Fitness Matters: A Deming Success Story (Part 4)

How do you run an offsite that actually changes performance — not just conversations? In this episode, Travis Timmons and Kelly Allan share with Andrew Stotz what happened during the Fitness Matters off-site. They discuss how a Deming-inspired approach helped their team tackle a critical business aim, align around system improvement, and turn employee engagement into measurable competitive advantage.

TRANSCRIPT

0:00:02.5 Andrew Stotz: My name is Andrew Stotz and I'll be your host as we dive deeper into the teachings of Dr. W. Edwards Deming. Today I'm continuing my discussion with Travis Timmons, who is the founder and owner of Fitness Matters, an Ohio based practice specializing in the integration of physical therapy and personalized wellness. For 13 years, he's built his business on Dr. Deming's teaching. His hope is simple. The more companies that bring joy to work through Deming's principles, the more likely his kids will one day work at one of those companies. And we also have a special guest, Kelly Allan, who is a long term practitioner of the teachings of Dr. Deming. And he's also been instrumental in bringing the teachings of Dr. Deming to Travis and Fitness Matters, and particularly to this offsite. So the topic for today is how a Deming style offsite can strengthen your company's competitive advantage. Travis, take it away.

0:01:01.4 Travis Timmons: Hey Andrew, thanks again for having us and super excited to share with Kelly and your audience how our offsite went a couple of weeks ago. The short answer, kind of the upfront, is it was amazing. We had fun, number one, which is always important, but engagement from the team was through the roof. For four and a half hours straight. We worked on the work together and had Kelly there to make sure we were appropriately following Dr. Deming's teachings. Had Kelly there to facilitate and a couple of fun things we did. One was the red bead experiment, which I'm sure we'll talk about as we go through the conversation here. The short answer is I know in the last podcast we talked about the preparation that Kelly worked with myself and our leadership team on in preparing for a Deming focused and led offsite. We did that and it was just amazing. What were your thoughts, Kelly?

0:02:06.4 Andrew Stotz: I'm curious, Kelly, as an outsider helping them, observing, what are your observations of how it went?

0:02:14.2 Kelly Allan: I think there was just incredible energy and interest in figuring out some of the challenges ahead for the company. People came in well prepared and it showed. The interactions in the breakout groups, interactions in the full groups. Often when you're in a full group of 60, 70 people, folks are often, especially new folks, and the company's been growing and adding new people, new folks are often somewhat hesitant to speak up. But the culture of the people in that room, the culture of the organization is bring it on, let's have a conversation, let's hear what people have to say. Let's share theories, let's get down and debate and wrestle with some of these things that are not easy. There's no low hanging fruit here. It's complex stuff in a complex and highly competitive industry.

0:03:28.9 Travis Timmons: Some of the feedback we received, I think I shared last time, Andrew. As Kelly said, we've hired several new team members and they've all shared with me just a breath of fresh air from where they came from before. The power of this offsite with it being focused on some of the core teachings of Dr. Deming allowed them to see how is this different? They know they like it, they know the culture is different. They know they can provide care the way they want to. They know they can have a voice, have an impact on the system. But they didn't really know why they just liked it. Having a Deming focused offsite to explain a little bit, you can't fully explain Dr. Deming in four and a half hours, but we covered quite a bit. Make the system visible, operational definitions. What are a couple other ones with the red bead, Kelly? We did some tampering.

0:04:28.8 Kelly Allan: Making sure that we're not being confused by visible numbers alone. That what's important is how we work on the system so that we're not doing special efforts all the time to get great results. It's built into how we do things.

0:04:43.8 Travis Timmons: To Kelly's point, part of why our team, for four and a half hours we had over 50 people all in, sharing thoughts without hesitation because one of the things we talk about in the very beginning of the meeting, one of Dr. Deming's core philosophies, if that's the right way to put it, Kelly, correct me if I'm off base here, but 96% of issues within an organization are system issues, not people issues. When you put that out there, we're here to talk about the system and improve it and make it visible. We're talking about problems with systems and processes, not people. Then the gloves are off and let's dive in and we're gonna say whatever's on our mind and there's no drama, there's no feeling of any backstabbing or throwing under the bus. We just get to work on making the system work better for everybody. That's where it's fun and fast.

0:05:41.9 Andrew Stotz: What I'm hearing is that Dr. Deming, my favorite quote is "people are entitled to joy in work." And part of the key to joy in work is contributing. People want to contribute in life. I love that word because I think everybody wants to feel like they're contributing to a mission, to an aim, to a goal, to a team. And one of the biggest problems we have these days is siloing off people and getting them focused on this little area and missing the whole bigger picture. And so to some extent, you've proven through what you've done that people really do want to contribute. Throughout this discussion, what we're gonna be talking about is this concept of Deming style offsite. And I'm gonna push back at times to try to make sure that we're clear on what's a Deming style offsite. Because it's not to say that Dr. Deming said this is how you do an offsite. But what we're talking about is your interpretations of how do we apply this thinking to this particular meeting style and offsite and ensure that we're true to that.

0:06:56.6 Andrew Stotz: One of the first questions I would discuss is just the idea that maybe you just had a really open, caring environment. And so is that Deming or was that just that? Or maybe you did a lot of prep. You guys have done a tremendous amount of prep. That's what I was impressed about in our prior discussions. Maybe you prepped, maybe you focused on the one thing. Those types of things is what could go through people's minds. Why is it that you're calling this a Deming styled offsite?

0:07:34.9 Kelly Allan: Well, I think in part it starts with Deming's teachings and continued Deming's teachings. I think it might be useful to start with the aim, to have Travis talk about the time that he spent researching and thinking and what's going on in the industry. And even though we can talk later about their industry leading statistics and data and recognition etc, it's off the charts. It starts with the aim. And Dr. Deming said let's be focused on the aim. And so there are a couple, Travis, you wanna just talk about the content aim and then we can talk about even a more cultural Deming cultural aim.

0:08:21.1 Travis Timmons: That was one of my early learnings years ago, Andrew, was the difference of an aim versus a goal. And so from the perspective of this offsite through the Dr. Deming lens, our aim as an organization is to maintain one to one care because we believe that results in optimal outcomes. And it's very rare in our industry to have one to one care. Part of how we do that is we have to be industry leading in everything we do. And the thing that we are industry leading in, but I feel it was the one thing that we could improve upon was our arrival rate. Patients get better if they show up, team members are happy, they don't want holes on their schedules. Referring physicians are happy. Everybody wins. So that aim of a higher arrival rate was our aim of this offsite and conversation.

0:09:17.6 Andrew Stotz: Can you back up just for a second and define arrival rate for those that didn't listen to prior discussions on it?

0:09:23.9 Travis Timmons: Sure. Arrival rate is a visit we have on the calendar. Do they show up or do they cancel? And part of what we worked on and a little bit of an aside here is operational definition of what's a cancellation on our schedule to make sure we're measuring what we want to measure. A funny aside, competitors, we hired several new team members came from other organizations and they tout an arrival rate that is high, like 92% arrival rate. Right.

0:09:55.9 Travis Timmons: And I asked them in the meeting and Kelly will remember this, I said, I know your institutions claim a 90 plus percent arrival rate. Did you have a 92% arrival rate? And they said, absolutely not. But they had people on their team, for example, the front desk might have been bonused based on arrival rate. So how they would take visits off of the calendar would not negatively impact arrival rate. So we talked a lot about operational definition and our aim is to study what we want to study, not to tamper or. Kelly, you share your favorite saying. There's only three ways to get better numbers, and those are

0:10:39.6 Kelly Allan: Manipulate the numbers which you were referring to from another company. Manipulate the system that gives you the numbers. So that also kind of fits with, well, we're not gonna call that a late arrival or a late cancel or a non arrival. We're gonna call that something else so we can manipulate the numbers. And then the third way, which was Deming's way, which is how do we figure out how to improve the system so that late arrivals go down. So that they're a natural part of what we do when people show up, the patients show up when they need to.

0:11:14.6 Travis Timmons: Yeah. And I think that's one of the things to your point earlier, Andrew, is was it just a happy go lucky meeting because Travis and Kelly have great personalities. Well, we know that's not true.

0:11:26.9 Kelly Allan: Speak for yourself.

0:11:29.3 Travis Timmons: But no, I think anymore people know when they're working on something meaningful that's gonna have an impact on their lives or where you're just there to drink coffee and have snacks. People don't suffer fools, right? They want to be there. To have a team of 50 plus people leaning in for almost five hours doesn't happen just because it's a fun environment. To your point, it's the right question to ask. I appreciate you asking that. It comes down to they understand that we're a Deming organization. They understand that what we're talking about is gonna be implemented in a Deming way. We'll talk about that more as we go on, but that, to Kelly's point, was starting with the aim. Our aim is improving arrival rate. How do we do that? That's where the Deming offsite comes into play. Kelly and I and our leadership team worked on, okay, how do we best convey this problem and this aim to our entire team rather than just five or six leadership people working with Kelly and just coming up with our own ideas and then spitting it out to the team at a monthly meeting?

0:12:47.8 Travis Timmons: The power of them owning and seeing the problem and then working on system improvement is the power of that is unmeasurable, as Dr. Deming would say.

0:13:03.1 Kelly Allan: Yeah. I think we talked about the aim to be able to continue to do the one-on-one care with patients because most companies are doing two patients, one physical therapist, three patients. Locally here in Columbus, Ohio, where Travis and I are at, we sometimes hear about classes of five patients with one physical therapist. Physicians and insurance companies, these people are not getting better. Right? These people are... Or if they get discharged, 'cause that's a way to get a better number. "Oh, we got them out." But they come back because they're not really healed. They don't really know how to take care of themselves the way they do when they come out of Fitness Matters. One of those overarching aims has to do with building the culture even further so everybody understands the why behind the what. We could say the what is how do we increase those arrival rates, and then the meeting was about the how we're gonna figure that out, how to do that. But the overarching piece had to do with the why. Why does this matter?

0:14:16.9 Kelly Allan: How do we see...If we see the organization as a system and we use a fishbone chart as a way to visualize some of that, everybody can see handoffs. Everybody can see how different parts of the system, of that patient journey, that patient story, intersect and how what happens upstream affects downstream and how the feedback loop from the discharge point of a physical therapist discharging the patient, how that can wrap back into the understanding of the customer care coordinators and how they can work with that at the very beginning of that relationship with the patient. It's all a part of a system, all a part of continuous flow. We wanted to make sure that everybody, especially the new people, really had a visual, a view of the organization as a system and how they interact. Part of those weeks of planning, it wasn't every day all day long. You start with some ideas, you refine them, you get some research, you refine them, you refine further. Travis spent a lot of time on that. Part of that value is time for reflection, time to have the others on the leadership team weigh in, give their points of view so that we're really seeing this from a fishbone perspective as well.

0:15:44.5 Kelly Allan: So now we can go into that meeting with everybody, and their homework was in part the fishbone with some instructions on how to do that and some examples of how to do that. And that was pre-work. So people came into the meeting already successful. They had already figured some things out. This just gave launch, just gave liftoff to the energy. They'd done this work, to your point, Andrew, they're making a difference, and it just fed on itself. The output was stunning.

0:16:21.0 Andrew Stotz: Travis, I'm gonna write your company aim as I heard it from you, and that is, or from both of you, is maintain one-to-one care. It's best, it's rare, it works. And the off-site aim was different from the company aim. It was the number one thing that we can do to improve that company aim is improve our arrival rates. Correct?

0:16:51.4 Travis Timmons: 100% correct. And you talk, I think you used the term silos earlier, Andrew. Part of the aha moments and making the system visible and working on this and building culture and teamwork, when everybody sees the complexity within your organization and understands that, there's a lot more willingness to support, like, "Hey, we need to change this process at the front desk," even though it may not be optimal for the physical therapist, as long as it achieves our overarching aim and improves joy in work for the front or less friction for a client coming in. Now the team starts to see and understand, all right, that's a system win rather than silos or turf wars. The amount of energy that is spent on that in organizations is... I couldn't do it.

0:17:52.9 Andrew Stotz: Another thing I think that would be difficult for many people with an off-site is you just had one aim. If we were doing prep in the companies that I know and I own and others, we're gonna list out 17 things we want to talk about in that four-and-a-half-hour off-site. From your perspective, why is it so important to get this one focus, one aim? And then I want you also to tell us more about how it went. We've set it up now, so just one last thing on the setup is this idea of focusing on one thing when you've got 17 different problems in our company and we got everybody together and you're telling me just one thing.

0:18:40.5 Travis Timmons: Well, and Kelly can chime in here because he was instrumental in getting us from pre-work to meeting day. But part of it, that's why it's two-and-a-half, three months of work leading up to this. We had the aim of arrival rate. All right, what are we gonna do? A lot of different ways we could have tackled that. We landed on fishbone and making the entire system visible. And that turned out to be the right move. I think Kelly can correct me if I'm wrong.

0:19:15.0 Kelly Allan: I would agree.

0:19:16.0 Travis Timmons: So we started with the aim and it's like, okay, how do we get 50 people to work on this together? Dr. Deming says make the system visible. And so we chose to do that via a couple different breakouts of a fishbone. And to your point, Andrew, when we did that, now there's understanding of complexity and then where are the biggest opportunities? Because we have seven things we're working on to achieve that aim. There's gonna be three or four large PDSAs. We're doing a software upgrade, which in and of itself... And a funny aside, so our organization's been doing the Deming approach for 13 years. Right, Kelly? We announced that we're changing softwares at this meeting. Right.

0:20:13.7 Travis Timmons: Everybody was like, "Okay, let's do it."

0:20:17.4 Kelly Allan: Unheard of. I see a lot of companies, that's usually panic time.

0:20:23.5 Travis Timmons: And it was announced at the beginning of the meeting. Any questions? "Nope, sounds like the right move for our aim."

0:20:32.3 Kelly Allan: Well, Travis, you provided the why behind the what. The what was that we have to change the software. You provided the rationale from all points of view, including from internal people who deal with the software to making it even less friction for customers and for physicians and for insurance companies, etc. People understood the why behind that what, and now they're ready to work on the how.

0:21:06.4 Travis Timmons: And I would even argue, because I agree with that, and because we've done Dr. Deming and have had success and accomplished so many things that people don't believe we've been able to accomplish as an independent organization, having lenses to look through and "by what method?" That's one of my favorite Kelly Allan-isms. By what method?

0:21:33.5 Kelly Allan: That's a quote from Dr. Deming.

0:21:36.0 Travis Timmons: Oh, okay. We're good.

0:21:38.9 Andrew Stotz: We stand on the shoulders of giants.

0:21:41.6 Travis Timmons: Yeah. There's a high level of trust in our organization that we can implement change. I think that...

0:21:51.3 Kelly Allan: I agree.

0:21:51.8 Travis Timmons: I don't want to undersell that in terms of how powerful that is that I announce we're changing our entire operating software in a few months and the entire team was... And we told them why, to Kelly's point. But to make that announcement and then just have everybody say, "Okay. Cool." I think that's crazy to me. I believe it because of everything else I've seen happen over 13 years. But to have a way, by what method, using Dr. Deming's principles, PDSAs, operational definitions, system view, we're gonna diagram it. Everybody left there confident that, "All right, we can do this and we're gonna do it." Anyway, what would you add to that, Kelly?

0:22:40.9 Kelly Allan: Yeah. I would say that fulfilling the promises that have been made at previous offsites just builds the credibility that this leadership team gets it, understands it, and is interested in engaging people and making things happen and getting things done in a way that doesn't disenfranchise people, it doesn't beat up on people, it doesn't cause harm, but people work together because they wanna figure it out. It's fun to figure it out. Yeah.

0:23:17.5 Kelly Allan: It can be at times a little too much fun, a little too exhausting to figure it out. But we're born wanting to make a difference and people can come to work there and know that they have a voice, they're heard.

0:23:33.1 Travis Timmons: And I think that's our superpower that I've learned from Dr. Deming is if I'm the only one figuring stuff out, we're in trouble. We're in trouble. So the team knows that we're gonna bring stuff, we're gonna talk about it, and we're gonna solve problems collectively through the Dr. Deming philosophy. That's something that just popped in my brain, Andrew, because it was such a non-event. But in most instances, that would have been the entire meeting would have been about that, the side conversations, people coming up to me...

0:24:15.0 Kelly Allan: And Travis, there would have been a lot of discussions at a non-Deming company about, "How do we get buy-in?"

0:24:22.4 Travis Timmons: Right.

0:24:22.8 Kelly Allan: "How do we manipulate people into saying this is okay?" We didn't have any...We didn't spend a minute on that.

0:24:30.5 Travis Timmons: Not one person asked me about the software the entire evening at dinner. It was just like, "We're gonna do it." It just struck me because it was a non-event in the meeting, but I think that would have been rare had we not had our history of Dr. Deming's approach and how we presented it in the meeting.

0:24:52.9 Andrew Stotz: Kelly, you said something that made me think of a book that I read in the past by Richard Feynman called The Pleasure of Finding Things Out. Great scientist. You talked about contribution and the desire for contribution and you talked about how people were figuring things out. And that's fun, that's exciting. That's what people want to get out of their management team and out of their employees. In some ways, I feel like you're talking about recess, a playground. Put all that stuff aside, let's go out and let's build this thing. All the joy that we did have when we were young. Think about, "Let's make a sandcastle! Yeah, you do that, I'll do this." That excitement...

0:25:45.0 Kelly Allan: That's what it was in the room that day. Different breakout groups working on different parts of the fishbone and then bringing them together and debriefing around it. It was very exciting. The energy was high. Andrew, you mentioned something, I think in part you were channeling Dr. Deming there because he also pointed out about how we're born wanting to make a difference, to make a contribution. Then we go to school and that gets beaten out of us with grades and command-and-control teaching, et cetera, et cetera. But to your earlier question about what makes this unique, special in regard to Deming, Travis mentioned the complexity. And so we go right back to the core of Deming: understanding variation and special cause, common cause, the important few things versus the trivial many, and how do you sort through those? That makes it very Deming. It makes it very Deming. The other thing that you won't see, and I've been in a lot of them through the years, in most offsites is those conversations about the why. It's usually, "Competitor's doing this," or, "We gotta make more money," or whatever.

0:27:01.0 Kelly Allan: No, the why for Fitness Matters is to achieve those aims. Right.

0:27:07.1 Andrew Stotz: Some of the things that you mentioned: have an aim, what makes this a Deming style, have an aim, think system, not individual focus, understand variation and how that can help you think system, not individual focus. You talked about pre-work, taking it seriously, and I would say that kind of responsibility for your employees and the environment. I was blown away with the amount of pre-work that we talked about previously. You talked about some tools like fishbone as an example. You've talked about the why. Travis, why don't you give us a very high level... We arrived at this time, this was then, we did this first, then we did that, then that. So we can just understand the structure of this meeting a little bit.

0:27:59.5 Travis Timmons: Sure. We've been big on operational definitions. So the operational definition of start time is Travis will start talking at 12:30 to start the meeting. Learned that one over the years. And I...

0:28:18.2 Travis Timmons: It was at a new location, so we had a couple people go to the wrong place. We put the map inside of the homework, swim upstream, try to make this as easy as possible. But to answer your question, we had an operational definition of the meeting starts at 12:30, and that means the meeting begins at 12:30. Operational definition, we had name tags. From an efficiency standpoint, we had six tables when we were going to do breakouts. People picked up their name tags, it had number one through six on it, so they know what table they would be going to at breakouts. We did a quick intro of every team member and what location they work at because we have had a lot of growth. Put names with faces, introduced Kelly so that everybody knew who he was. There's probably 11 people that didn't know who he was in person introduction and how that was going to be diving more into Dr. Deming. I made it very clear up front that this meeting, we're going to celebrate wins from 2025, but I made it very clear we're going to go through those quickly, not because they weren't huge wins, but because we had a lot of work to do to make sure we stay on that growth and excellence trajectory.

0:29:38.2 Travis Timmons: So we went through all of our wins for 2025. We reviewed our BHAGs, and then we got into the aim. In 30 minutes, we introduced everybody, we went over our wins for 2025, we reviewed our BHAGs, one of which is to be the best, leverage technology better than any physical therapy practice in the country was one of our BHAGs. Then I dovetailed that into, and we're switching softwares in a few months. Any questions? No. We go right into, here's what we're going to be working on today, referenced they're going to be using their homework, so they brought their homework booklets with them. We had PowerPoint slides so they knew what the directions were for the first breakout group. Kelly and I got there early and some of the leadership team got there early. We had the table set. We had the, I call it newsprint, up on tripods ready to go. You want to be prepared. They hit their tables because of the name tag. We had leaders assigned for each table.

0:30:50.1 Kelly Allan: And they were trained in advance. Yeah. Facilitators. Yeah.

0:30:53.5 Travis Timmons: We had leadership.

0:30:54.7 Andrew Stotz: So there was an intro period and then you said, "This is our aim and now go to your tables," or how did that... What were you telling them to do at the tables?

0:31:06.0 Travis Timmons: We told them the aim, reviewed the aim. To your point earlier, Andrew, overarching aim is maintaining our one-to-one care model.

0:31:14.0 Andrew Stotz: Yep.

0:31:14.7 Travis Timmons: Our aim of the meeting is how do we improve our arrival rate as an organization to greater than 85%? One of the ways we're going to accomplish that is making the entire system visible. We're going to go to our tables and we're going to work on... We had the fishbones drawn at each table, but we wanted them to fill in the fishbone as groups from their homework because everybody brought different ideas to the table. We wanted some conversation around that.

0:31:44.2 Andrew Stotz: That was a general fishbone. I think I remember later you talked about then breaking it down into separate fishbones, but that was just a general one to review what they'd done.

0:31:54.8 Travis Timmons: General one, work on the work together. To Kelly's point earlier, just the energy around working on ideas or, "Hey, I hadn't thought about that," or, "I didn't even know we did that in our system." Right.

0:32:07.0 Travis Timmons: Just understanding the complexity and really just getting the juices flowing on, here's what we're going to be working on because the next layer is going to be diving deeper into each one of those.

0:32:18.5 Andrew Stotz: How long was that period of going through the first fishbone and looking at their homework, discussing it together? How long did that last?

0:32:27.7 Travis Timmons: That one was a half hour because they'd already done the pre-work, so we assumed most of it was already going to be done. It was just kind of...

0:32:38.4 Andrew Stotz: Did you have them present any of that or that's just, "Go through that and that'll prep you for the next thing"?

0:32:46.0 Travis Timmons: We had them spend 25 minutes on that and then we saved room for five minutes for them to have kind of sharings or learnings or ahas. What did this experience teach you? Do you have anything to share?

0:33:01.9 Andrew Stotz: They're doing that within their group or they're doing that...

0:33:05.1 Travis Timmons: We went table by table and had them share with the entire team. Table by table, we had the team lead or anybody at the table, "Hey, what'd you think? What'd you learn?"

0:33:14.3 Andrew Stotz: Someone may say, "I didn't even realize that this impacts that and I just realized that now after seeing it." Okay.

0:33:24.0 Travis Timmons: Yeah. What are some of the things you heard, Kelly? I heard, "Oh, this is complex."

0:33:29.8 Kelly Allan: I also heard things like, "Well, I know how to handle this, but I need to define a process so that if I'm out, someone else can do it." Right? It's those kinds of little aha moments. Others were just, "Oh, is there a way for us to systematize that even further?" Again, it was that thinking about the system coming out in their comments. I think another part of the appreciation was really recognizing that a lot of people have to win. Deming talked about win-win being very stable and win-lose is not. They wanted to make sure the patients and the clients win, the physicians win, that the insurance companies are getting what they need, that the PTs and the Pilates people and the MAT people, etc., and the customer care coordinators are also having joy in their work. Because when you have a joyful staff, customers, clients really appreciate that. They just know there's something different. There's something different.

0:34:42.0 Andrew Stotz: And one question is, did you have any drift at that point where people started talking about other things that were unrelated but were key problems they're facing, or was setting your aim and doing the pre-work really kept them on track?

0:34:56.8 Kelly Allan: Great question. Yeah.

0:34:58.5 Travis Timmons: They were focused. They were focused the entire meeting. One of the things I learned it from Kelly or Ray, or maybe you taught Ray, I don't know, but we have a piece of paper we put up at every off-site, Andrew, we call it the parking lot. So that if somebody does have an idea that's outside of what we're there to tackle, we just have them go up and write it down so that they're heard, and it could be important, for sure, but we're not working on that today. We gotta stay laser-focused on what we're here for. So we have a parking lot, which has been super powerful, but nobody went to the parking lot the first half of the day at all.

0:35:39.2 Andrew Stotz: That's good. That's better than the woodshed. Excellent.

0:35:43.5 Travis Timmons: Speaking of the woodshed, this is one of my... I think this is one of the critical learnings, one of the many critical learnings I've had with Dr. Deming and the approach to leadership's responsibility. For me as the owner, at the end of the day, the buck stops with me, is to create joy in work, to create engaged teams where they can do fulfilling work. So you talked about the woodshed. It reminds me another one of my favorite quotes. A lot of owners or leaders talk about, "We have a lot of dead wood around here. Have a lot of dead wood on our team." The first Deming off-site I went to, Kelly said, "Well, there's only two ways that could have happened. Either one, you hired dead wood, and if you did, that's on you with your hiring process. Or number two, you hired live wood and you killed it. Either way, it's on the owner and leadership."

0:36:52.4 Kelly Allan: And I stole that from Peter Scholtes.

0:36:55.5 Andrew Stotz: Okay, got it.

0:36:57.0 Travis Timmons: But that struck me in terms of, okay, responsibility's on Travis to ensure we don't have that. Can't point fingers anywhere else. It's not people coming in with bad attitudes. So anyway.

0:37:15.8 Andrew Stotz: Okay, excellent. So now you've had the general fishbone discussion, you've had people present what were their key learnings from it. What happened next?

0:37:26.6 Travis Timmons: Just some quick aha's, anything from the homework, stuff like that. And then from there we did a couple-minute break and then we went right into the...

0:37:37.9 Andrew Stotz: It sounds like a HIIT, like a high-intensity interval training here. We did a couple-minute break.

0:37:44.6 Travis Timmons: We had work to do, man. People were there to get work done and get on to dinner. We had snacks and water in there they could grab real quick. Restrooms were close. And then agenda, we've gotta stay... And the team understands we have to do what we're doing, we have to be excellent in all categories. So the next thing we did, we came back together as a team, the entire team, and Kelly did the red bead experiment in preparation for the next breakout. Super powerful. For those that have seen the red bead experiment and how Dr. Deming used that to show how the willing worker shows up wanting to get all white beads, right? And the white bead, it's the white bead company, but there's red beads intermixed. No matter how hard they try, or Kelly offered a hundred-dollar bonus to somebody if they would just only bring out white beads the next time they put their paddle in, and it just had that visceral, in-the-moment realization that people show up wanting to do a good job. And issues, so the red beads were what we called cancellations impacting our arrival rate. Therapists want their patients to show up. Front desk wants, the client care coordinators want their patients to show up. Physicians want their patients to show up. So what do we need to do? It can't be bonus them if they show up or just try harder. What's not working? So that was a great...

0:39:23.4 Andrew Stotz: Why don't we go to that for a second. We're gonna have Kelly, maybe you can tell us a little bit about what you observed from that, and then we'll continue on with the rest of the structure.

0:39:36.2 Kelly Allan: Well, the way we set up the red bead experiment was very much focused on the real challenges and real issues that everybody at Fitness Matters faces in terms of this topic of increasing the arrival rate and how complex that is. I think the red bead experiment demonstrates for not only the people who are the willing workers and the people who are the inspectors and the person who is the scribe who keeps the spreadsheet, they realize that the numbers alone are not telling us what's going on. They realize that unless there's a system improvement, process improvement, and people working together to make those happen, you can bribe people, you can incent people, you can threaten people, you can send them home, you can give them a performance appraisal, you can do every kind of command-and-control management, but you haven't improved the system in which people work. There's still red beads. There's still red beads. We have to reduce the friction, we have to change the paddle. We have to figure out how it is we can help make it possible and easier for clients to want to show up so that they can get healthy and so that they can really appreciate what happens when they don't show up, how they are a part of the system. Once they become a patient, they're a part of the system of Fitness Matters.

0:41:18.3 Andrew Stotz: I'm just curious if there was also anything different. You've done the red bead experiment a lot of times with a lot of different types of companies. Were there any observations you had of the way they interpreted that that was either the same or different? What were some of your observations there?

0:41:37.7 Kelly Allan: Well, we planned it so that Travis and his leadership team could really do more of the debriefing so that they would have the context for the people in the audience as well as for the people on the stage, versus just a more generic, which is still powerful, to talk about how the system's in control and is this a common cause system or a special cause, what's really going on. Travis and his folks were able to then bring that context to the red beads, which I think made it especially powerful for this audience, for this group.

0:42:16.2 Andrew Stotz: Excellent. Travis, why don't you continue?

0:42:22.0 Travis Timmons: As Kelly shared, the leadership team debriefed after the red beads of the learnings and how that might be. The red beads were the cancellations that we currently have. Then we introduced, "Okay, now what we're gonna do is go do a deeper dive into the fishbones." There's five primary parts of our system, five bones. Each bone we're now gonna break out and work on the granular details. We did a fishbone for each of the larger bones.

0:43:01.8 Kelly Allan: Why don't you give a couple examples of the bones if you have it handy?

0:43:07.3 Travis Timmons: First bone is what we call initial contact. The first time a client has an interaction with Fitness Matters. Could be website, could be a physician referral, could be a neighbor talking to them, could be driving by. Initial contact, that's bone number one. How does that entire process work at Fitness Matters? Where's the friction point? Are there people that we don't even get into our door efficiently? They're not coming in set up for success, for example. Next bone would be setting them up for the evaluation. Third bone is evaluation day. Fourth bone is every subsequent visit up until discharge. And the fifth and final bone is discharge to ongoing wellness and how do we continue to stay connected? Those are the five bones as you flow through as a client at Fitness Matters, and the five major gates, if you will, is how we looked at it.

0:44:07.8 Kelly Allan: Every one of those is filled with complexity. There are a lot of little details to reduce the friction for the clients and for the system, for the patients in the system. I think that was an aha moment for people as well because a lot of them are in the quadrant four of unconscious competence. They've been doing this job well for a long time and they tend to forget the complexity. We have to identify the complexity so we can work on it and make it less complex, more streamlined, and so new people coming in can appreciate why Fitness Matters makes informed, thoughtful decisions about how they do things. It didn't just happen. These have been thoughtful things that have been worked on for years, but they can still be improved further and we can document them and make them more visible. When people saw all those little bones coming off the main bones, it's like, "Wow, there's a lot of little things that happen and we can impact almost all of those."

0:45:18.1 Travis Timmons: In some of the work we've already done on the bones to already have industry-leading arrival rate, but I think we can do better. We're one of the few, maybe one of the few medical appointments people have in their lives, not just physical therapy, but in general, that you go to do a medical appointment, do you know what it's gonna cost you out of pocket before you show up? Generally, you don't. We've swam upstream to make that visible to clients, so they already are coming in knowing what the cost is gonna be and are we providing that value? Just an example of, okay, can we swim further upstream with that and make it easier to pay and make it visible on their insurance deductible and all of that?

0:46:05.9 Kelly Allan: Well, and also, Travis, I think... I was just gonna say in terms of how many times have people been to a doctor's office, they've had to fill out a whole bunch of forms either online or in the office and then nobody ever looks at it. Something that Fitness Matters has been a leader on for a long time, which is how many of these questions are really required? How are we really gonna use that information? Let's not have seven pages. Can we get it down to four? Can we get it down to three? And increase... Because remember Deming's teachings are quality goes up as costs go down. Quality goes up as we have to commit less time. Quality goes up as joy in work goes up. Right? So that's that Deming structure of, no, quality does not have to cost more. In fact, Deming said if you're doing it this way, quality will cost less. And that's in part how Fitness Matters can compete against these big, big companies and win. I think, Travis, you've gotta share some of the statistics about what makes Fitness Matters an industry leader. What kinds of things are measured that you and others look at in the industry?

0:47:17.8 Travis Timmons: One of the big things in the physical therapy industry, Andrew, is what they call outcomes. They're measurable questionnaire by body part that you have a patient fill out at evaluation day and at discharge day, and it gives you a percentage of... In our industry, they call it functional ability. Are you 100% able with your shoulder or do you have a 60% disability with your shoulder? For example, across all body parts, we're 30 to 40% above national average on our outcomes. Not even close. Because of the efficiency, our patients show up. Again, the one-to-one care model is why it's our true north, and everything we do has to support that because of those industry-leading outcomes. Our no-show rate is one of the other things we define. Again, something we're working to improve upon, but we're already nation-leading. Our definition of a no-show is 24 hours notice up into a no-show. Most companies in our industry only call it a no-show if the patient just doesn't show up. With our definition of 24 hours notice or less, we're at 4% to 5%. National average of true no-shows, just not showing up, is 15%.

0:48:45.8 Andrew Stotz: Yeah, I can imagine even probably higher than that, but 15, yeah.

0:48:49.7 Travis Timmons: 15 to 20% depending on the research. Just two examples there. The Deming approach to system thinking, team engagement, getting rid of silos, operational definitions. To Kelly's point, we worked years ago on that initial client intake. I used an example several years ago around the time we were working on that project. My one son, got him an Apple iPad for Christmas. Other son got an Xbox 360. One product we got out of the box and turned it on, it was fully charged and ready to go in about 37 seconds. The other product took all kinds of unpacking, had to plug it in, and as soon as it came up, it said software upgrade required, and it proceeded to spend the entire day of Christmas downloading the update. We just use that as an example of how hard is this? We want that same experience for our clients. How do we make it an unbelievable healthcare experience for our clients?

0:50:10.1 Kelly Allan: Well, and Travis is being way too modest here, so I have to jump in. I don't know if I have the numbers exactly right, but Travis will correct me. Let's say you have an injury or you're recovering from surgery or whatever it happens to be, and the industry average is it's going to take 17 visits with a physical therapist for you to be at some level of functionality. At Fitness Matters, it might be 13 visits. Travis, is that too high?

0:50:42.3 Travis Timmons: 10.

0:50:43.1 Kelly Allan: 10 visits. 10 visits. So cut it in half. They're getting better in half the time. That's Deming.

0:50:52.9 Travis Timmons: Yeah.

0:50:53.3 Kelly Allan: Quality goes up, costs go down. Which is why Travis then can... Insurance companies also love them, right? It's like, wow, these people are getting better and they don't circle back just because they were... Operational definition is they're well. Discharged by somebody else, oh yeah, they had their 17, 18 visits, 19 visits, they're well. No, they're not. They come back or they go somewhere else and they're claiming insurance again. Fitness Matters, they learn how to stay well.

0:51:22.4 Travis Timmons: And that brings in another important thing that we've learned over the years, Andrew, with the Deming approach. Our data is industry leading, and we've worked hard at that. And we've got a great team that works within the construct that we've created through Deming. To get back to the unknown or unknowable quote that Dr. Deming would use, our marketing costs are low because patients go back to their physicians and say, "Hey, this is the best PT experience I've ever had." And after they hear that four or five times with us and they get complaints when they send them elsewhere, all of a sudden we start getting referrals from these doctors we've not even heard of before.

0:52:07.6 Kelly Allan: Yeah. Yep.

0:52:08.9 Travis Timmons: How do you measure that? What amount of marketing dollars would have to be spent to get in front of... Like, we doubled the number of physicians that referred to us in the last year.

0:52:23.6 Kelly Allan: Yes. That's a double, Andrew. Unheard of.

0:52:27.5 Andrew Stotz: Yeah.

0:52:28.1 Kelly Allan: Unheard of.

0:52:28.5 Andrew Stotz: Incredible. So you got amazing outcomes. Let's now wrap up about where did you get to at the end of this? What did you personally and the management team end up with?

0:52:45.9 Travis Timmons: So we had some do-outs. Our closing PowerPoint slide was within two weeks we would report back with one to two updated operational definitions and probably three PDSAs that we were going to tackle. That was kind of our promise back to the team, that we would look at all the work. We have paper everywhere. People got to vote. We had a one-page paper on potential PDSAs, and we gave them little stickers to vote on where they think we should put our time and energy and resources. Our takeaway, our product, if you will, three PDSAs. One that has two under it is the new software. We're gonna start doing online scheduling, automated waitlists. I won't get into all the details, but PDSA one has software change. PDSA two, there was a lot of feedback on, "Hey, it would be great if we had kind of a scripted conversation point for the client care coordinators for these four scenarios: first phone call, first in-visit, how we take payment and make their benefits visible to them, how do we take a phone call and handle a cancellation when they do happen to ensure that it's a positive experience."

0:54:12.4 Travis Timmons: And then how do we handle kind of a no-show? Another PDSA is we're gonna have those client care coordinators create their first version of what they think the best script would be, 'cause they're the ones that do it all day. Why would I try to come up with that? And then have them send it to us and do some feedback there. Then we updated our operational definition of canceled visits so that there was clarity across the system to make sure we're measuring what we want to measure, which is how many people show up to their visits each day. We reported that back to the team last Friday, actually, to make sure we hit the deadline we promised to them. And then we let them know we're also gonna be working on kind of a third or fourth PDSA—I kind of lost track there of how we're counting it under the software—but training the entire team on what does it mean to have client engagement and what is our operational definition of client connection and client engagement. So they know we're gonna be doing that on a location-by-location basis at the March monthly meeting.

0:55:26.4 Travis Timmons: That was our takeaway. A lot of product to come away with, and they're gonna have all of the context from the team off-site to understand what we're getting ready to tackle, especially with the software change.

0:55:40.1 Andrew Stotz: My first reaction to that is, oh, those seem like kind of things that you could have figured out some other way, or there's not that many things, or there wasn't some stunning breakthrough. Explain why you're happy with what you got versus you prepared, you did a lot of work, you got those things. Some of it may be that, hey, we need to go through a process. I may have known some of those conclusions, but if we don't have a process of going through that, first we have the risk of maybe I'm wrong in what I think. And the second thing we have is that we have the risk that it's just a business run by dictate rather than getting real buy-in. I'm just curious if you could explain a little bit about that.

0:56:30.7 Kelly Allan: You said the bad word. You said the B-word.

0:56:34.5 Andrew Stotz: Buy-in.

0:56:35.4 Travis Timmons: Understanding, Andrew. Not buy-in.

0:56:38.4 Andrew Stotz: We're looking for buy-in. No. Okay.

0:56:40.8 Kelly Allan: We change it. How do we get... The conversation changes when you say, "How do we get understanding?" Now it's about the why behind the what that leads to the how, versus buy-in, which means, "How are we gonna sell this to somebody?" Sorry, Travis, I couldn't resist.

0:57:02.8 Travis Timmons: No, it's 100% true. And to answer your question, Andrew, my first answer and probably the most powerful answer we already talked about earlier, but it's very important to reiterate and maybe close with, is because of our approach and the time and investment we spent preparing for the meeting, doing the meeting, the fact that there was zero concern or stress around us switching our software system. The amount of engagement that there's gonna be, 'cause there's gonna be work to be done by all team members in preparation for that software change. I am confident I'm not gonna have to do any motivational speeches leading up to that. I'm not gonna have to bribe people. They want this to work because they understand why we're doing it, they understand the value it's gonna provide, and they understand, now that they have deep understanding of our system, they understand why we need to do this to continue to excel.

0:58:13.9 Travis Timmons: I don't know what that's worth. That's unmeasurable. But I know had I just announced this and not had any process, not a Deming approach, just, "Hey, guys, Travis thinks we need to do a new software and we're gonna change how you document, how you schedule," I feel fairly confident how well that would've gone. That would be my answer, Andrew, is the power of being able to present that to a team. They're already asking me questions about, "Have you thought about this in our system?" We have a shared Word document across the team. What questions are coming up in your system thinking? "How are we gonna message this to all of our clients so that they know they're gonna get new emails for their home program?" Great question. I had not thought of that. That is unmeasurable, but I know we're gonna be successful when we switch softwares because of our approach via Deming. What would you add to that, Kelly?

0:59:14.7 Kelly Allan: I think that's the essential nature of what happens. When you set out with a clear, healthy, thoughtful aim, you have conversations around that with your leadership team and what they can do then to filter that and start to talk about that with their teams at their locations, and then you have time to reflect and continually improve that, you're really creating a racehorse. Most off-sites, and Andrew, you've been to these, I know, they start... It's the 17 things. I thought of this when you mentioned it earlier. We start out, we have a racetrack and we want to have a racehorse. But by the time most companies get to their off-site, they've put so much stuff on that horse that it's now a pack mule. It will eventually make it around the track, but if you're competing with Travis, his racehorse, that team's racehorse has been around that track past you many, many times. You may get there, but they're already onto another track by the time you get to the finish line. You're finished.

1:00:36.7 Andrew Stotz: Yeah. You may even be releasing kittens and he's got a horse.

1:00:42.0 Travis Timmons: Kelly brings up another great point there. The other thing that gives our team confidence, because of our system view, 96% of issues are due to systems and processes, not people, the Fitness Matters team is confident that there's gonna be hiccups with a software change. They're confident they're gonna be able to talk about it in a system view quickly, and they're confident we're gonna implement change to rectify that. That goes into one of the reasons why I got zero shocked looks or zero sidebar conversations the entire day. The only feedback I've gotten is, "Hey, we're excited about it. We think we need to do this. And have you considered this as part of our system change?" I don't know what else as a business you could want.

1:01:40.4 Andrew Stotz: Kelly, I was thinking about a good wrap-up from you is to help the listener and the viewer think about how can they apply this into their business. Let's step back a little bit from Travis and think about the work you do and give us some hope, give us some guidance about, can we do this? How?

1:02:04.6 Kelly Allan: Yeah. Several things come to mind. One is that when you first start to learn about the Deming lens, the System of Profound Knowledge, his approach, it seems, it's different. It is different and it can seem to be, oh my gosh, that's so different. We'll never be able to do that. But the point is, the Deming Institute offers a two-day seminar workshop and they can learn not to be incredibly proficient or masterful in two days of how to go back and do Deming, but they know how to get started and they do get started. And then it just becomes part of, again, the Deming magic is as you start to work on these things, your costs go down, your quality goes up, and sometimes you can raise your prices because of the quality and sometimes you just are more competitive at the existing price, but you're taking work and rework and waste out of the system through the Deming approach, which allows you the time. That's the big constraint in most companies. I don't have time to work on improvement. I gotta fix this.

1:03:29.9 Andrew Stotz: Yeah. Right.

1:03:30.9 Kelly Allan: So that's a fix that's gonna fail. That's a fix that's gonna fail. So I think the message is you just want to read The New Economics. If you get the third edition, start with the new chapter. It's like 40 pages and it sums up a whole lot of what we've been talking about. Then there's DemingNext videos through the Deming Institute. You can get your feet wet there. You can then, if you want, attend a seminar or read more things or reach out and have conversations with people. But you just have to try it so that you can see that the payback is there, that the joy in work is there. And in a war for talent, they wanna work for Deming. People wanna work for Deming-based companies because they're not about manipulating people. They're about joy in work. They're about reducing the friction. So you just gotta get started and don't be just because it's so different doesn't mean you can't learn it quickly. You can.

1:04:36.7 Andrew Stotz: Yep. And Travis is a great example of that. In our prior episodes, he talked about the journey, about the pain and all that. I think that's exciting. I'm gonna wrap it up. I just have to laugh because I've been out of the corporate world for a while, just doing my own thing. But I was thinking, you mentioned about buy-in and then you said it means you're selling something. And I thought that's funny. I remember my father used to say, he used to get so annoyed because he'd say, "Yeah, let's talk around this," which was a common thing back in those days. But then I was also thinking another thing that we were saying was onboard. Let's get people onboard with this. What if you're onboard? It pretty much means you're drowning. And I just thought about those types of things that when we talk about fear and work or fear in what we're trying to remove fear and stuff, part of it is the way we speak and the way we communicate.

1:05:41.1 Andrew Stotz: Travis, I feel like I want to leave you with the last word. So why don't you bring us home?

1:05:48.0 Travis Timmons: Yeah, I think I would follow on what Kelly said is I would just the amount of joy, the amount of stress this took off of me as a business owner and as a parent thinking about things differently. And the first time you start learning about Deming's teachings and the System of Profound Knowledge, it seems a little off. Seems a little like this just doesn't seem possible. I've had several people I've talked to about that. It just doesn't work that way. To Kelly's point, I would encourage just try a couple things, whether it be do you have clear operational definitions? Have you done a PDSA? Do you know how to do a PDSA? But the two-day seminars is where you kind of do the deep dive into like, oh, okay, I need to think about things differently. So anyone struggling with a business trying the latest and greatest book that's been out or the latest and greatest compensation model to create ownership thinking within your organization or whatever the buzzwords are, this is a long-term path to clarity and to just an understanding of how you can make your organization a place that has a positive impact on the lives of your employees and your clients.

1:07:17.7 Travis Timmons: And man, if you get that right, everything else follows. Sales, profit, all the stuff that a lot of metrics look at. If you get the point of your job is to have a positive place for your team to work and how do you do that? Deming is the way to do that. Everything else follows after that, in my opinion.

1:07:38.6 Andrew Stotz: And on that note, Travis and Kelly, on behalf of everyone at the Deming Institute, I want to thank you again for this discussion. For listeners, remember, as Kelly and Travis have both said, go to deming.org, go to DemingNEXT. There's resources there so you can continue your journey. This is your host, Andrew Stotz, and I'll leave you with one of my favorite quotes from Dr. Deming. I constantly repeat it because I love it, and that is: "People are entitled to joy in work."