In this episode, you're going to learn three things. Number one, how to spot the real bottleneck in your business before you hire another person and accidentally make the chaos more expensive. Number two, how to separate clinical work from clerical work so you stop doing tasks to drain your time, margin and energy. And number three, how to build the lean operating model using virtual assistants with the systems SOPs and oversight that make it reliable. Not risky. Welcome to Clinician to CEO, the podcast helping clinicians simplify your go-to-market strategy so that you can stop guessing and turn your working prototypes into international MedTech businesses. I'm your host, Hakeem Aade. Let's get started. my guest, Bob at Lash has spent years helping healthcare businesses redesign how work actually gets done. Not by hiring armies, but by building lean, well-structured teams that free founders up to focus on what they should be doing to go to market execution to. And scale. So this is not an episode about virtual assistant just as a service. It's about conversation about why you can't actually work and export chaos, and how the right operational backbone becomes the competitive advantage when you're trying to grow a MedTech business beyond your home market. Thanks for coming on, Bob. Thanks for having me. Appreciate it. No, really looking forward to this one because it's the one that not many people talk about. Actually, I think this is gonna be really useful for my listeners. Most clinicians and healthcare founders think scaling. Really means hiring locally and hiring fast. Is that the right thing to do? If it is, great. What's your advice to them? And if it's not, why is it not the best thing to do? Yeah, it's interesting and know we, uh, we chatted a little bit before we got on this call, and what we have found through the years of doing this is that, you know, ever since COVID, it's, it's a very, very interesting kind of change that has happened where different practices. Different, you know, different companies. No matter what it is, people are now open to looking remotely rather than in our own office. A lot of times we all thought that unless someone was sitting next to me where I could see, feel, and touch it, the job wasn't going to get done. But if you have the right systems, processes, and workflows that are aligned up with proper job descriptions and SOPs, et cetera, then outsourcing is something that not only. Is, is becoming more and more efficient, but also can keep our costs low. As healthcare, we, we all know this, healthcare costs keep rising and rising and rising, and there's gotta be some give to it. So for all of us, we need to make sure that our numbers are correct and yeah, and that's, that is obviously when you, especially if you're in a startup or you're a clinical founder, you know, that's one of the big things that actually kill lots of businesses is the. The costs. And a lot of those costs come from overheads such as staff. So on that basis, if you've got, you know, people listening to this and they're, they're in a position where they're thinking they need to scale, look, they need a few more people. What is your advice to those people in terms of what's the best way to do it and what are the key things that they need, um, to do it? Because it's not just, I'm gonna hire a virtual assistant, and then they, they start working and that's it. Yeah, the best thing to do for any, any small business, medium sized business, big business, to see where the bottlenecks are. Yeah, there's a bottleneck no matter where it is. You know, we break everything down into very simple forms. Four phases. And each phase is typically around the same, and we, you could, you could adjust it to your business, but there's a phase in any practice where it is before the patient is seen. And I'll just give you kind of a, a broad, you know, a hundred, a hundred foot overview, number one, before the patient's seen. Number two, when the patient gets to your office. Number three, when the patient is being seen, and number four, when the patient leaves and what happens? There's tasks at the beginning as an example. Phase number one, you have scheduling and prior authorization would be an example, and then when the actual. Patient is in your office. What happens? You know, think about this. You have a patient that walks into an office in any type of business, and I'm just giving you an example on this one, they hand you their, your insurance card, and then what happens now your front desk manager gets on a call, tries to do again. Uh, they look at all the insurance information and they say, okay, are you able to pass that step? And what happens if a patient walks up and needs to talk to now that front desk manager and then the phone rings, et cetera. There is, so the, the patient care at that point. Kind of gets a little messed up and there's a lot of missed calls. So that's in phase two. There's a lot of challenges that happen is phase two, your bottleneck is phase three, your bottleneck. Where when the patient's being seen, do, does the physician need help scribing? What happens when they're there? And then finally after they leave, is there a, I don't know, accounts receivable, ar backlog, et cetera. So there's a lot of different choke points, if you will, in bottlenecks within each office. Okay. Yeah. No, and that makes, and that makes perfect sense. So, and what are the things that somebody who founded a business, someone who's starting that go to market journey, what are the things that they actually shouldn't be doing that they, they tend to do? So we find that. You know when you look at it, you have individuals like doctors that have gone to school for eight years, let's just say, and we break it down into clinical versus clerical. They go to school for the clinical stuff, right? They're sitting with patients, their treatments, it's expanding their practice, it's building patient plans, et cetera. Where on the other side, it's the clerical stuff where they spend, I dunno, I think it's about 40% when you do research. It's about 40% of their time is done doing the clerical stuff that does not put money in their pocket, but it's all the stuff that also creates burnout. Yeah. Um, so how do you. Or, or do you give advice to people? I mean, how, how do you determine where you should put those people off? Obviously you, you're talking about, you're gonna put 'em in the iCal area. How do you determine exactly where they can put them and where they can then start off, obviously reduce their workload and, and burnout you just described? So we ask a question right up front, where is the biggest challenge if it's front desk as example, we ask, alright, how many calls are missed? Right? How many schedule, how many. How many different types of calls are missed? We have a perfect example of one of our, um, one of our practices where they had 60, they're missing 65% of their calls because of patient overflow come in, the office phones ringing, et cetera. So they implemented one of our VAs. And they cut that down to 30%. So that increased the revenue. Obviously every office has different type of revenue cycles, but that increased the revenue by seeing more patients. Yeah. Okay. And, um, um, if there any where. Where you've seen very clearly, because you talked about the clinical versus clerical. Is there any way you've seen very clearly that founders are clinging onto tasks that actually they should be releasing? So what we find is that there's a lot of things that happen with, one of the biggest challenges we see is expansion, because costs are going up and yeah. What happens in a lot of, in, especially in America, it seems to be that a lot of individuals do not wanna work and they don't wanna work long hours and they don't wanna work hours and hours and hours and years and years and years. So there's a lot of turnover. So a lot of offices that we. Come to us, say, you know, Bob, we're having a tough time actually hiring and recruiting and actually keeping staff because of burnout, because of overhead, because of, you know, all of those things that happen on a daily basis. It just feels like a lot of Americans don't want to work in those roles. Think about this. If you're sitting on the phone all day long and doing prior authorizations, insurance verifications, that leads to burnout. And a lot of individuals just don't want to do that anymore. I don't know why. You know, when I started business. I literally door, I went door to door to door to door and I cold called. I was on the phone all day long working. 'cause I know that's where you have to start to build a business. But today's different since COVID. I don't understand why Hakeem, but it is what it is. Yeah, no, I mean, we were talking about it before and it, it, it is difficult, um, to get and keep people doing. Um, admin tasks certainly, and actually even some higher level tasks than that, then people don't wanna do it, ever. I don't wanna get into social, social things. The, the things that people wanna do is wanna make quick money doing things that they think are super enjoyable. Yeah. I always say to people how, however, when you see somebody successful, I can guarantee you they worked hard and what you're seeing at this end is not what was happening at the beginning. And they're looking at, they're looking at the outcome rather than the input. Yep. You don't, you don't see the actual work, the foundation that gets built to be able to do that. And to get back to one of your questions, it's, those practices need the f solid foundation, right? Yeah. You got the SOPs who need the right people. 'cause we're only as good as the individuals that work for us. Yeah, exactly. So, so in terms of the. Concerns that people have. 'cause I mean, I've been using virtual assistant for years, uh, and I know, and I know from my own experience, lots of people I speak to don't even know what a virtual assistant is and certainly are not using them. So just, just talk to me about what is a virtual assistant first, then we can get into, and then how can that be used in your business to really make a difference when you're struggling either to find a local person or. Yeah. To to, to get people to reduce their own workload. So virtual is very, very simply. It's someone that's not working directly in your office. It could be someone in the other town, it could be someone in another state, another country. It doesn't matter, but somebody who's not working inside your office, right in that office right next door. So that's very, very simply put. It's somebody who works remote. So. And I know there's a lot of different, a lot of different answers to that, but it's a very simple answer for that question. Yeah. And, and then what, what are key benefits cost we've already talked about, 'cause obviously they're not, they're not in the office, so you're gonna have a lower cost base, but just talk to me about why it's a lower cost. Because obviously there's lots of people working at home, uh, in America. There's lots of people working at home in the UK and they're not, and they're not cheaper than whether they work in the office or not. Firstly, why are they lower? Cost would be the first one. Then what are the other benefits? Yeah, so all of our virtual professionals are outta the Philippines, so Okay. And it's a, it's a lower cost of living, but the beauty of the Philippines is the, the healthcare education over there is very, very high. So all of our virtual assistants have a four year college degree. They've already gone through all the healthcare training, et cetera, and in the Philippines it's a very, very big service industry. So they know that there's, you know, there's a lot of individuals that go into the call center area. This is not obviously a call center. They're, they understand that a lot of 'em either have to go into nursing that come to the United States. There's a lot of Filipino workers as well that come here to the United States or around the, around the world, Latin Australia, a lot of uk, et cetera. So they have a base of healthcare. Okay. So, so, and then what, what the other benefits would you say of using a virtual assistant, overusing, you know, you're building your team and you're building. Actual resource in your office? Yeah. So what we've found is that there, the companies that come to us literally have a great foundation built and the challenges that they see is their costs keep going up. And a lot of areas that bring us in are having a very tough time hiring. So hiring pool and the individuals that come and stick is very challenging in a lot of places, uh, around the world. So that's what we found. Those two things is cost and actually hiring and the availability of talent. Okay. No problem. And, and then the, I suppose the reverse question is on what's the risk? So you can tell me what you think the risk is, but then more importantly, what is the perceived risk? People who actually you try to convince, maybe if you're trying to grow and your costs are spiraling, you know, you could actually bring down your costs quite significantly without reducing your quality of work by using a virtual assistant. One of the, one of the big things that we get back all the time is how do we know that they're working right? And it's very, very. So, you know, front desk manager, how do we know they're gonna actually take those calls? Insurance verifications, how do we know we're gonna do, we're gonna finish those, we're gonna, you know, do prior authorization. So that's one of the biggest challenges. And we have, so every one of those virtual assistants are on, everyone's either, you know, E-M-R-E-H-R, so they're, they're working directly in there. So you could actually see that we also have what we call a client service manager that manage the VA client relationship. That is on top of them all day long, monitoring them to make sure they're doing their work. There's a started day report, midday report, and end of day report. Yeah, I mean, and and I, it always surprising when, and possibly because I come from a sales background, so I was a sales person, field sales person, regional manager, and national sales manager. So I've always had teams which are not in my office. Um, and they, no one ever think, I mean, people do say, uh, how you know they're working, but the results generally will tell you if they're working. So if you, if you've got a certain amount of calls to be done, let's say, saying that you've got 500 calls to be done in a day, or you're expecting to have 500 calls, it's not very difficult to monitor whether they're being answered. It's not very difficult to monitor whether the things that you're expecting to do is being done. So I think, I think there is, it's almost like a, a comfort blanket. That somebody's in the office, because actually there's lots of people in the, in an office that aren't delivering either. They're not actually working, they're, they're scrolling on the internet, they're doing all sorts of other things. Whereas what I found in, in terms of my virtual systems, you know, they work a certain amount of hours and they, and they generally, I mean like anywhere I've had, I'm been great. All the ones that I continue to work with have smashed me outta pot, uh, and a, and a reducing. My workload so I can actually focus on the things that I need to do to grow, to grow the business. So I think that's, that's really, uh, an important, um, point to make really, and it's, yeah, and it's an interesting industry because, you know, when I first got into, I first got into 2014, right? So it's, you know, that was a time when you talk about business. You start building your foundation, you start building your team. And we started with zero. Now we're, well. 600 worldwide, which is actually really, really good because, um, it's a, it's an industry that continues to grow and I feel if we look five years ahead, it's gonna be even, I think it's gonna be even a bigger industry from inside the healthcare world. Oh, yeah. No, I think so. I think, I think the, the more people start to, it's, it's like a, um, a snowball, isn't it? I think it's the more people start to use it and realize how effective they are. The more they'll use them and then the more they'll start telling other people about it and everyone be how, how, how has all sudden they got a lot more time in the have than they used to have. And because you got a virtual assistant. Um, the other thing, uh, I think is really useful about the, about the Philippines, 'cause I use people in the Philippines as well 'cause they're on a different time zone from, from me specifically. They're doing work when I'm sleeping. Um, which is great 'cause you can then leave them stuff to do. But also I've noticed they also work when I'm working. I don't, I don't know when they actually sleep, to be honest, because they, they work back my hours, but they then do other, obviously work because of their, the time difference. They're also working earlier than when I get up. So it's, it's actually you, you just get a lot more value. I, I think out them than when you're working with a, an admin person who's actually based here. And there, and there's a lot, there's less opportunity of office drama that a lot of people see. So I get that feedback all the time. And then in terms of, I know how I manage my, my virtual assistants, but is, is there any best practice in terms. Number one, onboarding them, and then how do you manage them to keep them motivated? Because obviously there's lots of talk about motivation and leadership. How do you do that when you've got a virtual employee in a different country? Yeah, so we had, we talked a little bit about this before we jumped on, which is very important and what we see is that the biggest challenge and one of the other biggest challenges that we see our doctor's office, like, oh, I have to train 'em. Right. I, and what happens if there's turnover? We gotta retrain him. So what we do is we have our a training team get in there and actually create a training for that role. Because, uh, if we look at everyone that we have come through our system, they start with one, they end up with four virtual assistants. So we help them with the training because that's a big, big pain point in any industry is the training behind it. I know for me, when I first start, I'm like, alright, how do you replicate this? Because I'm gonna have to go back and do the same thing over, which again, creates burnout. So what we do is we have our training team get involved and actually create that. Role, position and results that need be, and then we train 'em on your system. Okay, so, so what you say, so you guys will do the training obviously with, with the, with the company help but help, but you, you do, you the one, the ones that employ that training. So once you've done, you understand the training. If you get, if there is a turnover and there's a new person, you just employ that same training program again. Or there's an add on. Like I said, it's looking, looking at all of our, uh, clients. Start with one. This is 90% of 'em. Start with one, end up with four. That's kind of our ratio because what we always say is, Hey, listen, if you, if you're questioning it, start with one. I know you need help with four virtual assistants, but start with one. We wanna make sure we prove ourselves. So then, you know, after a while, over time, you end up adding on up to four. That's typically what we see, and I think if, if that, if that. Only one area that, that, that you produce, uh, virtual assistants for, or is there a variety of, um, areas, a social media admin, et cetera? Different things. There's a variety of 'em. So social media, we have clients that use us for social media. Then you have front desk management, you have prior authorizations, terms, verifications, verification, and then in the end is ar backlog. The account is a very, very big one. Yeah. I can't, well imagine. So, so, okay. So I think we are getting to, to the crux of how beneficial they are. I always like at this point to just jump into some kind of case studies and some real life examples. So have you got some examples to actually talk, talk us through where, you know, someone's tried to scale, they're struggling, you know, what was the situation before? What was the friction? And then how that then changed when, when you actually helped and, and, and more important than anything else, what difference did it make commercially? Yeah. So I'll give you an example of an IVF company that we work with and they had a, uh, uh, a backlog, a rev cycle backlog, which was incredible. So I'll give you an example. So they had 150 pa. They see 150 patients a week with a 30% denial rate, which means if you fast forward, they look at an entire month that's. 30 denials. So for an IBF company, that's a lot of revenue that is lost. So we implemented two VAs within that rev cycle and they increased their profit by over hundreds of thousands of dollars. They didn't give us the exact number, but they increased their revenue by that much. So I think. Yeah. Which is, I mean, you look at a lot of different companies, it's very important for us 'cause we're working very, you know, our practice companies are working very hard to get the patients in. They go through the process and they have accounts receivable. If you can't get that money, that's a, that's a huge, huge loss and a big hit to our bottom line as business owners. Oh, no. Yeah, one, 100%. And, and were, were those people using VA before or were they, how, how were they managing that backlog? Just with people. It was just their in-house staff. So it realized is there were missed calls. There were insurance, uh, prior authorizations that were wrong, insurance verifications that were getting denied just because of all those challenges. 'cause your front desk individuals were doing all of those tasks. And as you can imagine, there's a lot of different tasks that a front desk manager actually does. And if you don't see one task through from start to finish, there's gonna be misses. Yeah. Um. I mean, it, it seems so obvious when you say it, but I mean, people, I'm assuming that the reason why they didn't recruit anyone outside of that team was the cost. Cost. Yeah. I mean, let's talk about Boston. I mean, Boston's a big, a big city in this world, and Boston, the cost of living in Boston's. Very, very high. And you, you're not gonna hire someone No, no one wants to work for, for $12 an hour that's gonna be sitting in an office and you know, the, the, the minimum wage in Boston's a heck of a lot higher than $12. Yeah. Fa same in the uk. But yeah. You're not, you, you're, and. I can't remember what it's now actually, I think about 17 pounds or something. Like, I, I need to check, but it's expensive. Uh, so you're not gonna get, and, and that's for that is not going to get you a college educated, uh, correct person, been through all of the processes that you're talking about, you know, it's gonna get, it's, it's probably not, I'm gonna get you graduate. Really? It's gonna get you someone straight outta school. Yeah. So it's, yeah. Yeah. You're not even, uh, comparing apples with pears. So for me it's almost like that it's a bigger risk, not. To use, uh, a virtual assistant than it is to use one, because as you said, if you're not sure, try one. You, you have a trial period, it works. You then go to 3, 2, 3, 4. If it doesn't work, what have you lost? You've not lost a huge amount of money, um, and you've definitely not lost a huge amount of time because obviously they're working with an organization like your. So, interestingly enough, a lot of my, uh, list are quite lean and they're always looking to see how they can grow by remaining lean, which is why I think virtual assistants work quite a lot. But I think a lot of founders and a lot of people on this call will be wanting to know. So having a lean team increase. Does it increase risk? I don't. I don't believe it does. Um, I mean, I think we all think as business owners staying lean is more control. Yeah. And that's some of the things for us, business owners and business leaders, control is very, very important. So I think the answer to your question is staying lean. I think until you grow, you have to, all of our businesses are in phases, right? And every business has, you know, if you hit a million dollars in revenue, it's a different phase. And if, if you hit five, it's a different phase if you hit 10, right? As, as an example there. So staying lean at the beginning and building your foundation is, I think is one of the most important things in any type of business. Yeah, no, I, I would, I would completely agree. And I think the, the Dave, I'm not gonna say the David Bricks and mortar, the business are gone because they're not. But the Dave that you are gonna. Build your business purely on the number of people, which is what a lot of people do. I remember when I was, when I was a lot younger and we used to the, in the pharmaceutical market, we used to call it the armed Race. And it was just basically, um, you know, that our competitor company has taken on this many people, so we have to take on the same amount of people. 'cause it's all about the number of people out there. And I think that the same thing in, in, in the business world, that's the sales world, but just in the pure business world, people think, ah, the bigger the company, the more. Effective and the more successful I am. And I've always taken the view, well actually it's all about profitability. And if I can build a lean company and get the same level of turnover, then my profitability is significantly higher. And that's all I'm interested in. I'm not interested in outwardly everyone going, oh look, you've got millions of people working for him. Yeah, but how profitable am I at? I'd rather have five people working for me, and I'm superbly profitable. And I, and I'm good. So, so it's an interesting question. So, so what sort of mindset shift. Do you think a clinician specifically needs to make so that they can move from being the expert in the room and running everything to building a business that scales without them? To an extent. I think they have to be comfortable delegating because if somebody does everything themselves, I mean, think about this, we all think we're the best at everything. I mean, not everybody, but when you really start growing your business and what we have found through the years, I started business back in 2004, just, you know, you started, you've been in business a long time, and what we have seen and what we have found is once we all start delegating and opening our minds business, it's very weird, but it starts growing and it starts compounding on top of each other. Yeah, no, exactly. When you. Go into businesses, uh, obviously healthcare business obviously can, can you tell immediately whether that business is ready to scale on or not based on the structure, the operational challenges they're having? Well, it's interesting. It all has to do with the leader because if the leader answers certain questions and, and you look at the tasks that they're doing. If they're doing everything from start to finish, it's gonna take them a, it's gonna, it's gonna take a little while. They're gonna have to go through a mindset shift to start delegating. So at the beginning, you know, but you know, once you start talking and coaching and just telling stories and talking about other practices, et cetera, you'll hope they start opening their minds and then that's when they start changing. Yeah, no, that makes perfect sense. Um, and then, um, if. You're speaking directly to the listeners. If a clinician founders on listening to this, what advice would you give them if they wanted to free up 10 hours a week within the next 30 days? Where should they start? Yeah, I would, I would take your phone. So we all have phones. I would look at my calendar and I would see exactly what I'm doing every single day and break down income producing tasks to non-income producing tasks. Yeah. It's the same thing when we grew up, right? My father taught me that you do a T and you put, you know, you put the positives and negatives, so it's the same exact thing. Put income producing tasks and non-income producing tasks, and those are the. Non-income producing tasks you could typically outsource to somebody else. So that's how I would get started. Yeah, no, I think that's really, really good advice. Something that I think people will find very beneficial. So if you, if you had to give some advice to people or like almost like a 1, 2, 3 step guide in terms of people listening to this thinking, actually, this is brilliant. I need a virtual assistant. I've never even heard of those before. What would be the next step? I would start looking at what are your bottlenecks in your business, because we all have 'em. And then I would start looking at the tasks that are attached to those bottlenecks, and I would almost put a value on each one of them. So if you understand those bottlenecks, you understand the tasks. There's a value or a lost cost value that's attached to every single one of them. Because like you said, if you have a clinician doing non-income producing tasks, they're losing X amount of potential revenue that is sitting right in front of them. And I think that's very, very important. You know, I stood, I made that mistake when I first started business, you know, 20 years ago. You try to do better every single day, but it's, you know, when we have conversations like this, that kind of opens our minds. Yeah, no, I, I, I think that's, that's key. So, so if there was one takeaway. That you would want my listeners to take from this conversation? What would it be? I would go back to the word delegation and being comfortable with delegating. Because that's the only way that if you're looking to grow, that's the only way you could grow is by opening your mind on the delegation side. 'cause we can't do everything. If we do everything, we're gonna stay stagnant and we're not gonna grow. Yeah, I think that's, I think that's a really important, uh. Place to wrap up actually, because that, that to me is the takeaway. Uh, 'cause lots of businesses, if they fail, they don't fail because of lack of ambition. It fails because the business has a lot of Com complexity and that founder and his team can't absorb that complexity and they haven't actually looked externally to see whether that's something they can, that, that they can actually get people outside of the business to do at a cost effective rate, which I think is, is one of the key benefits of. Virtual assistance and outsourcing. So, you know, my, my, my, I plead to anybody, listen this, if you're a clinical clinician founder, which I know you are, you're listen and you're serious about scaling and about go to market execution and actually obviously your international growth of the world, the question question really isn't about whether your product works, is it, is whether your operating model actually works. Um, so. Thanks, Bob. That's been illuminating. I'm hoping that now people are gonna be inundating us with calls about, oh, virtual assistants. Um, and actually apps start to outsource, um, those non-income generating tasks as you've just mentioned. Yeah, and, and I just wanna add, add to that. I think it's very, very important because a lot of US founders, everyone goes to us with every single challenge and every single problem. So the delegation side's really, really important. 'cause if you are getting inundated, your in inbox is getting inundated all day long. Your phone, your text messages, your phone calls, your inbox, you cannot grow. I think it's very, very important, whether it's someone in office or out of office remotely with a virtual assistant, you need a second person or a third person that helps with all of those other tasks for you. Yeah. No. 1%. 100%. I think that's a, that's a great closing message. Don't try and do everything yourself, delegate and get support. Yep. That's it. I appreciate it. No, I really appreciate it. It's been illuminating. Thank you very much. Awesome. Thanks for having me, Hakeem. Appreciate it. So if you're trying to scale a MedTech business, the question isn't just does my product work? It's does my operating model work without me doing everything? Because if your calendar is full of non-income tasks, you're not scaling, you're just surviving loudly. So your next step is very simple. Go to your calendar, split your week into income producing and non-income producing tasks. Then pick one bottleneck to fix in the next. 30 days, and if you're struggling to know the next steps to turn your working prototype or product into sales, then head over to the show note for my Export Redness diagnostic, which will audit what is stopping you from achieving that breakthrough, and give you a plan of the next steps you need to take to get your product to market in the next 90 days. Keep listening and keep growing.