Transcript
Marla: Welcome to the Practice Growth Podcast. Michelle, it is such a special treat to have you on the show today.
Michelle: I am happy to be here. It was a pleasure to get up early and get on a train, come to the big city and spend some time with the team here at Prompt.
I appreciate it.
Marla: Oh, great. And I know we've got a special episode talking all about how you went from a clinician to a practice owner to an enterprise company and one of the only female and PT is left in that space. So we'd love to just start just hearing a little bit about you and tell me your story.
Michelle: Thank you for the opportunity to do that. It's a story like many others where I was a teenager, always interested in healthcare tore my ACL as a little bit of a jock, a basketball player.
And discovered the world of physical therapy or what we call physiotherapy. I grew up on a sheep farm in New Zealand, in a very remote area, had no idea what this profession even was, and really no idea of even where America was. Knowing I was from a different country at that age. I really did actually fall in love with the profession, and not because the physiotherapist I worked with got me back to running or snowboarding or doing what I wanted to do.
But they actually really empowered me to understand the impacts of my behaviors and how much control I could have over my own happiness or my own goals and objectives. So I think from an early age, it gained me this appreciation for this profession that I think others who are injured or seek our services in those times really get to learn.
So I decided from age 15, that's all I ever wanted to do. I did my bachelor of physiotherapy in New Zealand. Traveled to America for a one year visit working in the small but mighty state of Rhode Island in a hospital. I planned to then travel the world and go ho home. But I got caught up in grad school because I assumed that I'd wanna teach someday.
Did my advanced masters in DPT during the evenings while I worked during the day. Ultimately met my now husband, but got into a private practice. It was a single practice in a town called Pawtucket, Rhode Island, and I ended up being the clinic director and we gave amazing care, had the opportunity to mentor and teach and bring a lot of the skills I learned in New Zealand, which back in those days had much more of a manual therapy, hands-on approach compared to what at that time was happening in the educational system here.
Loved the people I worked with and then came into the opportunity to take over ownership. The previous owner of this one clinic decided it was time for him to move on and I wasn't willing to stay on for a private equity to come in at that time. So he said, do you want it now? I said, okay. And I was eight months pregnant with my first child.
I knew nothing about business. I had no idea of financial acumen. I somehow got myself this SBA loan from a bank who I believe was run by the mafia. It was partly seller financed. And yes, 3 weeks before delivering my first child, I walked into the business office. We had 2 people do billing and collectings and really said, OK this is it.
I can treat your spine and help your TMJ and work with any sports injuries, but I don't even know what a financial statement is. So that was the start of the journey. From there, it evolved 'cause I always felt very strongly about supporting clinicians or people to be the best versions of themselves.
We now call it toddling at our practice. Practice at the top of the license. But it means more than that. And I think that what comes down to many of the attributes of leadership, how do you inspire or help other people to be the best versions of themselves without you around. So that was the mantra we had at this single practice.
And with it, what happened is we'd have, these clinicians who would say, I would like to open a practice. And my message to them was like, man, I suddenly had to go hard and learn business and finance and all of that. And it really was a little exhausting. I would love you to have a clinic. Let's make sure you can have one.
And so we provided an environment where clinicians could evolve, whether they became mentors or teachers or clinic directors so they could follow their pathways. That allowed us to have our organic growth move into a place of 14 to 15 clinics, bring up folks through leadership development that we created internally, as well as a lot of clinical professional development until post pandemic, where we started looking around and go, and I was at the age of 49.
And I said, what next? How can we help more people? How can we make a difference to our industry knowing that there are many challenges to it and how can we innovate it and do it in a different way? And that's when I, we decided to, how do we take our company at that stage, which was called performance to the next level, and make it more of an enterprise level so that we can actually tackle some of the challenges of the industry as a whole, related to payment, related to burnout.
Related to our expectations of our clinicians avoiding commoditization and care. All of these things we are se we were seeing back in 2000, 2001, and actually allow our patient to be able to provide the value to the C that is quite capable.
Marla: Wow. Wow. And you went from a clinician all the way to now a CEO of high bar.
And how many clinics is your company at?
Michelle: We're right now at 35 clinics, we have close to 340 employees, and we're certainly in a significant growth phase. Over the last three years, we did bring on a financial partner, Rally Day partners, that was just over three years ago. And during that time, a lot of building the infrastructure from the business side, the financial, the systems, the processes.
So that you can grow in a way that does not commoditize care and actually provides a better opportunity and environment for clinicians to excel in and have different options and pathways. So that took some time to build. It's very easy to pull a couple of levers and suddenly make more money.
It's not that difficult, but to actually do it in a way that will support the long-term wellness of an organization and actually make a difference to the industry as a whole. Takes a lot of work, a lot of thoughtfulness, a lot of listening, a lot of different people at the table, clinical folks included, so that you can really look to how to scale, but scale it in a way that does, that serves the profession and the people in the community for the long term.
Marla: Yes, and I love that you are saying clinicians leading, clinicians growing clinicians. And that's a big point that I'd love to bring up is we're not seeing as many clinicians in those enterprise executive roles anymore. And love to hear your perspective on the value of that and the value of bringing those clinicians all the way up to those leadership and executive roles.
Michelle: Yeah, I think it's a great point because I think what happens is sometimes you'll bring in investors and larger companies and they'll say, look, you need people in the boardroom. Or at the C-suite, they do understand business acumen and have financial literacy. So there's automatically this predisposition to think, oh no, that's not what clinicians do.
We need folks who have the experience who've got the MBAs, who are truly trained that way. And I agree with that to a certain extent. You do need some of those people. They actually bring a huge amount of value. So what we need to make sure is our clinicians, first of all, understand that it is important for them to gain some grasp, some credibility in business, in financial literacy, in leadership.
There are different skill sets and different knowledge circles they need to be in. They also have to understand when they come into these roles, they have a lot of really important skills that need to be heard and need to be part of those conversations. As clinicians, we know how to problem solve. As clinicians, we know what empathy is.
We know how to develop relationships. These are the things we're trained in. We also can have a seat at the table. When you're really figuring out how do you truly provide extraordinary patient care? How do you really innovate on the delivery of care? How do you truly have a place to work that clinicians wanna thrive at and want to be at?
And that takes clinicians who have been in the trenches and doing that work and continue to get back in and listen to it because it is really easy to open up an Excel spreadsheet or use some BI tool and say, here's how the numbers work. But the strategy really thinking about the impact that you have on people, you need clinicians at the table to be part of solving that puzzle.
And I always think of it as a puzzle. If you want to grow into more of an enterprise business or a larger business or scale it, you need the clinical folks at the table. You also need the folks that really understand finances. My CFO is one of the closest folks I work with, and we each totally respect each other for what we bring to the table, ultimately have the same purpose, and that we want to create an extraordinary company that clinicians want work at and patients are saying, this is the best care I've ever had.
We have the same goals and objectives, but we've got to tackle and solve for the problems to get there with the team approach and with the collaboration. But you need that clinician there. And I sometimes hear clinicians say I don't want to be in the boardroom, I don't want to look at the numbers, I don't care about those things.
But I don't think they realize how powerful and important their voice is. Especially if they pause for a little bit and listen to the other folks and then come in and be like, here's another perspective. this is risk mitigation. Here's some opportunities you haven't thought of. So when you're in those positions, you actually feel like, you know what?
I'm ultimately helping a whole lot more people. Then the 8, 10, 12 patients that I saw during this day.
Marla: Yes. And you had said in the beginning when you had that one clinic, your mission, your values, what you wanted to do, and how you just continued to grow because you wanted to help other clinicians be able to do that.
And I think that's where it's so valuable, having that executive clinician at the table and that voice to continue to bring the business that's needed. Back to the reasoning, back to the patients and make the decisions always based off your patients and your clinic.
Michelle: Yeah it's hard and it's certainly been a big learning journey for me, and I can assure you I have a small lot of mistakes I've made along the way too many to even ride about.
But you as a clinician there, you can keep that focus and keep really understanding the purpose of our organization.
Because again, if you're just looking at making money, we can all do that in the short term, but we're dealing with people's health, people's careers, and you've gotta be much more strategic and thoughtful about your short term actions and the long term consequences, both good and bad.
Marla: Yeah. And you said you've made a lot of mistakes. You didn't have any business skills to start with. So for all of our listeners and potential clinic owners and executives, what do you think helped you learn those business skills along the way? What did you seek out to get those, to get where you are now?
Michelle: I think I've always been, like many physical therapists, I've always been super curious about learning, and I do think no matter what you're learning will help make you a better clinician. So I came to realize very early on that even when I delved into leadership skills, such as public speaking. or doing advocacy work or volunteering on a committee for APTA.
The skills I learned in those different positions I may have felt a little uncomfortable to start with, but they ultimately helped me be better, a better clinician. So I think thinking about your growth, and I, we use one of the values of Grow Forward, which is grow forward in a way that you're moving forward in your knowledge base.
So early on I picked up Harvard business books, basically finance 101, management 101. Some of the other things I'd advise people to look at is getting involved with APTA, especially the private practice section. They've actually now launched a business fundamental series, which is almost like a mini MBA, very focused for physical therapists in business.
So something that's really worth looking at. There's many podcasts I love. Richard Leaver and Agile & Me, Steve Anderson and his leadership profiles. Even the, How I Built This, you some of the other podcasts that are not physical therapy specific, McKinsey, Harvard Business Review. All of them have different podcasts, have different daily emails.
I get different ways of learning. I have gone off and done some courses. Specifically in finance to support my literacy in that area up at Harvard. So you can find different courses out there. and the other key thing that I found extremely helpful was being involved with a peer-to-peer group. I was able to do that through APTA private practice, a peer-to-peer group of other founders and physical therapists from around the country.
We came together 8, 9 years ago. And that group I was the token female in it. It was really profound at being able to be authentic, be coached, have friends, and be able to grow in yourself as a leader. So I think taking a well-rounded approach, leaning into all of the opportunities, being humble, being uncomfortable, it's okay to be uncomfortable.
That's how you're gonna grow and learn in these different areas.
Marla: And I love that you pointed out what you've done on the APTA and how that actually allowed you to grow. You said it was challenging, it was outside your comfort zone, and a lot of times we think being involved with the APTA is just to give back.
But you're saying that opportunity of being a president and part of committees gave you the peer-to-peer mentorship and the growth and leadership skills.
Michelle: Absolutely. Yeah, I do. You're completely right. Lots of people think I'm giving back when I'm involved. I'm like, the more you give, the more you get back yourself.
I served as the treasurer for the section. I had no business being the treasurer. I had to knuckle down and figure out how to do it, and I learned a tremendous amount. And the different people I've met throughout the country who I can pick up the phone or text or ask a question to whether I am curious or whether I'm thinking I've made a mistake and don’t know what to do.
You've got those mentors out there. And aligning yourself, surrounding yourself with people that are gonna support you and bring you up is going to help your own internal confidence of who you are. There’s a saying, you are the sum of the five or six people you spend the most time with, and I take that seriously.
There's people in my life, professionally, personally, that are going to pull me down. I don't have time for it, because it doesn't serve me as a leader and as a leader of an organization. I have a responsibility that I take really seriously. To show up and be the best version of yourself, because that's the responsibility you have to take for the people that are working within your organization.
Marla: Yes. And finding those mentors along the way. Not only the mentors, but the people that you look up to, that you just want to learn from and say, I'll shadow you. I'll spend some time with you.
So how do you set that up now in your company? You said you really want to grow clinicians and help them become in leadership roles and not everybody's meant to be a leader.
So how do you set that up and determine the ones that want to stay in clinical care and support them to become amazing quality clinicians, growth part, but also the ones that want to become leaders and what are you doing to have that process and procedure for them?
Michelle: We've tried to create many clear pathways. What I do find interesting, especially the new graduates, are a little lost and say I want to do everything. And so often, even when they're looking for jobs or roles, they're like, show me everything. But it's not clear what I want, but the only thing that is clear is I need to make enough money to pay my student loan.
So we sometimes come into this, what are the financial rewards, which is very important and part of the process of people choosing where to work and where to stay. So we've really leaned in to providing clarity in those growth pathways and in those opportunities. Whether it's a clinical and you want to be the best clinician you can be or whether it is more into leadership and administrative side of things.
So we have an accredited residency program, a certification in manual therapy, dry needling, one and two. And as people evolve and are able to do those courses, even as students, they can do them all. Not some of the residency, but they can actually come through and then become teaching assistants or become part of their faculty.
We have the special interest groups in all different areas so people can dabble in women's health if they're interested in that specialty or pediatrics or running. So giving people choices, but giving people choices that meet them where they're at. If you're a working mom and you've got a three month old at home, you are not coming in to do a weekend course.
But if you can jump online at night and listen to the presentation that was done earlier that day, great. So making sure we've got the different options to meet people where they're at within their career as well. So lots there clinically, that ties into some of the research things were evolved with some of the innovative ways in delivering care.
We then offer different leadership programs. We call it an Investing in Leadership series. So this is a nine month program. It really is about developing leadership skills. We have one specifically for folks who may want to work in, move into clinic director positions, but also for administrative staff as well.
So developing from the ability, from communication and time management, how you show up to difficult conversations, to negotiation, to true management. All of those things are incorporated in-person virtual case studies, presentations. In addition to that, there's different book clubs. I think every meeting I start with an article review, even with my senior leadership team, so that we are all staying up to date.
We did one last week yesterday actually, psychological safety that just came out in HBR. The importance of having a workplace where there's psychological safety so people can tell their opinion and have candor and feel safe, and so you can create a culture that is about being innovative and problem solving.
And everyone has a voice at the table. So I think having the formalized pathways, but also sprinkling those opportunities in even within our everyday work so that it comes part of just your culture continuing to grow and evolve. The last one I'll mention is we do a lot of peer-to-peer feedback surveys and learn a lot, spend a lot of time teaching people how to give feedback that is constructive and kind.
And also helping people learn how to receive feedback. Feedback can be really hard to give in a right way, because most people, we want to be nice and we want to be kind. And then people when they receive it are going to take things personally, actually have to spend a lot of time on helping people learn how to receive and how to give so it can be constructive.
I personally don't like the word feedback. I'd rather it be like, how do you behave in the future? What did you learn in the past? And so we spend a lot of time in getting comfortable from a cultural standpoint so that we can all grow as individuals so we can show up. And again, per total will be the best versions in ourselves, no matter where we are, our career.
Marla: Yeah. And you mentioned that nine month program to get people to even be a clinic director. I highly recommend listeners seeking out those companies or those own programs externally, because when you're just thrown into the leadership role without no guidance or organization, I think that's when people get turned off and potentially fail.
Michelle: Absolutely. We have at the stage now that if a clinic director moves into that position and fails, it's on us because we didn't set them up for success. It's not the person's fault. It means that we didn't have the right processes, the right support, the right structure in place to ensure that person can be successful.
So we see so often, and I've done it in the past, there's been many times we've put stellar clinicians into clinic director roles, and they're not happy. They don't know how to give feedback. They struggle with some of the communication things that are required. And it's not fair to them to put them in a role where they're not going to be happy.
So you're right. Investing in companies or finding courses or learning what it takes to be in that role, but making sure you're in an organization that has the process system set up so you can be successful in that role because it's different and it's hard.
Marla: Yeah. it os hard. and I think that in physical therapy I wan too continue to see more clinicians growing and not just to clinic directors, regional directors. I really want to see more of them become executives. I think that it's so impactful, as we are seeing these big enterprises popping up and more selling to enterprises we want clinicians to see a path and to really continue in this field without feeling that's their only option is to exit or sell.
Michelle: I agree. And it's one of the reasons for when I partnered with Rally Day was to try and solve for some of those challenges because what we were seeing in the marketplace is some amazing organizations, but starting to see some cracks within some of them and some concerns.
Exactly what you're saying. There's no clinicians that are even part of the leadership team. An that didn't feel good to me. We were also seeing people that were looking for exits and they didn't have a lot of choices. So as we decided to build what is now Highbar it was a couple of things.
One was about building a new kind of platform, where practices that were giving great care and took care of their people and we're doing really good work in their communities. were saying like, I want to be part of something bigger, but I still want to continue to build and take care of these people. And so we wanted to build a platform that would allow for that.
So we brought on Peak Physical Therapy, partnered with us end of last year. They're still Peak Physical Therapy. They're not Highbar. We took a long time figuring out what to integrate what not, because it depends on what Peak needed. We didn't walk in there and paint the wall’s orange and make it Highbar and straight away say, you're going to move to our EMR.
We took time to figure out, first of all, do no harm and how do we support this amazing company, continue to grow and serve its community, and now be able to provide increased opportunities to the team of and administrative staff. So as we look to grow, we are an option for folks out there who are looking to transition partner and make a difference to the industry as a whole.
Show that you can grow. And actually not commoditize care. Take care of the people and grow our clinicians who wanna move into these different roles and have these opportunities and make a difference and have a seat at the table to solve for the challenges we're seeing in the industry. But it takes people are gonna have to lean in.
Clinicians typically want to be asked. They want to be tapped on the shoulder. But I'd say for anyone out there who's thinking about, you know what I want to do more, don't always wait to be tapped on the shoulder, like knock on the door and say, how can I do more? How can I get involved? Can I come and observe a meeting?
Can you come and have a coffee with me? Like lean in. Because often we feel powerless or insecure. Or don't have enough credibility. And we're in this little sector here and we think if we speak up too much, we are gonna be like laughed at or judged. Or if, well if we're a woman, we're called the B word.
And if we say nothing that we're dismissive, we have nothing to say. You've got to learn to increase your sort of, your base of influence. And that's a lot about your own credibility from your knowledge standpoint. But also dealing with your own insecurities, your own inner voice, and also understanding like how to speak up and how to be credible, how to use passion.
When you show you're passionate about something, that can actually make up for some lack of knowledge. How to show you credibility as a clinician. Come in. Here's how we could make the patient journey better. How about this? Because your finance person or your nonclinical person, that hasn't even crossed their mind.
The one thing they're looking at is how much coding you could do, or how many more patients you could see. So unless clinicians get in there and say, how about this? Or how about that? Then these other solutions that look really simple on paper but are detrimental to our future will continue to be pushed.
Marla: Yeah, and I encourage, like you said, bring it up, but also learn some of those business skills and bring it up with a business case. Show the value, show how it's relating to the business. And I think that's sometimes missing with clinicians. They've got great ideas or they are building a business, but they're not showing.
Michelle: They're not showing it. I think with AI now, like it's easy. Dump in your ideas, say turn this into a business case, and suddenly you can now review it and tweak it and change it because you've got these resources out there. It can turn your clinical ideas and knowledge into something tangible that could be considered from a business standpoint.
So there's a wonderful opportunity for AI to help clinicians bring in some of the business and financial acumen that they may not be, have trained a lot in and combine these elements.
Marla: That's a great tip. That's a fantastic piece of advice. And I want to go back a little bit to, you said that you did end up going private equity or going towards that route, sometimes that holds a pretty bad connotation. So tell me a little bit about the positive, the negatives, and why you made that decision.
Michelle: I will. I, first of all, when I decided to go on this journey, I really had no, I didn't what we call go to market.
I didn't plan to go and find a private equity partner. What I did was went out at the age of 49 and said, my goal, by the time I turned 50 is to know where Highbar, what was then Performance, will be in the long term. I don't want to be in a position to retire one day and then be like, what? What? Now I want to be able to control some of the destiny of this organization that, a whole team of us that helped grow and evolve.
How do you do that? So I worked with some consultants from Belay Group. They were great. They were kind to me. They were patient. I learned a lot from them. I met a huge number of people. From VC to PE to strategics, to private to pub, like all over, like I spent a lot of time and what I learned through that is it's not so much the medium of how you're gonna do it, but it's a lot of time is finding the cultural fit or aligned people.
What I, during that process, I met with the founders of Rally Day Partners. They're out of Denver, Colorado, and they were really interesting to me because they were actually a group of entrepreneurs themselves who'd been very successful, but didn't always like the experience they had with private equity.
So they got together and said, let's do something different. Let's be a private, we are ultimately, they are a private equity firm. We don't want to be traditional private equity and anything that's different or creative appealing to me. And I was like, that's cool. We were part of what we call their first fund.
We all met. And we were all very much focused on people making a difference in their communities' culture long term. Like how do we figure things out? How do we sit down and really collaborate and work this out? So really what I've partnered with was actually a group or a team of people who believed in what we were doing and could bring skill sets that I didn't have.
I didn't have the financial acumen to know how to scale. And bring on massive amounts of debt to make acquisitions and do, I didn't know how to do that and I didn't trust that I knew enough to do that. So they brought the, those skill sets. They also had many other companies and many other folks that I could talk to that knew about recruitment and marketing and scaling and change management and leadership development.
All of these elements. That I knew that if we were going to scale, you had to be super thoughtful of, so you did not want to destroy the company. So what I found in the partner, which I think anyone who's looking to evolve, it's more about the people and what they're offering. It's not just about the money now going with private equity.
It is a way to gain some financial capital so you can invest in growth and it is important to gain returns. There needs to be economic returns. And that's an important part of business. But getting those economic returns allows us to pay our clinicians more. It allows us to invest in our clinics and make them more appealing.
It actually gives us choices. So figuring out the right puzzle and putting it all together is what, who you need the right partner to be. Yes, it took some time and I definitely felt a like I had a little bit of my head down when I went to the first private practice section meeting after I partnered with Rally Day because everyone was like, what?
You've gone to the devil? And I was like, you know what? I've learned a tremendous amount and I'm very appreciative to the collaborative working relationship, what I've learned in the last three and a half years. I wish I had. Half the skills or half the learnings, or I partnered with Rally Day. I don't know how I would've gained those without that partnership.
So they have been tremendous value because their believe in what I believe in regard to our purpose and our culture. The first three months of working with them was about codifying and really looking at our core values. Bringing in a purpose artist to really understand their purpose and really solidify it.
Because as you scale this risk, culture isn't about some celebration or some fun work poster on a wall, right? It's easy to create a good–I shouldn't say it's easy, it's simpler to create a good culture, a certain culture in one clinic, but as you scale, you have to embed the verbiage, the behaviors throughout. Otherwise one clinic with a poor culture or people not behaving appropriately can have a significant impact on the whole organization.
So I got a little off tangent there. However, bringing back, I think it wasn't so much about private equity that was a medium financially to support our growth.
It's more about the people that I was introduced to and able to work with. That have allowed us to be given us the opportunity to make a difference in the profession.
Marla: So as you said earlier, you were always seeking out those peer-to-peer, those mentors. So this was your way of gaining and that extra mentor or group to bring you to the next level and to learn.
Michelle: Absolutely. Very much, yeah.
Marla: What would you recommend for people who are looking at private equity, what are maybe a few pieces that you'd say evaluate this, and this? When comparing different groups or even deciding to do it?
Michelle: Yeah. It's a good question. I think there's two parts to it. You have to decide if you are looking at private equity as is starting from square one, which is what we did.
So I work directly with the private equity. Or if you're joining a group that already has a private equity fund attached to it, understanding the culture of that organization, having the chance to meet with some of the team from that private equity company, getting to know them and building a rapport and asking them questions about what they know about the world of physical therapy even was interesting.
When I was on this journey, I did meet with one group. And I asked, I met with the whole board. This was a different group, and I said to them, tell me how you assessed the quality of care, the clinical outcomes when it comes to physical therapy. And they didn't. They all looked at me and said they didn't even know how to make up an answer to the question.
And I was like this isn't even going to work if you're not even curious. So see what they know about physical therapy. And they may not know, they're not going to know everything in the weeds, but they have to have an appreciation that it's a people business. They have to have an appreciation that clinicians care about people.
They care about learning, they care about being successful. and they've got to understand the culture of a clinician. So spend time there. Spend time talking to the other organizations that have been involved with that private equity company who are involved now or have been in the past. Because private equity is a cycle.
So after so many years, you'll move from one private equity company, they'll transition out and they'll be a new one come in. So take some time to get to know who are the other companies who you work with, and look online at reviews. Ask people just like you would if you were finding a new job. I get to know the people.
And you can look at the results. It's not hard to see the financial returns, but more importantly, you've gotta look at the people side of it. Ask about engagement of the staff at those companies. Ask about the NPS for the staff at those companies. Ask about the retention at the staff at those companies, the things that would be key measures that would.
Give you insight about the culture of the organizations that are involved, with those private equity firms,
Marla: right? And probably the innovation as well. Where are they headed in terms of innovation and do they support the innovation into technology and sourcing?
Michelle: Yeah, and I think they all do. I think it's a big part is they're all looking for a way to innovate, to support a return on their capital, but they want to be smart about it.
And I respect and we need to respect that. And knowing how to collaborate and work, bringing the ideas and helping even the private equity folks get creative about what the opportunities are with the investments that they make.
Marla: So now that you've gained this private equity partner, how do you keep your culture, your model, your values?
How do you make sure as you scale and grow, you really do keep that and be supported by your partners to do so as well?
Michelle: It's really important to me. The culture of our organization, and as we scale and get larger, it becomes more and more important. So what we have done is created very tangible resources.
Call it our BBO. Here are our beliefs, here are our behaviors. These are the things that drive our culture. I'll give you one example. Lead the Way. Lead the Way is one of our values. What does that mean? That means that whenever you've got a problem, you try to figure out a solution. Okay? You can be innovative.
So you either find the solution or create one that's part of leading the way. So we instill that. So even for a new clinician that's got a patient who says I don’t know what to do with them, okay, find solution, go to your mentor, ask, don't just say, I give up. Go back to the doctor and figure it out. So bringing those values, those behaviors into every element of what we do, they're built into our performance reviews.
They're built into our onboarding so that people understand the behaviors that are expected that drive the culture. The title is one of As, and practice at the top and be the best version of yourself. So yeah, it is expected that if you show up on a day and you're not feeling great. Have some self-awareness.
It's okay to pull someone aside and saying, look, I slept crappy. I don't feel good. All of that. I need to go for a walk or do something. But be self-aware and know that the impact of your behaviors have on other people, whether they're your colleagues or your patients. So we instill these behaviors and create joy.
That's my most fun one. Create joy. If you don't celebrate birthdays, it's okay. But if you see a patient, it's their birthday. If it can bring them a little bit of joy by saying happy birthday, say it, or do whatever you want to create joy. So we have lots of fun things that we do and fun events to create joy and memories.
Celebrate all things big and small. Put a lot of rituals in place to continue to drive those. Our weekly memos always have who are we celebrating this week? What are we celebrating? These are driving into our culture of creating, joy and celebration. So creating rituals that stream through the organization.
Some might be clinic specific. We'll have one clinic that every Friday they listen to Hawaiian music and dress up luau. Great. That's not done company wide, but another clinic might do something different and that's okay. And that's the important part of the clinic director. To understand how they create rituals, how they behave to support that clinic, and really help that group of people in that community so it doesn't feel like this top down.
Michelle said, we have to do this. Not at all. Michelle said, here's our values that we all agreed on. Now go and behave in a way and take care of your people. So being very deliberate about the behaviors that align with your values. And constantly coming back to purpose. Empower people to feel better, move freely, live fully, like it will roll off the tongue of all of our people.
And that's not just our patient. It's empower people to feel better. It's also about our colleagues. Like my job is to empower you as a fellow clinician to feel the best you can, so you can move through your career at whatever pace you want to. So having very clear purpose that aligns with your action behaviors and being okay to.
Challenge people if they're not showing up or behaving in a way that aligns.
Marla: Yeah, absolutely. I love that it's embedded in the fabric and you continue to ring it through as you scale in each clinic and every clinic and workshops.
Michelle:. Partnering with Peak Tuesday morning, there was entire workshop on culture and what that means to really help people understand what that truly does mean.
It does mean your behavior. It does mean how you treat other people and help
Marla: People understand it. So what's next for Highbar is you now have gone from a single clinic all the way up to 35. You've acquired a new group, you've done some private equity. As a female executive and leader, where do you see yourself growing to next and how are you gonna get there?
Michelle: So a couple of places. I think in the short term, we're very focused on growth in the Northeast and have some ambitious goals of the number of new clinics that will be opening in the Northeast over the next year. So we can provides opportunities for existing team, but also for other folks that are interested in new opportunities.
We are also working closely with a number of groups for potential acquisitions. Those would be acquisitions that we would then partner with and help create more opportunities for growth. But we're super thoughtful about those partnerships because we need to be culturally aligned. The last thing I'd want to do is partner with an organization and have half the team lead because they didn't want to go through a transition.We just did harm to the profession if we do that. So making sure there's alignment there.
So big growth. Continuing with the innovation, how does digital play a role in complement? Yes, we are brick and mortar, but digital plays such an important role now and will continue to do, and how do we continue to innovate that and how we're offering those services, how we're using AI.
I do love AI. I think it has tremendous potential to support the admin burden, to allow clinicians to actually be people with their patients because you cannot replace that. So excited for how we can use. Those, the digital and AI innovations to support our ability to make better places for people to work and deliver right here.
Marla: It's exciting to see a group like yours growing and not just getting acquired by a larger enterprise and at Prompt, that’s one of our main goals. We call ourselves the practice growth platform because we want to see clinicians and groups just excel and grow and have the tools and resources to do it.
So love, love to see that happening. And would love to hear more about your tools that you've used, like you said, the AI and the growth. What do you feel has really gotten you there that you don't have to rely on other people's resources. You're able to use your own technology and infrastructure to continue?
Michelle: I think in, and obviously Prompt has been an incredible partner through all of this and seeing how Prompt has been a partner in that innovation has certainly supported us as an organization. It means that I can focus more on the strategy and the culture and having the best and the people part, but having a partner that can rely on the more tactical things that can make people's jobs easier.
So the automations and scheduling the improved efficiencies with revenue cycle management, utilizing bots to support. How we get authorization and dealing with some of the admin burden things. I love how AI is evolving in that area. Of course, being able to dictate and have AI there to take away our clinician's admin burden when it comes to documentation.
We certainly saw, huge improvements over the years as we've evolved with Prompt anyway, but I'm so excited for the day that. Which is coming right around the corner and we're halfway in it now, where the clinician can stand back and be with that patient face to face with them, working with the patient, educating the patient, looking to the patient, being a hundred percent present.
And AI takes care of the documentation and all of coding. And that to me is a dream and allows clinicians to do what they want to do and what they're good at and drive the value. So those are the, what I would say the key things. Yes, there's lots of add-on parts, the kiosks for virtual check-ins or different ways of dealing with some of the administrative things and how that's evolving with the customer or the patient.
Patients three years ago would not have been comfortable with some kind of kiosk check-in, but our communities are evolving very quickly and patients often do want that as an alternative. So making sure you're really looking at the towns or the environments that you're in and utilizing technology, what's appropriate for your patient population or where you're at.
Because there isn't a one size fits all. I appreciate technology being there as a tool that is leaders and practice owners, where the ability to figure out which tools, when, how to utilize them to optimize our efficiencies. So we can support the margins, so we can run successful businesses and ultimately our clinicians, what they deserve.
Marla: and as you said, less documentation time outside of the clinic. It not only allows better work-life balances, but at the same time, as you said, when you're trying to give them leadership courses and leadership skills. You can take that time where it used to be doc time for 45 minutes and say no.
Now that time is a leadership course or a culture course that we'd rather keep the eye on.
Michelle: Completely agree. I think there's, there is fear out there. There are people out there saying, oh no, if AI comes in, I'll have to just see more patients or I won't agree with what it writes. But those are just fears.
It's just fear and people have to work through their change management. And realize if you can take away the things that don't add value to you mentally and especially and personally, and that creates space for you to do the kinds of things that are gonna make you a better person. Whether that is a leadership course or maybe it is seeing more patience, but now there's options and choices.
Marla: Great. So it's been great to hear about your path and how you've taught yourself, but also found ways to be involved in the APTA and get leadership and mentorship. Found ways to have growth and acquire more clinics. Would love to hear just a good takeaway for anyone listening today, whether they're a brand new clinician, a one clinic owner, someone who's five clinics and starting to grow, what's your one advice on how to build their own leadership skills and how to get to that executive level?
Michelle: I would say it's okay to have fear. It's okay to feel uncomfortable. And if you want it, learn about yourself and your self-awareness. Take time to figure out how to overcome those things so you can lean in and make the most of the opportunities. It's very easy to make excuses. We're very good at that as humans.
Very easy to say, I don't have time. It's very easy to say, I'm just a girl and there's lots of boys at that table. Like those are just, it's just their fear and the labels and the voices in our heads figure out how to get past those things. Because when you step into new opportunities and what you learn and the impact that you ultimately have on other people, whether they're colleagues, that professional patients, is extraordinary rewarding.
So it's like running a marathon or doing something. You're going to have to get uncomfortable, but it's okay. And it's a really fun journey, because it is about the journey, not the destination. So I'd say to people like, get a little dirty, get a little uncomfortable, lean in, it's okay.
Don't worry what other people say about you. They're going to say that anyway. They're going to judge you anyway. So lean in and create. Create your path. Create your journey. Utilize the good people around you. Read, listen, be humble, be curious, and you'll do some, accomplish some things that you'd never, ever thought you would be able to accomplish.
Marla: Amazing. And really take that role that you don't think you're ready for. Take it. You said that's what you did every step of the way. And make sure that you just be able to support yourselves with others to grow in that. Yeah.
Michelle: One step at a time. Just go. Stop pausing. Thank you.
Marla: This is fantastic. I really appreciate it.
I can't wait for listeners to hear. Be inspired, clinicians, females, to be able to continue to grow in this beautiful industry and run large companies if that's what they want to do.