Helping Healthcare Scale
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Helping Healthcare Scale
Troy Bage: Revolutionizing Healthcare Expansion and Modern Dentistry with Strategic Real Estate and Cutting-Edge Technology at Tend
What if scaling a healthcare business was more about strategic real estate choices and less about the medical services themselves? Troy Bage, CEO of Tend, unveils his transformative journey from physical therapist to a leader who expanded healthcare locations from 30 to over 1200. Discover how he navigates DeNovo strategies and the complexities of franchising, while emphasizing the critical role of selecting the right partners. Troy shares his experiences and the often-misunderstood reputations of private equity and franchising, revealing the keys to sustainable growth and enduring success.
Enter the world of modern dentistry through the innovative lens of a company founded by venture capital group Juxtapose. They've reimagined dental care by addressing gaps left by large Dental Service Organizations in urban areas. Learn about their unique approach to enhancing patient experiences with technology and service, from a proprietary app to noise-canceling headphones, and how they leverage prime urban real estate for maximum visibility. Their strategic marketing tactics and commitment to accessibility have led to impressive growth across major cities, transforming how urbanites perceive and experience dental visits.
The future of dentistry is here, and it's driven by cutting-edge technology and strategic partnerships. From extended operational hours to the integration of AI imaging and 3D printing, Troy Bage discusses how these advancements are optimizing efficiency and patient satisfaction. He delves into the impact of proprietary booking software that revolutionizes appointment scheduling. Leadership and organizational alignment are also key themes, with insights into using OKRs for goal alignment and fostering a culture of continuous improvement. Explore the balance between remote and traditional work environments, as well as unique leadership philosophies that support growth and empowerment within the dental industry.
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by the time I left there, we were doing 40 to 50 de novos a year, and so it just started rolling and the success rate was 99%. We rarely ever failed on the de novos.
Speaker 4:The goal of this show is to help healthcare organizations scale by leveraging real estate strategies and interviewing high-level healthcare executives in order to pull out lessons learned along the way. If you'd like a free site selection analysis from our team, visit us at wwwreuniversityorg and drop us a line.
Speaker 2:Hello everybody, welcome back to Helping Healthcare Scale. I'm Austin Hare and I'm pleased to welcome our guest today, choi Beige. He's the CEO of Tend. It's a DSO with 28 locations. They started in 2019, and now they have locations across six states, and we're going to dive into his story.
Speaker 1:Troy, thanks for coming on, hey, thanks so much, austin, it's great to be here with you.
Speaker 2:Yeah, give us a little bit of your background. I know we were talking off camera a little bit, but just for the audience, maybe share just what started you on this journey and what led to eventually being CEO of this organization.
Speaker 1:Sure, thanks so much. I believe it or not, I'm actually a physical therapist, trained in physical therapy, have my doctorate in physical therapy, but I'm not the one you want treating you at this point in my career. I get to live. I've lived vicariously through others. I was real fortunate to both work as a practitioner for years, but then also got an opportunity to lead a couple of different organizations One based out of Chattanooga, tennessee, that we scaled from about 30 locations to over 300. More recently was with a company based out of White Plains, new York, that we took from about 60 locations to over 500. So really enjoy that growth and that scale and being able to do a significant amount of those via DeNovo. We did a mix of DeNovo's and acquisitions in both of those companies. I joined Tend in August of 2023 with this focus to be able to help them expand on their DeNovo model and grow the business, while also operationalizing key parts of the business so that we'd really be able to scale it over the next several years.
Speaker 2:That's fascinating. So went from you said 30 to 300 locations.
Speaker 1:We had a ton of fun and it's I always think of. I use the good to great analogy of a flywheel. It starts really slow You're pushing, it feels like it's barely moving, and then, once we got the DeNovo engine moving, by the time I left there we were doing 40 to 50 DeNovos a year and so it just started rolling and the success rate was 99%. We rarely ever failed on the DeNovos.
Speaker 2:Wow, how long would it take you guys to get to profitability.
Speaker 1:Our target was always to get to profitability within six to eight months, and then payback within 20 to 24 months was our goal timeline to be able to do that.
Speaker 2:Payback, the investors, or who exactly? Or just?
Speaker 1:like the cost Payback startup cost.
Speaker 2:Yeah, was it a private equity backed or how did you guys get your funding?
Speaker 1:Yeah, we were private equity backed by. The most recent company was a WOD Capital backed company and then prior to that, we had Charterhouse Group was our private equity sponsor.
Speaker 2:How are they doing now?
Speaker 1:The company that I took from 30 to 300 now has over 1200 locations, so they've continued to run with it. They're doing really well. They continue to be private equity owned by the sponsor that had purchased the company when I departed the organization, and then Ivy Rehab continues to also be owned by WOD Capital Again, great sponsor, super people to work with, and I've found that our private equity sponsors were incredibly supportive of the business and the leadership teams and I think private equity gets a bad rap sometimes and that it's just about the financial returns. They care about building enduring businesses and I think that's why the partnership with each of those groups was very successful.
Speaker 2:Yeah, that makes sense, I think. Look, it's like anything, there's good people and bad people, and so it's because there is a lot of bad connotations with private equity. But they're not all bad. Of course there are some bad, but yeah, I think it totally just depends on who you partner with and but it's I know you did fitness for a little while too as a franchisee and it's.
Speaker 2:It's crazy that the in terms of what you know and what you don't know, right With private equity, it's got like a really bad name but you can dive into it and you can actually find some really good partners. Franchising actually has a pretty good name but, like in your and my experiences and a lot of others, it was absolutely terrible. Like there's no, there's nowhere to go and find like that information. Like I didn't, I couldn't find that information. Like, in my experience, it was way worse than a multi-level marketing system. Like I felt like the franchisor totally took advantage of all the franchisees. Like way worse than you hear all these native things about multi-level marketing, and I think your experience was the same and I think the point is that you have to really do your due diligence with whoever you're going to quote, unquote partner with. Now. A franchise model is not a partnership, like they view you as like a customer. Really it's like an employee that pays his boss. Is what it's like? Yeah.
Speaker 1:I think you're right and I will tell you that was a key learning of mine through that process. One is be the franchisor, not the franchisee, if at all possible. But I think more than that, there are some great franchises out there and ways to be able to be successful. I think if I were doing that over again, I would spend more time diligencing the company, talking to both the given references, but then also making cold reach out to groups.
Speaker 2:The given references are cherry picked.
Speaker 1:You got it, you got. They're always going to be good. It's and I think that's with any employee that you're hiring the back channel references the people that you call that weren't on the reference sheet. They're the ones where you can get a lot more insight, and I would definitely do that differently in the future.
Speaker 2:Yeah, it's crazy. Like you and I both had fitness centers, we both sold in November of 2019. Like right before COVID, like that's just so coincidental and I know, unfortunately COVID took a lot of them out. But yeah, it sounds like your experience was the reason you sold burnout or just tired frustrations with the franchisor.
Speaker 1:It was a little bit of both less than the burnout side. Really it was frustrations with the franchisor, but also it was always a side business for us and I just didn't have the time, energy, resources to commit to it. I was working on other items, my business partner was working on other items, so we wanted to put our full focus into where we thought we could get the best returns, and not being happy with your partner definitely contributes to the desire to be able to exit that Us. They said that we're sometimes it's better to be lucky than smart, and selling in November, december of 2019 in the fitness industry was about as lucky as you get, so I feel real fortunate.
Speaker 2:Yeah, seriously, Seriously Okay. So that was always on the side for you. So what's the timeline here? Like, when did you? You went from? Sorry, what was the name of the first organization you were involved in?
Speaker 1:It was called Benchmark Physical Therapy, so we were an outpatient physical therapy group based out of Chattanooga, tennessee, and then ultimately worked with the parent company of them, which was Upstream Rehabilitation.
Speaker 2:Okay.
Speaker 1:So great group of people and had fun growing up.
Speaker 2:Benchmark to Ivy to Tend was your timeline Correct? Okay, cool, so yeah, how did that transition come about? Going into dental?
Speaker 1:Yeah, so I'd been with Ivy for about six years. We had a great run of being able to open up DeNovo's integrate acquisitions. The company was really successful. We'd had a positive private equity transaction, which was fantastic, and at that time I was sitting in the number two seat. I was the chief operating officer of the overall company and the CEO of one of our divisions, our pediatric division, which was the fastest growing.
Speaker 1:I really wanted the opportunity to step out and look for an opportunity to sit in the C-suite and sit in the CEO chair to be able to drive the culture but also the direction of the organization, and so looked for opportunities. I had some great companies I spoke with. Tend was one that really hit me for a few reasons for a great fit. One was that it was de novo focused, which is something I've done a ton of in my background. I've probably opened four or 500 de novos over the course of my career. The second was that it was very focused on disruption of the dental industry. So it wasn't just trying to be another DSO and another role of DSO and again, I think there's some wonderful role of DSOs that are out there.
Speaker 1:This was different and it was. Everything was started from scratch. It's under a single brand with a single culture and focus across the organization, so it just fit for what I was really looking for at that time. So I joined back in August of 2023. We had 25 locations at that point and then, since we've opened three more new DeNovo's this year and then we've got six planned for 2025 right now, Okay, perfect, and I want to talk about the concept of TEND.
Speaker 2:But first, hey, for everybody listening real quick if you're a multi-site healthcare group looking to grow, then we have a program especially for you where we help you lease or buy the real estate sites that outposition the competition. Email us podcast at leadersrecom, we'd be happy to help. And back to this. So, troy, yeah, in in terms of 10, I know it's dental done differently is the concept. So maybe what does that mean? Because you could take that a million different ways.
Speaker 1:Yeah, no, it's a great question. So when the company was being formed and it was started by a venture capital group named Juxtapose and they're in that incubation stage of trying to find great ideas where there's maybe a hole in an industry, and so the hole that they found with 10 was one urban core, most of the large DSOs and steered away from going into the major metropolitan areas, and for a lot of good reasons more expensive real estate, more expensive labor, higher churn of labor, higher churn of patients. So there's some challenges that come with it, but they thought there was an opportunity there that was differentiated. The second piece was service, and experience wasn't something that you think about when you think of going to the dentist, and so they wanted to create a differentiated experience that really made people look forward to going to the dentist. And the last piece was tech. Innovation was also something that was not synonymous with dentistry, and so we wanted to have a very tech forward experience in going to the dentist. So you fast forward.
Speaker 1:Now we're six years since opening and we've really accomplished a bunch of things that we're really proud of. One is that we've got 28 locations that we started from the ground up. We're probably got the most tech forward dental group everything booking and scheduling online through our app. It's a proprietary app that we built from the ground up, fully integrated with our scheduling system, so that you can book, change appointments, view your medical records all of that online from anywhere that you're at. So the tech piece was important. But we did a bunch of research in the early days with consumers to find out what didn't they like about going to the dentist, and so we heard everything from the anesthetic smell when you walk into dental clinic.
Speaker 2:Like just reminds them of I don't know pain or something like that.
Speaker 1:Yeah, exactly, you already start feeling. Your mouth starts immediately when you get that smell. So we put infusers throughout the facility to be able to have it smell more minty, fresh and not that anesthetic dental smell or other things. That people talked about was the awkward conversations with the hygienist when you've got instruments in your mouth. Have you ever laid back in the chair and they ask you a question? You're you just, you can't talk like that. It's just this weird thing. So we wanted to have something that was different. So we put noise canceling headphones. All of our patients get noise canceling headphones and on our app they schedule which television show they want to watch, and so we've got televisions on the ceilings and the streets.
Speaker 2:So you lay back, you listen. You could be watching Squid Games too. When you're getting your teeth operated on, you watch.
Speaker 1:Squid Games and enjoy getting your dental done Hopefully something more calming and relaxing than Squid Games, but absolutely so it was. And the other things, like the noises that you hear drilling might be down the hallway. So again, noise canceling had to help with that. So it was taking issues like those and trying to solve for them in our process and make it easier. Longer hours of operations in our more mature sites we're open 7am to 7pm. We have Saturday hours, so we want to make it convenient to go to the dentist. With this whole goal of making dental more accessible, we want people to come to the dentist who don't normally go to the dentist. So our largest portion of our patients are people who hadn't been to the dentist in the last anywhere from two to three years and we're bringing them back into good oral health.
Speaker 2:How did you get them? Was that the real estate selection component of it, or was there marketing outreach?
Speaker 1:Yes, it's all the above. Certainly, we're very active on social media Instagram, tiktok. We've really embraced being very forward and present in social media, maybe more than most dental groups are.
Speaker 2:What's your handle? Just Tens Dental or something.
Speaker 1:Yeah, it's HelloTen.
Speaker 2:HelloTen, Okay cool.
Speaker 1:Yeah, and so that's been a big focus, but also our real estate Going urban core. We've located in some of the busiest, most metropolitan areas in each of the major cities. So major cities that we're in, it's Atlanta, boston, new York, washington DC and then Nashville and so we go into some of the coolest areas in those markets and we get roadside frontage in those areas. So in places like New York, we look at foot traffic in front of the spaces that we're at and so we're in high foot traffic areas where people see us and our signage and our building, which is very inviting, tends to be something that draws people in. So we get a good amount of walking customers, but we also get people feel like I see you everywhere in the city and we might only have eight or nine locations in that particular market, but they are prominent enough that they feel like they see us everywhere, and that helps quite a bit too.
Speaker 2:Yeah, that's good. Yeah, because I know a retail location in New York City is among the most expensive rent that you could possibly pay, and we always coach our clients on this too. But like, view rent as a factor of marketing. Right, you can a lot of times offset what you're going to pay in marketing by having a good, prominent location that just gets a ton of eyeballs all the time. So I guess that and we don't really work in downtown New York or Manhattan, that's a little bit outside of our niche, but it sounds like it's working in that metro as well.
Speaker 1:It is, and I agree with you. I think it is part of our marketing. Think about if you were going to get a billboard in New York and how much you'd pay for that. We've got our billboard right at each of our locations, that's waving customers in, so it's-.
Speaker 2:What is the rent per square foot? Are you allowed to talk about that?
Speaker 1:Yeah, look, it varies. I think you can get rents in New York or anywhere from $80 to $200 per square foot. Yeah, $200 is nuts.
Speaker 2:It's hard with healthcare because with a restaurant, a retail store, obviously people can come in on a whim and buy whatever. But yeah, healthcare you're oftentimes a little bit capped, even by maybe your insurance reimbursements or whatever. It's hard to make those worries but it sounds like it's working in your case.
Speaker 1:Yeah, what you get and the trade-off that you get by being in the big cities. You get huge populations within a 10 minute walking distance. When we look at real estate, we're looking at walking distance in places like New York of how many people are in that market, and so when you can have a hundred thousand people sitting within a 10 minute walking distance in places like New York of how many people are in that market, and so when you can have 100,000, people sitting within a 10 minute walking distance.
Speaker 1:It gives you a lot of access for potential patients, or we call them members at 10. So it works out well for us. And so your trade-off is you've got to be highly efficient in your space so there's no wasted square footage, because every inch matters when you're paying the higher rates. But you also expand your hours of operation so you can have more time caring for patients in those studios than you might where you're operating a typical nine to five dental office. We expand those hours to be able to make sure we're able to keep busier in those sites during longer hours, which allows us greater throughput in our sites. Our average location does about three times what a typical dental office does from a revenue standpoint, so that gives us a leg up to be able to help pay for some of the more expensive things.
Speaker 2:Is that because the extra hours, or do you do extra associates, or are you able to be more efficient with your time? Because there's like they're booking online and maybe, I don't know, like having to interact less with the front desk staff?
Speaker 1:It's all of the above so we make it really easy for patients. So 95% of our new patients book online, so they go directly through the app or through our website, and so we make it super simple to book.
Speaker 2:Is that software you guys developed?
Speaker 1:in-house it is. We made a lot of front-end investments in the software side to be able to help position us for where we are now. So that's why we're excited about growth, because we've got this great engine to be able to power ourselves. That can scale significantly, so that's why we're focused on growth right now.
Speaker 2:I love it. This one of your, it sounds like one of your, I don't know. Trip wires would be like you have your social media presence and then if they click on your link then it's just real easy for them. They don't call anybody, it's just really easy for them to go and book. Yeah, it's crazy how difficult it is in a lot of health care to like just get appointments, and I think there was this mentality maybe that if you were booked out really far in advance, then it made you seem like you're busy, like, like successful, and so it's like scarcity. Oh, sorry, I can't take any new patients this month and it's, yeah, I think you're successful, but I'm frustrated. Right, I don't want to wait, even if it's like a couple weeks. Is that kind of? Am I thinking on the right track here?
Speaker 1:Like, exactly so we do a bunch of analytics around this. I'll share too much details of it, but I'll give you a little taste. 54% of our patients book one week or less. Patients book one week or less for their new patients.
Speaker 2:That's about how much patients I have too.
Speaker 1:And so if we had a four week waiting list, many of those people who book a week out. They just go find someone else who had availability.
Speaker 1:So we really focus on creating availability in our schedule in the near term for patients, so they get a little bit more of that instinct, gratification Look, you want to book your appointment, you want to get in, you want to get your teeth cleaned. It feels great. And we're focused on doing some other verticals within our dental sector right now. So we do a lot of whitening. We partner with a group called Zoom, which is the best in class whitening, and so that's worked really well and the results are just fantastic. I was in one of our studios yesterday and our studio manager said she just did the whitening program. It was unbelievable. I was seven shades lighter immediately afterwards, I know. And zoom zoom's really nice. It doesn't give you that hypersensitive.
Speaker 2:Yeah, like I've whitened my teeth and gosh, it's painful. Man, I buy you. Buy that. What did the at-home? Or I couldn't even really even imagine sitting there for those hours. But like I couldn't, I didn't drink everything through a straw, like the slightest temperature change or like it was so painful, so what?
Speaker 1:Yeah, 70 minutes and you're. I think it guarantees you at least five shades lighter, but we see results that are better than that. It uses both a combination of chemical but also light to be able to whiten the teeth, and it's all done in the chair, in the office. 70 minutes and you're done. And again, you don't have that sensitivity. I see you licking your teeth now. We're just talking about it.
Speaker 2:I know I'm like I wanna wipe off all the coffee I drank.
Speaker 1:No, so that's great. We're also doing some innovative work. Again, if we're going to be on the front edge of technology which we're focused on, we're trying to do some interesting items like 3D printing so that we're able to get patients things like night guards or even their crowns same day, which is very different, it's new and the technology is moving incredibly fast, so we're excited about that. Other items we're doing we're doing AI imaging, directly focused on x-rays, and so we get an AI overlay for x-rays, so it looks at the x-rays and gives a readout of what the x-ray is saying, based on it reviewing literally millions of different x-rays, and it helps our dentists be more efficient and to hone in on the problems faster, but it also helps them find lesions that they might miss. Again, I think the industry research is dentists miss about 20% of the lesions, so this helps not missing any of those, and then you can do interventions earlier. So all those are helping us being able to grow in a nice way.
Speaker 2:Okay, and so when you, when people do acquisitions, there's a whole. It's a whole different doctor partnership model than when you're doing de novos. So how do you guys structure partnering with doctors?
Speaker 1:Yeah, so so we've got a really innovative model. It's similar to what I've used in my prior physical therapy world where we partner directly with dentists at the startup of a location. So, as we're doing a de novo, they can partner directly and as our equity partners, and it's really changed the game. There's very few organizations who are doing something like that and we feel like this model is, and most of those organizations have a lot of strings in those partnerships. Ours is super clean, super easy. I've got again probably two 300 clinicians I've worked with in the past who've done those type of partnerships, so we're excited about that.
Speaker 2:In your previous roles.
Speaker 1:In my previous roles. Yeah, so this will be it's new to the dental world and the initial interest in it from our dentist is incredible.
Speaker 1:And it gives them the plan, yeah, so I'll give you a little bit. So look, it takes a lot. It's a different type of person who's willing to go take a second mortgage out on their house and go hang a shingle up and deal with all the billing, all the other aspects of starting up your own practice. There are certainly dentists out there who are willing to take that risk, but there's a relatively smaller number than the overall number of dentists. But there's a very large number of dentists who are interested in ownership and this gives a path to be able to partner with us. We're true equity partners in the business where they'll own anywhere between, let's say, 10 and 20% of the business. They put in real cash on the front end and then we're their partners. We put in cash, we start up the business, but you get all the resources that we have behind us, all of our billing collections, all of our payer relationships and is it optional?
Speaker 1:It is absolutely optional. So we're setting up so it's their option to be able to partner in on the business. They do not have to partner. We have a bunch of sites that don't have any partners in them at all.
Speaker 2:And they're partnering on the practice level or the corporate level, or how?
Speaker 1:does that work? They partner at the MSO level in dental organizations. You have to have a site level partner in all of the locations. That's part of the regulations of corporate practice of medicine and then and so we have that in all of our locations and then you can also have a business partner at the MSO level. We've got MSO set up for each of our markets and that's typical in the DSO business.
Speaker 2:So when you say MSO, you were talking about like a medical support organization or like a Metro. What do you mean exactly when you say MSO?
Speaker 1:Yeah, so MSO DSO can be used interchangeably. The dental service organization provides all the back office support, so everything that doesn't deal with clinical care. Dentists need to own dental sites and they own the locations where all the care is provided and they contract with a separate organization to come in and provide all the back office support and that's where the DSO comes in. So we give the dentists the opportunity to invest in the DSO part of the business.
Speaker 2:Okay, that makes sense. Yeah, so I think that's a better deal for them. Really, it's like there's trade-offs, of course, but then maybe because maybe I'm slow, but it took me a little while to wrap my head around this, but the concept is essentially right now you have 28 locations. There's a certain amount of shares. Each share is worth a certain dollar amount. When you add a new location, you're bringing in money, so you would increase the total number of shares outstanding. Is that right? You keep the share price the same, or how does that work?
Speaker 1:Nope, it's a good question. So it's a little different than that. We create our own separate LLC or PLLC for each location. So they partner in their individual location, not in necessarily in the top co. So they get to participate at the local level, which is where they can have the most impact.
Speaker 2:Okay, yeah, I think there's trade-offs to both ways. All right, yeah, so they're more direct. They benefit more directly from the efforts that they put in you better believe it. You better believe they've got control over the business that they're running, operating and treating them okay, okay and yeah, like just maybe one more question that I've been thinking about that might help people is just like your biggest lesson that you learned in your background that you're able to bring over into the dental space.
Speaker 1:Yeah, it's a great question. Look, I've been so fortunate. I have so many great mentors and people that I've learned from over the years. Let's say one that's more recent and it's around people, and particularly as a CEO, you've got to make sure you have the right team in place and the right people on your team to be able to execute on the vision and mission of the organization. We had to get the right people in place at 10. I feel like I've got a phenomenal team right now that's really ready to get after it, and I think one of the pieces that I've learned is always move faster. You never talk to somebody who says I wish I moved slower on getting the right people in place, and so if you think you've got a problem or challenge, the likelihood is you likely do and make the moves. The sooner you do, the sooner you'll be able to get stability and get the right people working alongside you to be able to grow the business.
Speaker 2:Yeah, that's good. So, on that note, how do you balance micromanagement versus holding people accountable? Because I'm part of this program. It's called Strategic Coach and it talks a lot about having a self-managing company, which is you put the right people on the seats in the bus and then you just let them go. But if you don't have any forms of accountability, you don't know if they're the right people right, and then you want to, I think, as the founder, the CEO or the entrepreneur, then we have tendencies to dive in and essentially fix the problems that we see. But then the employees interpret that as micromanaging, which maybe it is right.
Speaker 2:Because I'll just give you my personal experience, like whether it was in the gym space or the short-term rental space or the real estate space, like I always had a tendency to macro manage, like too much. So it was like, hey, here's the roles and responsibility, these are the results I want, okay, go, and I just let them. I let them off, and then I was always disappointed at the lack of results that I would see, because I wasn't clear enough. Obviously there was something on my part. So then I would come back in and then I would try and fix these problems and I try and hold them more accountable. And then they're like, oh, you're micromanaging me and I was like, no, I'm holding you accountable, but I think it's a really and there's no one right, particular way to do this. But I'm curious how you guys handle this issue.
Speaker 1:Yeah, I know it's great. And look, when you talk about that, there's an old quote that resonates for me. It's mostly attributed to Patton and it says don't tell your men what to do. Tell them what needs to be done and let them amaze you with the results. And I caveat with maybe an old Reaganism of trust. But verify evidences, for what data you review, what are the KPIs you'll review and when you'll review them is so important, and so having that operating rhythm is vital to any organization to make sure that you're trusting but you're also verifying that the work's being done.
Speaker 1:We use a system called Objectives and Key Results, so OKRs. It was made famous out in the tech industry, out in California, where you set organizational wide objectives and then there's key results that will drive those objectives and then they cascade down through the organization where your key results become the next group below you's objectives and on down the line. So everybody's working for this combined focus on results so you're able to really track what you're trying to achieve and you're doing it and you're all doing it together. So it creates great organizational alignment.
Speaker 1:When you're trying to build a company culture and you talk about these micromanagement cultures, you want to have some common language that you're all speaking between yourselves. So this creates that common language, and you set up your systems for review behind that, so you have your regular OKR reviews where you're making sure that you're making the progress and if you're not, you adjust and modify, because sometimes your first or second tactic doesn't work. You've got to be able to change that, and the only way you're able to do that is if you're looking at the business from a KPI standpoint I always say financials. If you're managing by your financials, you're looking in the rear view mirror.
Speaker 1:You wouldn't drive by looking in the rear view mirror. So you've got to have your KPIs that are predictive and really focused on your lead measures. That will drive the results.
Speaker 2:Do you have any specifics, like any of your direct reports, like what your any KPIs you can share and what your communication cadence looks like?
Speaker 1:Yeah, so a great one that we look at is a forward-looking utilization percent. So we look at the six weeks out of schedule utilization for our dentist and our hygienist so we're able to see are their schedules busy and that helps inform our marketing team of whether they're turning the marketing spend up or down. So if you look in four weeks out there's no appointments available, then we know we've got to focus on recruiting to be able to get people in there to be able to support that location. Or if there's a bunch of holes, then we've got to focus on marketing and business development to make sure we have the patients in there to fill the schedule. So that forward looking ahead those lead measures helps us be able to manage the business better and optimize each of our locations.
Speaker 2:Okay, and like, how often do you personally meet with your direct reports?
Speaker 1:We meet. We have a weekly one-on-one with each of my direct reports, and then we have a weekly team meetingon-one with each of my direct reports, and then we have a weekly team meeting where we're all meeting together every week.
Speaker 1:And then we talk almost daily I'll pick up the phone and call, or they'll pick up the phone and call me. So I think there's a value in that, because when you're in a distributed model where everybody's in different places, I think there's this old school of sitting down the hall from people and there's a benefit to that. I feel like I'm sitting down the hall from the people I work with because I can just call them. So, rather than getting up from my chair and walking down the hall and talking with them, I call them and talk to them like they were sitting in the office down the hallway. And so we don't feel, although we're in a bunch of different states for each of our leaders, we don't feel disconnected because we're really close together on each of the items we're working on.
Speaker 2:I know Jocko Willink says you can only really have like about six direct reports. Do you guys feel like that's accurate?
Speaker 1:Yeah, I might stretch a little bit from there. I think somewhere. I think that the standards are somewhere around eight. I think once you start getting above eight to 10 direct reports, you get the law of diminishing returns. You're just not giving the attention that you need to each of the individuals. So I think structuring your org to cap out somewhere around eight is probably a good focus.
Speaker 2:I love it. And then OKRs. It sounds a little bit like traction. Is that the EOS? Is it similar to that?
Speaker 1:Yeah, it is. It's similar to that. This came out of Intel and Andy Grover had developed this while he was there. It was his system and there's been several who've come out. There's a great book called Measure what Matters. That really walks through OKRs and how they transformed everything from IT businesses, but also Rock Group. U2 was real famous for using OKRs for their growth and how they looked at themselves as a business, so it really aligned. The key part for OKRs is it aligns the entire organization around just a few key objectives and then everybody's working towards it and you say, yeah, yeah, but everybody has objectives, but the way we focus on them is their stretch objectives. If you're hitting 80 of your okrs, you're doing great. If you're hitting 100 of your okrs, you fail you don't?
Speaker 2:yeah, you need to stretch.
Speaker 1:You didn't put stretch in it, and so that's the part of it that I think is a little bit different.
Speaker 2:And then just we hit about half, so we're definitely not too easy. We got a lot of room to improve.
Speaker 1:But then you're thinking you're getting stretched and one of the other key components is you don't set your OKRs up as your objectives for how you do performance reviews. Because once you tie it to performance reviews, then all of a sudden people are going to start getting more conservative with how stretched they sit in there because they don't want to come back on them if they miss their goal.
Speaker 2:Yeah, yeah, yeah, yeah, yeah, Okay, great, is there anything that you want to talk about that we maybe didn't get a chance to talk about so far?
Speaker 1:No, this has been great. Look, we're excited about what we're building. We think we're doing something different and I'm just really proud of the impact we're having on people's lives. I get fortunate enough to get a report every week of all of our net promoter score reviews. We ask for a review from every patient and the stories you hear in there about how fearful they were coming into the dentist and how great the experience is and I think 30 or 40% of the reviews call out an individual provider's name. So it's a coin of pride for me to know that we're doing such good for so many people and we just wanted to do that for more people.
Speaker 2:I love it. I love it. What's a good resource for people to reach out and learn more? You?
Speaker 1:can find us at hellotendcom. We've got a great site and you can book directly online there. We keep our appointments available almost immediately because we know you've got urgency to get in and we want to be able to take care of you.
Speaker 2:I love it. Thanks, man.
Speaker 1:All right. Thanks so much, Austin. Great talking with you.
Speaker 3:If you need help finding the perfect location for your practice or you're ready to invest in commercial real estate, email us podcast at leadersreecom R-E, as in realestatecom, or go to leadersreecom and fill out our form. See you next time.