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[00:00:00] Hello everyone. Welcome to The Testing Psychologist podcast, the podcast where we talk all about the business and practice of psychological and neuropsychological assessment. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

This podcast is brought to you by PAR. Conduct a broad-based assessment of personality and psychopathology with the gold standard personality assessment inventory, or PAI. The new PAI Spanish revised translation retains semantic equivalence while using clearer and more inclusive language. Learn more at parinc.com\pai.

Hey, y’all. Welcome back to The Testing Psychologist podcast. Good to be back with you.

Today is an EOS journey episode. Those of you who’ve been following the podcast for a while know that I’ve been documenting our practice’s journey going through the Entrepreneurial Operating System and [00:01:00] implementing this business framework in our practice over the last almost two years now.

Today, I am recapping our recent quarterly pulsing meeting. As usual, I will share some thoughts and feelings from this meeting, try to keep it as real as possible, and give you a little insight into this Entrepreneurial Operating System and how it’s working in our practice.

Now if you’re a group practice owner or a solo practice owner, there is a Testing Psychologist mastermind group that could interest you. I have new cohorts starting in January 2024, and all will be enrolling. So if you’re a beginner, intermediate, advanced practice owner, and you’d like some support from other psychologists and from me as the [00:02:00] facilitator, I’d love for you to check out the groups. You can get more info and schedule a pre-group call at thetestingpsychologist.com/consulting.

Let’s talk about the latest EOS meeting.

Okay, everybody. Welcome back. Here we are. We’re doing it again. This is EOS journey. Just to recap, if you have not heard any of the other EOS episodes, I would highly encourage you to go back and listen. You can just do a search for EOS in my podcast archives. I would encourage you to go back to the beginning, honestly, because there’s so much background. And at this point, it’s almost like a much less [00:03:00] dramatic and slow-moving soap opera in the sense that each episode builds on itself, but today we are talking about our latest quarterly pulsing meeting.

Just to review, EOS is the Entrepreneurial Operating System. This is a business framework that we have been implementing in our practice over the last two years to help bring more clarity, accountability, and vision to the way that we run the business.

Quarterly pulsing is our quarterly leadership team retreat where we go offsite for a day; it goes from 9:00 to 17:00 each time we do this, and we anchor in with our consultant- we have an external consultant who is guiding us through this process, and we spend the day working on things in the practice.

So last time we left off, it was July, and we [00:04:00] were settling into a newly formed leadership team after losing our office manager and our clinical director. We were wrestling with a disconnect between our staff and our leadership team. We were also on the brink of rolling out our salary model.

Last time I talked about going into the day with less energy than usual. I was just feeling unsettled. I didn’t like that our leadership team was shaky and just felt very scattered and a little demoralized, honestly, with leading the practice.

Now, my mindset this time around was much more energized and in a much more positive place. One thing that was influencing that is that we were coming up on our annual staff retreat which occurred two days [00:05:00] after the quarterly. I love our annual staff retreats. At some point, we’ll do an episode on those and how we structure those, but I was just generally excited to have had some energy for our practice. I was really looking forward to the upcoming retreat.

Another component though that was really big is that our leadership team just felt more solid than last time. This was our second round with a new team and I felt much more confident in the team and particularly in our new member. I shared with them at the end of this quarterly meeting that I was just really impressed and felt a lot of trust for them and appreciation that they were with us and engaging in our leadership process.

Otherwise, I was also excited because we as a leadership team have been discussing some exciting ideas over the last two months and I was really ready to dive in and vet those ideas.

[00:06:00] I will maybe comment on this later, but that reminds me of the general process here with EOS is that over the first at least a year, maybe more, I felt like we were really putting out fires more than anything. We were putting out fires.

A friend of mine who runs a practice in Chicago, Kristin Breeze, a very successful practice in Chicago, mentioned that EOS is like dragging everything out of your house, putting it on the driveway and on the street in front of your house, and going through everything and deciding what you want to keep, what you want to sell, what you want to throw away, and then going through the process of moving everything you want to keep back into the house and organizing it in a way that actually makes sense.

And so if I want to take that metaphor [00:07:00] even further, it’s like we started to move things back into the house, but almost constantly there was something on fire out in the driveway that we are having to attend to that these items from our home would just spontaneously combust and we’d have to figure out a way to put the fire out.

I feel like we’ve been doing a lot of firefighting over the first year and now we’re settling into like really visioning for the practice and implementing some really cool ideas, which is a nice transition.

Now, as far as our agenda for the quarterly retreat, same as usual. So we do a check-in personal and professional just to see where everybody’s at. Take the temperature of our team. We review the last quarter’s rocks or priorities. We go through our vision traction organizer, which is a fancy corporate speak way of saying our [00:08:00] values, our core purpose, and our goals for the next 3 to 5 years.

Every quarterly, we have a little section on learning an EOS tool. This time it was how to lead, manage, and keep people accountable. We engaged in a lengthy IDS session. IDS stands for identify, discuss, and solve. This is basically talking about issues that we have and finding solutions for them. We identified our new rocks for the coming quarter. That would be Q4 of 2023. And then we wrapped up.

Now, let’s start from the top.

Reviewing last quarter’s Rocks. A big part of EOS is accountability. We go through and we have to go down our list of the rocks from last quarter and just say whether we got them done or not. The theme here is that there is no storytelling allowed because people try to [00:09:00] explain why they did or didn’t get the rocks done- mostly why they didn’t. And it cuts through all of that. It’s a yes or no. Did you get it done or did you not?

And like last time, I was the one who was dragging our team down this quarter. We could have gotten close to 100% rock completion. The target is 80%, but we’d like to get 100% because we’re all overachievers, but I was the bottleneck.

One of my primary rocks was to finish up all of our backlogged insurance credentialing. We’d hired a bunch of folks and credentialing was just dragging on. We don’t have a great person to do that in our practice so I still do it. And then subsequently transfer a note signing over to my department leads for clinicians who need it.

Now, like I said, I don’t get to tell stories. I just had to say, no, it was not done, but I’m going to tell a story here and say, to my credit, I did all that I could [00:10:00] do. I just didn’t do it early enough. Insurance credentialing takes a long time to finalize and I started a little late in the quarter. Everything is in motion. I’m just waiting on insurance to finalize all of the credentialing.

Aside from me dragging us down, there were some big accomplishments. We finalized our salary model and we rolled it out. Over the last two months, we’ve been doing a salary meetings with everyone to communicate the salary and let people get on board or not. Everyone did get on board, which is great.

We made a decision on practiceQ or intakeQ. We have been deciding whether to switch our EHR from TherapyNotes to intakeQ, and we finally made the decision that we were going to stay with TherapyNotes at this point. And that’s huge. So that gets that off of our plate and we’re going [00:11:00] to try to go all in on TherapyNotes. They’ve been making some significant improvements over the last several months. I think I have some awesome updates on the horizon as well. So we’re going to stick with them.

We went through what we call phase 1 of organizing our Google Drive. I don’t know about y’all. If anybody uses Google Workspace out there, our Google Drive devolves into chaos very quickly as far as loose documents, disorganized folders, and things like that. And so this was, this sounds boring, but it was really big for us. We went through and organized our Google Drive. Well, we did phase 1. There’s plenty more to do.

And then another big project we got done is that we were struggling with one of our insurance panels who, for some reason, from January to April of 2023 stopped sending us electronic remittance advice. And so we had to hand [00:12:00] post by printing EOBs four months’ worth of claims payments from this one insurance panel. It was a nightmare, but it got done. So that’s huge.

Then we moved on to talking about our Vision/Traction Organizer. So this was interesting. This was an interesting moment for me as a leader, because I lost it a little bit during this section.

As a little background, we visit the V/TO every time that we do our quarterlies or any EOS meeting. What this means is we revisit our core values, which we established back in the very beginning. We’ve had these core values for at least 18 months now. They have not changed. We revisit our core focus which includes our purpose and our niche. [00:13:00] We revisit our marketing targets, our three-year vision, and our five-year target.

None of these things have changed over time aside from updating the three-year vision just to accommodate the fact that time has passed and it’s no longer a three-year vision. We need to reset it for a three-year time horizon. None of these things have changed.

And so in the middle of this discussion, we’re all sitting there, not really saying much, our facilitator is asking, how we’re doing with this section, and this is rare for me, honestly, but I blew up a little bit, and was like, why are we still talking about this? There are so many more important things that we need to be talking about. Why are we spending time on this? These things have been set for 18 months and I don’t know why we’re revisiting this.

So this is a little interesting for me. I’m not that [00:14:00] excitable of a person necessarily. I certainly don’t trend toward anything resembling anger at work. And so to my leadership’s team credit, they also got on board and were like, yeah, we’re with him.

But what came out of this was meaningful. So we figured out through this discussion that we did need to focus on the core values and the core focus because we haven’t really communicated these things to our team as well as we should have. So even though we weren’t changing these things, we need to spend time on them to keep them top of mind so we can roll them out to our team and continue to keep them or make them top of mind for our team. And this ended up being a fairly important part of the day. We need to be talking more about our vision with our staff.

I wrestle with this because a big part of [00:15:00] the three-year vision is profit and revenue numbers. That continues to be hard with our staff. Some folks totally get it and are on board; they understand the numbers and it’s important to talk about; some folks are indifferent, they just don’t care and just want to do their work, and some folks don’t understand the numbers and end up confused or frustrated.

Being transparent, as someone who has a pretty good grasp on finances and math in general, numbers, and an intimate understanding of our practice numbers, this is the hardest group for me. I’m personally struggling with how to communicate this information in a way that people can understand. So we’re still working on that, but this ended up being a valuable part of the day in spite of [00:16:00] my little blow-up.

Let’s take a break to hear from our featured partner.

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All right, let’s get back to the podcast.

So, the next section, we learned this EOS tool. We do an EOS tool every time it’s something different. Today’s topic was lead, manage, and accountability. I’m not going to go into detail here. There are plenty of resources for learning about leadership and management [00:17:00] styles and tactics out there, but generally speaking, our consultant presented it to us this way. Leadership is what he called the on work. So this is like thinking, visioning, creating openings for people to shine, and developing the path forward. It’s a big picture, like meta, what direction is the practice going and embodying that for your staff?

And we contrasted that with management, which is more the in the business, the giving the direction, keeping people accountable, good communication. This is more the doing than the thinking, if that makes sense.

The takeaway from this though is that we basically found out that we are not employing good leadership or management skills, which makes sense because we were never trained in these skills and [00:18:00] they are absolutely a skill set. So we all walked away from that a little bit discouraged, but also mostly hopeful to be able to develop these skills over time.

Now, our next and probably largest section of the day was on IDSing or identifying, discussing, and solving our issues. We always like these sessions because our consultant helps us. These are big issues typically that we bring to the quarterly. We are IDSing every week at our leadership team meeting, but as I said, the IDS sessions at these quarterlies are super helpful because we have some external help.

Our big discussion point this time was what to do with our admin team. Over the last few months, we’ve experienced some conflict and a little breakdown within the team for the first time ever. So we are needing to regroup, figure out how to move forward [00:19:00], and keep our practice on the rails.

So we spent a lot of time talking about the roles on the admin team, anchoring back into our accountability chart. If you might remember, the accountability chart is a pretty key component of EOS where everyone has a well-defined role and knows exactly what they’re responsible for. A big part of our problem was that when our previous office manager left, the other members on the team to their credit took on some responsibilities that were outside their accountability chart, and we had a little bit of what I’m calling accountability bleed over the last few months as people muddied their roles and took on new things. And it just got a little chaotic. People were stepping on one another’s toes and taking on tasks without communicating with the entire team.

I think it was all in good intentions and trying to be [00:20:00] helpful and much of it was helpful, but after some time, it has gotten confusing and chaotic and folks are just having some conflict. So we spent a lot of time talking through that and again, anchoring back into the roles and making sure that our accountability chart is dialed in.

We also talked about increasing our profitability. I think I mentioned on previous episodes that we ran a pretty low profit margin last year as we have really built up our team and invested in the practice. And now, it’s time to spring forward and leverage all of those things that we invested in, and so we’re going pretty hard on profitability over the next few months.

Part of that is having the salary projections, which are going to help greatly. We dropped one of our major insurance panels for testing, and [00:21:00] that is increasing our income quite a bit. And perhaps most interesting to all of you, we are also going to implement a testing materials fee which will be an extra fee that we charge the clients outside of insurance.

We did have to get approval from all of our insurance panels to do this, but it is doable and we’re going to roll that out to try to offset the cost of testing materials, which just continue to skyrocket. 

We started to wrap up by defining rocks for the next quarter. So again, rocks are just the top priorities for our practice. Here are just a few of the rocks, just to give you an idea.

We are going to implement two more private pay services. For us, those are going to be workshops and couples counseling. We are going to implement that testing materials fee, which I mentioned, and possibly a [00:22:00] administrative fee for our therapy clients to account for communication and consultation case management that are not reimbursed by insurance, our profit target for this coming quarter and the admin team initiative to get people back on track and dial in our collections.

Those are a few of the rocks that we’re going to be working on.

Now, as always, I left the meeting feeling pretty energized and really happy with our leadership team. I continue to be just blown away by folks’ willingness to jump in and invest and guide this practice to where it needs to go. It’s very humbling. It’s very humbling to see this thing that’s been my dream for a long time come to fruition with other people so invested.

And so, next time, let’s see, we will be gearing [00:23:00] up for our second annual meeting and starting to wrap up the EOS process. EOS is typically a two-year implementation. Some people go longer. We’ll see where we end up, but we’ll be gearing up for our second annual and we will be wrapping up 2023. And as always, I’ll check back in on these rocks and update all of you on our process and progress.

Now, if you have any questions about EOS or you want to learn more, there are lots of links in the show notes. It has been truly revolutionary for our practice. And I think once you get to a certain size, I think for us, it was somewhere between 15 and 20 clinicians, certainly over 20 staff, you have to have something in place as a framework to run your business. Whether it’s EOS or something else, you need something. So if that’s interesting to you, I [00:24:00] have no financial investment or kickback or anything from anybody learning about EOS. So there are lots of links in the show notes on EOS resources that you can check out.

Thanks as always for listening and I’ll catch you next time as we head toward our second annual EOS meeting.

All right, y’all. Thank you so much for tuning into this episode. Always grateful to have you here. I hope that you take away some information that you can implement in your practice and in your life. Any resources that we mentioned during the episode will be listed in the show notes. So make sure to check those out.

If you like what you hear on the podcast, I would be so grateful if you left a review on iTunes or Spotify or wherever you listen to your podcasts.

And if you’re a practice owner or aspiring practice owner, I’d invite you to check out The Testing Psychologist mastermind groups. I have mastermind groups at every stage of practice [00:25:00] development, beginner, intermediate, and advanced. We have homework, we have accountability, we have support, we have resources. These groups are amazing. We do a lot of work and a lot of connecting. If that sounds interesting to you, you can check out the details at thetestingpsychologist.com/consulting. You can sign up for a pre-group phone call and we will chat and figure out if a group could be a good fit for you. Thanks so much.

The information contained in this podcast and on The Testing Psychologist website are intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for [00:26:00] professional, psychological, psychiatric, or medical advice, diagnosis, or treatment.

Please note that no doctor-patient relationship is formed here, and similarly, no supervisory or consultative relationship is formed between the host or guest of this podcast and listeners of this podcast. If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with expertise that fits your needs.

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