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00:00:01
Michael Nula, NULA Training Systems
12 Plays2 months ago
In this episode, Steven sits down with Michael Nula, Founder/Executive Director of NULA Training Systems
Learn more about SaRA Health:
https://www.sarahealth.com/
Check out NULA Training Systems:
https://nulatrainingsystems.com/
Recommended
Transcript
00:00:02
Speaker
Welcome to another episode of The Disruptors, where we're arming you with the tools you need to innovate within the physical therapy space by highlighting those who have come before you. I'm your host, Stephen Cohen. Now, let's get into it. Hello, and welcome back to another episode of The Disruptors, where we're highlighting those who are innovating within the world of physical therapy.
00:00:23
Speaker
Today, i am blessed to be joined by Dr. Michael Nula. Michael is the founder of NULA Training Systems, a business coaching and professional development firm helping private practices around the country.
00:00:36
Speaker
As the founder and former CEO of Elite Physical Therapy for 20 years, Michael led the award-winning company to 15 locations, serving over 60,000 patients before integrating the firm into the Ivy Rehab Network, a world-class national physical therapy network partner.
00:00:53
Speaker
He's a passionate father of three daughters with his wife. They play zone defense and is always looking for the opportunity to help teams win. And so with that, Dr. Michael Nula, welcome to the disruptors.
00:01:07
Speaker
I'm really excited to have you on today. Yeah. Thank you for having me, Steven. So we're going to go jump right into it. Why? Why did you go get that DPT?
00:01:18
Speaker
Why physical therapy for for you? Yeah, my aha moment started in high school. I had some bad knee pain and was being told at that time that I had patella tendonitis.
00:01:29
Speaker
And playing through that at the beginning of my senior year, it just made things worse. And so I sought out another consultation and learned that i actually tore my patella tendon. So that that ended my my basketball career at that time.
00:01:43
Speaker
And I spent the rest of my senior year in physical therapy. But, you know, I'm thankful for that experience now. I never would have said this back at 17 years old, but I'm thankful now because I realize where I belong. You know, I love i love the idea of helping people, always like science and always big into fitness, health.
00:02:00
Speaker
So i looked around and thought to myself, this this is definitely where I want to be. And at that time, though, interestingly, I was going to a hospital setting for physical therapy. And while it was good, and learned another lesson that not all physical therapy is the same. So I had this idea, you know, someday I want to own my own practice.
00:02:16
Speaker
I've got some thoughts and ideas on the way the standard should be and the way the experience should flow. And i've I've taken that throughout all my years and all my seasons professionally is thinking about that patient experience, remembering what it felt like, you know, scared, uncertain and confused back at 17.
00:02:33
Speaker
um And again, having a good experience, but always thinking there's better than good. how How can it be exceptional? How can it be, as we say here in New England, wicked awesome? you know
00:02:45
Speaker
I love that. I love that there's there's better than good. I think that's a it's it's just a good quote, right? Of not striving just to be good, right? No one strives for goodness. They should be striving for greatness.
00:03:00
Speaker
um So I really like there's there's better than good. And I know we met through a a mutual customer of of ours. And so, you know, that's why you got into PT. But can you you ah expand on the why behind what you're doing today with NULA training systems?
00:03:17
Speaker
Yeah. So, you know, my first career out of college was a high school science teacher. So at that time, i to be quite honest, I, I, I, Always admired what my mother was doing teaching. She had a whole career as a high school Spanish teacher at the time.
00:03:32
Speaker
And I thought to myself, this would be a nice next step. Even though I know I want to do physical therapy, I want to own my own practice one day. This would be a nice next step. Let me go teach for a while. i always admired the relationship she had with her students and so much fulfillment. And so I taught 10th grade biology for two years and was a girls basketball coach.
00:03:50
Speaker
And at that time, I think it just reinstalled this passion for learning, you know, this lifelong commitment to learning, ah the teaching process. And so I took those experiences and and brought them forward into my leadership style and always had this sort of teacher focus and people development focus. And as the years went by in my own practice, that was my favorite part of my practice was the developing people.
00:04:13
Speaker
yeah having this leadership approach to where it's teaching it's coaching it's mentoring it's guiding and um had this vision i'm like wow this could be just a great thing to go work with private practices across the country you're working with them in in terms of how they're approaching running their practice and developing their people and i love this industry i love this profession uh so after 20 years of my own practice and growing to 15 locations i've just felt this real passion and and pull to just go help profession wherever I'm needed.
00:04:42
Speaker
You know, I want to work with, I don't, whatever size the practice is, whatever they're trying to do, I'm happy to help them get there. Oh, I think it's fantastic. And as I'm sure you've experienced on on your side, that ah many practice owners that that I meet are great clinicians but struggle to make that transition into the the business owner, right? And and that can be can be really tough.
00:05:09
Speaker
and And maybe you have some training around this, maybe not. So yeah I might be putting you spot a little bit. But the goal of this podcast is to help make innovation and in leadership just like one step closer, right? Just a little bit more accessible, right?
00:05:29
Speaker
And so as you've seen that your clients transition, have a lot of trouble in the transition from practitioner to business owner, was sometimes with a slash there.
00:05:39
Speaker
and what What did either you teach your rising stars who became clinic directors and and went off or or what do you wish you know these practice owners that you work with would have been taught on their way up, right? Like where are some of those like one or two key lessons that are just missed?
00:05:55
Speaker
Yeah, I'm glad we're talking about this. So I've always been committed to learning. Right. So um it obviously started out clinically and then very early on, started taking business courses, seminars, workshops, reading books, podcasts. So my jokes through the years is I've gone through all that boring stuff so that I can really just unpack it and plug play and help people like kind of cut to the chase. Right.
00:06:15
Speaker
Sort of the cliff notes of it. But what I'd want to pass along is um recognize, I mean, to build your business, there needs to be a focus in building your people. And it's great to do the continuing education for clinical development.
00:06:30
Speaker
Absolutely. We should always be staying current and learning how to become better clinicians. But there's these other competencies that exist in being a leader in today's PT practice um that starts at the top as a practice owner and then trickles down to leadership.
00:06:45
Speaker
And then recognizing that we want to identify people to become leaders so that we don't bottleneck the organization. right A lot of practices maybe are leaning on just one or two people. And the reality is the practice can't thrive if it's if it's just running through two people.
00:07:02
Speaker
You know, we think of how, i mean, let's look at physiology, right? And how the blood circulates through the body. You know, if there's plaque buildup in vessels, it it restricts blood flow. So if we're restricting how moving parts like workflows and day-to-day activity are happening, that if it's getting blocked up because it's trying to fit through just one or two vessels, for lack of better words, I mean, it really can back things up.
00:07:24
Speaker
And you know result in in total overwhelm on the practice owner or other leaders. And then the way that trickles down is the environment's not thriving as well as it could be.
00:07:36
Speaker
Absolutely. Gosh. I mean, we saw that all the time. And and I think we as we've talked, to you yeah I'm not a clinician, right? I don't come from the ah clinical side. I have other people on my team, on the executive team that make sure that that's well accounted for.
00:07:50
Speaker
ah But mean, that is... I mean, that's the first one of the first laws of manufacturing, right? Is don't operate for very long above 80 to 85% capacity or else things break and they break bad.
00:08:06
Speaker
Especially once you get into the 90% like, and like, oh, well that's manufacturing. Like that's different. Like, no, it's not. It's really not right. If you come to work in your 40 hours or however many you have, 36 of those are already allocated. Like one emergency.
00:08:24
Speaker
One. Right. And if you don't have redundant, like redundant systems in place to be able to handle that, then no one can take vacation. No one feels good like a lot of bad things happen. So I'm i'm there with you. And ah I'm glad that you're helping practice leaders understand the ah gravity of the situation.
00:08:50
Speaker
Yeah. So it's, like you know, empowering them to empower their people, right? Look to develop them, look for courses that that develop their competencies, um look for for learnings, whether they're books, they're podcasts. I mean, there's just so much out there. um You know, of course, I'm excited about some of the courses that my group offers, but at the same token, it's more about, you know, discover your why, discover the purpose, what's what's the overarching mission and vision and look for those learnings that can reinforce and strengthen that or, or expand like how they look at that, right? Like, is there clarity on their vision or is it just full of clouds and murky and you can't really think past today or this week.
00:09:30
Speaker
And that's okay. If that's where you're at, just get honest about it. And, and what's one more step we can do to look a little further past that. Right. I like that. And, you know as someone who did, mean, honestly has struggled with finding like,
00:09:45
Speaker
like what's my current why or like what is my why, right? And I'm starting to better understand that, but it's it's an evolving, very difficult journey. ah you what Are there any high-level tips for people that are willing to do the work, right?
00:10:03
Speaker
They say, hey, if you're looking to figure out your why, ah if you're passionate about data but you don't understand why, like, how how would you coach some of, especially your staff level folks? Like, hey, here's some some good questions to ponder, or even if you had like a, maybe this is too much to ask, right? And if you can't give it away, I get that too, right? Like, hey, staff PT, you're two to four years out of ah of school, right? Like, is it a 10 hour process? Like, it's probably going to be a 10 to 100 hour process to go through this, right? With these types of stuff, like how are
00:10:39
Speaker
How would you think about guiding somebody in and helping them on their their process of figuring out their why? Yeah, I think there's something just fundamentally that that anchors us first as a team, as an organization, but then each role.
00:10:53
Speaker
has a little like it's dialed in just a little bit more on on the purpose of the role. You know, I my world lives in basketball. I love the NBA. I love basketball. I find the more I make analogies to to basketball and the NBA, the more I make sense of things.
00:11:09
Speaker
um So when I look at private practice or just look at physical therapy as an industry, to me, it's a sport. You know, and we have teams and what happens with teams when there's confusion of role clarity, like who's bringing the ball up the court, who's rebounding, you know, who's going to tie up the the middle?
00:11:25
Speaker
Like those are things we have to visit quite regularly so that that the team can be where they need to be and win basketball games. Right. So same thing and in physical therapy. And quite frankly, any industry is, you know, be clear with roles, be clear with where the spacing, like let's get a space and pace offense here. Let's pace ourselves and not try to go manic where we're doing so much one week and nothing the next week.
00:11:49
Speaker
How do we space activity, space workflow, and then pace ourselves with that and have this pacing where there's this cadence of communication um touching base with each other where are you at where you you know what are you focused on cool now we're next week how did where did you leave off where are you at um what do you need for me and it's this sort of balance um but all that can tie up then again staying true to the purpose of of the the company and the role you know and hopefully we're thinking of something bigger
00:12:21
Speaker
um You know, I find that if we if we think of like a vision and a game that's bigger than just a job or just coming into work, I think it powers us on those tough days, you know, so really getting big with the why, you know.
00:12:39
Speaker
I like that. I like that. And and making it, you know, ah good at a tactical, guess, piece of advice ah that I'm kind of like bit of conjecture coming out of that is ah why, you know,
00:12:52
Speaker
why do you come back after a hard day? Right. And, and that's probably a really good place to start. Uh, Hey, you had a rough day yesterday. Like, why are you back here today? Why didn't you just say quit?
00:13:02
Speaker
Right. And I'm sure it's like, well, you know, and I need the paycheck. Right. Uh, think that that could be it, but there's typically more than that. Right. And i so that's, uh, maybe there's like a Dr. Michael Newla like bad day test. Right. Uh, yeah, yeah, you could, that's, that's yours. Uh,
00:13:20
Speaker
ah because ideas are are not worth much as the execution, right? um But i like I really like that framing of, you know, what what do you do after a bad day and and coming back for for that why.
00:13:37
Speaker
um But I also appreciate how much focus that you put on the importance of that clarity of role and clarity of company vision, but that's at the practice leader level, right? Like they need to dial that in. um and so i like I like to remind practice owners too, or the leaders, like it's not all on them. you know There's a nice way to engage the group and unpack that together.
00:14:01
Speaker
you know Ideally, we're hiring people that are like-minded, that are like values, sort of have shared philosophy of how we like to roll, approach our work day take care of people, take care of each other. so you know just engaging the group you can get so much you know by working together you know i'm all about collaboration and teamwork back to basketball like you can't win games and win championships doing it all by yourself you know so how do we move the ball around how do we share the ball and um How do we recognize that everybody comes with their talents, their gifts, um their ideas?
00:14:35
Speaker
How do we create a safe space to to really toke that fire of collaboration and and lead with curiosity? Like, let's not be all judgmental on each other and critical criticizing. Why don't we just be...
00:14:48
Speaker
like pretty kind and compassionate about it. I know it sounds cheesy, but be like, Hey, Steven, that was a really good idea. And if we don't, if we don't really know where you're going with that, just ask, like, you could you give me a little more color on that context?
00:15:01
Speaker
Seems like a neat idea, but I'm still kind of confused on where you're going with that versus like, what's that all about? Right. All judgmental and where then Steven shuts down he's like, you know what, i forget it. i I don't know what I was talking about.
00:15:12
Speaker
I'm done. I'm done. And then it's like mental note. I'm never sharing again. You know, I think that can stall organizations. And. right and constrict them too. Thank you for listening to this episode.
00:15:25
Speaker
This would not be possible without sponsorship of Sarah Health. Sarah is the relationship operating system for physical therapy practices, driving better patient outcomes, improved arrival rate and improved financial margins.
00:15:38
Speaker
If you'd like to learn more, check them out at Sarah, S-A-R-A health.com, Sarah health.com. And if you'd be interested in advertising with us and helping us produce even more great stories, please let us know at Steven at Sarah health.com. Now back to the episode.
00:15:58
Speaker
There's a, uh, a book that I love, um, called the happiness advantage, uh, by Sean Acor. Um, absolutely fantastic and brings data, uh, to support the, his, his argument, right. That you can do better if you're happier, right. And not like in a forced happiness type of way,
00:16:17
Speaker
Uh, but like and everything, you like everything's great and it's not, but a truly like going through celebrating successes and and doing some of those things. Uh, as you said, lead with kindness, it makes me think of, of that.
00:16:30
Speaker
Did, when you started elite, uh, is this, is this something that you always had dialed in or did you, you know, do you have your own set of scars, uh, from running your own practice? Like talk to us a little bit about your journey as as a leader and and running elite.
00:16:47
Speaker
Yeah, I think there's a few experiences that stand out that shaped how how I led, you know, with my leadership style, but also my vision. And, you know, and again, it started with me getting that injury in high school, tearing my patella tendon, then having the opportunity to be a high school teacher and a Pearls basketball coach.
00:17:05
Speaker
Then I worked for a large health care group right out of graduate school. And I think I'm grateful that I had that experience because I learned so much in a short amount of time. But I also learned some things that I didn't want to do or see professionally for the someday when I have my own practice.
00:17:25
Speaker
Excuse me. So that was very eye opening. You know, so at times perhaps where I didn't have the answer, I was i thought to myself, well, what should I not do?
00:17:35
Speaker
Right. yeah And then that's sometimes we guide what we should do. um And then it's realizing like all the learning is through the experiences. I think in the beginning years, there's this idea we have to be so get everything right. And the reality is there's so much learning that's going on in the beginning of any endeavor or venture, no matter what our learning experiences are prior.
00:17:56
Speaker
So just being okay with that and accepting that, um that there is no such thing as perfection. Let's strive for for excellence. Absolutely. And then these moments where we feel like things didn't go ideally or we had that tough day, like, where's the learning on that?
00:18:12
Speaker
What did we learn out of that? How can we grow? And then how can we let it go? You know, so we're not carrying that forward and going back. Remember that time two years ago? It's like, man, that's we're done. We already we already reviewed the film.
00:18:24
Speaker
We you know, we learned everything we could off that. Now we get on with it, you know. um I love that. There's a ah book I'm reading right now called Arate by Brian Johnson.
00:18:35
Speaker
You know, I just got that book. I'm going through it too. Yes. You're going to love it. Right. yeah When did you learn? Right. and And that is a a framing I think is so powerful and yet so correct. Right. As I'm seeing, as I'm sure you've seen now running two very, very different businesses. Like, yes, the core industry is the same, but it's a very different business to deliver care and basically deliver like knowledge.
00:18:59
Speaker
right Those are two very, very different things. And and so, yeah, I'm sure you've had your yeah your doses of learning as well.
00:19:10
Speaker
I definitely had it as well. Right. You know, I always like, you know, I remind people to like we can have our feelings on all this stuff. It's not always sunshine and rainbows. And when we lose, we don't like to lose.
00:19:21
Speaker
But, you know, like all the great athletes always say, like, you have to lose in order to to know what it is to win and to appreciate the winning. Right. And you can't win without the losing. Right. So there really is no failure. It's just learning.
00:19:34
Speaker
You know, and it's just it's like the not now is also the reframing, too. If it didn't go our way, it's like, OK, well, it's just not now, you know, like I'll. um But it's coming.
00:19:44
Speaker
Right. And being really like committed to that. um And ideally, let's I hope it's coming sooner than later, but it's coming. and Absolutely. Absolutely. There's I it was talking to a a mentor of mine and he he was telling me about how he hires. And they he does a pretty unique business where they basically try to find entrepreneurs and put them into portfolio companies that they acquire or a majority acquire. And I was asking him, like, okay, you know, what what do you look for?
00:20:18
Speaker
And he said, I look for a loss on that resume. I actually really want to see that because I know that they learned a ton from that.
00:20:29
Speaker
Like you learn a ton from that versus if I see someone that, hey, you know, they they started at DoorDash, right, at their their series B um and, you know, was promoted and all that and DoorDash IPO, like, was it because of them or in spite of them? Like, you'll never know, ah right? It would potentially, you know, be very hard to tease that out. But if you have a failure, say, hey, this failed because of X, Y, and Z. Here's what I would do differently. I would do A, B, and C.
00:20:59
Speaker
Oh, like that is a a strong, strong message. Yes, 100%. Yeah. yeah And then you're you're giving authority to the group like, hey, it's okay to not be perfect, you know, but do be excellent. Excellent means like I'm i'm committed to go learn right now with whatever I need to learn.
00:21:17
Speaker
If there's something that I think could have gone better, I'm going I want to figure that out so that I don't repeat the same less than desirable outcome. And if anything, I just do it a little bit better next time.
00:21:28
Speaker
And then then there's the next time to do that even a little bit better. And then now you've got that Kobe Bryant Mamba mentality, right? is You know just keep trying to get better every day. That's really the simplicity of what he was always about.
00:21:40
Speaker
you know Just one one degree, right? As you'll come to to read and ah and in Arte, I think that's really important for people to hear, right? Is to not be afraid of failure. Now,
00:21:53
Speaker
that comes with a caveat like anything else, right? It lives on some level of a scale and, and you know, a dichotomy um where there's, there's too much risk to to take or you can act unethically, right? Like, but if it's a reasonable risk done ethically, it's going to be recoverable from, I think. yeah and And so, yeah, and gosh, I've had more failures in this business than,
00:22:20
Speaker
I care to count or relive. ah Yeah, but jaron you you know if we're winning more than we're losing, then at the end of every year, it's another good year. you know And isn't that really like what it is to win championships? All these professional teams, they don't go through the whole season undefeated.
00:22:35
Speaker
Like each week, they've got some wins, they've got some losses as the weeks go by, as the months go by, et cetera. so But at the end of the year, they've won more than they've lost, lost right? And then they it's put them in a position to make a playoff run.
00:22:47
Speaker
And then ideally, maybe even a championship. that's and that's it wait in your normally we i it's i focus on like the the advice more to like the the staff clinician or those that want to innovate but i'm just finding where this conversation is going i want to take it a bit at of a different way as a practice leader and now i practice leader coach what i'll start at that level and then i want to work down and What are one to two things that you consistently see? Actually, I'll do one and one.
00:23:22
Speaker
What is a an activity or trait you consistently see good practice leaders get right that inspires innovation? Communication. 100%. They're always working on their communication, um how they now they organize their communication, how they deliver it, right? Talking points, thinking of the outcome.
00:23:42
Speaker
or First, what's the intention? What's the outcome? Desired outcome? What's the purpose for said communication? Get that really dialed in. So that way, the like after the delivery of it, it actually creates what you wanted.
00:23:56
Speaker
Right. So being very organized with our communication. I think that's I think that's tops on the list. Okay. And then the flip side of that is what is the one negative trait or characteristic like, stop doing that.
00:24:10
Speaker
then The thing that now stops a hard, hard ah ah request, but like the the idea of being being impatient, like it's hard to say, Hey, Steven, listen, man, stop being and impatient.
00:24:22
Speaker
But how about Steven, could you please be a little more patient? Like that's, that's an easier ask. um And we keep striving to be more patient, patient with ourselves, start there, patient with each other and then patient patient with things bigger like community, industry, society.
00:24:44
Speaker
I mean, you know, we don't have this magic wand like Harry Potter that we can just wave. You know, i know we were talking about a conversation earlier about having a magic wand. We'll see where that question comes. But, um you know, we have to be patient. But that's something that to continue to work on as I say that out loud.
00:25:02
Speaker
You know, there's things I can be more patient on too. And I'm committed to, you know, continue to work on being patient right and having families that's definitely good practice that's like an ongoing workshop right and that's just when you kind of master it then the kids get older and then you've got to kind of and get some adaptations and relearn some things but uh significant other you know parents siblings where all the learning and opportunities are right there to develop and hone in on those skills uh and competencies oh absolutely i find myself
00:25:36
Speaker
Consistently going back to a single quote when it when it comes to patience, and that is the one credited to Philo of Alexandria, right, of be be kind for everyone around you is fighting a great battle.
00:25:48
Speaker
um It does just irritate my wife to no end when I won't get mad of people in traffic. ah she and she She feels like everyone should know that they did something wrong.
00:26:02
Speaker
Um, and, and I have a different mentality about it. ah and, and that's ah a small microcosm, but the patience piece, cause there's a, there's two parts to that, right? There's both patience and business, right. And, and time needs to elapse in order for things to happen.
00:26:19
Speaker
Uh, you know, you need time to elapse for trust to get built. Uh, none of the other things you can do to speed that up, but like you need time to elapse, you need reps, you need those things to, to occur.
00:26:31
Speaker
in order to to build towards, you know, to grow towards towards what you're building, um but also with people, right? And understanding that growth is not something you typically plot on a perfectly linear curve, right? And there's, it's undulating, but as long as it's up and to the right, then everything is is is okay. that for people,
00:26:56
Speaker
i i like that for ah As for for more of the staff PT, right? yeah what What is a character trait or what is either a character trait or activity that whenever you saw it, when you're in clinic and you teach your practice leaders now, whenever you see this, hey, go after that. like what What are one or two character traits ah that that staff PTs can exhibit that just get you really excited about their growth?
00:27:24
Speaker
I'm always excited by the level of generosity they have towards their patients. And by generosity, it doesn't mean that they're coming in, giving them gifts and and all these little ah goodies. It's generosity with their time and attention.
00:27:35
Speaker
You know, and and those are those are big ad value points um because there's a way to stay in the pocket with a patient just a little bit longer. um And not be so quick to have to get on to documenting the note and getting to the next treatment. It's, you know, um it's being willing to stay there and be generous with the moment.
00:27:56
Speaker
um And pick up on the cues, the nonverbal cues. Being generous with like, man, they just rolled their eyes or they looked away. Like, why not follow up with a question? Be like, Stephen, did I like pass through something a little faster? Did I say something that you got a concern about or a question about?
00:28:13
Speaker
And then when they do the old like, oh, no, it's nothing. i mean, don't take that for face value. Be like, are you sure? I'm not feeling it with the sound of your voice. And now I'm making it light. They're smiling. they're like, well, I going to say anything.
00:28:25
Speaker
It's all right. I'm a professional. Bring it on. And then they share it. And then now I've i've deepened the relationship. um I've exercised generosity in this relationship that like, aye listen, I got your back. Like, you know, I'm with you on this process.
00:28:40
Speaker
I'm here for you. I know I have another appointment waiting after and I have a note. I'm kind of eager to get a few things documented, but make no mistake. Like I'm here for you. I feel you. I got you.
00:28:51
Speaker
You know, when we do those moments, I just think it's such generosity that we express because we don't have to do that kind of stuff. Those are the hustle plays in sports. and and And again, physical therapy, this is a sport.
00:29:03
Speaker
It's a way to bring some hustle to our approach in patient care. And the patient will love us forever for it. You know, they really will. yeah i Yeah, we we have saying at Sarah, which of course we copped it from somebody else, ah which is feedback is a gift, right? It is, and and people, think people overlook this way too much. If someone is willing to give you feedback, that they have overcome a lot of like,
00:29:30
Speaker
innate human behavior to give you that feedback, right? Like it is so unnatural, so uncomfortable. um If you've built the relationship to that point to where they're willing to give you feedback, like it's almost always, of course, there's always exception to the rule, but almost always coming from a good place.
00:29:52
Speaker
I love that you're sharing that because my my view on that is that's a reward for a great relationship. yeah Because if they're not sharing that stuff, there's something missing in the relationship. Like always beware of like, oh, yeah, we never fight.
00:30:04
Speaker
It's a great relationship. Like, how's that a great relationship if there's never fights or disagreements? But there's a way to have boundaries with that kind of stuff, and whether it's a working or personal relationship, to you know, that we maintain mutual respect. But we should be able to have our disagreements and be cool about it. Like, you know, it is it's a gift.
00:30:23
Speaker
You know, thanks for the feedback. you know, and try to check our our feelings about it. Like maybe our feelings are hurt, but right now, how do we make, again, be generous? Like it's about them. They opened up, they overcame maybe some nervousness or discomfort, right? It requires courage, yeah you know? So maybe just like, Hey, thanks for your courage. I'm sure that wasn't easy to communicate because it wasn't easy to receive, but right now this is about you, yeah you know? So like,
00:30:51
Speaker
and then stay there generously because that's what you would like in return if you were on the other side and had to have some difficult, crucial conversation, right? It's when a customer doesn't have anything to tell us but how we can get better, why like all the alarm bells are going off at that point because it it it's like if could be one of multiple things or multiple of multiple things, right? But none of them are good.
00:31:17
Speaker
i And it probably starts with, they don't they don't feel like they can trust us or that we deserve their trust, right? Or we haven't built a relationship to a point where that can be delivered.
00:31:30
Speaker
And that's, so yeah we use it as a a little bit of a bellwether, right? um And sure, sometimes there are folks that we are in contact with quite a bit. they're Like, yeah, you know, if told you guys like what to fix and I'm sure you'll get there. But yeah, it's first time and now it's perfect, like,
00:31:51
Speaker
There's no way there's right. Yeah. You're absolutely right. Yeah. So, you know, to be able to stay there generously, uh, don't go quick to judging yourself or the other person and just kind of stay there and just appreciate that they're, they're trying to talk through something that's probably more difficult for them to deliver than it is for you to receive it. Right.
00:32:11
Speaker
hundred percent. hundred percent. Oh, I'll, this, uh, Michael, it's, it's very rare uh, we get so many points for different, uh, different groups. Right. So, you think we've got some, uh, so some lessons and some tactical pieces of advice, right. Um, in terms of the, the bad day test, right. For, ah you know, figuring out your why, and then on the leader side, uh, to, to lead with kindness, right. Um, and you know, be always, uh,
00:32:48
Speaker
be okay with being wrong. I think that actually applies to to both practice leader and the staff um while striving for excellence. And I think especially for practice leaders to understand that if they invest in their communication and their patients, they're likely to see extremely high ah ROI on those skills. I completely agree with that. And then, you know, we rounded out with the discussion on you know generosity towards your patients. And you mentioned a couple skills around being generous with the moment and picking up on cues. And it's one of the reasons why, at least for for Sarah, um I don't think we will ever hire someone either on the sales or customer success side that doesn't have physical therapy experience. I guess just especially the picking up on cues piece, just so good at asking why.
00:33:42
Speaker
Right. I would put a physical therapist up against someone that's born and bred out of the born and raised in the Toyota production system, which came up with the five wise.
00:33:52
Speaker
I would put those two against each other. And gosh, that would be the nerdiest, you know, get to the bottom of a cage match. ah But it's what I would like to see.
00:34:04
Speaker
That's great. yeah I'd like to see it too. Let me know. Yeah, pay-per-view maybe. um We might have to pay people to view. So maybe that's that's actually how we would have to go.
00:34:16
Speaker
ah But you mentioned Harry Potter earlier and the magic wand. And yes, it is my it's come time for my favorite question. So Michael, if you had...
00:34:28
Speaker
ah magic wand and you could fix one thing within physical therapy, what would it be? Yeah, that's such a big question, right? um You know, I'd love to fix how we can simplify how everything works in the healthcare system and where physical therapy is integrated in all of that.
00:34:51
Speaker
you know um You can tell I'm really trying to be thoughtful with my word selection on this, too. You know, it's it's really evolved into quite a complex, kooky environment out there in the whole health care landscape.
00:35:04
Speaker
Right. And so where physical therapy sits in there, you know, we're seeing a lot of. um you know, opportunities to connect better, um more integrated care, like with all specialties for the betterment of the patient, having a very efficient experience in the system from the moment of what their episode to coming out the other side with a solution, you know, where they cross that finish line led by their physical therapist. There's there's a lot that has to happen inside of there.
00:35:30
Speaker
So I'd love to see, you know, a wave a magic wand and see that ah whole world be be a lot simpler. um and especially how it integrates with all the payers, that that would be a lot simpler and that the power is with all the patients and empowering them to have have all the power and how they are able to navigate and and, you know, collaborate with their payers. And then how the providers on the other side can have a really streamlined, simple process that's not so scrutinized, not so regulated, um that just... um
00:36:07
Speaker
gets back to some of the core foundation and fundamentals that makes us healthcare professionals. You know, we're highly ethical, deeply compassionate, super committed on a healthier ah society.
00:36:20
Speaker
And we are innately like wired to do the right thing. So like, give us the rope to do the right thing. um And trust that we're going to get it done, you know?
00:36:33
Speaker
put some, put some guidelines in there, but I think we can lift a lot of regulation and complexity throughout the whole system. So I know that's a loaded answer. I've got, it's layered with some of my opinion in there too, but that's what I would, that's what I would wave my magic wand very thoughtfully being like, how can we make things that much simpler and easier for everybody?
00:36:52
Speaker
I, I really liked the answer and I'm glad you did. Right. Like that's why I ask it as I like to see the, i like to see the differences in the answer. Um,
00:37:03
Speaker
And yeah what you're talking about sounds i mean sounds like trust, right? like There's a lot of rules and regulations and red tape and bureaucracy that has been spun up because of bad actors, right?
00:37:22
Speaker
Okay. ah But the this whole you judging the the entire barrel of apples by one bad one.
00:37:33
Speaker
um is causing an immense amount of cost in the system to to everybody involved. And it's resulting, i think i think that what you're talking about is the ah undercurrent, right, to why you're seeing clinicians exit, not even apply to PT school, right, because practice owners,
00:37:57
Speaker
are so burdened down with, it's not just the low reimbursement, right? It's the low reimbursement combined with the higher levels of documentation and systems that they have to pay for and and all that to to be able to even, you know, keep their doors open.
00:38:11
Speaker
um And I don't know, like, and maybe it's a self-selecting process, right? To where ah we're typically working with, you know very, very highly capable practices and and clinicians, but I just don't ever walk into a PT clinic that we work with and I'm like, oh, there's no value being created here. ah you just You go in there and you're holy cow.
00:38:36
Speaker
If anything, your a lot of these payers are are missing a massive opportunity because the trust between the PT and a patient is so radically different between a trust ah between that patient and any of their other providers.
00:38:51
Speaker
ah If you think a patient is going to be anywhere near as open with an NP or MD as they are with a PT, like I've got a bridge to sell you.
00:39:03
Speaker
It's just, it's it's not. It's pretty special. It's very special. It's very special. Not that that needs to be no weaponized against the patient or you know monetized the nth degree, but
00:39:18
Speaker
Are there are there different reimbursement mechanisms or systems that could be put into place to be able to reward the relationship that gets created?
00:39:28
Speaker
think Now you're getting into a fun topic. You know, it's it's it's this idea of reward versus penalty. You know how do we put more rewards in rather than deterrence? you know, um and, you know, have a penalty, have penalties for sure, but ah there should be consequences, right? I mean, in sports, I mean, if you foul someone, you're they're going to blow the whistle, there's going to be a penalty on the player or the team, you know, um but have more of a reward ah system in place, right? So, I mean, if we're thinking about like basic organizational psychology, I mean, it's like positive reinforcement, right?
00:40:03
Speaker
If you want more of a particular behavior, reward the the said positive behavior and you'll get more of that positive behavior, you know? And then how do you elevate said positive and behavior? you put higher rewards out there, higher tiers, higher...
00:40:16
Speaker
get everyone reaching, um but make sure it's crystal clear on the why. Like hopefully embedded in all of that is so that we have this exceptional, like super healthy, active society, right? that That is, I mean, how would this world be doing if everybody was a lot healthier and a lot more active?
00:40:34
Speaker
I mean, maybe we'd be doing a little bit better, you know, and not to say we're not doing good, but it's all about like, how do we do better? Well, I think you can look at, and then maybe I'll be get in trouble for this and that's okay.
00:40:46
Speaker
ah But and think you can look at the market for Ozempic and Manjaro and others in the GLP ones, and you can get a pretty good idea of what people are willing to pay.
00:40:57
Speaker
ah When I say people, payers, patients, et cetera, for behavior change, right, and lifestyle modification. ah So, yeah, I think it's the the data points are out there.
00:41:11
Speaker
Yeah. yeah so you know to kind of add to what you're you're talking about with the value that these pt practices and pts in general are bringing you know this this this reward system that rewards those that are bringing even more value and and even better outcomes and even more enhanced patient experiences Um, like those are the ones we want to recognize so that we get more of those kinds of professionals out there and then have more of those kinds of patients that are enjoying the exceptional experience with this, you know, the, the really great outcome.
00:41:44
Speaker
Right. A hundred percent. hundred percent. And, you know, as I look at like our company, even if, if there were better incentives put in place prior to the RT, the remote therapeutic monitoring codes, I could,
00:41:59
Speaker
we would have been a rat like we would have been in the fee-for-service world back when we started the company in 2017. Right? But there there wasn't there's not enough margin.
00:42:10
Speaker
ah There wasn't then. There definitely isn't now. Not enough margin. And there's so much... You've got to focus on like getting the visits in. Right? Versus now where, you know to your point on organizational psychology, now there is a set of codes that are high margin in comparison to a visit that are high margin that reward for delivering care in between visits.
00:42:38
Speaker
Right. It's like, well, and what's happening? Holy cow. Like we see practices are doing really cool things with that. We're hearing about decreased hospitalizations because they're able to get in front of things, especially for the elderly population.
00:42:51
Speaker
for seeing improved outcomes in even in fewer visits. It's like, well, it's not rocket science, right? Like it's just like hey, now we have this system that really just helps us and deliver more care in between visits. And what do you know that that does good things?
00:43:05
Speaker
um But without the codes, it wasn't ever going to happen, or at least not at the level that it can be incentivized now. So I couldn't agree with you more on the if if we can simplify the system, there would be a just plethora of benefits, a plethora of benefits that would just wash a lot of the the bad away.
00:43:29
Speaker
um and I think there's, there's some trust, the there's trust and there's also rewards and not just purely penalty leading with penalties. Right. Yeah.
00:43:41
Speaker
And that would, would help us get an an inch closer at least. So, so So what do we do in the meantime, right? So it's like we let our game do the talking, right? So bring bring the value now, find those value stacking moments, you know um look for ways to be consistent in all of that. Leverage technology like what you guys are providing out our industry.
00:44:05
Speaker
Like what a great thing, what a great tool to leverage um and increase the engagement with each patient one at a time. You know, so that they're elevating their outcomes.
00:44:17
Speaker
They're enjoying their experience more because of the increase in connectivity that they're having. This feeling like someone does have my back. There's this accountability thing because we all need a little lift when we're down.
00:44:27
Speaker
um And what's the easier way of doing it? It's leveraging technology. And you guys have done a fine job with this product to make it about as easy as possible. Right. so um yeah know It's pretty neat. So we have these tools at our fingertips. And then the reward is obviously on the other side is we've got you know stronger continuity of care, um certainly increasing you know what we can expect on on the average reimbursement, which is great. We can reinvest that back in the practice.
00:44:55
Speaker
you know People for development, raises, um expanding benefits, um resources for, you know, all our employees, but also our patients, our community. So around and around that whole economic circle is reinforced.
00:45:14
Speaker
I think you're exactly right. And I know for our journey, we still have miles, miles and miles and miles to go. And were we're blessed to be serving practices that will provide us feedback to help us get there.
00:45:28
Speaker
ah Dr. Michael Nula, where can people find you? A couple ways. They can reach out to me directly via email and Nula at Nula training systems.com or you can just go visit the website, Nula training systems.com and find me.
00:45:42
Speaker
So I'm always happy to connect and ah you know, people can jump into a discovery session at no cost and we can just talk shop, see where you're at, see what you're working on and see if you might be a good fit to work together.
00:45:55
Speaker
i I appreciate that very much. Yeah, we do something similar. We call it an RTM impact session. It's like, we don't know if we can help you. Let's just see if if there's even a there there. Right. ah So i i I would encourage those listening to to take you up on that offer.
00:46:14
Speaker
um It sounds like you're like me and and get energized from from those calls. And so with that, Dr. Michael Null, I want to say thank you very much for for joining me today.
00:46:24
Speaker
And hope you have a wonderful rest of your day. Thank you, Stephen. Thanks for having me. Appreciate it.
00:46:32
Speaker
Thank you for listening to another episode of The Disruptors. I hope that you were able to take one or two things the away that you can apply immediately to your own innovation journey. As always, I'm your host, Stephen Cohen, sponsored by Sarah Health.
00:46:45
Speaker
Let's keep moving.