You're listening to the PT Pinecast,
where smart people in healthcare come to
make noise.
Here's your host, Jimmy McKay.
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All right.
Let's talk about today's guest.
Started as a PT.
treating complex pelvic and jaw cases.
She still does that.
But today,
she's redesigning entire clinic cultures.
That's a different kind of treatment from
frontline resilience to executive
leadership development,
whether she's leading DEI programs,
improving communication systems,
or making lunch breaks a reality again in
clinical care.
She's proving that healthcare doesn't have
to be this broken.
Yes, one person is doing all this.
uh she's helping teams connect with their
purpose and each other uh let's bring in
today's guest holly cunningham holly
welcome to the show poof and there you
are hello all that's you i yeah i
mean obviously we have people in how about
we can delegate i just meant but what
i mean is like that's wide you're doing
a lot of things and i love it
i love the multitude of my every day
it's fantastic
So we'll get into some of the specifics,
but what I like people who went in
a door that lots of other people go
into.
And then when they're there,
they sort of make a left turn like
me.
Like I do some, I'm still a PT.
I swear I had the license.
I got the degree somewhere,
but I'm doing something different.
At what point were you like,
at what point and why were you like,
Hey,
I'd be a good fit for doing this
other stuff.
And how'd that, how'd that go?
Great question.
So I actually took a I call it
my sabbatical.
I took like a year and a half
in Michigan.
I am in Colorado,
but I was living in Michigan for a
year and a half and I was in
a slightly different setting.
I was kind of like bouncing around and
I noticed how many people that I worked
with were so
Burntown's not the right word.
They were just so much less passionate.
And they had been in the field for
so long.
And Michigan wasn't even that crazy of a
place to treat in.
They weren't asking people to double book.
They weren't doing all these things
because the reimbursement's a little
better than Colorado.
But I just noticed the lack of passion
and it wasn't that they weren't taking
continuing education, anything like that.
And I was trying to figure out what
was going on.
And I started talking to all of the
various higher ups that I worked with in
the various settings.
So this was between outpatient hospital
staff.
IPR, all those things,
and trying to figure out what the
disconnect was.
And a lot of them hadn't treated patients
in...
decades and they couldn't figure out how
to connect with their employees in order
to make them feel like their every day
was worthwhile.
Like the abusive patient or the abusive
family of the patient or the non-compliant
patient and outpatient or whatever it may
be,
they couldn't connect with their staff PTs
in order to make the staff PTs feel
like their day was okay.
And so we started coming up with
strategies and I really liked it,
but there was no space really in those
settings for me to connect all of them
and continue what I was doing.
And then I spoke with the company that
I had worked for in Colorado and I
missed them.
I was thinking about coming back to
Colorado and I was like kind of ready
and especially ready for better weather
and talk to them about what my goals
were.
And I was like,
I think this is really valuable because
you're going to improve your retention
rate,
your quality of care is going to go
up, all that.
And they came back to me and they
were like, let's do it.
So I came back in twenty,
twenty three and basically
have had a hybrid role as the,
as focusing on the employee experience,
leadership development, all of that.
And then on top of that,
treating patients and managing clinics.
So it was nice because I know it
sounds like a lot,
but it's nice because it all kind of
fits together.
Like I get to work on my own
resiliency while also helping other
people.
I get to
help run clinics in a more efficient way
that drops how much clinicians have to do
in order to meet a productivity that keeps
the doors open.
It keeps the higher ups happy,
all of those things.
So it fits hand in hand.
Plus you don't lose,
you don't fall into the trap
you just described which is you're still
doing it even in a reduced amount of
hours or interactions you're still doing
the thing i'm curious did the higher-ups
who were losing connection and not able to
relate did they try pizza parties because
a lot of times in our profession we
love people maybe two pizza parties so
many pizza parties literally like a
monthly pizza party they're like we're
feeding them i don't understand what's
happening i'm like well food is great like
we need the calories to have the energy
to help these people but like
you're not really you know making them
feel valued you're not reminding them that
like what they're doing is um incredible
like absolutely life-changing for people
so yeah
So let me start with this.
You've seen the system from both sides,
patient care and people ops,
and you still do that.
What's the one thing we still get wrong
when it comes to putting those things
together?
What's still the disconnect or the big
misconception?
I always say most communication breakdowns
are because of misaligned expectations.
I expect A, but I got...
cue and that's not good so i'm angry
so what what do we still get wrong
um remembering people's values so it is
that disconnect so like if i go and
talk to one of my staff physical
therapists and i come at them from purely
a if you don't see this many patients
you're not going to make enough money for
the company so our doors are not going
to stay open
I'm threatening their livelihood, right?
But I'm not connecting to what they value
the most.
That person,
that individual might value their PTO,
their time off to go see their family
in a different state.
They might value money.
Most people do.
They might value quality of care and
seeing more patients.
That's why they got into PT.
So if I come at them with a
conversation of,
hey your patients are starting to fall off
for where you know our empty our schedule
is pretty empty what's like asking them
questions what's going on but then
connecting it back to hey like if you
hit x numbers you're gonna get x amount
of more pto you're gonna be able to
travel more or you're gonna make x amount
of bonus you're gonna make more money
those kinds of things so so connecting it
to the individual is what i've noticed is
that's where
people lose that.
Like they think they just need to speak
to the general public, but in reality,
you have to speak to the individual.
Otherwise you're just going to go right
over their head.
If we say in communications,
when you try to talk to everybody,
you talk to no one, right?
Right.
Which is not a product for everybody.
I don't know.
Ice cream and pizza already have the world
sort of,
that's everybody except the lactose
intolerant.
Those people are out.
But if you can, right.
So I'll bring this up.
When I worked at a pretty large
multi-state clinic, we focused on,
you said, remembering their values.
So we brought in this big old fancy
company, paid them, I don't know how much,
that's about my pay grade,
paid them a lot of money.
And they interviewed a lot of people
across different roles,
different geographic places,
different parts in their career.
They got a good sampling, cross sample.
And they came back and they said, hey,
listen,
People come here and stay here for one
of three reasons.
It's probably a little bit of all three,
but you need to talk to each of
these archetypes or you're going to miss.
And the good part was, of course,
because we love in marketing when they all
have alliteration.
So these all began with the letter C.
And the three C's were craft, cause,
and community.
And at first people were like, no, no,
no.
And when you drill down, craft meant like,
I'm here to be the best PT, PTA,
OT, speech therapist, athletic.
I'm here because I am super PT.
I go to conferences.
I read, I eat, I sleep, I breathe.
I'm a PT.
cause would be what's the whole
organization doing we're here to protect
athletes we're here to protect old people
we're here to you know make babies better
that's what the mission of the group the
boat which what boat am i on am
i the best craftsman would be like am
i the best rower the person who cares
about uh cause would be like where's the
boat going and then community is like
what's the vibe of the people on the
boat is this a good party or a
bad party now we all want
generally a little bit of all three,
but there was, they were like,
you need to make sure there's a little
bit of, if you're making a meal,
if you're making a new program, um,
doing a webinar, something,
there needs to be a little something,
a little seasoning from each one of those
jars in it.
Or the person who values that the most
is like, I don't get it.
Why is this for me?
Notice I didn't say at any point,
people are there for a pizza party.
That's not why they're there.
They could buy their own pizza.
I will buy my own pizza.
I don't need you to do that.
I need you to do the other things
that I can't do.
at home.
So it sounds like we're speaking the same
language there too,
which is making sure you understand the
who and their values.
Now, you've said you've had patients,
lots of patients,
tell you that you were the first person
to validate their experience as a
clinician.
I want you to use that situation to
talk about the system.
What's that say about our system if you
were the first person to validate their
experience and they've probably had lots
of interactions with their clinicians
before that?
This is sad.
This is a canary in a coal mine,
right?
It is, you're right, it is incredibly sad.
It makes me incredibly frustrated with our
system because I'm nowhere near the best
clinician out there at all.
But what I think that people forget is
that patients are people and all you have
to do is listen to them.
And all you have to do is recognize
that there is truth in what they're
telling you.
It may not be everything because they
don't know everything.
We don't know everything.
But what they're saying is valid.
And this is true for employees, too.
So I use this technique for everybody.
I think with our health care system,
one of the things that is broken,
and this is true across every type of
MD specialist, every type of surgeon, PT,
whatever,
any type of health care provider,
is that when you go to school,
there are so few programs that tell you
to listen first.
They are told to, you know,
know what these symptoms added up should
equal.
They are told that this if this test
comes back negative,
then it's not this disease, you know,
blah, blah, blah.
But we are not told to sit there,
look at the patient,
see them in front of us and listen
to what they're saying.
And I think that would change if those
programs started doing that.
Our health care system would change
drastically.
Scary, isn't it?
terrifying because it doesn't cost doesn't
like it costs a whole lot it costs
nothing they can record it like it can
it can cost zero money it can cost
zero a lifetime like face to face like
you can still be productive and efficient
it takes no no effort to sit there
and listen
Wild.
It is crazy.
As somebody who's now leading, I mean,
is this employee experience?
Well, first of all,
what do you call it?
Is it employee experience?
Is that like, yeah, okay.
I mean, just people ops.
Just fancy.
People ops.
That's like the tech,
the business side of it.
But I'll call it employee clinician
experience.
As someone now who's leading that,
What are the hidden signals that a
clinical team or a member of the team
is burning out before they even realize
it?
My dad was a fireman.
He's like,
this is how you put a fire out.
He's like, the best thing to do,
make sure the fire don't start.
Like that is prevention, right?
So what are some of the things that
people could look at in their own teams
and go, okay, before this fire starts,
at least I know that there's something
wrong here.
What are the things that you suggest
people look for?
Cool.
You know,
I've always tried to figure out because I
do leadership development.
So I try to help other clinic directors
with this as well as our higher ups
so they can sort of see the trickle
down effect that they create.
But I think, honestly,
one of the biggest things is when the
clinician stops working.
listening.
So patients recognize this really quickly.
So they'll leave an MPS score or a
review pretty fast and say it doesn't feel
like they heard me.
It feels like I was just another person.
I didn't feel like it was treatment
tailored to me.
Those cues, especially someone who has
hadn't had that issue before um that
started to pop up i'm like oh that's
not good because all of a sudden that
clinician no longer has the energy to pay
attention to the person in front of them
their brain is shutting off and creating
an extra boundary so that they don't have
to put in that extra brain power and
they're just going through the motions we
know this though
Yeah.
And it's tricky because PTs are more
complicated because most PT programs and
OT and speech, obviously,
I haven't gone through those programs,
but PT programs are like PTs are taught
to listen.
Right.
But.
it's a it's not natural for everybody um
so if you come in and you've learned
it but then that starts to trickle down
that might be the first thing to go
if it's not natural for you and then
on top of that if it is natural
for you that's a big red flag if
you are no longer listening if you are
just kind of
Well, it's, you know, I mean,
it's what a four-year-old would do.
So it's what we default to,
which is like, uh-huh, uh-huh, uh-huh.
I should say teenagers.
I have experience with teenagers with
friends of mine.
I feel like it's a teenager thing.
Uh-huh, uh-huh, yeah.
Exactly.
Teenagers can have phenomenal boundaries.
Their frontal lobe not being developed
yet, like, good for them.
But as a clinician,
we need to find that, like, in between.
Like,
emotional boundaries where you're not
taking it home, right?
And bring yourself out that way,
but not to the point where you're losing
that quality of care and listening to
people.
Episode today brought to you by U.S.
Physical Therapy,
national leader of clinics focused on
developing clinicians,
not burning them out.
That's good.
Leadership tracks, mentorship,
career growth.
Oh, my.
And the stability to build your future in
PT.
If you want a place that supports how
you want to practice, that could be U.S.
Physical Therapy, USPH.com.
That's USPH.com.
dot com.
So what advice would you give right now
to someone who is not in the profession,
a PT student?
who wants to maybe come in and change
healthcare, but might also feel like, man,
I'm not even on the totem pole yet,
right?
But feels totally powerless right now.
How do they pick a place that they
don't get caught up in this?
If they do get to a place,
how do they use their words and not
their non-listening skills?
So let's go with the first one.
How would you tease out for a PT
student
If an environment they, because of course,
I mean, PT students are in demand now,
baby.
PT students, you have the power.
They need you.
They want you.
They need you.
But make sure you don't go and chase.
Listen,
I'm all about you getting that bag.
But if you chase it,
but you get there and the situation is
bad,
the situation is something that Holly's
describing.
How would you teach them to ask a
question or two that could tease that out?
That's a really good question.
I think a company like if you're talking
to the clinic manager or the owner,
whoever it may be,
depending on how big the company is and
talking to them about what the company
values in terms of day to day,
like the company is going to have their
values written on their website and it's.
their you know global mission statement
but which is yeah great everybody has a
good one regardless of how good the
company is uh that's the whole point but
what are they valuing day to day if
they're only valuing if they tell you like
we want you to see like keep your
schedule full um
Your patients can be seen one-on-one.
You don't have to double up.
That's already a good start because what
that means is that they're not
prioritizing you seeing absolutely as many
patients as possible.
They're giving you that time to have that
face-to-face with patients.
That's a pretty good thing.
On top of that,
what is their value of Con Ed?
We all want Con Ed to be paid
for.
That's a big deal.
However,
Con Ed has been shown to reduce burnout.
If someone has a lot of knowledge,
they are not going to be taxed as
much every day trying to problem solve and
figure out what's going on with patients.
So if that company can prioritize Con Ed
and not just saying like, oh,
we have our own in-house Con Ed that
you can take for free,
but we won't pay for anything outside of
that.
Not good.
You should be allowed to take what you
want because there's so many good
programs.
Shout out Institute of Clinical Excellence
and all those other ones.
But
It's how they are able to support your
growth and supporting you in terms of
making your life easier.
They all say get some mentorship,
but what does that actually look like?
Actual mentorship programs are so rare.
Residency programs, different, obviously.
mentorship programs are super rare so they
actually have a structured program with
someone who is going to sit with you
regularly with a structured schedule of
like how that meeting should go each time
that's a big deal because they're
prioritizing your learning and making sure
you feel confident and comfortable in what
you're doing i would also say making sure
you never work alone because
Then you get that extra support and that
community feel.
It is so rare that a PT does
well working by themselves,
even twenty years later,
because that twenty year veteran no longer
has that up to date research that the
new grad has.
So you are just seeing a different way.
Like not I mean, nothing against research.
Right.
But just like we get in ruts, right?
That too.
Exactly.
And you see like a new exercise or
yeah, I forgot about that thing or yeah,
that's a good idea.
Or, Oh, I forgot about that diagnosis or,
you know, whatever made me exactly.
Yeah.
You got it.
Yep.
I think, I think I'm getting it.
Um,
do you want to play a quick game?
We're going to call it,
we're going to call this game culture
check.
You ready to play culture check?
Sounds awesome.
Okay.
gonna throw a statement at you you tell
me if it's a green flag or a
red flag in a clinical culture you ready
for that yeah i'm a little sweaty but
okay let's go all right no one there
no one at the clinic ever takes all
of their pto green flag or red flag
red flag yeah why it's there for a
reason take a break yeah but that show
in my opinion it shows the culture
is we value you working hard which i'm
okay with we value not taking the thing
that you just you deserve everybody
deserves it when i ran radio stations i
said you have two weeks or three weeks
vacation and five personal days if any of
you hit january or december thirty first
with all of those i don't do it
don't do it that's amazing don't do it
that's how it should be red flag green
flag we talk about dei but no one
really knows who owns it if there's no
one who owns it red flag yeah why
Because someone should be making sure
initiatives are happening,
making sure that things are where they
need to be.
It doesn't have to be everybody has a
piece of it,
but one person for sure has to be
making sure that they're tracking and
making it okay.
Here's free consulting advice or one of my
things.
When I get brought into an organization,
it doesn't matter,
in healthcare most of the time for me,
I say, hey, if this doesn't go well,
who gets in trouble?
And it's a weird question to ask in
a room full of adults.
And when they can't answer it, I go,
oh,
that's why I'm here is because no one
owns it.
So if no one owns it,
everybody's just like,
they just look at it like it's,
you know, it's a turd on the floor.
Like, well, someone else will clean it up.
And then everybody just walks around it.
Yeah, you just sort of like,
you look at the court, you know,
it's there.
You own it, it gets done.
Nobody owns it, doesn't get done.
All red flag, green flag,
all staff meetings start and end on time.
Green flag.
Yeah.
Respects boundaries.
Yeah.
Values other people's time.
Absolutely.
Came prepared.
Somebody had a crazy statistic that if you
are going to lead an hour meeting,
you should spend like,
I don't know if I agree with this
person.
They're like,
you should spend twice the amount of time
preparing for the meeting.
And I was like, that seems insane.
to prepare for two hours,
but you do you.
I do like when you can tell there's
a structure, there's a purpose.
What are we doing here?
Okay.
Today's goals are these three things.
And if we can hit them in twenty
eight minutes, we're out of here.
If not, we got sixty.
Last one.
We have exit interviews,
but never change anything.
I mean, this is obvious, but red flag,
green flag.
And why?
That's a terrifying red flag.
I don't think that at all is great.
That's fantastic.
Right.
But flat out, we never change anything.
Like, even without extra interviews,
you should be constantly as an
organization trying to get better.
Always.
I was in a Facebook group the other
day and someone was like,
asking for the, you know,
what should and shouldn't I say in the
exit interview?
And I was very clear.
I'm like, if you're leaving,
you understand that that exit interview is
for them.
And I'll get an expert in here,
but I'm pretty sure this is a legal
thing for them.
They are right.
HR does exit interviews.
HR works for the company.
HR doesn't work for you.
Let's be very clear.
So do you owe them an exit interview?
I don't know if they, I mean,
I have never,
I did a bunch in the early career
because I was like,
I'm going to show them.
And then I'm like, oh, wait a minute.
If they cared,
they would have changed it six months ago
before I left or whatever it was.
So I have never done them ever again.
But if you do them and no one,
because there are those people who are
there to change things because they want
to leave their coworkers better.
And maybe I can, you know,
tell them and I wag a finger and
they do it.
But if nothing ever changes, man, oh,
that's so frustrating, right?
I can't even imagine.
I mean, honestly, like that,
that shouldn't be the only time you're
given to give feedback.
But if that's the only time you feel
brave enough to feel that, give feedback,
then I could understand it more.
That should have been on my list.
Red flag, green flag.
No productive or clear routes to give
feedback.
And is something done?
I've been in organizations where we've
done structured quarterly feedback.
And after the first two times,
when I thought, you know, the first time,
all right, let's do it thoughtfully.
What do I want to improve?
Because, hey,
this is where I spend eight hours of
my day or whatever it was.
And after I did it twice and saw
nothing changed, Holly,
what do you think I did the third
time it was time to do structured
feedback?
I wasn't even,
I was sitting in the back of the
room.
I filled it out.
Like I was like, yeah, everything's great.
You're great.
I love you.
You're great.
What am I doing?
Smart people don't do dumb things most of
the time.
They do sometimes,
but they're not going to put effort into
it unless they think it's going to
actually lead to something.
Right, exactly.
And I think companies need to recognize,
even if you can't necessarily fix
something,
people are going to have all kinds of
feedback.
But if they can't fix something,
you need to address it regardless.
If someone hears that you heard them,
Oprah said people want to be seen, heard,
and understood.
The amount of complaints and frustration,
and I believe,
if I'm getting the story right,
the amount of vandalism,
like damage in a city's subway system or
metro system,
went down when they installed digital
readouts telling you when the next train
was going to come.
Because when's it coming?
I don't know.
People would get, and people study this.
People are smarter than me.
They'd be like,
people would get frustrated after six
minutes of waiting.
But if you put a thing up that
said it'll come in twelve minutes,
they didn't get frustrated because they're
like, it's coming in twelve minutes.
I have some, okay,
you see me being frustrated,
but you're like,
it's coming in twelve minutes.
I cannot fix this, but I see you,
and when I have an opportunity,
that is number, it's in my top ten.
Just knowing that does not remove the
frustration, but it reduces it.
And sometimes that's all we can do.
I mean, listen, man,
I've been in leadership and I've been in
whatever, followership.
I've been a personal follower and I've
been frustrated.
But when I've understood, my boss is like,
I got you.
Listen, hey, man,
I wish I had all the money in
the world to just throw at this problem,
but I don't.
I'm like, all right, man.
Well, hey, I appreciate you.
That works.
It does.
And I tell all my staff this,
like whether you're a clinic director or a
PT trying to help a patient,
like managing people's expectations.
Woo!
changes the game.
It completely changed.
It makes you less frustrated.
It makes them less frustrated.
Everybody's on the same page.
You don't have to over-communicate,
but just managing their expectations.
This is what you should expect is
literally like magic.
I think it's a thousand dollars if I'm
getting it right.
I think the Ritz, Ritz Carlton,
says anybody in the organization is
allowed to spend up to a thousand dollars
to solve a problem without asking.
So let's say this,
you're in housekeeping and something goes
wrong in the room,
something broke and Holly was gonna go to
a wedding,
but now her dress is ruined and it
was our fault, like something in the room,
the hairdryer exploded and now her dress
is, you can just be like,
what size dress are you?
And you call the front desk and you're
like,
I need four dresses up here for Holly
to pick one.
And you're just like,
is it a thousand dollars?
No, it's less.
Didn't solve it.
We'll figure it out later.
Because solving it now for less than a
thousand dollars is worth ten thousand.
An ounce of prevention, pound of cure.
Thousand dollars of prevention,
pound of cure.
And...
It doesn't even need to be a thousand
dollars is what I feel like I'm hearing
from you.
And I agree,
which is it could just be like, hey,
man, you're right about that.
I'm going to I'm going to get on
it.
I honestly don't know when I'm going to
be able to fix it,
but I'm on it like that solves.
I'm going to go on the limb here
and say more than fifty one percent of
stress could at least help reduce.
Hundred percent.
That weird.
It's so nothing complex here, Holly,
but all of this is terribly important.
It is.
And it's so underrated.
It's so underrated.
It's understated and underrated.
Understated.
That'll be the title of the episode.
Understated and underrated.
Holly, we have a tradition on the show.
It is called The Parting Shot.
This is The Parting Shot.
One last mic drop moment.
No pressure.
Just your legacy on the line.
pressure whatsoever it's just this is what
everyone's gonna remember everything this
is how dumb humans are we remember the
last mostly the last thing we heard so
this is it uh what do you want
to leave with the audience as we wrap
up you can reiterate something you've
already talked about or go rogue on me
but what do you got for your parting
shot
I would say that the biggest thing to
remember, whether you're a clinician,
a patient, a human,
is just to communicate to any other human
like you would want to be communicated
with.
And remember that everybody just wants to
be, like Oprah said, listened to, seen,
and heard.
You don't even need to be like a
giant communication expert.
Listen to what Holly just said.
Think about how you would want to be
treated in this situation and do that.
Quite literally, again,
I'm not a mathematician or a researcher,
but that would solve eighty seven percent
of the issues.
I completely fabricated that statistic,
but I stand by my fabrication.
Holly,
if someone wanted to reach out and they
were like this, I like her.
How do they get in touch with you?
What's the best ways?
I'm on LinkedIn.
I'm on Instagram.
So either one of those, super easy.
Happy to always chat about all of it.
All the things.
Holly, appreciate your time.
Thank you for playing the games.
Great parting shot.
Thank you.
Thanks for having me.
That's it for this one,
but we're just getting warmed up.
Smash follow, send it to a friend,
or crank up the next episode.
Want to go deeper?
Hit us at pgpinecast.com.
Or find us on YouTube and socials at
pgpinecast.
And legally, none of this was advice.
It's for entertainment purposes only.
See, Keith?
We read the script.
Happy now?