How to go from Build to Scale (Part 1)
Have you been wondering how to move forward in the chiropractic profession and both grow your business and your practices? Dr. Cliff is here to show you how to find your path in this profession.
Get into a conversation with two leaders in the chiropractic profession with eyes on dozens of clinics and become the best doctor, best leader and best human. Join host, Dr. Cliff and co-host, Dr. Joseph Esposito as Align Your Practice helps you understand the transitions between build and scale and what and who you need to become to move to the next level of practice for you. It is time to start maximizing your operational efficiency as well. Too often doctors and leaders are jumping from Crisis to Crisis to Crisis. Learn how to stop that and be more intentional around that.
After you have built the practice where you are the only doctor, now learn how to make your office scalable and durable by adding doctors and teams to make a better experience for you and your team and your patients. Create that win-win-win!
- The book ends of build are launch and scale.
- Have your training planned out for a year ahead including a rolling 12 Month Marketing and Training calendar.
- Scale is defined by Multiple Doctors and/or Multiple Locations
- Use the Ceilings document to understand where you are at so that you can go from where you are to where you want to go next and then stretch yourself and where you want to end up ultimately.
- A doctor who is hired doesn’t have to go through or deal with Launch.
- Launch and build – you are trading time for money as you grow into scale. You are able to leverage other people’s time, and energy to focus on your money.
- One of the biggest concerns with scaling is bad associate relationships. Learn how to avoid those relationships.
- The Four things you need to know as you shift from build to scale.
- Better Metrics – Get way more granular. Business metrics vs KPI (Key Performance Indicator)
- Shifting from Manager to Leader
- Financial Modeling and budgeting your money
- Strategic Planning – Having a rolling marketing plan
- Write out your vision!
- Ask your team what the vision of your company is
- SAYING NO needs to happen
- What is the best return on investment?
Download the pdf here: https://bit.ly/AlignLifeLaunchBuildScaleCommunicationPDF
Schedule Time with Dr. Joseph Esposito. Go to www.Schedule30now.com
About the Hosts:
Dr. Clifford J Fisher
Dr. Cliff Fisher owns several offices all over the US and has a coaching business Dream Leadership Institute to help people find the greatest version of themselves. He will help you get to a foundational understanding to create the business and life that align with your being.
Dr. Joseph Esposito, CEO
Dr. Joseph Esposito, D.C., C.C.N. C.N.S., C.C.S.P., D.A.B.C.N., F.A.A.I.M. C.T.N., is the Founder and Chief Executive Officer of AlignLife. As such, he is responsible for the direction of AlignLife as it expands further across a dynamic and rapidly changing health care landscape. Dr. Esposito has more than 20 years of experience in a broad range of businesses, including chiropractic, nutrition, technology and internet marketing.
Dr. Esposito has extensive post-graduate academic accomplishments, as well as 15 years of experience managing successful chiropractic clinics in multiple states. He also is founder and CEO of Aceva LLC, a service-based nutritional company providing products and services to the AlignLife clinics. As the former CFO of an internet publishing company, Dr. Esposito understands the power of leveraging the internet to impact the lives of millions of Americans.
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Align Your Practice podcast with Dr. Cliff Fisher where your best practice and life awaits you. Are you tired of running a practice on your own. We want to come alongside you with experts to help you create your dream practice in your dream life. Here is your host.Dr. Cliff Fisher:
Hey guys, welcome back. I'm here with Dr. Joe Esposito. And we're going to go after it some more. And we're going to be talking more about a little bit about our build what we did last time, and today, we're really gonna dive into scale. So Joe, how you doing today?Dr. Joseph Esposito:
I'm doing awesome. I enjoyed this conversation. I like this next piece on scale. It's kind of where I focus a lot of my energy and attention inside of align life and helping people get to that level. But ya know, I'm excited cliff, probably recap, and then we'll, we'll get after it.Dr. Cliff Fisher:
Cool. So I'm just gonna share my screen. So if you guys are watching this, you guys can jump in and see. But last time, we talked about build in the space with build build, is the big part is that is training the team, like the first part, that launch is training the doctor, this is really training the team. So our Clinical Assistant starting to leverage software. And then, you know, getting past the competency of scripts into mastery. And then from a flow standpoint, kind of diving into the like number of steps, how many steps are we taking time patients are waiting cluster booking, making sure that we're staying in that zone, is what we talked about last time. And then communication, talked about the DC to the patient and the doctor to the team, and then also the table talk. And then from a team standpoint, like growing the team value, and then really diving into a curriculum and having a training schedule? Because no longer is it like you're the one person showing up to the ballgame. Being like, okay, cool on the All Stars, like now you have a whole band. And so it's really critical to have your whole team on the same page. And I don't know how you were Joe. But I noticed one of the things with RCA is is we thought that like they went through when they first started the day one day to experience and then we never really revisited again until we got onto these regular training tracks. So they had no idea what was going on in the back room. They're like I remember the first time about 10 years ago, when we did our training on it. They're like, Oh, I didn't know we did that back there. I'm like, Oh my gosh, like what a mess that was for us for years. Yeah, IDr. Joseph Esposito:
think training, you'd be looking at the sports, the training camps, they go in cycles. So they have preseason, and they have their training during the season their postseason. And I think we have to use more of that athletic kind of culture. But you're right with training itself, as you mature as a business, the training should be laid out for the year. So you're just taking laps around. mastering process. And I always use the baseball analogy. You know, you're throwing, you're catching, you're hitting, you're throwing, you're catching, you're hitting whether you're in little league or major league, but your development along that journey changed, but the training is the same, you just train on the same thing. So a lot of people just want to train on their crisis. And they just go from crisis to crisis to crisis. And it's a very volatile process. I like what you've done in the Align life. Training culture, is you built out a year long process, and you just keep running laps through it and changing the way you deliver or the examples or the the insights or the cuisine or whatever it is to cream self awareness to find our holes, I think you have helped create that maturity. But you just latch right?Dr. Cliff Fisher:
Yeah, well, and the secure thing, we keep developing it, but we're still developing it from the foundations, like I know, one of the things we're adding that's really critical is we're gonna start adding in, like, for an office manager training, so they have a different training over the same material than the doctor and the CA. And so everybody's gonna start having their own room to be able to train on because everybody's gonna be looking at it from a different perspective.Dr. Joseph Esposito:
That's huge. That's huge. Yeah. So as, as we have grown, the maturity of training inside of the Align life culture, you're gonna have to look at that in your own office and say, from launch, your training culture is going to be very different once you hit build, and we're going to talk about this today and scale that changes even more mature and the aspects of the business.Dr. Cliff Fisher:
Yeah, that's so spot on. And I think it's a great transition. And so then the next part, and this is really to go into Scale, which is typically going to be if you're over 300 visits a week. And the way we've defined it is or is if you have multiple doctors or multiple clinics, or both. And so that's really when you start to be in I would say from scale to scalable, because otherwise, if you're in build and there's nobody else in there except you adjusting, are you leading the meetings, then it's not scalable, you're just building it to get into scale. So um,Dr. Joseph Esposito:
so Cliff just to recap from the beginning, what just lets the final launch build scale exit. So if you're listening to this right now or watching, really refine your understanding where you are right now, yeah, what you need to do in the current state you're in to get to the next level if you choose. So choose to do so because we want you to stay inspired and business of where you're going. And frustration happens. Where is the delta between reality and your fantasy is, if you don't know how to get there, you don't have to change. So we want to change your fantasies into goals and goals into reality by having a pathway of going from where you are your current awareness to where you want to go. So just from the beginning, if you would mind cliff, just getting the listener to, you know where we're at. Yeah, absolutely.Dr. Cliff Fisher:
So the first part is launch. And so that's typically either going to be your first 12 months, or zero to 150. And that's all that is training the doctor that's going to be training on procedures on flow on team and communications. And then once we get to that, through that 12 months, or up to 150, then we start to dive into build. And this is really building your team, we just had, you know, one office inside of the limelight that he like went through, launch, build and scale in a year. And so he had to be able to keep up. And so that's why we want to keep this out in front of ourselves. So I'm not saying that, that I'm committed to the timelines, but we have to be aware of where we're at in the journey. So I think you're spot on. And so if your 12 months or 150 Year End launch, if you're between 150 and 300, you're in build, or if you're a solo Doctor, where if you don't show up to work, nobody gets seen, that's a space where I would consider your and build. And then scale is when all of a sudden, you can scale it where there's multiple doctors or multiple locations. And so if you don't show up one day, the office still can function. You know, ideally, normally, but you know, even if it's just with a limp.Dr. Joseph Esposito:
So we had talked even before we got on Cliff about the essence of scale, if we're going to move into scale now, yeah, let's go. If you are a business owner, if you're in let's say, if you're an employee, you never have to do with launch. Launch is a lot of work, a lot of firepower, a lot of money, a lot of stress, a lot of commitment, a lot of a lot of everything right to and if you're an employee, you don't even deal with lunch, right? So the book ends on both sides of build of launch, which is heavy liability, time, effort, money focus. And then on the other side of build is scale scale is about leverage. You're not getting paid for your time anymore. You're running a business and you're having gaining passive income, from not time for money build is when you're the clinician and you're exchanging time for money. You're working and doing a service and making money for your service. When you stopped doing the service yourself, let's say adjusting patients, you start making money. That's what Cliff was saying. Owning a job. So if you're never want to get into scale, I liked the debate. We're having cliff. Yeah, me too. Me not want to own a business. Because scale is the reason why you go through the hellacious process a launch is you want to build up the commission. And then you get into scale where you can leverage. I mean, would you agree with that concept? Or what are your thoughts?Dr. Cliff Fisher:
Yeah, 100%, I think to go through the pain of both launch and build, because there is a lot of pain, there's a lot of learning, and there's a lot of risk. Like, you know, they say most businesses go under, you know, under five years, and that's when all that space is at. And so if you want to, if you don't have that risk tolerance, or if your goal is not to get to that point of scale, it might be better, just like you were saying, was to be a caregiver or a business builder, Doctor, where you're not having to worry about that. Because, you know, you have, you know, there's so much risk we talked about, like all the different things from, you know, from team to, you know, lawsuits to debt to, you know, revenue, like there's nothing you know, more stressful probably than money stress, except maybe relationship stress, but usually those two go hand in hand.Dr. Joseph Esposito:
Yeah, so so when you're if that's your student right now, or a young doctor, knowing these stages that there is launch, launching a clinic, building a clinic, scaling a clinic and exiting the business. And those you're not interested in those last two, a leveraging assets, leveraging staff leveraging your experience, leveraging your business and scale, which is what today's podcast is all about. Then it's it's less risk to just build a career in the profession. So let's get into scale. What are what are your when when I as a doctor, let's have been built for 10 years and you always say Cliff most of the lifespan of a of a chiropractor, at least at the level of maturity are professionals in right out. Most clinicians doctors live most of their career in built right, would you say? Yeah,Dr. Cliff Fisher:
I think most people are stuck there. Because one, they're scared, they've heard the nightmare stories of having associates. It's a bigger risk. Typically, when you go from build to scale, it's scary because you don't have you don't know how to have the resources, and then they're gonna hire the wrong doctor, I think is typically the wrong move. The Wrong move I made was, I paid the right doctor the wrong way. But that was, you know, that cause stress. And so really understanding one who you are just like you were saying, like, should I be even getting into this, which Joe, I know you guys, we have that PDP, which, you know, if you want to know what kind of doctor you're hardwired to be, like, just sign up for that PDP. And that will tell you exactly who you're supposed to. It'll tell you who you're hardwired to be not that you can't go against the grain, but you'll at least know your blind spots.Dr. Joseph Esposito:
Yeah, PDPs you can get from Cairo. matchmakers is the company that can provide the insights and the service for for that tool to understand business behavioral process, the way you think the way you're wired for business. And I think that's a great tool. But I liked what you said, Cliff, because in scale, in going back to launch, we can make a lot of mistakes, and our first hire our first staff member, well, the same thing happens in scale now, making the hiring the wrong doctor or paying the wrong way, the same pain we would have when we open the business, we hire the wrong staff. And we question our ability to run a business because you hired the wrong staff like oh, maybe I'm not made for this, maybe because the business was not working because you have the wrong team member, the same pains going to happen when you get to scale. Most Cairo's or students that clip on I talked to what 30 clinics, 20 clinics want to five clinics and five year they want this mega enterprise. And a lot of them get burned by that first hire of their first doctor, or their first real manager of the clinic, right? And then it's like, oh, I don't want any part ofDr. Cliff Fisher:
that. Yeah. And they certainly got it right, youDr. Joseph Esposito:
can leverage a beautiful business. And in an enterprise level, where you have multiple clinics, you and I have both been through seasons of our life, where we had things dialed in with multiple clinics. And we were living a dream life with great revenue and inspiring doctors that did great work. And we've also been through periods where we couldn't get things to click correctly, even though we had great experience and knowledge, right? So it sees it's,Dr. Cliff Fisher:
it's a different muscle, the same muscle, they got you to be a great bill doctor will be a different muscle group to make you a great scale doctor, like there's just, you know, it's just a different set, you know, it's not less work, it's just different work.Dr. Joseph Esposito:
So let's go into in scale, I'll give my perspective. And you had some also great perspectives on scale, what thing what thought process have to change or modify, getting into scale. I'll throw a couple points out, and then we can we can talk through them. But the biggest thing for me is the amount of time you spend planning in scale first built, because build, you're the main character in the movie, you're the main player in the business, you're the clinician, you're the leader, you're the energy, right, you're that person. So any adversity, boom, you're on it, you fix it, you change it, you smell everything going on you you get the morale, the relationship, the energy, because you're there, once you're not the main player, you have to have way my perspective for things that are leveled up and more mature, when you're not the main player smelling the smoke before there's a fire in the clinic. So to smell the smoke, you're going to need better metrics, more granular metrics than you had before, before your higher level metrics like revenue, new patients, and now you're looking at stick rates and you're looking at a little conversion rates on four levels of conversion from lead gen to, you know, show rates to conversion rates, right. So metrics get way more granular, because you're not the main player. That metrics was one. The second one is management, you're no longer the main manager like Cliff said, hiring that right person, doctor and manager are going to be two big lifts you're going to do in scale. So management. My third one was financial modeling, which is how to model out where you're trying to go with your revenue and that includes budgeting your money, marketing, budget, payroll budget, so that we're looking at what's going to happen over the next three years where the exact dollars spent and revenue coming in and money spent to get there. And I have a lot of meat on that one that we could do a All podcasts on and the last one is strategic planning, effective strategic planning way different than you did in the past? Way more future planning like in October for next year, verse, January for January, which is probably what you used to do. So those are the four What are your thoughts on those click for if you want to add more, that's my perspective.Dr. Cliff Fisher:
Ya know, there's so many things came up for me on the planning part, when you know, you talked about that they say, for every one minute of planning you do is six minutes of productivity. And so we think it's like up, we got to be busy, but nobody wants to be busier. But we all want to be more productive. And so that's where that happens is just like you're saying in that planning stage. And then the metrics, that's the data, all of a sudden, we can't go with our gut anymore. Like we're not in it like we used to be. So data versus gotten I love what Stephen Franssen always says is two parts data, one part gut. So it's not that we get rid of our gut, but you know, we really need more data. So that's super critical.Dr. Joseph Esposito:
And one thing with that cliff on the metrics is, you know, I define that I separate first, the difference between business metrics and KPIs. business metrics would be overall numbers like gross revenue, and net profit. A KPI is missed appointments. It's a KPI, a key performance indicator. The key word there is the middle word performance is someone's performing something. So performance indicator, a KPI for those that are listening, I want you have real clarity here. That's a performance indicator of a behavior pattern of a human being. So that's given as a gift to a staff member, they have a KPI, which measures key performance, which is behavior of a human being inside the business. A business metric is overall revenue or net profit. Those are outcomes. Those are behaviors. So really understand the difference between a KPI and a metric. And the last thing I'll say to that immaturity of the business, is you want leading and lagging statistics, the leadings are some of the KPIs like behavioral base, like how many missed appointment calls did you make, which is a behavior? Yeah. And then the outcome would be how many reactivations that you have, right? I mean, there's lead lagging stats are very different. When you are in build or launch. All you're looking at is lagging outcome, like what happened? You're not looking at behavior, KPIs, right, that's that I learned a lot through that cliff, in running the businesses that we run.Dr. Cliff Fisher:
Yeah, absolutely. And it's so important to get in front of it, to set the goals the right way for the right reasons with the right data. Awesome. Then the other space where he talks about strategic planning, like that's really the vision casting, because as you start to shift from, like, launch and build, you're the only one who asked to see the vision. But as you get into build and scale, as you come into that talent to build, and they're beginning of the scale, now have to transfer that vision. So it goes, it really transfers into vision casting so that people can catch what your vision is that they can get on board.Dr. Joseph Esposito:
It's so true, because some doctors do real great at the vision. But they fall down on this trip, planning the strategy, or vice versa. Jeff, great on the planning, and they lost the vision. And I appreciate you, you've helped me as the CEO over the last couple of years, trying to keep pushing for real conviction on clarity of where we're going. So we're all rowing the boat in the same direction. Because if you don't do that, as a leader, even mild confusion, creates friction. It just creates friction in the business, right? I mean, you see, I've seen it for decades.Dr. Cliff Fisher:
And it's so critical. And the hard part is, is we feel like it's so clear in our own head. And what I would challenge you guys to do is write out what your vision is. And then the one question I love if you want to know have a true pulse on where your business is at if you want to know if you're in, builds killer launch, like go ask your team members say, hey, you know, what do you think the vision of our company is? Where do you think we're headed? And then just shot then be quiet and listen? And you'll either be like, yes, or like, oh, my gosh, I have a lot of work to do. Like that one is very, like, it's not a middle of the road answer typically.Dr. Joseph Esposito:
No, I agree on that. I agree with that. And with strategic planning, I like in the book scaling up, Vern Harnish talked about separating that from strategic planning to strategic thinking and execution planning. Your strategy is a thought of like, what is the strategy and then when you execute it, that's a whole nother mindset. What corner am I going to do it? What's going to be done this month? What's gonna be done this week? How am I going to do it? What's the task? What's the deliverable? What resources do I need? What training I mean? On and on and on. There's a lot to it. So I think in future podcasts will help break down strategic planning. As those two parts, strategic thinking and execution planning, I think that will help a lot of the listeners on this podcast.Dr. Cliff Fisher:
Yeah, I totally agree. And I think one of the things that came up for me is, is a business built as a, like, when you're in build, you're like, Yeah, give me more, give me more, give me more. But as you get into scale, at this point, your time is super precious, and you need to be get way better at saying no, that's how you build the biggest practices is by saying no, not yes to everything. But notice the things that aren't going to bring that extraordinary value.Dr. Joseph Esposito:
In scale, you're leveraged, you got a reputation, you have trusted people, there's a lot of energy. I like you're saying that because one of the tenants we should be real talking about and scale is their ability to say, say no, and turn down, not not accept every opportunity, except the right opportunity, because we become overwhelmed as an entrepreneur. And you may hurt your scale by just saying yes to everything. So, you know, knowing what we should start doing, but also knowing more importantly, what we should stop doing, right?Dr. Cliff Fisher:
100%. And that's like ROI. So it's like, you know, when you're building your practice, I do this event or that event, don't go with your gut, you need data. And so that's where that becomes super critical. And so you always have to look back. And the easiest way to kind of move that forward is once you're done with an event within the week, and within two weeks, like within the week I review, how did this event go? Did we like this event? You know, there's a way to grade that and then look at the ROI within two weeks, and be like, okay, cool. This is this was an A, B, C, D, or F event. And then next year, you don't have to think about it, you look at it anything above a B, we're doing again, if it's a C like I'm going to look into the reason d and f I'm out. Yes. So. So I feel like I thought scale was going to be like one episode job. And I really feel like we need to do two parts to this episode. So. So I loved your four points. What I would love to get into in our next episode is, you know, really like, how do we train the team? How do we focus on these procedures, the flow, the communication, and stuff like that, because I feel like we've done this high level 30,000 foot view of this. Now I'd like to bring it down to what can you guys do with this so that you can go from build to scale? What are the next steps you have to do? So that's what we'll talk about in our next next episode. Any other thoughts on this episode? Joe?Dr. Joseph Esposito:
No, I think that was a good high level overview. If you're listening now, try to refine where you are. As we define the launch, build scale, we haven't gone through exit yet. But on those three, if you're living in one of those, maybe write down what steps you feel you need to take to get to the next level. And then I agree with your next session, let's get more granular on deliverables that they can bring into their, into their business.Dr. Cliff Fisher:
And yeah, and then just go to the notes, click on this PDF, and just grade yourself one to five, and it tells you and you'll see your weaknesses. And those are the things that will help you move from launch to build to scale. And so it's already already written out, you just got to download that PDF, look at where you're at. And then if you have questions, that is the place sign up, you know, talk to Joe, Joe, Dr. Joe's run, you know, multiple offices, I don't know how many he's open, it's, you know, north of 40. And he's seen offices in, you know, every aspect of its, you know, lifecycle lifecycle. So if there are questions, this is the space like reach out to Joe to set up a consultation, talk to him, say, Hey, where's my Jama like, and I'm happy to do it also. But like Joe is just a master at this and then you've seen so much so don't miss that opportunity.Dr. Joseph Esposito:
You could go to schedule 30 now.com as a Lincoln, if you're interested in sketch some time on gaining some more awareness as to where you are, and create the strategy to get to the next level. Again, that's scheduled 33 Zero now.com. We'll get you a quick consultation.Dr. Cliff Fisher:
And we'll also put that in the links in the show notes. So you can go right back there and just click on that link and get time with Joe. So awesome. Thanks, Joe. I appreciate yourDr. Joseph Esposito:
time. Excellent. Have a good day.