Grow Your Clinic

Nicole French: Metrics that Matter, Focusing on Patient Outcomes Over Revenue | GYC Podcast 292

• Nicole French • Season 5 • Episode 292

Share episode

In this episode, we chat with Nicole French, an award-winning exercise physiologist and clinic owner, of the Exercise Rehab Group in Melbourne, Australia, about transforming healthcare practices and leading inspired teams. Nicole, who leads a purpose-driven team of 18, shares her passion for diabetes management and discusses her recent achievement of securing a $250,000 grant to implement evidence-based practices in collaboration with GPs aimed at diabetes remission. The discussion delves into Nicole's visionary leadership style and her practical approach to fostering excellence in healthcare. You'll also hear about the unexpected challenges Nicole faced in her journey and how her vision helped her navigate through those hardships. This episode is packed with valuable insights for clinic owners and health professionals looking to inspire their teams and enhance client experiences.

What you'll learn:

💡 How to shift the focus from revenue to patient outcomes

📊 The importance of clinical excellence indicators

🤝 Strategies for effective team communication and feedback

🏥 Insights into Nicole's groundbreaking diabetes remission program

💪 Overcoming personal and professional adversity

Join us for an inspiring conversation that will help you lead your clinic to success! 🚀

👉 Subscribe to the Grow Your Clinic Podcast for more strategies to grow your clinic sustainably and confidently.

If you found this episode valuable, please give us a thumbs up, share, comment, and give us your ratings on:

  • iTunes - https://podcasts.apple.com/us/podcast/grow-your-clinic/id1332920944?mt=2
  • Spotify - https://open.spotify.com/show/03nmt7gYDfeeOPV6qBmVTu
  • Watch on YouTube - https://www.youtube.com/@clinicmastery

We appreciate your support and feedback!

This is the Grow Your Clinic podcast from Clinic Mastery. We help progressive health professionals to lead inspired teams, transform client experiences and build clinics for good. Now Welcome to the Grow Your Clinic podcast. My name is Ben Lynch. If you feel like talking numbers with your team, is particularly uncomfortable or a little bit icky, or perhaps you're having a really challenging time right now personally or professionally in being a clinic owner, or perhaps you've got a really big vision for where you want to go and you want to galvanize your team behind that vision, Well, then this episode's for you. We've got a little bit of everything. I'm in conversation with Nicole French, an award-winning exercise physiologist and clinic owner of the Exercise Rehab Group in Melbourne, Australia, a team of 18 that are very purpose-driven. Nicole is super passionate about diabetes and recently received a $250,000 grant to install evidence-based practices alongside GPs to prove that they can help with diabetes remission. Will you talk about an exciting visionary leader? Nicole is exactly that. Not only visionary, but super practical in the way that she installs certain practices to ensure that the team are championing excellence in healthcare and everything that they do. This conversation goes in a number of ways, and in particular, the hardships that Nicole went through, something that she did not see coming, that nearly wiped her off the map. and how she navigated that with her vision. Stay tuned for that part midway through the episode. Alright, let's pick up the conversation now with Nicole. So Nicole, you have quite a unique lens on performance for practitioners. I remember a conversation recently where we were talking about removing revenue from the discussion with practitioners and instead focusing on behaviours, the things that they would do supporting their patients that would ultimately lead to revenue. Can you just expand on how you arrived at that model of talking about specific Yeah, sure thing. Well, I suppose My thought process around anything that we do in the clinic is it needs to be directly in line and reflective upon our vision. And what is our vision about? Our vision is about driving outcomes for patients. It's about providing high quality evidence-based treatment for people. And it's about supporting people to have an amazing experience in the healthcare journey as well. And so when I look at any level of coaching or when I look at any level of targets or anything like that, anything that we talk about needs to be based around our vision. And, you know, my personal feeling is that revenue and financial success and all of those types of things will come about as a product of focusing on the key behaviors that are going to support our clinicians to drive the best outcomes for our clients because that's ultimately why they come to see us. They come to see us to provide a solution and to support you know steps towards that solution so you know, I'm a big fan of setting up success criteria for our clinicians and setting up clinical excellence indicators. So drilling down on the behaviours that are going to support excellence in service delivery and driving outcomes. So they might be things like, you know, focusing on what was someone's net promoter score, which we focus on in the clinic, you know, after an initial assessment and after various parts of the client journey. So how positive is the client reacting to their experience? We look at things like cancellation rates, rebooking rates, and really looking at those key drivers. So things also like our treatment notes up to date. That's really important. Making sure treatment notes are there, making sure that we're writing back regularly to our referrers, that we're cross-referring within the clinic and looking at a true team approach to care for our clients as well because you know we're not the jack-of-all-trades we're about staying in our lane and celebrating how other health disciplines can be invited in to the party as well so something that we focus on is creating treatment pathways for our clients and that's inclusive of an interdisciplinary team care approach which is truly client centered. So it's all of the ingredients that are going to drive great outcomes and give somebody a great experience along the way. That's the success criteria markers or they're the clinical excellence indicators So over time, do you do repeat measures for those client outcomes? So early on in their journey, you're after the initial assessment, getting a net promoter score. Do you then follow that up into the future? And what does that look Yeah, so we do them quite regularly. So if we look at the average number of times that somebody might come in to see us, we'll look at capturing pockets in time of that journey. So it will be at the very start and then it might be something like six sessions in or it might be 12 sessions in. We see a diverse range of people within our clinic where they might come and see us three or four times for something like a BPPV versus somebody that might come and see us for 12 months ongoing when they've got like an ACL-based injury and we're going through a complete rehab process and return to function and return to sports. So The frequency of net promotion score will remain fairly consistent throughout that time. But depending on the pathology that we actually see, that patient might only be asked two or three times versus maybe 10 times throughout their journey. But we definitely do measure it. And we also follow it up. And I think there's real power in that too. So it's one thing to ask somebody for a score. But it's another thing to be daily on that feedback and to be asking ourselves, what can we be doing with this feedback as well? So it can't be set and forget and just having numerical value, which will give you a lovely chart. But in anything that we measure, we've got to ask ourselves, what are we doing with this information? And so it's really important for us to check that information really regularly, to give that information to our practitioners. So we import that onto their practitioner dashboards, so they have real time access to that. And if there's something that we feel like we need to clear up or discuss with the client, we're on the phone to them straight away to Did you know that you could send an email to helloatclinicmastery.com and request a free assessment of your clinic and get a report that outlines detailed action steps for how you should sustainably grow based on the findings? Just send an email to helloatclinicmastery.com and we'll organize a time with one of our growth specialists to review your clinic and outline the path to sustainable growth. Right, back to the episode. I was going to ask, and that's a perfect segue into using feedback, because like you said, it's easy to get that feedback and go, yeah, we can plot it on a chart. It's trending up or down or sideways, but how does that inform our decision-making? So what are some of the routine practices that you have in place or systems for then actioning it? Does it show up in like a weekly meeting or Is it something part of a leadership team chat that you have? How do you systematically or mechanically then Yeah, no, that's a really good question. So we have our senior administrator that will actually run that report formally once a week and we'll pop that information on individual practitioner dashboards. And our leadership team have access to all of those dashboards. So they run their eyes across it and on a particular day of the week as well to actually see is there anything that's an outlier in there? Is there anything that we need to get onto straight away? I'm quite partial to jumping on and running those reports quite regularly throughout the week as well. You know, client experience is huge to me and I want to make sure that people that are coming through the service are really happy with that service. And if they've got constructive criticism, I want to be across that really early as well to see how I can support the process of following that up. But it's really important that it gets into the hands of the clinicians because the clinicians have context. around it and it's really funny because sometimes somebody might score you a particular way but it's because they've misread the scoring system and you know they may score you a one where they meant to score you a nine but you can cross check that then with the comments in there or there might be particular reasons why the clinician And the clinician will be able to detail this, why they think that somebody might have made those comments, or they might be completely by surprise. So I think transparency, lifting that information regularly, putting it into the hands of the people that it relates to is important. And then having a leadership team across that. And certainly if there's something quite standout-ish, when our senior administrator runs those reports and updates the dashboard, she'll reach out to me if she thinks I need to know about it, but That's good. I love the fact that, yes, you're engaging the therapist delivering that service and giving them an opportunity to provide commentary on it because so often there is that context that's missing from, you know, just a score. I've definitely had those before. You freak out. You're like, is it a one out of 10? Oh my goodness. I did not see that coming and the person misread the question. You go, oh, phew. But for those folks that do have feedback, I think it's such a wonderful thing to give them the call or to follow up via email and allow them to, one, feel heard, and two, also expand on that to find opportunities to improve. So I love that. How often do you refer to these specific success criterias, as you called them, with your therapists? What does that look like? And how do you dovetail it into Absolutely love that question. So we have what we call focus sessions within our clinic. So they're mentorship based sessions, they're check-in points, they're about reflecting on the week that was, celebrating wins, looking at areas of progress, behaviors that we need to look to do, some keep doing around, some start doing, some stop doing. And having the success criteria elements, having the clinical excellence indicators, having the metrics, having all of those things available to the practitioners in real time and NPS, for instance, too, so that they can be discussed in those focus sessions. So in our organisation, focus sessions might run once a week, they might run once a fortnight, they might run once a month, depending on the needs of that particular person. And depending on the stage of career that they're at as well, they might be quite an established practitioner that comes into the practice. And the assumption might be they might not need a lot of help. But in those first few months, they need a lot of help as far as getting them on boarded and working through our systems and policies and procedures and finding their feet with our processes and routines and workflows. And they need that support just as much as an early career health professional needs it as well. So usually what happens is when we've onboarded somebody, they'll actually have their focus sessions once a week. And that's a great opportunity to bring success criteria and CEIs into that conversation. And then, or it might be, you know, once a fortnight and then once a month, depending on what people need, what projects they're on, but they might have regular touch points with me around projects too. But they're really great sessions where we can prepare for them, where people actually pop in some feedback that populates into their dashboard so that our Director of Allied Health can actually review that and best prepare for them. And everybody has access to their clinical excellence indicators via Ali as well. So we can talk a little bit about Ali throughout the session today. But that actually helps our practitioners to map their progress over time against a standard that is there for them. So where they're not comparing themselves to others, there are actually standards in place for them to move towards and charts and graphs and all of that sort of stuff. which will help to support them to become more accountable and more proactive in asking for help because, you know, the information's right in front of them. So, you know, our practitioners have access to ALI as well as their their behavioral-based measures in their dashboard. They have access to that in real time so that they can be proactive in asking for help and we can be across that at any point in time. But then everything's bundled into a lovely sort of agenda for their focus session as well. So they have that distinct pit stop. It's that idea of a pit stop, that pause moment where they can really reflect on what has been, think about what could be and specifically work This episode is brought to you by AliClinics.com. If you want a single place for all of your policies, procedures, and training, Ali is where to go. You can test it for free. You can download our library of policies, procedures, and training in three clicks of a button, immediately share it with your team, and see whether they've read it using the custom acknowledgements function. This is great for compliance purposes. You can also upload police checks, working with children, CPR and first aid, professional indemnity insurance, and make sure that you have all the compliance docs that you need to run a good business in one place, not scattered systems, making sure everything's efficient, and you never have to answer the same question twice. This is the brain outside of your brain, a key tool in helping you grow your clinic that's less reliant on you. You can test it for free. Go check out allyclinics.com. All right, back to the episode. I love those three points. It's a great self-reflective process and set of questions, quite open-ended as well, which is really great for exploring where someone's at. I want to ask you in a moment about performance reviews, because that cadence, you know, brings up for me a number of clinic owners asking about performance reviews. But before we go there, I want to ask you about any resistant team members that you've had over time. any things that you found useful in bringing the team along the journey with you to be comfortable enough to talk about some of these metrics. And the context that I often have is we're dealing with health professionals who typically are pretty A-grade students. We're taught at health school, no matter your discipline, to know the evidence, know the best practices, know the answer. And so we're dealing with people who are pretty smart, pretty intelligent. And when there are moments that maybe they're not at the standard of peers or where they're meant to be in their role, it can be a little disheartening or they can switch off and not be engaged in the conversation. So to come back to the question, how have you helped any resistant team members come along the journey with you to talk openly about how they're performing and not feel like it's a big attack Yeah, and I think you hit the nail on the head when you talked about standards in there. We're not talking targets here. We're not these huge commercial monetized businesses that are running billions and billions of dollars. It's not about that. It's about establishing professional standards that puts the patient or the client at the center of the care. And we need to always remember that it's less about us and it's more about the person that we're serving. That's what we need to be reminding ourselves of. One thing when I think about reflecting as a practice, if I can look at that, what's one of the things that we've even changed along the way in working with people when we're looking at challenging some belief systems around clinical excellence indicators. We've changed a lot of our systems, particularly around our onboarding. to get people across why we measure what we measure and how that aligns with our vision and best practice outcomes. And, you know, we need to take ownership of that as clinic owners and support our leadership team with really great onboarding of our clinical team members. Because when we have rules, we have standards and we have boundaries at the start, you're finding that you're not having to be reactive and having to draw people back in and have this push and pull with them. So one thing that we have changed as far as our onboarding structure goes is being really clear and setting people up with their clinical excellence indicators and our systems and our focus sessions and Ali and all of those things from day dot, because to be clear is to be kind. And to be unclear is to be unkind. And if we want to support our team to provide amazing client experiences and amazing clinical outcomes, we need to be really clear from the outset about what our expectations and what our standards actually are. We can't be moving the goalposts on them. Again, another learning of 18 years in practice. is that as owners and as leaders in our clinic, we need to know what those goalposts are. We need to be clear in that communication. So onboarding in such a way that we are really clear about what the vision is, what that means, how it aligns with our mission and our values, and then putting those measures and those standards in place and holding people to account early so that they're very, very clear. And in looking at something like that, look, even as we've tried that, we still have levels of resistance across the way. And I think the main reason for that is because we're humans. and as much as our value and belief systems are quite aligned we do still feel like feedback at times is personal because we wear our heart on our sleeve, we're trying our best and sometimes things just aren't working and so it's really important I think in organizations that we understand that from a leadership perspective and we lean in to that and we need to lead by example and you know practice levels of vulnerability and sharing some of that too and starting conversations with when you look at something like this how does it speak to you? What are you seeing? Let's talk about now what I'm seeing and let's see how we can work together at getting ourselves back on track. And look, if there's still a level of resistance in there, perhaps they're not the right team member to be sitting on your bus as well. There's some of that. And I think as a practice owner, sometimes we need to make those hard calls as well. Onboarding is great, but off boarding is also very powerful and sometimes very important Talk us through that. You've had some team members leave your clinic over time, as most clinics have, unless you've just opened today. You have team members leave. And I love that framing that that can be a positive thing and that there's also a process of offboarding. Just expand on that. You've been in the game for a long period of time. You've seen peers, you've experienced it yourself. Tell me a little bit more about your lens on offboarding. Cause it sounds like you've really come to terms with it. That actually can be quite a Yeah. I think there's a certain level of acceptance that over time, not everybody can be that success story. Um, and people's levels of success and view on success are often very different to a business owners as well. And look, over time, it's been challenging at times, but one thing that I've learnt is that, again, to be clear is to be kind and having candid conversations, you know, that Kim Scott idea of radical candour, as well, we lean into these things, we come across authentically, but we need to be true to ourselves and why our organisations exist. And that is really important. And we can't compromise on that, because the moment we begin to compromise on that, the moment the wheels of the bus or the those, you know, the tracks on the train, for the train, everything just starts to part. And then there's this cascading effect throughout the clinic. I think it's really important that we accept off-boarding for what it is and that's a reality of running a practice and the reality of running an organization. And one thing that I've learned around onboarding is it can be a positive experience if you choose for it to be. So instead of accepting a resignation and getting all stroppy about it or being really clear with somebody that it's time for them to move on again, getting emotional, stroppy, reactive and all of that sort of stuff, accept it for what it is. and run through a process of off-boarding where you sit with that person and you have an open conversation and you ask some key questions. We've systemized that in our organization, just like we've systemized everything else. I'm a big fan of systems and certainty around those things. And we have a questionnaire that goes out. We have a transition of care plan that is set up and we have people that are in charge of leading the transition of care. We have people and systems in place to make that off-boarding experience quite a positive one. And I think it's where I've learnt some of my most valuable lessons in having great interactive sessions with people where they are going to be honest with me. And I lean in and I own the things that I need to own and I listen, but I also provide the level of feedback that I think should also be provided in those sessions as well. And in having that level of approach, every party leaves that interaction with mutual respect and It's a great framing. And I remember when I worked as a podiatrist, and I worked with my now business partner, Daniel Gibbs at his clinic, I left the clinic. And Daniel said, we do leaving well. And that stuck with the both of us and then has carried through because you just don't know what the future holds. And it's a small community, it's a small world. And you know what, the amount of therapists I've seen return to a clinic after a number of years, doing whatever they need to do to test out the variety in their role or career or their life, whatever changes, and then they return. But I think they only return because the off-boarding was a good experience. That certainly plays a key role in it. And that distinction on it's a learning moment, sort of one, accept it, two, have a process for doing it. But one of the positives is you're going to hear some things that are challenging, whether you agree with them or not. It's often where people are quite open and tell you the things that maybe they hadn't shared before. And you get those opportunities to change what you need to change, essentially. And those systems that you spoke to, having created and loving having, may not have existed if you didn't get that feedback. So I love that framing on it. to capture that point around performance reviews and where this all fits in from whether it's off boarding and the commentary or exit interview that you get there or the sort of regular sessions, focus sessions that you have with therapists. The traditional performance review that happens annually, maybe a clinic owner runs that annually or quarterly. Is that a process that you use If We mix and match. It's a really interesting one because I feel like we're really evolving in this space. And I feel like different people also need different things. So if I look at an early career health professional, we need to be supporting them in a huge number of ways. And one of them is obviously focus sessions and then case conferences and tutorials and all those types of things. But I think for early career health professionals having a formalized pit stop at month three of employment is really important. One thing that we've really refined in our clinic for our graduates is actually having an exam. at that point in time, a clinical exam as well. So we're not just looking at something that you would inherently look at in a quarterly review, it is actually looking at people's clinical skills because remember we're problem solvers, remember we're health professionals. We need to actually understand what levels people are at with their clinical application and their clinical reasoning and their assessment skills and their manual handling, their exercise prescription and all of those things. So what we've started to embed with our early career health professionals is a pit stop at month three. So they'll have their focus sessions where we can get onto things early and work proactively, but a pit stop at month three where we can do a clinical examination and actually provide feedback. And we've created a skills matrix and a scoring criteria and all those types of things, which our grads adore because that's what they're used to at uni. And we need to look at that transition from uni to private practice. And that's a part of what we do in our Graduate Plus program is bridging the gap between university and private practice. So we've got to carry over some of those elements. So we can give feedback about the clinical application of their skills in addition to the clinical excellence indicators and the behaviours and all of those types of things. We actually then repeat that at month six. because we have quite a concerted effort in our clinic in and around professional development and tutorials. And we want to make sure at different points in time that we're consolidating knowledge from that previous quarter, that previous three months, to ensure that we're actually ready to go to that next stage of the program. It's that skills readiness to keep going. And if we don't know where someone's at, how do we expect to be able to coach them into this higher level, higher performing clinician. So we have those pit stops, which have the clinical element and the non-clinical element, which are all as important as each other. And then we'll look to have a nine month and then at a 12 month, we'll do an annual review. So we look back on the year that was, which is a beautiful exercise because people often don't realize just how far they've come. in that 12 months and we can reflect on all the jump shots. So we have clinical and non-clinical jump shots that we set up for our practitioners at different stages. And we look at that, reverse it to see how far they've come and then what our opportunities are moving forward. And one of the things that we also do at an annual review as well, we're big believers in that in annual reviews, there shouldn't be surprises. like I genuinely don't believe that someone should get to a year in to employment or another 12 months after that and have that sit down and feel really anxious about going into the room that things may be raised that they were completely unaware of us. I don't believe that that is a great way to run an organisation and I don't feel that people should go into interactions like that as well. So we have a rule that there can be no surprises at our annual review. It's really about the looking forward and we have the opportunity to have the annual review about looking forward because we've had all those pit stops and those opportunities along the way to address anything that might be moving a little off track. So for early career health professionals they'll work through that process and for the rest of the team they'll have their regular focus sessions again so we stay on track and move proactively and then moving to the annual review where we also get them to do things like desire statements. and redo key driver questionnaires. So, you know, were their drivers last year, which might have been, you know, money or lifestyle or, you know, independence with activities, you know, are they still what they were 12 months ago or have they changed? Because the drivers for people working do change over time because it's based on behavior rather than on personality. So those things we need to expect to evolve and they'll evolve in response to what they've been doing in the clinic but several other environmental factors as well. So annual review, no surprises, we need to be proactive about where we're going and set up the plan which includes three main targets for that following year. They might be performance-based, they might be projects. It's a whole lot of things to a whole lot of different people, and we need to redo things I've got a favor to ask. Would you mind reviewing and rating this podcast, please? It helps us attract great guests and partnerships from companies who want to do business with you, and we can negotiate the best possible deals and discounts so that you can grow your clinic sustainably into the future. Just open up your podcast player and hit the review. It looks like 70% of you use the Apple podcast player to listen into this show. So next time you open up the show, can you give us a review and rating? Every single review counts and we are so grateful for it. All right, let's head back to the episode. All of these systems, the way you deliver them and engage your team, shout excellence to me, really. You have a high attention to detail, continuous innovation, and yeah, I believe it's no mystery as to why you've won so many awards, why you've continued to grow and have the impact that you've had on the patients and the community that you serve, but also your team and as a business owner and operator. One recent one for you has been this grant from the government, the RACGP, which is around type 2 diabetes and the remission. Just expand on that because this is a pretty meaningful grant and it received some great acknowledgements in the parliament. Talk us through the grant itself I'm going to get teary because I get so excited about this area. My area of passion has always been from an early career health professional to where I sit and stand right now in the metabolic field. And particularly in and around type 2 diabetes. So I've worked in it historically, you know, for a very, very long time. And I've watched the evidence emerge over time for diabetes remission. And, you know, five years ago, diabetes remission was this taboo area. We weren't allowed to say it. It couldn't be real. And we needed to focus on what I would frame as a palliative care approach for people diagnosed with type 2. Everything goes down. It's a progressive condition. You're going to need to be on all these medications. You're going to have these complications. The complications are going to be there at one point or another. So just be prepared for them. there was this whole mentality that just didn't need to be there when we were seeing so much evidence emerge internationally, particularly around remission. So I got together with a general practitioner, friend of mine, who also happens to be an associate professor, super smart man, very, very forward thinking and we get along like a house on fire. And we share this vision about not only changing the perception of diabetes in this country, but for those people that are remission candidates, we wanted to provide them with the opportunity to reverse this condition. So what we looked to do was find all of the international data that we could and looked at the different protocols that had been delivered. And we looked at how would we possibly get this information into an implementable model, assessing feasibility and all those types of things. How could we bring it to Australia? How could we bring it to primary care? And how could we bring it to the people that need it at most? And the people that need it are our community. They don't need all of these big research papers written up about what could be. They need the delivery of a program or of a product to actually serve the purpose in looking at reversing this condition. So what we looked to set about and do was create our own protocol of diabetes remission. involving a GP, an EP and a dietitian and we looked at all the international research and we basically went we think that we can do this but we want to make sure that we're doing it properly as far as let's set it up for success from the start because we believe so strongly that we can impact the entire Australian population of people affected by diabetes, type 2 diabetes, that we wanted to set things up really well from the outset. So we went down a path of looking at grant opportunities in order to support our work. And I'll let you in on a little secret as well, is even if we didn't get this grant, we were doing it anyway. We were going to find we were going to find a way to deliver this service to the community. So we went about going through the process of applying for the RACGP Foundation combined NIB Foundation major grant. And very, very happy to report that we were actually awarded the major grant of a quarter of a million dollars to actually support a certain number of people in our local community to work through our protocol. and assess how we could work in a primary care setting in delivering a diabetes remission program. So we've partnered with GPs in our area, so they're all sending us a certain number of patients. to put through our research protocol. We've got some great partnerships happening with suppliers and the like as well to really hit the ground running. And we're looking to implement a diabetes remission program in a primary healthcare setting using a collaborative approach, highlighting the feasibility of this program running in a private exercise physiology practice. which is my practice. So we're not looking to implement it in GP practices, because quite frankly, we can't scale that. And GPs are such incredible, wonderful health professionals that are also overrun. with work and their practice nurses are worked to the absolute bone, again incredible health professionals, but they can't manage to run this within their current service delivery model. So what we're looking to do is not only achieve remission, for our group that are coming through, which we're very confident that we will and quite a significant level, but looking at all of the areas of feasibility in running it through a private exercise physiology practice with the overall goal of scaling the program to provide the ability for any exercise physiology practice owner in Incredible. The impact could be massive. And it sounds like there's a lot of great evidence behind it already. And so are you designing then the protocol of care, or is it already well-defined and it's about actually implementing it and getting some more, you know, validation and evidence that The study is more along the lines of an implementation process. What we have done, though, is we tweaked the original protocol. So it's based off the protocol of the UK direct trial, which was incredibly successful, even at longer term follow up and not just for diabetes remission, but also to support management of hypertension, where most people actually got off their hypertensive medications as well. So we're not just looking at reversing diabetes, type 2 diabetes, it's also about getting people off medication for their comorbid conditions and particularly hypertension too. But we've looked at that model and we've gone, okay, like we do with any sort of service innovation type of activity, let's look at what's working and let's see what quality improvement steps we can also put in place. So we've tweaked this model by popping in exercise physiology assessment and exercise physiology exercise prescription as well. So our participants will have access to group exercise sessions, individually prescribed but in a group environment to support the social activity side of things and the interaction. And we're also going to be including some elements of telehealth if we feel that we need to. And that will be a part of the implementation process to see what we're needing to do. But we've really looked at what has worked from a data perspective and what's achieved the goals. How can we quality improve that? But that overall goal is looking at what level of success can we have in implementing it They're very afraid. They're very, very afraid. I think, quite honestly, they're sick of me talking about it because it was such a long process to go through. And look, we went through a couple of grant opportunities. We didn't get our first one. And we were a little bit sad, but we were also really accepting that it was the first time that we ever tried to go for a major research grant. Now, I'm not a researcher. I'm going to be very clear about that. I'm a business owner. I'm an implementer of the science. I don't tend to gather information and do the research. So this is really, really cool. And I'm partnering with some incredibly smart people, including an implementation scientist. as a part of the team, so a bit of an eye-opener. But my team have ridden the waves with me. We got a lot of letters of support along the way, so the research committee at ESSA got on board. It took me three attempts to do it, but God bless them, they got it done. for me. And we got letters of support from our local mayor, from the Deputy Premier of Victoria, who is also the Minister for Medical Research too, got on board with it, and our local MP as well. And, you know, they were aware of the work I've been doing in this area for a very long time. And, you know, the Deputy Premier has been a big supporter of me for probably the last 10 years. and was quite happy to support this. So I think from a team perspective, I think they were really happy that we got the grant, but also like, oh God, if this was the work to get it, what's the work going to be like to implement the thing too? But they're excited to be a part of something I think that's bigger than all of us. and you know that's the opportunity that this presents to work on a project where that level of impact is potentially going to be so great that we're all going to need to grow into the people that we need to in order to deliver on this project too. So we are fiercely recruiting as well for more people to join the team because this is something that we need more people to support us doing as well. And we're very excited about having some key stakeholder organisations showing some interest in being involved and helping us to scale it. We haven't done it yet. But part of my role will be to actually look at building the business case for it as well and having it be able to be rolled out in practices all around the country. And that's something that really excites me. We'll get the evidence that we need and we'll run our protocol and we'll refine it and all those types of things and have some amazing research learnings from it. But I really get to be that person that says, how is this gonna run? in the real world, how do I get colleagues just like me who want to run this thing, how am I going to support them to be able to do it in systems and process, which I love that distinction of how we're going to grow into the people we need to become in order to deliver this. It's such an empowering belief and statement. And I just want to go on a slightly different track here, because I know for plenty of folks listening in, whether you're experiencing it now, or have done, no doubt you will in the future, a version of hardship or adversity, you are an incredibly positive, optimistic person and just bring the energy. I can see why you attract just awesome folks to work with you and you create, you're a catalyst for change. Just look at this, the impact of this work. But it hasn't always been easy or optimistic in COVID times. You had a real hit, a real chapter of adversity. I don't know how you'd characterize it, but you were hit pretty hard in your health. And you've spoken a lot today about having a strong vision and allowing that vision to kind of pull you forward. when you're faced with some adversity, it's pretty hard to have a clear vision or be compelled to meet that vision. Just expand on what it was like for you dealing with the health challenges circa 21, was it 2021, 2022 in your world and how your vision helped or wasn't particularly Yes. Look, I think adversity comes with the territory, doesn't it? Everybody's going to be hit with some level of that. But I think it's the truly grounded people that know why they're there, that know what their purpose is. They're the people that are going to continue to shine no matter what happens to them. I'm incredibly purpose-driven. everything I do is for a reason. My team know that. They may not always agree with my decisions on things, but they know that it's coming from a place of purpose. And certainly look, during COVID, I felt like I had, I thought I had escaped COVID as far as the condition itself. And, you know, there was a really hard time during lockdowns where I did get COVID. And just as I felt like I was improving, I started to see surface some other challenges that my body was screaming that I needed to listen to. So I found myself in a position presenting to an emergency department with a suspected stroke. Back at that time, I had lost all of my speech. I was not thinking clearly, anything that could come out was complete gibberish. I had lost sensation of movement in my left side. And what ended up happening is a different neurological medical condition had actually surfaced as a result of having gone through COVID. And I found myself hospitalized for a month. and just ripped away from the baby that I had grown for all of these years in some of the most trying times that we had ever seen. So I found myself in the Epworth Hospital trying to come up with the diagnosis and then start a rehab journey and you know in those times I think the most Back when I think about that, I didn't quite realize at the time probably the severity of what I was going through. I was in a bit of la-la land. You could have me in a hospital bed looking around a cubicle for two days and I wouldn't have known that two days had gone past. Things were a little bit serious at times. I was having seizures. Nobody knew what was wrong with me and it was really tough. I was taken away from my family. I'm a mom of two beautiful boys. I have a gorgeous husband. I have two dogs, my beautiful big Samoyeds. And my life was just completely turned upside down. Nobody knew what was happening. I couldn't think properly. I couldn't communicate and I couldn't walk. And I was taken away on top of that from the one business that I felt needed me. The one thing that I felt really needed me, which was my business as well. And as I started to go through rehab and regain my speech, I had to go through speech therapy and OT and physio and EP and then got discharged from hospital. But then I had six months of follow up treatment as well with twice weekly rehab. The thing that I really learnt at that point in time is that when you have a strong vision and when you have a strong purpose, you're very likely to recruit like-minded people around you. And one of my proudest moments in going through all of that is how my leadership team rose at that time. And they took over everything. And it was a real moment in time which left me a little bit concerned about what was going to happen to my business. But on the other hand, feeling really peaceful and at ease that I had developed this beautiful little entity that had grown its own legs and was walking on its own without me. And it was a really defining moment in time where I thought, I've done what I've done to reach this point. And that idea of though, when I started to get re-motivated to get back in and I was getting better, what got me here won't get me there, I started off on my next mission. And that was to make sure that I had all of the right people in my business to have it sustainable and to have it flourishing and to really develop that position description or that model of why am I even there? And it really lifted me to understand this is actually what I do. It's this, it's this, and it's this. And I've got people that can do this, this, this, but I started to see the gaps as well. Or I started to understand I had these amazing people, but they don't know where the goalposts are. Where are the job descriptions? where's the accountability in it? And it was a wonderful opportunity once my recovery was starting to get on track to get back into the business and to look at it in a different way, a way that I had never looked at it before. Because you know when you're really entrenched and I know business owners are gonna be listening to this and you don't see any other way of doing things other than the way that you're doing it because you're in it. And fortunately and unfortunately balanced for me, I was taken out of it and had to look at it in a different way, which is a wonderful eye-opener. And for so long, anyone around me, my coaches, my mentors, were just ringing that same message, which really got under my skin, which was you need to trust people to do your job. And quite frankly, I disagree with that. I don't think that it's about trusting or not trusting people. We need to have our people set up for success so that they can deliver the very best of themselves. And what we went, we'll go back to from before to support them to grow into the people that they need to be. in order to be leaders in that area as well. So I had this remarkable opportunity where I had to make a choice as well. Do I just go back in at the level that I was before knowing that my path is set? it will be exactly the way that it was before? And I wasn't dissatisfied, but I also didn't know any different. Or do I look at this as an opportunity to really dissect each part of the business against our mission, our vision, and our values? And how do I create this business 2.0 in there? And so that's what I opted to do. And it's been a wonderful journey. And that was, you know, a few years ago now. And as much as it was really trying times for me personally, I look back on that now with an immense amount of gratitude for having gone through it, because if it didn't happen, nothing would have changed in the trajectory of my life, That is powerful story. You think, do you, Perhaps I wish I didn't have to go through that to realize some of those things, but I'm so grateful for it. I know so many people have their own stories and challenges, adversity moments. Hopefully they're able to make some of those changes that you've made to version 2.0 without having to go through it. But so often it is the catalyst that sparks it. What I have loved from today and I've taken a bunch of notes is all anchored and centered actually around vision and that mission that you have and getting so clear on it and that everything's anchors back to it from performance conversations with team members to their onboarding and their offboarding through to strategy and where we're going, the rebirth or version 2.0 of the clinic and your own role as well. being so centered around that vision that you have. and not allowing adversity, perhaps, or challenges to be an excuse for not having it. In fact, maybe the most important time is when it's tough to connect with that. Nicole, thank you for sharing so openly, giving some real practical insights. But I think the thing that I love is hearing some of the principles that you use to make decisions. because those are kind of timeless. Some of the practices may change, but the principles kind of stay with you over time. If there's a departing message for folks tuning into this episode Wow. Um, vision, everything comes back to vision, have a clear vision for what you want and what you want your organization to represent. Because the thing is, is that people will never live up to your level of expectations and they'll never be able to deliver things at the level that you feel that you want. If you yourself aren't clear on your vision. Every decision needs to be filtered. That way, you've got your vision, you've got your mission, you've got your values. Stay true to them. You'll attract those like-minded people. And when you find that there has been an error in judgment, in onboarding perhaps the wrong person, don't be afraid to offboard them. It's okay, and it's nothing to feel guilty about, and it's not a failure. It's really not, it's actually a point of critical decision-making. You should be proud of yourself for having Very well said. Well, for those listening or watching on YouTube, you can catch all the show notes over at clinicmastery.com. We just launched a new website actually. So go check that out. Plenty of free resources to download, including these podcasts. And we'll catch you on another episode, Nicole. Thank you so much for sharing Thanks for tuning in to the Grow Your Clinic podcast. To find out more about past episodes or how we can help you head to www.clinicmastery.com forward slash podcast. And please remember to rate and review us on