Improving retention and visit completion

What happens when an entire company learns to see its work as a system? In this episode, Travis Timmons reveals how his team uses Deming-inspired pre-work, collaboration, and the Red Bead Experiment to make their offsite energizing and impactful. It's a practical, engaging look at how clarity and shared purpose can transform improvement efforts and build a happy workplace.

TRANSCRIPT

0:00:02.2 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 teachings. 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. The topic for today is bringing systems thinking to your next team off-site. Travis, take it away.

0:00:41.5 Travis Timmons: Hey Andrew, great to be with you again. And, yeah, looking forward to sharing a little bit about how we're preparing for our next annual team meeting. And focus for this meeting is going to be, well, a little back story, we had three of our newer leadership members attend some Deming learning, some Deming education. And the biggest comeback, the biggest aha moment they had was they now better understood what I meant by the system view and systems thinking, which got me thinking, boy, it would be great if more of our team fully understood what the system meant, how to visualize it, and then how that further dives into the Deming System of Profound Knowledge. So that's what we've been working on. Our offsite is January 30th, so about a month away. We're about six weeks into preparation for that, kind of going back and forth on what needs to be in there. And the biggest thing, the first exercise, they're going to have homework to do coming into the meeting. We're going to have them kind of diagram what they think the system is. What is the Fitness Matters system? And we're going to prime them a little bit.

0:01:51.7 Travis Timmons: We're going to be doing it via a fishbone chart is the method we've decided to do that with. So, yeah, very excited about that. And it's a great way to get the team working on the work together and making sure they have an appreciation, as Dr. Deming would say, an appreciation for the system. And if you don't know what the system means, it's hard to appreciate it. So, trying to make more team members understand that.

0:02:14.7 Andrew Stotz: And what you're describing, I think is like pre-work that you're asking them to do?

0:02:21.1 Travis Timmons: Yes, yeah. So we'll have we've been spending the last few weeks on making sure we get the right questions in there because we want them to come in prepared but not feel like it's overwhelming or not feel like it's too heavy, if you will. But we want them to do the work so that they can come in and we can dive deeper once we get into some of the teachings and making the visible system of what everything looks like for them. So, that's kind of what we're working on.

0:02:49.1 Andrew Stotz: Did you guide them on, "Here's a fishbone chart, here's how to use it," and then, "Here's the system"? Or do you want them to just understand the fishbone chart and how to use it, and then, "Okay, don't talk to anybody else, you come up with what your vision of the system is"?

0:03:05.0 Travis Timmons: Yeah, so we have a total of seven locations. So what we are going to put in the homework is a one-page definition on what a fishbone is, how to use it and maybe pre-fill in a few of the primary bones, if you will.

0:03:20.3 Andrew Stotz: Yep.

0:03:20.8 Travis Timmons: Just to give them a primer. But we do hope they work together around the lunch tables and the break rooms, and the local leadership will be there to kind of guide them. Because that's where a lot of the collaboration and culture starts to happen and continues to build. So yeah, there'll be some learning about what is a fishbone, how to use it, because several have probably not used one before. And then we'll prime it a little bit, but then we want them to work on it, kind of kind of work, struggle a little bit to see, like, "All right, what's been invisible to me that happens behind the scenes, and it just happens." And make sure that then we can kind of dive deeper into when we say somebody has a good visit at Fitness Matters, how does that happen? And it's everything from first contact to insurance, to in the clinics, to how they pay their bill. So, just making sure that somebody understands what piece of the puzzle they play and then how it all works together. So we don't have silos, is one of the things we try to avoid, having silos within the organization.

0:04:25.8 Andrew Stotz: So, just so that the listener and viewer can implement what they're learning from you just to be clear. So, you're giving them the fishbone chart, teaching them about it, maybe filling in some of the main bones, as you said. And then just to be clear, you talked about them discussing things. Are you saying when you're working on your fishbone, talk to others about it and try to figure that out together?

0:04:51.7 Travis Timmons: Yeah.

0:04:52.5 Andrew Stotz: Okay.

0:04:52.6 Travis Timmons: Yeah, we want them collaborating and there's going to be people who wear different hats in our company. Some are physical therapists, some are Pilates instructors, some are client care coordinators, some are billing managers. So it'll be interesting to see what they bring to the table. And part of it is we don't want them to struggle. We want to kind of prime the pump, but we also want them to see the big picture. So that's why we're doing the fishbone methodology is so we can see it when we get to the actual team meeting. And then we're going to work with them on, then you can do fishbones of individual processes or individual pieces of the system.

0:05:33.1 Andrew Stotz: And, I mean, the reason why I'm asking this is because something like a system, for some people, they understand it, but for other people, they'll just get lost. And then what they bring to the meeting is not really some deep thinking on the topic, but, "Here's my best idea of what you meant."

0:05:50.1 Travis Timmons: Right. Right. Yeah, and we assume like some people may not have the opportunity based on how their schedule works to do much interaction and collaboration, others will have more. It'll be interesting to see what each location comes up with. Our hope is it's similar because we do spend time with the onboarding process talking about Dr. Deming, but we don't currently have a full fishbone diagram in our onboarding manual, for example. And that might change after this offsite. We might add that. You might find that that's a very good idea.

0:06:23.8 Andrew Stotz: Okay, so you got them working on their pre-work, which is the systems thinking, lay out your system in a fishbone chart. What's next?

0:06:35.0 Travis Timmons: So they'll have about two and a half weeks to work on that, heading up to the team offsite. And then we have a four and a half hour agenda for the team offsite. And first part of the phase is we're going to have them break out into groups, six groups. We have a total of 50 people there. So, six tables, and we're going to have each of them with posty notes. We're going to have the fishbone, like the bones there, and they're going to use posty notes to kind of fill in the system. That'll kind of be activity one. We're going to talk about what their learnings were from the homework, what were their aha moments or things they hadn't considered or complexities they didn't realize existed. Talk about that for about a half hour, 45 minutes. And then we're going to take a little break and come back and Kelly Allen's going to be there. He's going to walk our entire team through the red bead experiment, which is one of my favorite in-person Deming exercises. So we're going to go through the Red Bead experiment. And if people don't, that's probably too long of a conversation to explain what that is on this conversation, but opportunity there then to show where there are kind of defects in the system, if you will. So the big thing we're working on for this team offsite beyond system view is how do we improve arrival rate? So what arrival rate is in our industry is how many of our scheduled visits, whether it be for personal training, Pilates, physical therapy, how many of the scheduled visits show up? So a lot that goes into why do they show up? Are they scheduled appropriately? Do they understand their billing? Do they have a good experience? Is it easy to do the scheduling? So that's what's going to be our example of a red bead in the Red Bead experiment. So yeah, going to spend about an hour on the Red Bead experiment. And then myself and our director of operations are then going to, at the end of the red bead, when Kelly debriefs what we just saw happen and people feel the angst of people that, you know, put the paddle in and keep pulling out red beads, even though they were offered bonuses and they just can't quite do it. Talk about how that correlates to our system.

0:08:55.9 Travis Timmons: What are our red beads and what can we impact within the system to have a positive impact on less red beads in the system?

0:09:05.5 Andrew Stotz: And just to go back to one thing, you mentioned a total of 50 people. Is this a total, this is a total company offsite or a leadership team offsite?

0:09:13.5 Travis Timmons: It's going to be the entire company. So what we've found is, I think there's just so much value in everybody on the team understanding what's happening. They don't have to be an expert in all of it, but they need to, using Dr. Deming's term appreciate the system.

0:09:30.9 Andrew Stotz: Yep.

0:09:31.4 Travis Timmons: And appreciate the complexities and appreciate their role in it and everybody else's role. And it also allows some opportunities for sure. There's going to be team members that could be brand new to us six months in. When we make everything visible, they're going to have some fresh eyes and point something out to us that we've always done it that way. So we're going to, let's keep doing it that way and they're going to point it out to us and say that's not a good idea.

0:10:02.7 Andrew Stotz: And you've chosen four and a half hours. Sometimes you could look at that and think, that's a long time. And other times you look at and think, that is such a short amount of time. How did you come upon the time?

0:10:15.2 Travis Timmons: So, a lot of feedback from the team, to be honest with you. So there were, early on there were years where we would do an all day. And I got feedback that, hey Travis, we know you love all this stuff. We don't love working on systems quite as much as you do. So how about a half a day? So a half a day seemed to be about right as long as we did the pre-work. So what we found is if we didn't do the pre-work, then there's just so much wasted time getting everybody kind of up to speed on what we want to work on that day. So the team is all kind of, we come to a mutual agreement of like, hey, if you guys will spend extra time on putting the pre-work together, you'll agree to do it. And then we'll agree to have a four and a half hour all-in meeting, gas pedal down and then we're going to, you'll have a celebration dinner at the end of the meeting. So that's what we do.

0:11:08.6 Andrew Stotz: Sounds like you're still getting eight hours out of them. I mean, when you think about it, it's hard to go into something without putting some time aside. And what I'm hearing here is that this is also a very narrowly focused event and that I could imagine the mistake that many people make is, oh, we want to talk about that and we want to talk about that. And don't forget about that. We got everybody together, we might as well talk about that.

0:11:37.0 Travis Timmons: Yeah. Yeah, it's hard to narrow it down to, okay, what are the two or three things that we need to make sure we accomplish in this meeting? So one of the things we have in our meeting, I learned this from Kelly and Ray Kroc, another mentor of mine. We have a big whiteboard that we call the parking lot. And if somebody brings up an idea that's a good one, but we don't have the time to tackle that day, we just go right on the parking lot and tackle it later in the year. But yeah, that's part of leadership's responsibility and feedback from the team is, all right, we got four and a half hours. What are the top one or two things we need to work on as a team? And then that pre-work from a culture standpoint, people tuning in if they're listening to this, one of the things I'm sure everybody hears, you have to have a culture where people have a voice. That's probably one of the things people get most frustrated about when we hire from other organizations. They don't have a voice. They just got to show up and whatever happens, happens.

0:12:42.5 Travis Timmons: And that can suck the life out of you pretty quick. So I've never had anybody do anything other than be excited about the homework. You'll see them in the break room talking about it. It just brings a lot of energy. And folks that have never done an offsite with us before, I always get the question, what are we going to talk about for four and a half hours? What could we possibly talk about for four and a half hours? And then at the end of that they're like, that was amazing. We didn't have enough time. So, kind of a delicate balance there, but we've landed on four and a half for our current size and what we try to accomplish.

0:13:20.9 Andrew Stotz: And the next question is I've sat through a lot of offsites over the years and you end it by going, that was awesome, now let's get back to work.

0:13:32.4 Travis Timmons: Yes. So we always do a wrap up on what are the deliverables. We let them know up front kind of the expectation of we may, we'll probably not have everything fully decided at the end of the day. The purpose of the day is to get feedback from the entire team. And then my goal, and we'll tell them this up front, or I should say aim, not goal. We'll get in trouble with Dr. Deming there, but is to have two to three PDSAs to walk away with. So we wrap it up, kind of report back on what we've all been working on for the day. And then we let them know we're going to report back in the coming one to two weeks on big picture items and then kind of continue to give the team feedback on here's what we did, here's what we worked on, here's what we're now going to implement. Because you're right, you go to a lot of these meetings, a lot of good ideas are tossed around and then absolutely nothing happens. And then when team members see that happen a few times in a row, then they just stop working on the work. So, yeah.

0:14:41.0 Andrew Stotz: I have a client of mine that he does offsites. I think it's every six months. And he does it only with his management team that's to be clear. And that's about roughly 15 people for his business. And he picks a pretty unique location each time. So it's... And it's usually a couple of days, which I would say with a management team, you maybe make more sense than with the whole company. But he has something interesting that kind of ties in with your work. He has me come occasionally and give a presentation and talk about either Deming or some other principles. But in the mornings at 7:00 A.M. they all meet at the gym. And he has trainers and then they go outside usually, if they're at the beach, they go to the beach. And then they have activities that they do together where they sweat and exercise all of them together. And I just felt like that was so unique. And I felt like, I don't know, if I was an employee, I would be like, oh, I don't want to, why do I have to?

0:16:03.4 Andrew Stotz: I could imagine that feeling, but I just felt like he really left the whole event every time as people really connected. And I just thought that was an interesting activity, it just made me think about.

0:16:17.8 Travis Timmons: Yeah. Yeah, no, I think one of the things I've learned over the years is the less I'm up speaking to the team and the more the team is working on breakout. So I plan on out of the four and a half hours, I hope to not be speaking to the team for more than 20 minutes. And just let the work happen because if I'm up there talking for three hours and they're just listening that's another great way to probably kill morale if they're not working on the work together.

0:16:49.6 Andrew Stotz: And so just to rehash what you're talking about, about a four and a half hour meeting, you got pre-work. It's focused on one thing, which is understanding the system. Then you're going to have people talk to each other with this pre-work and then come to it with their own ideas. You're going to put them in groups and do post-it note types of things to try to figure it out, you're going to do it in groups, I'm assuming, for the post-it notes? Is that what you said or is it everybody?

0:17:18.3 Travis Timmons: Yeah, we're going to have them stay with the same group of six because as we work through the process of the larger fishbone, then there's six key elements or six key pieces that I want to make sure we identify. And then I want to have, later in the day, we're going to do a fishbone specifically of each part of that and see if we can identify two to three PDSAs out of those six that we really can have a big impact on whether it's through technology optimization, better training opportunities, better defining operational definitions. Those are the three key areas that I'm assuming based on where I'm seeing things from my seat. That's, I hope, the direction I think we're going to go. But we'll see what the team comes up with.

0:18:09.3 Andrew Stotz: And one of the things that inevitably comes up with the concept of systems thinking is what's a system? You know, come on, for me, it's this and that and for another, it could be the whole world and we could, you know, how do you help them understand system, but also how do you guide what is the system?

0:18:33.9 Travis Timmons: Yeah, I mean, it's tough, right? Because there are things that are fully under our control within our system, like the software we use, the people on our team. So we talk about things in and out of our control. Things out of our control are health insurance companies. Right? But they're part of our, they are part of our system. We interact with them every day, but we have zero real control over decisions they make. Referral sources are another example of... So we talk about the inputs that are coming into our system but not part of Fitness Matters. So it's internal and external conversations, we get into that quite a bit. And then individual...

0:19:13.5 Andrew Stotz: What about people that are trying to narrow it to say, my system is a much smaller thing. How do I think about system?

0:19:24.0 Travis Timmons: Yeah, yeah, we get into that a little bit because you get a lot of that, right? People just want to optimize what they do and everything else will be fine. That's one of the hopes of making the system visible. We get into tampering, system capability and tampering is one of the ways we address that.

0:19:42.7 Andrew Stotz: Right.

0:19:42.8 Travis Timmons: So if somebody says, hey, I just want my little world to work this way and if the front desk could put patients on my schedule this way and I could make my schedule work this way, and I want a 15-minute break here and like, it's like, no, no, this has to work well for everybody. And when they understand an appreciation for how it all works together, then we found they're much more on board with working on being a part of a team, getting their head up a little bit and looking around and understanding patients don't come in just because you're a great therapist or you're a great Pilates instructor or just because the front desk process goes really well. They come in because everything works. And patients and clients can feel that. So we really try to educate them on just kind of that feeling of, is everybody here getting along? Does it feel professional in here? Does it feel like they care about me when I walk in? And it can't just be one person out of 15 in a building caring about them and paying attention to them as the client.

0:20:50.3 Travis Timmons: So I don't know if that answers your question, but we get into kind of why that system visibility is so important. And for them to be successful, the entire system has to be successful. And if you optimize it for one person, that just doesn't happen.

0:21:05.5 Andrew Stotz: Yeah, I like the system visibility that just brings that awareness. One other question is, you talked about a target, how do we improve the arrival rate and how many scheduled visits show up? You've already decided this as a core metric for the business before you've gone into this offsite. It's not something that's up for discussion in this offsite. Correct?

0:21:30.0 Travis Timmons: Right.

0:21:30.4 Andrew Stotz: Okay.

0:21:30.6 Travis Timmons: Yeah, it's the, kind of we... You know, there's a book out there, the One Thing, I think it's called. It's sort of like, what's the one kind of aim or target that we think we need to, from a system view, have a positive impact on in 2026? And that arrival rate is something we study weekly, monthly, daily, really. So we know what historical trends are. And if you look at a control chart view from Deming, the same thing happens every month. And it's like, okay, we have to do something different with our system if we're going to move that. And what are those two or three things we need to do? But yeah, to answer your question, myself and the leadership team came up with like, that's the one thing we got to tackle this year. We have to move that one because it's really been the same basic number, that arrival rate percentage since COVID hit. We really haven't had that fully recover since COVID. And it's like, okay, we've got to get that. We're already ahead of national average by a long shot but we can do better, I feel confident of that. So that's what our metric is.

0:22:47.0 Andrew Stotz: Yeah, that's interesting because you start, I'm sure with, how do we improve ourselves internally so that the experience internally and all of that. How do we have best practices in what we do? But then this one is, okay, how do we accelerate this pipeline feeding into our business? How do we make sure it's as smooth and as efficient as possible from the moment that somebody starts working with us? The easy stuff for us, meaning you, is doing the work at our location.

0:23:22.1 Travis Timmons: Right. And one of the things, just to make sure our team understands again from a system standpoint and Dr. Deming talks a lot about psychology, but we could have a great onboarding experience for a patient. First two or three sessions could be amazing. Greatest physical therapist, greatest personal training experience they've ever had. And then they get their first invoice and they're shocked or don't understand it, and then they stop coming in. So just making sure everybody understands all that goes into, again, our operational definition of a good visit means the entire system has to go well. And most people have a hard time wrapping their head around until they are shown it. I didn't fully appreciate it till I was shown, so, when you see it all come together I think they'll have a better appreciation for why we spend so much time making sure their benefits are understood by the patient. Because patients don't understand health insurance. They just don't. Everybody says, well, it's their responsibility. I'm like, well, that's nice, but they don't understand it. So, that's part of our system too, to your point earlier. Like, that's part of our system, patients don't understand their health insurance.

0:24:43.0 Andrew Stotz: One of the great questions to think about on this is, what if we never lost a customer? You know, what would our business look like today if we never lost a customer? You know, it may be that they're in the physical therapy business, the process is run, the person is improved. They don't need to come back. Great. You haven't lost them, you've achieved the goal. But we... And in the case of my coffee business, we lose a lot of our customers to competitors, and we're constantly back and forth, taking them from competitors, they're taking them from us. Whoever's gaining market share is getting a little bit more than the competitors because of what they've done. But what if we never lost a customer?

0:25:38.4 Travis Timmons: Yeah, that's a great way to look at it. And that's one of the other metrics that we really measure. And that's why arrival rate is the thing we're going after because there's a strong correlation between arrival rate. So they might cancel a visit but then come for all the rest, or they might cancel two, but then come for all the rest. Strong correlation to arrival rate and a high outcome and they go home and they're better, to your point.

0:26:04.3 Andrew Stotz: Yeah.

0:26:05.7 Travis Timmons: But the industry data right now is pretty poor in physical therapy, for example. Current data shows that 80% of patients that start don't finish their plan of care. That's horrible. [laughter]

0:26:19.8 Andrew Stotz: Yeah, it's not just that industry. I mean, I do a lot of courses that I moved online and if you do just a standalone on demand course, the average in the industry is 90% of people do not complete that course.

0:26:36.0 Travis Timmons: Wow. Yeah.

0:26:36.8 Andrew Stotz: And so I asked the question, how do we improve that? And I was able to get to about 50%, but it was basically designing a cohort-based course, guiding them, dripping content, holding their hands, holding them accountable, having all of those different things, but then my goal in my teaching is to deliver the transformation. It's not just to deliver the information. And this way I was able to get closer to my objective, which is the transformation, not the information. So, yeah. Well, if you want to wrap up, any last things you want to say about it and then we'll wrap up this great discussion.

0:27:20.4 Travis Timmons: Yeah. No, I mean, it's been fun working on this offsite. I think one of the things I've learned through the Deming journey, and preparing for these offsites as a leader, a lot of the work... Most of the work happens before the offsite. And I've been to offsites, I'm sure you have too, where there's a very little preparation put in by leadership. And just some slide decks put together. So that's one of the things I've found through the Deming journey, is appreciation and who's responsible for the system, at the end of the day, it's me, something I take very seriously. So the pre-work and having a process by which to, by what method, something I've heard many, many times, by what method are you going to have this offsite? But the pre-work, if somebody's out there looking at kind of starting offsite or they have had offsites and they haven't gone well kind of to your point earlier for your online learning modules or consulting that you do, it's like, but what's the outcome? So if these meetings don't produce meaningful outcomes, then it's a waste of time and resources.

0:28:42.8 Travis Timmons: So we take this very seriously leading up to the meeting. It's hours and hours and hours of prep time. And then the offsite day is kind of almost relaxing for me. I'm just capturing data as the team comes in, so it's fun. It's a lot of fun. Then we leave with a PDSA or two.

0:28:59.4 Andrew Stotz: This is great. Well, I really appreciate this discussion and getting down into the weeds is I think very valuable for all of us as we all try to continue to implement the teachings of Dr. Deming. So, Travis, on behalf of everyone at the Deming Institute, I want to thank you again for this discussion. And for listeners, remember to go to deming.org to continue your journey. This is your host, Andrew Stotz, and I'll leave you with one of my favorite quotes from Dr. Deming, which is, "People are entitled to joy in work."