He Went From Vet Hospitals to Running a 130-Office Dental Group | with Dave Gaspar, BOAC #59

0:00A veterinarian out in Queen Creek, Arizona pulled me aside and called me out on it. And I was like, no, no, I don't do that. I don't do that. She's like, yeah, you do. You don't just get to come in when it's fun and then leave us when it's not fun. When I left vet, because at vet, where I grew up and how I learned to do it was like, in the back being a vet assistant. Like, here's how you express anal glands, which if nobody's ever done that, that is disgusting. So when I came into dental, the first place I went was like, I got to learn how to be a dental assistant as good as I can. So currently I'm the CEO of Smile Partners.

0:29We're a DSO in seven states, predominantly in the Midwest. We began in 2017 and have grown to 130 offices in seven states through majority acquisition up until this year. We started the DeNovo path to kind of diversify our ability to grow. So ideally, what we'd like to do is be able to motivate that patient to accept the treatment before it becomes painful. Right. So like, hey, you have a large filling. If we take care of that now, then you're going to be able to avoid a lot of pain and financial in the future. Because we know that filling turns into a crown, turns into a root canal, turns into an extraction and an implant.

1:08Like, let's intercept that sooner. And so the framework that how is it going to impact patients is the first thing that I want to understand. Two is how is it going to impact the clinician? And then how is it going to impact the team? And then the final one is, how is it ultimately going to impact the business?

1:32Welcome back, everyone. This is Jared, one of the co-founders at Coherent Healthcare. I'm really excited for this episode because we've got Dave joining. And Dave has a really interesting background cutting across healthcare for people and healthcare for animals, which is an unusual combination. and we'll hear a bit about both and perhaps similarities and differences. But just before we get started, David, obviously, I've had a chance to learn a bit more about your background, others less so. Can you give us the two-minute intro that helps people understand who they're hearing from and where you are right now in your healthcare journey?

2:05Absolutely. Great to be with everyone and share my story and some of the perspectives that I've learned over the last decade plus, supporting clinicians and practices, both as you said, on the vet side as well as on the dental side. So currently I'm the CEO of Smile Partners. We're a DSO in seven states, predominantly in the Midwest, and we support GP practices, some specialty, mostly GP. We began in 2017 and have grown to 130 offices in seven states through majority acquisition. Up until this year, we started the DeNovo path to kind of diversify our ability to grow. I've been the CEO for the past two years.

2:48Prior to that, I was the COO within Smile Partners, so responsible for the day-to-day operations and really the growth of the operations, as well as the integration of the new practices that we've brought on over the last four years. Prior to that, I worked for Pacific Dental Services on the West Coast. I was a regional partner in Washington and Oregon, as well as spent some time in Colorado there. Did that for a decade plus. And then prior to that, I worked for Banfield Pet Hospital as a field director in Arizona, overseeing veterinary hospitals and working in that market and helping that business grow and support those clinicians.

3:25Thank you. Got it. So when we talk about the the business of a clinic, as is the name of the show, you've really lived that. This is not a, you're not new to this world. This is really in your DNA. I'm curious, and we'll probably focus more on the dental side, just in terms of the audience and obviously focusing on human health care. But we don't have a chance to speak often with folks who have really done anything in the vet space. So maybe just as a sort of appetizer, it would be great to understand maybe just high level similarities and differences. What do you carry across from the vet experience and dental experience?

4:06What do you not carry across? Just like that picture for us. Ned probably will focus a bit more on the dental experience, but I think there's always opportunities to learn across practice type and certainly vet to dental. We want those examples. Yeah. I mean, there are a vast number of similarities. And if you can run a successful dental practice, you probably have the framework to run a successful veterinary practice and vice versa. Obviously, you know, you've got clinicians that you're working with, whether it's a dentist or a veterinarian and highly trained, highly educated, successful clinicians that, you know, are helping people in the dental space or helping pets and family members that, you know, a dog and a cat oftentimes is seen as a family member.

4:50So delivering that care to a family member on the vet side. So a lot of similarities there. Within the space that I worked in, in both of those, I kind of look at that as kind of retail healthcare. So you're in a retail setting where obviously you're trying to attract patients in, deliver outstanding quality of care, deliver a great patient experience, and try to reduce as much friction as possible for either that pet family member to get in or the patient to get into the dental office. So from that context, a lot of similarities in terms of how do we reduce that friction of access to care, delivery of care, delivery of a great customer service.

5:32I think probably a couple of the biggest things that are the differences. One is the insurance component. So in veterinary, there is pet insurance, but it's not as widely used as part of the business model. So it's a lot of, you know, you do a transaction, you pay for it, you collect the money at the time of service and you move on. Clearly there's third-party financing and those kinds of things, but it's a lot of a monetary transaction at the time of service. Whereas in the dental space within the world that I've existed in, you know, we have been working with insurance companies. So there is that, you know, I'm going to call it for, you know, speed of the conversation, a 50-50 breakdown where 50 % of the procedure is going to be covered by the insurance company and 50 % is going to be covered by the patient.

6:17And so you're collecting that patient portion up front, but then the amount of time that it takes to get the money from the insurance company could be 30, 60, 90 days, depending on the complexity of the procedure and how quickly the claim gets adjudicated. So that is a sizable difference between the vet field and the dental field and the need to understand the nuances and the intricacies of dental insurance. And again, how do you reduce the friction for not only the business side of it, but also for the patient side of it so they can utilize their insurance and the office can benefit from the dental benefits that the patient has to make sure that they're getting the care that they need to be healthy and happy and be able to live a productive life.

6:59So that's one piece. And then, you know, certainly, you know, the severity sometimes, I guess, you know, I say this gingerly, but like, you know, In dentistry, you're not dealing with life and death the majority of the time, hopefully, and never. Whereas in veterinary, it is an emotionally charged business because you have family members and pets are born and pets die just like humans. And you're more involved with that in the veterinary field. And so not that dentistry is not emotional, but veterinary was more emotional for me. Maybe it's just how I look at it and saying goodbye to those pets is really tough for me.

7:37and you kind of have to figure out how you navigate that and how you deal with that. In dental, you don't have to deal with that. Luckily, I've never had to deal with that in dental and hopefully never will have to. But that's another piece of that, of just that emotional connection and kind of, you know, that life and death nature, you know, is a little bit different as well. It is interesting. I think a lot of the practices that we support and that we engage with through the business of a clinic are definitely not in the life and death space. Right. You might be in a life and death Sunday afternoon, but you're definitely not in a life and death lifetime.

8:10I think it's very interesting. And one of the things I'll probably pull out and put in a summary somewhere is what would you change if you also applied that lens of where could you bring? because I imagine like the empathy that you put forward for a family or ultimately a customer or patient of a family that's experiencing loss is radically different than the empathy you put forward in your patient communication, patient engagement in a dental space or an elective care space. So I think there's probably a, there's a thought exercise for clinic leaders somewhere to say, imagine that, you know, you were, imagine you were in the bed space, it was life and death.

8:47What would sound different in your outreach? It's probably a very interesting thing to think about very cool so okay so you made i understand you started there um you built maybe uh a particularly sensitive and heightened view of patient experience family experience along the journey absolutely then you made the jump some of that carried over what was new what what did you see for the first time coming into dental uh or into human take a pic yeah that wasn't there before that you sort of said oh okay i gotta i gotta learn this piece ground up you said something It was on like insurance and billing, et cetera.

9:22Yep. Where else were things new? Yeah, I think, you know, it was the patient communication nuances. And so, you know, obviously, as you mentioned, I mentioned the insurance piece is a different piece in terms of and trying to figure out how you reduce that friction. But when you're in the dental space and you are actually being in the vet space and you are being able, trying to convey the urgency, the severity, the condition of that pet, you are a human speaking with another human. And the person that is experiencing that pain cannot speak to you and cannot talk, cannot share verbally the pain that they're in.

10:05Obviously, I'm sure we've all seen a dog limping because their leg hurt. And so that's an indication that clearly there's pain or there's something going on, but different than if you saw a human, that was in pain, most likely they're going to be able to communicate to you where it hurts, how long it's hurt, the severity on a scale of one to 10. We'll just use that. How bad is it? It's a 10. It's a two. You can't have that conversation with a dog and then answer that the same way that a human can answer that. So that communication with the patient, which in that is the family of the dog. And in dentistry, it's the human that's there with the condition.

10:44So that patient education, that patient communication, that urgency, that empathy, you know, that was something that was different because in dentistry, in theory, you're able to say, okay, hey, you're coming in because you're in pain or you're swelling or your mouth is swollen. How bad is the pain? How long has it been going on? What is the condition? Let's figure out how do we map that out? Are you allergic to any medications? or you're not, all those kinds of things, as well as you're able to say like, hey, you know, the urgency is like, we need to get this taken care of today or as soon as possible to relieve you of that pain or to solve that situation.

11:17That is, I'm going to say maybe an easier conversation in one spot. And I'll get back to that in a second. Within the vet space, it's harder, right? Because you can't say that to the dog or the cat, hey, how bad is it? These types, how long has it been going on? Those kinds of things. So there is that piece that is harder. On the other side where it's a little bit easier if you do it effectively is that you are able to connect and really connect with the person that is in pain to motivate them to solve the problem. Right. Because, again, in veterinary, I still got to motivate the family to spend the money on the dog or cat.

11:50Whereas in dental, I'm motivating the patient to take care to get the care and take care of the issue right then and there. And so there's some more challenges to it, and there's maybe a little bit easier way to be able to get case acceptance and helping that patient say yes to the treatment that they need. But that certainly was a different dynamic of leaving the veterinary space and how we communicate that and how we approach delivering that care into the dental space. How do we motivate that patient to do the dentistry that the doctor has diagnosed that the patient needs to be able to get healthier and happier?

12:23You know, there's certainly some similarities, but there is some of that nuance in terms of the empathy, in terms of the urgency, in terms of how you have those conversations. It's really interesting, the idea that patient is able to self-advocate as opposed to patient is not able to self-advocate. Similarly, the patient is able to question or not question, although I imagine that even though there are some differences in there, I would almost liken it to, you know, a healthcare provider serving a minor or a healthcare provider serving someone who's under the direct care supervision of someone else.

12:55Maybe it's an elder. And so in that sense, even in that difference, you might actually have those similarities come across where, again, thought and exercise. What would you say? How would you say it if your patient couldn't, you know, respond back and engage? Correct. which is very interesting. Okay. Got it. So, so, so seeing that journey now and bringing some of those learning across. And it, it also goes to the empathy and sympathy kind of conversation, how you think about things of, you know, being sympathetic to somebody's situation versus being empathetic to the situation and what you can't understand and what you can't understand is, you know, I can be empathetic to some, it is easier for me to be empathetic to somebody that is in a dental chair that I'm talking to that has a cracked tooth because maybe I've experienced that or I know somebody that has experienced that or has been in pain or I've gotten a root canal because I was in pain.

13:49Now I'm talking to a patient that needs a root canal. I can empathize with what that feeling is, whereas in veterinary, I can't necessarily empathize with a dog that ate a rock that is now in their stomach that's causing them pain. I've never done that. It's harder for me to empathize. I can empathize with a family of being upset because maybe I had a dog that did that, but it's a different nature of how do we empathize or how do we sympathize and how do we build that emotional connection so that we're all working towards that outcome of improving the life of the dog or improving the life of the person, the patient type of thing in the dental chair.

14:24It's interesting. And it may have been a convenience of choice in terms of how you described your experience, but I sort of came into this assuming I knew I was going to ask you about vet and dental and that crossover. And I was almost, if you had to make a bet, I would have bet the thing, the place you would have gone would have been, you know, systems, operations. And we've ended up at the completely other end of the spectrum. It's like actually relationship, relationship, relationship, empathy, sympathy. And like these are the dynamics that seem, from what you're describing at least, this is the thing that seems to be front of mind for you.

14:59This is what's undercutting healthcare, irrespective of its provision and its audience. because that's where it sits. 100%. And I don't want to oversimplify it, but how I look at both spaces and a lot of the retail spaces, the path to success is not complicated. It's not easy because you are dealing with humans and it is the relationship and it is the motivation of all of us to do what we need to or what we want to do. But the pathway in terms of the veterinary offices that I've worked in and the dental offices that I've worked in, in a variety of organizations, there have been four things that have been absolutely true in everywhere that I've been.

15:41The successful vet offices and the successful dental offices, they have providers, they have access to care. So patients can come in, whether that's morning, evening, weekends, whenever, and they have the doctors or the veterinarians or the hygienists. They have patients. Patients are wanting to come in and see them either through marketing online or insurances or word of mouth. Or at Banfield, we were inside of PetSmart. And so we had all the patients from PetSmart that had dogs and cats right in front of us. So you have to have the doctors, you have to have the patients, then you have to get really good at delivering the care that gets diagnosed.

16:16Whether it's the dentist saying you need a crown or you need an extraction, or it's the veterinarian saying you need to take this medication or you need to have this procedure, and then collecting for the services that you provide. In dental, get paid from the insurance, get paid from the patient and vet get paid from the family member for taking care of that dog. Every dental and veterinary practice that I've been a part of that does those four things really well has been successful, not only financially, but has also been successful growing and taking care of more people and helping the communities that they serve.

16:46So the pathway, again, is not super complicated. If you just get really good at doing those things every single day on repeat, you're most likely going to have success. Why it's hard is because there's human beings in all of those elements. So how do you work with human beings? How do you connect with them? How do you build relationships? How do you motivate them? Because underneath those four high-level things, there's so many sub points and so many bullet points underneath that that are going to affect whether you actually accomplish that or not. And so to your point, one of the things that I look back at my career and feel very lucky about the journey that I took was that I could figure out the processes and the path to success operationally in vet and it carries over to dental, but the heightened emotional component of that, I think truly helped me in the dental space because when I left vet, because at vet, where I grew up and how I learned to do it was like in the back being a vet assistant, like here's how you express anal glands, which if nobody's ever done that, that is disgusting.

17:42I give credit to every vet assistant that ever has to do that. How do you help with a catheter? How do you do all those things? I had to learn that. And in an, in an emotional setting, So when I came into dental, the first place I went was like, I got to learn how to be a dental assistant as good as I can. Like, I'm not good and probably horrible. And the doctors that I've supported are probably like, get out of here. All you do is like suction on the inside of the cheek because you're looking and you're not paying attention and you're doing it all wrong. But I knew that that's where I needed to learn how this business work and what was the nuances of it and where was the emotional connections and where were the relationships that were happening.

18:16and ultimately it's in the operatories between the dental assistant, the dentist, the hygienist, the treatment coordinator, whoever, that is where the relationship and the connection is happening. So you've got to spend time in there and understand that to then be able to give advice, perspective, guidance, or just be a sounding board to anybody that's asking questions and really understanding that to be able to help people be successful from a business standpoint or from just delivering quality care to a patient. It's interesting. There are a few things you said that jump out. The first one is you said it's not complicated and it's not easy.

18:50And we always say, even at Coherin, we say, we basically follow up with patients, right? We follow up with hundreds of thousands of patients. So we always say, following up with patients is very simple. It's just not easy. Right, exactly. It's really simple. You need to follow up with patients. Everybody knows that. Everybody agrees. It is very simple to say, follow up with patients. Doing that, that is not easy. Getting everybody to do that and having these processes in place and the humans and the automation, it is not easy, but it is simple to understand what you need to do. Exactly. The other thing that I think is great, and I've spoke with a few practicing group leaders, some of whom I think have had a similar experience to you whereby they've come up from being very frontline.

19:35Like I'll go, I don't know if they've been as frontline as anal gland expression, but they've been, you know, And like cheek socket. Like, yeah, absolutely. 100%. That's very frontline. But they've come up through, you know, front desking. They've come up through med sec. Like they really understand. And I think consequently are able to have a conversation with the frontline and practitioner team that they are now ultimately responsible for where they can say, listen, I know things have changed in the last 20 years since I've been frontline. But like ultimately, you know, I get it. And that either sounds right or that sounds like nonsense.

20:11And I've spoken with group leaders who have had the experience. I've also spoken with group leaders who come from a slightly more like pure play M &A, sort of banker background. And it's interesting. There's a very different perspective. And I think there's a very different, not necessarily better or worse, just different and also a very different operational understanding. And I think the fact you've come up through like a COO track into the CEO seat makes it more the case that you've really seen, felt, touched the nuts and bolts almost all the way through the organization. So my question is, one of the things I'd love to understand is I see how you've been like next to the fire in two examples that you've just given, you know, working in the dental surgery, working in the vet room, like being there, being patient facing, et cetera.

20:57where else in your journey have you been right up next to the fire and seeing and feeling and touching these very important moments in the in the care continuum where you've really been brushing elbows with whatever it is the thing is where else have you seen that so how has that shaped how you think about you know the evolution of the group yeah i mean i think two areas uh One, to your point about the front desk, being there to help present treatment plans and help understand why patients say yes or why they say no and why they accept treatment or why they don't. And certainly a patient that is in pain is more motivated to accept the treatment and move forward with that, which is good.

21:45But ideally, what we'd like to do is be able to motivate that patient to accept the treatment before it becomes painful. Right. So like, hey, you have a large filling. If we take care of that now, then you're going to be able to avoid a lot of pain and financial in the future. Because we know that filling turns into a crown, turns into a root canal, turns into an extraction and an implant. Like, let's intercept that sooner. And they're like, well, but it doesn't hurt. OK, well, how do I help motivate you to step in now and get it taken care of before it becomes a problem? So that piece and learning that and seeing that and having that conversation is one area.

22:19But I think probably the piece that has even been more impactful with that is being on the front lines of helping identify new dentists to join a practice and then thinking through how do they ramp up both clinically as well as non-clinically. And certainly I can't do the clinical side of it, but a dental student that graduates from dental school and comes out and they have a bunch of debt and they're trying to figure out how do I have a great life? How do I enjoy my profession? How do I have financial success? How do I take care of patients? All those types of things. I've been a part of the hiring and the onboarding and the ramping up of a lot of dentists in my time.

23:01And so I think that gives me a unique perspective of understanding how do we build a business that is going to be really focused on helping those dentists become successful. I look at my responsibility as building an organization and helping build an industry that is not only able to take care of and be successful for the dentist today, but also into the future. And that's a really critical thing for me is that the profession is changing, the clinicians are changing, the world is changing. And we, as a space, as a company, as an industry, have to be able to continue to evolve. And I think you can do that more effectively if you've been shoulder to shoulder with that young dentist, that middle-aged dentist, that older dentist.

23:46Like, understanding their why and being a part of that recruitment. You know, my advice to anybody and everybody that asks me or cares about anything that I've done is like, you know, A, get in the operatory and learn dentistry and learn that piece of it. Totally important. learn the insurance because that's a unique dynamic as well. But then be shoulder to shoulder with the dentist. Be there, understand their thought process, how they think, build the relationship with them. They are a great artist and they're a great engineer and be next to them and learn how they think and how they look. And if you can pick up on that, then I think you can really help support them and ultimately help make a difference in patients' lives by helping support the doctor, get into the position where they can be successful.

24:30It makes a lot of sense. And I think we've heard a few times as well, this idea that irrespective of organization or provider size, being frontline on hiring and being really clear on what that mold and that fit needs to look like to serve the group mission is a non-negotiable. So it makes perfect sense. I would imagine, you haven't said as much, but I'm pretty confident in thinking that the role that you have played in supporting, enabling, approving hiring has changed dramatically from the early days to now where you're sitting in the CEO seat. So one thing I'd love to understand is how did you make the transition from you were making the hiring decision and pulling the trigger to helping other people in the organization maintain the same standards or maintain even higher standards, but to try and get that cultural blueprint sort of copied down to the organization at all levels of the organization.

25:27That's sort of one question. The natural knock-on question is, that's probably one of many things that you had to come face-to-face with as you stepped into a CEO role from a COO role. And so I guess the place that I'd love to go after that is not only would hiring have been something that changed for you and your role in hiring across the organization, but what else did you discover for the first time stepping into the CEO role where you're like, hey, I've been in this industry for 10 plus years and 20 plus years and I am learning a bunch of this stuff or I'm coming face to face with a bunch of stuff first time.

26:01This is new to me because the role is new and the expectations are different. So I guess using hiring as a bridge into the transition to CEO role from a COO or operator track beforehand. Yeah. So I think in terms of, I guess, developing and training individuals to do that as I'm scaling, you know, honestly, a lot of shoulder to shoulder, side by side role playing and having them be a part of those interactions to be able to see that and then discuss that. You know, I was lucky enough to grow up in dentistry within PDS and they had a really strong culture around that and teaching that and educating and helping build those skillsets.

26:45So I was able to see that and then able to replicate that. And then I think just the repetition is also really critical. So here is what I saw, here's what the culture is, here's what we're trying to accomplish. The continued repetition of that message to everybody within the organization that is aligned with your mission, your vision, and your values is really critical. Again, I'll give credit to PDS and Steve Thorne, who started that company and continues to run that company. He was really good at saying the same thing over and over again, which was in alignment to the mission and vision and values of their company and where they were trying to accomplish.

27:17And so we all knew where we were going and he was able to lead us down that path and say that consistently. And so now for me, it's like, how do we continue to repeat that message? And how do we continue to develop and educate and be shoulder to shoulder, teaching people how to do things and then giving them space to do it on their own and then be able to give them feedback on what worked and what didn't work. And then just continue that as well as making sure that, you know, I am being thoughtful about who I select that is side by side with me and shares my mission, my vision, my values, and shares what we are trying to accomplish, shares, you know, this isn't just a job for me and I don't want anybody next to me that it's just a job.

27:56Like we, we, I tell everybody, we're like, we're literally changing the world every single day. If you don't get excited in the morning about having the opportunity to change the world every day, you're going to be ignored working with me because I'm going to talk about it all the time and I'm going to be chasing that. And it is such an impactful thing for our organization to be able to have that opportunity to do that. And so I think it's really critical to have that communication as well as repeat it, as well as be shoulder to shoulder teaching them as people are learning. So that would be the thing about the interviewing, the candidate selection, whether it's the clinical team or the non-clinical team.

28:31the scaling size. And, and I look at my job now is like the, the key is, can I help the organization reduce friction in all the different ways that we operate? Whether that is what I said earlier, can we reduce friction and getting clinicians into the practice? Can I help reduce friction by getting, in getting patients into the practice, reduce friction and delivering care and reduce friction in, in getting paid for the services that we provide. The biggest difference as we've scaled is there was a time when I could just go fix it myself in an office, in an afternoon, or in a day, or in a week.

29:05And I can't do that now. It's a much bigger, it's much larger, and you have to work through people. And I can't just drive down the street. You know, a practice isn't just 20 minutes away from me like it was when I was growing up as an operator. And so that piece of it has forced me to have to think through, you know, what do I take on? What do I not take on? Where's your focus? What do you choose to communicate? What do you not choose to communicate? How do you attempt to reduce that friction and prioritize what are the important things to do, as well as how do you select individuals that are going to support the organization to go and reduce that friction, right?

29:42Because I think my wife would say my happiest days are when I spend in a dental office. I'm much more happy there than I am in a board office, with doctors, with the front office, with the team, I come home in a much better attitude, but I don't get to do that as much anymore. And so I have to have people around me that feel that same way and have that same motivation and same passion, and then be able to empower them and work with them and communicate and over-communicate so that we're all aligned and we're going out there and being able to do that. Because I may have been really good at reducing friction in one single office 10 years ago or eight years ago, but ultimately that's not necessarily my job today.

30:20It's to build an infrastructure that can do that across a wide range of offices. And so it doesn't mean that I forget how that was or don't think about that all the time, but it's just how do I attack that differently than what I did as a COO or even as a regional manager? It's interesting. The idea that one of the, you know, you've got three job, your job's probably three bullet points, right? Like keep, like grow, keep paying people and reduce friction or like whatever it is well not easy right that's right yes correct yes there is again so it's interesting that that um one of the what sounds like one of the north stars for you is is just reducing friction and i say it's interesting because i think right now we're living through and this keeps coming up in a lot of the other episodes as well we're living through the like the the techno moment uh or healthcare tech healthcare's techno moment like a lot of other industries experienced the upside of technology, you know, two decades ago, and healthcare is sort of getting there now.

31:18And who knows why? And let's see if it actually sticks. But we're sort of going through a version of that. And it's always interesting, because a lot of the conversation tends to go toward, we want to be tech first, or we want to adopt technology, we want technology to be part of the core strategy. And actually, that doesn't sound, not to say that, I don't want to put words in your mouth, that's not what you're not saying. It's just what you're saying, actually, our job is to reduce friction, the how is up for debate. The how is, if it's tech, great. If it's not tech, that's cool too. We just want to reduce friction.

31:49And it feels so much more natural for me as a former site leader, it feels so much more natural to think actually fundamentally if we reduce friction, patients are happier, practitioners are happier, it shows up in profitability, life is better if we just start throwing technology at the problem without understanding the manner in which it reduces friction then ultimately we may have actually created more problems uh rather than this way so i'm curious how does how does the reduce friction you know vision mandate in self-imposed whatever way of operating how does that come head to head with um you know tech can do some pretty cool stuff today and oftentimes implementing tech even if it's the right tech it increases friction initially and then hopefully decreases friction over time i think how does reduce friction is sometimes you have to you know eat the pain in order to get the upside how how does compress friction marry with okay we're going to consciously introduce new friction with the belief that it will then ultimately reduce friction how do you sort of balance those Yeah.

32:58So I think it's, you know, I try to start with the framework of why we're introducing technology, automation, AI. And so the framework that I use is that, you know, how is it going to impact, benefit, maybe not benefit, but how is it going to impact patients is the first thing that, like, I want to understand. Two is, how is it going to impact the clinicians? And then how is it going to impact the team? And then the final one is, how is it ultimately going to impact the business? Because I believe that if we find a technology or quite anything that helps reduce friction that benefits the patients, the doctors, and the team, the business is going to win, and it's a slam dunk.

33:38Those are easy. Where it gets more challenging, to your point of these companies looking at us included, at automation, technology, AI, whatever, hey, this reduces friction for the patient, but it doesn't for the doctor. Or it reduces friction for the patient and the doctor, but not for the team. Or it actually reduces friction for the doctor and the team, but it doesn't reduce friction for the patient. And so then those are the hard ones that you have to then solve for and understand what are you willing to accept and what are you willing to give up? and ultimately what is the why that we are doing this?

34:12And I think if the why relates back to helping people, improving their lives and taking care of the people in our communities, I think that is a really good North Star to start with. And then how do you revert back from that to kind of check those boxes around that friction to then say, yes, this is something that we're gonna try. Yes, this is something that we're gonna pilot or bring into the organization or no, hey, I'm not seeing how this helps patients, doctor and team. I just don't see how it's doing that or reducing the friction in those areas. So I don't think that's the right thing to add into it.

34:44And so I think it's that framework and then really being thoughtful and communicating the why and how the why of the thing that you're thinking about implementing then connects to what is your true North Star that you're trying to accomplish. I think if you work through that more times than not, you'll probably pick things that have less friction. Two is you'll help everybody understand the why you're doing something. So, you know, people, I think, are more tolerable of increased friction if they know the why. If you just make my job harder without telling me why you're making my job harder for the short term, I don't like that.

35:23That's going to upset me. Whereas if you say, hey, here's why I'm going to make your life harder for the next three months. In the next nine months, it's going to be much easier. And this is why we're doing that. Then people are like, okay, I understand. It still sucks. I don't want friction more than three months. But I understand the why. And I can get on board with that. I feel like sometimes we as an industry don't always spend the time on the why. And we don't give everybody, particularly at the field level, back to where I grew up and where I spent my time, we just say like, hey, this is a new change.

35:58We're doing this new or we're rolling this out to the organization. And the dental assistant's sitting there going like, I don't understand why we're doing that. Well, not that I'm perfect and I can do it all the time, but I feel like I got to try to explain to the dental assistant, Here's why we're making this change. Because ultimately the dental assistant is the one that's actually going to be doing it. It's not going to be Dave Gaspar. It's not going to be the senior leadership team that be making that decision. And I can't make that in a vacuum. It's going to be the dental assistant that actually has to live with the consequences of a decision, a technology, an automation or whatever that I have to implement.

36:28And so like, you've got to help explain that why to deal with that friction and get everybody on board to then embrace that, which then ultimately, hopefully if you choose a solution that checks as many of the boxes in the framework as you can. And you can explain that and understand that. And you can get more pluses than minuses. You can explain the why you're increasing the friction to the team. Then you get it implemented. You get everybody on board. It speeds up the time to less friction and it gets more adoption, more implementation. Then you see more success. I think one of the questions I sometimes ask is, what's your decision-making model for new tech?

37:03Like what do you run it? What rubric do you run it through? Yeah. And I've heard, I mean, I've heard a lot of different answers, which is cool. Like people make decisions in different ways, but I think the simplicity of patients process team, can we put check marks next to all of those? You know, there's always some downside somewhere in there. Totally. Somewhere. Yeah. But like generally speaking, can we put smiley faces next to patients process team? It's interesting because one of the things that we will bang on about very regularly is the whole AI reception wave. Yes. And no doubt there's value in parts of it, but it has become this, you know, sort of blanket movement of put it everywhere.

37:46It's like, actually, right. Now I find myself saying, show me how to show up for your patients. How to show up in your processes. How to show up for your team. So maybe your team get five minutes back a day, but then they spend 25 minutes verifying something down the line. There's a tax you don't expect. The patients are pissed off. They're hanging up. They're calling back. So the tactical implementation with those three things in mind feels like a really healthy way to approach it and allows you to say, you know what, actually, even though there's always some risk around new things, if we go in thinking there's going to be green boxes against these three things, like how bad can it really get?

38:20It can only be so bad if we've got those things in place. I think sometimes, well, I'll speak for myself and not everybody else, but sometimes when you have success, you want to make it feel bigger or smarter or like you accomplished something more. It was more complicated. And I often find that simplifying it makes it so much easier to have a conversation, to understand the pluses and the minuses, to have a thoughtful interaction, and then be able to wrap your mind around what are the solutions to the problem. So the more simplistic that we can keep it and focused on what we all align to, I just find that the conversations are that much more impactful.

39:03It makes perfect sense. And I think largely aligns with where a lot of the forward evolving groups, at least that we've spoken to, match up to. I'm conscious of time. You've been very generous with your time already. I would love to ask, do you send your comfortable answering? Yeah. Let me know. But one of the things that I often find people learn the most from is the things that other people wish they didn't do, or if they could go back and do it differently, they would have. And so one of the questions I have, and maybe this is a good go out with a bang, is what is the, in the time since you've been at the, you know, senior decision maker table, COO, CEO, whatever it might be.

39:46What's that one thing where you say, even today, like, I really, that was not the right call. That really bit me in the ass. It came back five months later, five years later, we got that one wrong. I should have played it this way. Do you have that sort of skeleton that you think about and you carry with you? You know, I think there's two that I would say, one from a long time ago, going all the way back to vet. And then one is from, you know, more recent over the last, call it five or six years. And it's really been the times that I have not slowed down enough to build the relationship with the partner that I'm working with, with the clinician, with the operator.

40:38When I moved too fast on that and I didn't align on the why and I didn't align on what the motivation was and what we were trying to accomplish, those are the times when I was moving too fast and I didn't slow down, get aligned and then speed up for success. that amount of trust, that amount of faith in each other, that ability to have open dialogue and communication, both the positive and the negative is really critical. When that has been absent in the past, it has made life harder and it has made success more elusive and has ultimately either delayed the success that we were trying to achieve or on a few occasions, it is meant that we're not able to achieve the success that we set out to achieve.

41:21And so, you know, continuing to keep front and center the importance of the alignment and the relationship and seeing a great practice on the surface. But then if there's not that automatic alignment throughout the entire process, or maybe it's great clinically, but not great operationally, or it's great operationally and not great clinically and slowing down to understand that and be able to make sure that That alignment, that's one thing that I have made some mistakes in the past that I continue to bring with me as I look to new partnerships. And whether that's my team or whether that's new acquisitions and partnering with new doctors.

41:58So that's one thing. And then the thing that probably one of the events that has gotten me to where I am the most is the back to the vet days that we talked about, the empathetic piece. So back then, it's still now, but back then I was an operator. I would go in and I made a lot of mistakes. I was lucky because I got to make all the mistakes at Banfield as a young, arrogant business person operator that didn't understand the clinical. And I had some great doctors that brought me under their wings and taught me the clinical and really helped me understand how you speak to a clinician. But as we mentioned earlier, there's life and death in veterinary medicine.

42:35And I had a convenient tendency to when bad things happened initially, I had a call. I had a meeting that I had to go to and then I would leave the vet clinic because I didn't want to be a part of that draining emotional bad outcome. And I was lucky enough that a veterinarian out in Queen Creek, Arizona pulled me aside and called me out on it. And I was like, no, no, I don't do that. I don't do that. She's like, yeah, you do. Yeah, you do. If you want to have the difficult conversations and you want us to align with you and build a relationship with you, you don't just get to come in when it's fun and and leave us when it's not fun.

43:08And I didn't accept it initially. And then I had to do some soul searching and look at myself in the mirror and realize that's what I was doing. And I was asking people to work really hard, do really hard things in a really tough emotional environment that I wasn't willing to do. And I was like, oh my God, I wouldn't want somebody to do that to me. I can't believe I'm doing that to somebody. And so I was lucky enough that somebody called me on it that then I could change my behavior and I could be there to celebrate and I could be there for the wins, but I could also be there for the tough times and the emotional draining times that then ultimately form the relationship to have the conversations, the good and the bad, the willingness to learn from each other, the willingness to figure out how do we overcome the challenges and the obstacles that we have, that that single moment has absolutely run through my entire career.

43:59And without that moment, I don't believe that I would be here today because I don't know that I would have had understood the importance of being there in those moments of challenge, in those moments of not winning, of not feeling good as much as I have showed up the rest of my career. And that was such a pivotal moment, quite honestly, personally and professionally that has enabled me to be successful. But it was the niceness, the courtesy of that doctor pulling me aside and having a conversation with me that then enabled us to build that relationship. And then I was able to take that learning and use it in other areas of my life and learn how to grow and always have that as something that was important to me so I could expand my ability to connect with veterinarians and then with dentists and move forward through my career.

44:45My sneaky punchline to both those things is, so in a world where it's all about automation, it's still all about the people. It's still all about the people. Both of those experiences highlighted. Dave, thank you so much. I want to be respectful of your time. I'll just close out quickly. So for those listening, this is Dave. Initially, that subsequently to dental, leading a group now, combination of acquisition and now Greenfield more recently, sharing insight across his journey as an operator through to executive leadership and across all the conversation, I think hitting most vibrantly the idea that the why really matters and that ultimately retail healthcare is a service business, which means that people are at the heart of this thing, even if everyone will tell you that someday AI will replace every part of the care continuum, we're probably still very far away from that.

45:30At least Dave and I will be in the ground for many, many decades before that happens. Dave, thank you so much. Really appreciate your joining today. Dave Kahneman Absolutely. Thank you for having me. Appreciate it.