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Episode 20

Doing Leadership RIGHT

This week we talk to Tom Denninger, Senior Director of Learning and Development at ATI Physical Therapy about developing leaders! Some of what we talk about: How many organizations still develop leadership WRONG An organization’s responsibility to provide leadership opportunities How pushing people into leadership roles can backfire
Published on 12/14/2023
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Episode Transcript

Allison: Good morning, good afternoon, and good evening. Welcome to the Therapy Matters Podcast, your one-stop resource for expert insights and advice on everything therapy and rehab. I’m your host, Allison Jones, and today I’m joined by Tom Denninger, Senior Director of Learning and Development at ATI Physical Therapy. Tom, thank you for joining me today.

Tom: Thanks for having me, Alison. Very excited.

Allison: We’re excited to have you here with us today too. So, Tom, why don’t you take a few minutes to give our audience some background on who you are, what your journey has looked like over the years, and what it means to lead the learning and development team at.

Tom: Absolutely. I’ve had a bit of a circuitous journey. I’m a physical therapist, graduated about 2008. I’ve been in the space for 15 to 16 years, came out of DPT school, did an orthopedic residency, had the opportunity to do my manual fellowship and took a very typical clinical practice for a few years, became a CD, became a multi-site CD, went up the operational chain, and ran a region for a little bit. 

In 2017, had the opportunity to more formally step out and work exclusively in terms of clinical development, working with ATI’s platform, working with their clinicals to improve skills, patient management, things along those lines. I did that for a bit and then had the opportunity to work with our business development team and help inform them about physical therapy and why outcomes matter, and those different pieces gave me an opportunity to lean into some research. 

Then just about a few years ago, I had the opportunity to come back formally to learning and development. Instead of exclusively focusing on the clinical development piece, I had the opportunity to flex into more of a leadership and professional development space, putting all three of those buckets together rather than just traditionally focusing on clinical products and clinical treatment.

Allison: Excellent. Okay. Today we’re going to focus on a topic that is, of course, very near and dear to your heart, I’m sure. We’re going to talk about learning development, but we’ll look at it through a specific lens—leadership and professional development. When discussing today’s session, you mentioned that something ATI has turned the dial over the last 24 to 36 months, making this a priority for your team members, is the concept of leadership and professional development. My first question to you is why is this a priority for HCI?

Tom: I think the simple answer is we weren’t doing it very well, representative of most of the rehab space. When we think about professional development, we immediately go to clinical skills, patient management, becoming a specialist, things along those lines. Whereas when we think about someone’s leadership development, many have gone through that unequipped. Even those who become leaders, clinic directors, or regional operators, a lot of times that’s represented with the idea of being promoted to incompetence. They were great clinicians and clearly they are qualified to lead a time. That’s not necessarily true. For a lot of folks, leading by example is their only leadership tool. They are not necessarily gifted coaches, being trusted, or communicators.

When I first came up that chain, it’s a bit of an exaggeration, but “Hey do you want to be a CD? Sure, what do I need to know?” “Here’s how you approve payroll and here’s how you approve paid time off. Okay. What else? Here is how you read a report. Okay. What else? Oh, you’ll figure it out.” 

That is representative of a lot of folks, maybe still present, but certainly in the past. In my DPT program, I wasn’t taught how to lead a team. Some people have those gifts organically, or they’ve developed them and other life experiences, but most people aren’t innate leaders. Leaders are developed, not born. It was a huge opportunity for us because we recognized what we were doing wasn’t having the effect we wanted. People weren’t effective at communicating, leading, building trust—all the things expected from a leader.

So, you end up with churn of the position. I wonder how many clinicians out there right now, I talk to someone who’s been practicing for five, ten, fifteen years and they’re not in a leadership role. A lot of times, you’ll discover that they were at one time and felt, “Hey, this isn’t for me. I wasn’t very good at it.” I say, “No, you never had the opportunity to learn and develop. You’re not thrown to the wolves but certainly didn’t have the support and scaffolding needed when taking on an entirely different role.” 

I think that’s the leadership piece, and then the professional piece I know we’ll get more into this later. We had a lot of people looking to understand other opportunities within the organization, bi-directional. Clinicians looking for non-clinical roles. But also, non-clinician roles or non-licensed roles asking, “What else can I do here? I’m a PT tech. How would I go about learning to be in recruiting or a non-licensed clinical role, where I am more patient-facing?” We said, “Hey, this is our huge opportunity. We think we do clinical development pretty well. We don’t think that’s our huge opportunity. There’s been a disproportionate focus on those two aspects simply because we weren’t doing them well or even at all.

Allison: Why is it important to develop leadership in an organization?

Tom: Well, if you don’t have leadership, things don’t tend to go well, and people don’t tend to stay around. I think the mandate was people are interested in becoming leaders, but not if they’re not going to be supported. The other thing is, if you don’t have good leadership, you’re not likely to win, and the people under that poor leadership are likely to leave. I think all of those, it’s performance, it’s stickiness, and it’s self-fulfillment and development.

Allison: Do you see this among your peer groups? Do you see this as a growing trend across physical therapy practices, this concept of creating a leadership and professional development program?

Tom: It’s interesting. I don’t know what everybody else is doing, but you certainly follow the trends on whether it’s LinkedIn or social media and things like that. You certainly do see that things are in place. People are being developed somehow. I don’t know the particulars. I had leadership training probably early on, but it was a lot of business exposure or it was, “Hey, this is how you read a report. Here are the tactical aspects of this leadership position,” which I think is a bit different than having a foundation in general leadership models that then you can instill situationally. 

I think a lot of people are doing some really great stuff. I know just from a lessons learned perspective for us, we’ve tried to take a step back and be less tactical and a bit more general in the beginning because once you have that foundation, it’s easy to lean into tactical situations versus if you’re trying to teach tactics, that makes you good at one particular scenario, and it doesn’t necessarily generalize.

If anything, our real lesson learned is to start with the foundation and move to functional expressions and then tactical applications, as opposed to just going straight to the tactical job-specific applications.

Allison: Okay. I think you’ve touched on this next question, but I’m going to ask it anyways. What do you think is the responsibility of the company in developing team members?

Tom: Yes, that’s a great question. I think a company’s responsibility is to create opportunities for folks who are interested. When development becomes the expectation, that can sometimes go a little bit sideways. This whole idea of an upper-out type of mentality that we see not necessarily in health care, but certainly in other functions of the job market.

It’s good for a business because it drives upskilling, retention, and fulfillment. You end up with a better individual. The idea of build-not-buy from a talent perspective. It’s great for business and a really big reason to do it. What is the responsibility? It’s creating a mechanism for those opportunities without requiring individuals to do it. If everyone learns a little bit differently and has different timetables in their life, no one should feel compelled to take on an opportunity if it’s not the right fit or not the right time for them. The responsibility is having those channels available for folks to take advantage of, not necessarily pushing people through them.

Allison: Not everybody is meant for leadership. Not everybody wants a leadership role.

Tom: Absolutely. But we also need to challenge what is the idea of professional development for a physical therapist or an occupational therapist or a physical therapy assistant instead of this idea of, “Well, you’re a clinician, this is your background. You can become a better clinician, become a mentor, become a CI, become a specialist, or be an operator. We’ve really wanted to challenge the idea, and you had such a wonderful conversation with Maria Carson a few weeks ago regarding this idea of becoming a non-clinical person almost had this like “ew”. It’s okay if you go into education, maybe research is okay, but if you’re stepping away from not even the care for patients or physical therapy generally, if you’re stepping out of a non-clinical role, that’s looked down upon. I just think that’s ridiculous.

Allison: There’s other ways to serve. You’ve been at this for a little while in terms of your program. Tell me, are there any side effects, whether positive or negative, to having this program established at ATI?

Tom: Any changes are going to be multifactorial, and I’m always very reluctant to point or raise my hand and jump up and down and say, “Look over here, look over here.” I would say directly focusing on leadership and professional development has helped with our staff attrition. There are multiples of factors, but we’ve certainly improved immensely in that in a post-pandemic world quarter over quarter. 

I think that’s driven one from having opportunities for people to develop, but also to the point before being led by someone who is developed. So much of changing jobs is, “I don’t have confidence in my direct leader. They don’t communicate well. They are just button mashing, whatever it ends up being.”

Seeing there is a route for them to grow and being led by folks who are better leaders, quite frankly, has helped immensely. I would say that’s probably the biggest thing. But it also goes beyond that in terms of just having a leadership bench. You’re not, “Oh, my gosh, so-and-so left. What are we going to do? Who are we going to push someone into a role,” where maybe they’re a reluctant leader or maybe they are really going to have a tough time. They really need a lot of support for that as opposed to being in a position where, “Oh, my gosh, we have this many people who would be qualified for the role. We need to pick out of great options,” as opposed to always feeling like hair is on fire and you’re plugging holes in the dam before it completely breaks.

Allison: I want to go back to something that you said at the beginning of that staff retention. Staff retention is a big issue right now. It’s a big challenge for a lot of therapy practices today. You mentioned that it’s helped reduce your attrition. Could a leadership program help retain top talent across other therapy practices if implemented correctly?

Tom: Yes, once again, I think staff retention is a multifactorial piece. There’s no doubt about it. But hopefully, I really do hope that when people have better leaders, they’re better engaged in their work, and engaged workers tend to stay. When they see that there’s an opportunity for them, and it’s not an opportunity where I’m holding my nose and gritting my teeth, doing it just for a paycheck, or it’s the logical next step in my career, even though I really have self-doubt or imposter syndrome about my ability to move from an individual contributor to a leadership position.

I think when people have confidence that the development and support are there for them, and it’s not just a hope and a wish, “Oh, sure, I’m going to be right by your side. Here’s the one-pager on running all the reports. Here are your keys to the clinic. Yes, text me anytime,” thing. They’re much more willing to stay for those opportunities because it preempts this idea of gasps. The grass is always greener. “Hey, maybe I would be willing to be a clinic director over there. It’s an unknown known in terms of what support I would have. But if I stay here and I take that position, well, I already know what that’s going to look like, and it’s not pretty.”

I think when people can see the future, they’re less likely to leave for the opportunity versus take and embrace the opportunity that’s in front of them.

Allison: There was something that you mentioned, I think it was a conversation that you had with your head of HR or your head of people, and it was a statement about this being the last job that you’ll ever need.

Tom: Yes, our chief people officer is incredible. The first meeting I ever had with her, I had been in the role for learning and development, and she came in and the first thing she said, “Well, at this previous employer, we had a saying in HR that this should be a clinician’s last new job. They might be with us for five, ten, or 20 years and they might do different things while they’re here. But we believe that we’re a company that grows with people and people should not have to leave to express their passions and interests.” 

She was very direct and said, “I don’t know if we’re there yet, but that’s what we want to build. That’s what we want to create so that if somebody has an interest that’s not directly patient-facing, it’s learning more about IT. It’s having a pathway to look at talent acquisition or business development, or instead of working in the clinic, working on a job site to have those opportunities because right or wrong, especially our generation, millennials, if we don’t feel like we’re moving up, we feel like there’s something innately wrong. We’re always looking for the next thing. Part of it is work we need to do to say, “No, I’m well-situated here. I don’t need to always be looking for something new. Okay, I’m pretty good at this. Now on to the next thing.” 

I think there’s some self-work we’ll need to do a little bit to be good with where we’re at. But if you have other interests in other expressions, why go and need to explore that somewhere else? That clinical background combined with some upskilling in that functional knowledge area makes someone who’s more qualified than someone who doesn’t have knowledge of what we do with patients or in our clinics or in our job sites. We’ve really tried to foster this idea of clinicians by clinicians that it’s not that we’re losing people from the floor, it’s that we’re gaining team members that are super knowledgeable and super empathetic to the patient-facing clinicians and workers.

Allison: I love that idea. I imagine it’s a trickle-down effect that helps with many challenges therapy faces today—patient engagement, staff retention. Those issues naturally addressed by keeping your team happy, engaged, and productive. You just have that natural trickle-down effect.

Tom: Yes, I really think people want to learn. They’re with high levels of burnout, with all the things you said on what drives people to consider non-clinical roles. A lot of the time, people are saying, “I need to look for something different. I don’t know what that is.” But having a mechanism in place where people can understand what a project manager does, what an application specialist does, what it means to be a recruiter? 

A lot of times people don’t know what they don’t know. It’s a matter of, “Well, hey, maybe let’s have this conversation with someone who went from the clinic to the project management office. Let’s have a conversation with this person.” What I try to express always in those conversations is it takes work. There is some investment, at least in time, if not something monetarily as a learning and development professional, went back to school and did three certifications in instructional design because being a great clinician and having a lot of education didn’t mean I was a great educator or a designer of learning.

It’s an understanding of, “Okay, could see myself being interested in that. How much time and resources am I willing to devote?” But I almost always take a step back when watching football or TV and there’s some great Amazon commercials showing how went from a warehouse employee to that name your role. It’s about having channels and opportunities available for people. Even more than that, having the culture where that’s okay. You’re not going to get smacked down because we’re in a labor crisis and can’t have someone else leave the floor. 

Well, if you don’t have those opportunities, you’re going to leave the company and try to find those expressions otherwise. Might as well develop someone who’s going to be a superstar in this new role, keep them, and also have that benefit of it being an attractive place where, “Hey, hiring you for one job only versus our supposed vision of this is someone’s last new job. They might do a ton of different things but shouldn’t have to go anywhere else.”

Allison: Okay, then there was one other thing you had mentioned—the concept of by clinicians for clinicians. We talked about this in the preparation for the interview, creating a voice for clinicians in corporate roles and how that can be very beneficial for organizations. Take a second and explain that a little bit more and how it can be beneficial for an organization.

Tom: Yes, absolutely. It goes back to this idea of committing to build, not necessarily buy. Companies are always at different phases, and sometimes the right thing to do is buy talent that has some specific subject matter expertise that can plug in. But the most valuable folks in those roles are the ones that understand the product intimately, the clinical care, the operations of a clinic, or a worksite. Because when you have that knowledge, I think you have a lot more credibility. If you have been with the company for a while, there certainly is some reliability associated with that, as opposed to the person who rides in on the horse. We’re not really sure, will that translate over from retail to health care or pharmaceutical to whatever the example being? If it’s someone who’s been in your shoes and also has the appropriate skills, you really benefit from it.

This isn’t novel. When we look at any other enterprise, when someone gets tagged as a high potential individual, what do they do? Well, they go through developmental rotations. They get exposure across the entity, across the organization. They learn from being in a variety of situations. Ultimately, when they land their future home, they have all of this content expertise and subject matter expertise and all of this cache of experiences that really prepares them to be in that role versus when you think of people in singular roles or silos, you never actualize that idea of someone understanding the entire enterprise or all of the verticals and how they fit together.

I just think when you have folks that come in and they don’t have knowledge that really relate to physical therapy specifically or health care, some of them do a great job. They really commit to getting out there and understanding and diving in, but some don’t. Some just assume it can be managed from a spreadsheet and X’s and O’s and things along those lines. They don’t understand it because our business is so personal. 

It’s always about the patient. It’s always about the relationship between the provider and the patient. It’s just very different than a lot of other enterprises and industries. The person who understands that and has lived that and walked in those shoes will always prioritize the patient and the provider as opposed to the bottom line. 

We all have conflicting pieces. We need to do better here. We need to do better there. Yes, but at what cost? At what sacrifice? I think when someone has lived in those frontline provider shoes, they probably think things a little bit differently. That’s nothing against people who haven’t. Because I think if you do it the right way, you can really lean in and learn and ingratiate yourself and become extremely knowledgeable about what that looks like. But I just think we’re not always better off, but we’re often better off when it’s this idea of for clinicians by clinicians.

Allison: Excellent. All right. What’s the next step? Where do we go from here in terms of continuing leadership and professional development?

Tom: Yes, I think there’s plenty of work still to do. We’re maybe transitioning from phase one to phase two, where a lot of it was standing up these leadership pathways and programs. How do we refine them? How do we make them better? How do we make sure that we’re taking good feedback both from the folks who are in the programs and also the people that are in the orbit of the programs to make sure that we’re getting better? 

Excellence is a bit of a moving target. Sometimes it feels like we got to make sure we have a much bigger bench. It’s always going to be a moving target from a professional perspective. We’re getting better every day at opening up those pieces, but we have much more work to do on that in order to have a formalized process for folks to shadow or do project work, get different levels of exposure.

There’s always a debate on how much assistance do you do in folks with upskilling. There’s always this idea of skin in the game or an investment, but also what’s the investment the company’s willing to make in its people and itself. We are in the midst of transitioning our learning management system simply because the one that we had before was 99% clinically focused, which was the right thing for us when we initially entered that relationship ten years ago. 

However, when we thought about professional development content, whether it’s people learning Lean Sigma six or individuals understanding Scrum and IT methodology and project management methodology and general communication and leadership principles, it really was an opportunity for us to say we have this clinical aspect, we think we can do that. This is going to be the next stage for us to really think more holistically and programmatically about developing people through that professional development piece with many opportunities for non-clinical skills. It continues to go that road to really mature from a singular focus of clinical development to a much more holistic one around true professional and leadership development.

Allison: Excellent. Any final thoughts for folks that are listening in today and are thinking about spinning up their own leadership or professional development program?

Tom: Yes, I would just say, make sure you take a step back. Normally, when we think about great leaders, we think about our own journey and our best boss or what they did. That is probably great, but it’s by definition singular or narrow. One of the things that was really important for me was to work with learning and development individuals, instructional designers, leadership coaches, things like that who weren’t from the healthcare space.

If you want to get more general, get more general. Don’t stay just in your bit of the camp because there are wonderful resources within the PT space. From a leadership development perspective, a new podcast we started today about the clinical leader profile. There are a lot of people very interested in these things, and if I could offer any advice, it would be to make sure you look beyond just here. 

The ATI has wonderful leadership development programs, but they’re narrow when we think about it. I really had this realization in my days as a bit of a researcher in that Implementation Science Translational Research. How do we get people to do the research? The stuff that research shows is effective, and there’s this really novel concept, and PT is spending a ton of time in it.

When you really back out, all of those Implementation Science models, it’s just models from the 1970s. It’s not new concepts. It might be new to us, but they’re not new concepts. Once again, there’s great stuff outside of what historically has been a PT or OT channel to make sure you’re getting foundational enough and that you’re being widespread enough.

There is lots of great stuff out there you can get exposed to. Ultimately, I think the model matters less than having a model because most of them are 90% the same, just with enough differences to monetize it, but have something, and then also stick to it. That’s probably the other lesson learned in terms of not having the shiny object syndrome.

I love Book of the Month clubs. But also, by definition if everything’s always new, you never really get deep knowledge of it. It takes a ton of discipline to say, “Yes, that’s cool,” and we really want to focus on what we’ve been doing because when you’re not disciplined in the frameworks that you’re implementing, people just assume it’s a flavor of the day. It’s a fly by night, and if they just wait it out, they don’t have to get behind it, and they can keep doing whatever it is. 

I love the idea of being eclectic. I love the idea of really investing in different things. But as oftentimes, good-natured things like Book of the Month or, “Hey, we’re going to do this, we’re going to do that,” it ends up just being a net zero.

Allison: Yes and flaming out.

Tom: I’m glad I read all these books. They all seem pretty similar. But also, I don’t really know what I’m doing, and I haven’t taken the steps to go from model and understanding to application because I can’t apply something different every month. The same thing with our patients. If you do something different every treatment, they’re not going to see improvement, and they think that you’re very disorganized. Well, that’s what happens to you when you’re constantly shifting models.

Allison: Yes, consistency and repetition.

Tom: It’s boring, but it’s probably what does it.

Allison: Yes. All right. Well, Tom, we are out of time for today, but this was amazing. Thank you so much for sharing insights into what you’ve been doing at ATI and what’s worked from a leadership and professional development perspective. Lots to take in today, and hopefully, our audience will walk away with one or two tidbits for their leadership and professional development programs.

Thank you so much for sharing that wonderful information with us and thank you to the audience for tuning in to the Therapy Matters Podcast, your one-stop resource for expert insights and advice on everything, therapy, and rehab. We look forward to seeing you on the next episode. Thank you so much.

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