In this Business of Functional Medicine podcast episode hosted by Kristen Brokaw, Ari Meisel, a business coach, discusses the importance of productivity and scalability for healthcare providers. He emphasizes the need for providers to shift their mindset from being indispensable to creating systems that allow for growth and delegation. The discussion covers the impact of technology on business practices, the four entrepreneurial mindsets, and strategies for improving patient experiences and communication within practices.
Ari also shares insights on effective delegation and the importance of overcoming overwhelm to find hope and success in practice management.
Tune into this episode to learn about:
- How Ari’s “Less Doing” system can help providers become more replaceable in their businesses
- How technology amplifies existing habits, good or bad
- Planning for an “exit strategy” to have an eventual option of selling one’s business or stepping into less hands-on, time-intensive role
- Using delegation to empower team members, not just offload work
- Improving communication to improve your business and clinical practice
Ari Meisel:
…if we can move beyond that and become the engineer. Now we’re talking about the difference between working in the business versus working on the business. So, the engineer is the one who’s sort of designing it. They’re still hands on, but they’re the ones coming up, some of the ideas and the concepts and pushing things forward when the engine is the one really doing the work. And that’s where you can sort of step out of the day-to-day.
You’re still very involved. You’re still very much there. We say that at that point you’re more free-range and integrated. Integrated in terms of a work-life integration.
James Maskell:
Welcome to the Evolution of Medicine podcast, the place health professionals come to hear from innovators and agitators leading the charge. We cover the latest clinical breakthroughs and health technology, as well as practical tools to help you transform your practice and the health of your community.
This podcast is brought to you by the Lifestyle Matrix Resource Center, who provide a range of options to help you deliver successful, effective functional and integrative medicine. To find out more and to get started, go to goevomed.com/lmrc. That’s goevomed.com/lmrc.
Kristen Brokaw:
Well, hello Ari. I am here with Ariel. And Ari, why don’t you tell our listeners a little bit about yourself?
Ari Meisel:
Sure. Hi, Kristen. First of all, it’s good to see you. Yes, I’m a business coach for the most part. So I created a system in productivity about 14 years ago called Less Doing as a response to a personal health crisis. And I’ve been teaching, speaking, consulting and coaching since then. And for the most part now my focus is on one-on-one coaching with business leaders in various forms in various industries to help them become more replaceable.
Kristen Brokaw:
Yes, because I would say providers, which that’s our target audience, they don’t believe that if they’re not there, work doesn’t get done or how can I make money? I’m the sole provider. It is fee for service typically. So that’s what you’re saying is, and I know you said you work with providers as well.
Ari Meisel:
Oh yeah, tons. Tons. And especially now that I feel like more and more there’s a lot of providers who are actually able to do health coaching remotely there. There’s a lot more opportunities to do things that are less hands-on in some ways. So they’re being faced with the daunting task of having a more scalable business. And I think it is an interesting problem to solve.
Kristen Brokaw:
Well, I think, I think they would all love to scale, and the big problem sometimes with clinicians is that they don’t even know what their exit strategy might be if they did even think about that and how sellable is their practice. I mean, that’s obviously for a whole ‘nother discussion, but I hear that I’d love to sell my practice. Well, a lot of times selling a practice really is like you are the practice and potentially doctors need to think differently about what is plan B or what’s the long game. So like I said, that’s for a whole ‘nother discussion, but I want to just give you a little shout out on how I know you. I think, what do you have 10 books or something like that? I don’t know if I have the number.
Ari Meisel:
I think 12.
Kristen Brokaw:
Okay, got it. Well, I have read three. And your most recent one, I believe it’s called On Productivity.
Ari Meisel:
Yep.
Kristen Brokaw:
Yes. Okay. And I will tell you, listener, that Ari is hilarious. I don’t know if you naturally are that hilarious, if you have ChatGPT’d that hilarity, but literally it is if you are speaking to every human in your book, it’s hilarious.
Ari Meisel:
ChatGPT did not exist when any of my books came out. Sorry.
Kristen Brokaw:
Well there you go. Just playing where it’s all him, right? It’s all my own material. So something that you say in the beginning is tech doesn’t make you more effective, it just amplifies your habits. And I also like how you said in the book, and man have I heard this, that a provider will go to a tradeshow, get enamored with the vendor area, buy software, machinery, come back only for their staff literally to be nail-biting at the gosh when they come back, they’re going to have us do a whole bunch of whatever. You’ve heard this before, so tech can be your friend, but it can also amplify these bad habits. Do you have any comment you want to add to that?
Ari Meisel:
Yeah, so I mean the thing is, is that a lot of the way that people do business now is the same way people have been doing business for literally decades. And some of that is not just because people have maybe been in that job or in that profession for a long time and they just sort of kept those habits and those methods. But a lot of that also gets generationally passed down to the people that end up working with us. So finance is a really good example of that, right? There’s finance, the finance industry like investment banking and private equity and stuff. There are a lot of innovative things that they do in terms of how they manage their workflow maybe and how they do research and stuff. But for the most part, a lot of the logistical, mechanical ways that people operate within those businesses, it’s almost like just a repeating cycle.
The way the meetings are held, the way that the conversations are had, the way that people are sold on things. Some of those literally you see tactics that have been used in the sixties, they’re still being used now. Some of that is because some of those work and sometimes just because that’s just the way that we’ve been doing it, change is hard. So it’s also, well because change is hard, it’s easy to say, well, this piece of software made this person’s business scale 10 times in a year, it’s going to have to do it for me. Obviously I want that magic pill that shortcut. A lot of times, this may sound surprising since given what I do, there isn’t a shortcut, there might be a better way of doing it along the way. And ultimately the result will we get to hopefully will be a more effective place. But software and tech, as much as I love it and use it every single day for something, it really does just get you wherever you are currently going faster. So if you’re going the right direction, that’s great. If you’re going the wrong direction, it’s not so great.
Kristen Brokaw:
So in other words, what you’re saying is how we do business really hasn’t evolved much tech is new in this arena, but unless you have the right mindset, unless you have the right processes, unless you’re avoiding the issues of procrastination, as you list out in your book procrastination, disorganization, decision paralysis or teams that are going nowhere, it doesn’t matter what you have, you’re still up a creek without a paddle.
Ari Meisel:
And one of the things I always like to give a sort of example or way of looking at it that is biology versus tech, right? So the spoken word by most accounts is about 150,000 years old. The written word by many accounts is about 30 or 40,000 years old. And I would say that most people, even people who are writers by profession would tell you that writing is not easy. Most people, everybody says writing is really hard and some people are just better at doing the hard thing than others or that hard thing. Email is about 40 years old, so people struggle. Email is one of the number-one sources of stress for so many people that I work with in manage email. If you think about biologically, we’re still catching up with something that we’ve been doing for 40,000 years. So something that’s happened 40 years ago, we’re just not there yet. And I know that may sound like a little bit grandiose, but it’s an interesting way of thinking about it. Our biology just doesn’t adapt the same way that technology does.
Kristen Brokaw:
Interesting. Okay, so something else you said in your book that I really liked is most people and providers alone spend their time firefighting versus fireproofing. And I think that’s a fun analogy for you. You are someone who is a, I believe volunteer, EMT in Brooklyn—
Ari Meisel:
Princeton, New Jersey now.
Kristen Brokaw:
Okay, New Jersey. All right. Well it used to be Brooklyn and I love that. So I want today everybody, we are going to be focusing on fireproofing and not unless firefighting. So I want to start with the concepts that you put out on cog engine engineer and inventor. Let’s talk about that.
Ari Meisel:
So those are the four mindsets, basically the founder mindsets, entrepreneurial mindsets that I identify with people. So the very quick overview there is the cog is where you’re just sort of a wheel in the machine. The machine does not run without you. If you’re not spinning, the machine is not running. And so the cog is really caged. They really don’t have the flexibility to work from home or take a day off or get sick even because the business will grind to an absolute halt. They are absolutely essential to the minute-to-minute, moment-to-moment operation of an organization. After that, above that, we get to the engineer now, oh, sorry, the engine. So the engine is the driving force of the business still, but it’s a bigger sort of part of it. And the engine might still be able to function and move along even if one or two parts maybe aren’t functioning optimally, there’s a little bit more ability to wiggle room there.
We always say that that person’s sort of on a leash as opposed to in a cage. So there’s a little bit more sense of freedom. There’s a little bit more frustration that comes with that because at that point you’re not so in the weeds that you can’t see that there’s other more interesting, bigger things you should be working on, but you can’t necessarily work on them. So it’s kind of like a really purgatory place to be if we can move beyond that and become the engineer. Now we’re talking about the difference between working in the business versus working on the business. So the engineer is the one who’s sort of designing it. They’re still hands on, but they’re the ones coming up, some of the ideas and the concepts and pushing things forward when the engine is the one really doing the work. And that’s where you can sort of step out of the day to day.
You’re still very involved. You’re still very much there. We say that at that point you’re more free range and integrated. Integrated in terms of a work-life integration. So it’s not all about work. You can do other things and the business will continue to at least operate, probably not grow, but operate in your absence. Once we get beyond that, then we become the inventor. Now the difference, as I said, between and engineer is the difference between working in the business and working on the business. I like to say that difference between inventor and engineer is the engineer is pushing the business forward with their hands and the inventor is pushing the business forward with their words. So that’s where they can work anytime, anywhere anyhow. And their ideas or the driver in the business, and most importantly, they have the freedom, ultimately the freedom to leave the business if they so choose. It’s not the goal. And in their leaving, the business continues to thrive and grow. And on top of that, because they’ve left, they’ve now gotten to experience new things, learn new things, create new opportunities, and they can come back to the business with those opportunities, those learning to further enhance the business. But at that point, all you’re doing is accelerating the growth of the business. Nothing else.
Kristen Brokaw:
That’s very interesting because I would say most providers probably are acting in every single one of those roles, especially if they own their own practice. That’s the majority of the people that would be listening to this are providers that own their own practice or run their own business health business. And they are coming up with the ideas in inventor, they are having to create systems, then they’re potentially even managing people, but then also they are the ones making the whole thing go. And that’s where the overwhelming burnout comes from. I mean, don’t you believe that they’re acting as the cog?
Ari Meisel:
Yeah, exactly. And I think that especially with providers, a big part of it is they feel like they are the only one who can do the practice of the medicine or whatever point it might take itself. And while that may in some ways be true, it’s usually unlikely. And look, I’ve met with, I’ve worked with as a patient, as a consultant with some of the best doctors in the entire world, and a lot of what they do is not necessarily that they figured out some secret sauce that nobody else knows or they know how to push on a spot in a way that nobody else knows how to do. A lot of it is that they’ve created a better experience for their clients and their patients. And that’s a really interesting thing to me because it seems like I’m crazy sometimes when I’m talking to a doctor and they’re like, well, nobody else can meet with the patient and put their hands on the patient.
It’s like, sure, maybe. And that’s probably not true. But a good example of this is I went to the dentist with my son yesterday, pediatric dentist. They had a really good reminder system because we made this appointment six months ago, I completely forgot about it. They reminded us, we got there, we waited in the waiting room for 35 seconds. Amazing. They took him into do the X-ray, we went next door, the hygienist did her thing. In about 15 minutes, the dentist came in for two minutes and then we were on our way. And then on the way out, I get a notice on my phone, they billed the card that I have on file. It was a really great experience. I have no idea what the doctor’s name was. I don’t care. Everything about the experience was great. The actual doctor saw my son for two minutes and it could have been, there’s like six doctors at this particular practice, but it was a really good experience for me that doctor, if they’re spending two minutes with my son, maybe that means that they can see 30 patients an hour.
I don’t know. But we have to get out of this idea. And this is where replaceable founder comes in. People are not coming for you. You are not that unique. And me too, none of us are. And we have to accept that It’s a big ego thing, especially for entrepreneurs, especially for doctors because they’ve had so much training, such so much extra training in this degree and that degree. And we get to this place where it’s like nobody could possibly do what I do. So now I’m stuck. So essentially what you’ve done is you haven’t created your own business, you just own your own job. And worse than that is that you are now completely disregarding your opportunities to create a great customer experience because you think that they should just be so grateful that you are the best practitioner in the world and they get to spend a few minutes with you. That’s how it goes.
Kristen Brokaw:
I mean, that said, so well now let’s just go back to that experience that you had yesterday because that was really, it’s the experience. So a lot of these providers are dealing with very sick people. I mean, we’re talking sick and they take a long time. However, I have heard, and I know that providers say, gosh, my patients sometimes wait in the waiting room 20, 30 minutes, and maybe it’s longer. I sure hope not in some instances, but let’s just say that’s the case. And that’s maybe even, I don’t know, sometimes unavoidable, but it sounds like there’s still some kind of an experience they could be having to even address something like that. Some provider could say, well, yeah, but you don’t understand. I can’t just come in, do my little magic trick at the end and pop out. But I don’t know. Do you have anything to say to that?
Ari Meisel:
Yeah, absolutely. So take that example. First of all, there’s a whole scheduling issue that goes into that. We know, we all know that most doctors’ offices are scheduling four patients in the same 15 minute period. We know that that’s how most—
Kristen Brokaw:
Not necessarily in functional medicine, I will definitely say that—
Ari Meisel:
But in many cases I’ve seen enough offices, they’re literally trained to do that in some cases because they’re just going to have people sit and wait. So that’s a problem in itself, but even if you’re, and I get it, because you also don’t want to tell somebody, oh yeah, yeah, the doctor would love to see our next appointment is in 17 months, which I’ve seen that too, which is terrible also.
But there are things that you can do if that person’s coming and waiting, don’t keep ’em in a waiting room. A waiting room is a bad place. Want to get them into, even if it’s not a room, get them into a space, get them with someone, right? Because someone can have a conversation with ’em. Someone can take their vital signs, somebody can offer them tea, it doesn’t matter. You think about a really high-end bank or even a hotel. If you go to a really high-end hotel like a Ritz-Carlton or Four Seasons, and you get there and your room is not ready, they don’t tell you to sit and wait. They’ll say, please come to the bar, have a drink, have coffee, or like, oh, you have a child with you at the Ritz particularly, can we, we have a teddy bear, we can give your child, right?
There are things that you can do to create a more, and I know people love to say a medical spa, spa-like experience, but they usually don’t do that. You can do that. You can offer somebody something other than a magazine that’s been expired for three months. So if you have to keep them in the waiting for that long. But I’ll give you another one, not just waiting like aftercare too. And this is a really, really typical one I see with dentists. I’ve spoken to, what is it, DEO, which is the YEO or YPO, whatever for dentist, DPO. I don’t know. I’ve spoken to a lot of dentists. For some reason there’s a really common practice, at least I’m sure all the doctors do it, but among dentists particularly where they will call every patient that they saw that day at the end of the night just to see how they’re doing, which is a great touch.
And I’ve had that. I’ve been on the receiving end of that. And I asked this at this big event, there were like 500 dentists. How many of you do that as a regular practice? And literally three quarters of the room raised their hand. I was like, cool, how many of you, when you make those calls, actually get to speak to somebody? And it was like literally, I think out of 500 people, maybe 20 people raise their hands. It’s like, okay, so the rest of you leave voicemails, right? Yes. Okay, good. Of the people that you leave voicemails for, does anybody ever get a call back and I think six people raise their hand out of the room. Okay, fine. Cool. There is a service, which I’ve used with many different providers and companies called Sly Broadcast, which is ringless voicemail. So it doesn’t ring the phone.
It’s not an auto dialer, it just shows up. They missed a call and there’s a voicemail and you can prerecord a message, Hey, it’s Dr. So-and-so I just want to see how you’re doing after your appointment today, blah, blah, blah. Your staff, well, we don’t need the staff. You can automate that voicemail message to go to people. It produces the exact same effect where somebody’s like, oh, that’s really nice. My dentist called me at eight o’clock at night at the end of his day or her day to see how I’m doing. I don’t need to call back. It’s just nice that they called, great. And then that frees up hours of a practitioner’s day. And if they’re not doing it themselves, they should be, people should be getting that call, but it doesn’t require somebody spending their time to do that.
Kristen Brokaw:
Yeah, that’s a really good tip. So let’s go to the meat and potatoes of what you’ve lined out for the entrepreneur, which is you have your roadmap or your levels of success. And I want to hit this from this 30,000 foot view because I want providers to hear these different, is these three levels of success. But I want you to think of it through the lens of every step of provider’s office from getting patients to come in, handling, managing the patients once they come in, hiring staff, dealing with staff, communicating with staff, up to then you as a provider, even logging your notes, doing your admin tasks, getting into the portal. I mean, and that was so 30,000 foot view, but I just want you to think of it through that lens. Alright, so Ari, take over what you think the levels of success are for.
Ari Meisel:
Can you tell me what you’re referring to?
Kristen Brokaw:
Oh, we’re communication, communicate effectively—
Ari Meisel:
Managing projects, the levers of success, you said?
Kristen Brokaw:
Oh, I probably said levels and I do mean levers. I apologize.
Ari Meisel:
Okay. Sorry.
Kristen Brokaw:
My bad. My bad.
Ari Meisel:
Really great marketing I’m not aware of. So the three main areas are communication, project management, and processes, and usually go in that order. That’s what you’re talking about, right?
Kristen Brokaw:
Yes, sir.
Ari Meisel:
Yeah. Okay. So communication generally is like 80% of every business’s problem, both internally, individual team, and then external as well. And a lot of it just has to do with the way things are managed. So that talks about things from inbox zero, which is really about decision making to the asynchronous communication, and then the six levels of delegation. So I’ll give a brief quick overview of those as they relate here. So inbox zero is a lot of that is about how we deal with incoming communication. On a personal level, it is about inbox, but it’s also about a much bigger thing, which is decision-making. We want to be reasonably accessible to the people in our sphere without making it a leash on us or a gateway where people can get to us anytime they want. So that’s where the asynchronous communication really comes in. So this 99% of my communication in my week is pretty much asynchronous, meaning that it’s the opposite of what’s happening right now with me and Kristen here. So this is synchronous, and this is a very rare event for me in a week. Fortunately, I make exceptions for people that I think are yay,
Are exceptional. So I have five small children, or well, 12 and under. I have multiple things that I’m involved in volunteer, EMT, as you mentioned, I’m currently running for school board locally here. And so I need to be able to do what I need to do when I can and where I can essentially. So it can take a lot of different forms, but one of the main tools that I use is an app called Voxer, which is a voice communication app that allows for asynchronous communication. So I can send a voice message, which I think voice is better in general because it gives you a lot more intonation and emotion and you just get a lot more information. And I can listen to it at multiple speeds. It’s perfect. I send a message, they can listen to it either live if they’re there or later on when they want.
They can respond when they want. And I can do the same. I use this with team members, I use this with my family, I use this with coaching clients. So all of my business coaching is done asynchronously. I have no live meetings with my coaching clients, which means I’m able to have 26 currently coaching clients in 11 time zones and spend about 20 minutes a day talking to them because I don’t have to book hour-long calls with 26 people. The other thing it allows for is more effective communication. Because if you walk out of a patient session and you want to say something to somebody, you can just talk really quick. And it’s not the same as old school transcription on your notes. You can just have a conversational thing and the person can then on the other end, can receive those later and do what they need and then respond in kind.
Some people, I know some very high level practitioners who do this kind of stuff with their health coaching clients. So a client could literally be like, oh, I just walked out of this workout and this didn’t feel right. And that could be at five in the morning and the practitioner can then get it at 11 in the morning in their time and respond later on before they have their next workout of the day. So we don’t have to schedule a 45-minute session for both of you when you need a one minute answer. So asynchronous communication is a really big one. It allows people to communicate at their best essentially. And then the sixth level delegation is another really important one, again for everybody, but for practitioners, I would say, because the problem for most people with delegation is it feels very binary, right? Either I have to do everything or they have to do everything.
And that’s an uncomfortable scenario for many people. The sixth level delegation teaches that there’s a gradient of those, and it goes from just do what I say to just get it done. And in the middle there’s things like, make a decision, but keep me informed or do the research and then I’ll make the decision. So you can dial up the level of empowerment, which is really what delegation should be. It shouldn’t be pushing off work that you just don’t want to do. It should be an opportunity for somebody to take something and engage with it and take it further than you could have on your own.
Kristen Brokaw:
I want to interrupt. I do apologize. So I think we could just stick with, since you said it’s 80% of the meat and potatoes, I mean truly someone can get your book and dive into managing projects or perfecting processes. Any other day, and maybe we’ll do a part two to this, but communicating effectively, I want to just give a couple of examples. I love Voxer. You taught me to use Voxer. I use Voxer with my team. So I encourage everybody to get Voxer and to use Voxer. What a provider that I encourage to use it. What she does is she gets kind of, I guess you could say, a fires that she needs to put out potentially from her staff. She listens to them in the morning after she’s worked out, she gets back to them asynchronously. So they’re hearing the context, her intonation, if she’s, Hey, blah, blah, blah, no big deal.
Okay, this is going to really not be good if they get the context and it’s worked so well for them to just even get quick answers to things. Oh my goodness, you have no idea. And then you talked about those six levels of delegation, and in the book you talk about bottlenecks. And I would say that that’s a big, those six levels of delegation, honestly just Google six levels of delegation and his article will be the first to come up. I have sent this to so many people because it is, it’s like you can say to your office manager, this is a level five, and that literally means what Ari, if you would say that to somebody.
Ari Meisel:
So level five is explore and decide within limits, which is one of my favorites. So it’s basically like you can set a limit on time or money is typically what it’s, so it’s like if this is a $300 decision or less, I don’t even know about it, just go for it because I don’t want to hear tomorrow that a patient or a client is upset because I wasn’t able to answer my team member about giving a $200 refund, for example, because they wanted it. It’s like, no, you are empowered to make those decisions within these limits.
Kristen Brokaw:
And that decision would then get unquote put off the patient’s getting ticked. Nobody’s getting back to them. The provider’s very busy. So maybe it’s three days before they get back to them when that could have been handled right away. And again, giving that better patient experience. So I wanted to just remind providers that you have several books. The most recent is called On Productivity. It is a hilarious way to get a big pie in the face on holy cow, there is hope, and I’m doing a lot of things, probably not as effectively as I could be, but I feel like it provides hope. What do you say to that?
Ari Meisel:
Yeah, I think that overwhelm in general, a lot of the overwhelm that people experience, they don’t know what’s causing the overwhelm, which sounds like very circular, but it’s true. Having a chance to stand up out of the weeds, look around and have a view in terms of optimization of what we do, and knowing that that’s a possibility is I think really important.
Kristen Brokaw:
Yeah, absolutely. So if someone were to say, Hey, I really want to work with you. Is there something that they would have to do? Are you even taking new clients? Honestly, I think your book is amazing and gives so much information, but how would you answer that?
Ari Meisel:
I do take more clients actually. I mean, they can go to less doing.com, but the best thing is to go to Vox with re.com and just get in touch with you on Voxer. It tells you how to do it and what it looks like. And we can just have a conversation
Kristen Brokaw:
That is Vox with a V like Victor, VOX, like X-ray with er.com.
Ari Meisel:
Yep.
Kristen Brokaw:
Right. So I just want to thank you so much, providers. There is hope. And if anything, Google some of these concepts that we’ve talked about today and get ahold of Ari by his book if you are truly in need. Ari, thank you so much for your time today, and you’re really giving us hope. And because of your journey, you created the system, correct?
Ari Meisel:
Yep, that’s right.
Kristen Brokaw:
Awesome. Well, thank you so much for your time.
Ari Meisel:
Thank you. Good to see you.
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