Allison Jones
Good morning, good afternoon, and good evening. Welcome to the Therapy Matters podcast, your one-stop resource for expert insights and advice on everything related to therapy and rehab. I’m your host, Allison Jones. Today, I’m joined by Janie Taylor, VP of Clinical Operations at Confluent Health. Janie, thank you for joining me today.
Janie Taylor
I’m glad to be here.
Allison Jones
Excellent. You have quite an accomplished career so far. Take a minute and tell the audience a bit about your background and what has brought you to your current position as VP of Clinical Operations at Confluent.
Janie Taylor
Absolutely. We laughed and talked about this and that. You know, I’ve probably sat in every jump seat possible in the traditional private practice outpatient therapy world. I entered the PT space in 2005, working as a technician and ultimately becoming a student at a little startup company in Oklahoma called Physical Therapy Central. At the time, we had three clinics.
Our founder had opened one, and quickly, two others joined. We really just grew with PTC over the next ten years. I moved into the staff therapist role and then, of course, a traditional clinic director role. I was really fortunate to have a growth mindset leadership there that allowed us to become minority partners at the time, and we just kept growing.
Suddenly, the brand had a need for a regional director, and I ultimately assumed the role of Chief Executive Officer in January of 2020, just two months before the pandemic hit. So, there were lots of learnings there with Physical Therapy Central. The other component of that is we joined the Confluent family in 2014, and the last ten years have just been a crazy, fast-paced, growing ride.
Indeed, as you start working in your local market, you suddenly find yourself connected across the country, learning more about the industry in the last ten years than you could have ever imagined. I went through the pandemic as a CEO here in Oklahoma and came out on the other side, moving into the Vice President of Operations role. I’m still here and still kicking, which is a win, considering what the industry has been through over the last three years.
But now, I primarily work with our clinics in Oklahoma, Kansas, and Colorado. I get a chance to lead some pretty amazing people there.
Allison Jones
That is amazing. Thank you for sharing your background. Today, we’re going to be focusing on a critically important topic. We’re going to be talking about leadership and developing high-performance individuals within practices. It’s something that we have discussed before on the podcast. We’ve had a few folks come in and talk about leadership and development, but it’s a topic that is really worth revisiting.
Indeed, it’s something that every therapy practice struggles with, regardless of your size. You could be a really small practice or a large conglomerate like Confluent. The question is, how do you find the best people for your practice? And once you have them on board, how do you provide them with leadership and development that really creates a high-performing culture and helps you retain them and keep them on your staff?
Indeed, there’s a twist today. We’re going to look at this through the lens of how to achieve this while also running a high-performing practice. So, it’s about having high-performing employees and a high-performing practice simultaneously. Sometimes, people might find this challenging or even consider it a bit of a ‘dirty word’ when you’re talking about incorporating revenue into the subject. But it’s an important piece when you’re looking at creating a high-performance culture. So, we want to dive in here. The first question for you is, how does Confluent view leadership and development?
Janie Taylor
We obviously put a huge emphasis on leadership and development. It’s interesting that you mentioned being a conglomerate. There are so many mornings when I wake up, go to work, and I’m still the staff therapist that was treating around 12 people a day. I do still treat patients every week.
You never really take off your clinician hat. That’s something everyone in our industry gets right – the focus on developing clinical skills. Where we sometimes get a little sideways is in how to systemically ingrain leadership development into our culture. It becomes an expectation, not just a bonus.
It’s also something that you bring to the employee. It’s not them seeking it out and bringing it to you. With Confluent specifically, we pride ourselves on being a three-legged stool operation where we have clinical excellence, operational excellence, and then we have this leadership development leg of the stool as well.
We have a very structured pathway for that. I think that’s where I’ve made mistakes early on in my career. I thought, “This sounds great. Let’s do it with these new incoming providers.” But then we didn’t reproduce it down the line. That’s been something we’ve been able to do at Confluent – have a system that’s reproducible, sustainable, and scalable across multiple platforms.
We’ve been able to create these common leadership terms, language that we use. That’s what’s made it successful. In a nutshell, you have to have a system. You’ve got to treat your leadership development just like you do learning how to do a lumbar manipulation. It takes practice, repeat practice, and that’s what we’ve been able to do across our company.
Allison Jones
Excellent. You said that you have a common terminology for your leadership. Could you tell me a little bit more about that?
Janie Taylor
Absolutely. So, we’ve laughed amongst ourselves. We have a very structured pathway to teach what we’re going to rebrand in this podcast as human skills, not soft skills. It’s a thing. I had a mentor not long ago. I was speaking to a group of leaders and mentioned soft skills, and she called me out right there in front of everyone and asked, “Why are you calling these soft skills?” It’s like knowing how to type a note in your email is a hard skill, but having a difficult conversation about feeling overworked isn’t as important a skill.
They’re human skills, and that’s what we’ve really been trying to drive. You have to train your providers not only to do the operational tactics, but also to have human connection, manage emotions, employ emotional intelligence when working with others, and communicate not just with proper English, but with openness, transparency, vulnerability, and honesty.
These are things that have to be ingrained from the beginning. To get someone who’s a really stellar clinician to become a high performer at another level for your organization. That is what we’ve done. We specifically use the conscious leadership model and Enneagram training. We’ve gone to great lengths to scale this from people in the Confluent C-suite to our incoming technicians working part-time. The training is available to everyone. It doesn’t work unless it’s across your entire organization.
Allison Jones
What have you seen works the best when you’re trying to motivate and inspire your employees?
Janie Taylor
That’s a great question and one that I’ve probably done the wrong way more than I’ve done there. I think when I was really thinking about this and preparing and looking at the last three years of our industry post pandemic, I’m going to answer this question so differently than I would have in 2020 because the workforce has changed. As private practice owners, or any kind of person trying to run a practice, the ante now is that you have to offer your employees a safe work environment. You have to give them the tools and resources to complete their job, and you have to pay them and reward them fairly.
At a current market level, when I came out of school, if you went to a company that gave you a new fancy laptop and had the best treadmill and recumbent bike in the business and paid for your continuing education, you were winning. That was the job, and that to me now just gets us as an employer at the table to have the conversation.
Then you move into how to motivate them. We’ve been saying this for years, but it’s truly about autonomy and mastery, allowing that employee to have autonomy and mastery as a clinician. In the last three years, the most critical part of that is meeting them where they are. It has always been a longstanding expectation here at Confluent that you become a board specialist, whether it be in orthopedic sports, neurology, or any other field. You went into residency and started your job with us. You started a residency program that has undergone significant changes over the past three years. Despite these changes, our desired outcome remains the same. We aspire to have 85% of our clinicians board-certified, a figure that stands in stark contrast to the industry standard of 11%.
We’re doing it so differently. We’re motivating them differently. We’re meeting them where they are. They might not jump into a 20-hour-a-week residency program. They might do weekend clinical content courses that lead them up to setting for that test. That’s a very specific example. But they’re still having mastery. They’re still having autonomy, and the employer is now meeting them where they are. That is truly motivating to the employee.
The other side of that point is that you’re building a relationship with them. While you’re doing this, you’re being honest with them. You’re communicating with them, and you’re having conversations about what they really want in their professional development. I think, in short, the answer to motivation is mastery and autonomy. I’m saving the word “purpose” for the next level because you’re like, “Where’s that purpose? Where’d that go?” I think that’s the gap. To me, that’s the gap from motivating to inspiring.
Allison Jones
What’s the difference between motivation and inspiration?
Janie Taylor
I’m no expert, but motivation to me, as an employee, has all those things we said: a safe work environment, tools and resources, fair wages, setting their own pathway. The inspired employee is one that is truly aligned with your organization’s goals, mission, and core values. They’re living your purpose, and you’re living your purpose together.
That’s where the inspiration comes in. Employees are able to reach their highest potential, being creative at work and literally consumed by the organization’s mission. We see it with high performers in our organization every day. They are reaching potentials we never thought possible because of meaningful relationships and human skill development that they’ve developed in their tenure as a provider.
That’s what I think. When I can get in front of a group of high performers who are tied to and believe in our mission as much as I do, that’s a really awesome and fun thing as a leader.
Allison Jones
How do you get folks on board with your mission and vision? How do you get them to adopt that purpose?
Janie Taylor
That’s a great question. I used to think that you just got lucky and hired the top 10% that were innately like that. But as we’ve grown and our need for people has grown, I’ve learned that it’s really on us to develop these people. We start from day one of creating a foundation. This is our vision. This is our mission. This is what we believe.
We believe in that three-legged stool. We’ve got a real structured way to get you there. We’ve got a professional development plan that we’re going to incorporate not only our clinical expectations but also our core values, our patient engagement, and our conscious leadership. When you’re done with that, we’re going to put you in a program called Thrill in the Ville that teaches you all about leadership development. When you’re done with that, we’re going to put you in a manager’s course. We have created real structured touchpoints along the entire employee lifecycle with different pathways. Some people might say, “I don’t want to be a clinic director” or “I want to be a teacher.” A fellow trained therapist? Okay, we have a pathway for that.
I think, again, it comes back to that system. We introduce it on day one and create a culture of “this is what we’re going to give you.” These are our expectations from you. That’s really what’s gotten us to having, I would say, not only great leaders in place but a really strong bench right behind them. That’s our job, right? To create the next generation.
Allison Jones
This all sounds wonderful. How has it paid off for Confluent? How has this worked out in terms of retention and development? Can you speak to any of the successes?
Janie Taylor
I think it’s just grown. You can’t grow if you don’t keep your people, and the organization has been able to do so. I don’t know if you’re doing a great job of getting to the profitability word. But that is definitely the proof in the pudding as well.
I think when you have set that foundation and suddenly you’re implementing all these systematic things—and by the way, being a very vulnerable, authentic, open leader in the process yourself, you are now leading a group of high performers—the most awesome thing about high performers is that they care about the sustainability and the viability of your business just as much as you do. I think, I don’t know who said it, but the phrase “people first, then profit” rings true. High performers crave accountability around sustainability, viability, and profitability. That’s what we’ve seen. It’s a truly awesome thing when you have them at that level. You can have those conversations, those open and honest discussions about revenue and all the metrics that drive a company, along with the human connection part.
That leads to success. That’s what we’ve seen in Confluent is being able to stay successful despite what we know has happened in the industry in the last three years.
Allison Jones
We’ve discussed how to create a high performer, and now we have that high performer. But ultimately, our business is about making money and staying in business so we can serve our patients. The hard truth is, we do need to make money in order to do that. We are, for the most part, a for-profit organization. So, we do have to look at that side of the business.
As you mentioned in our prep call, as part of the development programs and training programs, first, you have to figure out how to manage humans before you hit them up with how to manage your numbers. Let’s talk about now that you have your high performers, how do you marry that with creating a sustainable business model? You mentioned some of it. They’re wanting to be accountable. How do you then bring in the accountability with running a successful business?
Janie Taylor
I hadn’t even told you this, but part of my leadership experience, I’ve done a lecture, and it’s literally called the “A Word”. It’s about accountability. In the last three years—I know that you guys have talked about it on the podcast—the fact of the matter is that salaries and wage inflation, supply, occupancy, inflation is vastly outpacing reimbursement. It’s hard it’s, and the margin of error is getting smaller. You can’t go eight weeks without having patient providers seeing patients. They have to be at a certain level of productivity. How do you have that conversation around accountability?
Again, I put the onus on the leaders and that we set the expectations from the get-go. Nothing is worse as an employee than getting in an organization and being surprised of what they expect out of you. That’s number one. Number two is having the data, the tools, and resources to be able just to see if we are hitting those metrics. Confluent has put a lot of time and energy into infrastructure around that so that our leaders can have that.
It’s about holding someone accountable. I say this in my A Word lecture. When I ask the audience, what do you feel when you hear the word accountable? It feels like I’m going to the principal’s office. I’m being held responsible. I think if you’re doing that human skill part right, you change that A word to not just accountability, but truly a culture of accountability where you have employees that are taking ownership in their results, and you’re working towards a shared desired goal.
When you sit down, and you’re having routine one-to-one meetings between, let’s say, the staff and the clinic director—you’re having these all the time, it’s not like you’re getting called into the principal’s office. This is a normal thing we do. We meet every month. We talk about how’s it going, am I happy? Is my career pathway going where I want it? We talk about those operational metrics too. There’s nothing dirty or wrong about wanting to make sure our business is still here in 20 years. I mean, we talk about reimbursement going down, and at the same time, the inverse is happening with the need. There’s so many more people in our country that need physical therapy right now.
I see our legacy as making sure that the industry is still here to serve them. You can’t do that if we’re all going out of business, to be honest. Take the A word, take it away from the principal, turn it into a culture of ownership, and then communicate it and connect with your people about it.
Communication is one thing. I can post an email all day long, but you got to take it a step further and connect with it individually and talk about it and normalize the discomfort around being held to those expectations.
Allison Jones
You’re taking it as instead of punishment, you’re turning it into an achievement.
Janie Taylor
Absolutely. Celebrate it.
Allison Jones
Yes, it’s a celebration. What is the greatest challenge that you face as a leader today?
Janie Taylor
That’s a great question. I think, just talking throughout this podcast, it’s really a tightrope. It’s a balance walk between driving meaningful relationships in the workplace while at the same time getting the operational tactical results that you need for the longevity of your organization and be able to continue to give employees all those benefits.
I think companies that only focus on the human connection, that’s great. You do have to have the tactical operations, or you’re not going to survive. But the fact of the matter is that as employers and as PTs, we don’t work with widgets; we work with humans. That is just as important as a KPI of how many visits you’re seeing in a month. I just think as a leader, that is my constant struggle is when to pull on my “empathy, emotional intelligence, listen, not speak” skill set and when to lean in hard with my “I know this is what it takes to keep our doors open.”
We saw that through the pandemic when patients couldn’t come to therapy. All of a sudden, we’re just making sure our employees don’t lose their jobs. You lean in really hard here, but you come out of the pandemic with things like quiet quitting and the great resignation, and then you got to lean in really hard over to your connecting with those people, and that’s the balance.
If anything, I think I’m really glad that I’ve had the chance to be a leader during a time when, as a society, our workforce is maybe getting a little more entitled and asking for that balance, asking to have connections in the workplace, asking to feel valued, asking to work for someone that doesn’t necessarily see them as a widget and a bigger pie.
We can call it a millennial thing. We can call it a generation thing. As a leader, sometimes I want to scream, but man, I really just am counting my blessings around that and that this is going to be a workforce where my kids are going to be entitled to ask for those things. That’s what I try to think of as a leader is being centered, not swinging too far either way, and knowing that ultimately, to get to the profitability side, I have to have the relationship side. That’s really it in a nutshell.
Allison Jones
One of the comments you made is that companies that focus on leadership and development that don’t talk about metrics and don’t talk about operational tactics, the comment you made is that they can’t ignore it. I think you said they will tank if they do ignore it. Tell me why you think that is the case.
Janie Taylor
I had a wise mentor once tell me, and this is, again, dabbling into those dirty words. Allison, money in minus money out equals whether your doors are open. I think you just can’t ignore that. It’s gotten to become what I referenced earlier is you don’t have the margin in our industry to ignore it anymore. That’s why I believe that is because I’ve seen some of my friends in practices not make it in the last couple of years or had to lay people off or had thriving clinics that they kept doing things the way they’ve always done them. If it felt good, we were good. Then all of a sudden, you’re not, and you’re having to make really hard decisions about who you can keep employed and who you can’t, not to mention, losing the community, losing out on a service.
That’s why I believe that it’s really just a math equation. You have to have the math working to be able to do all the other things. The problem is that the math doesn’t work unless you have the people, and you don’t have the people unless you do the human connection. You really could argue what comes first, the chicken or the egg.
Allison Jones
Yes, it’s just the dynamics changed. We’re just at a point within the industry that you can’t do one without the other anymore. It just simply doesn’t work. Any final thoughts that you want to leave the audience with today?
Janie Taylor
I think, if I was listening to this podcast, I would probably take back to my leadership team with let’s define what a high performer is in our organization. What are we looking for? Are we looking for someone that just cranks out patients and bills? Are we looking for someone that can collaborate, connect, become a team player, have behaviors beyond numbers? Then if we know that, what do we have to find a high performer, or what systems do we have in place to develop that?
I think that’s the challenge is developing that system, and it takes work. I think that’s the part too, is it’s a marathon. Just like your relationships at home, relationships in the workplace take energy, time, and maintenance. You can’t just teach a weekend course about human connection and then never do it again. What is your organization doing to make sure that piece of the pie is happening day in and day out in your culture and in your organization?
Allison Jones
Let me just follow that up with another quick question. Is a high performer going to be different from one organization to another? Should it be the same, or is it going to be different?
Janie Taylor
I would think it would be the same. You can have a clinician that is producing, for lack of better words, a lot of revenue for your company but has terrible relationships at work and doesn’t connect with anyone and doesn’t truly live your mission. I think unfortunately, sometimes in our industry, as long as the dollars are there, maybe that keeps going. I would challenge that organizations would say that’s not a high performer. I know that’s what we hold ourselves to here at Confluent, but I would hope across the industry that you would get to that.
Allison Jones
What are the secret skills of a top performer?
Janie Taylor
I think that a high performer is coachable. I think a high performer can communicate, and I think a high performer can connect with others around them. If they can have those three things at the table, I can teach them all the rest, and we’ll get there on the patient skills because they’re coachable, and they can communicate, and they can connect patients like that to the process.
Allison Jones
It’s the three things about being coachable, communication, and ability to connect. Excellent. Well, Janie, we are out of time for today, but I want to thank you so much for joining us. This was a wonderful conversation. I think we have some great takeaways for our audience and some great actionable advice for them. Thank you so much for taking time out of your busy schedule to join us and provide us with that insight. I really appreciate it. I want to thank our audience for tuning in to the Therapy Matters podcast, your one-stop resource for expert insight and advice on everything therapy and rehab. We look forward to seeing you on the next episode.
Janie Taylor
Thanks, Allison.
Allison Jones
Thanks for listening to Therapy Matters. Do you like the podcast? Give us a five-star rating, subscribe, and tell all your friends about the show. Want to be a guest or know someone that would be a great guest speaker? Contact me at marketing@raintreeinc.com
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