Jason Smith Interview: Future Trends in Health Care

Back In Motion Health Group Founder and Group Director was recently interviewed about his thoughts on future trends in the health care industry. Listen to the interview with Paul Wright here:

Interview Transcript

Paul Wright: Well welcome Profit Club members to your next CD of the month as part of your Profit Club program and then I've got a ripper for you today. I've tracked down Jason Smith, who's no stranger to Profit Club, and Jason today is going to share with us future trends in the business of healthcare. What you must know. Jason, are you on the call?

Jason Smith: I am. Thanks for having me, Paul.

Paul Wright: Glad to have you back. It's been a while since you've been in the Profit Club. What have you been doing?

Jason Smith: Wow, lots of things. In fact I don't know how long it was since we would have spoken last in this format, but life keeps moving and life's much more than work, so there's heaps going on in every direction. I mean firstly and probably most proudly, still happily married and four young children, so that keeps me busy at home and then on the work front I guess my days are split into three main categories. One would be directing the Back In Motion Health Group, which is a big undertaking, but other than that, I'm still very heavily involved in the SOS Health Foundation which is a charitable works where we take physios and other health practitioners into indigenous communities and the urban poor, really with the mission to improve the health of disadvantaged people. And then my third main area of interest is as principal of the Iceberg Institute, which is all about leadership development. So I have lots going on.

Paul Wright: You always got lots of stuff. You've been doing this for ages. But thanks for giving up your time to be on the call today.

Jason Smith: No, my pleasure.

Paul Wright: Well let's get to the guts of the call. Future trends in the business of healthcare, what you must know. Let's talk first about… One thing we'd like to talk about, workforce shortages and how they're now turning into surpluses. What's happening on the workforce shortage situation?

Jason Smith: Well, I think things are changing. There's a lot of movement particularly on Australian soil in this regard. If we're talking in my area of expertise which is first and foremost in the physio space, there's clearly a lot more schools of physiotherapy graduates now running. There's more than 20 across the country. 10 years ago there would have been half that. So we have a lot more graduating cohort every year that the number sits well about 2,000 for 2014. So that means we literally have more warm bodies in circulation and that's always a good sign for the employer and we've come out of probably a 15 or even 20-year cycle of being always under-resourced in terms of physiotherapy supply and now from that labour perspective, we're getting a slight turn around and I think that will only grow over the next five to 10 years as the schools mature their numbers and the graduates stay in the system.

Paul Wright: Is that across all professions, Jase, or just physio?

Jason Smith: Look, I couldn't speak confidently about what's happening in some of the other Allied Health. In fact some would suggest it might even be contracting in some of the other ones but physio is growing, but I guess the other element to take into consideration there is the attrition numbers. So we might be pumping more into the profession but what's happening with them after a decade or so, and the data still seems to suggest we're losing some good talent, some great people to other professions. So we just gotta watch that carefully, so that the net effect overall is still a surplus.

Paul Wright: Are you noticing a change with your guys in terms of their skill level, or the new grads with the skill level they're coming out with?

Jason Smith: Well, I mean, that's a broad… Skill competency is a really broad assessment, if we were looking purely at clinical competency, I would say there hasn't been necessarily a lot of detectable change, not in my time. They are probably being given a broader clinical experience as undergraduates than maybe a decade or more ago, but in terms of depth there, they're probably not a whole lot different. But if you looked at the skills competency maybe in some of the non-clinical areas, I think there are certain schools doing that better and then there's just the natural demographic of these millennials who are coming through now who are just probably more sensitive and more attuned to the non-clinical dimensions of professional life and that innately gives them probably a higher skill base in what you and I would think of as those life skills that just have to accompany someone in the private sector.

Paul Wright: Curious thing is I'm dealing with a couple of podiatrists at the moment who are finding the skill level of their new graduates is decreasing. So they have to do more intensive inductions and more intensive training when they first start their careers in private practice.

Jason Smith: Yeah, well 'work readiness', which is probably the buzz word to catch all of this is certainly a hot debate in the industry and my experience isn't that it's worse; it probably just hasn't materially changed yet. And I think it's on the university radar, at least at a debate level. It takes another five or 10 years to get a change in curriculum and then an output in real life, but I think work readiness will improve. That's my punt, work readiness will improve. There's still a massive onus on the employer to DIY your own staff, so you get a certain amount of raw skill and raw talent but it's how you onboard them, and nurture them in the job that ultimately will determine their overall fit for your practice. But yeah, I'm optimistic and encouraged by what I'm seeing in the last five years.

Paul Wright: So what does it mean for you guys? What is Back In Motion doing in response to that trend, Jase?

Jason Smith: Well, I think the really exciting thing is that we get to be more selective, as do everybody else. Long past are the days where you run an ad for two months or three months and you get one applicant and irrespective of their experience, you're sort of obliged to take them on. So we can be a lot more selective which allows us to quality control what we call the ABCs, and ABCs are attitude, belief and commitment. And if we have now a dozen applicants to a job, we can really be more thorough about what their motivators are, about what their aptitudes are, and we can get a nice mix on that and hopefully make better recruitment decisions.

Paul Wright: How are you… You mind me asking, how are you guys doing your recruitment? One common buzz we get is what… How do you pick the right people? You talked of ABCs, what's the process for you guys? How long does it take and how many… Is it multiple interviews? How's the structure? How do you find the right people in your organization?

Jason Smith: Well, I mean, in our group, we represent 60 something individual practices and more than 500 staff so we have been able to afford to centralise the screening of all of our recruitment. So we will have most applicants coming through our national office and some form of high-level preliminary review, and then all of the matching of the candidates to the right jobs with the right people in the local practice would then happen at the local practice level. But the micro of that process, I think, is the downside actually of these workforce surpluses because all of a sudden, we now have 12 candidates to supposedly choose the winner from. If we don't have a good process, and we don't have clear criteria against which to match these candidates then we have actually just multiplied our chances of getting it wrong, and wrong, and wrong again, and again, and again.

Jason Smith: So, I think the… For everybody listening to the call, the upside of having a more… A broader selection is exciting. The downside is you're under pressure now to recruit at a higher quality level or make your decisions more carefully. So we would include, more than just interviewing, we would include probably more through referee checking than we have before. That's not always effective for new graduates clearly, but certainly any one who has worked elsewhere. We would look at skills testing, or the old “try before you buy” concept of getting them in the practice for even just a couple of half days of observation can give you a feel for those intangibles that might not emerge in an interview.

Jason Smith: We do psychometric testing now. We've probably done that on and off for 10 years but we are probably be a little but more determined around that now, to try and understand what some of those counter-productive workplace behaviours might be that you've got to look out for. I think getting the team involved in some of the recruitment is also useful. So actually allowing the peers who are mostly gonna be working with this person to have some insight or input into who's gonna be the final pick, has merit. Now that's complicated and delicate but I think in the real world of this century where we're dealing with much more autonomous millennials, it's probably the right approach and just needs to be carefully executed.

Paul Wright: Alright. I have this question… What's the biggest predictor you've found, if there was one, the biggest predictor of success in your employment? What's the key?

Jason Smith: Yeah. All the hard data, the pure analysis would suggest to you that past performance is the best predictor of future behaviour. So, how they finished in their last job, and what sort of things they achieved in their most recent employment is actually the best predictor and that's really unfortunate for someone who finished poorly or made one big fatal mistake at their last job because they might be prejudiced. But if you look at human nature, that actually is, on the analysis, the best predictor.

Jason Smith: I think if you were to park the data to one side and take the more intuitive street fighter approach, obviously, psychology accepts that there's a lot to be said for gut feel and intuition and that takes you part of the way. I think for me, if it's not hard data on which I would base my decision, it's probably identifying their primary driver. So what's that intrinsic motivator that gets them out of bed in the morning? If I can lasso that, if I can identify and, or they can articulate that, it's gonna give me a really good insight as to whether they've got the fit for what we're doing. 'Cause at the end of the day, there's no amount of money, there's no amount of rewards, there's no amount of workplace conditions I can give somebody that motivates them to stay or compels them to stay if intuitively they don't want to be here. So identifying that which is a hard gig is probably the holy grail of this thing.

Paul Wright: I love that. The whole ideas of the workforce shortage, as I said, what that meant for us is that we have to better at the employment process. When we don't have any applicants, we take whatever we can get. Now, we gotta be better at it, that's it. That's a big change. Isn't it?

Jason Smith: Yeah. So, when we had workplace shortage, recruitment was irrelevant and it was all about retention. So, once you've got them, how do you retain them, because they were so hard to get in the first place 'cause there's so few of them out there. I think that's gonna flip itself now, and it's gonna be more about how do you recruit well 'cause you can blow a lot of cash, a lot of time, a lot of emotional energy, if you keep turning over staff, or choosing poorly. Retaining staff will probably take second now to having chosen well in the first place. Always important but, yeah, bit of a change in emphasis.

Paul Wright: Yeah. What's your best recruitment tool, Jase? Is it people contacting you these days? Or you still in the advertising of positions market? What the best recruitment…

Jason Smith: Yeah. We get both. So we get a steady stream of unsolicited candidates, coming through the online channels and through the national course here. But we will still always be perpetually advertising our positions vacant, even for our own internal staff just to help our career path them through. I think the best quality candidates or the best outcomes are always going to still come from personal referral. So someone's either worked with them, studied with them, knows them well, and they've advocated on our behalf and we have this excited, enthusiastic person standing in front of us and we haven't even told them what the job is yet. They are the best predictor of a good result, which is not that dissimilar, I guess, to our clients in the practices. We know that a personal referral is going to be the yellow pages ad or an SEM campaign of some sort, because they've already been emotionally biased toward us by the positive experience of someone else.

Paul Wright: Alright. Great tips there for Profit Clubbers first up. You've mentioned a couple of times, let's talk about millennials. Now, what are the millennials? What do they… How do we structure our business best to accommodate these needs? What's this millennial business?

Jason Smith: Well, millennials, they are otherwise known as Gen Y, it's not by any means a new topic of conversation. We've probably been talking about millennials or Gen Y for six or seven years now and grappling with who they are and what their attributes are and how we're adjusting our workplace to suit them. I think what's becoming more and more interesting about millennials, is that they make up the majority of our Australian workforce now. And with more and more graduates coming out of these physio schools that are popping up all over the country, it's just changing, it's displacing the Gen X and giving us a much higher proportion of Gen Y to deal with.

Jason Smith: And they look at the workplace and life in general very, very differently. They care, and this is a great thing, they probably care more about the people they work with and the excitement of their workplace and mentorship and things like this, less than just the money itself. And they're becoming increasingly more focused around flexibility and purpose and probably the opportunities that we can create for them rather than just a steady, long career in the one organization. So, that's probably not new for anybody who's listening. I guess the challenge is how do we adapt, how do we contort our teams and our shape of business to give these millennials the best opportunity? How do we give them oxygen so that the attributes that they inherently have can be optimised?

Paul Wright: Because you talk about engagement. They want autonomy, how do you give the millennial autonomy in your businesses? What should we be doing as business owners?

Jason Smith: So, I think the three key driver of the millennials if you read Daniel Pink's work, would be autonomy, mastery and purpose. And I think in our business we reverse that order. We've just found that it's so much easier to engage our team if we talk about purpose first, then work on mastery and then the reward is autonomy. And so, purpose is really just a big question of why: Why do we do what we do? Obviously, everyone's gonna have a different why and that's very acceptable. In our business, we don't let it get too far removed from daily practice that why we do what we do is to be significant in the lives of others and we can do that lots of different ways but that actually means something very important to everybody who joins our group.

Jason Smith: And when you get onto the mastery, it's about helping them truly develop, hard and soft skills and become excellent at what they do. So, the millennials want to be saturated with education, they wanna be given lots of mentorship, they want the luxury of trying and failing, than just being told, “You're not ready yet”. And so, we've been criticised over the years for promoting people through career pathways prematurely or sooner than they… Maybe the industry thinks they're ready. We've been criticised for letting 20-somethings own their own practices or take shareholdings in practices. But the truth is this is all part of how we would help them develop their mastery, because until you actually get given real responsibility, how are you possibly meant to develop it? And so we do that in supported ways, with lots of safety nets, but that then ultimately gives us the platform to gesture then autonomy. And autonomy is that ability to decide for themselves, to actually make their own decisions.

Jason Smith: And we talk about delegated authorities, we talk about boundaries, and all of those things are important. But to rather than tell people what to do in the workplace, I guess our ethos is we sell it. We try and compel and influence others, but at the of the day, you are an autonomous practitioner, you need to make your own decisions and the consequences will be your teacher. And so it's quite a new vogue, and we're still journeying with this. We're probably six or seven years into understanding a little bit about our workforce and how it ticks, but it seems to be right, it seems to be how they're wired, and we need to accommodate that.

Paul Wright: It's a balancing act, isn't it? Because you're balancing independence and autonomy versus control in the business as the business owner, controlling the steps, controlling what happens. It's a tough thing to balance, isn't it?

Jason Smith: Well it is, and control is a very 1980s sort of word.

Paul Wright: Oh, I'm a dinosaur, Jase. [laughter] Thanks very much.

Jason Smith: And I think… But, I think you are right. There's this contest between, “How much can I control?” and “Is it a benevolent dictatorship?” that is “I'm controlling for your best interests” versus “You know what, I need to let go and concede a little bit so that you can live and experience and then learn because that learning will be a richer, more sticky result”. And it's a matter of degree, isn't it? It's a spectrum. So where you sit on that, and how you, I guess, adjust is gonna be slightly different for different people. But in characterising the millennials or characterising the majority of the physiotherapy and Allied Health workforce of Australia today, I think business owners, practice principals truly need to think differently.

Jason Smith: They need to be very courageous in this space. And it's not about just letting go and abdicating in being structureless. It's about intentionally putting a new structure in place that still has safeguards and financial controls and value checks and accountability, but the not-so-subtle shift is rather than being top down, it's more multi-directional. So you are asking for a little bit more peer accountability, we talk about managing upwards in our organizations, so… Some of my staff wouldn't think twice to call me to account on things I say, do, that they feel needs to be checked, and I think that's healthy, I think that's ultimately yielding better results.

Paul Wright: You never sit there and say, “Hang on, it's my business. This is how it's gonna go down”? [chuckle] Does it ever… Like I'm out of it. What… You never have those conversations anymore?

Jason Smith: Look, we definitely don't have those conversations, but I don't think that's what you are asking me, I think you're asking do I think that from time to time, the higher the stakes, the more temptation there is to call back control. So when we are talking about $10 decisions, ah, it's no big deal to let the team have some autonomy. When we're talking about a $100,000 decisions you might be a little bit more selective, and when we are talking about million dollar decisions, the temptation to wrestle control to the pinpoint of my locus is extremely strong. But let me tell you Mike…

Paul Wright: I bet it was.

Jason Smith: In all fairness I think it's a journey and gradually, over the years, I have learnt that there is so much more intelligence in the collective, and there is so much more experience to draw on that gives us a better result if I actually be collaborative. And I think that's the way around that. It's probably shifting from control to collaboration. You can always reserve the right as the business owner because the buck does stop with you to make the ultimate decision, but in taking on the input of others around you, you are actually sharing the ownership, at least figuratively, you're sharing the project, you're sharing the outcome with them. And this is the way the millennial is wired. If they don't feel like they have influence, if they don't feel like they're a contributor, then they might as well go somewhere else where they can be valued for that.

Paul Wright: Was it Tom Watson at IBM? “Use your best judgement, there'll be no other rule”?

[chuckle]

Jason Smith: Yeah, I don't know if it's Tom that said that but I've certainly read some one-sentence policy and procedure manuals of other organizations where it's literally that brief. And, that's an extreme, and probably more urban myth than reality, but the sentiment is a healthy one and that is “Bring your people into the inner circle, disclose where the business is going, share the problems, help them be the creative solution, let them feel like they are making a difference”. And as long as that's authentic, and not contrived or staged, as long as it's a genuine invitation that they can change the outcomes in their workplace, you are starting to scratch the itch of the millennials and I think that's an exciting space to be in.

Paul Wright: And the thing I'm hoping I'm getting this right. Profit Clubbers shouldn't think that there's no accountability or consequences. I am sure you've got definite key performance indicators, you've got measurements, you got all this things in place. I'd assume that's the case.

Jason Smith: Well, you have to because every healthy organization stills need to have checks and balances. The difference is, I am not running around, one man with my big stick or my sweet or carrot trying to motivate every individual to a one page, a balanced scorecard. What's happening now is, peers are doing that with each other and they're helping even frame what the right measures for accountability are, and that's all driven by what we collectively think the objective is. And so it becomes a much more internally self-managed, self-led, self-driven group of people. I think… It's good that you asked me that, because there is always the temptation to over-simplify those things, and when people hear me talk like this, they'll immediately reject the notion, because “How can a business not have accountability? How can it not have structure?” We are entirely wedded to structure and accountability. It's just a different form, it's a different expression. The fundamental principles can't be violated, though.

Paul Wright: Okay. Although I'm really a dinosaur. I'm getting better listening to you guys, but gee, if I went back into healthcare, I'd be a disaster. As an owner, I'd have to go back to finishing school with you and do this sort of stuff. I'd be upsetting the millennials straightaway, I reckon.

Jason Smith: Well, and the problem with that, Paul, even the new guys coming through and having their first five years in business ownership, they themselves are probably millennials, and certainly in our business' case that's the fact. And it's funny because they wanna be managed or led a certain way, but as soon they assume ownership or responsibility for a team, it's funny to watch them go back to the only model of leadership that they have seen, which is the more hierarchical command and control. And so you see these millennials kind of nearly recede into that old style, because nobody has yet modelled what this looks like for them. Even though they, as the team member being led didn't flourish under it, it's kind of like they need to be mentored in this. And so I think we're all facing this as just a new era. And management technique, or philosophy, is like technology. It's only there to serve our interests. We're not… It doesn't impose itself on us. So we can change our approach to how we manage people as often as technology and other things change, because we are, as a people group, we are ever changing, and who's to say that in 100 years we don't come full circle and maybe become a little bit more instructional again in our leadership style? But for right now, this generation, it seems to be right.

Paul Wright: You hear it a lot that… I mean, I get a lot with my, the people I speak to, that they say these new guys coming up, they wanna own the place in six months. But you've identified that and capitalized on it and helped them do that.

Jason Smith: Yeah, people say that as though it's… They nearly have a derogatory tone when they say that, you know?

Paul Wright: Well, because it took them 20 years to get it. So they think “Well, why should this guy get it in six months?”

[chuckle]

Jason Smith: “This young guy, he's fresh out of school and he wants to be a team leader or a practice owner”, and they say that as though it's a negative. Whereas I think what we're starting to accept is that that very attribute in them can be harnessed for their good and the good of those around them in a really exciting, colourful way, but we've just gotta do it differently. Because just because they have the aspiration for it doesn't necessarily mean they have the life skills or the aptitude for it. And so we just need to round them out a bit.

Paul Wright: Alright. And let's move on to technology. You're big in technology, or certainly your business is. Couple of big trends in healthcare coming up, the way healthcare is delivered, and you sent me out some information, I don't even know what it is. Let's talk about some of these trends in healthcare, what's VR, what's that all about in healthcare?

Jason Smith: Well, VR is just the acronym for Virtual Reality, but…

Paul Wright: All the more, I'm a bit of a techy, too, and I wouldn't even pick that up. Virtual reality, alright, what's that for us?

Jason Smith: Well, you've got virtual reality, we've got the Internet of things, which is all of our wearable devices in the fast-moving space of how we can put sensors into products and people and start sending biometric data and all of sorts of analytics across the internet, all to try to give us to faster response times and indicators in our space of health, indicators of a patient's health outcomes. I mean, this is a fast-moving space, Paul. There is so much going on in technology. We talk about digital health… If I was to kinda zoom out, we talk about digital health as being really the delivery of healthcare through digital interfaces.

Jason Smith: And then you zoom in a little and we start talking about tele-health, which is the healthcare service being delivered through telecommunication formats. And then if we specifically go a layer deeper to tele-rehab, which is where we're actually trying to perform assessments and treatments, like actual interventions through technologies like video conferencing and store and forward imaging and streaming media and wireless communications. I mean, we're in a whole other world. And my prediction, and I'm not really a tech nut, but I appreciate that this is the future of healthcare. My prediction is that in the next 10 years there will be a whole wave of advanced technology that's already prototyped, if not actually being used by early adopters today around the world, that will change the way Allied Health does what it does.

Jason Smith: We pride ourselves on our… The handiwork of our two hands and manual therapy and everything that that involves and I don't think that will become obsolete, but I think the way we assess patients, the way we provide at-distance interventions, the way we service rural and remote Australia, the way we cater to the conveniences in the local suburbs of people who, 10 years from now will be buying everything online, and there are already people who are that way inclined. We're kinda fooling ourselves if we don't think heath will get swept up in that current. There would be some commentators who would say healthcare is probably the driver for a lot of this technology being developed, not just the beneficiary. And so heat's going on, and…

Paul Wright: But, what are you guys are gonna do about it? What's the upshot? And…

Jason Smith: What's the application?

Paul Wright: As I said before it's not just Australia, like you are now delivering services internationally online, so how… It's a global thing.

Jason Smith: Yes.

Paul Wright: What are you guys doing about it, what are you gonna do about it, and what should we do about it if we're going to be a profit leader and a leader in this whole game?

Jason Smith: Well, you got to get into the conversation firstly. We've gotta understand both the opportunities, but the dangers, the threats of some of this technology to the quality of healthcare. So we've got to get into the conversation, which means, I guess, for me personally that looks like a lot of online reading, a lot of networking

[ends]

Paul Wright a former clinician, has more than 20 years’ experience operating health practices in Australia. During this time he has learned techniques which have allowed him to operate very successful practices while only spending minimal hours in the practices and more time with his family and doing things be loves. You can find out more about Paul Wright's Profit Club Program for Health Professionals here.