Timothy Zercher 0:00

Lou, thank you so much for joining us. We really appreciate you taking time out of your busy day. We'll jump right into the questions. First up, what pulled you into behavioral health? And then what made you want to become more of a leader in the space?

Lew Zeidner 0:12

You know, one of my first experiences after graduate school was in the emergency department of an inner city hospital, a large inner city teaching hospital. My job was really to assess mental health in patients who were brought into the emergency department. And what I was struck by was how caring people were when it came to trauma, how caring people were when it came into cardiac illness. But when a behavioral health patient came in, the climate was very different. It was seen as a burden. They were more often than not restrained physically. And it was not a very pleasant process and didn't lead to a very good outcome. And I think that's drawn me in ever since. I think in terms of leadership, I think we have a lot of work to do to counteract some of the bias in our cultures, some of the challenges in our economic culture. And I think that's important work for us to do as leaders as well as clinicians.

Timothy Zercher 1:07

Absolutely. And that passion has carried you through the years. Very incredible career. You've had a great career. So you talk a lot about turning ideas into reality. In your opinion, what is the moment where most organizations actually break down in doing that? Because I think most organizations start with a great idea.

Lew Zeidner 1:24

Right. I think of the great idea is about 10% of the work. And so if you are too excited about the idea and forget the 90%, like everything else, you fail. And I think oftentimes executives like CEOs bring their leadership team into a retreat or a conference room and you know, noodle about good ideas. And everyone sits around and feeds on the good idea. It feels very promising, and they leave with a timeline expectation. But what's missing in that discussion is any involvement of the people who do the work, who are closest to the work, who understand the obstacles of the work. And so that good idea fails because the people doing it understand the nuances of how it works in a much more detailed way. And I think in order to succeed, whether it be in that meeting or in subsequent meetings, those good ideas need to be brought to the working folks, the folks who do the work every day, who understand the challenges in documentation, who understand the challenges in working with clients, in understanding all those kinds of issues that get in the way of those good ideas becoming good operations.

Timothy Zercher 2:35

I love that. That's really insightful. I think too many leaders come up with great ideas in boardrooms and have no idea of how the rubber meets the road. That's really smart. If you don't mind, I want to ask another question on that. At what point do you bring in those frontline people that are actually doing the work? Do you bring them in like right up towards the beginning of like, hey, here's the big problem. You're going to come in with the executive team to help solve it.

Lew Zeidner 2:55

Sort of a step two in the process is really beginning, and this tends to be your head of operations or some sub-departments of operations that need to begin to break the idea into its pieces. We talk about how do you eat an elephant with one bite at a time and how do you implement a good idea? It's the same way. And so I think we'll start with all the obstacles. And those are important to understand. But if you start there, you often hear all the reasons why this could never work because we haven't done it before, or we tried it last year and something about it didn't work. So I think you need to make it more palatable, break it into more sections, and that's sort of your next tier down in terms of the organization, your managers, those folks who supervise the work may not be day-to-day in the midst of the work, but supervise it and can then break it into, okay, we're going to break this into a subcomponent parts, and then we'll bring that workflow to the line staff to say, where does this workflow break down in your work? The patient never comes with their ID. So therefore, we don't have the information we need for this idea. In a sequence, taking the good idea, but not assuming that you can set timelines to the good idea in that first discussion, break it down, and then break it down further, and then test it. And then even beyond bring it to the line staff, I would say then are some pilots. And I know people are resistant to pilots. We can't hit goals with pilots, but I think testing where it's going to break down before you go system wide often allows you some insights that are useful.

Timothy Zercher 4:34

Absolutely. Well, and it also reduces risk, right? Organizational changes can be very dangerous in terms of revenue, staff retention, et cetera, if they're done too quickly and if you have big blind spots that you miss.

Lew Zeidner 4:46

Absolutely. But most of us have had a lot of years between the time we were actually on the front line and the time we're CEOs or COOs or CFOs. And so I think there's a certain arrogance that comes with assuming we understand what happens day to day.

Timothy Zercher 5:02

Yeah. And we're living a different world than we did five years ago, 10 years ago. Yeah, absolutely. So in behavioral health, where do you see often the biggest gaps between the intention and the execution of organizations?

Lew Zeidner 5:14

Yeah. I think it correlates with the last set of questions we've been talking about. How do you ensure that the people doing the work understand it? Just taking that to a next level as a part of keeping mental health care cost effective, we use a great many clinical extenders. And what I mean by that, obviously in medicine, those are your nurse practitioners, those are your physician assistants. But in mental health, we use entry-level counselors, we use interns, we use many people who may not have had a good deal of experience. And so we assume that they're able to provide that work competently. And then we set up supervisory strategies to help us with more advanced clinicians supervising the work. But oftentimes those are the activities that are short-circuited when things get short staffed or time gets short. And so I think oftentimes we assume the quality of the care on our front lines is better than it is. And I think we have a responsibility to shore up much of our supervision of that care to ensure that the extenders we're using are as capable as we hope they are.

Timothy Zercher 6:24

Absolutely. Absolutely. I know that I see within my client practices almost every time people assume that there's a higher level of customer service and customer experience that is really the case as well, even before they even get to a clinician, right? Just the frontline staff. I have one conversation that comes to mind. I've speaking with a CEO and I asked, How many minutes does it take for someone to get seen by a clinician if they just call? And he was like, Oh, probably five, 10 minutes for scheduling, they can get scheduled for the next day. I said, Cool. I tried calling and I was on hold for 15 minutes yesterday before I talked to anybody. And it goes to the same point. So you're demonstrating people assume high quality of service and quality of care. And but you have to actually be looking, you have to actually be checking.

Lew Zeidner 7:02

Yeah, I think we use the secret shopper model for some of that as well. And again, in an efforts to keep costs down, we both hire entry-level folks, which is great. Often they have great aspirations and great motivation. Sometimes the training, the role modeling, the role playing that often needs to go into training for things like telephone answering or interacting with clients.

Timothy Zercher 7:26

Exactly. And those are so essential, even though they're small pieces of the total model. So what have you found is the hardest part of growing your organization? Because you've scaled multiple organizations, I think, in the past now.

Lew Zeidner 7:36

Translating the vision into day-to-day operations, much of what we've been talking about for the last several minutes. And how do you make that work on short budget with very short timelines and all the things that keep us running every day? And how do you continue to do that? We compete, 80% of our work is in the Medicaid space. Reimbursement rates are very low in Medicaid and most areas of responsibility. And so we work on very thin economics. And as a result, we try very hard to keep our costs down, which means our supervisors are in short supply. All of those sorts of things are in very short supply. And I think translating it to something that people can buy into, the people on the front line, whether they're answering the telephone or doing entry-level clinical work or whatever they're doing, are as passionate about it as the most senior executive. And to do that, you need to continue to listen to whether the obstacles, whether the challenges in everyday work burns them out. We often talk about burnout and mental health care amongst clinicians, but I think it's true of staff, it's true of AIDS, it's true of many of those groups. And so without overfocusing there, because sometimes organizations can do too much of that, we have to be aware of when those things are interfering with our vision for how care should be provided and our vision for the level of service that we should be offering. So I think continuing to stay close to that, I know too many senior executives who like their offices too much. Nothing happens in the office. Everything happens outside the office. And we need to stay out of the safe spaces and into the spaces where the work really happens. If you don't know your staff, no matter how big your organization is, then there's something that's missing.

Timothy Zercher 9:17

100%. Shifting topics a little bit. Since we're a marketing agency that specializes in mental health care marketing and strategy, we always have to ask some marketing questions. So the first one is what is working best right now for client acquisition in your organization?

Lew Zeidner 9:31

We made a decision several years ago to not focus on our quantity and focus on our quality. And so many marketing and sales organizations are very focused on how many new patients come in, how many referrals you get per unit of time. And while those are critical in driving your economics, what the organization needs to be focused on is the quality of the experience. That's the quality of the experience for the referrant. So if it's a professional referral, what's their experience of you? And then what's the experience of the patient, both in terms of some of those service issues that you talked about, but also in terms of the quality of the care of the response to difficult situations. I think if you're focused on growing and put quality and some of those issues on the back burner, you will grow a lot slower. And so we've reversed it. Everyone is incented by quality. And we believe that and have seen that ultimately the volumes and the economics will improve.

Timothy Zercher 10:30

Absolutely. Well, I think a lot of people discount, especially when it comes to marketing, the amount of wasted time that happens internally when marketing generates clients that are not in good fits for whatever reason. They have the inaccurate diagnoses, they have the wrong insurance provider for the location, et cetera. It's shocking how much wasted time and energy can go very quickly with just a few hundred wrong leads.

Lew Zeidner 10:51

And how much time you burn with trying to work some of those issues if your reputation in the marketplace is failing. What people remember most is their experience.

Timothy Zercher 11:01

100%. And if their experience is they took 10 minutes to get a hold of me, and then once they did, they actually couldn't help me. Why am I even talking to these people? That damages damages more than you can ever fix with that one relationship.

Lew Zeidner 11:12

And you can't deliver enough cookies to offset that.

Timothy Zercher 11:14

No, you cannot. Donuts is what a lot of my clients do. That's great, but that just does there's only so much that can do. What is one marketing tactic or strategy that you're watching really carefully in the marketplace right now or even considering for your team?

Lew Zeidner 11:26

Something we've explored, but have not found it to be effective at this point is the use of AI. There's a lot of discussion about where AI can save costs and engage patients, et cetera. And I'm not talking about even on the clinical side, I'm talking about replacements for IVRs and replacements for phone response systems. And we have found the rhetoric ahead of the actual functionality. And what we know about mental health patients is that they're fragile. It takes a lot to make that first phone call. It takes a lot for the family member to make the first phone call. And so if their experience isn't engaging and effective, the chances of getting them into care is reduced. And so we are very skeptical right now of how AI might help us, although we recognize you know the amount of energy it's getting in the marketplace, the amount of time investors are focused on it. And so we are tracking it, but so far I've been underwhelmed by its productivity.

Timothy Zercher 12:35

Yeah, yeah. I think that's I think that's pretty universal, unfortunately. I've had multiple people as far as similar issues. I think you hit the nail on the head and in terms of the quality of that first engagement has to be perfect. Yeah. It cannot be an AI that misunderstood how to spell your name three times in a row. Right. No matter what, it doesn't matter how much it saves you, it will damage your entire business.

Lew Zeidner 12:58

Yeah. And I think of our personal experiences using IVRs when we call the airlines or we call a utility company and how frustrating that can be. And presumably most of us are functioning at a slightly better level than the patient who's calling in crisis. So add those two pieces together.

Timothy Zercher 13:16

Absolutely. Absolutely. Yeah, the last thing you need when you're in crisis is I'm sorry, I didn't get that. Please try again. Yeah. Well, thank you so much, Lou. We really appreciate you taking time and expressing some of your insights and sharing those with us. And we appreciate the work you're doing with your team as well.

Lew Zeidner 13:30

Thank you very much.

Timothy Zercher 13:31

Absolutely.