Inside Reproductive Health, Ep 27

Setting the Vision for Your Practice with Intentional Culture. An Interview with Angie Beltsos, MD

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In this episode, Griffin Jones hosts Dr. Angeline Beltsos, CEO and Medical Director of Vios Fertility Institute as well as the founder of Midwest Reproductive Symposium International (MRSi). In the competitive climate of large fertility networks, Dr. Beltsos’ independent fertility center, Vios Fertility, has thrived, largely in part to implementing an intentional culture of transparency. Dr. Beltos discusses how Vios is built on three important pillars: an unparalleled patient experience, early scientific adaptation, and robust and dynamic culture that starts at the head of the team and trickles down.

Griffin Jones: Today on Inside Reproductive Health, I am joined by someone who used to be the REI Division Education Director for OB-GYN residency programs at Illinois Masonic Medical Center, Lutheran General Hospital and St Joseph’s Hospital in Chicago. But, you likely know her better as the CEO and Medical Director of Vios Fertility Institute. She is also the chairperson of the Midwest Reproductive Symposium International, as the Founder of MRSi and of Vios, one of the largest, fastest growing independent fertility centers in America, I wanted to have Dr. Angeline Beltsos on to the show. Dr. Beltsos, Angie, welcome to Inside Reproductive Health.

Dr. Angeline Beltsos: Thanks for having me, I am so excited to be here!

GJ: I am thrilled to have you on this show because you are really creating something really different and I look to you as an example in the field very often. I want to talk about the trajectory of Vios Fertility because I look at you and I look at a few others and I think about all this talk about what is happening to the independent fertility center. Can they still grow their own vision? Can they still grow, period? With all of the consolidation with large fertility networks forming in the country and you’ve totally gone the other way in the last four years and proven that it’s possible. So I wanted to just talk a little bit about what you owe that trajectory to.

AB: Well, thank you for that lovely introduction. I am so excited to, and actually very honored, to be invited to speak with one of our thought leaders in the field, Griffin Jones. When you look at your life’s opportunities, life is for living. Whatever you dream about, wherever you really want to be, where you want to land: what the heck, take the chance and go for it. Life sometimes offers you some obstacles and you may feel like that dream is so unattainable, but you’re going to miss 100% of the shots you never take. Life is now, so enjoy your life. Dream what you want to be. That’s what we did with Vios. We had learned a lot, I was very blessed and honored to be a leader of past organizations. That gave me ‘baptism with fire’ *laughs* and an MBA by virtue of experience. Leading an organization, the financials, the marketing - with that exposure, I started Vios Fertility. It’s been nothing but crazy fun!

GJ: So when you’re talking about dreaming, I sometimes called that the role of a visionary. Some of the criticisms I have from a lot of practices now is that the way my company is built - the way a lot of companies are built - is that there is a visionary at the top. In bigger companies, there is an integrator - somebody who helps with operations - and then there are different people that own different seats. One of the biggest problems that I talk a lot on the show about, is that in the independent practice structure, you have the person that is supposed to be the visionary of the company - but they are in every other seat in the practice. I can’t tell you how many clients that we work with that still write me paper checks because they do not have somebody else doing that part of the business. They are the ones tracking down the Facebook, who has manager permissions because they don’t have somebody in that seat. It takes so much to be in this seat, no matter what the business is, and then you’re going to do 200, 250, 150, 300 retrievals, or whatever that number is, and see however many patients in the year, it’s daunting. I think you are one of the few people that really has this seat of ‘I’m the visionary’ but I also have to be a doctor - how do you balance those two?

AB: I think your question is extremely important. We feel, in an organization and in life, so many pulls in different directions. With a small organization, you may not have a C-suite, you may not have a whole list of people that are going to take care of taking you from paper charts to an electronic medical record, from paper money to making transactions online. And having all of that very nimble and using technology. I don’t think you have to hire someone for every job inside the organization. There are many ways that you can look at consultants or people that are part-time on your team, that allow you to access the latest in technology. You brought up financial pieces as well as EMR’s, so I think at Vios we were - by purposefully and intentionally - looking at getting a core group of people that can execute the job. We’re building for speed. Not just hanging one shingle out of one office - one doctor, kind of thing. We were really intentional about saying if ‘this is a network of great docs and great clinics,’ we have to be starting from the beginning - that framework built for that. You bring up something very important: you can’t do everything yourself. But what can be easy to do is say ‘here are some critical steps and important jobs that must be done - some daily, some weekly, and some monthly.’ Some of that you unload on your actually talented people within your office. In the beginning, we said ‘alright, we are a small group of people - we divide and conquer.’ And then the other piece is, again, not necessarily having to hire a full-time CFO in the beginning, but maybe outsourcing some of that so that the job gets done in a really great way. But it’s not on my shoulders to do all of that, because God knows that’s not possible.

GJ: What’s on your shoulders, and the shoulders of any visionary, is to focus on the culture, on the key relationships with vendors, strategic partners, the biggest clients you might have and to think about future value. I want to talk about those first and third things with you because I think you do as well, if not better, than anybody - which is culture and thinking about future value. You eluded a little bit to future value: we are building this from the beginning in a structure that can scale. You’re doing that on the back of a very unique culture. For those of you that aren’t familiar with Vios Fertility, go to MRSi next year, Midwest Reproductive Symposium, in Chicago in June and take a look at the Vios team, because a lot of them are there. That is a culture. It reminds me of a college sports team in some ways. I walk into a lot of fertility centers, I’ve been to dozens in my career, and I don’t see many cultures like that. That’s very intentional. How do you maintain something like that? And maybe even just talk about why it’s important, because Angie, I am dubious that a lot of people understand how important it is.

AB: The importance of culture is as much as oxygen is to life.

GJ: It’s everything.

AB: It’s what carries the team forward. I learned from success, and in this case, I also learned from failure, where you can lose this very delicate and vital part of an organization. So we know that how people feel about their job when they wake up, and knowing what they're doing, and how it impacts someone else's life, allows Vios to really push forward. Specifically, I think a culture is, and at Vios a young culture, it starts at the head of the team and it trickles down. Simultaneously, you have the team that is on the forefront, the soldier, and it bubbles up. There is this bi-directional flow of culture and it impacts how we all work together. I elude to if you have a project in your organization and you’re up and running, many people forget that they’re not in a vacuum. So imagine you have a job to do today and we are going to roll out something new, or frankly, something old. You have some - maybe five to ten - basic subgroups. We have our team, we’ve got different players that do offense, defense, some are goalies - just like a team, you’ve got some subgroups of what their job entails. Specifically for us, you’ve got a clinical team, an admin team, a marketing, financial - and in that you also have these worker bees that flow in between that. I love blurry lines in some aspects: what’s your job? The answer is: whatever it takes. If you define the job too crisply and too defined, then you get “I don’t do IOI’s, I only do IVF.” “I only counsel on financials that have to do with saline sonograms and not HSG’s.” Yes, you need clarity, but you also need to have redundancy in your team. Cross-train them. And also this attitude, this culture is like ‘Griffin, whatever you need, I am here for you.’ ‘Can someone grab that garbage?’ ‘Of course!’ Roll up our sleeves, we are all in this together. My team teaches me that intentionally say it so that it's like a relay race in the Olympics. This baton gets handed off from one person to the other. That needs practice and a lot of organizations forget that this isn’t by accident - that you have crispy and clean flow. If you are watching any basketball game or any hockey, Stanley Cup, games - they practice one thing again and again and again to make it incredible. Once you’ve been incredible, there are even more coaches and more people that teach you this one item in their job. I encourage people to check their egos at the door. However many initials are after your name becomes irrelevant. Teach each other how to flow and how this job gets executed. So let’s talk about a new patient visit. It impacts every bit of the organization. If I went to the track on Saturday, and I ran around the track and pretended to hand off this new patient to Griffin Jones and he takes the baton and hands it off to the next person, and I did that by myself every Saturday, I bet I could run pretty fast and I might create endurance. But it does nothing for team building and execution. You have to practice ‘how do I hand that patient off?’ ‘Where do I receive it?’ ‘Where is my hand?’ To get to the Olympic level, you have to practice those things. My analogy is: you have a new EMR, it impacts everyone in the organization, but you need to talk - not only teach that individual but teach the team.

GJ: My critique is that I think a lot of practice today are not putting that seat first and foremost - of building that culture and that team. They are more in the seat of ‘I’ve got to see 500 patients this year, or however many. I’ve got to do however many retrievals.’ And then what’s left of the business that is immediately taking up my time that’s right in front of my face is what I have to deal with. How do I possibly zoom out and look at the big picture and invest in all of these other areas of the practice? I think that’s backward. That is part of why certain companies are moving a lot faster than others. We saw - at your conference in the month of June - Gina Bartasi speak at the CEO dinner that you hosted. That’s a person whose job is future value, culture and building a company to race forward in one direction. Now, all of these people are in seats where - they are supposed to be in that seat for their own practice - but they are too busy in the day-to-day. This is now a rhetorical question: do you think it’s too late for them?

AB: No. But I do I think that you bring a really good point. So you want to execute what you have to do, and it’s not that complicated, it is to find three things that you think your company needs. For us, we are built on three important pillars. Number one: an unparalleled customer experience. We can talk hours about that. What is the patient experience like? Obviously to get pregnant immediately is important, but while you do that, what does it look like for the patient? Number two: early scientific adaptation. So we are early adapters, cutting edge technology and innovation. You talk about innovation and being evidence-based, because it’s very important to follow standards and guidelines from organizations like ASRM, and simultaneously using innovation to push our industry forward. Ironically, the word innovation has no evidence, so you have to understand how to fuse that ethically, properly and medically. The third piece of this is a very robust and dynamic team. We are talking about that third element here: the culture that you create. How you do that has to be intentional. When you come to the midwest meeting, for example, people come for two reasons: to learn and to network. You have to embed in your culture - for MRSi, we do very targeted things to get people to loosen up, to feel vulnerable in front of other people, laugh with each other. And then you get this vibe at the meeting, in our Vios team: what do you want to get out of it? For me, it is love. It is this idea of education, as Nelson Mandela said “the most powerful way to change the world is to educate.” So, what do I do to educate my team members about all of the things that are important to us at Vios? These values: we want to have vision, we want to be innovative. Teamwork: one plus one equals three. Synergy: super powerful in an organization. Be passionate about it. People are starving to be inspired. What do you if you want to build this into your organization as well? Plug it in. Schedule it. You’re not going to do stuff if it’s not on your schedule. Sit down for an hour with your team and say ‘okay, we need to teach our nurses and team members something.’ So we do huddles, quick ten minute meetings. You don’t want death-by-meetings, but you also have to plug in crisp, clean concepts of education. We do that in our organization. We’ve adopted Lessonly, which is a really cool technology, to say ‘here is how we are going to do this IOI,’ for example, and then the Lessonly will follow and everyone has to take this quiz online. So you’re reinforcing the education. If you have any kids in school, one of the big theories of education in 2019 is Spiral Learning. Spiral Learning means you just keep coming back and it just keeps coming into the organization. A lot of leaders forget that you can’t just send a random email into the outer space and everyone suddenly has learned what you said in that email. ‘Here’s how we are going to do something.’ Yes, that is just the preface of your book. Now you have to say it, you have to do it, you have to teach it, you have to come back to it. That’s Spiral Learning - the repetitiveness is critical to your culture and to getting people educated. I said ‘love,’ what I mean by that is: supporting each other. What do you want to be when you grow up? You’re fifty, you’re fifty-five, you’re sixty - what do you want to be? What’s next in your life? Supporting people to become the best person that they can be, without sounding too corny about that, that’s part of the culture that we create at Vios.

GJ: Which you do because that’s just who you are. I see that in a lot of different areas outside of just business. I’ve seen that in social events for charities that I’m involved with, that I’ve invited you to, that you’ve come to because that’s just in you because in your company it’s top-down. In my company, I feel confident in saying, it’s top-down because that’s who I am. There might be others where that’s just not the person at the top, they might realize that. Does the culture have to start from the person who is in that CEO seat, or at least in the founder’s seat? Can it be hired? In other words, if there’s somebody that’s running the company, and they know that’s not them, can they hire a Chief Human Resources Officer? Or is it not replicable?

AB: Yes and no. The yes part is: everyone will have their own signature, their own style. And their own way of portraying these core values. That’s really cool because you get the same thing but in a little bit of a different flare. There’s a famous quote that says “the fish smells from the head first.” The head person must continue, in their own way, to embody this. Some people are shy. Some people may not always do the example in the same way. But they have to do it in their way. They have to use the words ‘Griffin, you are important to me and I want to help you be amazing in your job.’ Everyone says that in their own way, but that has to be part of the leadership and their behavior. Simultaneously, there are going to be people that are a little bit more dynamic about that. That’s really cool too. Whether you’re outgoing and really fun and you do that, you still want other people to do it as well. Letting them push forward this culture, because your culture is young. I described our Vios culture as making Jello. If you’ve ever made Jello, it’s really important to stir. You’ve got to keep stirring it, otherwise, it’s going to get gooey on the bottom. In your organization, even if you’re an old organization and you want this new vibe, you’ve got to stir it and constantly, every day, go in to stir this idea. Then, once you put this Jello in the refrigerator and it sets, that culture is set. Habits are set, good and bad. The way people dress, the way people have their hair, what shoes they wear: all of this is malleable, but once you allow that to set, those bad habits or that bad culture can be very difficult to undo. My point is that we have to be very intentional and stop the noise for a minute. Put in your schedule from now until the next six months and the next twelve months, scheduled events and scheduled meetings. Not only for key players in your organization but with the whole organization, so that you have opportunities that are blocked to quiet the noise and send this message forward.

GJ: Because I think this is where a lot of people are running into the issues with Millenial employees, Millenial patients, we’ve talked about this. Your Director of Operations, Hannah, was on the show earlier in the season.

AB: It was great. You did a great job - thanks for having her.

GJ: Vios is not really having an issue in the sense of hiring millennial employees. Not to say that there aren’t challenges, but you have a lot of Millenials that are really enthusiastic about working for you and so do I. The take away from our show, for anyone that didn’t listen to that episode, is you can get a lot out of Millenials. While previous generations tolerated poor cultures, millennials just won’t. I don’t expect any successive generations to either. Now that Gen-Xers and baby boomers have tasted a little bit of that, they are more demanding of a good culture as well. It isn’t just within your own organization - I cannot stress enough that it touches everything you do. In other words, we do have a client - we have a few - but I am thinking one particular client, just has a great culture that’s so authentic to them. My project manager said to me last week “I just love working for them so much. I feel like I have to do a good job for them because they’re so great and I feel like I work for them. I want to see them succeed.” I thought: Yes! That is the core of a good culture. I certainly want my employees to think that of me and of our company, but also to think that of our clients. People that we work with - whether they are vendors or strategic partners, or experts that we hire - they need to think that way also.

AB: Yes!

GJ: So I want to wrap up with saying: where do you see this going for those that are maybe on the fence? I do see a group, Angie, that what we are speaking right now might as well be Ancient Egyptian to them. I think there are a few that are already off to the races, like yourself. And then there are probably some more, and I don’t know how to break up any of those percentages, but there’s probably a third group that could go either way. How would you conclude in talking to that group about culture? Where they know it’s important somewhere inside of them, but have not really invested in it yet and probably won’t unless they get a little bit of a fire lit up under them.

AB: I think I have two things that resonate with me and your question. One of them is today’s consumer and employee. The consumer, in this case, is someone that is the employee. The young, vibrant employee. That person also could be simultaneously the same kind of person as your patient. Dan Nayat, who’s in Toronto, and I were talking and he said: “this is now the field of transparency.” And I am going to take that and say it’s a culture of transparency. We live in a place today where there is so much more access to information because we live on the screen. Whether it’s LinkedIn, whether it is Indeed, where you can rank your employer. Your employees are being judged, but your employers are being judged. With places like Yelp and Google that talk about what happens in people’s offices, what staff member drew their blood. No one talked about that before. So this younger person is starting there. For some of us, we entrance-ramped, we fused into this. But there is a group of people that don’t know anything else but this. It doesn’t really matter how old you are: transparency today is something that is so completely mind-bogglingly different element to our fertility practices.

GJ: There’s nowhere to hide.

AB: Number two, and you better know that, right? With even how you market yourself, social media, live, Instagram: you’re there, front and center, whether you like it or not. That’s very different and you’ve got to understand: it ain't going to change. One way or another it’s your kids, it's your spouse, it’s your work and your play. Transparency involves technology and that technology will begin to infiltrate very rapidly, you’ll see, in the next year. This idea of Artifical Intelligence. You know where your Uber is. You know what time they are going to pick you up. The seamless transaction: you walk out the door of the car and you shut it, there’s no cash, there’s no credit card, there’s no signature, it’s all seamless.

GJ: I don’t want to interrupt your thought, but you just hit on something that I wouldn’t want to let you walk away with without commenting. People know that this is happening, they’ve seen the Uber takeover. They’ve seen how they said twenty years ago they said they would never enter their credit card into a computer, and now they use it for everything at the press of a button on their phone to acquire just about any consumer purchase that they use. But they are very often, many people - not just in our field, are very often resistant to apply that to their own business. As though we are somehow immune or as though it’s not just a question of time, so they want to put it off for as long as possible, even though there is no putting it off. Why do you think that is?

AB: Well, it’s coming. What will happen in the next year to three years, this technology, this infusion of that idea will enter with the ‘tomorrow tank,’ a robotic artificial intelligent place to keep our cells safe. As a consumer of that, to be able to see on your phone what temperature that embryo is at, whether it’s on a vertical positioning, and that it’s safe. Just like you do with your kids that are sharing their location. This idea of transparency is going to infuse into our business and the customer will demand it, and so will standards. The other thing is that when you hire people, and understanding this difference between loyalty and giving people wings, that there is a little bit of insecurity of trying to keep people contained. I would argue that you need to give people in the organization your trust. Not to say you don’t micromanage - because micromanagement can be a little over the top, and yet get out of their way and let them do an amazing job. Allow loyalty to supersede insecurities about trying to tie people into a certain position. Where we look at the culture, relationship-building with strategic partners, like you, and being thoughtful about your future - whatever that is. Future valuation is always good to know that you’re a valuable player in the marketplace, even if you stay as you are.

GJ: Very well said, Dr. Angeline Beltsos. A good friend of mine and somebody that I look to for example in the field, founder of Vios Fertility, thank you for coming on Inside Reproductive Health.

AB: Thank you!