Grow Your Clinic

Josh Nelson: Building Multi-D Clinics, Fostering Team Collaboration, and Balancing Work and Family Life | GYC Podcast E285

• Josh Nelson • Season 5 • Episode 285

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Unlock the secrets of building a successful multidisciplinary clinic with our special guest, Josh Nelson from Thrive Health Co in Brisbane. Josh takes us through his journey of integrating a diverse team of health professionals, from chiropractors to child health specialists, all under one roof. Discover how he managed to foster collaboration and mutual respect among his team, overcoming tensions to prioritise patient outcomes and create a centralised client care experience.

Josh doesn't just stop at team integration; he shares insights on personal growth and effective team management, drawing inspiration from the book "Radical Candor" by Kim Scott. Learn about the innovative strategies he employs to maintain an accountable and supportive workplace, like moving discussions out of the office and replacing traditional performance reviews with engaging quarterly catch-ups. His approach highlights the importance of recognising individual differences and providing tailored support for both personal satisfaction and team success.

But it’s not all work and no play. Josh opens up about the delicate art of balancing work and family life, offering valuable advice for entrepreneurs navigating the same path. He reflects on maintaining structured work hours and effective communication, which allows him to pursue personal interests and foster a positive team culture. With insights on financial literacy and future aspirations, this episode is a treasure trove for business owners keen on achieving both personal and professional growth. Join us for a conversation that's as enlightening as it is empowering.

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Speaker 1:

This is the Grow your Clinic podcast from Clinic Mastery. We help progressive health professionals to lead inspired teams, transform client experiences and build clinics for good. Now it's time to grow your clinic.

Ben Lynch:

Welcome to the Grow your Clinic podcast. My name is Ben Lynch. If you're looking to run a multidisciplinary clinic, or you already run one and you're looking for ways to get the team better integrated, connected, collaborating, cross-referring, then this episode might be the one for you. I'm in conversation with Josh Nelson from Thrive Health Co in Brisbane. Josh uncovers throughout conversation some of the things that he's found really useful in attracting great talent from different professional backgrounds to come together and work on a centralized client care experience how to remove ego and get people to work together from different perspectives and worlds. Josh has a team of over 15 humans and is continuing to grow and develop the CPD that they offer as a key attraction tool for that talent in their recruitment and also for the development of quality humans on their team. Let's pick up the conversation with Josh now as we explore some of the challenges in growing his clinic. You've grown a multi-D clinic. Now you've got how many team members?

Josh Nelson:

So last count, including administrative staff, I think we're 23, 21 or 23.

Ben Lynch:

Yeah, and so sizable multi-D team. Had you set out at the very beginning that that was, or this is, the type of clinic that you're going to build, as sort of just organically unfolded? Talk us to the design of Thrive as it is today and how it's evolved over the years.

Josh Nelson:

Yeah, so I suppose I always grew up playing a lot of sport and I always worked with different modalities whether it be physios, chiros, podiatrists and I loved kind of being in a team and I love that team-based approach. And I think, coming into chiropractic, probably the one thing I noticed there wasn't a lot of multidisciplinary chiropractic teams and I I really saw the value in that continuity of care, because I think there's some things that we do really well and um, and I think there's other things where I don't feel like I've got the skill set, say like post-surgical rehab, and things where I wanted to have great physios on board that could do that. Um, also going through that journey then to to go onto that exercise side, I feel like I know enough about rehab to be able to guide people. But if you know someone really needs the, you know the intricacies of how to do things perfectly and movement patterns and all the rest of it, my time, I feel like, is better spent working in that hands-on approach and giving more broad based rehab. But if they want more things, more things specifically, can go down that road and then yeah, so I suppose I always wanted to move in that direction and it definitely just naturally shifted from me as a one-man band, uh, through to uh having a couple of chiropractors.

Josh Nelson:

We then brought on massage, uh, we then brought on physio and ex-vis at the same time, and now we've even branched out, because my wife is a chiropractor but she's got postgraduate studies in pregnancy and pediatrics, and so we also have a child health nurse, lactation consultant within the clinic as well. So, yeah, we probably had two key areas to our business. We have one that's a bit more MSK, sports focused, and then the other side, which is a bit more that sort of pregnancy, pediatric development sort of side as well.

Ben Lynch:

When you made that shift from chiro massage to bringing in the other professions, were there any challenges that you faced? Things you look back you wish you did differently, because I hear so many clinic owners that have similar intentions ambitions and maybe try it doesn't quite work out like. How did you navigate that?

Josh Nelson:

yeah, I think, look, it is a tricky one and I must admit, there I still feel like there is probably I wouldn't say the word tension, but between certain physio groups and chiro groups there's still that uh little bit of how well we work as a team, and I think it it has to come from both sides, but it has to come from, you know, everyone checking their egos at the door and realise it's always about getting the best outcomes for the patient. And we were quite fortunate with our first physio that came on board. He was very much more of a mature age physio, so he'd had years behind him. He was recommended to us from a patient who saw both of us and it was just a mutually beneficial relationship and that kind of flourished from there. So yeah, it is.

Josh Nelson:

I think it still is challenging and I think the most success we've had with employing physios has been with ones that definitely are able to, you know, just check egos at the door. It's all about, hey, how can we work best together? And that I'm sure is vice versa of the physios wanting to bring on a chiropractor into their clinic, and so yeah, but for us it's worked really, really well and I couldn't actually imagine any other way, because of the two can be so synergistic.

Ben Lynch:

So how do you talk to that you know as part of your recruitment or even just internally to your team, to continue that kind of integration of the two professions? Maybe the cross-referral, like what are some of the ways that you know as Thrive, would be really distinctive as to how you frame it up and communicate it.

Josh Nelson:

Yeah, like so say. Let's say, for example, we have someone who has had some sort of surgical intervention and we might have been working from that with them, from more of a movement, by mechanical standpoint. But you know, the surgeon might have said you know, you need to go and get some physio done. So it's a very easy sort of push on because you know we've already built that trust and we say, look, you know, we've got Matt and Alistair here. They're fantastic from physiotherapy point of view, highly experienced, and the nice thing is they can see what we've been doing. We can talk back and forth. I can pop my head in the room and see how you're getting on. And so while we're working with the sort of underlying sort of function and movement, they're going to be working on more the strength and stability and they know the milestones you need to reach postgery, to then potentially even get you in to see our exercise physiologist, which is going to just keep that journey going.

Ben Lynch:

So then, what does that look like from a CPD perspective and mentoring perspective? How do you continue to, like you know, develop as a team rather than individuals? What are some of the things you found work? Because often that is a stumbling block or a challenge for a number of clinics looking to have multi-D.

Josh Nelson:

Yeah, look, I'm not going to sit here and lie and say it's easy and that we do it, you know, weekly and all the rest of it. I think it probably comes from a lot more organic conversations when we're talking about patients and explaining what we're doing and why they're improving or not improving or whatever it might be. I would love to do more of that. I think the challenge with our clinic is we have so many practitioners working different days. Getting everyone together at the same time is quite challenging. We've looked at doing potentially like Zoom, teams-based calls at times just to go through cases, and again, that comes with its challenges as well. We definitely have culture days where we all come together for the benefit of the clinic.

Josh Nelson:

And one thing we did do a lot of during COVID time, when, you know, we didn't have the capacity to see as many patients. I kind of looked at that as a time Well, ok, well, let's get a lot of CPD in. You know you're still kind of working within the clinic and we're working on things, so we can come out of this all upskilled. And then I subscribe to a few or, for the clinic in its entirety, a few online CPD platforms where people can you know kind of go on and get their CPD through that way as well? Fantastic.

Ben Lynch:

That's a really great way to do it. I'll just pick up on culture days. That's not common vernacular, certainly within the wider community. Can you just explain what that is and specifically how you go about running them and what you found really useful? Uh, because they're quite an investment they are huge.

Josh Nelson:

Yeah, look, yeah, it's definitely a big investment. We we're currently doing two per year, um, so we tend to do one. Well, sorry, I should say we do two culture days and then we have a big Christmas party where it's, you know, fun and getting together and all the rest of it. But yeah, a culture day, to me it shouldn't be a review, it shouldn't be. It should be more about team building. Usually it includes doing some sort of activity.

Josh Nelson:

So the last one we did back in March, we actually went to a local self-defense studio and kind of learned some self-defense techniques out in, you know, out in the big bad world.

Josh Nelson:

We then came back to the clinic and we kind of it was actually run by our senior ex-phys and one of our senior physios and they put on the day. So we want to kind of give them some ownership around this. So it's not kind of give them some ownership around this, so it's not just the business owner just preaching over and over again and we talked about like, what do we feel like we're doing really well, what are some things we would like to try and implement moving forward and what are some things we think we could stop doing that aren't really serving their purpose and the stress they're creating. And then we typically go out for dinner afterwards, and that's obviously. We put that all along. So we shut the clinic for half a day generally, and then as clinic owners we pay for all that to go on, so the staff feel like they're really getting something out of it.

Ben Lynch:

Commercially. How do you justify that? I mean, take us back, maybe even to your first one, where you're like we're going to shut down the clinic for a half day. Some people do it a full day, everyone's off, but we're going to do this. How do you justify that? Review that in the subsequent weeks and months to say you know that was worthwhile.

Josh Nelson:

Yeah, it is definitely a process I'm constantly looking at. I think I definitely the key is with these sorts of days is you really want people to feel like they're getting something out of it. You just don't want to feel like, okay, we're ticking a box. It's like, oh yeah, we're progressive, we're a progressive team because we do culture days. You want and that's always to me being that head in my head after it like was it worth it? Did we really get enough out of it? Or were we really just reiterating what we talked about last time?

Josh Nelson:

Or, and I think the financial benefit, I I look at it as like, hey, when we uh budget out the year, we factor in that we're only really working 46 weeks a year. So as part of that, I know if we're working, say, maybe 47 and a half 48 weeks a year, there is that little bit of leeway there. Um, there, we haven't. I have looked at potentially bringing someone in externally to talk. The people I've looked at would be flying from interstate so that's a huge commercial expense to fly them in, put them in accommodation, pay for their services. So we're not quite at that level yet, but that's where we've kind of thought about potentially going in the future, but I do feel like whether official culture days are necessary or whether it's just having more regular team catch-ups where you might go to a brewery and have a chat and work on some things. But yeah, it's a constantly evolving thing.

Ben Lynch:

It's a great point you make because you don't need to be necessarily precious or committed to a certain way but, like you're pointing out, it's really about connection of the team, the cohesiveness. Where are we going? What roles are we like? How are we doing that on a regular basis is perhaps just, if not more important than you know any given day or two days in a calendar year. So how have you changed as a leader? What have been some of the major step-ups for you as a leader, growing to a team of mid-twenties and, I'm sure, more in the future? What have been some of your reflections on the things you've had to do to be a better leader, to enable that to grow?

Josh Nelson:

Oh plenty. Honestly, I, yeah, from early on. I think probably I'm a reasonably driven person. I naturally want to learn and grow and I kind of feel like if you're not growing you're dying, sort of thing. So I always kind of push myself very hard early in my practice life and I think I expected a lot of my team as well and really in the early stages ran thing very much very tight ship. There has become, I think, more flexibility over time and I think it's understanding that you're not going to be good at everything and you need to employ people that, although it's important to work on your weaknesses, you know, I think you need to employ people that have strengths that maybe aren't your strengths, and for me I am one of those people.

Josh Nelson:

I don't absolutely love confrontation and I know a lot of people don't. I don't know there's too many people out there that love it, but I think because of that I tend to fill the space. I'm a talker, so I'll tend to overfill the space, and then in the past I feel like probably a lot of my team have been not felt like they've truly been heard. So two things I think I've tried to do really well is first, seek to understand before being understood. So really taking the time to sit down and just talk to team members like they're human beings you know how's life, how are you getting on? Is there anything we can be doing to support you better and then you can feed into them making decisions on their own accord rather than you dictating what they need to do?

Josh Nelson:

The other thing I got put onto was the book Radical Candor by Kim Scott, where what I didn't realize is that if you're a leader of a team and you're not great with confrontation, classically because you do care, we inherently care as healthcare providers we go into this bucket of what they call ruinous empathy. And what I realized through reading the book long-term, that's actually more toxic to a business than that obnoxious aggression of you know carrot and stick sales type work, because you get frustrated with something someone does, but then you don't tell them about it. You might just moan to your practice manager or your wife about oh, I can't believe they didn't do that, but you don't want to hurt their feelings, so you don't actually let them know, so they don't know where their boundaries are.

Ben Lynch:

And how have you gone about addressing that practically? What are some of the things, perhaps, that you do at the moment, whether it's you know there's systems or structures in place, or is it just literally a mindset shift for you? How do you go about ensuring you do that as well as you could without being perfect in it?

Josh Nelson:

Yeah, I try as hard as possible now to take our chats out of the clinic or out of my clinic room, because I feel like the environment can potentially create tension in itself. So, whether it's going for a walk, going grabbing a coffee, kind of getting to know in advance before you have a chat, is there anything specifically I want to go through so you can be prepared beforehand. And then it's really I'm trying really hard to just sit on my hands and just let people talk and myself just listen more and then trying, when little things pop up along the way, just trying to say, hey, look, notice, this happened the other day. Do you want to just film in on what happened there? Because, um, I know that's a bit odd for you for that that situation to happen, rather than just going in and saying, hey, why did you do this? You shouldn't do it that way. You know this is how things should done and I think it's probably going to create a better environment for long-term team members.

Ben Lynch:

It's a really great point. I've had the same sort of experience or similar experience as you that actually asking the question, not assuming you know the answer or the reasons why, can actually be really conducive to a good combo and the accountability sort of is taken on a team member's part. And I also think, like for myself, if one of my team needed to call me out on something which regularly happens, that they would also give me some version of the benefit of the doubt, like, hey, what were you thinking when that happened? What know what? What was the reasoning behind it? Because so often you miss things, you weren't part of the context of the moment. So I actually find that really diffuses it for me as well. It's just like maybe there's something I'm not seeing here. Um, but this was my observation. Just talk me through it.

Josh Nelson:

It's such a great open-ended question yeah, and I think we've taken the word review out of our vernacular, because I feel like sometimes a review can have a bit of a negative connotation, and so I like to kind of think of things like a quarterly catch-up and it's like and as part of that quarterly catch-up, we know we're going to be talking about life are they happy with the hours they're doing? Are they happy with their financial situation? Um, and then maybe touching on some KPIs or things that we might need to see improvement in. And then I think it's also knowing the individual, because we will have certain people that freak out if they see numbers or stats, especially in healthcare, when it should be about helping the patient. And so for me, it's always about hey, we've noticed this key area is probably just, you know, a little bit lower than what we would expect.

Josh Nelson:

Now, these are the reasons why we would usually expect a rebooking percentage to be around X, you know, because it actually comes very much back to our communication and the way we educate the patient. So is there anything we can do to help you in that regard? To help you in that regard? Do you feel like your education, your communication, is doing well? Or is there, you know, if you just had a bad run of new patients that kind of weren't going to commit to your recommendations anyway, or whatever it might be. So it's knowing the individual and how they tick as well, while still holding everyone to a certain standard.

Ben Lynch:

Yeah, it's such a delicate balance at times, right? So it sounds like when you talk about numbers, especially in perhaps a performance context, because we've got to run a sustainable business, you know it's just not possible for practitioners to come in, you know, be paid full-time and see one client a day. That's unlikely going to be sustainable. So it sounds like you're really emphasizing the client journey first and as kind of the anchor point, and then you talk about well, here's how we can have a measure of that. Is that right, like, talk us through some of that, because it's such a sensitive topic with people. Right is numbers, as you said. So how do you go about doing it?

Josh Nelson:

Yeah, look, I think there has to be. Like you said, there's a reality of running business and it's costing more and more to run a business these days. So in the early stages I often say to someone coming on board like, look, the reality is people are going to have different ideas of what success is. But at the end of the day, I want to let you know that until you are seeing this many clients a week, it's actually costing us money to have you here, and I don't mean that in a negative way, but that's just the reality of it. We're paying you a wage and if that's not being met, however, at this point it's kind of a an equal relationship and anything beyond this point, because you're rewarded for the revenue you generate for the clinic. This is more beneficial to you.

Josh Nelson:

Now you might be really happy to just work four days a week and be on X income, but what you need to understand is it's it's, I mean, and it comes down to this whole work-life balancing right. It's like it's very hard to work three days a week but earn 500K a year. You know there has to be. If you want to have more of that balance, then you need to understand there's going to have to be a payoff somewhere else, and vice versa. If you want to earn a higher income, then you have to be willing to do the hours and generate the revenue for the business for us to be able to pay you that.

Ben Lynch:

So talk us through. Then the connection of someone on the team. Maybe you've had this experience, you know. Offline we're talking about your approach to care being very evidence-informed. Looking at you know, getting great patient outcomes. How do you strike that balance in the conversation with a therapist? That is all you know, so focused on the client, uh, hair and outcomes, and then sort of bringing in the commercial reality to it. How do you address a practitioner who is really concerned about those things?

Josh Nelson:

reconciling, look, I think for me the big thing that really hit home that someone once told me early on is if you underservice the patient and then they don't get a result, they're going to go somewhere else. And they're going to get the results somewhere else when someone has given them the correct recommendations that they needed to get better, and so that can be in an active or a passive care model. But I suppose the language I use myself when I'm speaking to a patient that comes in with a musculoskeletal based injury is right. In this initial phase, the goal is to obviously get you out of pain as quickly as possible and get you moving better again. Now what we do know is that in that period of time it's probably better to see you just a little bit more frequently so we can get that momentum going and getting that healing process moving in the right direction. So I tend to stay away from numbers, so I might say look. So I think we're probably going to need to see you early in the week and late in the week for the next two weeks. So we're probably looking at four visits over the next fortnight to at least get you to a point where I believe you'll be X percent improved on pain and blah, blah, blah. After that point, what we really need to then focus on is starting to strengthen and stabilize those tissues so that we can retrain your body, how to support you better, so this just just doesn't come back again in the future and that might be seeing you less frequently, but over a slightly extended period of time.

Josh Nelson:

And then my, my third phase, and this is probably a little bit more. I know other professions are starting to move in this direction, but I think chiropractic has probably been one of the leaders in that sort of prevention is better than cure and that sort of proactive health model where it might be hey, you know what? And a lot of people find because they do sit too much and they do do these specific sports like I look after a lot of golfers, they're rotating in one direction over and over again that a lot of people find coming in periodically for a bit of a tune-up and a check-up allows us to address things before they become a bigger issue and allows you to keep on track. But again, that's always going to be up to you. All we're going to do is guide you with our best recommendations, and I feel like that's a healthy spot where it's not aggressive. It's not saying you need to come in three times a week for the next six months, but it's also not the see how you go type mantra.

Ben Lynch:

Yeah, and I love the way that you've got that structure there, but always individualizing it to the patient. You've got a lot to do with the next generation of therapists coming through with teaching roles. What are some of the things that you're noticing about this generation of therapists coming through the university system?

Josh Nelson:

Yeah, look, it's interesting. It's actually been really interesting, especially post-COVID. What I've noticed and I think it's just, you know, societal pressures around inflation and everything as well, like when I went through uni, and when you went through uni that was your full-time job, you know. You, you worked your butt off at uni, you studied hard and you, you had a job on the weekend working in a pub or something to just pay the bills, whereas nowadays I think, because I know in the chiropractic program up here in Brisbane we tend to get a lot of mature age students and so they might have families, they might have, you know, mortgages and all the rest of it, so there's very much more that balance of the more they can do online the better, and trying to still hold down almost a full-time job whilst they're going through their other studies.

Josh Nelson:

So that's something I've found from that perspective, have found that interprofessionally chiropractic because we aren't in the hospital system, we're not in aged care as much, we're very much more in private practice and we're very much more in musculoskeletal, neurological health is we really harness that for five full years, whereas I find sometimes with some of the physio new grads coming out because they're pulled in every direction. They have to do a cardio respiratory area, then they need to do a neuro, then they need to do PEDS and then into all these different things they need to do hospital. They probably don't come out with the same confidence in that skill set if they're going into a private practice. So I do feel like the mentoring and coaching, if you will, has to be a little bit more intensive in that first sort of six to 12 months.

Ben Lynch:

Yeah, it's a really good point. I spoke at the Australian Physiotherapy Association conference six to nine months ago and they did a Q&A at the end with a whole panel of speakers and there was a lot of questions from the audience. I would say that were also concerns wrapped up around, you know, the progression from university into private practice, given that well, depending on the profession, you know at least half are going into private practice and there's just not that preparation for it for it. So it's even more a responsibility of private practices to have really good training and support structures CPD structures as well to be able to train these new therapists into the profession. That's an interesting observation around that. What have you done, what have you found effective as well in being able to bring a therapist onto the team and you know quote unquote get them up to speed, you know pretty efficiently and also be quite effective. You know, in their first few months. What do you do at Thrive?

Josh Nelson:

Yeah, so I think a lot of it, and, to be fair, we probably haven't had any new grads come on board for a little while now, um, so I think my, my style's probably changed again. Um, but I think probably the first thing we do is just say, like, right, what is the bread and butter, what are the things that you're going to be seeing day in and day out from the very beginning? And you know it is the acute and chronic low back pain cases. It's, uh, you know, postural issues. It's headaches, migraines, tmj issues. So it's like, okay, well, let's break that down. How do we, uh, how do we do a good physical examination on those? How do we, what are our differential diagnoses and then how we treat different ones? Um, I do, I'm a bit of a proponent of the sfma type work, the selective functional movement assessment, for a lot of things, because I feel like if you learn something like that, well, you kind of have a system.

Josh Nelson:

No matter what the specific tissue in lesion or diagnosis is, you've at least then got an overarching understanding of right. Is it more tissue based, is it more joint based, or is it more motor control based? And then, no matter what, it's a little less daunting because you know you're all going to treat them in similar ways. But then it's a matter of saying even things like right, well, let's talk through. How do we educate a patient on that first and second visit? How do we make sure they come out of there with a definitive plan of understanding what's wrong?

Josh Nelson:

What can you do to help? What can I do at home to help this move in the right direction? And-term, how am I best going to prevent this from coming back again? So I think if you, if you go through those really well and then you might kind of say, like, look, what are the top five to ten uh, grievances or questions that a patient's going to come with? I'm not getting better, I'm. You know that exercise hurt me, I, I was sore after the last visit. What is our communication around that? So we come across confident, so we still create certainty in the patient's minds that you're the practitioner that's going to help them.

Ben Lynch:

How do you go about then delivering that? I imagine there's a fair bit of like one-to-one live interaction, but are there any other tools or systems that you like to set up and use in adjunct to that Look?

Josh Nelson:

it's definitely, I think, when I've had new grads in the past come on board. I have had the time We've had our third child since then, so that's always comes with its challenges and our teaching at the university as well. I have created a lot of videos recording myself around communication things, so I might say, hey, why don't you go watch these couple of videos and I'd love for you to come to me with your thoughts and of what's going on. I would say most of those are more from the communication standpoint and like experience standpoint, rather than the clinical side. We're at a point now where I think we have a large enough team that, let's say, for example, we had a new physio or chiro come on board, I could then allocate some of those resources to one of our senior practitioners to actually do some of the mentoring, rather than me doing it all myself as well, which is nice to hear it from a different person's perspective.

Ben Lynch:

Great to be able to have those leaders quote unquote on the team, those senior therapists on the team. So you talk about the training role, your teaching role, business role. What does your role look like today and perhaps how does that reflect in your week? If we were to kind of look at your calendar globally, how's it split up and what are you doing in the business today?

Josh Nelson:

It's busy still. I'm not going to lie. I think that the next sort of transition for the clinic is to me to move a little bit more off the tools and be on them so much. I'm still working, seeing patients four days a week and a couple of those you must enjoy it.

Ben Lynch:

You must I love it Absolutely.

Josh Nelson:

I'll never stop treating patients.

Josh Nelson:

I absolutely love that side of it and I'm really fortunate I've got an amazing practice manager that does a lot of the day-to-day running of the business.

Josh Nelson:

I think, as I've started to really enjoy doing a bit of teaching and things like that and, you know, doing some mentoring and things like that, it's just getting to that point where something's going to break a little bit at one stage. I know I said before to you off air that I'm a golf tragic and I love my golf and it's something where I would love to have a bit more time to do that in my downtime and even potentially share that with my children. So it's kind of getting that balance right, potentially share that with my children. So it's kind of getting that balance right. I think long term I'd always want to at least be on the tools two days a week and then maybe have two days a week working on the business and not having to fit like catch ups with staff in between my lunch break, actually have time to be able to sit and not be rushed, and I think that will be the next morphing of the clinic over the next sort of 12 months.

Ben Lynch:

It's a really great point because we so often talk about this idea of quote coming off the tools. It's actually kind of a podiatry type term because literally use tools like a lot of, like a dentist, quite literally. And I think the nuance, the distinction, is that for those listening and watching in, is you, do you Like? If you're passionate, your desire is to support and serve patients great. I think that's why we all got into healthcare in the first place. I think the distinction is can your business function without you doing that, and predominantly from an income perspective? Can you function?

Ben Lynch:

And there's a whole lot of systems and operations that need to be developed in order for you to grow. Otherwise, a whole lot of systems and, um, I'll say, operations that need to be developed in order for you to grow. Otherwise, you kind of hit this ceiling. Clearly you've been able to navigate. You know, growing a team into the mid-20s whilst also still consulting um, what, what do you attribute? There would have been some key things that have allowed you to have that. You mentioned a good practice manager there. What else has enabled you to kind of build that team out, create the structure and sustainability, whilst also you're able to see and serve patients?

Josh Nelson:

Yeah, yeah, I think it does help when you hold onto team members. That always makes it, because if you're not constantly retraining new people, that takes a lot of that stress away. So I think having a good, solid team that you don't need to micromanage is a big one, obviously having really good systems and procedures in place. And then, yeah, like I said, having a senior leadership team around you that you can pass certain things off to. So, you know, we might have the practice manager that's doing a lot of the day-to-day running of the business. Then we might have our senior physio that he goes off to a B&I meeting and he promotes the clinic externally. We have our senior ex-phys that also helps out with some social media stuff behind the scenes and you know, going and talking to doctor surgeries and you know, like, like. So, by doing that, it frees up a little bit more of my time already and I think probably just go back to what I said before.

Josh Nelson:

I do also believe that we're our biggest stumbling block when it comes to coming off the tools. Um, that, yeah, at times I almost think that, like, I need to lead by example and if my staff are saying, oh, you know, like I'll, they'll think I'm a slacker if suddenly I'm having a day off, heaven forbid. But from speaking to others, it's almost the opposite. They think, geez, you should be having more time off. You know you should be spending more time working on the business. So yeah, we ourselves are our biggest stumbling block at times.

Ben Lynch:

It's a great point. Actually, one of the CM team returned from six weeks holiday. It was a meaningful holiday for a milestone, but return and the clinic has actually been performing way better than when they were there and the team have basically said, hey, we've got this stay out of the way. And it's quite interesting there around that paradigm shift for the owner and team member as well, and I think as well. Like you said, we're so used to having a good work ethic.

Ben Lynch:

If you go into business, I think you've got an appetite to put in the hard yards, do the weekends, the long hours, et cetera. That when you don't have almost every minute accounted for and a practical example of that is seeing patients it's like I know quote the value of my time because I've seen 10 patients today. I literally have brought in this much revenue, I've helped serve these patients to their goals that you can kind of be like all right, I've been useful, I've been productive. And when maybe not every minute is accounted for in the diary, either you feel some version of like guilt, uh, or or you think that the team are thinking something um, it is an interesting wrestle that I think everyone goes through, myself included. Everyone goes through. I think, um, that's where, to your point, having those regular touch points of mentoring, culture days, communication channels internally you've got a vision that you're working towards and you're getting the team engaged. Yeah, I think that's a really, really great way to go about doing it. I'm interested in, obviously, you've worked with us for a little bit through CM.

Ben Lynch:

What were some of the reasons that you decided to get support? You've obviously built a really successful clinic yourself. Uh, done a lot of the hard yards. What were some of the reasons that you wanted a another perspective on business?

Josh Nelson:

yeah, look, I think I've always believed in utilizing coaching and from, like I've said, from a young age playing a lot of sport, and in the past it's been predominantly within the chiropractic space. And I think within the chiropractic space no one I had worked with really truly aligned with my exact philosophy and ethics around how I wanted to run a business. But I got some really valuable tools, especially around that client communication and education, and then I kind of peeled it back a little bit for how I wanted to structure it myself. I think the two biggest things I got out of CM would one be the importance of that team culture and, like I think, in the before then I was just like, well, people should, they're making good money and they're, you know, busy, they should be happy.

Josh Nelson:

But I think these days people need more of that. They want a sense of belonging, a sense of they want to come to work each day and enjoy the people they're hanging around and the clients they're seeing. And the other one is just probably having a little bit more financial literacy around. Okay, when do we actually break even as a business and how much of a percentage should be paid towards admin staff? How much should be towards rent, and is 10% a good profit or is 15% or 20% a good profit margin, and how much as directors, should we be paying ourselves? And so those are probably the key things I've found really beneficial, and also just recommendations like that radical candor book. I probably wouldn't have stumbled across that if it wasn't for Andrew Bersak, or I mentioned it to me.

Ben Lynch:

Two three years ago, and what have been some of the key changes that you've made, either for yourself as a business owner or within the team, like we often talk about, like structures and systems that are in place, because that so often helps with sustainability into the future. What have been some key things you feel like you've implemented?

Josh Nelson:

Yeah, look, I think definitely the culture days and just understanding that as a business owner these days, you truly have to be someone that people feel they can come to and actually, when they're having an issue and I feel like that is one thing we do really well here especially when people are struggling you know whether there's, you know, challenges with health in the family or things like that I think we go we really do go above and beyond to make sure people feel like they're being cared for throughout those times, which is a really big thing for me. One thing I think I did really struggle with actually when I first started with CM is because I love numbers and I love KPIs and I think that's something that I got so excited about. I just threw it all in and implemented so quickly that probably for quite a long time, I had certain team members that had never been held accountable or never had numbers. So it actually created a few pretty tough conversations where I had to peel back and be like, oh, I'm sorry, I got so excited to let you know these things that it probably came across in a different way. So I probably found over time I've peeled back on regular letting people know where things are at and more.

Josh Nelson:

Hey, how do you feel like you're going? Just a heads up what I've just. We've noticed a bit of a trend over the last three months of this, that and the other. Any idea why you think that might be the case? If you want to look at it further, this is where you can access those reports and have a look at it yourself. And so, yeah, you just need to understand that just because you're excited about things, not necessarily all your team members are.

Ben Lynch:

It's a great point. Often we've probably all experienced that being super keen about a new thing that you've learned or want to implement and the rest of the team having no idea the context of it, so often, maybe after an event. Or you finished up a good book yes, we've all had that experience. It's quite funny, but it's good that your team gave you some flexibility, understanding to get on board with it and allow that time to implement progress, create the change. Now you mentioned your wife works in the business. Yep, growing a business, growing a family. Added third child, which is really exciting Yep, slowly filling the minivan, yes, but that's really cool. What have been some things that you've found useful, helpful, effective, productive in integrating a growing family and a growing business? Because we know it's never perfect. Everyone's circumstances are different. But what have you found that's been really useful? Because we have so many people in the community that are starting a family, thinking about starting a family as well as being business owners as well. So what have you found useful together in growing both family and business?

Josh Nelson:

Yeah, look what I would say is I'm very thankful that I started this business back when I was in. I think I was 23, 24 when I started the practice, so it allowed me to grow and put a huge amount of time and effort in and grind away before I had any significant commitments. What that has allowed me to do over the years and I'm extremely thankful for it is, even though there's certain days in the week where I do big hours, like two days a week, I work from seven in the morning till seven in the evening, but that's the way I like to do it, because it means I get Fridays off and I get a whole Monday morning off. And what that's allowed me to do over the years I've been able to do reading groups with my kids, I coach my daughters, help coach my daughter's footy team. I, you know like I'm able to be there.

Josh Nelson:

And I think a lot of that comes with our generation. When we look at our parents' generation, they didn't have those abilities. You know I remember my dad would leave early morning, get home late at night. You might see them on the weekends, but you know they had to really work hard, and so I think that's probably caused our generation to think well, you know what I actually, what the reason why I'm working hard is so I can have time with my family and with my, with my kids. So it's, it is one of the benefits of owning a business to be able to structure your days accordingly and and I'm happy to work really hard sometimes but then have times off at other times to be able to be a dad.

Ben Lynch:

Yeah, that's really cool, the ability to have that integration. I think we've got book week next week. Looking forward to doing that with the kids as well. For myself, it is great to be able to do that. No doubt that there isn't a balance between it, that you need to be flexible at times. We were talking in a recent episode about really the expectations for yourself, for your business, need to be a little bit flexible, especially when you're starting a family in business, whether you're expanding the family because so much of it doesn't quite go to plan um as best planned you might be, um being flexible, therefore adjusting some of those expectations.

Ben Lynch:

I've actually found it to be a really good forcing function, if you would, about prioritization as a skill set that you need to get really good at being able to know like is this really meaningful work for me to be doing right now? Yep, in fact, I'll share a quote with you that came through this morning. So we do a morning huddle at CM. Our team's like distributed around the country and internationally, so for 15 minutes every morning we jump onto our huddle, and the huddle this morning came from James Clear, and so one of the team, james Clear, didn't join us on the episode That'd be cool but came from one of the team members, from James Clear, and it was the most invisible form of wasted time, is doing a good job on an unimportant task, and I was like, oh yes, everyone actually clapped. They're like that's a great one.

Ben Lynch:

So I actually feel that you know there are so many things you know in business, in life that you know give us constraint, whether it's time, money, team members, and you've got to just be really good at being able to prioritize, I think, which means that at times a sacrifice. So I really like that distinction of hey, you know, there are days where we all work long hours. There's also time that's really precious with family that we want to prioritize. I really love that. That's awesome. When it comes to business, money, finance, what are some of the things you do with your kids to teach them about money, like what happens in the Nelson household. What are some of the things you do? We often have this discussion behind the scenes at CM. You know how do you teach your kids about? Um, you know commercial realities and business, whether they go into that realm or not. Um, I think it's useful to pass on some of those lessons yeah, 100.

Josh Nelson:

I'm a yeah like the old barefoot investor sort of jam jar type thing we haven't we. We've tried the jam jars in the past, we do I. I think I'm probably a little bit hard on my kids at times. If they, if they want things, they're going to work for it, and so fashion work in that my children are definitely not going to be too entitled.

Josh Nelson:

They are definitely going to know where money comes from and then, on top of that, really understanding from time to time that actually do we really need these things, or could that money go towards, um, you know, a charity or something along those lines, and it's stuff we sort of do through the business as well, with supporting a few different charities and, you know, local, uh, sporting clubs and schools and things that, yeah, I hope that rubs off on them long term. Um, yeah, but no, they definitely have their chores they have to do every week. We got a new puppy recently and part of it is just their responsibility and that's just part of they wanted it that they've got to do certain things. So, yes, hopefully we're not too harsh on them, but yeah, they're learning some good lessons along the way.

Ben Lynch:

That sounds really good. I've heard a number of parents use the Barefoot Investor. It's the kid's version, right, there's a family version of doing that which is really cool. So, from here, as you look to the future for the clinic, what are some of the things that really excite you and that you're looking forward to bringing to life with the team that you've got today and the future team that you're building?

Josh Nelson:

Yeah, look, I think the thing that excites me is definitely just being able to help keep providing, hopefully, a great environment for our team members to be able to enjoy coming to work each day but also earn a good living and then be able to have great time with their families outside of here.

Josh Nelson:

We do have in the works, with some other team members coming on board in the next sort of six to 12 months, which will allow me to just step back a little bit more, which I'm really excited for. I must admit, in the past, like I've never had lofty goals of opening multiple practices, I feel like our business here is large enough and successful enough that we can, all you know, earn a good living without high stress of opening up multiple sectors. But I've never closed the door on that. If we had a team member that was really driven to do that and we could help support them doing that under our banner, then awesome. But yeah, at the moment I think the next 12 months for me looks like maybe a couple of less hours seeing patients and a few more hours just continuing to help build that team culture and a bit more golf.

Ben Lynch:

And a bit more golf. Yeah, that sounds good. You speak my language, that's for sure. Clinic Mastery was actually founded on a golf course in Adelaide, mount Osmond. At the 19th hole, we sat around a table and said let's give this thing a crack. But there you go. Golf is good for the soul. Well, that's really insightful.

Ben Lynch:

I love the vision you have for the clinic. Also the model that you've adopted in marrying clinical care and the excellence there with also sustainability and accountability of team members as well in their roles, true to who you are. I so agree with that that there's no one size fits all. There's no perfect clinic out there. You've got to do your version of success, as we call it, and that may be a different version each season, especially if you're growing or expanding a family or you've got other things on your plate. So thank you for sharing so openly here on the episode. Now you're also doing a little bit with chiropractors as well, not only teaching chiros as part of the university role, but also you get chiropractors to reach out to Tell us a little bit about what you do there and some of the questions that chiros come to you with yeah, sure, yeah.

Josh Nelson:

so look, I do a little bit of yeah. I don't sort of scream it from the rooftops, but I do. People kind of reach out to me and I do a little bit of mentoring and coaching very boutique on the side, with sort of like-minded health professionals that are just usually in those stages of either they're, you know, just not getting through that next level, that bringing on staff or things like that and just trying to fit that mold of right. How do I get across from that? You know, how do I attract the right people that I want to see into the business? But how do I actually give the best possible experience possible so that then they can go on and grow practices to the point of whatever their goals are? So no, that's been a, it's been a really interesting. I think it's actually made me a better business owner and it actually, at times when you're sharing information, you think, oh, geez, we used to do that and we're not actually doing that at the moment. I've got to practice what I preach a little bit.

Ben Lynch:

Yes, yes, walk the talk. That's really cool. I think the really great thing is that there's a lot of awesome clinic owners out there doing amazing things for client experiences and progressing the client experience or patient experience, as well as building great places to work as well. And I think that's really cool because when we see therapists burn out and churn out of the profession because of a bad sort of work experience that they've had career experience, it's sad to see and there's a number of reports that are coming out around that from the various associations. So I think it's awesome to hear of great clinics making great experiences, not only for patients but also team members. So I think it's awesome to hear of great clinics making great experiences not only for patients but also team members.

Ben Lynch:

So awesome to hear your story and how you guys are doing it at Thrive so you can catch all the episode notes at clinicmasterycom. Also, come over to YouTube and subscribe. See the video. We're doing heaps of videos each week on how you can grow your clinic sustainably. Josh, thank you so much for sharing on this episode. Pleasure, awesome. We'll see you all on another episode very soon.

Speaker 1:

Thanks for tuning in to the Grow your Clinic podcast. To find out more about past episodes or how we can help you, head to wwwclinicmasterycom. Forward slash podcast and please remember to rate and review us on your podcast player of choice. See you on the next episode.