The Practice Gap
The Practice Gap
What Your Small Clinic Can Learn from a $500 Million Company-With David Bandele, CFO
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What happens when you apply corporate strategic thinking to a small healthcare practice? In this eye-opening conversation, Elisabeth speaks with David Bandele, Chief Financial Officer at a company with 1,000 employees and a 5 billion Norwegian crown revenue, about the powerful business lessons small clinics can adopt from larger organizations.
David reveals how strategic planning processes that drive corporate success can transform small healthcare practices, starting with the foundation of any thriving business: clarity of purpose. While most practitioners intuitively understand their "why," formally articulating this mission creates a powerful framework that guides all business decisions. Taking time away from daily operations to look three to five years ahead isn't just a corporate luxury—it's essential for sustainable growth in healthcare too.
The conversation dives into practical tools like SWOT analysis (Strengths, Weaknesses, Opportunities, Threats), with particular emphasis on how small clinic owners can better anticipate market changes and position themselves strategically. David shares insights on team motivation that small practices can leverage through their unique ability to customize incentives based on individual drivers—whether that's financial rewards, schedule flexibility, or growth opportunities.
Perhaps most valuable is the discussion around value-based pricing, a significant advantage for independent healthcare practices that can differentiate their offerings in ways corporations often cannot. As David notes, "It's trying to understand what value you are providing to that person," encouraging practitioners to consider pricing models that reflect their unique expertise and comprehensive care approaches rather than simply matching market rates.
Thinking of starting a practice? Listen for David's practical advice on business planning, from honest entrepreneurial self-assessment to creating competitive differentiation in a crowded marketplace. His insights on using digital platforms to quickly build visibility offer particular hope to new practice owners.
Tune in to discover how bridging the practice gap between clinical excellence and business acumen might be exactly what your healthcare practice needs to thrive in an increasingly complex landscape.
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Elisabeth Aas-Jakobsen, DC, MSc
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Introduction to the Practice Gap
Speaker 1Hi and welcome to the Practice Gap, the podcast for closing the gap between the practice you have and the one that you want. I'm Elisabeth, a chiropractor, a business owner, coach and entrepreneur, on a mission to help you move from frustration and overwhelm to clarity, focus and joy in practice. Hi and welcome back to the practice gap. Today we're going to do something a little bit different. I'm sitting down with david vandele, who works in large structured company, and we are going to explore one powerful question what can small clinics learn from big business? Could you please tell the audience a little bit about yourself?
Speaker 2Sure, and hopefully we'll learn vice versa, right.
Speaker 1Yeah.
Speaker 2So I don't know about big company, I would say medium company, but obviously, versus smaller practice is reasonably big. We have a revenue of 5 billion. Norwegian crown Market cap tends to vary somewhere between 5 to 10 billion, so it's a decent-sized company, 1,000 employees 1,000 employees.
Speaker 1In my world that's a really big company, but I guess when you look outside myself on the little bubble, I guess that's medium-sized. So I learned something new what is a big company?
Speaker 2That would be tens of billions, the market cap in the hundreds of billions, for example. They have different categories, but I think this is medium-sized, I can keep my hands around it.
Speaker 1Could you share what your job looks like and what it kind of looks like to work in a medium-sized big company?
Speaker 2Sure, well, my title is Chief Financial Officer. It's what they call a C-suite role, so you're an executive officer, so you do get involved with everything about the business, and I guess we're going to talk about some of the processes that you may not have so much time for or expertise in with a smaller company. But we get involved obviously starts with the strategy. We're a listed company so we have a what they call an equity story. So what should shareholders buy into if they want to buy into our business? And you know basically my hands-on tasks the finance, treasury, investor relations, tax, esg something that you escape as a small company.
Speaker 1What is an ESG?
Speaker 2Yeah, it's environmental, social and governance, so it's more what you would say how green is your company, what are your social practices, your governance and, of course, how you impact the environment?
Setting Strategy: The Big Company Advantage
Speaker 1So what are, if you like, think, something a big company does really really well that a small company like ours could benefit from.
Speaker 2Sure, I'll speak in terms of a public listed company. So I think one of the good things a big company does is that it has a lot of resources at hand and expertise so it can specialize in many different areas.
Speaker 2So, for example, they have a finance department, right, it takes care of all of those things that you know might be somewhat cumbersome if you're a one-person clinic or whatever. The other good thing is being able to step outside, because we definitely do need to market the company. There's lots of companies that investors want to invest in, and how do we make ours more attractive? So marketing the company is very good. We spend a lot of time thinking what do we want to project Business development? Again back to resources. I can go to somebody else to say, guys, we need to grow this top line as a small company.
Speaker 2Obviously, everything you're doing is by yourself and I think the time to take to really look at the strategy is a key thing. I would imagine, when you are just a one person or a small clinic or small business having to take care of many things, things the strength of that is that you really know your business. I mean you know it inside out. The weakness is you don't have time to do everything and sometimes you're so caught up in execution, the actions you have to do daily first of all, how you're practicing in your clinic and then doing your accounts etc. Versus being able to stare a little bit down the road and say, well, what's going to happen in three to five years? What is the playground like? So that's kind of one of the advantages of having enough resources and size to do that so what you are actually saying.
Speaker 1We can start very specific here. What I hear you say is set aside time to put together a strategy correct is that what? Would that be kind of like the first thing you would do, or would you? I was going to do a little bit more kind of intro questions, but we just came straight into this one.
Speaker 2I think everything tied to strategy would be the first thing, but you could sort of start with a, you know, classic big company is your mission statement. What's the why?
Speaker 1why do you exist exactly?
Speaker 2and how are you gonna impact that and what are you aiming for? So I think that's you got to be clear within yourself in order to because you're going to be telling this to the rest of the world and trying to convince them to buy into your company, same as you would try and get people to buy into your practice. That is definitely the key. If you don't know what you're doing and why you're doing it, you may not get to where you want to go.
Speaker 1And also from experience, a lot of small clinics actually never sit down and do that. You might kind of know in your heart why, but it's very different to actually sit and write it down. What is your like?
Speaker 2why, compared to something dreamy, wishful shit to actually have a sentence yeah, and it's understandable because actually probably the passion is your, why you know it, you live it but. But then again, are you objective enough to hold the mirror and say, yes, this is truly what I want? Hopefully it's yes, but along the way, are you getting there? That might be more difficult.
Speaker 2So I think sometimes it's good to be different people to give you an outside in sort of view on things, and again I'm speaking from more from a public company, so we're very much in the spotlight and we very much want to project out there.
Speaker 2But I think at the end of the day, you should also turn things around to see what your strengths are. And often with big companies, the starter or the or the person who founded the business probably knows the most. And then over time, depending on what your business is, you gain lots of knowledge, expertise etc, of course. But then when you have professional management, are they as passionate, do they understand the business as much? And yet those are the people marketing it. So there is probably a middle ground.
Speaker 1Yeah, so the strength of a small business are the people marketing it. So there is probably a middle ground. Yeah, so one of the strengths of a small business is the people in it kind of knows or at least the owner knows has to know everything about the business.
Speaker 2Has to know everything about, certainly what you're doing your mission and what you actually produce or service.
Understanding Team Incentives and Motivation
Speaker 1So when you look at how your company sets goals and also track performance and build teams, what practices do you think could be useful in a small clinic?
Speaker 2yes, so I would say a small clinic is typically partnership. Uh, you have the concept of equity and depending on how many partners you have, you share.
Speaker 1Say, let's make a fictive clinic. We have a clinic with two owners and three people kind of renting their space in the clinic, so a clinic of five.
Speaker 2Exactly so. Always the people with the equity bear all the risks and responsibilities and rewards right.
Speaker 1What do you mean by equity? It's not uh sure um.
Speaker 2So equity just means your ownership, right? So if you're um in that example, maybe one person's a 40 owner the other two are 30 owners, so you have 30 equity in that partnership again.
Speaker 2So, looking at the partnership and the equity, of course you already, as a partner, understand that the more you work, the more you earn, the more you will get personally that reward. The example that you gave with was it three other workers there. They may have different incentives in this situation. They may be working elsewhere as well. This is just one of many jobs, etc. And and of course, you need to then first of all know the strengths of your team, which hopefully, hopefully, you've done. You all feel that they're good in contributing.
Speaker 2And then, in our experience, no matter how big the company is, you need to see the incentives. Do the incentives work? And there can be cultural differences. Our company operates in norway, us and europe and I can tell you the incentives culture can be very different between those countries or even regions. So um, really intimately know what drives um that person and then try and target an incentive. It may just be a cash bonus, very simple. It may be a promise to partnership in the future, you know so, a promise to some equity in the future, etc. And you can then track these two very targeted objectives like bring in 20 more people, bring in 20% more people, bring in 50% more, whatever. So once you track those, when you set those goals and objectives, it's very important, as you said, to track them and actually really track them, measure them. First of all, comment on the performance versus what you expect. Everybody, I hope, sits down and makes a budget at least once a year.
Speaker 1Yes, at least now we do. It took quite a few years, but a lot of, because we are in health care, very many people in health care. They don't want to talk about money. It's very difficult. So even then just saying, you know like what's the budget? It creates this like fear. The money should just be something.
Speaker 1It's easier almost to say well, I would like to help this many patients, but to actually do that, to put down the numbers, which I think is also it's important to have some concept about what, what you need to earn right it's.
Speaker 2It's very difficult for me in health care and this is where you go back to the basis. Why did you start up number one? So maybe some people say I want to help everybody. Perfect, you know. And then then you start narrowing it down. Um, I want to have 100 patients, I want to have 500, and that's why you should set your strategy. Say, in three years time, I want to go from, you know, the one patient I have today to 500 patients, for example, example, and then track that. And of course you will have to reset along the way, but at least have something to go for. It's like doing a run, right, yeah, 5,000 meters. If you just say, go and run 5,000 meters, you'll do something.
Speaker 1But if you set some goals and targets, so a good stretch if you're starting out is to sit down. Okay, in five years I want to practice where I have 20 patients a day, 100 in a week or 400 a month or something like that. You have a specific number. How do you just to go back to the incentive, do you have any suggestions on us? If I'm a clinic owner, what actually drives the person in front of me? Because I mean, you make assumption, but how how can I find out what really motivates them?
Speaker 2if it's money, if it's time off is something else have a direct conversation with them, understand their lifestyles and why they do what they do.
Speaker 2And again, I think it boils down to whether they want to limit their time or whether they want to maximize their return or their income, for example, and I think a good combination of of all those as you grow is is crucial.
Speaker 2And again, the strength then, being small, is that you can customize all of this. In big companies, you tend to have to standardize so that to make it work and function, but you can very much sort of get to know that person, your employee or your partner, and really sort of target then. So also when it comes to objectives, maybe this person is better at marketing and they should focus more on those and take those objectives for the benefit of the partnership. And another person maybe is just better with people generally, so they could probably follow up and ensure that you know you have a environment that patients want to come back and back and repeat, for example just just to give some examples. But when it comes to specific tools, really it boils down to, like you say, what they like. That is maybe non-monetary, that might be flexibility and in time versus monetary, and you can you'll soon understand the motivations of when you have those conversations and it's most of us who's been working for a while.
Speaker 1We know they're different, but maybe we're not very good at actually ask them and we make we may make assumptions because we are this way or many people are like that and to actually explore, to take time to explore what are your motivations?
Speaker 2exactly, and you'll be surprised sometimes, yeah yeah, definitely all right.
SWOT Analysis for Small Clinics
Speaker 1if we think about staff development and learning, what are things that we can do in small clinics Because I'm sure you have some bigger problems to ensure that we are all moving along and learning the new things we need to? What can smaller clinics do?
Speaker 2I think it's the same there. Again, what are you aiming for? If your mission is to have the highest quality and practitioners and standards, then of course, without keeping up to date with what's out, there would be, I I would say, a deviation from your, uh, from your, your mission objective. So definitely again, back to what are you driving, what, what you're out for, and then just target the um, for example, education. There's nothing like learning on the job. So in most big companies you have these models where it's 70 percent learning on the job. You know 20 percent is can be specific targeted training and 10 percent general awareness. So I would do some some, some healthy discussions around that, and it may be that some people like to. Just, it would be really nice to have a course in a foreign country that happens to be warm weather at the time.
Speaker 1Yeah, yeah.
Speaker 2And it's a smaller thing, it's affordable, but it really generates some sort of how would you say?
Speaker 1employee or partner loyalty. So just for the 70-20-10, I do like kind of structures to hang things on. So you're thinking 70% of the week would be learning through patience, having patience and then you should really set about 20% of your time to actually you know work on some specific like this month we learn a work on infant exam or whatever you're interested in and then 10 percent should be just general learning about anything.
Speaker 2Yes, and you can swap that 10 or 20 or the percentages absolutely, but I think probably, and it depends on the phase of the career, I imagine, because it's so important to get the learning on the job quick, but you don't want to be learning the wrong things as well. And then we haven't touched it. But competition, you know you're not in the race alone, unfortunately, or if you are.
Speaker 2You're in a good position, but the competition's out there, then you have to really keep an eye on what's going on. And again, a strategy. You mentioned the term SWOT analysis. The strengths and weaknesses are very easy to do when you're a small practice I mean to hold a mirror to yourselves but the opportunities and threats are out there let's, let's.
Speaker 1Why don't you? Can we go a little bit in detail to make sure the audience is with us with this analysis? Could you explain what that is yeah, it's one and how we do it?
Speaker 2sure it's, um, it's very much a textbook, uh, analysis, one of many different tools that are out there, but I prefer the SWOT meaning strength, weaknesses, opportunities, threats because it really covers everything you need to think about Strengths being you know what you do well, what does your practice do well? Your individual partners or practitioners, what do they do well? Practice do well your individual partners or practitioners, uh, what do they do well? Um, and then, obviously, weaknesses, uh, and the human brain is geared towards more.
Speaker 1Really great that, especially like females, are super great at all their, all their weaknesses.
Speaker 2So so that should be a no issue as well. Um, and you can't really hide, right, you, you should hold that mirror to yourself. And then, as I explained earlier, I think the the issue is really spending time, um, with the 100 meter gaze and saying, well, what are the opportunities and threats? So is this a changing landscape or not? Um, am I going to be doing the same sort of techniques? Uh, now that I do before, are the patients going to be the same? Things are changing a lot.
Speaker 1Yeah, things are changing.
Speaker 2And I guess they impact when and where and what style of patient you will have in the years to come. How are you prepared for that? So that's a very generic question, but I think you could probably do two days of discussions and find out quite a lot.
Speaker 1It's quite interesting because they are changing, their demands and their lives are so different now and of course we see their problems are so much more complex and their the lifestyle problem, I mean, it's the patients now are completely different from when I started out almost 30 years ago exactly, exactly so again.
Speaker 2And then you would hope that not only the education of yourselves, but your staffing or you have to be a little bit strategic with the type of person you're looking for as well. They may not be the same as you have today.
Speaker 1So as an owner, I have to also look at how are the people now. So I'll have to check out what my patients need and then maybe look for other things.
Speaker 2Yeah, start from the customer first or what your interpretation of the customer need and, of course, try and meet those unmet needs and if you're the first person to meet the unmet needs, you're doing good.
Value Pricing in Healthcare
Speaker 1You're doing good, yeah, perfect, thank you. So what advice would you give a young person who's starting in a clinic or a small business about taking ownership early and contributing to clinic and to their own kind of growth?
Speaker 2you're probably better placed to answer that, but let me just imagine I'm I'm new coming in and I have a slightly different mindset, just because of generation, whatever.
Speaker 2Um, I would want to make myself useful immediately. I would want to hopefully impress and I would probably go into the areas where I feel that, hey, this might be old-fashioned or something, or have you considered this? So, as a young person coming in, it's like, okay, you need to learn what you need to do, but what sort of angle can you bring to it? That is different, because that does make you more valuable, and if your current employer doesn't find you valuable, I'm sure somebody else will, and I think you need to be both again.
Speaker 2You know you come in, you assess the situation, see if you can add more value, but of course, at the end of the day, if you're in that profession, you need to learn it well. So hopefully it's an environment that will allow you to learn the basic skills. But how can you put your little measure on that? So if I was recruiting and I can tell you an example in my company you know ai analytics is really racing ahead- on everything, not just how you work and making your work maybe, maybe more efficient, but even just manufacturing products, autonomous manufacturing.
Speaker 2You can just keep the lights on and it does what it does. You can't afford to close your eyes and say that's not happening. So I've had to also staff up with people who understand this, people who can code, people who you know, because don't do that, you won't get far. And of course, you can also buy that in. But I think you also need to start bringing that into the dna of your company or the dna of your um praxis or practice. That's important. So owners tend to be know everything right and you tend to do, but you don't know. Your environment change as well.
Speaker 1You know, and that's what maybe so maybe spend that time, even more time on like what are the new challenges, like that, what are the new things we need to know and new thing, how we can change exactly the strategy and and then I'm not sure about because things are regulated in your business and maybe pricing is regulated.
Speaker 2But um, I know we've had discussions about value right, value pricing value pricing?
Speaker 1it's not. It's not. Uh, it's not restricted? No, it's not. You can choose your own price okay, you can, yeah, yeah.
Speaker 2Well, that's a good thing because, um, especially in this uh environment that everything is getting less personal I think that's a huge gap for people who tend to have, uh, whose business is close contact with people, and because you provide a service, but you also provide a listening service and you know you are hopefully holistically trying to make that person enjoy life in a better way, right, and I would say that's a lot of value. So, if you're caught up in a very standard pricing model, either because of competition or regulation, if it's unrestricted, that's great, but, um, I really think that's an area where you can maybe differentiate your pricing to the service that you provide, because I do believe you provide a kind of quite holistic service it's not just fixing the acute problem at hand how could you give, like some example, what you mean about different pricing, because this is a big discussion among a lot of my colleagues.
Speaker 1Like, if I've been working for 30 years, should I take a different price than somebody's working for 10 years or five years if you're? Should it be pricing based on time? Should it be pricing based on expertise or extra knowledge? Do you have just gen? Could you just general feel it? Think about this and have some. What are your thoughts about it?
Speaker 2my answer is that again back to the question is like what value are you providing to that person? Some patients may just want you don't want to be out the door as soon as possible, and that's what they pay for. To me, that would be the starting point you are offering your immediate service to address the issue.
Speaker 2But I imagine a lot of more of your patients hang around longer and if you have patients that repeat, it's not just unless they have a really serious chronic problem. That's the same thing. It's probably not just that right, there's something else that you're providing. So it's trying to. In a big company you would go out and do these surveys and get price points from various people you know, from potential customers. You may not be able to do that here, I'm not sure, but be bold and say you know, offer that. Hey, you know, you can stay longer. Where we talk about uh, more holistic, uh type of thing and that can encompass maybe the different services you have in your clinic. I'm not sure.
Speaker 2Probably people buy into the person that's really what they they do, but then why are they just getting the same price for you? Um, you know, as a person, I'm just being honest, and it may not be because you're more senior and know more about what you're talking about. It could just be the young person that has just got a different, interesting, um, take on life maybe even outside the clinic, but it complements.
Speaker 2Maybe they're um nutritionist expert or something. Hey, have you tried? This is when I did this. I you know I felt amazing. Whatever, and and people will pay for that. It's like a joint, yeah yeah, product you know, and I I feel people will pay for that, but you know I'm not the expert you.
Speaker 1You should uh, you should know your market yeah, I, I think also, um, like, when you go to the dentist you get, uh, okay, you have the standard cleaning and then if you have a little bit of extra cleaning, or you take an x-ray or you take, and I mean they have, you get a bill with like 17 different things but you know what I pay for most?
Speaker 2no pain, right?
Starting a Clinic: Business Planning
Speaker 1yeah, because it's like I never check you have like, I just get just fix this exactly if you were to open your own clinic today, what would? How would you start? Now listen this is not a chiropractor.
Speaker 2Here we're talking, yeah, so I give the most respect to all the entrepreneurs out there who take the risk to do this on their own Because, honestly, it's serious. If you don't work, you don't eat. So I have a safe job.
Speaker 1That's one of the pluses of being a big company, but of course.
Speaker 2then we do things like we open new businesses, start a new business, decide to invest in a new business, and what do we look at? We definitely look at very definite things. Number one SWOT analysis. First of all, am I the right person to be an entrepreneur?
Speaker 1Am I bold enough?
Speaker 2Am I risk-loving enough? Am I in it for the? You know, will I get through the pain at the start? Okay, you need to answer all of those questions. Assuming you have all of those, then it is opportunity stress. You will do a business model to say how many patients do I need to break even Pay?
Speaker 2my rent, pay your rent is the basic or where's the rent, but how many patients in that area? You should do some market sizing. That's what you're doing in bigger companies. Can I place that okay? What's the competition? Am I using reasonable assumptions or am I just pointing a high to the sky? So you just need to do your work. First of all, does this look like something it should fly? And what I would do is also take that to a few either colleagues or friends of mine to say you know, am I biased here? Does this sound like something that would fly? And I'll tell you if you put a business plan on paper, you quickly most people see what could work and what is exactly?
Speaker 2So so be honest. But let's say you've done that and you're in your new building, you've got your friends to come and decorate it for free and you know all this kind of kind of thing, but hopefully you'd have worked out like what is what? Can I differentiate myself from the competition? Because you need a trigger. You need a trigger that you know it's not just one other cairo coming in. You know why should those people change their habits and go to you? So there has to be some trigger and one. It could just be a nice looking building, modern or something different, two hopefully different services available in one.
Speaker 2But of course, I think you really need to go out there. People aren't just going to walk in. That's the way the world is. You have to start somewhere. The good thing is, especially with all this digital media now, the exponential ability to market and and convince people why they should at least come and open the door to you can happen quite quickly. Probably need to talk to these young people who know how to put your name out yeah influencers, etc.
Speaker 2Or at least the version of that in your practice.
Speaker 2I would also try and especially as you get on, try and get into the boards or whoever controls, some of the regulations in your industry, just so that you're known that way and hopefully maybe become a speaker or a figurehead for your organization in one form or another, so that your name is out there. And if you can connect your name to the lay audience, meaning the, just the general population, maybe for something different. Maybe you're a dj, I don't know, but a very famous one who happens to also have a health practice on the side, you know, you can just use that connection. So that's, that's the way I think you should do it. But you should be always honest to yourself. If what is your, you know your passion, if it really is to go into really tech not technical, very medical detail to help people, maybe that's a different path you need to get your name out with. Otherwise, if it's just to generally help people, try and try whatever works so I can read for me.
Summary and Key Takeaways
Speaker 1There are so many opportunities out there for us, the small companies and the ones who haven't been put into action yet yeah all right. So if I'm going to sum up a little bit, the big takeaway is start doing SWOT analysis. If you haven't done them, yes, they're all over. It's a textbook thing. Or you can also ask chat GPT how to do a SWOT analysis in my clinic.
Speaker 2Exactly.
Speaker 1And then to really look at how the patients now are different from what they used to. And if you've been working for a while, maybe you should change something you do and also start using all the AI stuff and all the new stuff that's out there and to see, not be scared of it, to embrace it and to see it. How can I use this for my advantage and for the patient's advantage and also use them really get to know the people in your clinic. If you get new people in, ask, check, find out how they can get, renew the things your clinic and not be scared of it and invite them into health, transforming it exactly could that be?
Speaker 1is that okay so?
Speaker 2much. I think this is a very good summary. Um anticipate the change.
Speaker 2Yeah, look a little bit further ahead um not only for the opportunities but defend against the threats in your industry. You know you've had a lot of pressure uh, both from regulation uh wise and also other um practices uh wanting to steal your market share, yeah so, but I love this thing about the patient. Just think, you know, in in five years time, with all this gaming and that kind of use, I think there's a heavy market there for getting people to be mobile yeah, so that's a good thing, that's a good trend, that's a good trend for us all.
Speaker 1Right, thank you so much for coming and sharing your knowledge, knowledge with us, and I am so happy that you're here and I hope all you, the audience out there, have things, practical things to do tomorrow to help grow their best business.
Speaker 2Perfect Hope. So too, yes.
Speaker 1Thank you.
Speaker 2Cheers.