Helping Healthcare Scale
Imagine you're friends with multiple CEO's of billion dollar organizations. You can call them anytime you like and ask them all that they've learned about real estate and investing, including some of their biggest mistakes.
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Helping Healthcare Scale
Beyond Burnout: Transforming Healthcare Practices into Thriving Businesses
Dr. Kevin Kremer reveals his powerful "Three C's" framework—Customer, Culture, and Company—that drives success in healthcare practices. As the visionary behind Kremer Dental Care, New Smile Now, and the Kremer Leadership Institute, and author of "Quantum Accountability," Dr. Kremer shares proven strategies that have turned struggling practices into thriving businesses.
The customer experience hinges on seemingly small but crucial details – like the 10-foot rule of acknowledgment, proper handoffs between team members, and ensuring patients are never left unattended during their visit. These service elements create the foundation for practice loyalty and growth.
Building a thriving culture means creating an environment where change is embraced rather than feared. Dr. Kremer details his systematic approach to team management through weekly check-ins between leads and team members, establishing regular feedback loops that prevent burnout and enhance performance. This democratic approach ensures team members feel heard while maintaining clear direction.
Perhaps most revealing is Dr. Kremer's discussion of financial health through comprehensive KPI tracking. He shares the remarkable story of a burned-out dentist making under $70,000 despite working four days weekly, whose income tripled after implementing proper business systems while simultaneously improving patient care.
Beyond practice management, Dr. Kremer introduces the concept of "mental obesity" – how our minds are becoming overwhelmed by digital stimulation just as our bodies struggle with processed foods. The constant dopamine hits from smartphones and social media create addiction patterns that directly impact our productivity and happiness. His practical approach to implementing technology "guardrails" offers a path to reclaiming mental wellness.
Ready to transform your practice through accountability and strategic implementation? Connect with Dr. Kremer at kevin@kremerleadership.com or through his social media channels to discover how these principles can create sustainable success in your healthcare business.
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Our success level is a result of the value that we provide to society. So if someone's worth a billion dollars and we have a mindset oh my gosh, that's ridiculous, that's way too much. How could anybody ever do anything with that amount of money? We should take money from them and give it to the poor people that need it, or this or that. Well, that all sounds great and is wonderful and compassionate, yet it's also not a positive mindset, because that person that is worth a billion dollars provided enough value that the world saw that they were worth that amount, so they did something there. And so this book is about how we develop our mindset and our thought processes, and who we become in here determines what we choose to do, the action steps we take in life. That then determines the success we have. So it really starts with us working on us.
Speaker 2: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 3:Hello, welcome back to Helping Healthcare Scale. I'm Austin Hare and today I'd like to welcome our guest, dr Kevin Kramer. He's the founder of Kramer Dental Care, founder of New Smile Now and the CEO and founder of Kramer Leadership Institute, where they talk about a lot of topics in his book Quantum Accountability, which is also an Amazon bestseller. So, dr Kramer, thanks for coming on the show.
Speaker 1:Thanks for having me, Austin. It's great to be here.
Speaker 3:Well, there's a lot to talk about today. I mean, your book is just chock full of knowledge. But maybe, quickly, if you can kind of explain to people how did you get into dentistry and like, how did it lead you on this path of being, you know, a leader, an author, ceo of different types of you know?
Speaker 1:masterminds and companies. Well, I think, for me, dentistry like a lot of us, I'm a product of my surroundings and my environment and I grew up in dentistry and my family was in dentistry. And you know, I didn't know that's what I wanted to do going away to college and whatnot. But I knew that I liked health sciences. I knew I liked a type of industry or work where I could provide and give back to people and I chose dentistry because of that combination of art and science, as well as the ability to be your own boss and kind of run your own business. So it's for those reasons that I went into dentistry. And as the career progresses, you know you learn things along the way, you figure out what makes you successful and then you get to the point where you want to kind of give back and contribute and help others on their way.
Speaker 3:Yeah, that's cool. So on that note, you know one of the things we're talking about off camera is just the three C's that you know to run a successful dental practice. So maybe explain to those listening what those are and let's kind of dive in.
Speaker 1:Yeah. So when I talk about success in a dental practice, the three C's are the customer, the culture and the company. And so we want to make sure we're taking good care of our customer. I mean, that's basic tenet of business, right when we want our customers coming back. We want repeat business, so we want to be making sure they're having a positive experience through how we interact with them, as well as being a good clinician, and making sure they're having a positive experience through how we interact with them as well as being a good clinician and making sure it's a comfortable thing when you're talking about dentistry. And then the culture is the team. It's the employees, it's the people that help us.
Speaker 1:I don't know many people that want to do it alone when it comes to something like dentistry. So having a good, healthy culture and good team is important. And then the third C is the company, and you know what I talk about is sometimes in a single practice, a small mom and pop shop, they'll provide great, great service, they've got a good team, but the company's suffering and they're not really paying attention to the bottom line, and I've seen a lot of dentists who want to sell their practice and they're making less than their assistant or they're making less than their hygienist and it's just. It's just kind of the way it is. So. And then I've seen the other extreme where a DSO is so focused on the numbers and the bottom line they the and the company they lose sight of the culture or the customer service, and so that fades over time. So I think really having a good balance and looking at all components and making sure that all three are winning is the real sweet spot in dentistry. Okay.
Speaker 3:So maybe we'll dive in a little bit on each one of these customer service culture, company. Do you have an example, and even if you have a story, that'd be best. But like in terms of customer service, like what would be considered bad customer service, what would be considered good customer service, and any examples that you can provide would be great.
Speaker 1:Yeah, you know it's changed so much in the last five years. It's kind of interesting in having perspective and you know that's where wisdom comes in. When you've been doing something for more than a couple of decades is, I think sometimes what we think of is as common sense is something that we've learned along the way. That's not very common and you have to train your team. For example, sometimes some of the younger generation with technology doesn't even recognize, like, for example, a 10-foot rule in a company where if someone is within 10 feet of you, you look up and you make eye contact and you acknowledge them. So if you are working at a front desk position and you're on the phone and someone walks up, a physical person in front of you in the office is more important than something on technology or somebody on the phone. Doesn't mean you hang up the phone but you look up and you acknowledge and you make a gesture. So an example is some people maybe don't know that and know that hey, we want to show somebody that we're present and we're here. So simple things like making eye contact or hey, how are you today is great customer service.
Speaker 1:The other thing we talk a lot about in our company is. An ideal level of customer service is no customer. We call them guests in our company, following a Rich Carlton approach. But no guest is left stranded. So we want to escort someone wherever they go, throughout the experience or throughout the visit. So if their customer journey is an experience, then somebody is escorting them through that and then we have a good handoff from one person to the next. So if we're working on them clinically and the dental assistant is finishing up and escorting that guest to the front desk scheduling coordinator, there would be a good verbal handoff explaining who the person is, what was done and what their next step is and then letting that guest or customer know that hey, sally is going to take great care of you. You're in good hands. It was great to see you Having those little verbal handoffs can be huge in customer service.
Speaker 3:Yeah, is that something that you have visually drawn out for the team to see anywhere, like a customer success journey, anything like that, like how do you coach that?
Speaker 1:Yeah, so we have training videos and we model that. And then we have regular team trainings where we have team meetings, where we devote time to addressing the different components of the customer journey or the guest experience and what good customer service is, and so, yes, it's all modeled through that.
Speaker 3:Okay, Well, let's talk culture. Like what would you say? I mean? Because the thing about culture is everybody has culture, right, it's just you have good culture, you have bad culture. A lot of times, culture is simply what's inherited from the founder that may or may not be verbalized or written down anywhere. So you know again, like maybe, if you have examples of bad culture and examples of good culture, anything that might have been not intuitive to you, that you learned along the way, I think would be helpful.
Speaker 1:Culture is tricky. I mean it's all tricky, and I think in dentistry in particular, in healthcare, sometimes a good culture is perceived as a team that has been around for a while. Fear of change, and people in generally are so afraid of change that it's hard to instill a sense of growth in team members. And so a healthy culture is training teams and empowering them on the value of growth and constantly providing more value and doing a better job for the team. So an example is like we want the team to understand that we're going to be updating technology as time goes on and we're going to have to learn new things.
Speaker 1:We're now 3D printing things and milling things that we weren't doing five, 10 years ago. We've gone from using putty material to 3D imaging, and so having a team and a culture of embracing change and embracing growth is important. But it's also important to make sure that your team's feeling heard and making sure that the team understands that they're part of the decision, that it's a democracy, it's not a monarchy, it's not a dictatorship, and so we want to have regular check-ins with our team members. We want to have team members having a lead, where there is a lead person that is checking in with three to no more than seven people every week and making sure that they're feeling heard, that any issues they have are being brought up and they're that happens every week.
Speaker 3:There's a feedback loop every week yeah, wow yeah, we hear about it happening this is this is not an hour-long meeting, it's five minutes, 10 minutes, like hey, how's everything going?
Speaker 1:How's your week been? Is there anything that you know that is a pain point or a friction point, anything we need to address, are there any issues? And having a cadence of people being able to verbalize things, putting it down on a written issues list and then having other meetings where we all get together and we go through those issues and address those and making sure we're coming up with solutions. So the team feels like they're a part of coming up with issues, but they're also part of the change and the coming up with the solutions and solving problems.
Speaker 3:Yeah, because I've heard about it. You know, quarterly, right, I guess maybe that's the minimum, and then even monthly seems quite a lot, but I guess, to your point, if you're doing this weekly, so then let's talk about. I like to use the teams of three to seven, or really rather report like one person gets reports from like three to seven people, because any more than that it just gets like unmanageable. Have you read Extreme Ownership by Jocko Willick? Yeah, yeah, he, he maxes that, that out at about six. So in your organization, like how does that, how does that look? You've got, I guess you've got, you know, your lower, lowest level, maybe the admins, whatever. There's three to seven of those and there's going to be somebody who's getting feedback from them and managing them. But then somebody is going to be managing them, right, so, and then I guess there's weekly feedback loops all the way down the organization.
Speaker 1:Yeah, so in healthcare there's usually a clinical team and an admin team. So our admin team will have, like schedulers, treatment coordinators, financial coordinators, office manager and sometimes, underneath the office manager, will have a front office leader and admin lead. I like to not use the term, which can be very common at front office and back office, because it creates this separation and that's a common divisive situation in dentistry.
Speaker 1:So if we have an administrative team and a clinical team, in the clinical team we'll have a clinical lead and then in the administrative team we'll have an office manager and an admin lead. So the team will have a clinical lead and then in the admin administrative team we'll have an office manager and an admin lead. So the team will report to the lead and the leads will report to the office manager and then I'll usually have a hygiene lead and then at the different locations we'll have a lead doctor as well.
Speaker 3:Yeah, perfect, okay. Well, let's move on to company health, or health of the company, right? Just from what you're saying, I'm sure it has a lot to do with managing your P&L, right? Well, I?
Speaker 1:mean our KPIs that we've created. Look at, I mean, from the very beginning. You've got the marketing right and then you've got the online reputation. As part of that is what kind of reviews and what are your rankings coming in, how many new five-star reviews and what's going on there On your marketing, what are the different measures, different areas you're marketing, how much you're spending, what the ROI is not only the number of patients but the accepted treatment on that. So you've got the marketing, the online reputation. Then we're looking at HR. We're looking at the longevity index of employees and team members and we're looking at making sure that they are up to par on their longer-term meetings, like their quarterlies and whatnot. And then we have operational metrics that are in regards to utilization rates of the chair, doctor, hygiene, production, production by procedure. And then we have finance numbers that are more traditional KPI of looking at the overhead and EBITDA and that operating income. So we do a monthly KPI meeting with our management team and we look at all of those areas of the company and different metrics.
Speaker 3:So do you have any stories, maybe of groups that you've worked with or even within your own organization? Like again, what was bad company? Bad company health? I mean, you mentioned a person who had a. I think he said his admin or his hygienist was making more than him as the owner of the company. What were they doing wrong?
Speaker 1:well, it's interesting because you know, I used to look at dental practices in the 90s. So we're looking, we're going on 30 years ago or 25 years ago and a lot of dental practices on the market would be, say, making doing $700,000, $800,000, $900,000 a million a year, top line. 30 years later I'm seeing the same trend and those single mom and pop shop practices. It could be a good clinician, but sometimes those dentists aren't very good business people to where they're not managing and looking at their numbers and their overhead. So the story would be I had one dentist that he reached out to his supply rep and said, hey, I kind of think I need some help here. I'm just kind of the biggest thing that doctors come to me for is they're burnt out on managing their team or their staff. You know, and it's the people problems and I think that's anywhere in the business world is managing people's the hardest thing and the most challenging. So this one doc came to his supply rep and said, yeah, you know, I think I need some help, I'm just burnt out. And so the supply rep introduced him to me and we met and we aligned on our clinical values and our company values and so we acquired his practice and when I looked at his practice he was making less than $70,000 a year and he was working four days a week and he was burnt out and he was churning and burning.
Speaker 1:And so you get to a point where you're paying all the supplies and expenses and the team and doing all the stuff and going through all the motions, but then if you stop and really drill down and look at the bottom line, wow, there's really nothing there.
Speaker 1:So a lot of these doctors they're not paying themselves as a producer a percentage of revenue, base pay, like we do associates. And so once they start paying them as a producer and they can see, okay, this is what I get paid as a doctor, and then they can say, okay, as an owner, this is what's left. His story and some of the other doctor practices I look at is there's nothing left, you know. So there's just not a whole lot there. And so he came into our company and in the first year working with us he made three times more than what he did on his own and his patients were better served, his team was better taken care of. So it's like we created that win-win-win between the culture, the customer and the company by just measuring things, having conversations, looking at everything and seeing where we can create those winnings.
Speaker 3:Do you remember? In that case? I mean, going at 3x in your income is a lot and you went from 70 to around 210, 200, it sounds like. Was there anything specific that you did? Was there, just like I don't know, were the expenses out of control? Did you just go through and kind of figure out a lot of these expenses that you could eliminate? Was there anything that stands out to you?
Speaker 1:Yeah, we got pulled him away from the administrative and let him focus just on clinical so he could do good clinical days, and so we built up his production as a result and this was in a very healthy, sustainable level. But before, because he was wearing both an owner and clinician hat at the same time, he wasn't separating that out well to where his clinical days could be really dedicated to quality patient care.
Speaker 3:Well, yeah, fascinating. Okay, let's talk about quantum accountability. The book you wrote, you know, is not just about dentistry, it's about business in general, because there is a lot of overlaps. I think when you take out the chair side part of the of the business operations, it's just a regular business. You know, there's so many things that all businesses have that run in parallel. Whether you're healthcare or not healthcare, you know dentistry or optometry, right, there's just a lot of things that that run parallel. So what is like, what was the motivation behind quantum accountability? And like what do you think are some of the most important principles?
Speaker 1:Yeah, you know quantum accountability the motivation is about. You get to a point in your career and you look at where things are and you change how you evaluate things. You change how you measure things. So I started measuring things based upon impact score, meaning how could I provide a greater impact to the world with what I know and what I do? And not that, you know, there's anything magical about it, but it's just that if there's some knowledge I have that I could help others with, then getting it out there. And you know the old adage if you, if you positively touch one person or have a positive impact on someone else, then it's a worthwhile difference, you know.
Speaker 1:And so as the career developed, the impact was having additional locations, having more doctors and more team members and providing more patient visits on a local bricks and mortar level. And then, as that grew, it's like, well, people were asking me to go out and speak and lecture, and I was at a point where it's like, oh, I don't really want to go out and be out on the road. This is when the kids were a little younger. So it's like, okay, how could I provide an impact? And that's changed now, and now I'm to a point where I'm willing to go out and help people and go speak, and so the book came from, looking at the foundational tenets of success that are often missed.
Speaker 1:And when I went to write it, I realized, even though I'm a practicing dentist, more than that, I'm a leader and a business owner, and all of these tenets, they interact across all businesses and the tenant is the accountability, meaning as a person, we have to take accountability for our results and what we're going to do in life.
Speaker 1:No one's going to do it for us, and I think that sometimes people get lost along the way and I think, like when we get too much stimulus and this or that, a result of the value that we provide to society. So if someone's worth a billion dollars and we have a mindset oh my gosh, that's ridiculous, that's way too much. How could anybody ever do anything with that amount of money? We should take money from them and give it to the poor people that need it, or this or that. Well, that all sounds great and is wonderful and compassionate, yet it's also not a positive mindset, because that person that is worth a billion dollars provided enough value that the world saw that they were worth that amount, so they did something there, and so this book is about how we develop our mindset and our thought processes, and who we become in here determines what we choose to do, the action steps we take in life. That then determines the success we have. So it really starts with us working on us.
Speaker 3:Yeah, I think the changes over the last couple decades have been significant because of the iPhone, like we're talking about, you know. I think like there is a thing about human nature that doesn't change like the older generation always thinks the younger generation is slacking right, so that's something that is just you can read about it in papers from a hundred years ago, but there's definitely something to be said that, like you know, talking about seeing money that people make that they don't deserve, like we, what I think the biggest problem with social media is that it just is a window to compare yourself to everybody instantaneously. Like we've never been able to compare to so many different people so frequently, so easily, and so, yeah, it absolutely gives you. I mean that you know it's no secret that deaths of despair and are of like addictions are up, suicides are up, depression is up, mental illness is up. You know we weren't really meant to like interact with this many people, you know, and it is fun and it's, like you know I'm all about the free market and like letting the market kind of decide, but at the same time, like there's some serious trade-offs that happen and so, like the iphone was invented in 2007, that we have less than 20 years of data, like on how this long term affects you. And it's really. It's not like the iphone's I mean a lot of. It is just social media apps that are literally designed to use the algorithm to give you dopamine hits, the same way that they get you addicted to gambling. Like the same type of research that's gone into casinos and slot machines in vegas to keep people hooked right and get them addicted. It's that same type of thing. So we are competing against that.
Speaker 3:And it's like I mean, even on that note, even like the stuff in our food, right, like they're putting stuff in your food to keep you addicted to food. That's like not really healthy at all. So what does that do? Well, that's going to zap your energy. That's not going to make you motivated, right. So you eat crap. You feel terrible. You combine that with, like, comparing yourself to others who have more than you, and you constantly feel worse than them. So you've really got to balance.
Speaker 3:I like your mental, your mental health really is what it comes down to, right? And then to your point. I think that's going to ultimately motivate you to do better. Maybe put some guardrails up, which is a hard thing to do but like, and then you can start to take steps for yourself. That gets you like hey, we looked at you, know, you mentioned a billionaire. Like, maybe your goal is going to be a billionaire, but maybe you want to be more successful than you are now.
Speaker 3:It's like there's such a tendency to just, yeah, use Instagram, complain about what you have and then be miserable versus like, no, like I want to take agency over my life and I want to take steps towards getting there. There's a quote that I heard from Chris Williamson that I really like. He's like there's two men on the ladder. One is that one rung away from the top, one is one rung away from the bottom. Who do you want to be? The answer is whichever one is moving up, you know, because it doesn't matter where you are, it matters the direction that you're going. So I don't know, maybe that's a little bit of a tangent, but are those kind of some of the things that you address in the book too?
Speaker 1:Yeah, in the book we go through breaking down. You know where our mindset comes from and how we build that and how we nurture that, and I talk about a lot of mental wellness and different techniques to really work on self-care. Unhealthy and being modified and this huge obesity physically that came about because of the food that we were feeding our body. So as a dentist, I know very firsthand that what we put in our mouth goes into our body and impacts whether we're 30 pounds overweight or not, and what I talk about in the book and what I think is important right now. So we have a an epidemic of mental obesity right now and what that is is what we're feeding our mind now is so much and so overstimulated.
Speaker 1:And so, yeah, with the iPhone and oh seven and and, by the way, technology is phenomenal, it's a great device and we can do so much. And then social media that came about in 2012, 2013,. And the ability for us to take a selfie picture that came about and open this up. The research is out on anxiety and depression, and in the younger generation, as a result of these changes. So the changes aren't bad, but those byproducts are. So all we can do is gain knowledge, become aware and then take control of what we choose to do with it.
Speaker 1:And, as you said, every single social media site. They're all great to an extent, but they all are measured there the way. Their KPI is your time, how much time you're spending on their site. So their whole thing. I mean they're measuring how far, how long you're staying on each image and how much you're flipping through, and they're feeding you exactly what they think your brain needs to stay on that site. So that stimulation. You're losing control unless you are in control, so controlling how much you spend on the social media sites and really what you're spending your time.
Speaker 1:So, when we talk about accountability of your mindset, what are you looking at? What are you watching? There's great, great content online. You can watch some amazing videos, or you can just be caught in this spin cycle of this death spiral of going nowhere and all of a sudden, holy cow, 30 minutes an hour went by and what the heck? What rabbit hole did I just go down?
Speaker 1:So, really being in for the younger generation and, in particular, I think they really need help with how to manage their time and structure their day and what they spend their time doing, or else they're constantly just picking up their phone, picking up their phone, picking up their phone, and so so my team members, these days, they're constantly wanting to sneak into the break room and check their phone, check their, because it's like they're, they're hooked, hooked. Oh, I got to make sure there's nothing. Nothing happened. You know.
Speaker 1:It's so funny because, like I've been on trips to the Amazon where there's no phone and no access, for when I was a kid, my dad would go on hunting or fishing trips and he'd be gone for 10 days and it'd be like, okay, my wife would be honey, I'll see you when you get back, and that's the way it was. You know, now it's like we can't go 30 minutes without checking a device, and so it's important, I think, to create awareness around this and people to empower themselves with knowledge so they can make correct decisions and say, hey, if you want to be successful, it's totally. This is an amazing country and an amazing time. You have to be disciplined with how you spend your time and where you spend your time if you're going to be successful.
Speaker 3:Yeah, it's so funny, it is hard. It's like you just get this constant dopamine hits. Like I mean, I'm involved in Instagram chats where my friends are always sending me funny stuff, and so it's like if I, you know, have a break in between, something like sitting in the car in line, it's like, yeah, I want to go, maybe I'll check my email I do that a lot but maybe I'm going to hop on and like get a quick dopamine hit from looking at some funny reel that they sent me. So, yeah, it's like you know, they've gotten so good at rewarding the do it. So I mean, is there anything maybe outside of just like telling yourself, hey, don't do that? Is there anything that you found effective to put into play to actually keep you from looking at your at your social media too much?
Speaker 1:Yeah, there are certain apps where you can have timers on how much time you're spending on certain things, or even on your device. And so I think it's really good when, when you talk about guardrails I like that term is putting up those guardrails, where it comes down to self-discipline and saying, ok, I'm only going to check email or whatever site you know, instagram or whatnot at this time and I'm only going to check it for this long and putting timers and checks and balances on that. I mean, do you remember when you're in the line somewhere at the grocery store, we used to actually talk to people. You know, we used to have conversations. And now maybe we're interacting, but on a device and I don't know, maybe that's not worse. I don't want to be old school or whatnot, it's just old school or whatnot. It's just it's important to not lose sense of that human connection.
Speaker 1:And having face to face conversations is still powerful and important. And you can do a lot in this type of setting. You know, virtually you can have powerful conversations, but making sure that it's meaningful and it's the type of content that you want to spend your time on. And you know, I think this book has been really cool and resonated with a lot of people and that's why you know, anson said it was one of the best books of 2024 and became a bestseller. So it's been rewarding for me to see that result and see people embrace it with like, oh yeah, this is cool, this is helpful, and I can be a better version of myself because of this if I follow some of these principles.
Speaker 3:I love it. Well, we're kind of getting close to our time here, and is there anything that you wanted to talk about that we didn't get a chance to talk about yet?
Speaker 1:Well, I think you know I'm always willing to help people. Well, I think you know I'm always willing to help people. So if you can drop my email or contact info, people can follow me on LinkedIn, instagram and maybe for people listening.
Speaker 3:You just want to want to spell out your email.
Speaker 1:Yeah, it's first name, k-e-v-i-n and my last name, so it's at K-R-E-M-E-R leadershipcom. So, just like my company, it's Kevin at Kramer Leadership and, again, I'm always willing to help, answer questions and be there to help people be a better version of themselves and help them in their direction of success that they want to go, which is different for everybody.
Speaker 3:Yeah, well, I love it. Man, it's been really helpful having you on. We dove into a lot of topics and really appreciate it.
Speaker 1:Thanks, Austin. Thanks for having me. It's been great talking to you.
Speaker 4: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.