A million-dollar growth spurt

I didn't realize until well into the growth of my practice that there are distinct phases of growth that all businesses go through. What I thought were unique trials and tribulations were actually common crisis stages between these growth spurts. It wasn't until I was mired deep in these crises that I finally saw the obvious.

Dr. Brian Huss and his practice survived the traumatic side effects of growth as his practice evolved.

My goal from the beginning has been to build a high-quality, well-managed specialty surgical practice. I started a mobile surgical practice by myself, and it eventually grew to accommodate three exceptional technicians and an SUV packed to the gills with equipment. With the staff never more than a couple hundred feet away from each other, everyone knew everything about the practice: our vision, our mission, and all about each other. We had lunch together and we could air any issues or problems immediately.

No one was late for work or they were left behind. We had a tight bond, a clear mission to provide the best patient care, and a strong desire to get the work done. Very little management was needed, just guidance.

We started developing business systems early in the growth of the practice with a chance encounter and relationship with E-myth training. An advertisement for the system came addressed to the previous owner of the home I had just moved into. I later found that we had averted a major crisis with the development of our technical and business systems because we had adopted E-myth methods.

The practice grew rapidly, and we realized we were going to top out in the number of surgeries we could perform in a day, which would limit our financial potential. While the overhead was low in a mobile practice, the inefficiencies of the mobile experience were beginning to take a toll. Developing a fixed-site surgical practice had been the eventual goal, and now was the time.

The downward spiral

Initially everything went great in our fixed-site practice. We did the same things we had done for the last few years; we just didn't have to worry about traffic. I took a pay cut to offset the increased overhead, and we were always profitable. But as the practice got busier, I started seeing problems with the team.

There was less camaraderie because we had a higher patient load and increased job responsibilities. I had to start managing the team more to make sure the work got done. Like most entrepreneurs, I used a dictatorial management style. That got the job done, but I could see it starting to take a toll on the staff.

As we hired more team members, we diversified the job duties. We hired receptionists and exam room technicians, while my original employees stayed in the back as surgical technicians. Of course, the whole crew no longer stopped to have lunch together each day, and the staff started to drift apart.

Problems that we'd addressed quickly and easily early in the life of the practice now festered until they resulted in periodic explosions. We no longer had a cohesive "provide the best care for the patients" and "get the work done" culture. I was so busy producing that I had to start divesting my management responsibilities.

Stuck in a growth rut

The natural managers, from my perspective, were the team members who had been with me in the mobile practice. So I put them in charge. And while they had everyone's respect from a technical perspective, they were not winning over the staff with their "do it my way or else" style.

We continued to grow and provide exceptional patient care despite the rough management culture. But we lost too many competent employees who just couldn't put up with the junior managers. And our annual growth slowed to a crawl with a gross profit of a little over $1 million. I was at full capacity as a surgeon, and I knew the only way to grow further was to add another surgeon.

My junior managers, which now included an administrative assistant, expressed a great deal of trepidation when I told them we were going to add a surgeon. But we made the move and doubled our staff within a few months.

My managers complained about not having time to both manage the team and perform their technical duties. One of my original team managers quit, only to return as a technician without the management duties. The others started complaining that they were being left out of the loop and that I wasn't implementing their suggestions.

Power struggles ensued between the junior managers and the new surgeon. Thankfully the new surgeon had the strength to stand up to the onslaught, but morale suffered. During this period, I worked to change my management style for the future success of the business. I read management books—I particularly like those by Jim Collins—and I hired a business coach and relied more on my other consultants.

Hard realizations

As I reflected on the challenges the practice was facing, I knew we didn't have "the right people on the bus," as Jim Collins would say in Good to Great (Collins, 2001) and Built to Last (Collins, 2004). It was a depressing and emotional time for me when I realized I would have to part with staff—and friends—who had been with me from the start.

I was forced into action when a marketing consultant I'd hired told me there was no more he could do for my business until the team issues were resolved. He recommended a management consultant who specialized in team building to come in and take the practice to the next level.

The new consultant spent a week at my practice and worked with the team on defining the practice and the profiles of the team members' positions. She then told them they needed to fit the profiles or they weren't the right fit for the practice. Within a month, five of our 12 employees quit, including my head technician and administrative assistant. My assistant head technician quit a few months later. They quit on their own when they realized they weren't the right fit and the rest of the team was going to hold them to it.

It was a miserable summer. Imagine how you would feel if half of your team quit, including your most trusted senior employees. However, over the next month the remaining team members started stepping up. The quiet ones started to talk—and even laugh.

The employees who stayed were fully on board, sharing the vision, mission, and work ethic of the practice. The team members who stepped up to be managers still didn't have the skills, but they were willing to learn. We have all adopted a consensus and delegation management style, and we hold regular team meetings.

I'm now being paid an amount equivalent to the staff surgeon. And I can comfortably leave the practice for a couple of weeks at a time knowing my practice manager and junior managers are maintaining the quality and standards of the practice. The practice is grossing a little over $2 million annually at about 80 percent capacity. We're interviewing a third surgeon with plans to accommodate at least two more.

Looking back, I wish I'd had the training to recognize the natural evolution of a business. It's certainly a more comfortable feeling looking forward and recognizing where the bumps will likely come in the continued growth of my business.

Dr. Brian Huss, DACVS, is the CEO and chief of staff at Vetcision in Waltham, Mass. Send comments to ve@advanstar.com