Live From NOLA: Going the Extra Mile

From the floor of the American Academy of Ophthalmology meeting in New Orleans, Gary Wörtz, MD, meets with Matt Jensen of Vance Thompson Vision. Listen as they discuss the process of creating a successful practice culture-from building effective leaders, to motivating staff members, to going the extra mile for top-notch patient care.

Gary Wörtz, MD: Open, outspoken. It’s Ophthalmology off the Grid—an honest look at controversial topics in the field. I’m Gary Wörtz.

Speaker 2: Ophthalmology off the Grid is an independent podcast supported with advertising by Alcon.

Gary Wörtz, MD: This is Dr. Gary Wörtz with a very special episode of Ophthalmology off the Grid. We're coming live from New Orleans at the American Academy of Ophthalmology meeting.

We're actually going rogue. What that means is, I'm going to be going around the convention hall getting insights and opinions about real-time topics, and we're going to bring them straight to you.

Today, I'm really excited that I was able to track down Matt Jensen from Vance Thompson Vision in South Dakota. Matt, I've been wanting to talk to you and have you as a guest on a podcast for a long time because you're kind of the guru. When I have a management question or something brewing on my mind, you are the guy I will email or text, and usually I will get a direct response and usually a book in the mail not too long thereafter. That's happened a couple of times. With that being said, Matt, I'm so happy to have you on the show today.

Matt Jensen: Well, I'm glad you had me Gary, and I'm excited to talk with you. I love your show, and I'm impressed by all the people who have already been on. Hopefully I am worthy to stand among them.

Gary: Well, I don't think there's any question there. One of the things I really think about and I think a lot of folks think about when we think about Vance Thompson just is the culture he's created at Vance Thompson Vision and the partners that he's been able to attract and the quality of care that you all provide, it's just a really special culture. You think that's fair? Is it palpable?

Matt: It is palpable. There's a specialness within the spirit of our organization, and, while I'd like to think that it's something that happens within the four walls of our center in Sioux Falls, South Dakota, the thing that we've found as we've grown into North Dakota and now we've grown into Montana, is that it's grown within the four walls of those buildings too, hours and hours away. And so it's really something that emanates from within the people. It comes from a people-first kind of atmosphere, but you can feel it when you walk in the door.

Gary: Well, it's not just ophthalmology that's recognizing that Vance Thomas Vision is a special culture. Correct me if I'm wrong, but I think Entrepreneur Magazine ranked you all something like number 19 out of mid-sized companies for best team culture, and it was the only health care company, period, to get that honor in the top 100.

Matt: That's right. Our team actually went out, and they sought the nomination and they announced it to our doctors at our Christmas party last year. We didn't know what we had won or where we ranked but just that we had both been nominated and we were among the highest. So we had to wait for the article to come out in February of 2017, and we had a little party for it. That was a real proud moment to hear that the team is so excited about that culture and the code of behavior that they would do that on their own accord.

Gary: I think that speaks volumes to having people who are advocates for wanting to show up to work, not only just to do their job but to make a difference. It really gets back, probably, to that wonderful TED Talk by Simon Sinek, the why. John Berdahl introduced me to this concept years ago that really people don't really care what you do or how you do it, but they really care more about why you're doing it. And it seems like maybe you guys have been very intentional about the why. Is that fair?

Matt: I think it's fair, and you know what's funny is everybody that we know that works alongside us in our center but that we know in the industry when they went into health care, it was because they wanted to do the right thing. They wanted to help others…

Gary: Right, they wanted to make people's lives better. They wanted to make a difference.

Matt: That's right, and there's all these barriers on the way to the point of care. You've got to turn around and look at a screen. You've got to make sure you check the box right on the code. You've got to make sure you're wearing the right thing, saying the right thing, hiring the right people, training them properly. You've got the right certification. There's state rules. There's federal rules. By the time you're sitting in front of the patient who's really counting on you, it's easy to forget...

Gary: Right, that they're not another box to check.

Matt: ...how important that moment is to them because what we know from our own research and the books that we study is that we have one-twentieth the human interactions that we had just two decades ago.

Gary: Can you repeat that? I was checking my phone.

Matt: Yeah, that's right. Not only that but loneliness is up higher than ever, and it's because of your phone, right?

Gary: Right.

Matt: We keep comparing ourselves to this fake social media gratification. We are comparing ourselves to it. We know that we don't measure up and no one does, but it makes people even more dependent on those social interactions when they do happen, and we more commonly now let them down, in any service industry, but especially health care.

Gary: I think that's really important point. We do get mired in the drudgery of the clicking of the boxes and not just physically, on a screen making sure that we are getting all the elements of history and the physical and the exam and plan. But really the mental box checking of procedural, going through your day, doing all of the PQRS, all the alphabet soup, the reporting, and it really is hard to set that aside and really let yourself engage a patient when you have all these other things floating around. How is it that you have been able to maybe overcome that barrier in a way that other practices perhaps want to do? I'm sure we all want to do that but what's the secret sauce, if there is something? Is it just being very intentional about that experience?

Matt: Well, first of all, one of the things that's important is to surround yourself with leadership who's going to model the behavior. You mentioned Dr. Thompson and you mentioned Dr. Berdahl, and Dr. Tendler, and Dr. Swan, and Dr. Greenwood from our centers. These are all servant leaders. They are never going to ask a team member to do something or serve a patient in a way that they wouldn't be willing to do and go low themselves. That's really important especially in the doctor world because you run the gauntlet. By the time everybody comes out at 31-34 years old, they are expecting a certain level of "I've got it. I've made it now."

If, at that point, you can still manage to have a servant leadership mentality where there's no special parking space for the doctor, actually the doctors park furthest away. That’s a cue to the team that we are really here to serve each other and the patients. These things are the things that we remind ourselves in our daily meetings. It's really inefficient. Over time, when you add up all the hours, it's really expensive, but every member of our teams gets together every single day for what we call a holy huddle. It's holy because we don't miss it. It's sacred. It's holy because while other practices come and visit us and vendors come and visit us and research studies come and observe us and we participate in all these kinds of industry activities, it's the one place where nobody gets to go. It's only us.

Gary: That's the sacred spot where you guys kind of reaffirm the mission and be a team.

Matt: It's 10 minutes, and we're going to go through a few things that might trip us up that day. We're also going to remind us that there's a patient coming in today a 9:00 from 3 hours away. They have been on the appointment calendar for 3 weeks, and they're counting on us.

If we treat them like, "Where's my 9:00? Where's my third patient?" If we treat them like that, we steal because they are counting on us to deliver more of an emotionally charged experience because of the lack of human interactions that we have and because of the loneliness that's up. When we key in on those things and we talk about them as a team, not only do we do that for that patient but we are more present for each other.

Gary: That's right. That awareness goes up. We're all focused on the goal.

Matt: And so we do that. We've done that for 10 years, every day for 10 years. After a while, you start to believe that we've got a responsibility here that goes beyond just excellent patient care.

Gary: Again, not beating the horse too much, but Simon Sinek says people don't buy what you do. They buy why you do it. If you don't communicate that in a tangible way to the patient, it can become very procedural and very sterile very quickly. It's a transaction.

Matt: Yeah, especially in an environment that's rooted in routine, and it needs to be.

Gary: It needs to be efficient.

Matt: It needs to be because, when we don't follow protocols, care isn't as good. So, in environments you think of a couple of industries where they are heavy in protocols, you know the health care world, the military world…

Gary: Flights, maybe like airlines…

Matt: ...airlines, finance world. These are areas where customer experiences are remarkably low, but the companies who do it well, they jump way out as an outlier for the smallest things.

Gary: Southwest, for example. They make it fun.

Matt: They do the smallest things, but it stands out because it's so remarkably different amongst their class.

Gary: You mentioned something earlier that I want to kind of jump back into, and that's the concept of servant leadership. Growing up in the church personally, and you share similar background, that was something that was pretty natural to me because the idea of a servant leader is really founded in seeing and demonstrated again and again in Christianity. We don't always do it the right way, but at least it is modeled that way. That whole idea has really had a renaissance through a book I read by Jocko Willink. He is a Navy SEAL who was head of the Battle of Ramadi. He was the squadron leader. He has written a book called Extreme Ownership. If you've not read it, it's fantastic.

Matt: I haven't, but I will.

Gary: I will really recommend it to everyone. He, as a leader of the SEAL team in the Battle of Ramadi, there were some things that went down that he could have blamed legitimately on a lot of people that reported to him in that there were mistakes made all over the place. When push came to shove, when the investigation came through, he took all the blame on himself because he said any mistake that's made down the chain of command from me is ultimately my responsibility. In the book it really just talks about how you have to own everything that happens and that your standard is not what your ideal state is. Your standard is what you are willing to put up with. What you'd settle for is actually your standard. It sounds like in your environment you are really calling people to a little bit of a higher standard on a daily basis.

Matt: That's right, and internally you have to role model that behavior as a leader. Once you see that common amongst the team, they'll emulate it. Like Simon Sinek's other book Leaders Eat Last, your team also has to see you go out and defend them when things go wrong. Leaders have to go out to reference the topic you were discussing with the book. They have to see us slay the giant. As leaders, not only am I going to serve more than anybody, but nobody's going to mess with my team.

Gary: That's right. It's “protect your team.”

Matt: Right, it's both.

Gary: Right.

Matt: I think that that's really important for the team to see, and then they'll follow. I'll share a funny story. Our team now does things that I would never brainstorm or imagine. We just had a story this last week of a patient interaction from a few months ago, and it's worth sharing. We shared it in our huddle this week.

What had happened was I was at a board meeting in our community and I was talking about the customer experience at our center, and I was proud of it. To the gentleman that I was talking to across the table, he was eating it up and following along and giving compliments. A gentleman in the corner was quiet, awkwardly quiet, to where it kind of made me a little nervous. Out of the corner of my eye…

Gary: Like what's going on here?

Matt: Like, uh-oh, this guy maybe had an experience and it maybe wasn't as good as I was as I'm proporting that it was.

Gary: Right, he's about to call your bluff.

Matt: He's about to drop a bomb.

Gary: Right, right.

Matt: So, and he did. So, I called it right. I finished the story. He says, "Yeah, that's good. So that wasn't my experience at your center."

Gary: Oh, no.

Matt: I said, "Well, what was the experience?" He said, "Well, you know, I pulled up to your office and I asked for a general eye exam, and the front desk lady said, ‘We don't do general eye exams, but I'm happy to give you an appointment for next door. There's an optometry office that does general eye exams.’" You know at our center, we're typically…

Gary: Right, in tertiary care.

Matt: And I said, "Well, was she nice in the way she said it?" He said, "Yeah, they actually offered to make the appointment set up happen right there at the front desk, or they offered to actually walk me next door." I was like, okay, well that's pretty good.

Gary: Yeah, above and beyond the call of duty.

Matt Jensen: He said, "Well, I was just kind of disappointed that you didn't do general eye exams." I said, okay. He said, "But that's not the part that's remarkable." So I'm kind of guarded again, and he said "When I was walking out, I walked out with another gentleman, and he was carrying a cookie cake, like a 9-inch cookie, and it said Happy 40th Anniversary on it. And he turned around to the building, and, as we are getting in our cars that are right next to one another, he's tearing up,” and he looks at our building and he says to this other gentleman telling this story, “Isn't that place amazing?” And he said, "Yeah, well, I mean, I guess so, why?" And the man holding the cookie cake starts to weep and says, "You know, I called them for this exam 3 weeks ago, and they recommended today, and it just happens to be my 40th wedding anniversary, but my wife passed away 6 months ago. When I walked in today, they had this cookie cake for me." He just started to weep, saying how much it meant to him.

Gary: Right, that little…

Matt: That little thing. That cost $14, but what I love is that somebody on our phone team keyed right into it. Someone on our phone team felt empowered to go do something about it, get it ready in the clinic.

Gary: They didn't have to run it up the chain of command.

Matt: I didn't even know about until a long time later. So our team runs out in front of us and performs at a level that's at a much greater pace that we could ever do because they believe.

Gary: That is awesome. Let's talk a little bit about physicians. This is something that I've been reading a lot about leadership because I feel like it's something that I am called to do in the role that I have. I don't really see myself as a leader per se. I enjoy interacting with people. I enjoy kind of a flat leadership structure. I like eating lunch in the break room with my techs.

I always say the initials that come after you last name do not determine your IQ, nor do they determine your self-worth. So, as a physician, I don't really see myself as any more or less important than anyone else on the team because I feel like we're really a team.

Regardless of that, I know that I am asked to lead in certain ways because I have been reading a lot about leadership. It really seems like there's this spectrum of leadership where when you come out of training, you're just so tired of everyone bossing you around and telling you what to do that there's a temptation to be ready or think you're ready to rule something, to rule a fiefdom and to make people finally do what you would want them to do rather than approaching it from a teamwork or a collegial aspect.

I've been guilty of this. I've been guilty of that feeling that I'm entitled to a little bit more respect. I'm entitled to having things … a double standard that suits my needs rather than the team's needs. You've seen, I'm sure, a lot of physicians in your life. You're recruited tremendously talented people.

What pearls would you give people who are either just out of residency, about to take on that role perhaps for the first time, or maybe people who are transitioning into a new job where they are the new doctor. Maybe they are not new out of training but they're new in this position. What advice would you give to someone about not necessarily letting people walk all over you, because that's the other end of that spectrum, but also not letting your ego get in the way of really just doing the job that He means you to do?

Matt: Well, you know, I see this really modeled again with the doctors of our program, but just like you and I walking up to do this session, we ran into a couple of your mentors. We ran into a couple of my mentors. I mean, I think the thing is, is that if we're all really honest with ourselves, we'll realize that none of us are self-made.

Gary: Right, right.

Matt: And so, it doesn't matter how great of surgeons you are, what your research is, some of the people who have invested and sold the best companies in our field and the companies that have invested in them, they will all tell you they are there because someone took a shot on them. Someone brought them up. Someone grabbed them by the collar and stood them up tall.

So, if we really believe that we are getting more than we deserve, I think it's easy then to back up and say, okay, so it's my responsibility to be a good steward to what I have been given, in response to what I've been given. When you are a good steward to what you've been given, we find that it's really then easy for people to follow that. So there's a certain kind of leadership that naturally begets followership, and it's a stewardship style, a servant style leadership that does that.

Gary: Yeah.

Matt: Now, again, for people who are as far along as folks like you are in your craft, it is easy to say, "You know what, I'm the man. I kind of got this now." The problem is that the world will tell you, your patients will tell you, your staff will tell you, and your family will tell you that "No, actually, you're not." Especially your family.

Gary: Especially your family, right? It doesn't matter. They see you…

Matt: You're a big deal that this meeting.

Gary: But when you go home, and your 14 year old…

Matt: Chief bottle washer, you know, and that's good, though.

Gary: It's important.

Matt: You really need to make sure you don't tune out those voices in your life that are willing to say, "Hey knock it off. You put your pants on one leg at a time, just like everybody else."

You know, but a lot a people in this industry or who are listening to this podcast, they know John Berdahl. They know Vance Thompson. They know the other doctors I mentioned: Alison, Russell, and Michael. What they know is that when you have people as nice as those folks are who have given me as much trust as they have in me or our team and you wake up every day, all you know is that you might a great debt of gratitude. You don't want to mess it up. You're going to give it everything that you've got, right. You come to the team with everything you've got to try to make everybody serve in a capacity that's as good or as close to those individuals as possible. That's what we owe them.

Gary: That's awesome. So let's talk about that. I know a story, and I'd like you to recount it because it's talking about giving it all you've got.

Matt: All you've got.

Gary: So, you wanted to go into marketing, if I'm not mistaken. From right out of college, you were sort of saying I want to be in marketing. Tell the story about how you landed your first job because I think this is instructive about don't just take what life gives you.

Matt: Right, well first, I'll say that the story that I'm going to tell, and I love telling this story; it has a pre-story. So, for folks that are listening…

Gary: Alright, alright, alright, let's do the pre-story.

Matt: No, no, no, no, no, we won't do the pre-story now.

Gary: Okay.

Matt: For the folks that are listening, if you ever corner me, find the pre-story to this story because that's even better. That's for the next podcast.

Gary: Alright, alright, we're going to tease that for the next one.

Matt: So, by the time I knew what I wanted, I wanted to work for this mid-sized ad agency in Sioux Falls, South Dakota, but I wasn't classically trained in marketing. I was a psychology and philosophy double major from a small, private liberal arts school in South Dakota. There was no reason for this firm to take me seriously. All I knew was that I wanted to be in this firm. It was the most prestigious. They had a really competitive internship program, and I had applied several times. I was kind of a big man on campus, the student body president.

Gary: You thought you were definitely qualified, overqualified.

Matt: I was qualified. Overqualified. I put in some development work with the school, and so I'm ready.

Gary: Right, give me a shot.

Matt: I'm ready to walk in this job…

Gary: Put me in the game.

Matt: And, especially for an unpaid internship. I got this in the bag.

Gary: Right.

Matt: Well, after applying three times throughout the first half of my senior year of college, I got zero response.

Gary: Not even a rejection.

Matt: Right. I think they looked at my resume, looked at my majors, and they're like, "Who does this guy think he is?"

Gary: Right, wrong internship.

Matt: Right, sent this to the wrong, got the address wrong. And so that was hard. That was hard for me because I was an okay student, but I was really involved. I really thought I had this thing in the bag. I was overconfident. Many of you probably know that I still am. So, it was the end of January. I remember waking up, and I was disturbed by this. I remember thinking to myself, and it's funny because I'm almost 40 now, but I remember thinking to myself when I woke up in the middle of this January night, I don't want to be 40 years old and look back and wonder what would have happened if I went after this, if I would have went after this as hard as I possibly could, giving it everything I got.

Gary: Right.

Matt: And I couldn't get back to sleep. And so I took that day, and I went around town. I got my first credit card. I bought a bunch of trinkets and things, because I said if these guys would just read my resume and pay attention to me and get me in a room. If I can get in a room…

Gary: Foot in the door.

Matt: I think I can get this done.

Gary: Right.

Matt: And what I ended up going, I didn't know this at the time, but I was about to write the best ad of my life.

Gary: Alright.

Matt: Okay, so I went around and got all these trinkets. I got a boat propeller. I got an airplane propeller. I got an oar. All these different things that I could write about. And I set and made several different concepts. And I settled on this 5.5-foot airplane propeller.

Gary: Subtle 5.5-foot airplane propeller.

Matt: It's varnished all nice, and it had brass fittings. I had a special box made for it. I wrapped my resume around it, and I had it specially stuffed. I FedEx-ed it so I could track it. It got there at 10:00 the next day addressed to the CEO, and by 1:00, I had a call to come in for an interview that afternoon. I started the next day.

Gary: That is awesome. You literally wrapped your resume around the propeller.

Matt: An airplane propeller, and sent it through the mail. I've used that trick a couple more times. I've applied for, you know, when I did some experience design work, I applied for that training by telling that organization I wanted to blow the doors off, and I sent a regular car door through the mail. Standard mail, right?

Gary: That is awesome.

Matt: It's made it into all their PowerPoint slides, which is a nice little boast. But so the point is that we all have these things that we want to swing as hard as we can at in life. And we have all these regrets and wonders, like what would have happened if I had just pursued that a little bit more. And it takes about 5 seconds. There's a great book out called The Five Second Rule. It takes about 5 seconds for that to just dissipate and us to say, "Well, I don't know. I'll just…”

Gary: I'll figure something out.

Matt: “...I'll go to Facebook instead.” Then that moment is gone.

Gary: Right, right.

Matt: We just can't go to that. The people who get what they want out of life and really find ways to serve others more properly are the ones who follow up on those impulses.

Gary: That's awesome.

Matt: By the way, nobody does that better than Vance. You'll be talking to Vance, and he'll say, "Oh, that reminds me of my buddy in Beverly Hills." And he'll look down, and he'll be texting his buddy in Beverly Hills the funny thing that just reminded of him. That's why everybody loves him.

Gary: Right. Just a little touch, a little reach-out. So, your career basically started in marketing. Then you started doing some marketing with Vance. Eventually Vance somehow…

Matt: He stole me.

Gary: He stole you.

Matt: Okay, much to the dismay of the firm, he and I ran off together. He closed every meeting for a couple of years by asking me to join him. You know, "When are you going to join my team?" And I loved what I was doing, but I also knew that I wanted to run my own team. I also knew that I wanted to do something more than just create landfill because, back at the time, everything was in print or dissipated. I felt like life should be more than just messaging. It needs to be more impactful.

Gary: Got it. Well I think that that's probably … those are just some wise words we can probably leave it on. We've got so much more to talk about. I want to leave this as an open invitation. We need to do round two, but thank you so much for coming on the podcast and recording this.

Matt: Oh man, it's been a lot of fun. I look forward to doing it again.

Gary: Awesome.

Matt: You do a good job at these.

Gary: Thank you.

Matt: Thanks.

Gary: Take care. See you.

Matt: See you.

Gary: Alright. This has been Ophthalmology off the Grid with Dr. Gary Wörtz. Again, we're going rouge from the academy meeting here in New Orleans. Hopefully, we'll put out a couple more fresh episodes in the near future. Until next time, bye.

Speaker 2: Ophthalmology off the Grid is an independent podcast supported with advertising by Alcon.