A long while ago, I wrote a guest article called “Reflections as a Rehab Director” that continues to send email queries my way. During the time of that article, I had just reached new heights from a company station and corporate performance standpoint. Namely: I was leading the region in profits, despite having the highest operating costs while scooping up a historically failing trio of business units from crashing further into the red.
Needless to say, this garnered a notable amount of attention — the world of allied rehab therapies is small. Well, it’s been five years since then… AND, since then, I’ve had the honor to help co-found two companies and take these brands into national acclaim — even becoming a national spokesperson for the APTA while on this journey.
Therefore, I felt it was high time to revisit this post — a reflection on reflections. Now, keep in mind… these are reflections from a corporate culture perspective vs. the entrepreneurial world of which I am now proud to be a part of.
5 Things They Don’t Tell You About Management
1. The Budget, Isn’t. It’s A Budgeted Budget.
“Keeping the lights on” is a challenge, no matter what business or which industry or which sector you’re in. In terms of Physical Therapy and healthcare, times have been getting tough — the comfortable margins that once existed a decade or two ago, are no longer the case. Operations need to be highly streamlined, lean, and as automated as possible. These three must-haves are challenges of their own. Streamlining requires process optimization, which costs money. Leaning out a supply chain require killing off redundancies, which costs money. And, of course, while automation itself isn’t exactly expensive — creating authentic and effective automation, certainly does cost more money.
All this money flowing out of the business means these costs must be contained and budgeted for. AND, HERE IS WHERE THINGS GET FUN! The thing of it is this: Depending on company structure and sector, most corporate budgets aren’t the true bottom line expressed by the business as a whole. Rather, these budgets are themselves, budgeted out. This is especially true for publicly traded companies that must meet certain levels of financial performance as projected and otherwise promised to their stockholders, many of which can likely be their own employees.
So! When a bottom line reads “break even” or perhaps reads in the negative, this may very well actually mean being in the negative according to the projected and/or prescribed budget. A business unit or department… even clinic, may be slated to be 10% profitable for this quarter. However, if they met 10% profit, a corporate budget may actually read “0% margin” despite having provided a fair amount of profit in reality. This type of budgeting isn’t always the case, particularly for smaller private practice entities; in these cases, the numbers are the numbers. If anything, their managerial financial sheets likely do not report further additional costs in running the business as these numbers may be attributed beyond the clinic level, to the entire practice and/or entity level in terms of cost structure and accounting.
All of this to say: The budget isn’t necessarily what you think it may be. Or, it might be exactly. Though, more likely than not, the budget is a budget of its own — regardless of size, every company has its own complexities. Operational finances go far beyond “dollars in vs. dollars out” as it churns through the accounting machine.
2. Everyone’s Problem Will Eventually Become Yours.
Expected this one, huh? Yeah… it’s not exactly a secret. When you finally reach a management position, whether as a company supervisor or practice owner/partner, everything will eventually stop at your door to which all questions end… with YOU (at least to some degree).
Of all the “secrets” they don’t tell you about becoming a manager, this is my favorite one because it is the one you can potentially have the most positive impact on.
Here are a few examples: (1) Say the local director of marketing isn’t fully understanding your marketplace. They may have been transferred from a different region, or, may simply be having a disconnect with the way you like to run the business unit. You are now in a perfect position to actuate new marketing strategies. When they are successful, you are sure to attribute credit to the marketing director as you’ll naturally receive credit for improving the market position of your department. (2) Your boss is under a lot of pressure to improve the overall dashboard performances for 5 or 10 other business units like the one you are managing under them. They are getting short on patience and on low performance tolerance. This is an opportunity to step up under their leadership and sequentially elevate not only your own numbers, but perhaps serve as a resource to a struggling business unit to help them out as well. Your boss wins, you win, and a colleague who may have been facing the meat grinder gets to win also — crediting you all the while. (3) A completely different department is affecting the way your team can deliver on patient care. They have limitations on how they can operation; limitations that now limiting your staff. Here’s a great opportunity to connect with the manager of the other department and craft an operational solution that can boost efficiency for both departments, and maybe, even an unknown but affected 3rd business unit!
Now, I’d be remiss if I didn’t mention the obvious fact that should your team have problems of any kind, it all trickles back up to you. But, these are the expected kinds of management problems. The less expected kinds are those that are completely tangential, or, come from fossils far and long hidden away.
3. Set Boundaries. FAST!
Most people jump up from floor or staff level positions into their first management position and find that boundaries are hard to set. This is true for two reasons: (1) they ARE hard to set, and, (2) it’s not an easy transition to move from colleague to supervisor, especially if the powers at be selected you to supersede someone who felt they were “in line, first.”
Boundaries are tremendously important in management as they will protect your duties, your roles, your responsibilities, AND, your home life. You need to set clear times and topics for what is appropriate, approachable, accessible, and advantageous to the team — these will direct the way people regard your position, how your superiors engage you, how your direct reportees reach out to you… literally everything and everyone are affected by the boundaries you set. It is, in fact both a management lesson and life lesson: YOU teach OTHERS how to treat you.
If you don’t set boundaries, it’s easy for your various roles to cross over… many times, detrimentally if not toxically. There is truly a big difference between healthy boundaries and being a disengaged manager, however.
The difference is here: Healthy boundaries protect key points between your responsibilities that should not merge. Disengaged management happens when helpful connections between responsibilities are not made, and are in fact, avoided by the supervisor — the reason is typically due to fear of past mistakes or having personally reached a ceiling of competence. Should the latter happen, it is incumbent on leaders below to manage up -AND MORE IMPORTANTLY- for said supervisor’s direct reports to initiate process improvement plans ASAP… or, even, begin a parallel leadership track as a legacy strategy.
4. Kobayashi Maru – Sometimes, there is no win.
It’s a Star Trek reference, known as the “No Win Scenario.”
There was this time when my department got sabotaged. Yep… SA-BO-TAGED.
A customer with a history and reputation in the region finally decided it was our turn to receive their graces. And, so we did. Despite having absolutely blowing away their service experience, the last day of care seemed to fall short for them. As a result, they filed some incredible, outlandish, and egregious complaints — all which were formally investigated and concluded to be unfounded. Crisis averted. However, the process of weathering that storm was, well… a process.
Due to the severity of the complaints, certain staff had to be put on administrative leave, leaving two of the three business units I was managing with massive gaps in our supply chains. By some miracle, I was able to plug those holes with some temp and registry staff. Much of the team were scared out of the minds, fearing the worst of repercussions. This was literally a no-win scenario. The best anyone could have done is to mitigate losses and engage in as comprehensive of a damage control plan as possible.
Could there have been ways to prevent this crisis? Probably. Maybe not. After all, this particular individual had a reputation. It could’ve just been our turn. Maybe we got lax towards the end. Who knows??? The fact is: regardless of hindsight, many Kobayashi Marus exist in business management. It’s on you, as the manager, to screen as many out as possible… taking it upon your shoulders to shield your team, while empowering them to take the turn around victories “from the jaws of defeat,” should those situations come with fortune to bear — fully crediting them for their efforts, grit, and teamwork.
5. You don’t get paid “that” much more.
Many managers make only 5-10% more than entry and/or “floor level” staff. And, many of them are on salary -AND- are exempt employees; meaning, they lose on the dollar value of their salary (though typically guaranteed per pay period), the longer they stay in the office — plus, they are never really “off the clock.”
To put this in realistic terms: According to the data we have in the Job Market Pulse and Physical Therapy Industry Prospectus, most line supervisors are likely only making $3-5/hour or 6k-10k more a year… while working 50-60 hours a week, bringing their true hourly equivalent to the mid-high-$30s per hour in the outpatient Physical Therapy setting.
Like anything else: Residency, Clinical Specialty, getting certifications, or pursuing an MBA — it NEEDS to be for YOU! If you’re in it for the money, status, pride, power, or otherwise… you’ll lose and take everyone down with you. #BadNews
HOWEVER, if you are in it because you wish to become part of the solution; because you have the grit to sustain a challenging career path; because you see the system for what it is and realize to change it, you must change it over the course of a mission driven career — well, then… you’re looking in the right place. AND, if this describe your drive, you probably want to check out our Business & Career mentorship community called “Pathfinders.”
Reflections on Reflections
It’s so interesting now…. thinking back that I’ve worked in practically every major healthcare setting, in every rung of the corporate ladder… now part of a team of fired up rockstars, growing two companies… there are so many things I hope to be able to do differently and so many landmarks I hope we can achieve together.
I hope that these companies will grow into transformational culture centers; taking the best of what has been learned, bettering them — and, learning from the necessary lessons gleaned only from mistakes and failures… pushing past them and removing such problem sets from our company culture.
The biggest thing is this: I hope that there is always a way for driven, performing, invested individuals to find ways to move up and grow into UpDoc Media, UpDoc Inc., and Recharge. And, should anyone outgrow and perform beyond the core value systems — I hope such individuals would do me the privilege of being able to promote them outside of the organization on towards bigger, better, bolder paths.
As always, your communiqué is warmly welcome should you have any concerns, questions, comments, or if you have the desire to make your voice heard!
Yours In Service,