Ep. 155: How Strong Leadership Cut Healthcare Clinic Closures by 76% - Interview with Joni Lutman and Deniz Garrett from Carbon Health Technologies

WIW (00:00)
What is going on? Walk-ins, welcome family. We're glad to be back for another Wednesday drop of another episode. As always, we're here to help you get more patients, deliver better care, get repeat visits and scale your clinics. Michael, I can safely say that if you're listening today, you're going to learn all about what scale looks like in urgent care clinics. What's up, buddy? Hey, what's up? Yeah. Scale, leadership, real world, you know, what's going on in terms of like moving pieces, moving, like adding locations.

All the fun stuff. So what are we talking about today? So we have on today from Carbon Health, have Joni Lutman and Dennis Garrett. So Joni, she's been the regional medical director and director of clinical quality at Carbon Health. And then Dennis, he's the area manager in the Northwest area. And he's more on the business side and the financial side. Like he's the business arm of the Carbon Health in that area. And the cool part is, for those who don't know who Carbon Health is,

They have well over a hundred locations. They're always growing and adding and spreading their areas on a regular basis. So it's really cool for us to have them come on because we get to hear from them, like what it means to kind of have moving around like tons of locations and what systems work and what systems don't work, things like that. But Joni and Dennis, thank you for coming on today. Welcome to the podcast. We're glad to have you say hello to the audience and tell us one thing about you that nobody else knows. And we'll let the ladies go first. Joni, step up.

Deniz Garrett (01:22)
Yeah.

Joni Lutman (01:22)
Okay, on the spot. So I'm not sure if everybody does know this. I've been in healthcare for a really long time. So people think that I've always wanted to be in healthcare. And that is really not true. Like my dream was to be a sports broadcaster. I love sports, but my mother was a nurse and said, why don't you go into nursing?

WIW (01:37)
can hear that too. You would be awesome. Yeah. Yeah. I could see that.

Deniz Garrett (01:38)
Yeah.

Joni Lutman (01:48)
And I did, and I quickly went back and got my NP. So absolutely love it, but people always assume that, you know, that's what you always wanted to do with your life. And mine is not the case. I secretly would love to be on the sidelines reporting football games.

WIW (02:02)
And I have to, I have to encourage everybody. If you're, if you're listening on the podcast, like through anchor or something like that, or podcasts, Apple podcasts, go over to the YouTube channel. We're recording this. She's got the look to be able to be a broadcaster. Like the cheekbones are there. everything just adds up for you to be a sportscaster. I love it so much. That's such a cool. Why not that way? Who's your favorite team? Denver broadcast.

Joni Lutman (02:20)
It's yuppie.

Okay, so Ohio State is my favorite college team and Georgia Bulldogs, my daughter went there. So it's a split household, but yeah. my favorite pro team is Steelers. I grew up in New York, yeah.

WIW (02:28)
Okay. Bye guys.

Okay. You and your endeavor. Crazy.

Okay. Nice. All right. You're not meeting any stereotypes at all. That's kind of fantastic. All right, Dennis, your turn, man. One thing about you, nobody else knows.

Deniz Garrett (02:44)
Yeah.

Okay, how's it going fam? Thanks so much for helping me on board. My name is Dennis Garrett. I am the area manager for carbon health for the Northwest area. Something I guess unique for me, I've always wanted to grow up to be a pilot and I had the worst vision possible, but I actually ended up joining a military aviation unit and I got a chance to fly the OH-58 Kiowa in Thailand for a little bit. And so just a dream come true for me.

WIW (03:12)
guys.

Deniz Garrett (03:15)
You know, but, you know, it wasn't meant to be ended up becoming a signal officer and doing the communications piece of it. But I still just having that joystick, being able to maneuver the helicopter, especially in the, the, the, the landscape of Thailand was, you know, that's, that's definitely a bucket list. So wonderful experience.

WIW (03:33)
You and I can some stories. I was about to say, I think you just opened a scroll already, and the pilot work. so Nick is a pilot as well. Guilty. Yeah. But, yeah. That's it. that's cool. Yeah. That's outstanding. Well, y'all are doing much harder things because you actually have to use everything that's going on. I can keep two fingers on the yoke and just do my thing, but,

Deniz Garrett (03:37)
man.

Okay.

Joni Lutman (03:40)
So cool.

Deniz Garrett (03:42)
Fantastic. My wife is a helicopter pilot. you know, yeah.

Hahaha

it's so much going on.

WIW (03:57)
I love, here's what I love about this. Y'all seem like two very different people with two very different backgrounds. And then you've come together and, and Dennis was saying, even before you hopped on Joni, that you guys are like two peas in a pod. Y'all are out. You're right. die. Right or die. Love working together. So all about this dyad.

Deniz Garrett (04:03)
Mmm.

Joni Lutman (04:06)
Yeah.

WIW (04:20)
Once you lay that up, Michael, let's get into it. Well, and to be completely transparent, like when he said dyad stuff and he sent out information, I was like, I've seen this, but I've never heard people talk about it very much. it reminded me of like a DSO situation in dentist world. So where you're just allowing administrative side to work with the healthcare side and kind of like can help the business side of an urgent care. Because I think doctors quickly forget that they're running a business too. They're not just helping patients. Right. And we find it all the time that when the doctor

Deniz Garrett (04:29)
No.

Joni Lutman (04:46)
Yeah.

WIW (04:48)
takes time to focus on the business side, the urgent care naturally begins to grow a little bit. nothing against working on helping patients. But at end of the day, you have a business, you have money coming in and money going out. And you always want more coming in than going out. And the dyad side helps control that. But yeah, you guys hop in and explain what dyad is, how you are using it, the ups and downs of it, everything like

Deniz Garrett (05:11)
Yeah, Jonah, you want to?

Joni Lutman (05:12)
So yeah, I'll tee it up and then Dennis will take over there. So it's a structure that they have throughout the organization, so from the top down, since we've restructured, we have area dyad leaders and then we also have local dyad leadership structure. So Dennis and I are at the area level. Dennis manages like the clinical operations piece, the facilities piece, and he manages like the support staff, the...

the MAs, XRTs, everything to do with like operations, supply costs, all of that, the PNL, he's a PNL pro. He will find anything wrong or right with the PNL, so he's your expert. And then I am more on the clinical side, so I manage specifically just the clinicians. I manage their quality of care, practice.

What are levers that we can utilize for them to increase profitability for the centers? And that centers around like metrics like coding and documentation, chart closures within 48 hours, their NPS, how, you know, in Google reviews, are they getting great reviews? How can we help that? Because that's all gonna help bring patients back to the centers. And then we added a metric of follow-ups.

Deniz Garrett (06:25)
Yes.

Joni Lutman (06:29)
We have some PC in some of our clinics, primary care, not in all of our clinics. And what we're seeing in urgent care, I'm sure everybody is, is we're getting more of those patients that cannot get into primary care providers. So it's our responsibility to help them, to be that bridge between UC and PC and get them in to be seen. So we do see them. And that requires some follow-up. Whether we follow up with them one or two times, that's bringing revenue back to the clinics.

WIW (06:40)
yeah.

Joni Lutman (06:58)
and it's also helping our community. So Dennis, I'll tee it off to you to talk a little bit about.

Deniz Garrett (07:02)
Yeah, and thanks so much, Joni. understanding the levers that we have to pull are super important. Understanding the financials are super important, but also teaching them to the clinic managers. And they understand, what does EBITDA mean? What are the things I have to do in the clinic to be able to pull the right levers to get to the goals that I need to have?

How does ADFIA, how does, you GRPV, the gross revenue per visit, affect my monthly output? You know, we have a lot of folks that have really high clinical acumen, but not, you know, so great operational acumen from that standpoint, because they just never have really been taught. And so, my job is really to help really provide awareness, coaching, understanding.

And, know, and really with Joni understanding the process so that we tailor all of the operations, all the metrics, you know, according to that workflow. And then, you know, do we produce the right output or not? And really that's the summation of really all of it. And really making sure that our clinic managers understand, you know, the financials, they understand what their goals are, their targets, and they understand from a workflow standpoint what needs to be done in order to achieve that in a sustainable way.

And, you know, the culture of each of our clinics, it really stems from the leadership. And the leadership is that local dyad partnership that Joni was referring to. And if there isn't a tight, cohesive, unifying relationship, there's just a direct correlation with clinics that are profitable that have that and ones that don't.

And so we really strive to make sure that the culture, the soil, we always talk about the soil, making sure that our folks are in good soil and what creates good soil, having great leaders, having great operations, having great metrics, having great reports that we can see that are accurate so that we know how to navigate that. In the military, we always say, Intel drives maneuver. What you know dictates how you go.

And so, you know, when we look at our financials, we look at our reportings, you know, I will put holes in these reports to see if it holds water, just to make sure that they're accurate, they're trustworthy, and that we can we can move in the right direction with them. And all that really culminates into folks having a much better, clearer understanding of their job, of their position and what their expectations are.

you know, they are these clinic managers and the clinic medical directors. They are the CEOs, if you will, of their their clinics. And we we we really take our time to hire great folks that we can provide autonomy and enough rope for them to be able to just lead and and give them the resources to run an effective clinic. And that's.

you know, we've had a lot of turnover, you as a result of that, to get to that point. And sometimes you shake the trees a little bit, right? You lose a few leaves, but the tree continues to grow. And in our region...

WIW (10:14)
I'm loving all these like comparisons.

Joni Lutman (10:17)
Yeah, he's the king of that too. loves these analogies.

Deniz Garrett (10:20)
Yes. We can talk more about this too, but just from an effectiveness standpoint, and I'll give you an example. Back in July, last July to the end of the year, we had over 100 closures in our clinics. That translated over to over half a million dollars in lost revenue. Who wouldn't like a half a million dollars in revenue? When you really just look at the

WIW (10:21)
Hahaha.

Deniz Garrett (10:50)
the granular part of that. It's, you know, from a leadership standpoint, it's a recruiting effort, not having the right folks, loyalty issues, all that kind of, the culture just wasn't on kilter. And so Joni and I really campaigned together and strive to get this right sized, you know, and in year to date, we've only had 23 closures.

for the entire year for our entire region. It's a 76 % improvement. you know, those are all things that a great dyad partnership can do. It can create the culture that has an effective result that really contributes to your bottom line.

Joni Lutman (11:29)
Yeah, and it's about one of our mottos, right, is hiring people who genuinely care. So we do try to hire people that really, really care. And that can get along with the diet. So we were a diet structure at the regional level, but we also have a diet structure at the clinic level. And it's a one to one. So we have one clinic manager to one clinic medical director at every clinic. And it's split the same way the manager handles the ops piece.

Deniz Garrett (11:33)
Yes.

Yes.

Joni Lutman (11:55)
supply ordering and ancillary staff. And then the clinician medical director handles the provider metrics, making sure that they're taking care of patients well. They were meeting our metrics, follow-up rates and doing really well on that end of things. So I think it's really good. And to Dennis's point, we shifted and did it locally because it wasn't working at a larger scope, right? It was too much of a...

of a lift when you're managing several clinics that you really can't laser focus on the staff that you have in one clinic and what those clinics need. So it's really helped us get to kind of like mediocre, middle of the road to kind of exceptional in a lot of these clinics.

Deniz Garrett (12:34)
Yes.

WIW (12:36)
Okay. there's so many questions. I've almost got a choose your own adventure here that we could go down. Yeah, exactly. So I'm going to throw out a couple of things. Michael, throw out a couple of things and then let's figure out which rabbit hole we want to go down. Joni, you said right out of the gate, you were talking about follow-up. We did an episode way back called the patient care power move. And it's all about there's fortune in the follow-up. Like always book a meeting from a meeting, always book a meeting from a meeting, book an appointment.

Deniz Garrett (12:38)
Thank

Sounds great.

WIW (13:04)
Gosh, there's so much value here. I'm trying to figure out where all we can go. We can talk about EBITDA. I love that. That's awesome. And how you manage that at the clinical level. We can talk about, there's how your Intel drives your maneuvers. We talked a little bit about your net promoter score. Are you tracking your net promoter score, your door to door time? I think you said patient value, cost per patient or value per patient. How did you write that down?

Deniz Garrett (13:09)
Hmm.

Mm-hmm.

Yeah, gross revenue per person. Yeah, right. Same, same.

WIW (13:32)
the GRPV. Everybody calls this something different, that I try and get it away. So, so GRPV. I happened to resonate the most. We literally, our last episode was about my failure and the fact that you just talked about 100 closures. I don't know. Where do y'all want to go from here? This is like, I've got so many things that could go. And then I, and then I was just leaning into, one of the things that we find a lot of our listeners do.

Joni Lutman (13:36)
Yeah.

Deniz Garrett (13:48)
Mm.

WIW (14:01)
is that they hook on to something practical and try to implement. So if there were some things that you guys, obviously you've learned tons of items, but if you were going to make a change right now for a clinic or you're like the number one key indicator you were going to look at, if somebody said, hey, come look at my 10 clinics and tell me what's wrong, where do you go first? What's the quickest and fastest fix to kind of get the ball moving in the right direction? what was the, when you started going through all these clinics, you had the aha moments like,

Why didn't we think about that in the first place? That could have solved so many problems up front.

Deniz Garrett (14:35)
For me, from an analytic standpoint, I would want somebody from the outside to look at our reporting structure and see, are we measuring the right things? Are we looking at the right things? We have a metric called door-to-door time, and it's measuring from when a patient walks in to when they check out. And then all the processes that happen in between then.

But I would want them to look at the reporting and to see if it's accurate, if it's showcasing what we need. Are we pulling the right data? Are we missing anything? And that way, then we're not going in half-cocked to making directional changes because we've got good solid information.

Joni Lutman (15:18)
And I think the big thing me is the people. So if I would go in, if I'm going to make a change, first thing I did when I came in to Carbon, I was a part of one of our largest acquisitions over four years ago. And it was a look at everybody in those clinics doing like an analysis, a, you know, are they a good fit culturally? Are they good fit clinically? Are they able to move the mark?

WIW (15:18)
That's good.

Joni Lutman (15:43)
Are they knowledgeable? Are there skills and procedures up to par? How can we help them? And we had a lot of turnover because we are looking for a specific type of person within carbon that actually wants to be there, wants to care for patients, wants to make improvements. So I would say looking at your roster first, looking at your roster and seeing your A players, your B players and your C players that actually need to be managed out, that can make an

Deniz Garrett (15:53)
Yes.

Yeah.

Joni Lutman (16:13)
enormous difference in the success or failure of the clinic. So that's one people.

And second is like education and knowledge level. We've recently implemented some fellowships, urgent care fellowship programs, because a lot of new grads are getting out of school. They went to school during COVID. They didn't have a lot of experience. And a lot of these urgent cares are single provider coverage, right? So it's only one provider. And if you are not knowledgeable and well versed in the skill set,

it's not going to be a good experience for the patient or the provider. So we want to make sure that they have the tools that they need to succeed. So we do have a six month fellowship program, which I think is really, really unique. And we have the AI charting, which is also something that we're trying to, it really allows providers to spend more time. Our average door to door time, think Dennis, when we started tracking this was like well over like, my gosh, 200 minutes. now it's like clinics are below.

Deniz Garrett (17:00)
Yes.

200 minutes.

under 50 minutes right now.

Joni Lutman (17:15)
Yeah, with most of them being under 50 minutes, which is what the goal is. And that was like improving who's there. It's improving how their onboarding was and kind of offboarding people that really just did not fit with the culture and the skill set and what we were looking for in an urgent care setting.

Deniz Garrett (17:25)
Yes.

We tell our teams too, you know, in the roster for a AAA team looks a whole lot different than the roster in a major leagues team. So if you really want to get to the major leagues, you got to make sure you have the right roster. And if you've got folks that you're just suffering from the halo effect, you know, or the pick of the litter syndrome, you know, you really have to take a hard look at, know, choose your hard.

You know, it's hard to, you know, continue to suffer through toxic work environments, but it's also hard to make a change and find great leaders and, and, you know, and get those folks on board. So you choose your heart. And we really have tried to make that as the emphasis in the culture and how we try to lead our teams. Because there's no way you can achieve those workflows or those results without those folks being on board.

WIW (18:04)
on that.

Deniz Garrett (18:27)
you just spin your wheels. And we kind of realized that, you know, from last September, you know, for a couple months and just did a really hard evaluation on that. And Joni, really looked and had to have some really difficult discussions with some folks about expectations and what kind of decisions they wanted to make. you know, and if they left, it would be very difficult for us to fill the slots and schedule and, you know, just trying to make sure that we've got clinics open. we chose

We chose that as our hard because continuing the path that we were at, you know, just it wasn't attendable to the goals that we needed to make.

WIW (19:05)
You remind me of, we, someone, potential urgent care comes to us that we could probably work with. They usually give us like Google Ads access or something so we can take a look at it. And you'd probably know where I'm going with this one. And talking about people making the hard decision to get rid of certain people. So we had a situation where they're at, let's look at the ads account and we're like, hey, there's a lot of things here that we could fix. But the person that was running the ads was on the call too.

Deniz Garrett (19:34)
Mmm.

WIW (19:34)
And it was a family, it was a family friend type of thing. Like she was part of a family. And so she actually hopped off at some point and we turned to the owner and said, all right, look, we got to tell you right now, she's costing you a ton of money and we can fix this. And she hopped right back on. So we couldn't continue the conversation later today. I know it centered a conversation anyway. So she saw it, but it was okay. But we love AI too. Yeah. We love AI even when it does things we don't want it to do. But all that being said,

We quickly recognize like, you just simply got rid of this person, you would be much more profitable just from the standpoint, like they're spinning the wrong wheels the whole time. can see the look in that guy's eyes too, man. He was just destroyed. Yeah, he was. And then we have, we have situations where the front desk person is destroying the amount of patients coming in the door. Like just absolute disasters on phone calls and things like that. Like it's real.

Deniz Garrett (20:26)
Yes. Yes.

Joni Lutman (20:29)
What is, and you gotta learn from each other. Like, so speaking of that, right? If there's something going, like not going right, or Dennis and I both are pretty opinionated people. And so I think that that works for us. I'm not really offended if he says, Joni, you need to change this, you need to do this, you need to get rid of this person. We need to kind of like pivot and do something in the same, when I approach him. So I think that you have to have really an open mind and open communication.

Deniz Garrett (20:49)
same.

Joni Lutman (20:57)
And we try to teach that too with our dyad leaders, because I don't think that, you know, they would be successful if not, and difficult conversations are one of the hardest things to teach, right? But to see them succeed at it and to be comfortable in it and to say, Hey, this isn't personal. We're all trying to be better here. And that goes without saying like Dennis and I admit our wrongs, right? Hey, I messed up there. I, you know, I can do better. And when your team see that they're like, okay, you know,

Deniz Garrett (20:59)
Yes.

Yes.

So good.

WIW (21:23)
Yes.

Deniz Garrett (21:24)
It's okay to be vulnerable. Yeah.

Joni Lutman (21:25)
It's okay to be vulnerable and they do care about us. And I think that that's probably the second thing is hiring people who care and walking the walk, right? I've been a nurse practitioner for 28 years. I still practice in the clinic a day a week. I want to see what my teams are doing. I want to see what their struggles are. Dennis is in clinic every week, meeting with his team members, going over stuff. So we're not like out of touch leaders. We're in it. We're in it with them.

Deniz Garrett (21:53)
No armchair quarterbacking.

Joni Lutman (21:55)
Yeah, so I think that that also makes you really successful as a unit when they see us kind of like diving in, picking up the slack, helping, advocating for them when they bring up, you know, because that's the biggest thing I've heard. They don't care about us. They just want us to see patients. And we have our staff know we care.

Deniz Garrett (22:00)
Yes.

That's right.

Joni Lutman (22:18)
They know we care because we really do get about for them. We never have anybody stay late. I know some urgent cares, they're over. We have specific like scheduling, velocity scheduling that manages the schedule and walk-ins. And we have a staffing model. So if you get to X number of patients per day, when it's consistent, we add staff.

to help support the teams so that they're able to kind of absorb that volume and that load and not be overwhelmed because burnout is.

Deniz Garrett (22:48)
It's a very objective response to an emotional situation. And again, I think if you don't provide that framework in your environment, you just continue to spin. It's like a hurricane. And so, you know.

you know, after a certain ADV target, we're able to add a half a head or a full head, you know, and showcase the volume and still meet our payroll goals. So we're not giving the farmer way on payroll goals and we're, we're, we're efficient on our, on our operations, but all that, everyone kind of knows what those numbers and those targets are. So it kind of just helps with the, the conversations that you don't really end up having to have, because you've already got the framework in, in place and the understanding, and it makes sense logically, you know, to the team. So.

And going back to what Joni was mentioning about just that culture and that relationship, and speaking honestly and truthfully to each other, that only happens if you have a solid relationship.

WIW (23:48)
Yeah.

Deniz Garrett (23:48)
That only happens when you have the ability to speak that truth into each other, you know, and showcase that. If that's not there, I think things would become very offensive. It would not be taken in the right context or tone or whatever have you. And so that relationship is foundational in everything that we do as leaders. We are in the people business first and everything comes after that. So relationships are the most important part of this foundation.

WIW (24:15)
When I think you mentioned, you know, the ability, how leaders should be apologizing, admitting wrong and being a real person. We're finishing as a company, we're finishing up the book on Unreasonable Hospitality. don't know if you have. Yeah. So good. Such a good book. So good. I highly recommend. We do team reads as a company. Like every quarter we have a new book as a team we read. We don't have a hundred locations plus. Yeah. Thousands of employees. Just to be clear. One location. But, it's so, but that book, even though it's about the restaurant business, it's really about

Deniz Garrett (24:26)
Mm-hmm. Yes. Yes.

WIW (24:46)
how to deal with people and build a relationship side. In the chapter we just finished, it talked about leaders need to be able to apologize and admit when they're wrong. And it creates deposits into that relationship where they can now be vulnerable on both sides. So yeah.

Deniz Garrett (25:00)
That's right.

Joni Lutman (25:00)
Yeah. It does trickle down to the clinical teams and to patients. We have to admit our wrongs to patients too. We have to apologize. You know, and I think that that goes a long way. If you have those open conversations with patients instead of taking a defensive stance, it changes the whole conversation, right? And relationship. I've had patients that have come in angry and not in a good place. And I...

Deniz Garrett (25:05)
Yes.

everything.

Joni Lutman (25:26)
you don't have a defensive stance and when they leave, they're like, I'm so sorry. And I'm like, it's fine. You know, we all have bad days, no, it's good.

WIW (25:33)
That's real. Wow. I want to talk a little bit about, I'm to go back. I'm hitting the rewind button. Sorry. At this point, I honestly don't care if we go a little long because I'm having a good time. You guys are awesome. So you've closed more clinics than most people have ever even stepped into. You have taken that and I believe you said this year, and if these are numbers that we don't need to share, let me know. But I believe they were, you were

How about I say it this way? You've reduced your closings by 76%, I believe is what you said. Okay. So the common denominator that I'm hearing from you is the dyad leadership coupled with your people and your processes. leadership, right people, right processes. Help me connect those dots. You identified where things were going wrong. You put this...

Deniz Garrett (26:06)
Let's cry.

WIW (26:30)
a dyad into a triad, guess, how you look at it, but you put these three pieces together. How did you implement that at scale?

Deniz Garrett (26:38)
think the first thing we did, Joni and I did was kind of look at our schedule and see where all of our gaps were initially and then really drilling down into what was causing those gaps. And in some situations, it was just terrible management of the schedule. And in some cases, it was just really a geography issue where the location was a very hard place to recruit for.

So it wasn't a black and white across the board. So we had to really find what the nuances were for each specific geography. And then from there, what's the hottest fire? And is it a leadership? Do I have a people issue or do I have a process issue? And really figuring out what that looks like. And for the people issues, which kind of stood out pretty easily for us, is really performanceing them out.

and getting those, this is not just providers, but these are MAs, these are clinic managers, these are everybody that is involved in that process. And then getting ads out quickly and working very closely with our recruiting team and putting the pressure on them to get us some candidates so that we can start interviewing. We also found out too that in our recruiting process, we weren't really asking the right questions.

WIW (28:00)
Hmm.

Deniz Garrett (28:01)
And so I worked with our recruiter, our head recruiter, on really just defining what is it that we want to ask our candidates and see what those responses were to help us really judge who is the best candidate and bringing them forward. So that was the first part of that. And then really getting the folks in.

then you can really build your team. It was really closing those gaps with schedules. So this was a, what would you say, Joni, almost a three month process to get to that point. It was a slow go.

Joni Lutman (28:35)
Yeah, yeah, we had to kind of review things. And we did utilize locum coverage during that time to fill those gaps and to narrow the number of closings. But we did, in the process of like having like Dennis said, more like structured, like recruiting efforts and interview process, we did that on the provider side with clinical scenarios to make sure that they were a good fit for the organization. And we ask organizational cultural questions too.

Deniz Garrett (29:02)
Yes.

Joni Lutman (29:02)
because they might be a good fit clinically, but not culturally. So we're able to kind of delineate out who would do well in this environment and who wouldn't. And then we revised all of our onboarding. Our onboarding was really lacking, right? We didn't have a good onboarding process for providers or for staff. So we standardized all of that across the board and looked at what we needed to include in onboarding. And I think the biggest thing was frequent touch points with these new leaders to kind of make sure that it's implemented.

Deniz Garrett (29:29)
Yes.

Joni Lutman (29:32)
at the local level. what that looks like is Dennis and I, have an executive leadership meeting every Monday, right? It's Monday. They go over all new updates. They go over operations, clinical research, because we have research and we have a lot of different areas. And then we will take that and we meet the following day with all of our leaders across our entire region, every dyad structure, every dyad partnership.

and we review that with them. They're able to ask questions, able to dig into it. Dentists and I take stuff back that needs to be revised or revamped. And then that information is taken down to the clinical teams, right? So they will disperse that information to the clinical team so that they're a part of that and they know the why behind it. Because I think that I've worked in medicine for a long time. And when I was at the clinic level,

executives and that were up here and I'm like, I don't know what they do. They know what we do because we communicate. So they're aware of why we're changing things, how it impacts our bottom line and, you know, how we can achieve profitability, how we can sustain the business of urgent care and how we can grow. Like I said, we're adding primary care now, which is fantastic. And fellowships and different things that are going to be able to sustain that, the pipeline for our recruiting efforts, which has really been critical.

Deniz Garrett (30:49)
Yeah. And that becomes a self-fulfilling prophecy too, right? Because if you have a well-run clinic and then you introduce new candidates into this clinic, it's going to showcase well. And you we want this place looking like an Ethan Allen showcase. You know, I want someone to walk in and say, this is great. This feels warm. This feels, you know, you got trained MAs, got, you're greeted properly. The place smells great. You know, you know, just all the scent, you know, I want to appeal to all the senses for this. I it's hard to do that if you're in a toxic environment.

Joni Lutman (31:18)
Yeah, and we do in-person interviews too. We do in-person interviews, which has really helped, don't you think? A ton. There's people that look at it on paper, that I talk to on the phone, that I think are fantastic. I meet them at clinic and go over stuff and I'm like, there's no way we're hiring them.

Deniz Garrett (31:18)
It's hard to do that if you go. Right.

WIW (31:18)
Yes.

absolutely.

Deniz Garrett (31:24)
100%.

Yeah.

WIW (31:33)
yeah. We understand that. We could talk hiring process with you quite a bit and extensively. We've gotten really good at it too, but we've done it in a very unique way, but that it's not about us. Yeah. We're, we're quirky on our hiring. One of our pieces that toward the end, like they may be great culture, great skill, great everything, but if they have a spouse, we get to go to dinner with them and the spouse and make sure the spouse is on board.

Deniz Garrett (31:38)
Yeah.

WIW (31:59)
Because if they're not on board, then it doesn't matter how much they like us and we like them. It doesn't work out. time they go home, if they have a spouse in there going, I can't believe you took that job or this, that, and the other. I mean, they're going to bring that to work. Yeah, they'll bring it. so that's wild. I love that.

Joni Lutman (32:09)
Yeah.

Deniz Garrett (32:12)
Yeah, 100%. So yeah, you know, in, in understanding the journey for that, you know, but really just empowering the teams, you know, that they can do this and they have the ability to do this and, and, being responsive. think, you know, that really is one of the most.

It's one of the things that I enjoy the most about our team specifically is that Joni and I are very responsive. mean, we're kind of hypocrites when we tell our folks to have boundaries with their time, you know, because we will get messages at 9.30 or 11 o'clock at night, whatever, and we will respond and we will follow up and do whatever. And I think it just showcases to the person, know, hey, if it's important to you, it's important to me.

WIW (32:42)
Why are you laughing at me, Michael?

Deniz Garrett (33:01)
that really really seats really well from a relationship standpoint.

And then they see the follow-up and they see the results. a lot of the clinics we exist to help really provide a really great product in the EHR. And so the feedback from the field, it needs to get to our engineering team so they can at least address it and do that. That has to happen in a very quick and a short amount of time. So if there's delays in that, it just causes issues. so making sure that there's no bottlenecks in that process from the clinical side or the operational side. And then you have the person that brought

the issue up, seeing the results, you know, in a, a such a, you know, in broadcasted way that makes people feel good. Like, okay, yeah, my voice is being heard. I'm, I'm being listened to even though I'm just an MA, even though I'm just, you know, whatever the case might be. Yeah. You're important in your opinion matters.

Joni Lutman (33:44)
Yes.

And Dennis, you brought up a good point too about I'm just an MA or I'm just a provider. What I like about the org as well is that we reward talent. It doesn't matter if you have a master's degree, a bachelor's degree, if you've done healthcare. We have some of our best clinic managers that started off as MAs. They know more about PNLs now than I do because they learned it and they really...

You know, we're able to kind of move up and be that leader in the clinic. And they're proud of that. So they're going to work harder for you too. So we believe in like promoting from within and not just promoting, don't think, you know, qualified applicants, but applicants that have the drive, that have the personality, that have the intelligence, that they can do it and maybe never have been given the chance. That's my best success to see people succeed like that.

Deniz Garrett (34:30)
Yes. Yes.

Joni Lutman (34:50)
Like I love it.

Deniz Garrett (34:51)
Yeah, and I worked with our boss to initiate a quarterly bonus structure for all of our teams, which are tied to the KPIs. So it becomes a self fulfilling prophecy. You know, these CM's have the ability to earn over a year in bonuses. Every single one.

WIW (35:08)
That's outstanding.

Deniz Garrett (35:09)
and it's tethered to supply cost and your EBITDA, your margin. So it makes the conversations a whole lot more aligned when you've got a financial incentive that's very, you know, attendable to that. So that really helps spark the right behaviors and whatnot, especially if you've got folks that are hungry for it, bring them on,

Joni Lutman (35:30)
Yeah, we have that on the provider side as well. So I think that that's helped something. And they know, they look at the metrics, they know what they need to do. And so it makes it pretty easy. Yeah, they want to, yeah, it's interesting.

Deniz Garrett (35:38)
Yeah, they want to look at the metrics.

WIW (35:43)
If I could tie every position.

Deniz Garrett (35:43)
When our reports don't come out on time, when our reports don't come out on time, we get an earful. Like when is the financials coming out? We want to know how we do. So yeah, that's good. It's a good problem.

WIW (35:49)
Right.

If I could tie every position in my company to a performance metric where you're on base or off pace or whatever, I'd do it. Not everybody's built that way, but they are built for bonuses. Everybody likes that cushion. Yeah, absolutely. Especially if it's attainable and you can celebrate it. I'll tell you from my perspective, we were talking about, you know, PAs and all that kind of stuff, but we believe personally, and just with all the urgent cares that we've worked with now over the years,

Deniz Garrett (36:10)
Hmm.

100%.

WIW (36:23)
The front desk person is the most important person in the clinic. And there's not really even a close second in our opinion. And when you treat you, can tell because we get to listen to a lot of phone calls. We get to see the conversions just on the marketing side of things. The clinics that have a well-respected, well-paid, well-trained and talented front desk person are thriving, thriving. And it's outstanding.

Deniz Garrett (36:29)
Hmm.

Yeah. I'll say something controversial about that, though.

WIW (36:50)
Yeah, that's you wouldn't be the first one. Most people are trying to take them over to AI.

Deniz Garrett (36:53)
You know, so in our lower staffing locations where it's a three-man team or less, the front desk is also an MA. And so because the clinical acumen

WIW (37:06)
Okay.

Deniz Garrett (37:10)
that's really required at that level, you know, to be able to communicate. It's hard to a front desk sometimes, especially in certain geographies where that really exists. And so you end up having a lot of back and forth from a communication with the patient, communication back to the clinical area, back and forth. And then you look at the spaghetti diagram and it's like, my God, they're wasting the treads on their shoes going back and forth.

versus having an MA that has that clinical acumen that can speak into the situation and provide that consult. They can provide that information to the patient a lot more efficiently. So in our territory, all of our lower staffing levels all have only MAs and they kind of switch back and forth with front desk and MA operations, but they are all MAs.

Joni Lutman (38:03)
Yeah, and they are trained.

WIW (38:04)
Well, I don't find that controversial at all. I think it's brilliant and that you're now leveling up that experience.

Deniz Garrett (38:11)
Yeah. Thank you.

Joni Lutman (38:12)
Well, it is, it's helping with staffing. It's helping with, you know, when they would have to fill in. We did have just office assistants, right? They would man the front desk, but we're able to utilize MAs in different capacities. So it's kind of like a win-win for us. And those double, we have two-person teams. I work in a two-person team clinic. You really have to have a good relationship with your MA. So we're able to help each other. If my MA is busy,

Deniz Garrett (38:28)
Yes.

WIW (38:37)
Hmm.

Joni Lutman (38:41)
I'm rooming a patient and bringing a patient back and getting everything set up. So I'm dual trained too. I can do my own testing and all of that. So it is really a collaboration. Yeah.

Deniz Garrett (38:44)
100%.

She can pick up the phone, she can schedule an appointment, she can do it all. Combat multipliers is what we call them. People that can shoot, move, and communicate. That's his point.

Joni Lutman (38:54)
Yeah, so I think that that's.

Yeah. Yeah, but I do agree with you.

WIW (38:58)
There you go. Combat urgent care.com combat urgent care.com

Deniz Garrett (39:04)
Johnny, hey, we got this.

Joni Lutman (39:05)
Yeah.

WIW (39:08)
Hey, believe we might have just birthed a new business right here. No, I love that. And let's, let's do a bit of a transition. Like I said, we're going long and it is what it is. And I want you to, tee up AI, but I want to talk about it for just a second. And that we're using so much AI at the moment. Part of that is, helping alleviate or even like remove the front desk need from the standpoint of answering phone calls and scheduling. It's all doing online schedulers or.

Deniz Garrett (39:13)
Ha ha ha ha.

WIW (39:38)
Now we have AIs that'll just do it over the phone and text you a link or whatever. But you were talking about it and I'm very fascinated with this because we don't get to see it the way you do because I'm not sitting there with the stethoscope around my neck. But you were talking about how y'all are using AI. Charging. In the charting. One, you are using your own proprietary AI or are you using one that you like? And if so, which is it?

Deniz Garrett (39:42)
Thank you.

WIW (40:04)
And then three, how are you implementing that to get your door to door down? That was my question.

Joni Lutman (40:08)
Yeah, it's our own proprietary AI that we've developed. I think the good thing about that is that we have a product team that works with our AI charting. And so we get frequent updates, feature and product updates based on feedback from the staff, based on feedback from providers and the MAs in the clinic to make improvements. But the way it typically works is and how it helps with door-to-door time is when you have a patient come in, it starts from like when they're checked in, when the MA checks

WIW (40:11)
Okay.

Joni Lutman (40:38)
checks them in. And then the clock ticks. So we do efficiency metrics from the time of check-in, how long, once we initiate AI, it should be under 10 minutes, two to 10 minutes in the room. Obviously, sometimes that falls, you know, if you have a really complicated patient, but 10 minutes is pretty long time. And then when you are able to do checkout with the patient and close that chart. So it goes into like

several different phases for completion. But I typically would go in the room, you take a chart or you take the, you have an iPad computer, all of our full-time providers get iPad. And you ask the patient, know, we have a user, you know, would you mind being recorded? And then you hit the recording and you have a conversation, just like we're having a conversation. I'm able to focus on that patient. picks up what I'm saying and it picks up what they're saying.

Deniz Garrett (41:25)
Yep. Yep.

Joni Lutman (41:32)
So typically I'll go over their history, looking at them, I'll talk to them, I can move around the room, I can do my exam and kind of talk out loud what I'm thinking about differential diagnoses and any findings that are positive that I found. And then I will talk about our care plan of care, what we're gonna do if we're gonna order tests and what that's gonna look like. And then I'll hit summarize and go to the next patient. And by the time I'm out of the room, my notes already in. It's summarized way that captures

WIW (41:32)
Mm-hmm.

Deniz Garrett (41:59)
Yes.

WIW (41:59)
Mm-hmm.

Joni Lutman (42:02)
everything that I said, it provides the differential, it provides a diagnosis for you. You know, the caveat to that is sometimes you have to change it. Sometimes you have to change the diagnosis if it doesn't quite align with what you wanted to select, but it really reduces that time to chart. So basically, I'm not spending any time charting. I come out of the room, I click my summarize and I'm able to get the patient out of there.

WIW (42:14)
sure.

Joni Lutman (42:25)
And it's really reduced our, we have two person teams, which is rough, right? We have an &A and we have a provider, which I have. My average door-to-door time is 30 minutes. So it's really, it's really.

WIW (42:35)
Wow. I mean, yeah.

Deniz Garrett (42:37)
And we have, we have providers from, know, they're single, single providers using the AI charting without any scribes, anything like that, you know, and they're able to see, you know, upwards in the fifties, you know, on provider visits. you know, it's still a busy day, but it gives them more capacity and, know, Aaron Bali, the, our founder, you know, the

the conviction behind him and creating this whole thing was not as much like for us in the United States to have this, because we have a lot of resources, but for providers that live in Sudan or Ethiopia, where there's just a tremendous demand, but you've only got one or two or three providers, this EHR has helped to increase their capacity to be able to see more patients. And so that's the spirit in which all of this was even founded on. And like I said, our clinics are helped,

basically the quality control for the EHR to make it a better product, you know, and really make it a sustainable product for the community.

WIW (43:38)
Good info. Yeah. Well,

Joni Lutman (43:39)
Yeah. And for me, I like most being able to see the patients. I know that, I don't know if you guys have ever gone to the doctor and they're on the computer the whole time or. Yeah. Yeah. So this is just, kind of put that away. You're able to kind of face them. And so it does help with patient experience scores too. All of our patient experience scores in Colorado are 100%. And patients really, really enjoy that like, you know, face-to-face interaction.

WIW (43:47)
Yeah, and they're not even looking at you.

Deniz Garrett (43:49)
Yeah, yeah.

Yes.

100%.

WIW (44:06)
To me, it's almost like a weird view of AI has allowed the doctor to go back to 100 years ago where it's all about the patient and the visit and not about all the documentation and the paperwork that has to follow it. Because now it's all automated. Now you have a live assistant with you all the time and just takes away the busy work and lets the doctor be a doctor for a second, which makes all the difference in the world.

Joni Lutman (44:20)
Yeah. Yes.

Deniz Garrett (44:24)
time.

That's right.

Joni Lutman (44:30)
And it's not effective because you're not using scribes or you're not using, you know, you're not using like dictation devices or anything like that. This is all built in to the, to the actual EHR product. So yeah, right.

Deniz Garrett (44:34)
Yeah, so it's a head count reduction.

Instead of hiring a scribe, you can hire another MA.

WIW (44:43)
Yeah.

There you go. Well, guys, we've gone over time for sure, but it's been an amazing conference. We knew it happened. Yeah, this one was one I was like, I'm allowing it. Yeah, it's totally fine. But we also recognize like our listeners, like they like that 30, 40 minute type thing. So we want to not go on too long. What's this going to become? It's another episode. I want to come get guys come back and kind of deep dive some more. But this has been fantastic. Like just at the end of the day, listening to this episode, like for the clinics that are listening right now, leadership matters.

Joni Lutman (44:58)
Thanks.

WIW (45:17)
people matter and your processes. Like it sounds intuitive, but some people just completely missed that mark. But you guys are proving the point right now. We know how to make, you know, make all those items work. And now our clinics are doing what we want them to do. And everybody's actually excited. The culture's a lot better. Like all the things that matter to help increase the profit and all those items.

Deniz Garrett (45:39)
No closed days.

Joni Lutman (45:39)
Yeah. Yeah.

WIW (45:41)
There you go. Yes, exactly. Well, give us some parting words of wisdom before we shut down. What would you like our audience to know about growth and what you're doing with this dyad leadership?

Deniz Garrett (45:53)
I would just say, investing in the relationship of the dyad partnership is probably will be your best ROI. And if you, the stronger you make that relationship, you will see a correlative relationship into the bottom line of your clinic with the cohesiveness of that relationship.

Joni Lutman (46:14)
And I would say, I would just say lean into difficult conversations and lean into that uncomfortableness because you need to have that to get to the other side. And it makes it so much more just wonderful when you get there, but you can't get there without having those type of conversations. It just doesn't happen organically. really have to kind of like, you gotta have to that. Yeah.

WIW (46:14)
I love it, Joni.

Deniz Garrett (46:35)
Yes.

Lean into the heart.

WIW (46:42)
100 % of the best opportunities come outside of your comfort zone. yeah. That's good. Joni, Dennis, thank you. Appreciate you both coming on and visiting with us. We'll have you on again here in the near future. We will drop information on LinkedIn for both of y'all in the show notes and you can find out more about carbon health at carbonhealth.com. we look forward to seeing y'all again in the future. Thanks for being on the show with us. Thank you so much. All right. We'll talk to you soon. See ya.

Joni Lutman (46:46)
Yeah.

Deniz Garrett (46:48)
Thank you so much for the opportunity.

Joni Lutman (46:50)
Yeah, I appreciate it.

Deniz Garrett (47:09)
Thanks so much. it. Thank you.