Episode 18: Building a High Performing Team

Richard: Welcome back to Agile&Me a physical therapy leadership podcast series. A podcast devised to help emerging experience therapy leaders learn more about various topics relevant to outpatient therapy services. Today's podcast is titled Building a high-performance team and our guest is Ryan Cleps. Good morning Ryan.

Ryan: Morning, Richard.

Richard: I'm excited about chatting with you about this particular topic because you're both a therapist and have also been working in an IT environment. So I think you'll bring a unique perspective perhaps on how to build a high-performing team. So before we dive in, it would be great for you to provide listeners with a bit of information about your background.

Ryan: I graduated with my doctor of physical therapy from Quinnipiac University and essentially turned out what started as our graduate thesis myself and my classmate turned into a little bit of an obsession and that developed into a fledgling startup that we ended up getting a tiny bit of seed investment on and we moved up to Boston and quit our jobs as therapists essentially right out of school and founded a company called strive labs and strive labs ultimately was a software. Strike labs created a software called strive hub and strive hub was the first patient relationship management software and marketing software specific for outpatient, private practice, and physical therapy. So. In building strive labs. And that software, we, obviously brought on a small, small team. Ultimately we ended up merging with web PT about four years ago. Strive hub is now rebranded as web PT reach. And over the last couple of years, I've continued to take on more of an active role at web PT across. The business. So currently I serve as the vice-president of operations over all of our software operations at web PT. So that includes our onboarding, our training and member education teams, our interoperability and data operations teams, our customer support teams and the like.

Richard: I've always got a lot to say. It's just whether it's a value or not. We. Talk about how to build a high performing team. We need to first understand what exactly a high-performing team is. What do we believe are the attributes or, or components of a high performing team. So I'd love to get your thoughts on that first.

Ryan: For me, a team is any group of people that has a common objective, a common mission. A high-performing team, in particular, is to be a team that has a common objective and a common mission, but that also has deep trust in one another. Has a clear understanding of what the team's purpose is, has a clear understanding of each individual, and how they contribute to that purpose. Also, common characteristics for me of a high performing team are folks who are intrinsically motivated, highly engaged and find deep satisfaction in their day-to-day roles. Right. They love doing what they do. And those characteristics, I think, end up resulting in a group that is highly efficient in achieving their goal and highly effective. But I feel like the conditions that I just went over are the essence of a high-performing team that ends up producing something effective and efficient.

Richard: What I find interesting is the fact that the words that you use are trust, understanding, and intrinsically motivated. These are all essential soft skills that aren't there. So when we're talking about building a team, obviously hard skills are important, but All the literature just focuses on the fact that you've got to get the right people in the right seats. And they've got to have certain behavioural styles and also certain attributes, soft skill attributes. Isn't it? Because I've always believed that you can teach most of the hard skills. It's really, the success of the team is that soft component. Would you agree?

Ryan: I would agree. And it's what I think is interesting is they are soft skills, but I believe, and I think we can get into it as we go, that there are, as a leader, there are hard frameworks that are more concrete that allow you to facilitate some of the soft skill development and organizational structure that breeds this breeds, this, these characteristics. And I think from a little bit more of a background perspective, why I'm passionate about this. I mean, I've always been passionate about culture and leadership development, but when I was at Strive labs we were a small team of six or seven folks and we had an excellent culture. I think we had a lot of the characteristics I previously mentioned. And we were highly effective at what we did for the size of our team and in transition. To a broader role at web PT, overseeing many teams, many, many, many times more employees. What I realized was I didn't, I didn't personally as a co-founder do any of the building of this team, this small team with any particular intent, right? I wasn't intentional about building this culture that ended up having a highly effective team. And so I decided in my transition to this broader team where I was coming into some teams that, honestly I was coming in because they were lower-performing and the morale was low. That my challenge to myself was can I intentionally invest the time and energy to understand the problems and the frameworks that can help facilitate them. This type of environment for teams. And what I've found as I said, is, that there are some really hard things, hard frameworks that you put in place that can help you build these soft skills in your team.

Richard: I want to perhaps. Mention or throw out the idea that we're not talking about good and bad team members, our way it's just, are they the right fit? So what might be a person who isn't necessarily a good fit for one certainty and might be a great fit for another type of team? Is that, would you say that's accurate?

Ryan: I would say it's completely accurate. I mean, I put a lot of investment to serve as leadership principles. And I think a lot of people do, but I also think those who haven't explored servant leadership can sometimes give it a bad rap and say, you know, servant leadership is too soft and it doesn't provide it, it doesn't drive results in the way. Command and control and pushing on KPIs does. And what I think is important is, is the concept in servant leadership that you're giving your employees what they need, not necessarily what they want. And for me, with leadership, if you're setting the conditions we talked about and you have a team. Has a high degree of trust, high degree of autonomy, and alignment on vision. It's kind of incumbent upon you to start to demand excellence. And if somebody, if somebody is not performing relative to the line that you've set, the bar that you've set, then yes, it's up to you to work directly with that employee to coach them up or out can be aggressive about it and be very transparent about it because ultimately when you're trying to build high performing teams making it clear to the people on your team that are busting their butt every day, that you won't accept subpar performance and that you're going to surround them with the most excellent people helps to build the trust that I talked about. Right. The idea is if somebody is not performing on a given team, it's your duty as a leader to figure out where they fit? Is it a different team?

Richard: Yeah, I think everyone can be successful. Are they in the right place also, right time I talk about, you know, having, being in the right role because very often people, we don't set people up for success or teams up for success because people in the wrong roles are sitting in the wrong chairs? Perhaps it's the. The wrong environment or even just the wrong task for that group. So I think there are multiple factors, both internal dynamics of a team, but also I think one has to take into account the task, the processes, and the external environment because that can equally impact the success of the team.

Ryan: Yes.

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Richard: We've talked about excellence and high-performance, but first and foremost, as I say, you've got to build a team because without the team, you can't perform. Personally, when I move into new roles or different groups that I manage, the first thing I spend a lot of time on is looking at the team, reviewing the team, looking at their strengths and weaknesses, and trying to understand who needs to be on the bus and also which seat they need to be in. When you took on your role within web PT and looked at these different teams that you started to lead. Was that the case?

Ryan: It totally was and again, for context, you know, I started with one or two teams across about maybe 50 people. And then I took on another team with another 15, another team with another 35-40 people. So for me, what I've been able to do, I'm sure, you know, Richard, you've gone into many teams that have already existed as well. I've been able to kind of test out what I feel works. And it's, it's very similar to, to what you, what you're talking about for me, it's, it's harnessing the mental model and framework of getting to first principles and first principles thinking. So it's for its sake. How can I break down the complex problems and all the work that's getting done to the basic elements? How can I seek to understand as deeply as I can? The way things truly are. How can I put aside my assumptions and challenge my assumptions? And the only way that I've found that is successful or that what I found is the most successful is to take the time. It does take a lot of time to interview everybody one or many times, taking a lot of notes, synthesizing your notes, analyzing, looking for trends and patterns and. Okay. And then socializing what you were, what you're uncovering and what you're seeing back to a select few, maybe your direct reports to see, am I on the mark? I'm off the mark, continuing to revise over several weeks, maybe, a month or so. And once you feel like you nailed it, once you feel like you have the essence of where the team is at, what the pain points and problems are and where you need to go from there. For me, it's all about. Presenting it back to the entire team and making sure that everyone has a strong sense, of good standing that you understand their problems. And the global problems of the team have been identified, and have a vision for solving them. And for me, that alignment building has been important. And yeah, as I said, I guess to circle back on, on the question of right seats on the bus, I feel like doing that exercise for me helps to set the environment where I, if I can deeply understand what's happening and what needs to happen. It allows me to start doing what I call right butts, right. Seatwork which is, off the bus on a different seat on the bus, et cetera.

Richard: I love the concept, right. Butts, right. Seats. I think I'm going to use that. Perhaps. That's the title of your book, Ryan?

Ryan: It might be in my direct reports. I say it's so often that they, don't quite roll their eyes, but we have a short like when we're typing it to each other over slack, it's R B R S

Richard: Interesting that you mentioned the word time because I believe in creating a high-functioning team. It takes a lot of time and energy because it's trying to get a balance. Isn't it? Between the various skills that you need, personalities, behavioural styles too, to not only make sure that each individual is affected, but they can collaborate effectively. So they're kind of the idea of gestalt therapy. The whole is greater than the sum of the parts. And I find that a lot of people. Don't necessarily take that time. They put people together and just start focusing on the task a lot sooner than perhaps they should because you know until that team is put together, it's significantly less effective. Perhaps once you get to work on the task, would you agree?

Ryan: Yeah, there's no substitute for, for time and energy and understanding. And I think. It's a challenge, especially in the way I see it. Or at least my experience is everybody who finds themselves in a leadership position has previously, you know, Been excellent individual contributors. They know how to get things done. They know how to execute. They're smart. They can think critically. And so the intuition is to jump in and start kicking ass and taking names. Right. And what I've come to realize is the best way to build high functioning teams is to understand my role, which is to create the environment. That allows trust to be built, which allows the employees and the people on my team to feel valued. That gives them the autonomy to deliver exceptional results. My mistake that I've ever made, I feel like I make it every time, a little bit less and less often, or for a shorter amount of time, but I make it every time I either expand my team or jump into a new team. If I get into that analysis paralysis mode where I'm like, I have so much to do to change this team. I have so much work that needs to get done. And it's an absolute trap because the idea is that what you need to do is you need to figure out what's going on and then empower the folks on your team to help begin doing the work, show them the way. And if they're not the right people, right. That's when you have to have the right bus, right. Seated conversation. But that's is that, am I kind of hitting the mark in terms of what you're asking there?

Richard: Absolutely. I think, yes. Then, you bring up a good point. I believe where, when I talk about spending the time in establishing and maintaining the team and making sure you have the, as we say the right butts on the right seats, we still. You still have to generate output, I think that's the challenge, isn't it? The reality is it's not as if most people are starting from scratch, you're starting. You're ready to often inherit a team or a situation. And then having to maintain output whilst you're also at the same time trying to get new members on the bus and perhaps reseat others and, and letting certain members off the bus. And I think that's the, truly that the challenge isn't, it is juggling not only the development of the team in the, for long-term success but also continuing to maintain sufficient hours.

Ryan: To your point before, I still feel like it's a part of the process, meaning if you're taking the time to get to first principles and to understand how things function at a baseline. In my personal experience, you find the low hanging fruit quickly. And if things are very broken, You can start to identify the absolute, no-brainer things that need to get changed relatively quickly. And some of those might be people changes. They might be little processed tweaks, but it's all part of that process. And there's no substitute for time, right. To get to the essence of it. But as you're getting to the essence, some things just manifest and appear to you. As just so clear, this thing needs to change tomorrow. And as long as the teams, yeah. This is kind of broken in that. I understand where we're going. Then you know, you're on the mark and you know that you can start to implement those, those that yield big results right away. We are afforded the opportunity where the team is relatively high performing already, and you're coming in. Maybe you can spend all the time in the world, just information gathering. But I feel like ultimately that's not why new leaders get brought in. That's not, that's not why you take on a new team, it's because things need to improve. And I think it's that iterative process of understanding and tweaking and testing that happens along the way that ultimately gets you there.

Richard: Right? Also, I think the structure dynamic and members of the team also need to change as well. Over time-based on the needs of the business and what you're trying to achieve, isn't it because you can have what I believe is a great team for the start of the journey. But as the journey continues, it might well be that the requirements, the output changes, which also requires us cause a change in that team, dynamic or members, doesn't it. Have you experienced that?

Ryan: I have an. It's funny. Like it's almost going to feel like you know, we pre-rehearsed this, but like, this is right up my alley as well. My teammates and the folks on my team, they heckle me and make fun of me a bit because every six months I Pull up our organizational chart. I make like four or five copies of it. And I start to tweak and I start to say, is the work that's coming in, able to be executed optimally based off of the structure and layers that we have based on the team configuration that we have. And then I start trying to workshop, right. And it's. Often it is small incremental changes. Sometimes you've got to blow it up and start from scratch. Right. But often it's small incremental changes where you're just trying to view the organizational structure, the workout put where decisions are being made. Are the decisions being made at the right level of the organization? Or do we need to, to change the, you know what I call it? The conveyor belt of information, right. So that we can get the right work done in the right place. So I completely 100% agree with you. And I think again, that's an iterative process. That's you don't set your org chart once and say, you're done, you've got to continuously assess every couple of quarters in terms of how the work has changed, what the requirements, how the requirements have changed and how that impacts your, your organizational chart.

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Richard: One of my fears as a leader of teams is that either consciously, well, certainly unconsciously I might direct the output without wanting to. Perhaps I'm not structuring teams correctly, or fear structuring teams incorrectly, or perhaps they don't have the right people on the bus where they don't feel comfortable or capable of challenging. My thoughts and opinions and ideas, but certainly as a leader, I'm always cognizant of preventing the best solution from coming through. Inappropriate design of the team or, have you know for whatever reason is that something you're cognizant of as a leader of, of making sure that you don't influence the process or the dynamic to a point where it jeopardizes high performance.

Ryan: It's a challenge. I think I understand the question. And the reason, I guess, the way that I try to avoid that is, you know, set autonomy a lot, but it's when we talk about an organizational structure and we talk about alignment, one of the things I talked to my team about a lot is basic role and responsibility. What my directors and managers and supervisors team leads have the autonomy to solve without needing to get permission, from me or their direct manager. How to database. Right. I'm sure we've all heard of RACI matrices or matrices, and who's responsible who needs to be informed of all of that. Truly. You need to do the work to make sure that your team at various levels understands what they are, what they can impact autonomously, and what they need to go check with their supervisor on or run up the chain. What needs to be decided upon by, by me or the CEO and laying that out and trying to push decisions down as, as far into the context as possible while also having the beam of communication upward, where I can stay informed of the decisions and be able to, you know, say, whoa, you know, talk to me about why you're doing that. It has been how I've been able to, at least from my perspective, try to mitigate that. But the fact of the matter is Richard. I even say to my leaders that I'm trying to facilitate more leadership skills in them. There, you have to be aware that you as a leader are going to affect people's decision making and thinking if you are weighing in on the decision early And people are first and foremost if you're not careful going to tell you what you want to hear and allow you to bias their decision and kind of jump on board. So trying to fight the urge to put your thumb on the scale early can be challenging, but it's something I Kind of grapple with day in and day out, right?

Richard: Perhaps I'm a little too controlling at times. I want to drag the horse to the water. Not only drag it to the water, but that force its head into the water as well and make it drinkware. Whereas, you know, well that might be quicker, but it doesn't necessarily get the right results. Does it? And I

Ryan: I'll jump in. It depends on how thirsty the horse is if the horse is dehydrated and it's going to die. Yeah. You gotta take it over and you gotta stick its head in the trough and say, drink the damn water. Right. But if the horse is okay and just needs to learn that, Hey, when I feel thirsty, I need to go and drink some water. That's where I feel like you can influence and try to shape and, and, and build the behaviour. Right?

Richard: I think that that's a really good point because if you have that high functioning team, I think. They will then teach themselves when they need a drink. It's, during that process of building that team, perhaps you don't have the necessary strength of certain individuals or the entire team itself where you've got to perhaps cajole or push them to the water a little bit harder. Absolutely. The MIT's human dynamics laboratory investigated explicitly observable communication patterns. So it looked at behaviours and communication and found that a high functioning team, really required high energy engagement and exploration to be. Powerful predictors of the team's ability. So those three factors, really energy engagement and exploration as you've worked with your teams and built teams. Would you agree with those three fundamental factors of observed communication are the foundation for success and high performance?

Ryan: Yes. I think if you're observing any team that is operating within the conditions that I talked about previously, I think the actions that you will observe from each team member are a high degree of energy and a high degree of engagement. And, exploration in terms of how you're going to go ahead and solve the problem. So I look at those as more outputs. Once you've already gotten there and done the work, it's really hard to tell it to a team member. You need to explore more. I mean, you kind of can, right. But unless they're in a position where they're already engaged and already finding satisfaction in their day-to-day job, that's where. That team member, that manager, that, that supervisor that you rely on. I'm going to naturally explore right there. They're gonna, they're gonna say I see this problem. Let me go investigate it. Let me figure out what the actual root cause is. Right. And if you're doing your job as a leader, to help them build their toolbox in terms of being able to critically think and explore effectively itself perpetuates the behaviours. Right? So I hate to sound like a broken record, but for me, The environment that you set as a leader and the skills that you're building in your next level leadership team for me absolutely will facilitate those three things you talked about in the team, energy engagement and exploration.

Richard: Now we've covered a huge amount of ground in a very short time, based on what we've chatted through to this point. Are there any other points that you think are worth highlighting or perhaps reiterating or, or spending a little bit more time talking about as it pertains to building a high functioning team relevant for outpatient therapy?

Ryan: Yeah, there's, there's one anecdote I'm you know, just as a warning, I am a baseball fan and I grew up in the Northeast Soma of Boston red Sox fan. And there is one story or anecdote that I share with my team in terms of what alignment within your team means and how important it is for leaders to help create alignment throughout their team. So this one is, I mean, Alex Cora, for whatever you think of the guy, isn't it, it's just a fantastic leader flat out. In the 2018 world series, he decided not to put one of his players in the line of Eduardo noon yet. And Eduardo Nunez was upset and Alex Cora looked and saw that, and this is all, you know, out talked about this entire thing. During a game interview, I saw that Eduardo was upset that he wasn't in the lineup and he pulled it aside and said, you know, listen to what I got. I got two right-handed hitters in the lineup already. We got a righty on the mound. And I got to save you, right. And what I'm saving you for is I'm saving you for a pinch-hit opportunity when a lefty comes into. Because you are a fantastic hitter against lefties, and I need you, you're going to have a big at-bat today and need you to get your head ready. That's your job to be done. And he said after that conversation, Eduardo understood what his role was fast forward to the eighth inning. They bring in a lefty because it's you know, lefty-lefty I left you left the You know, pitcher hitter. Cora looks at Nunez. He says, gets out there. Right. And Nunez all game is he has his tablet in front of him and he's studying all of the left-handed relievers and how they approach their hitters and what they do. And he hits a three-run home run. Right. Because he was prepared, he understood his role. He understood what his job was relative to the overall mission of the team and that work is a leader on a day by day, on a week by week, on a month by month basis is critical, right? Your team needs to know how they fit and what their job is. And it's not a one-time thing. It is a consistent habit. And it's critical because if your folks don't understand how they fit, it could breed discontent. It could make people upset about where they are and not really understanding. And that creates misalignment and frustration and poor performance. So it's an anecdote, but I think it goes to show the type of leadership that Alex Cora provides on a day-by-day basis. And you can see the results that he has had when he's, he's been managing.

Richard: That's a great point where they're gods too. You know, we've talked about building a high performing team, but that's only half the story, isn't it, it's, it's sustaining and maintaining that team and the amount of effort and energy and input required to do that to maintain high performance. So thanks.

Ryan: Yeah, Simon Sineck says, right? It's just like, you know, everyone knows that you need to work out and eat healthy to get into shape. And if you do that every day, you will ultimately get into shape. There's no doubt about it, but the only way to stay in shape is to eat healthily and work out every day for the rest of your life. Right. And that's, that's the idea here with leadership is it's not. Something you do to just build a high performing team. It's something you have to do every single day to build and then maintain that team's performance.

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Richard: Most of the guests I bring on, I'm interested in finding out the perception on the future of outpatient therapy in the US?

Ryan: I'm very cautiously optimistic. I do think that some things are lurking behind the scenes that give me some pause and reservation and I think in particular. There's a massive investment in digital therapeutics that manage musculoskeletal issues, right? As you look at a group like hinge health, that's raised $450 million and there's, you know, competitors like sword and Kaia that have raised similar amounts of money to effectively manage musculoskeletal issues. Purely through digital means and they're selling into employer basis and they're selling into and they're selling into they're starting to insurance companies as a lever, right. That, that these folks can, can pull to decrease the total cost of care. I think physical therapy should be really. Laser-focused on the fact that that is happening and that there's a lot of institutional investment behind it. And we should, we should be a part of that conversation and a part of that solution. And I fear that we might be letting it happen without our direct involvement. Perhaps as much as, as we could be involved because I, I believe that. Physical therapy clinics can provide very similar technology and very similar benefits and essentially increase their slice of the pie versus starting to face some more of that, that downstream pressure that ultimately comes from these, these digital-first platforms. Effectively decreasing the cost of care for certain patient populations. And then all of a sudden that's the steerage mechanism to get them into a digital-first apartment. So we've gotta be ready, to state our value relative to those solutions and get in front of these employers and large insurance companies and advocate for ourselves in order to continue to thrive. I think we will. I think we can. But I mean, that's what I'm seeing from the technology side of things and where I think the risk and opportunity is for private

Richard: practice. I couldn't have paid you any more to set up for me, the plug that I'm going to do, obviously for agile, virtual PT, which alliances established as a standalone. Tele-health PT service that is going to compete directly with those entities that you've, you've just stated. And I couldn't agree more with the idea that you know where we are. There is a threat for therapists to be. Sideline or existing outpatient therapists to be sidelined by these technology companies that are entering the health and wellness space calling themselves the provider for musculoskeletal care. But that, that, you know, in the past, that's certainly not been the case. They started more as wellness and they've realized that. You know, there is this need and they are going to address it. And if the more traditional outpatient therapy company is not going to do it, then they will. So I completely agree.

Ryan: I'm looking forward to after this podcast jumping on another phone call with you and learning more because I think we need a lot more of that. And I applaud you for, for getting out on that, the tip of the spear and. And helping physical therapy solve this problem.

Richard: Any Final words of wisdom for our listeners. I am. I know it's a cruel question in a way because it's so open-ended, but you know, to sum up, or any, any final thoughts for our listeners.

Ryan: Invest, not only in your teams but invest in developing your leaders as leaders because the larger your team is the more reliant you are on your next level leaders to mirror the habits and to create the environment for their employees that you would create for them. And then that takes just as much time and energy as anything on investing in your leaders, make them as strong as you can. And that will. Cascade its way down throughout your organization.

Richard: Thank you so much Ryan for chatting with me, your knowledge has been in the last hour a great insight, and I'm sure that therapy leaders will benefit from your, your experience and knowledge. So thanks

Ryan: Thank you very much. Appreciate it."