you overcome that.

15:17I'm curious for, I don't know the extent to which you spend a lot of time with dentists, as an example, but for people who are in that world of healthcare where they are impacting the body, it is hands-on. It is, you know, be it cutting, injecting, touching, moving, hands-on healthcare. How do you, What have you learned in your journey to do that? My background is mostly surgical. So the last part of my NHS career, and then I went into private healthcare at Spire Healthcare, and I was there for six or seven years. So a lot of patients are coming in and they're having an operation, so they're going to be super scared.

15:52It isn't just you've got a chest infection. They're coming in, they're having a procedure, they're thinking about it for weeks. They might need it desperately. It might be the first time they've ever been in a hospital or the first operation they've ever had. so you very quickly be able to overcome people's nerves and anxiety and I just think you just waffle to them a bit talk about anything and then if you can warm to them they know that they feel a bit safer and explain everything to them that's going to happen as well because otherwise they don't know what's happening next whereas they know they're going down at a certain time you have to say okay this is what's going to happen someone's going to come and collect you and once they know and then I'll see you afterwards and then you collect them from theatre or what have you so as long as people understand what's going on and you're really clear with them then they know and then they feel a little bit better don't they I think it's interesting when I take my kids to the dentist yeah they will do this yeah because the young kids they want they know that the way to overcome yeah the a child's natural pushback or pullback from the dentist is to explain as you're suggesting but then for some reason they're just like oh it's an adult yeah we will we'll rush right past that and just do you know important so i guess this you came from hospitality spent time as a nurse how do people who have 25 years of deeply clinical experience who haven't had the background in service in hospitality in thinking about experience yeah what's the journey for that maybe put yourself in the patient's position so sit yourself on the other side of the desk if you've got a practitioner, perhaps get them to give you a consultation and see what you need or what you should have and then get on the bed yourself and see how it feels to have that treatment done.

17:35And I think put yourself in someone else's shoes is the best way to understand how they're going to feel, isn't it? Almost do your own service. Yeah. Even with things, small things like the clinic, when you're thinking about what the clinic looks like, we sit behind a desk, a reception, but I encourage the girls to say, come because we've got chairs like this in the waiting room and then you're looking at the clinic and I say come and sit here because if you sit here you can see this there and that so look at what their side is don't just look at your side sticking coming patient facing you've got to put yourself in the patient's chair and just sit there for a minute and have a little look around and quite often we greet our patients and I'll sit and we'll have a chat like this before I take them through to the room so it's calming them down a little bit and all having a little chat about something.

18:19it's interesting the the i think you're describing of the experience that happens when a patient's there but that that connection yeah that i assume is established as a result the time you spend with the patient the care you give yeah we have a really good retention rate at the company there has to be this right that that's going to be a natural so how do they work together those things yeah yeah and what is the has it always been the case from day one that was just the dna of the practice or has there been a conscious effort to say okay this this thing needs to get better and we need to focus on this in the retention rate how is that we are always looking at what we can do so for example we're building in treatment plans so you know from the new year we're going to be calling in the patients that may have fallen away for a while just saying would you like to come in we'll do a treatment plan for you so we can work out what they need for a year we're doing a lot of payment plans so people can either save money monthly on a direct debit just a little bit whatever they want, put it in a little piggy bank towards treatments, or if there's a specific treatment they want, they can have that treatment done and then they pay for over a 12-month period.

19:25So we're doing lots of things like that which are quite new, and that's just to retain the patients we've got and to reignite the ones that have fallen away, because we've done marketing, we've had cold leads, it's really difficult to get people in that don't know the clinic, so we're better off to see the ones that have been before and know us, and so that's how we're trying to improve our numbers for retention and things like that. 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.

20:03As you get bigger, your patient body grows enormously, and it becomes much more than just another hire, just another front office team member. It'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. How big am I asking? How many patients and or appointments? Just give us a sense of size. Are you seeing a year, a month? We're about two and a half thousand on the books.

20:40Okay. But I'm seeing I work five days a week so I'm working Monday to Friday. And you're seeing patients through the... Yeah, yeah. So sometimes it can be 13 a day depending on the... sometimes it will be less if you've got longer appointments so it's always a little bit, yeah. Have you found that the, I guess when we look at practices in general and I'll maybe I'll use the hands-on healthcare piece because we speak with physiotherapists, with chiropractors, I think oftentimes it's a similar journey. It's the journey of being someone who's clinical with a passion for doing things differently, doing things better.

21:14In some ways, that was your journey. And as well, you were a nurse. And then you said, okay, I'm going to, I have a vision for a way that we can do this a little bit differently. Can you just take, I'm curious about the personal story, the personal journey of being a business owner, an entrepreneur, which sounds like that was your first foray into entrepreneurship as well. You were part of hospitality then in larger NHS, private healthcare. Those are big companies. What's the entrepreneurial story for you? How did that go? I'm just a terrible employee. I've been my own boss. A lot of people say that.

21:47You'd be surprised. I know. I don't like being told. I don't want to just be in control at some point. And if you've got a vision, or I think especially in healthcare, you can see so clearly what's not working you just know it's not working and you'll tell people and you'll tell people and you'll tell people and they don't change it and that just drives me nuts because if especially in perspire for example the equipment that's broken you're trying to do a job and you haven't got the things that you need and then you just think i can't do the job if you're not going to replace the broken equipment i'm not gonna i can't what can i do then it just infuriates and sometimes i took things into my own hands.

22:28So during COVID, it's really busy. We're all working hard. There's no thermometers on the ward one day. No thermometers. We're having to take people's temperatures as they arrive to make sure that they... No thermometers, right? And so I went to Boots and I sent a healthcare assistant with my own cash. I had some cash. Just go and buy some thermometers. I don't care. Just bring them back and then we'll have thermometers on the ward. And so I took control of that, but then obviously they weren't the right thermometers. But that's just, just do things. just stop putting things off. It's like it's not that hard.

22:59And so I think I've got very frustrated with the NHS and very frustrated with private healthcare, because when you want simple things to change and they just don't, you just, it's like putting your head against a brick wall.

23:15We have heard versions of that, people, for this idea that it's, you said it's so clear what needs to change and yet it just doesn't change and I think if you had to write one sentence to describe why healthcare has not modernised the way that other industries have it's probably that obviously it just needs to be this why can't we do this but it's really I'm talking really simple things I'm not talking about massive changes it's just it's a cultural problem yeah I think it's cultural it's the management when it's the tear systems, it's people having no common sense at all. To just... To just get it done.

23:57See a problem, fix a problem. Just get it done. There's a way on the tube, see it, say it, sort it. But really what happens... Yeah, so that's what one of our nurses, Sharon, she's see it, say it, sort it, isn't she? And that's not, that has not been your experience previously. That was not the... No, yeah. It was see it, say it, and then that's the end. Just that was the end of the... I didn't go into nursing thinking I was going to own a clinic. That's not what I did it for. I loved nursing, but it gets sucked out of you. And it's dangerous. And as a registered professional, you risk losing your pin because you don't have the supplies or the equipment that you need to do your job.

24:36And people are in danger. And then eventually you just think, I'm not doing it anymore. I have a choice now because I've skilled in other things and then things just bubbled along. But I think there was a lot of reasons why I left. But I do obviously miss the patient contact because I love that type of work. Not in that setting. No. We had a consultant on a couple of months ago and we were talking about scribes. Listen to the conversation. OK. Write up the notes. And we were talking about it and he said that it was one of the biggest things for him has been more time with the patient, less paperwork, etc.

25:16And I said, that sounds great. Yeah. And he works in a big private hospital setting. Yeah. And I said, that sounds great. You've got an hour of your day back. Surely you must be full of energy. This must be the thing you were waiting for. And he said, yeah, it's great to have the hour, but I'm still broken by the weight of the sort of inability to change at a systems level. It's like lack of go forward motion. And I don't think it's as bad in other countries as it is here. and I think you can go even to European countries and I know there's the private aspect of that. For example, I was on a holiday with my family and my uncle fell over and cut his foot and I think we were in Portugal.

25:56He went straight into a clinic. Every day he could have daily dressings, there was no queuing and I just think there's just not that availability in this country to even go and get your cut foot seen to. If you're an average day or anywhere, where can you go and just go into a clinic and just get seen to. And my daughter had an accident in Thailand. It was New Year's Day. 9 a.m. we got into a clinic. She was able to get antibiotics, have some stitches done. Just in other countries, it seems to work. It's more accessible, some of the health care, isn't it? But in this country, it's just A &E, five hours, queuing, haven't been seen, can't even get a paracetamol, haven't got an IV in.

26:36It's just crazy. Don't get me started on that. No, no, no. Wait, wait, wait. where I can tell we're tiptoeing around the badlands. So you were in that environment. You said, I love what I'm doing. I hate where I'm doing it. I'm going to go off. Okay. So now you're a business owner. Yeah. And you have a clinic. You have renovation. You have a brand to build. You have a booking system to choose. You have a staff to repeat. You have uniforms to choose. You have all of these things that previously someone just said, this is what it is, and you just need to do it. Yeah. How are you, you made the decisions, of course, the business is growing, but how are you feeling at this time?

27:14Is it a, wow, there's a lot of new stuff going on? Is it a, you know what, I feel like I've controlled this. I'm trying to, for people who are thinking about that change. I think when you first start, you've just got to take baby steps and try not to think about it too much. You've just got to do every day as it comes and every decision as it happens and try not to think too hard about what you haven't done. Because when you say that, I say, oh God, yeah, I do a lot. I don't really think about it like that. You just have to do it in stages, don't you? I think if you overthink it, you're just not ever going to do it.

27:43You've just got to start it on your own, get one member of staff to help you, then you can get another one, and then you grow like that and try not to be a huge corporation or whatever too big because it depends what your goal is anyway. So I've done a few things. I've worked for different companies, teaching a bit like Joxane. But you have to think, if I'm coming down to London and I'm doing some training, it's quite exhausting. You've got to do a PowerPoint. You've got to teach all the delegates. And then you get paid. But you're thinking, what's really in that for me? Apart from a pat on the back, they've asked me to do something.

28:17I'm important. Actually, for me, I would rather be working on my own business for the day than working on somebody else's business just because I look good because I'm working for someone else's business because I'm a KOL or whatever. But now you're building. Yeah. Yeah, so I think you go through a sort of a curve of where you want to be. And I think for me, I'm happiest in my own environment. And I'm happy to build that for myself. And if I happen to do a little bit of support for one brand or another, like Neogen or M-Face, I'm happy to talk about my experiences with it. But I don't really now want to be affiliated with any one particular brand because that's not going to benefit me.

28:55You're building your brand. Yeah. That is the thing that's in focus now. Yeah. And where does that, if we sat down in eight years or 18 months, you picked the timeline. Where is that? Well, obviously, you've got to make money because you want profit, don't you? We agree. Yes. But all of these devices, they're all really expensive. And you want the best devices because they tend to have the best results. So it's a slow and steady climb acquiring these different devices that promise the world. but you need to be sensible and you've got to make sure that you've got the demand for it but obviously I want to have the best brands and with that I need to have more turnover so I want to get bigger but not so big that I lose sight of it because my parents always had businesses and the minute you get too much going on you don't really know what's going on anywhere so I don't personally want to get that big I don't need to I just want to enjoy my next 10 or 15 years or what have you building building your business corporate and still be very much hands on and very much involved in it it's a lifestyle business for me really and that's and that i mean yeah you have a clear sense of what that would be yeah and is there a i guess i'm curious because so much is happening right now in aesthetics but also more generally around longevity and biohacking and stuff like that except i'm really interested in all that so we've got the hyperbaric oxygen pod and we've got a sort of a soft shell a soft chamber and I've got that and I would like to upgrade that to one of the hard shell chambers but obviously you're talking like 90 grand it's like just have a little piece of kit sitting there because I'm interested in that personally so sometimes you have to stop yourself just think I'm gonna want that for myself but I don't know I just we need a bigger premises if we're going to have bigger devices and the oxygen pods are quite large as well we haven't got the space for everything because we've got this really quaint middle listed building with beans and things.

30:49Do you feel like that is a, I had a person who gave me a something toothpaste with something which was biohacking for my teeth and whatever, which it was very cool. I'm all for healthy and whatever, but in a certain, how do you feel like your customers, your patients are, are they thinking at that level of longevity? Some of them are, some of them are. Some of them are and some of them aren't. I think with Instagram and TikTok, a lot of people are educated, aren't they, now? They get to see a lot more of these type of things. The longevity summits, people are following people, aren't they? So they're seeing more biohacking, peptides, all this kind of stuff that's coming out that's very controversial at the moment.

31:29But I'm interested in everything. And I think that's where having a business, if you're always on to the next thing, you've got to follow trends a little bit. But you've just got to be a bit sensible with your decisions and just sit back sometimes and think, OK, is this going to work? have we got any evidence but I'm all for trying everything once. There's a, I'm going to ask you the question in a second, like what have you tried recently but I think it's... I couldn't possibly say it. Of course not. It's always a question of there's the trying stuff wearing the two hats of business owner and also a healthcare provider.

32:04There's the trying things that are in service of the clinical outcome and there's the trying stuff that's in service of running a more efficient and et cetera, et cetera business. I'm curious about the business side in particular. Your business has grown considerably. What have been some of those sort of levers that you've pulled, that you've tried, that have helped you take one step up, one step up? What have been some of those things that actually, wow, that really moved the needle for me. That was really a thing to help us move forward. So I guess for the first 10 years, it's about learning your craft, isn't it?

32:41So you've got to go on lots of different courses, you've got to keep educating yourself. And then I think you get to a period of time where you start going to conferences, or you might go to training sessions, you think, I've heard all this before, really, there's not as for it's, you're refreshing it. It's like revision, but you're not really learning anything new. Forward. I'm trying of think where I started okay so yeah so I started really for those 10 years was mostly all injectables skin treatments micro needling very skin centered and then when I got the clinic I thought okay so I've got to offer something more and that's where the devices come in so obviously the first device I got was the Neogen and that was great because it offered something that I didn't have so I was able to sell it really easily to the patients because they were already there they were my patients anyway they're all happy and they're all happy to try something new so that was really fundamental really and we did a lot of treatments in that first year and it's a great device it's a really good brand they're very supportive so they've got a lot of celebrities that having the treatment done people relate to them so it's easy you can show them a picture of Shirley Ballas and go oh Shirley's the same sort of age as you look she's got these great results this could be you sort of thing so that that was quite good and then is it continuing towards you're still adding in more services now.

33:57Yeah, so then a year later, so I'm thinking, okay, what other devices or what other treatments haven't we got at the clinic? So we invested in M-FACE, which is muscle stimulation, which is great. So that's a different thing that I didn't have to offer. And then just recently, we're doing the body treatments. So it would be M-Sculpt because I didn't have any body treatments in the clinic. So that's where we're going. It's just kind of think, okay, what haven't we got? what will fill that void, and then you go on from there. So it's made a big difference having the sort of big brands, I think, affiliated with the clinic.

34:29How much of that is sort of customer-led, by which I mean we often see a lot of practices that they'll hear from patients, thinking about in musculoskeletal in particular, a lot of feedback from patients is, oh, I just, as an example, and postpartum X number of weeks, X number of months, and so I'm interested in pelvic floor. So how much of that service expansion that you're doing, that you have done, has been because you're hearing from the patients that they are, is it really in this discovery world with customers or is it more of a, I'm seeing this in industry and I need to educate? Is it both ways?

35:03I think it's both ways, but you're educating a lot, aren't you? When you're speaking to your patients, so they're coming to you with their concerns all the time. So you've got to be able to address all the concerns. So if there's sort of 10 major concerns, you think, OK, how can I please them? Where can I help? So I think that's why the devices sometimes fit in with the lasers or Neogen, or we've got the pelvic floor jet oxygen pod for wellness. It's helpful for long-term sort of chronic conditions. So people who come in for the oxygen pod aren't necessarily coming in for aesthetic things. No, they're very different.

35:38But you get this really nice crossover. We've got people who are coming in here running marathons and or they've had an injury. So again, that then goes back to the nurse side because you know all about the injury, I know all about the operation they're going to have potentially. So there is a really nice crossover. It's nice to have all these different types of patients coming in. I think it's incredible that you are able to see a range of patients, even just the examples you gave. Some are coming in for aesthetics injectables, some are coming in for on track to a surgery. you are able to and the brand is able to move yeah which is very cool and i'm conscious of time and you've been very generous with yours a closing question i have is and recognizing that some people might be listening are thinking about opening their doors at some point going on that that journey the beginning of that entrepreneur clinician clinician entrepreneur journey what do you say to that person who's sitting down from your cross and having coffee with someone and they're saying, oh, I'm thinking about opening a...

36:37Get yourself a good mentor. Okay. Give me a call. I'll chat to you. No, but have a good mentor, a good support network. So even though I was a loan practitioner originally, I've got a really good network of support of my friends. We've all got clinics in different parts of the country. So we chat a lot about lots of different things. Also ask the brands for help because actually you have a lot of reps that come in to see you. And to start with, they'd come and I'd go, oh, another rep coming in. And they go, what can we do for you? And I go, oh, nothing, nothing. I don't need, but then, but you have to say, what can you do for me?

37:12Because I don't know what you can do for me. And actually when you start asking the reps what they can do, they go, oh, I can do this, I can do that, I can offer you this business support, I can offer that. And I'm like, for 10 years, I used to give you coffee and you used to come to my clinic and I never used to ask you. I didn't even know you could do that. I will take that and I'll take that. So take some of the stuff because the companies are really brilliant and they can really help you. And obviously go to the conferences and things and educate yourself as much as possible. But I guess you've just got to just do it, haven't you?

37:41And just start somewhere. Just start somewhere. Julia, thank you so much. Thank you everyone for coming for an episode of Business of a Clinic coming up on number 100. We really appreciate your time and sharing a bit of your story. Thank you. 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. We'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.

38:09Thanks so much.