Dr. Amelia Case: The MMM Blog

The Something Missing Part

2011-02-02T12:07:00.003-05:00

I reread some previous posts, plus my last post that was written over a year ago. I hardly feel like the same person. I feel like I've been gestating so long! Not that I've arrived, but that now, at least, I am born.

It was hard to write the blog, in general. Initially I thought it would be fun. Not so. I wondered about how to make sure I didn't complain about all of the stress...every day...all the time. I felt like what I had to say wouldn't be a blog. It would just be one bitch-session after the next. So, I focused on what was positive or what I was trying to do, and wrote about that. I restrained myself from expressing all of the fear and doubt I had about my business growing, my business problems and challenges. I didn't lie. I just didn't tell both halves of the experience.

I can feel the tension when I read the posts. I feel pain sometimes - just remembering the confusion and sense of restriction and tension.

About four years ago I asked one of my patients (who had a very successful business career) if he could explain what Leaders do. I felt baffled by the question. I thought if I got that answer I'd be in better shape. The funny thing is that he didn't know how to answer - or he did but I didn't know how to hear! It all seemed so fuzzy. I felt silly asking the question, and never asked anyone again. I did end up reading some books on leadership, too, after that. They seemed dry and contrived - or maybe out of my league.

I wrote something on the M3 yahoo group yesterday that was a note-to-self: Struggles don't determine where your business goes. How you respond to them does. As I read it I realized that it sounded like something I could have written about parenting. I've learned alot in parenting that has helped me answer the question about leadership. Leaders have to be incredibly generous. I don't think I knew how generous until I had kids (late in life; my first when I was 41). I don't mean generosity the way it is used in common language - that has to do with giving stuff. When I say generosity I mean a willingness to give, to be magnanimous, to think in terms of bounty, act with nobleness, not to be petty or caught in small mindedness; to create possibilities that are larger, more full and have a greater amplitude than that which exists. To be a leader means to jump into possibilities; it means to be vulnerable and brave at the same time; it means to share the good, and even the bad, sometimes! I thought the struggles would kill me. In fact, they have birthed me - and the business. And leadership.

In the last post I wrote I said I wanted to find out what was missing. I think I have found it when I say 'Leadership'. It's not enough to work, or work hard. I was taught to work hard, and that would be the key to success. I have had to change my thinking about it. I don't believe it anymore. I think the key is to Lead Well.

I love my work. It's not difficult to transform my work into play. It feels natural. It didn't feel natural to lead. Now it is starting to.

Feb 09 to Sept 09

2009-09-15T17:18:00.001-04:00

January 2009 through August, 2009

Dr. Amelia Case reporting here from Chicago. Can it be possible I haven’t written a word this year?

When I won the CMI in April, 2005 we were asked to write a paragraph on the CMI Website Blog for our Make Mine a Million Sisters. In fact, we were asked to keep it to one-to-three paragraphs, tracking our journey to the million-dollar mark and beyond…what it is like to be a woman in business, growing a business, handling real-life problems and challenges and achieving success. I think I have written pretty steadily since then, mostly because I was told to, and gladly did it because I felt so grateful to be part of such an important group sharing such an important journey. However…

Writing a monthly paragraph about business…is like trying to tame a Tasmanian Devil while you’re sleep walking. Business moves so fast and there is so much going on in a single day that the blur is hard to distill into a clear concoction hour to hour (nevermind monthly). I now understand why people write about business after they’ve Made It: Then the collections of similar stories must come together into chapters that can be truly meaningful and helpful.

In a monthly report, like those I’ve written, it seems a dull journal of challenges at best, veiled complaints and occasional successes (clouded by more challenges and problems). Is this what I read on the other CMI blogs? Kind of. In fact, not too many people continue to write them, and I think it is because (1) it is one more thing to handle on an already full plate (2) the pressure of recording something of meaning (when the endless details of meaningfulness crowd the head) is daunting and (3) it’s painful to review the same issues month after month, leading towards the inevitable feeling of futility (i.e. God! I had the same problems last year…).

I read the E Myth many years ago. I’ll use Michael Gerber’s words here: I’ve spent over 20 years becoming a doctor and refining the Technical Aspect of my work….and I became the master technician. I’m great at what I do. I’ve spent (seriously, since 1999, I guess, after dabbling for the nine years before) years defining the Managerial Aspect of my work….became (despite myself) a good enough manager. I can handle most managerial challenges with grace, dignity and integrity, and still come out okay in “business” (i.e. not going bankrupt and even making a profit). Now, I’ve spent a little over four years (since Christmas, 2004) working on the Entrepreneurial Aspect of my work. The problem is, the speed of the streamlining, prioritizing and delegating (the necessity for the budding entrepreneur) is, well, hardly existent, evident by the slow growth of my business. The proof of my ability to act as an entrepreneur is in my growth, yes? Growing is something I expect in general…and I’ve done it…but so slowly. Growing as an entrepreneur whose got-it-together must feel different (it must). It must be more of something. It must feel different. It must be something different than what I am experiencing, anyway. It can’t be simply taking on more and more work. It’s got to be smarter (than what I am doing).

Building my consulting business was much easier. Find clients. Schedule clients. Help clients. Charge clients. Get paid. Get return clients. Get referrals. It was me and the client. One after the other. Consulting. Teaching. Consulting. Teaching. There was even enough time to be a mom, own my business and practice my doctor work! I stopped growing my consulting practice about 36 months ago, thinking I’d put all of my effort towards growing UHI. I could always go back to consulting, I knew. And, teaching for John Demartini (here and there in London and Paris – woo!) plus offering my classes gave me satisfaction with my main consulting tool (Demartini Method). I thought I had it all solved! I thought I’d make it Even Easier!

Wrong. I thought removing the bulk of the consulting would give me more time, for one. For two, I would somehow simplify UHI when all of my attention was there (and not split)! However, I may have been wrong. Things are different with this larger service business (than the smaller one-on-one consulting gig). The complications are greater. The streamlining is markedly more challenging. More people make it, simply, more work. For THREE: I left out the fact that it actually does require more money to simplify. Is anyone else out there finding this true? Right. It takes money.

Anyway, here I am. It has been a bit over four years since I won the M3 Award. UHI has grown. Some things are better. However, I am not satisfied with the Way Things Are. My company has so much to offer. So much that is timely. So much potential. Yet, here I am – “Chief” – stuck in the tsunami of the daily grind, trying to figure out how to get out of this suction of a tumbling whooshing pattern. All over my office I have my Words of Wisdom! “Create Success: Prioritize. Streamline. Delegate.” I’m lost in the in-between words (that shouldn’t be there), whatever they are.

Entrepreneurs appreciated: I have a great deal of respect for Entrepreneurs, particularly those who have done so well, grown their businesses and Made It Happen. They are my heroes. At this point in my life, I really get why great CEOs earn what they do. They should. Building a business is not for the faint-hearted. Great Entrepreneurial Talent takes boatloads of creativity, genius and courage - and insight and intuition – and the tough sharpness and savvy of something-like-a-whaleship’s-confident-captain who has Sailed It All, and still got his Goods and his crew.

I wonder if there ever was (or could be) and entrepreneur who went with the flow; in other words, didn’t feel like he or she was pushing Up Hill all the time. I read Entrepreneur Magazine and often marvel at some of the stories about people who (seem to) simply have had great timing. Am I silly wishing for Good Timing Karma? Is the God of Entrepreneurs going to give me an audience? Is it shameful for a self-proclaimed Entrepreneur to ask such questions? Does it give me away as a pretend-Entrepreneur…talk without substance? I am supposed to be so focused there’s no time for fear, self-doubt, or worry, right? I’m supposed to revel in the struggle, right?

So, to my Fella M3ers, I’ll admit: Something is missing. I’m not sure what. So I begin the examination and diagnostic process, then I’ll move into the Entrepreneurial Treatment Plan. Now my attention goes outward to find like-minded people to find out how they’ve Done It. Surely someone will offer up the right specialist in Entrepreneurial Care, someone who will give me a diagnosis…so at least I’ll know what to treat.

January 2009

2009-02-11T12:24:00.001-05:00

It turns out that our growth in 2008 was 12.6%. Better than I had been tracking in the fall. I imagine what the level of growth will be when we have all of our people in place!

Collected revenues fell by 2.5%. Medicare and the State of Illinois insurance have been paying late and slow. Luckily, that is not the bulk of our patient base, but in a small company, we feel it.

Young would-be chiropractic doctors and natural health care providers regularly call me to find out if they can shadow our staff. Before I say "yes" I do an interview, then tell them the requirements to do it. (Most of them don't do it when they find out that they have to fairly exchange work for observing. Occasionally, someone expects to get paid.) Over the years, every one of the people who have come to do it have firmly decided to enter natural health care, yet have had one over-riding concern, and that is about the job opportunities that will exist after graduating and getting licensed. The problem is, I tell them, there is not a specific venue for natural health care providers to work. The health care system is set up to give jobs to providers that tow the party line (drugs and surgery); of course there are exceptions here and there, but it's rare to find natural health care providers in that environment. So, the drug and surgery economy keeps moving - and growing. More importantly, there is a place to find a job if you are trained to be in that system. On the other hand, natural health care providers have the option to open up their "mom and pop shop" or join someone else's; that's about it.

Okay. If you are a natural health care expert - trained and ready to go - and you open up your "mom and pop shop", you must be a blackbelt in a myriad of subjects besides the clinical work. [Clinically, you have to knock the patients' socks off with great technique, giving them a reason to come back as well as something to talk about (referrals)!] In the "mom and pop shop", you have to be the great boss, manager, entrepreneur, human resources ace and business strategist...at least. No wonder so many natural health care providers default on their student loans. They aren't trained with an MBA.

I see UHI and my new division (New Results Headache Relief Clinic) as the venue for these great natural health care providers to work their magic. Health care insurance and flex spending covers this kind of care, plus people are willing to pay (and they want something other than the old drugs-and-surgery-model). I intend to do two things: give the providers the perfect place to do it; and give the public a perfect place to find it.

I have gained a great deal of clarity about this over the years, and it has never been more sharp than it is now.

Listen up, friends, countrymen and countrywomen! This is the time for this company to grow and thrive!

That said, January was a tough month for business. I don't care what anyone says, the weather does play a part (especially those '40 below' days)! I shouldn't forget to mention the general attention and concern to our economic challenge and financial climate seems to have, at least, made people forgetful. There is a consequence to the strain.

November and December 2008

2008-12-29T16:44:00.000-05:00

It didn’t work out the way I thought it would with the new doc on part-time status. She wanted what she wanted to join full-time, and it was not realistic. Going forward, I don’t think I can seriously consider a young woman, in fact. It seems that the corporate urban legend that young women can’t be hired is founded on truth. Dating, engagement, social life and marriage really do seem to beckon to that demographic. That hurts: Sorry, men, but I just think women make superior clinicians. Too bad they don’t want to work! (If only I had a big enough outfit to hire steady part-timers. There would be a place for them.)

The rush of the past 60 days has created a blur of mundane events not worth mentioning. The biggest thing that happened was finding out that we are tracking at 11.5% growth. I nearly fell over. On a year with such trouble, it’s hard to believe. I was shocked. Totally out of touch with the big picture, all I was doing was putting my head down and going forward.

At the end of this year I feel full of ambition to make this business grow and spread, and this is why: This health care changes lives, both physically and mentally. Not only do people feel better outside, they feel better inside. It builds confidence in the body’s natural healing abilities. We have had such success stories this year. Despite the business challenges, I want to recognize what this is all about. When I sit to think about patient success stories, this is what I remember this year:

* Chiropractic – Successful for back pain, pain in pregnancy (and the Webster Technique for helping babies get in the right position in the pelvis), carpal and tarsal tunnel, headaches, incontinence, erectile dysfunction, asthma, reflux and sinus pain.
* Craniosacral therapy – Successful for insomnia, headaches, bipolar disorder, constipation and sinusitis.
* Physical Therapy – Successful for hip replacement preparation and rehab, headaches, frozen shoulder, spinal disc problems and plantar fascitis.
* Massage Therapy – Successful for asthma, chronic pain, gastroesophageal reflux (GERD), and for a great pregnancy.
* Astrotherapy, Psychotherapy and Energy Therapy – Successful for depression, anxiety, interrupted sleep or sleeplessness, to quit smoking, lose weight, choose the right career and mate, handle break-ups, death and grief, and life-planning.
* Acupuncture and Clinical Herbal Therapy – Successful for menstrual disorders, hives, digestive problems, immune compromises, low energy and thyroid problems.
* Nutritional Therapy – Successful for reducing inflammation, improving energy, restoring sex drive, normal bowel function, and better skin.

The list is not comprehensive. It is just what I can write down in a few minutes while I think of our meetings and our patients. It’s just the tip of the iceberg of stories that make it all worthwhile. The purpose of this business is to help people feel and get better, inside and out. The mechanics of the business aren’t simple, and can be discouraging, but it is the stories that buoy me up and make me ready for the next day, the next story, the next step and the next challenge.

October 2008

2008-12-29T16:42:00.000-05:00

I was trying to fit a square peg in a round hole (a few times). Clear to see after the fact. The staff who don’t fit – even if they are good clinicians – don’t fit no matter how hard I work. They can’t be cajoled, massaged, fed or otherwise babied to fit if they just don’t fit…however much I fantasize that I can make it happen. My idea is so worthy of fitting into! That’s my ego talking, and it deserves a slap for being foolish: I’ve only heard (and read) tens of business owners say the same thing.

October was dedicated to interviewing (at 9 p.m. at night and on weekends, mostly) and working on the business plan. I figured out that I do have to put in a line item for a full-time HR person to keep interviewing new talent. So, that’s done.

As for me, I continue my role as the only doctor in my department. Fun, but overwhelming with all of the other things. I may have found another doctor, but not sure if it is going to work since she seems to want only part time. For now, we’ll see with her working a little bit of the week. That is a good test for “fit”.

September 2008

2008-12-29T16:40:00.000-05:00

I have been so challenged this year that it’s been easy to overlook the accomplishments and opportunities.

I am going to explain. I have been dissatisfied. Really dissatisfied. So much half done. So much almost figured out. So much not-quite-so. So much still a mess. Simple stuff. Easy stuff. Hard stuff. Stuff that I have attacked a thousand times but that still is poorly functioning. One evening my attitude was so bad that I caught myself having a wicked conversation (with myself) just as I stepped into the foyer of my apartment after a long, frustrating day. It went something like this: “Who am I kidding? What ever gave me the idea I could pull this off? I’ll probably be alone starving to death by the time I should have ‘really made my impact’. What am I going to change, anyway? I am just one person who knows practically nothing. I can’t even keep my paperwork in order and I think I’m going to keep my health care empire in order? What was I thinking? I have to do something else. I have to get away from here. How am I going to get out of this?” I don’t know how to exaggerate how vicious the words were (and the tone of my inner voice was), or how hopeless and depleted I felt. I caught myself, actually hearing what I was saying, shocked. I decided to move my feet out of that spot. Indeed, I said to myself, “I am not having this conversation.”

Some days later I heard someone say, “What you fear you draw near.” Then it hit me. It is not a bogeyman that draws something near. It is not even the person who fears who draws “it” near. It is simple. When filled with fear, that is all we can see. When filled with doubt, that is all we can see. When filled with frustration, that is all we can see.

For much of this year I have focused my awareness on what I can’t do, what I don’t do well, what I should do better, what I still mess up, what I haven’t got the hang of, what my weaknesses are, what I should have done better. As that point of view became a more general state, it took on a persona of its’ own. When I was filled with moments of discouragement, futility and failure, it was all I could see; (by that very fact) it was validated. Naturally I could only see more. It fed on itself. Worst of all, my normal strategies that have uplifted me through the years have fallen by the wayside as my work has increased and my children have needed more attention. Without those strategies I lost my buoyancy. So, now I am getting back to basics. First, my energy has to be on target, so that is a priority item, where it belongs. It’s already helping me to refocus my inner dialogue and my outer actions.

What happened in September? UHI handled getting rid of two problematic employees who were in key spots, and got the opportunity to fill the spots with staff that fit better. Yes, it’s tough! But, hey, it happens. At least now I have the chance to search for employees who are not only great clinicians but who are a great fit at UHI. I get a chance to look for people who are fantastic at what they do and are also team players. I will work to build the staff of my dreams in every way (not just great for the patients, but great for me, too)

August 2008

2008-12-29T16:38:00.001-05:00

Hi Team M3:

People. People. People. Get the right people. Keep the right people. The riddle begins with “How”…to get them…but that is not all. It gets very complex when the question “Who?” enters the mystery. Then, the final part of the riddle is how to keep them.

The Recent Lesson: Great staff are not just people who give great patient care or who fit our five primary covenants. Those criteria make a really great candidate, and that’s all.

At 10 p.m. on a Sunday night in August one of the doctors emailed me her “quit notice”. I didn’t get it until the next day, Monday morning. No call. No notes. No meeting. Only an email. She quit, she stated in her email, because she was getting paid too little. (She copied her email to several other staff.) In fact, I would agree, in the sense that she was earning too little. According to our contract, if she had no patients, she would not get her full salary. Until she increased her patient load to an appropriate level – and a fair level – she would remain at a reduced salary. Getting paid too little was a strategic point in the contract that would get and keep her busy in case she decided she wanted to get paid for doing nothing. That was my guarantee for a fair exchange of work for money. The problem was, after taking off nearly 12 weeks of time for her wedding festivities in 2008, she had very few patients upon her return. She didn’t want to wait to increase her patient load to get paid. She wanted the salary now. When I said, “no”, she got mad enough to quit without notice (her contractual obligation was six-weeks notice).

Here is the bottom line: She was a great candidate, but a bad choice. One of the top criteria for choosing a candidate has to be “ability to be part of a winning team”. That immediately weeds out people with “entitlement issues” (i.e. I get to play when I want and everyone has to support me when I want.) It weeds out “poor sports” (i.e. This didn’t work out the way I wanted so it’s your fault.) Team players can’t have those characteristics and be on my team. (My husband, who loves sports, keeps me in the loop about great coaches and great teams. Now I believe that I should have been listening to him more carefully over the years!) As for now, I am correcting my interview process to find a Great Choice. No wonder headhunters get paid so much. This is what it’s all about.

So, there are people applying, as usual. The point that becomes clear comes from what one businessman recently said to me in a lunch meeting. He said that my staff is just the wrong size;(it is too small to be big and too big to be small); when there is more depth (as in, more staff who do the same thing) I won’t be caught in quite the same conundrum when one staff member leaves. That is where the pain is right now. Being down a critical player in the staff really hurts. It effects business, negatively, in many ways.

One of the reasons I am growing UHI is as a strategy to keep staff by giving them a place to grow and expand into. There is that added perk of (more easily) being able to let go of bad staff because I’d know I have back-ups.

July 2008

2008-08-12T20:10:00.001-04:00

May, June, and July were busy months with lots of patients. With me around – on site every day participating – the business soared. It is exciting and depressing: I love the result, but it makes me feel handcuffed. The truth is that not many people put as much into it as I do. Am I hiring the wrong people or is that just the way it is? I have some employees over the years who do put their “all” into their work, but it is not that common. I figured it in when I wrote the business plan. That is, I figured average work by an average clinician in an average environment. Somewhere I remember reading that the best business is one where work can get done with employees who are an average IQ and can do the average amount and quality of work. How upsetting. That doesn’t belong in health care, either. So, I remind myself, this is the business of health care, and I have to make the two – business and health care – work together. I carefully hire. I won’t take someone who is average in terms of his or her clinical capacity. I work to make sure there is competence in handling a group of patients in a busy setting. I won't hire someone who is average in terms of his or her interest in people. So, I expect more than average. Is that crazy? On every hire I learn something new, and the process keeps getting better. In fact, however, it is a slow process. HR Director is one of my Hats, and that means another job that is done with limited resources. I’m sure I could do better.

Over all, the background theme of July was the realization that owning and operating a business means having an enormous amount of risk tolerance; not just financial risk tolerance, though that is perfectly true. I have to be willing to risk time; that is profound when I stop to think about it. Time. All these years for this. There is also the intangible risk of confidence. Owning a business builds it up then destroys it. There is so much to tolerate in terms of mental drain, too, emotionally and intellectually. Sometimes I think if I have to figure out one more thing or solve one more problem I’ll pop. In the end, I think risk tolerance is proportionate to purpose. If I didn’t think this was a very important endeavor that affected more than me I couldn’t do it. Health care in America is awful. The longer I am in practice the more I am aware of the limitations of the medical model, starting from the education (training limited, by design, to sell drugs and do procedures or surgery) of the professionals, and ending in the education of the public – by the pharmaceutical industry and the doctors who are captured in the system. There should be a UHI on every corner.

May and June, 2008

2008-08-12T20:09:00.001-04:00

Well, I worked day and night from May 1st through the end of June while the other doctor was out getting married and honeymooning. I think if I had to do it over again, I would have told her, simply, to leave. At the time, it seemed like I had to keep her to keep the boat afloat, but I was wrong. I’m not sure she is the right fit after all. It took her absence for me to understand her priorities, and UHI might not be high enough on the list. She loves to do what she does, but it strikes me that it is more like a favorite hobby. I'm still not sure. So, for now she will stay, and have a place here, but it will be different from what I originally thought. I want to hire leaders, self-starters who see themselves at UHI; who want to be part of the path of serving the community and opening the eyes of the public to the benefits of this kind of health care. There has to be a passion and commitment to something bigger than their own agenda. I don’t want someone selfless, but I do want someone dedicated. UHI's mission has to be part of their higher purpose.

In the meantime, I interviewed several people to either replace her or help me. A couple of good candidates, but I haven’t finished the process yet. One candidate was angry that I didn’t offer him a job after a short interview process. He had no idea what it would take to really work in this environment, so his expectations were out-of-line. Every hire is so important. In this small company it could make or break the flow. So, my interview process gets more refined, still. I am looking for Great, and sometimes, when I am certain it’s worth waiting for and I follow my mind and heart, I hit it! I enjoy working with people I respect and admire. It's a thrill to work with someone who really sees the vision. I know they will be keys for growth and expansion.

Financially, wow, this has been a struggle. How do people grow their businesses without going broke? There are so many mistakes along the way – time and money mistakes – and they are so incredibly expensive. I can’t even believe my risk tolerance, in fact. Despite our growth, it is hard to make ends meet. It seems to be what I think about, ask about, read about, and hope to understand….but I don’t get it yet. I just keep taking steps (and risks), crossing my fingers and continuing to learn. It doesn’t help that health care payments are at a trickle, but that’s another subject. I firmly believe that a great service can exist with or without the insurance industry. Being caught in the middle of it is really tough right now, though. There has actually been a freeze on medicare and state insurance payments, meaning "no payments". Thank God we don't rely on medicare. On the other hand, we have a large chunk of payments that aren't coming in. That hurts.

So, the review of the last two months? Love doing the clinical work; it makes me feel alive. That is really where I belong – that and teaching. My executive work piles up and up and up, though. I need, at least a part-time secretary, but don’t want to add on the expense. I love training and going out doing the new business development, too. Doing the things I love makes me feel powerful and special. But when I stick to that, I think I am not developing my weaker areas of being in business. It doesn't matter that I don't have the answer yet. Right now I have to work like a maniac to grow this business, and everything else has to be put on hold.

February and March, 2008

2008-04-07T16:00:00.001-04:00

When I reviewed last year, I found out that we grew our revenues by 19%. I don’t know how that happened, because it felt like it was such a struggle for the better part of the year. There was growth in some departments and not in others. I have to figure out what to do about that. [One thing I found out that I had to do was change a salary – as in reduce a salary - to be appropriate to the amount of money that we could earn in that department. (I don’t know how that slipped past me last year. I thought I was looking at everything so carefully. How could I have missed such a glaring mistake?) Needless to say, reducing a salary is an unpleasant and risky task, considering the employee is very good, and the work is very good. (It was just a bad set-up with me to blame.)]

Adding to the challenge of staff management, I fired the new business development employee at the beginning of March, and it was a bona fide drama at UHI. She acted out, in front of other staff and patients. To top it off, she has filed for unemployment, despite the fact that she had many chances to up her game. I don’t want my unemployment insurance to go up, so I’m in the ring. The challenge of it doesn’t bother me at all, but the time it takes to handle does. The good news is that I hired two part time people in her place, and they are off to respectable starts. They seem to be more organized and professional, and equally enthusiastic as she was. It is a second round of “hire” in a department I’ve never had, and I know my sense of who to bring in is much more refined.

Working full-time while the other doc took off three weeks (sick, then vacation) reminded me of how much I love the doctoring work. I had no time to pay attention to management, so I just let it go. Besides the helpless feeling of work piling up in the background, I was so happy just to see patients and work with the staff as a clinician only. It seems so much easier than the administrative and executive work! I remember back – now 18ish years ago – to how exhausted and overwhelmed I used to be seeing patients (very few of them, too). Now it seems like riding a bike – so familiar and almost freeing. I hope that I get that same comfort level being an executive. Despite the fact that I have owned this business and worked as the administrator and executive for all of these years, I don’t think that I really mindfully worked at it until after I won the M3 award in 2005. So, I figure something is going to click any minute. So far, it is getting more familiar and less overwhelming; however, no less cumbersome.

At the end of February, the investor deal fell apart. I did get all of my legal ducks in a row as I was instructed, yet it tanked. I found out that the woman who was helping me (representing me, as she would put it), was lying, and that was the end of it. I regret that I put all of my eggs in that basket for nearly three months. I must have had a sign on my head that read S-u-c-k-e-r. A deal isn’t a deal until it’s a deal. My mistake. Do over.

This week I go to work on understanding this first quarter’s statistics. They are not strong. I am going to put some definition to what went “wrong” this year so far. Distractions. Bad prioritizing. Poor leadership. I have my work cut out for me.

January 2008

2008-03-03T12:24:00.003-05:00

We are off to a slow start this January. It’s always difficult in health care at the beginning of the year, since deductibles start over again, and patient’s must pay for so much of their health care in cash. This January has been particularly tough because of the frigid weather in Chicago. It’s been very cold and very messy.

The most challenging part of the month is that the new Lead Doctor has asked for a Leave of Absence from the end of February through most of June – basically four months worth of time off. She wants the time off to prepare her wedding, get married, and go on a honeymoon. (I planned my wedding – 160 people - by myself and executed it while I was working up – right up to the day of the Rehearsal Dinner.) I can’t even begin to describe the level of shock I felt, and frustration I feel dealing with this. It’s simply inconceivable to me that someone would ask for something so outrageous, tradition or not.

I have been interviewing other candidates, in fact. (That is part of my regular job duties now.) However, I haven’t found anyone who is a good fit. How do I honor my staff’s values when they cause so much business turmoil? She is a very fine doctor, but not been easy to please since she has been at UHI. I want to focus on what the staff can do for patients, rather than how I feel about them as employees. Yet, in general, the employees want so much of something-or-other that it hardly feels like I can get any business done. I search for information on “The Servant-Leader”, and find all kinds of idealistic nonsense that I can’t apply. What is the answer to this conundrum? In this case: Give her a part-time schedule and lots of time off, slow down our growth, go back to working as the full-time doctor…. She’s happy that her values were acknowledged, but I am left with four months of lowered function. The point is, if I fired her, I’d be in the same spot – maybe worse if I couldn’t find anyone to fill the position. At least with her returning in June I have someone who should be a “fixture” thereafter. (Who knows what request she’ll have next?) Anyway, I decided that the only option for me right now is to have her work part-time, and give her a Leave for May and part of June. It’s the best decision for a rotten situation. I’ll keep interviewing, and be ready for a new problem.

We did not yet get the money from the investor. That’s frustrating, too. I have been working with my attorney to get my ducks in-a-row. I found out that UHI couldn’t even have an investor who is not a licensed physician, so I had to open another company to accept the investment – to manage UHI. The investor assures me that I will get the funds by mid-February, after the paperwork is done. I think we are on track for that part of it. In the meantime, I have had to push back my plans.

November and December 2007

2008-03-03T12:23:00.000-05:00

The two months ran together. I am starting to think I am Scrooge. As far as business, I can’t stand the holidays. There is too much distraction. It’s an unhealthy time of year for the body, mind, and business. Everyone is off-schedule and off-focus. Management takes on a whole different feel at this time of year. I feel like I am trying to herd wild animals through a small gate.

We had a good finish to the year, with revenues up almost 20% from last year – yet we were not full in our schedule. It just shows how much growth we have available. The staff worked well through the holiday period, if distracted. They have to work so much harder with patients, communicating the necessity of care. This is the first time in my career that I spend lots of time pondering the meaning of health care from the patient’s point of view. When the patient is not in lots of pain, the whole shebang becomes elective – just another activity. We have to have a way to communicate the importance of this type of health care in their values; in short, to make them want to make it part of their life’s activity. I don’t know how to do that, other than talk one-on-one with them. I think we will have to work more in 2008 on what message we give the patient, to help them value themselves enough to invest in themselves. We do great work on helping people get out of crises, but that is just the tip of the iceburg. I wonder if, in a country where no one saves money, it is likely that people will invest in their health. It seems like we are up against some short-sighted philosophies.

The new business development is not really under way yet. We have had some small activities that have been productive, but they are spotty. Our new employee – now here for three months – is not handling the department the way I expected. It is the first time I have had someone in that position, and I am quickly learning what it takes to make it successful. For this employee, I find that I have to supervise too much, and that other staff members have to get involved to a degree that is distracting. It is a small company, so I understand the need for cooperation, but in this case, I wonder if she is qualified for the position. The jury is out, but it doesn’t look good.

The good news is that, in the middle of December, we got a commitment for an investor for 100K (in exchange for 2.5% of UHI). We are supposed to get the money by mid-January. I feel good about it, even though it isn’t enough money for exactly what I’d love to do in 2008. (I will continue to look, but in the meantime, I will work at getting a business loan or higher line of credit. I may have to change banks, and that is a bit daunting.) The investor says that after 6 months when our new business development has kicked in, there is more where that money came from – another 100K, and maybe 200K. For now, I am focused on this first installment. When I look at the business plan, I can’t believe how little the 100K covers! I’ve been reworking the plan to choose the best actions for new business development.

October 2007

2007-11-30T11:04:00.002-05:00

I did complete about 8 of the Nutrient Packs, and train on three of them. The staff likes the information very much. We haven’t ordered them to start selling them since we have been running on the edge of cash. We order two of them next week. We have to order in bulk, and it costs a bit. Finally we will have product on the shelf that I can stand behind and sell with the UHI name on it. I am so glad about that.

The New Business Development employee has got ants in her pants. She is ready to go. So far she has scheduled several events; some of which went well and others not well. Now we have something to talk about, in fact. I finally have an idea about how this works. Despite the fact that it is really stretching the payroll beyond what it should be, I know it will work to our benefit. It is great to be reaching out into the community to grow awareness about UHI. I know we’ll grow from it. [I believe in it enough to give up my paycheck. I haven’t taken one in about 5 payrolls. Dipped into what little I had left in my savings. I don’t like that, but what else is there right now?]

This is an unbelievable amount of work. It even seems to grow from when I thought it was unbelievable before. I’m interested to see what comes next, and ready for the payoff to start.

No news on financing or investors yet. The plan has been presented a few times, been good enough to get to the “next level”, but that’s it. Lots of Waiting.

Still working on the credit score. Capital One will not cooperate; making the fraud thing impossible, even with the police report in hand. This is now over 18 months of “handling”. Even the credit repair guy is going ballistic.

Thank God for the team. They are a great bunch, and I love working with them. It makes it easier to handle the pressure and enjoy the process.

September 2007

2007-11-30T11:04:00.001-05:00

Back to school this month, so the schedule now includes at least two hours of driving on most days. The shrinking hours in the day force me to prioritize.

I took time off this month to go to teach a couple of classes and to go to the M3 conference in Washington. It was refreshing, but hard to keep in touch with my regular duties, including watching the stats and numbers. I think I have to have one day per week to do it no matter where I am in the world, and it has to be in the proper form. I made the format for the three key indicators to be reported to me, but I didn’t holler when I didn’t get it (daily). I thought I’d get to it the next day (then I didn’t and I didn’t and I didn’t). Hence, I am disconnected from the details of UHI. (No one on the staff complained that I was gone. They were, in fact, supportive. I appreciated it, but then had second thoughts, like: “When the cat’s away, the mice will play.” I hope that when I check the numbers and stats that I will not be disappointed.)

Coming up on the new Lead Doc’s six month anniversary. Now we will finally have something to talk about.

August 2007

2007-11-30T11:03:00.002-05:00

What to do with August. I look through the stats, and it has always been a slow month – slower than the others. I wonder if I should just give everyone a mandatory vacation and make the loss of business constructive in an HR way. I think I am not being creative enough. In a city this size, there seems no excuse not to be completely and always as busy.

Some staff are not taking their vacations. At the end of the year I do not want any bad blood because of time that has to be wiped out. I simply can’t carry it over to the next year. I can’t lose that large a percentage of the business adding time off to time off. And, I can’t pay for time off that’s not used. It is another HR problem that is causing aggrivation.

Business is not growing right now. A steady state of blah-blah-blah that makes me nervous and annoyed. The only saving grace is that the business plan is done (i.e I have reclaimed some time for other things) and ready to present, and the work on the new nutrient packs is progressing. It is huge project to make a great pack that fits the needs of many people and that is priced well. I want to have it done by October 1st – at least the basic four or five packs. I want to start training the staff on it by then.

July 2007

2007-11-30T11:03:00.001-05:00

Working on the business plan all the time. Getting ready for investors. One of our patients is a private equity placement specialist who tells me that there are people out there who will love my plan and want to give me money. Okay. The business plan is being revamped. The detail level is extraordinary. Thank God for my accountant and her financial forecasting and planning ability. One of my business advisors told me that she is a great CFO. Almost in her words, “You dream it, and her job is to tell you why you cannot do it the way you want. That’s a great CFO.” She said more than that, too. She said that a good CFO believes in the plan and vision but puts it into reality

May and June, 2007

2007-11-30T11:02:00.002-05:00

The business feels good in terms of the team. The team building started. I signed up for a year. Now I am waiting for the numbers of new patients to grow. While I am working on the business plan I see what’s possible. We have only to plug in the new patients. Historically, our retention is fantastic. We don’t need as many new patients as my colleagues. My goal is to keep great health care going and the teamwork to help and teach the patients; then we’ll be more-than-great with an increase in new patients. I can’t find the New Business Development person yet. I don’t know what I am doing wrong. I’ve been studying, changing the ad, asking for help, and not getting any good candidates. It’s very frustrating. No good candidates. None.

Lots of work. There is no downtime. I have been getting up at 4:30 several days per week just to get the basics done. I finally realize I need my own secretary, and have put an ad in the paper. It’s a little unnerving to think that the secretary has to be in my home office, but that’s where my stuff is. This business has so much Creep.

March and April, 2007

2007-11-30T11:02:00.001-05:00

The new doctor started and it is going well so far. I have barely had time to breathe with the schedule so full. I am still staying on full time as a doctor until she is more settled. Then I am going to reduce my schedule a bit. I decided that I will stay in the office more than I originally thought. I like it. It gives me energy and helps me keep an eye on things during this iffy-process of staff rebuilding.

It’s been a year since – last March - I found out about more theft related activities by our former Account Supervisor. She was spending on my credit cards. I am still trying to deal with the fraud departments on one of the cards; had success with Chase, but not Capitol One. In April I decided to hire a “Credit Repair Guy” to handle the case. It’s expensive to pass it off (around 2K), but I can’t even get a human being on the phone, and it is ruining my credit. In the meantime, Braden and I decided to remortgage our place to consolidate our bills, including UHI’s bills. Thank God he is so supportive of the UHI plan. He believes in it, too.

I look at the last year as one of rebuilding structure: Getting rid of old and unnecessary policies, people and practices then emphasizing what does work. Slow and painful process that makes the pressure seem worth it. The business feels more clean and promising.

February 2007

2007-11-30T11:01:00.000-05:00

This month was the first month without the other doctor on staff, and it was freeing to have it over, even if it was lots of extra work. I keep wondering why I didn’t take action sooner and what action I could have taken. One of the original consultants I spoke to in M3 told me that the problem of abdication is pervasive in management. That is, it is common for an executive to give a job to someone and then not check it carefully – make milestones, benchmarks, specific tasks in space and time; then have a reward or punishment when appropriate. I gave him the job of Lead Doctor and then let it go. I knew he wasn’t doing it well or right, but all I did was discuss it with him. I didn’t reset a goal or make a new milestone. (I did revisit benchmarks, but didn’t put any oomph behind it with requirements.) When we met it seemed like we were having a friendly discussion rather than one about Business. What was I thinking?

Now I am the Lead Doctor. It’s a role I know well and do without any problem. In fact, it’s easy. In any case, it’s simple. Owning a business is anything but simple, and though I revel in the activity, sometimes it’s exhausting. I am not naturally savvy as a businesswoman. In some ways it makes me think that I should just go back to a small private practice set-up. So often I wonder if I am just too big for my britches thinking that I can grow this company as a businesswoman. On the other hand, one conversation with someone about the poor quality of human health management reminds me of why this company is so necessary and why I love doing it. I am sure that I hate management of daily or incidental things. I love leadership activities like teaching, passing along the vision, reviewing numbers and planning ahead. If I can get the right manager I think I will be in heaven.

In the meantime, the new doctor starts in a few weeks. I am gearing up for that!

January 2007

2007-11-01T10:27:00.001-04:00

How is it possible that the whole year of 2006 could have gone by without touching all of the New Patient Activities that we had planned? The fact is that it did. While I was busy recovering from the theft, patching up and retraining (and training and retraining) the staff, prioritizing cash flow...I somehow let my New Patient Plans slide away. Suddenly now, in the middle of January, I am looking at my plans for this year and see that we are off to the same kind of start with our new business initiatives. I realize that I simply can’t handle it alone, but am confused about who to set to the task. I am going to reach out to figure that one out….

Being the full-time doc right now is lots of fun and very freeing. I love working with the staff and patients. The down side is that I am left with the evening (and late evening) to catch up on all of the administrative things. My administrative assistant is helping me quite a bit, but there are just things that I have to do that are waiting a bit too long. The result is an agitation that I can’t shake. I look forward to having the new doc in place, pulling my hours with patients back a bit, and finding time to do the work that waits. The fact that my feet feel like sandpaper, my hair hasn’t been cut by a pro in a couple of months, my orthodontist hasn’t seen me in 12 weeks, and my body parts are falling closer to the center of the earth (without appropriate counterforces called exercise) are just incidental. I wonder if the patients – or anyone – notices my General State (not too polished). With the little teeny-weeny bit of free time that I have (calculated right now at 9 hours in the week from Monday through Saturday), I simply want to see my girls and my husband, not get a pedicure or a haircut.

Onward

November and December 2006

2007-11-01T10:26:00.003-04:00

Well, the poor performer (the key player) resigned in mid-November. It took a lot of handling to get the transition organized, but it has been handled, and it should be smooth. In the meantime, the challenge is to make sure that the remaining work gets done without skidding. I totally and completely understand why companies just escort people out the door when they resign. It is so much cleaner. Easier. This last month has been a challenge almost too much to handle. We are working together to make it smooth for the patients’ sake. However, it is not easy. His mind is elsewhere. Adding that onto an already unmotivated character has a result that is no surprise. I wonder why I let it all go on so long.

In the meantime, I feel a renewed vigor for business. I am really glad about this transition, and it has given me lots of new ideas and some more guts to make other changes. Why not? The people I have been interviewing are very impressive, and I sense that I am much clearer on what type of person is right for the position. I will select better this time!

Cash flow is still a challenge, despite the fact that we had a shockingly good year in production. After a loss last year with the theft and the complications (and collateral damage), we bounced back – even with crappy production (an unmotivated head doctor) and much staff turnover at UHI, and personally, with a new baby this year and the nanny disaster for four months. – to hit the million dollar mark. In fact, we passed it by about 100,000 dollars, but the numbers aren’t all in. I am so shocked, grateful and relieved that we pulled it off. I still can’t figure how we were able to do it, but I have to think that staff turnover had a way of getting me back to the basics, communicating really closely with the new staff (particularly about the priorities) and what I would like to happen…and, most importantly, asking lots of questions to the staff on a more regular basis. The bad thing about the year – looking at it right now (that I could have done better) – was that I didn’t do quarterly reviews, or, even, official reviews where we talked about what went right and what didn’t, and then agreed upon goals and objectives. I had lots of meetings, but not lots of careful contact points with the staff. I will make up for that in 2007 with a different tact. I want to hold onto the stars on this staff.

October 2006

2007-11-01T10:26:00.001-04:00

Two of the women that I hired are very focused and professional. The last couple of months I have had great support to clean up any leftover mess, plus work on what really needs to be done. It is really a pleasure to have the support, particularly because there is such little task or emotional management for either of those employees. They do what they say they will do, they are able to figure out what to do or how to do it (at least they try before asking me!), and they are in good humor. This is what I have been looking for. In stark contrast, I hired someone who is no good. I am pleased to say that I recognized it early (wow!) and am moving on very fast. I have heard the motto “Hire Slow. Fire Fast.” Now I can own it. There is nothing so expensive and draining as a bad employee, especially in a small business. There is no one to cover up the problems that a bad employee creates. We each have to really do our job well – and reliably well.

The better the staff gets, the more the sore thumbs stick out. There are two employees who are poor. One is in a key position, and that (change) is almost too much to face. It seems there is hardly any time for doing business! There is so much time spent working on the business.

July, August, Spetember 2006

2007-11-01T10:25:00.003-04:00

Time has flown by. I have hired new people in to a few positions; I think I have some winners. I continue to interview on a regular basis for all posts, for the positions that I think are the shakiest, or the ones that seem the most unstable. I am insisting on good work from the beginning, but haven’t figured out a way to systematize that. I probably need an HR Person, but I sense that is a way off. Sometimes it seems too much to get on my plate. How am I going to cultivate staff teamwork, sportsmanship, individual productivity and company pride when I am already stretched? The words that come to mind are “prioritize” and “delegate”.

Incidentally, when time flies (the way it has these few months) I wonder if I have been doing the proper priorities or not. I can hardly remember what has happened, and that makes me nervous.

The biggest Ah-Ha has been to find that the payroll has been reduced substantially from the last years even though the production has (astoundingly) gone up. Sadly, sales do not equal collections: Health care reimbursements are at 45 cents on a dollar. So, we will have to find ways to increase our sales substantially to get back to healthy earnings

June 2006

2007-11-01T10:25:00.001-04:00

It is six months since I found out about the theft that my account manager was carrying out. There has been no update from the Chicago Financial Crimes Detective. He hasn’t returned my calls. It is probably too small a crime to handle as top priority. I keep calling. In the meantime, I have still not been reimbursed by my insurance company. They are dragging their feet (The Hartford). The red tape is exhaustive. The insurance was called Employee Dishonesty Insurance, and it was not enough (25K) to cover the damage of the theft, but I would, at least, like to have that money.

Since I had to fire my accountant (the one who had not been reconciling the accounts for six months or-the-theft-would-have-been-discovered-earlier one), I was prowling for a new accountant. I ended up hiring a dear and professional friend of mine, Kirsten Dixner Young. She is a professional of the First Order. I think that all of this nonsense has been worth it just to hire her. She is cleaning things up, and promises to whip me into place with a new and improved bookkeeping and accounting system. I am pretty excited to have her on my team.

The vendors were really quite accommodating and helpful during the cashflow problems. As long as I communicated to them I was able to reduce the amounts of my payments (but not miss one) until I could meet a new goal. I had dreaded the vendors response to my plight. It was my error. I think they have all been through some difficult times or had other businesses go through difficult times. As long as I continued to communicate and pay something I was staying on good terms. It is, in fact, what we expect from people who owe us money here at UHI; we treat them the same way. It just feels good to have someone take responsibility, commit to pay, and stick to it. At the very least, the accounting is easier and there isn’t a need to refer to collections.

The “Clean Up The Company” Theme continues!

April and May 2006

2007-11-01T10:24:00.003-04:00

Wow. So now I know what happens when my lead doc gets married and goes on a honeymoon. I couldn’t have predicted the distraction level; most importantly, how it would effect his production. The rest of the staff is irritated. They count on him to lead the way to higher patient numbers and referrals. If he goes down, they all go down. I have had a very hard time understanding what tact I could have taken to make the outcome different. He has been complacent. In fact, the priority for him has been his wedding, simply not work or patients. I simply don’t know how to discipline for such an outrage. It is, once again, the challenge of the small company. I don’t have a doctor waiting-in-the-wings salivating over his position. That would provide a constant awareness not to take the position for granted. In any case, I have learned during the last couple of years that my job responsibility is to staff – constantly. Instead of thinking that I will get staff that last forever and ever (my fantasy), I have to plan on the staff leaving as soon as he or she starts. I remember hearing that Jack Welch of General Electric recommended to cut out the bottom 10% producers in the company (even if they were excellent producers); that kept the company fresh and clean, and created space for growth and competition. I thought it was an awful idea back then. Now I think it is not so bad

April 2006

2007-11-01T10:24:00.001-04:00

Wow. We got our production numbers for the first three months of the year, and they are good. Really good. We have been growing in a couple of departments over the last eight months, but it only really shows throughout the whole group now that we have a more complete staff. With one critical staff member down it was very hard to get the whole business looking productive. It is a relief to have the physical therapy department back; both from the business standpoint and from the clinical standpoint. It’s taken a while for the referrals to pick back up – for patients to take us seriously again.

We are finally starting to take in the cash from the last few months, too. It is always hard to plan for the first two or three months of the year when people have to pay their deductibles for insurance. The cash that comes into the business is less, particularly in February and the beginning of March. Even though the same amount of people have problems, our visit count is less! It is part of the business cycle that is difficult no matter what we seem to do. Thankfully, we are at the end of that part of the year. Now I have to figure out how to dance through it better next year.

New Patient activities are increasing. Our speaking engagements are growing, and we are initiating in house activities that are very satisfying. The staff turmoil is not over, and we are still having turnaround (seeking the right people for the right positions) despite some recent hires. So, that makes the new patient activities a little less exciting. (I am acutely aware that once the new patients are in the door something can go wrong to turn off a new patient. It happened last week!)

February 2006

2006-03-30T11:38:00.000-05:00

Staff changes and theft aside, we are back to work in force. Staffing is an ongoing challenge, and I think it will take three more months of training to get it really comfortable again. I am still short two positions and continue to interview. Unfortunately, one of the new hires is not capable of handling her job. It is over her head, I think. So, I am preparing to let her go. She has a chance to bring up her game, and I hope she does it. However, I have doubts. It's a tough thing to let go of someone for alot of reasons. The greatest reason for me to resist it is that I am so tired of it after this last year! Hiring the right person is one of the most difficult things to do.

It is amazing what kind of havoc (i.e. business trauma) comes with staff changes. The staff turnover has been something that I have never experienced in 16 years of business and I still can’t make sense of it. Some good things have transpired as a result. There are better training methods in place, and it certainly has trained me to focus on the actions that are most critical to effect to have business continue. I did count the changes and there were 16 staff turnovers in 18 months. Nothing like this has happened in 16 years of business.

There are still challenges associated with cashflow even though the thief was identified. The amount of money stolen and lost, as well as other complications, have been growing since January. It is tedious and demanding to handle it. It takes a lot away from the priorities of growing a business. On the other hand, there are better cash controls in place and I have learned some really valuable lessons.

Interestingly, just when I am getting back to spending some time on new business activities people seem to be coming out of the woodwork to help with marketing and advertising ideas and campaigns. This support comes out of the patient base. Patients have just started to volunteer their time and ideas. They tell me that they are excited about their experiences and want to share them with others. It is serendipitous that many of the patients are also advertising or sales execs. I have had three meetings this month with different people and will continue in March with two more.

In the meantime, I have arranged to speak at some new mother and women’s groups to present the Program for Solving Incontinence. That, along with the new lecture I am selling, “After Pregnancy: When Women Are Forgotten” should be good for enlightening our community about this particular service. This will take place in March and April. One of our doctors just wrote a new lecture that he presented last week. He did a great job. I am going to teach him two more of my lectures and get him scheduled, too. Public education goes a long way towards increasing new patient activity. Since we are in a large city it is almost impossible to get into advertising for a digestible price, so we are sticking with marketing and public relations for now.

With the advise, support and interest of my coach and some advisors it has been a period of growth – most of all ‘reality checks’. It is amazing to see what a second pair of eyes see. Ginny’s questions are really helpful and have helped me to prioritize. With all of the many, many tugs in different directions it really is critical to get to the issues that matter most rather than try randomly to put out fires.

January 2006

2006-03-30T11:36:00.000-05:00

It is almost the end of January, 2006. I have a three week old. Labor and delivery were short, fast, furious, and welcomed. Our new daughter, Sophia, was born like our first, without any drugs or special effects. Besides being quite painful at times, it is very weird and intense to push a baby out of the body. Birth is the metaphor I am going with for getting this business to where it is going. A lot of pushing, breathing, a mess, blood, guts, some screaming and a lot of groaning; hopefully followed by a happy floating sensation!

I watched the movie The Bear last night. It has Alec Baldwin and Anthony Hopkins as two men who have crashed a plane in the Alaskan wilderness and are trying to survive. At one point, they decide they have to kill the bear that has been stalking them. The two of them make a plan to impale the bear on a wooden spear by getting the bear to fall on the spear with all of his own weight. Alec’s character doubts that it can be done. However, Anthony’s character says, simply, “If one man did it another man can do it!” (He is referring to how the Indians used to kill bears.) A scene or two later when Alec cries that he cannot do it, Anthony makes him shout “Today I am going to kill the bear! Today I am going to kill the bear! Today I am going to kill the bear!” I have decided that I am going to watch that movie again soon.

To continue the “Year of Employee Bummers”: I add that my Senior Account Supervisor has been fired (and is being arrested) for theft. She has stolen around 20,000 dollars from my company that I know about, and the data is not all in. Solves some of the question I have had about cashflow, so that’s a plus. I do have Employee Dishonesty Insurance (didn’t know it existed until this), so there is some coverage for the loss.
Theft is administratively heavy; freezing accounts and deciding whether to close and reopen new accounts…. It is amazing how much paperwork a crime like this requires (paperwork for the banker, the fraud department at the bank, the police detective, the insurance agency…not to mention the staff.) Lastly, it appears that my bookkeeper did not do her work properly because the theft began in August. She did balance the books, but only by numbers. She didn’t reconcile the actual checks.

Our cash controls, having been challenged this way, have just gotten tighter.

In this difficult P.T. market I was able to find a great one. He came through an ad that I wrote, so I didn’t end up having to pay a finders fee to a recruiting agency. I feel like this was pulling a rabbit out of a hat. Thank you Universe! Service and revenues can return to what they should be.

It is a weakness in the business model to have only one clinician per department. There isn’t the depth necessary for departures or even sick days. However, I am not sure how to remedy that.

Instead of thinking that I am living in Groundhog’s Day for the past months I have decided to believe that I am in an intensive one-on-one tutorial for becoming business savvy. I have asked many business executives and founders and have been told that this just goes with the territory. The theory is that it is part of growth. I guess that means that I am in good company.

The internal challenges definitely effect the business production. There is a lot of introverted action and no extroverted action during times like this; that effects new business. Now that things are settling down internally I can get back to the new business efforts. I am looking forward to it.

December 2005

2006-01-26T22:50:00.000-05:00

I am searching for a replacement for my Clinic Coordinator who suddenly quit in November. And, yes, the P.T., is quitting. So, I am searching for a replacement for her. I think that puts me at 8 or 9 turnovers this year. The P.T. has me between the rock and the hard-as-hell spot. She won’t stay at UHI long enough for me to have this baby and interview unless she sees some cold, hard cash. It is going to cost me to keep her until the end of January. A “bonus” in this case feels like blackmail, but I am very grateful that she is willing to do it even if it is for a price. I am due any minute! I can’t bob and weave like normal, and that means that I simply cannot successfully interview, solve the billing issues, conduct meetings, figure out the cashflow, meet with the staff, oversee and correct the many problems that are in any given day, see patients, prepare for a baby, go to the OB appointments...not to mention drive my three-year old to school…groom...sleep.

The P.T. agencies are charging anywhere from 5,500 to 25,000 dollars to find a P.T., without any guarantee past one month, and they cannot promise a “find” in a certain amount of time. So, I am registered on all kinds of sites as well as with recruiting agencies. Ginny, my coach, who is an executive in a headhunting firm, says that the deals the P.T. agencies are offering are terrible, sleezy, unprofessional; she can’t believe it. I am only hoping that someone responds to my independent ads. So far, I have had two resumes come through for new grads and one for an experienced P.T. I pray that one of them is a gem. I fear with such a limited time and with the baby due that I will have to “settle” for just a regular P.T. That is hard to swallow. I want to offer great clinicians, not average clinicians.

I forgot to say in November that I have continued public speaking. At my size I must be an imposing sight. I spoke to a group the other night and spent half of the time burping (…due to the limited diaphragmatic space it is impossible not to). My introduction was “Hello, my name is Dr. Amelia Case. I am so glad that you have all come here tonight on such a snowy evening. I’ll make it worth your while, I promise. I have to excuse myself in advance for the burping and the shortness of breath. I have a baby due any moment and it seems to be pushing on everything as a threat to its’ forthcoming arrival.” In addition, my pants were falling below my belly and my sweater was sneaking up above my belly. I might as well have belly-danced my talk. Not to worry: there were three new patient calls within the next two days. Ginny and I think that I should be doing much more public speaking. I would love to do it, but it is so difficult to do it with everything else. I think I must get the cashflow issue straightened out first…. I still can’t figure out what is wrong in that department. My lack of artistry and skill in finances (accounting) is really obvious. I think the fact that I am an amateur at the computer complicates it, too.

I have, incidently, finalized some really important spreadsheets that help me analyze the collection issues…from prediction to write-offs to agreed-upon discounts. It has taken me about 26 hours of work to get this far, and even the staff thinks it is quite a coup. So, I do have something to celebrate inasmuch as my computer skills are growing. Work becomes so much easier when I think I know what to expect and have concrete real goals.

Another woman, Margery, who is a friend of mine is coaching me on one point, and that is that I should be “feeling” more when I am being the boss. Several people have brought this up to me, but it is hard to apply. I want to go cold when I am the boss; feeling seems like such a risk. Anyway, I am taking the advice to heart! I have decided to laugh more, raise my voice more, and tell the staff if I am worried or upset. It is my impression that such behavior is in conflict with leadership, but I have been assured that is not the case. Seeing as how I am not where I want to be I have decided to listen to someone more successful and just do it. It will not be easy.

November 2005

2006-01-26T22:40:00.000-05:00

This month so far is “employee bummer month”. First, my Clinic Coordinator (who has been with me for the last few years) suddenly quit. Not only that, she gave me less than two weeks notice even though she had a contract. She did tell me quite casually at the end of one day, as if it were a ‘sidebar’. She has been a student during her tenure at UHI, so I knew her priority was school. Well, she got a great position at her school (that she could not pass up); I believed that she must take it. However, I did also believe that she should have given me notice. In her position two weeks would have been skimpy, nevermind nine days. The truth is that I felt completely crushed, ambushed, shocked… I have supported her school and her ambition since she has been an employee. I thought that I would get some consideration in equal and fair exchange when it came time for her to leave. It is just another event that makes me want to crawl into a hole and forget that I ever had employees. Frankly, it hurt to have good employee suddenly disregard me and this company. We have given so much to her.

To add to “employee bummer month”, my physical therapist seems to be quitting. She is not certain about it yet. There is a serious P.T. crisis (limit of P.T.s) in the U.S.A. The first time around this year – despite great diligence – it took me four months to find a full time P.T. I can only fear what search is to come if she is really resigning (and I think she is). UHI is not a good fit for her; I believe her.

I guess that is the way of the business owner: The employees hurt you in a way that no one else can – and help you in a way that no one else can. There should be a class for employers that prepares you for the heartache and headache of employees. All I can say is that I better get a tougher skin! Anyway, that put a certain wet blanket over the month. I have already had a turnover this year of 8 employees; nothing like that in nearly 16 years. I don’t know what is going on! I am going to contact an astrologer. I need an explanation!

I have been really excited about the growing numbers at UHI. Our services, despite a ridiculously challenging year, have grown 20% since July. I still don’t know how. That is great. The only thing I still wonder is “Where is the money?” Our collections seem to be poor given what we are creating in services. I am still spending a lot of time trying to figure that out, but as the pregnancy goes forth I do feel a bit limited in energy. I am short of breath, heavy, anemic, tired – ordinary late pregnancy stuff. It is hard to stay very focused when I have to pee every five minutes and I am breathing like the Hulk. Anyway, I keep working on the billing department because of the cashflow challenge. It is not adding up. I guarantee I will figure it out...that or die trying.

As we go into the holidays I am overcome by gratitude for the patients over the years who have come to us and put their trust in us. I don’t know how to honor them the way that I feel I should. Right now I just feel reverent. In a moment of humor I realize that when the employees get me down I turn to the patients for consolation. When the patients get me down (and they do!!) I turn to the staff. If I think about it more I realize that I am really grateful for all of the employees, too. However, right now, as my holiday gift to myself, I am going to focus on the “easy happy stories” of both.

October 2005

2006-01-05T13:26:00.000-05:00

October was a month of collecting the final data to understand the collections issues that we have been challenged by. I accomplished collecting it all and analyzing most of it. I spent a lot of time with the billing staff doing time studies and talking to them about their jobs. We did fix some of the problems and streamline. There were some obvious problems that were easy to fix; others that we are still trying to solve. The attitude is better now than it was in the beginning. They did not like doing time studies!

The other highlight in October was that our lead doctor was upset about the salary cuts this year and finally expressed his anger. I was glad that he finally got angry. He holds much of the function of production in his hands, and has been a bit too insular, despite repeated discussions. Anyway, his anger seemed to fuel some behavioral change on his part that is good. Two unfortunate things happened with staff, and those are resignations. They both caught me off-guard since they have both recently had positive reviews and feedback. It puts me back into high gear for hiring, and it is very upsetting. One of them has a two-year contract, so I am figuring out how to handle the breach of contract. (I think it is hard enough with nothing else on deck. But, my due date is the beginning of December, so this problem along with the project of a newborn is a bit daunting.

Ginny and I have worked so much on understanding how the money goes in and out that we have talked about little else. Understanding the statistics particularly projecting the collections from our services - has been instrumental in my putting realistic goals and pressures on the staff. It has also made me very nervous. There is a lot of money that we are not collecting, and I am trying to get to the bottom of it. Ginny can 't help me that much in answering that question since health care is its ' own entity. She has recommended that I talk to an expert in health care consulting whom she knows, and I am going to follow up on that. Despite the upheaval and the questions that are outstanding our services have grown. Collections are still dragging so cash is tight, but I am more in control of what to ask and where to look for the income. It seems to be picking up. In the meantime, I let our new part-time salesman go. I think he departed before I let him go, in fact. He just stopped showing up. I have a new person on deck who will start part-time in the next few weeks.

The sales department still doesn't exist and I have fallen on my face a few times now so I am ready to get a good person who can produce. Next week I start to interview to hire new people for a couple of positions. I hope to find someone who is stronger as a front desk manager so that I can reduce my work on that front. Since our manager left in May I have been doing the management. The many hats are getting too heavy manager, doctor, entrepreneur and financial analyst. Too much, too much!

September 2005

2006-01-05T13:25:00.001-05:00

Wow. Making things better or getting things organized must be euphemisms for the shock of the truth.

In September I thought I would just participate in a little clean up of the billing department so that our collections (i.e. cash flow) could improve. (I had a list of several things to accomplish during September. The clean up was supposed to be just one of them.) I thought I could just look at things and identify what processes needed to be tightened up. In fact, it turns out that I spent the majority of the month buried in computer files, A/R reports, patient statements, insurance billing coding manuals, program screens I have never seen and, unfortunately, more. The end of the month was a crescendo of staff meetings to review what I had found. Needless to say, there were some stressful conversations at the meetings. (One of the things I found out was that several of our reliable, tried-and-true procedures and processes had broken down for no-good-reason other than some of the staff thought they could wing it. To add insult to injury, our checklist that audits work processes was checked off as if everything was being done. The staff justified it by saying that they were doing it in their heads.) In short, I did not see, hear, smell, feel or taste September. It might never have existed for all I know.

The good news is that I did make some progress, and as anyone probably feels after such an acute learning curve, I am empowered by the information I gathered and the changes I have made or foresee making. Ginny, my coach, has been helpful in several ways, one of which is most valuable. She told me to slow down and reintroduce the old processes and procedures more tenderly than I was planning. I was as mad and anxious as a hornet when I had all of my facts and data in front of me, and I intended to get it all straightened out right now ! She encouraged me to hold back. Wise advice, I think. (My temper has gotten me in trouble before.) Ginny reminded me of one of my mottos to live by: Staff retention increases patient retention. So, I reined myself in and have been taking it one painful, plodding step at a time. I think that I did get some other things accomplished in the month 's flurry, but it is hard to think of them right now. I am still suffering from the billing department aftershocks. It is really true that bad cash flow can be the downfall of a perfectly busy business. The benefits of this month's brutality: I have gotten a better idea of what to insist upon as reports and actions of any manager who comes in here in the future. (Right now I am acting as manager.) That is one of the two big weaknesses in the history of this business (i.e. never a really effective manager and no sales department), so it feels right to get some more clarity and intention on the subject.

The focus of these last months has been to grow this business, yet most of the actions have been out of my comfort zone and have given me the impression that I am going nowhere fast. I have to remind myself that I love this business; I love being a creator of this business; How much I believe in the mission and products of this business. Finally, what else would I rather be doing? Nothing other than this; And that is the truth. I am inspired by a passage I recently read, and will share it here in closing. It is from a text I have on Christian Mysticism, and refers to Jewish Mystical idea of tsimtsum the withdrawal of God, of the lurianic school of the Cabbala. (Don 't worry. You do not have to be interested in the source to love the passage!) The first act of En-Soph, the Infinite Being, is therefore not a step outside but a step inside, a movement of recoil, of falling back upon oneself, of withdrawing into oneself. Instead of emanation we have the opposite, contraction The first act of all is not an act of revelation but one of limitation. Only in the second act does God send out a ray of His light and begin His revelation, or rather His unfolding as God the Creator, in the primordial space of His own creation. More than that, every new act of emanation and manifestation is preceded by one of concentration and retraction. (Gershom G. Scholem, Major Trends in Jewish Mysticism, London, 1955, p.261 It really makes my heart sing. Tomorrow afternoon I will meet with Ginny to get a reality check on my plans for October. I will, officially, wrap up September. All hail a new day!

August 2005

2006-01-05T13:23:00.001-05:00

August was more-of-the-same in terms of managerial issues: I have continued to fortify job responsibilities, accountability to statistics of production, and general expectations. Also, the new staff has started to become more familiar with each other and me. That brings in its' own challenges. The more familiar they become, the more the natural pecking order forms. Also, the more familiar they become, the more they state their thoughts for better or worse. I don't have any regrets because the statistics are better. Our patient volume, services, and collections are rising all up from July. As long as that happens I won't complain. I keep saying, Staff retention promotes patient retention. Cash flow remains a real issue. Our volume hasn't grown enough for me to be comfortable with the new expenses.

Despite the fact that I cut payroll (starting in May) it is still a challenge to make ends meet. (I won't even describe what a challenge it has been to deal with the staff attitudes regarding pay cuts.) In addition, insurance companies (a good portion of our income is generated through insurance coverage) have not only been slow to pay, but have been throwing up extra roadblocks to reimbursements. In fact, I have spent nearly three weeks re-analyzing our prices, reimbursements, write-offs, and accounts payable in fine detail. I am still working on it; trying to understand exactly what has already happened so that I can better project cash flow for the future . In addition, I decided to re-evaluate our collections department. (That begins next week. I am going through the training from A to Z, hoping I can ferret out any glitches on our side of the collections process.) The cash flow problem has been distracting me from the more fun, creative executive plans I had for the month of August. I don't think it hurts the business in the long run; in fact, it probably helps UHI. (I am learning so much, and have never been so tuned into the financial side of this business.) However, psychologically, it is brutal.

August has been a comedy of errors (at least it should be funny in the future). Our payroll company messed up payroll twice (one of those times being a double-debit). Our bank returned a check despite the fact that the account was properly funded. The air-conditioner broke (90 degrees in Chicago, thank you). Our mail woman went on vacation and her replacements did not show up 5 out of 20 days (i.e. no mail delivery equals no income from the mail). And, an important part-time employee resigned to go to a full-time job elsewhere. (And those are just the highlights. On the personal side of it, during one week of August I did not have a nanny for my 3-year old daughter. It was nearly impossible to work, and I was very anxious knowing the projects were piling up. My husband just got up and went to his office, as usual (never gave it another thought). Midweek of that week I talked to him about it, and he seemed genuinely surprised. He told me that he [had] to work. (He owns his own business, too, so he could have taken time off, even though it would also have been difficult. It just seemed that I would take care of it all and he would never have to think about it. If this happens again and I bet it will he agreed that he is going to take care of our daughter for 50% of the time. At least we ironed that out.)

Meanwhile, at home, my carpenter did not show up during the week he was supposed to finish his job (and our place goes up for sale at the end of September). Finally, and sadly, I grieved the death of my 17 year-old best-buddy cat companion, Khufu. I battle every day to keep my self-talk sensible, positive, or, at least benevolent. It 's not easy; when I get frustrated I am the first person I beat up. I think this is a painful learning curve. I have been through them before, and they are not fun - in retrospect, satisfying, learning experiences, but not fun.
See you next month!

July 2005

2006-01-05T13:22:00.000-05:00

There have been three challenges that I have been working on during July: Managerial, Sales and Entrepreneurial. Most of my time in July was spent growing and grooming the staff; that's been the managerial challenge. Not only did our structure change, so did the personalities. In a small business, that is a lot of change in a short period of time. I stuck to my guns and hired “slow” – carefully. I improved training. I immediately created boundaries and quantitative expectations. I think the result is the beginning of a good, strong team that knows what to do. At the suggestion of my coach, Ginny, I used a different approach with them than I have used before. I have spent more unstructured time with key team-members learning about what motivates them. I had two unique meetings with the entire staff, one of which was a “biography meeting”: Each person had 12 minutes to give his or her place of birth, general career background, family birth order, and favorite foods. It was really a good meeting, and seemed to get everyone on a different level of familiarity. We laughed a lot in that meeting. (And, by the way, chocolate and cheese scored high as favorite foods! Now I know what to bring to the office for rewards!) Finally, I have been sharing my dream of the company with them, both in writing (mostly email) and verbally. My motto has been “Staff retention promotes patient retention.” That came from Daphne at Action Coaching, and it puts me in the right place with respect to the staff.

The other big deal in July was dealing with cash flow. Building an expanded staff and replacing old staff members is expensive. I had lost services with the staff change-over, but still had the same overhead. When I met with Ginny, my coach, we talked about the cold, hard facts of the cash flow issue, but there was something else important that came out of our meeting. She reminded me to listen to my intuition. It reminded me that everything is not simply linear. When I listen to my intuition, I know that everything is working right, and on a good course, if difficult or challenging. I have come to think that my intuition is one of my finest resources, and to respect it as such. On the other hand, she gave me some practical advice, like “get new patient numbers up and keeping current patients happy and on their schedules”. I put a lot of attention on that, and we did have new patient growth, though not as much as I'd like. This month, however, our new part-time “new patient guy” did start. (It's nice to pay someone to think about and act on new patient ideas for 25 hours per week.) I know that new patient numbers will grow just because there is someone dedicated to that effort.

The company seems to have a stronger presence in my own mind, just because I am paying more attention to it as a company. In other words, I am thinking about it as its' own entity. All of the things I am doing are creating an organization that works with or without me. I guess that is the entrepreneurial challenge of creating a company that is independent of the creator – at least to some degree. My biggest challenge, emotionally, is keeping my self-talk positive. The doubts I have about my ability to achieve success sometimes roll in at a frantic pace. It is uncomfortable to take on new challenges and to grow. Philosophically, I am following a particular leadership model that is keeping me on track, and practically, I am reading the signs that I have hung up around my office. I keep reminding myself that if others can do it, so can I. Finally, I am reading about business people who are notable in business. I get their names and stories from a book called Business: The Ultimate Resource. I am using their stories as a guide for understanding this path.

Talk to you next month!

June 2005

2006-01-05T13:21:00.000-05:00

The changes in the business right now are centered around creating a new leader – me. That has been the biggest priority since it appears to be the plug to progress.

The biggest hurdle (in June) was to follow the advice that I got from Daphne (from Action Consulting), and that was to take more time to do what I imagine leaders do and delegate the non-leadership jobs to my staff. I shared with her that I have known that I have been doing something wrong since my business has not been able to break out of its' cocoon for the last few years, and that now I believe the problem is in between my two ears. How am I supposed to act differently? What are the behaviors that lead the staff to better accountability, responsibility and, ultimately, production? How do I get to top priorities? How do I get past the guilt of “just” reading, thinking, analyzing when I think I should be doing something more productive? In my Irish Yankee background planting potatoes is work; thinking about it isn't. (It doesn't put a potato on the table.)

It was refreshing to hear Daphne say that she has heard that same question asked by many different business owners. (That, and, “How do I hire great staff?”) I decided to buckle down and try something new. I took 6 hours to review my cash flow statement line item by line item to make some decisions about how to spend (and stop spending) money, then I had a leisurely meeting with my bookkeeper. (Usually my meetings with her are hurried.) I took about 15 hours to think and write details about what I wanted my staff to do and when I wanted them to do it. I wrote up training notes and filed them in logical sequences with logical names so I can find them. (That even led me to carefully rename several groups of files!!) These three activities were high priority and done during a normal 40 hour work-week instead of done in the evening during my ‘family time'. It made me nervous to say “no” to other things, but in the end I gave myself a 10 for sticking to it. I felt different inside, and the production at the office was still quite good. In other words, a change of habit didn't seem to harm anything.

The other thing I started doing was building a different relationship with the staff. I cringed after Daphne, Ginny (my M3 coach), and I met on the phone and they suggested that I just bring in some food and sit around to talk with my employees to start a new type of dialogue and relationship. They thought (by my description) that my relationships with the staff didn't sound very congenial or supportive, and they were right. I have been keeping them more ‘business relationships' probably. It scares me to feel more vulnerable to the staff by getting to know them or vice versa. So, when it was suggested that we start with sharing food and chatter I thought, “How unproductive! What kind of example is that? I would be paying everyone to chat!” But, I have done something like that twice, and I am learning about their priorities and enjoying the candor of their conversation. I have yet to see how it effects production, but I am humble to the process. I must say that I have been reminded what really talented, smart, interesting people work for me! I like them personally on top of respecting them professionally. This is a new ‘team' since we have had 6 staff turnovers (of 12 full-time positions) in the last 10 months. (The transition has been brutal: expensive, time-intensive, frustrating, worrisome, and downright all-consuming. In fact, the story of my experience was a small feature story in Crain's Chicago Business a couple of weeks ago!) I have been focused on building a new team in a different way, so food and chat has been our starting point. That is not where it ends, but it is now part of the process.

Lastly, Ginny suggested that I add to my data collection by making trend graphs with my statistics, and that has helped somehow. Looking at the data collection in a different way – many different ways now – helps me ask better questions. High quality questions are the road to high quality answers, so I appreciate the new insights I get and the questions that come up.

It has been a really challenging month in the wake of staff turnover, but I think a good opportunity to start with a “new me” too. I feel hopeful, and with good reason. There is a good ‘feel' at the office, and the stats are growing stronger.