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If you’ve ever tried to get doctors, embryologists, and executives on the same page…you’ll want to hear this one.
In this episode of Inside Reproductive Health, Dr. Alison Bartolucci (CSO) and Cara Reymann (CEO) of First Fertility talk candidly about leadership, lab management, and network-wide decision-making.
They discuss:
– The emotional cost of leading a fertility network
– When to build consensus (and when to just drive the bus)
– The decision to implement digital witnessing across all nine IVF labs
– The “magic question” Cara uses to align stakeholders
– Why First Fertility abandoned plans for a single EMR
– Why Alison swears by using a lab monitoring service (and the business benefits beyond happy embryologists)
Alison Bartolucci Trusts This System. Here’s Why…
When a refrigerator failed, XiltriX caught it immediately - saving the lab.
“Their customer service is second to none. When we needed help, they were on a plane getting us hooked up and troubleshooting right away.” -Alison Bartolucci, Chief Scientific Officer, First Fertility
With 24/7 live monitoring, automatic escalation alerts, and a dedicated response team, XiltriX gives IVF labs an extra layer of security others don’t offer.
Request your free demo to see if your IVF lab can benefit from the same advantages. In your free demo, you’ll receive:
A tailored presentation focused on your lab’s priorities
A live software walkthrough
Real-world IVF case studies
An overview of XiltriX’s 24/7 SafetyNet Team
See why Alison and her team rely on XiltriX to keep their labs safe.
👉 Request your free demo today!
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Cara (00:00)
How you manage people's expectations can really determine success or failure. We want alignment, but we also have to be realistic that we're not going to get a hundred percent of people on board a hundred percent of the time. And so this idea that there will be times that we have to disagree, but commit is important because what matters is what are we trying to accomplish and does that accomplishment represent, a step forward for the organization, even if it's not the way that you see it.
Griffin Jones (00:41)
Ruling fertility practices with an iron fist. That's what I'd do, but I can't get doctors to come work for me for reasons that are probably unrelated. So I talked to two people for whom fertility doctors and embryologists do actually work. And we talk about when and how to build consensus and when and how to say this is the direction the bus is driving in. I think it's the first time I've had the CEO and the CSO of a fertility network on at the same time. I've wanted to do it for a little while. And because of Ms. Cara Reymann and Dr. Alison Bartolucci from First Fertility, I think we'll do plenty more of it. They share the emotional cost of being a leader, the network wide decision to implement digital witnessing in all nine of First Fertility's IVF labs, the relationship between the clinical business and lab executives, including Alison's and Cara's. A magic question. I'm the one calling it that by the way, that Cara asks. to get stakeholders on the same page about an issue. Cara's decision to abandon a mandate to implement one EMR across first fertility. Why Alison thinks the customer service of a lab monitoring service called XiltriX is so phenomenal and the business benefit of that beyond happy embryologists. And Alison's approach to building rapport with her embryologists and lab directors when they were at first reluctant to open up to her.
Each Dr. Bartolucci and Ms. Reymann deserve their own interview. Don't worry, I will. In the meantime, enjoy this one.
Alison Bartolucci (03:11)I think Cara and I, you know, share the same vision. And that's why when, when, at least when I met her, I was so excited to have the opportunity or the potential at that time opportunity to really have a seat at the table as a lab representative, as a lab director. And our interactions are sometimes very formal and have a clear mission. Other times it's more casual, but I would say all of the above. We talk on the phone, we text, we meet once a week, we meet with other executive leaders, other lab leaders. She's very much in the trenches as am I.
Griffin Jones (03:51)
So a good interviewer would have looked up who the chief medical officer of First Fertility was first before asking this question, but let's pretend a good interviewer was asking this question. Are you doing it with your, is it always CSO, CMO, CEO at the same time, or sometimes you're having one-to-one meetings? How does everybody come together?
Cara (04:14)We don't have a chief medical officer. So what we do have is a medical advisory board and we meet with that medical advisory board on a monthly basis. And so other executives in the organization participate in that meeting. And it's really the opportunity to shape the direction of the organization clinically. We really let the lab and our scientific partners as well as the physicians shape the agenda for that meeting.
And then our administrative team is there to add contact support, take away, know, thoughts, ideas, make sure we can execute on some of the things that they talk about. But it's been a journey over the last two years to really build that part of the organization. I came to First Fertility in 2023. We did not have active teams in these areas at that time.
So it was one of the first things that we tried to organize around was, what does our medical leadership, clinical leadership look like? What does our scientific leadership look like?
Griffin Jones (05:18)
There wasn't a medical advisory board at the time you joined, Cara?
Cara (05:22)
There was not. There was an idea of one. There was not a formal cadence of meetings. There wasn't a lot of engagement around that. So I think the foundation was there. And then it was just, how do we actually make it meaningful? And really, what do we want that group to add? What value do we want to learn from that group? What value do we think we can bring to that group?
I'm very pleased to have a very engaged group, both with the Medical Advisory Board and the lab, and really pleased to see that they come to the table with ideas that, you know, their own. do a journal club, think. What is it, Alison? Once a quarter, the Medical Advisory Board meeting, actually, rather than just being a board meeting, it's a journal club. That was the idea of one of our board members that leads some research in one of our centers. So...
I think all around it's created a culture of engagement that has created a lot of camaraderie and great value, just professionally, but also for the organization.
Griffin Jones (06:26)
How did you decide, how did you all decide on that structure of having a medical advisory board as opposed to, or as opposed to and or a chief medical officer?
Cara (06:35)
Yeah, it's a good question. I think it's an evolution. think for sure as we grow, a chief medical officer is something that has been on my radar and I have a desire to pursue that. But I think we were still trying to learn who we were as an organization when I joined. And this has given us some room and some space to get to know each other, to understand what everybody's priorities are.
to really build our own priorities as an organization. And also we grew really quickly. We almost doubled in size just in a single year. So there was a lot to work through, adding as many new team members into the mix during that period. So one step at a time, and I think we still have a lot ahead of us and are still looking forward to this landscape evolving and our leadership evolving.
Griffin Jones (07:27)
So it's part of the evolution. Alison, do you have a scientific advisory board or are you ruling the labs with an iron fist?
Alison Bartolucci (07:35)
No, that's not my style. And again, like that was something that ⁓ Cara had envisioned and really formalized as well as creating this laboratory advisory board where the lab gets to come together, the lab directors and even the lab managers as well come together once a month and they are deciding what's important. They're deciding the policies that they want to have implemented across the network. They're deciding what
vendors they're going to align with, things that are important to everybody. And they're making the decisions and they're making the plans on how to execute on them. What was really exciting for me was that I feared that as we came in as First Fertility, there would be resistance from the lab.
I was initially a little bit nervous about how they would embrace being part of First Fertility, being part of the advisory board. I have to admit, it was a little bit quiet in the beginning.
a lot of me talking and crickets. But over time, we really formed these relationships. And what was so telling to me was that everyone actually was really looking for this opportunity to have a bigger community. By design, the lab is, if you think about the physical IVF lab, if you've ever seen one, they tend to be completely. Exactly, yeah.
Griffin Jones (09:03)
Not much bigger than a prison cell. I'm pretty sure Scandinavian
countries have bigger prison cells than most IVF.
Alison Bartolucci (09:09)
Yes, there's
no windows. It's on purpose, isolated from the rest of the clinic. And what happens is that physical isolation kind of drifts into the cultural isolation. So to bring everyone together and sharing these tales of woe, but also shared experiences, it's become this broader community that they
ask each other, know, they ping each other when they have questions or it's been really great to watch it unfold.
Cara (09:43)
Yeah, and I've watched this evolution. And I warned Alison that these first meetings, it's always going to be very quiet. I think people are wanting to know what to expect. They're afraid to engage. And I told her, just keep moving forward. Keep developing a agenda or a forum where people can speak up.
And then the more they do it, the more they'll speak up. And so I don't attend all of the lab board meetings, but I like to drop in periodically. I do that to everybody. I don't know if they love it or hate it, but I learn a lot from those interactions. And it is remarkable. It's remarkable to see how enthusiastic that team is. It's remarkable to see how much candid conversation they have with one another. And Alison and I, some of our conversations,
you know, have been, you know, hey, I had this meeting with the lab board, it did or didn't go as expected, you know, what were your thoughts about what you saw? So I think a lot of leadership is just being reflective and unpacking, you know, okay, I took this approach, did it work, it not work? You know, what might have worked better? And that's why I try to spend a lot of my time because I think how we engage with each other matters. And then, you know, it becomes
It creates that momentum for more engagement.
Griffin Jones (11:01)
Alison, when you were having a bit of one way conversations in the beginning, do you think that was because people were thinking, this, she's just going to make us do it her way that this is, they weren't necessarily seeing it as a First Fertility team yet that here's Alison, she's from cars, she's from Yukon system. and so like,
That's her way of doing things as opposed to our way of doing things. that why you think there was a bit of trepidation in the beginning?
Alison Bartolucci (11:36)
Definitely. Definitely in that, you know, almost all of us are total introverts and shy by nature. So that those two things combined. Absolutely. But I think, you know, and that's that's how I felt. You know, that's how everybody feels. And it's completely normal. But, you know, I I think that once the realization occurred that I just like Cara had brought me in to have a seat at the table for First Fertility, I was bringing these
people in to also have a seat and to really voice their concerns, their perspectives and really make a difference in First Fertility, but that translates to the field as a whole.
Griffin Jones (12:19)
Looking back, do you think of any things that you might have been able to do to speed up that process? Or is that just the nature of rapport building? It takes time. It takes you just showing up, doing it, them seeing that they can trust you. Are there any things that you look back at and you think, maybe if I had introduced this practice, I could have started to get the ball rolling a little bit more quickly, or is time just necessary?
Alison Bartolucci (12:47)
No, I mean, I think, I mean, we're in different, we're in completely different locations. I think, you know, when you were first asking me that, the first thing that came to mind was like, well, yeah, if I was with them every day and working side by side, like I used to be as a lab director, but that's impossible. Cara really was the one who encouraged me to meet with them individually, one-on-one. So that process evolved, I think.
if I had been more maybe proactive about meeting with them one-on-one, maybe we would have expedited that process. But overall, I think the way it unfolded was very organic and contributed to the success.
Griffin Jones (13:26)
what have the consequences been of the prisoners getting together? Have the riots started yet?
Cara (13:30)
I know you always wondered.
Yeah, exactly right. Will the inmates run the asylum?
I think the way that we manage expectations is, you you have to be realistic. You're working with groups of people and not just the lab group. you know, everybody wants the outcome that they want, right? But that outcome has to be delivered in the context of a very dynamic environment. So, you know, the lab team might want one outcome.
the physician and clinical teams might want a different outcome. The network of First Fertility might want yet a third outcome. So How you manage people's expectations as you kind of move through those exercises, you know, can really determine success or failure. I think we try to message at every step of the way that, you know, we are seeking input. We want alignment, but
We also have to be realistic that we're not going to get a hundred percent of people on board a hundred percent of the time. And so this idea that there will be times that we have to disagree, but commit is important because what matters is not your opinion or my opinion. What matters is what are we trying to accomplish and does that accomplishment represent, you know, a step forward for the organization, even if it's not the step forward, the way that you see it.
you know, helps people at least be able to feel like, okay, I got to have a say. And more importantly, can you understand where somebody else is coming from? I have this conversation a lot. I've had to have a lot of difficult conversations and I try to tell people, you know, my commitment is you may not always agree with me, but I want you to understand. And I think when you give people those opportunities, you know, everybody in the end,
is generally a reasonable person. And if you can just establish that respectful culture where feedback is not only sought but appreciated, then I find it easier to kind of get through those difficult conversations where there's kind of multiple different goals and personalities and desires at the table.
Griffin Jones (15:42)
That's what makes it hard being in that top seat is that you've got multiple constituents and those needs are sometimes at odds. Your job is to find out where they aren't at odds and to bring them together. But that does require some people to focus on some of their needs more than others or getting them to see the value in the bigger picture. Can you think of a specific example? And you might be limited into how much detail that you can go into, but to the extent that you can.
What's a specific example you can think of where you had to have one of those harder conversations?
Cara (16:18)
can think of many. ⁓ But we've done a couple of things over this last year. We implemented the electronic witnessing system, which Alison can talk more about. But we went through a thoughtful process of how we evaluated the different products that were on the market, what we felt was going to serve our goals and needs. And the word that people like to use, and I never let them get away with this, by the way, and I think it's part of a healthy culture, is people like to show up and use
Alison Bartolucci (16:19)
Thank
Cara (16:45)
you know, sometimes some language that's not always productive, like, you know, just tell me if this is a mandate. Is this a mandate? Because if it's a mandate, then, you know, we'll just do whatever you tell us to do. And, you know, I just don't let people get away with painting it, you know, with that broad of a brushstroke. We all agreed that pursuing an electronic witnessing system was material, you know, to the quality of the services.
and the risk management of the organization. And that's what it's about. It's not about whether or not it's a mandate. It's about whether or not this is technology that makes us safer and creates more value. And if that's the goal, then it just comes down to, it going to be product A or product B? And what does it mean in practical reality when we have to actually implement and use those products?
I try to do my part in keeping people's perspectives coming from the right direction because you definitely, I think, get some of that language and verbiage. But Alison can talk about the process because we also learned a few lessons in how we went through the exercise. And we were communicating in one channel and maybe needed to communicate a little more broadly and in a little more detail to other channels so that they could also
be brought along and understand. So, know, Alison, maybe you can share some of your lessons learned there.
Alison Bartolucci (18:15)
So, I mean, that's actually, it's a good example because the, I was really patting myself on the back about bringing the lab board in and letting them kind of vet the vendors and the products and then make a decision as a group, which they did. And it was really a wonderful process. And the whole point was that, you know, to Cara's point, I mean, it's not about being a mandate. If it was, that's not, that's going to defeat the purpose of
implementing these systems because if they're not embraced and used as part of the daily operation of the lab, then there's no point, then you're wasting your money. So, you know, it was this great process, but I kept it very much, you know, contained within the lab people, you know, the lab directors, lab managers, the embryologists, the andrology technicians, but, you know, I was really proud of how much I was communicating.
But the one piece I didn't think about was like all the administrative people and the center leaders totally in the dark. And when we kind of just made the announcement, yeah, it floored me. I was like, well, what do they care? But yeah, it does affect them substantially. It's their budgets. They actually have to use the systems as well. And also just having
transparency and visibility into what we're doing is key. And again, that helps.
Griffin Jones (19:43)
Let's spend
a little bit more time on that. might sound like the minutia of one particular example, but I think it illustrates the principle that a lot of people are going through. What are some of the, because I probably would have shared your default point of view, which is what do they care? We're doing witnessing in the lab. What does it matter to these admin folks? What were the downstream implications that mattered to them?
Alison Bartolucci (19:58)
Yeah.
I don't want to waste their time.
You know, I think at the very core, was just that they were kept in the dark. And I think that is important for me as a leader to understand that people, you know, fear what they don't know. And I think we all do this. You can kind of construe all these imaginary conspiracy theories in your head as to what people are cooking up. And so the fact, just the mere fact,
that I was not sharing this with them was, I think, the most egregious. But really, was, I think, from a real practical standpoint, just knowing, understanding what it was, what they were going to need to prepare for from a logistical standpoint, how they could then support their lab in terms of
purchasing consumables and budgeting and expectations and.
Cara (21:02)
Yeah, there were some downstream things that
were fair when you think about, who needed to know? There was a budget implication, because obviously you're purchasing a system. You can't bill for that system, and so you're absorbing the cost of that system. There was some installation that had to happen in terms of hardware, software, devices. I don't know all the details, but there certainly was an element of that. So then it's like, OK.
How do you schedule around that, especially in a busy laboratory where you're trying to do your day-to-day work? I do think there's some point of entry that maybe happens across different team members. So now it becomes a workflow consideration. And then it's timing, who's going first? And you learn something every time you do an implementation. So it's always like, OK, you've got to get one under your belt. What do you learn from that? Then you move on to the next one.
You know, they were really fair considerations across all of those things. And to Alison's point, you you can think that you're doing everything right. And listen, we could have a whole podcast about how it would be so much easier to just run things with an iron fist and say, we're doing this. This is what it's going to look like. Move along. I mean, we could move so fast. ⁓ But what you do when you approach things that way is you lose the goodwill.
Alison Bartolucci (22:01)
Hahaha.
Cara (22:18)
I think eventually maybe you can get it back because if these things then prove themselves out and everybody ultimately comes around and says, yeah, this is better. That's great. But like, man, the friction, the goodwill that you have to try to push through is really difficult, can be very damaging. So we choose to do the hard work upfront, which is to be engaged, to welcome opinions. But we're not going to be perfect. In this instance,
you know, we had to take a step back and, know, tell us this point. She was really proud of the process that she ran and she did get some harsh feedback when she shared that we were going to be doing this, expecting it was going to be so, you know, well received. And she called me and was like, man, I'm a little caught off guard. And I said, well, and you know, I'm here to give her the perspective of like, okay, well, if you think about it from this perspective, kind of, you know, then you can understand where that might be coming from. And she said, okay, you're right. I didn't think about it that way. And it's like,
The great thing is, you can just go back and fix that. It's not like you've lost that opportunity forever, right? Like you just pause and say, hey, I listened to your feedback. You're right. I should have been shared more information sooner. Let's do it now. And then we'll get there. And that's what we did in that circumstance. I think how many more do we have to do, Alison? We're almost done.
Alison Bartolucci (23:37)
Just two.
Yeah, two more left. Nine.
Griffin Jones (23:41)
Out of how many labs?
So I want to ask about when you decide to do something across all nine labs versus when you decide to do some things at some labs, because I imagine there are things where it's more important to do it across all nine and others where you can do it this way or that way. know that at some of the labs that you use, I think you use XiltriX. I've had people like Dr. Jindalhan seem to really like it and
People like Dr. Shankman seem to really like it. What do you use XiltriX for?
Alison Bartolucci (24:15)
So we use XiltriX in a couple of our labs. It's the main alarm system for one of them and will be for ⁓ one of the ones that's sort of under construction right now. I remember Dr. Jindal talking about the customer service and I second that comment. It is second to none. actually the lab that
we have it installed in currently needed something kind of urgently. And they were, I mean, on a plane getting it hooked up, troubleshooting. In fact, this is a great story that I kind of forgot actually. They put ⁓ a temperature probe in one of the refrigerators that was in there and they called me and they were like, I think this refrigerator is dying. And I was like, ⁓ that's a coincidence.
You know, like you just put something in there, blah, blah. But we looked at the data and it's true. Like the temperature was like all over the place. And I mean, literally, as soon as they installed that, they were saving our butts. So they are exemplary. I do like they, one of their features that I think puts them apart is they have, you know, the
The alarms will call the lab people and there's a phone tree kind of like what you would expect. But if none of the lab people respond, it goes to them and they're there 24 hours. And I think that's a really nice measure of security there that others don't offer.
Griffin Jones (25:45)
I want to come
back to that principle of customer service. I want to not lose the other question I wanted to ask about when you decide to do something at the network level. So for example, for witnessing, you could have said just some of our labs should have witnessing. Sounds like you all came to a consensus and decided that it's material to the quality of the work to have all nine labs have electronic witnessing.
What, how do you decide when something should be done at all nine versus this lab can decide for themselves?
Alison Bartolucci (26:18)
Well, with the witnessing, know, it was a unique opportunity to really align on something because none of them had anything in place currently. you know, understanding and identifying that this was an important technology that I think we all, everyone can agree is crucial. And then saying, so none of us have it and we have an opportunity to all have the same thing.
So that was how we approached it there. Now, when we look at other systems, like alarm systems, for example, they all have alarm systems. So it's a little bit different. So it's like, as you're looking for new systems, here's what we've recommended from the network standpoint. Here are the people we have good experiences with, but we're not going to sort of fix something that's not broken.
Griffin Jones (27:06)
So
one part of the criteria is, there a blank enough slate? But is there also a criteria of need? Like, so for example, let's say they were all using, you know, some were using this kind of time lapse or that some were using this kind of alarm or some were using this kind of oil and media or some were. At what point is it, or maybe there isn't one.
Alison Bartolucci (27:10)
Yeah, right.
Griffin Jones (27:25)
is to say, not just is there a blank slate, but one in any one of these categories is clearly so much better of a product or maybe so much better of a practice than the others that we've got to standardize this across the board.
Alison Bartolucci (27:38)
Yeah, and I'm not sure, you know, there's so many great products out there that I don't know. I don't know if there's anything that's not really subjective, you know, in terms of this one is better than the other. But what we do again, the lab board together with me is we establish criteria like you can use you can use whatever media you want. But this is how you know, this is what your blast.
This is what we've established for benchmarks for blastocyst development for fertilization. So as long as you are operating within these guidelines, that is sufficient. So I think the approach that we've taken is to say, you have the autonomy to some extent, but we all have to be meeting these standards together.
Griffin Jones (28:26)
Cara, that doesn't drive you crazy as a business person to have different labs in different clinics, ordering things, doing different things. And if I can say so, I think First Fertility has a reputation of being on the spectrum that allows for more clinic autonomy. And I think that might mean for more lab autonomy as well. So if there's a spectrum, maybe on one end of the spectrum, you've got, I had Dr. Kishitz Murdi on from Indira IVF in India. He's like, I hired 250 docs.
who are all younger than me, and I tell them exactly what protocols to do. It's more democratic in coming up with the protocols, but those are the protocols. You don't do other protocols. And as a business person, I'm like, yeah, I like that. But you all kind of have a reputation of being on the other end of the spectrum where you let this clinic decide and that lab decide. And I don't know that situation too intimately, so maybe I'm making that up. But Alison seems to...
Alison Bartolucci (29:07)
my god.
Griffin Jones (29:23)
be providing some evidence for that. doesn't drive you crazy as a business person. Just say, let's let's come up with these things. So we're all buying the same thing and following the same processes. So it's easier to have a scalable business.
Cara (29:36)
Yeah, I wouldn't say that it doesn't drive me crazy. I would say that I'm a very practical person at heart, and I also am very committed to a long-term goal and vision. And I know precisely how to make progress along that timeline. And sometimes the best way to make progress is actually to move a little slower so that you can build the trust.
Get people's, know, build consensus, get people's buy-in. You know, what you're seeing with First Fertility is that we are moving closer and closer to looking alike, but it's by choice. It's by choice because we've done things one at a time. People have seen the value of those things. And now when we want to do the next thing, their experience is such that, well, the last time we did this, had a good outcome. Maybe it wasn't a perfect outcome.
⁓ But they're more trusting in that next decision to do the next thing. And so what I expect to see with First Fertility is that we will accelerate on that journey. But I also believe you don't have to have everything look exactly alike. I remain probably one of only clinics that doesn't have, I mean, big networks that doesn't have a single EMR. When I came to First Fertility, there had been
a mandate as I was informed that everybody would move into the same EMR, that EMR had been selected, and there was a complete uproar across the organization about that decision. And, the first thing I did
in my role was to just say, hey, I'm going to pump the brakes here. I need to learn a little bit more about this decision before I'm ready to commit. I do come from a background. I worked for a company for 12 years. I went through the process of that company moving on to a single EMR, but it was a different circumstance. That company came together under a single tax ID. That's typically not the case in networks. You don't have single tax ID. fertility is not a space that has matured.
in its technological advancements and applications. And so it's somewhat risky, I think, to move too quickly in forcing some of these changes at a network level, because the field, the technology hasn't matured to that point. For me at that time, I was less, I had less of a desire to force physicians to make
clinical workflow changes than I did to just have access to the data that I needed the way that I needed it. And so the way that we kind of compromised early on in First Fertility was to say, like Alison said, look, we have to meet certain criteria. Some of that is our criteria and some of it like is imposed upon us just regulatory criteria. And I said,
You know, look, clinical decisions are your decisions. I respect the tools that you want to use for your clinical practice. But the administrative decisions are my decisions, are our decisions, and for fertility and, you know, the administrative team. And we need the tools that we need to do that work for you. And so we'll select those tools, right? So I'm not going to select your tools, but you're also not going to select my tools. And kind of once we looked at it that way, everybody thought, that sounds OK.
So we've moved into a single billing system. Same thing. We'll do our last installation in the next month or so here on that billing system. I knew that the network was going to naturally move probably towards a single EMR. We're down to, for all intents and purposes, two EMRs in our network. I don't doubt that our journey eventually gets us there. But again, it will get us there, I think, in a more organic way. And I think that will be healthier.
Griffin Jones (33:18)
Let's
talk about that overlap for a little bit because I ask every CEO that comes on when every CEO says we don't make clinical decisions for our doctors, we don't tell them what to do. And everybody except for Dr. Murty has pretty, pretty much said that. And I don't think that they're being disingenuous. I think that that's the way they view it. I just don't think that they fully really appreciate the overlap between administrative operations and clinical operations and that if I
If I'm saying, okay, here's the pharmacy that we're using guys, you might think that's an administrative decision, but not entirely. That does impact what works with nurses. Or if I say, here's the patient software that we're going to use, the patient education software that we're going to use, that impacts how well patients are informed and they go through treatment and they might sound like administrative decisions.
And again, I am a person that I like standardization. I don't think it's standardization is always good or always bad. These are trade-offs. But I do think that you're pointing to something, the MR being good example where there is that overlap between admin and clinical. at the end of the day, somebody's got to win. And in this case, you were willing to say, all right, we're just going to do the billing part and you make the decisions on the clinical side. But doesn't, isn't.
their attention there.
Cara (34:43)
always, the way that I handle that is you gather the information holistically. What happens on the admin side? What happens on the clinical side? And then you look at it, you actually just ask the question, tell me how we can afford not to do it. And that's a hard question to answer when you put the right information together. So that makes the conversation a little bit easier. And when physicians
finally get the opportunity to have dialogue around what it takes to be successful in the environment and support and provide everything that they want, they begin to understand that everything is a series of choices. And I'm perfectly willing to support their choices, but they have to tell me, you know,
how we can do that under certain restrictions or limitations because I'm always willing to compromise. But oftentimes, what you have to compromise, you're not willing to. So you have to go back and re-examine your decision and say, OK, I understand now there's many more moving parts to this than I realized. And it requires me to be more thoughtful or critical in how I'm looking at something.
⁓ And then we come back to the table, we have another discussion and you know, I have yet to be confronted with a circumstance and I've been confronted with some very, very difficult ones that I haven't been able to navigate successfully. That doesn't mean that everybody's walked away happy, but I think it does mean, you know, we've all been able to walk away and say, you know, that, okay, I'm satisfied, I can live with this because at least I understand it.
Griffin Jones (36:25)
Some people might not have an answer to the question, tell me how we can afford not to do it because it's not their domain. But does that question sometimes help people to see that there are implications that are much more broad for the organization than just their domain?
Cara (36:42)
100%.
Griffin Jones (36:43)
have you all and Alison, maybe you've come to this or maybe you haven't yet, but you've talked a little bit about the there's benefits to ruin, ruling with an iron fist, but there's benefits to consensus. And you've talked about the benefits of coming to consensus and hearing people out. But there are also downsides to that. And I think ultimately, good leadership is about building the skills
that allow you to hit the perfect spot on the X, Y axis. It's very, very hard to be perfect with that stuff. But I've definitely erred on the too much consensus in the past and realizing that I was involving people that it wasn't really their domain and they didn't really have consequences if the decision didn't pan out, yet they felt like they should have the say over certain things. that was a consequence of ⁓ poor management on my part. But I did see that
Cara (37:12)
you
Griffin Jones (37:36)
there is a way to build the consensus and then there's a time for saying, now we've made the decision and this is what we're doing. And there has to be a spokesperson for that. And that's the leader's job. So if you come to the point where you've gotten bitten from too much consensus or too slow to execution,
Alison Bartolucci (37:58)
Yeah, absolutely. I mean, somebody said to me once, you know, it's about giving everyone a voice. That doesn't mean that we are going to, that doesn't mean they have a decision, like they get to make the decision necessarily, but having a voice so that their opinion is heard is what is important. you know, yeah, I have certainly fallen victim to trying to get everybody's consensus, trying to...
to sort of like make everybody happy. And we all know what happens. mean, nothing gets done and everyone is unhappy. So, you know, I think, yeah, it's a learning experience. It was important to me to form relationships with all the lab directors. But of course, at some point I need to say, and have had to say, no, this is not a non-negotiable.
this needs, like for example, I mean, I'm not saying they were doing this, but we, know, some of the things that I have said are non-negotiables. There has to be, before we had electronic witnessing, double witnessing, there has to be, you have to be identifying patients and samples with at least two unique identifiers. The men have to be present when they bring their samples into the clinic. So there have been, and,
You know, I did get some pushback on some of those things that, you know, down the line. But those were things that I, you know, in my experience will burn you. that those are the non-negotiables. And these things come up all the time.
Cara (39:32)
This has been an interesting evolution for Alison and actually I've loved watching it. I think she and I had some conversations early on about the tendency to be too nice, to want to build too much. And by the way, you know this is a female thing, right? This is completely a female thing. The desire to want, to make everybody happy and to please people and we're wired.
to do this. And it really, I think, erodes our ability to be strong leaders sometimes, or to be seen as strong leaders sometimes, because you're too busy trying to please people. And you need to learn in those moments to be very clear and very confident in what you are willing and what you are not willing to either tolerate or accept based on what it means.
for the team or for the organization. And those are really hard moments. So I've been super proud of how Alison has really embraced her leadership skill and developed that. Because she certainly, I think, stepped into this a little more timid. This was her first chief scientific officer role. So it's always hard to step into that first role and show up in a way.
where you can walk into a room and have the command of the room. And she's worked very hard on it, and she's earned it with her team, and she's coming from the right perspective and direction. Sometimes you just need somebody behind you saying, why are you questioning yourself on this? Like, of course, this is the right decision and the right direction, and you just need to be clear about saying, like, hey, I appreciate your point of view here. You the rationale is the safety and the risk and all of those things, and we can't compromise on those things, and therefore, this is the process.
There does come that time when you have to draw that line.
Griffin Jones (41:16)
I think that you're hitting on the balance of mature leadership, which is the balance of agreeability and disagreeability. And it's not being infinitely one or the other. think after Sheryl Sandberg wrote her book, it was like, let's just be disagreeable. just, it's like, you didn't like that from the old guard. Why would you like it from a new generation of leaders? It's more about, no, there are times where you have to be disagreeable. And
in those times, you do it. And that's part of being a good leader. in those moments, like the examples you were illustrating, Cara, what I like to do is meet with the stakeholders that I know aren't bought in that prior to any group meetings individually, steelman their argument to them say, I understand this is important to you because of A, B, and C. And A, B, and C are important. We are going to go in this direction instead because of D, E, and F. And here's why I've got to
I've got to prioritize D, E, and F over A, B, and C at this time. It helps a lot. I run a very small company. I imagine that would be really, really hard to do in a bigger organization. What's the limit to how much you can do that in an organization your size?
Cara (42:26)
I would tell you maybe the unexpected answer is I don't know there's a limit in terms of you know number of issues that you can do that with but I will tell you there's an emotional limit. It takes a lot to invest in you know just building the consensus across an organization because you are personally like you said Griffin you are personally showing up you know you are personally you know there to listen and learn and and you are
giving that the airtime it needs and you're letting that inform your decision. And then, knowing you've put that much time, effort, emotion, care into something and know that you can never please everybody and there will always be people who no matter what are just gonna throw all the darts at you.
can be super difficult because you know how much you put into caring about, you know, making the right decision and giving people the right platform, but also knowing like you're going to end up at a student. It can be hard. And so the more that you're navigating that, you know, if you're doing three, four, five different things, yeah, it's super hard, I think, to absorb, you know, that type of feedback because we're all human at the end of the day and we all have good intentions.
⁓ We hope that we can align and you know end up at good conclusions. But yeah emotionally I would tell you is the limitation like how much can you absorb as a single person in terms of you know, just Heat, you know, and sometimes it's very personal by the way, right? Somebody's not happy and they can be very personal with that Yes, as long as I've been doing it
You know, I don't always have as tough of an exterior as I need to make it through, you know, kind of multiple different disruptive phases at the same time.
Griffin Jones (44:22)
When do you decide that, okay, we're beyond the point of having healthy debate and a consensus now somebody's this person's a saboteur, they're not letting this go forward. And therefore, we have to part ways with that person, because I've been there before, too. I want my team to bring issues to me, I want them to fight for what's important. And I want to hear them out. And I do that steel man steel manning. if they're if they're still fighting, I'd see like, okay, did I miss anything? But I don't mean to do this.
to say that I'm doing this infinitely. We get to a point where it's like, okay, I've still managed argument back to you. You're not pointing out anything else that I've missed. This is the decision that we're going forward in. And if someone were to keep fighting against that, I'm going to part ways with that person more quickly than I would have in the past. at that point, it's not about, you haven't heard the opposing sides. It's
that you have someone that is making a decision because they think they're at the top of the organization and they're not. When do you decide that this is somebody that you got to part ways with?
Cara (45:28)
Yeah, I think there's a dynamic that we have to acknowledge that is unavoidable, which is you can't part ways with doctors necessarily. I mean, of course you can, but you never want to get to that point. And that can be a major barrier. And so in those circumstances, what I rely on is the whole of the group has generally been very aligned. And so that's the strategy of look.
we're all headed this way. We invite you. We invite you to be with us. But if you don't want to be with us, that's OK. But you will end up alone. And then we just have to be OK with understanding. We can't bring that person along. There are certain things that, again, what do you tolerate and not tolerate? That we won't tolerate safety, quality, risk, things of that nature.
But generally speaking, those aren't the problems. And so we all just support each other and say, let's just keep moving forward because we can't let one person be an obstacle. On the administrative side, obviously, there's more discretion there. And Alison can maybe speak up for me here. But I believe I do a very good job of being very clear in setting expectations, not just
know, directionally, strategically for the company, but just culturally, right? Like there are things that we can do as a team and there are things that we cannot do that I will not allow because they do not represent the team that we're trying to build here. And everybody gets to have a choice, right? Like, again, you can come with us, you know, or, you know, you'll be left behind. And if being left behind makes you very disruptive to what we're trying to accomplish,
then we will have a conversation about what it looks like to be successful here. And I tend to try to handle those in a way that says, listen, this is what success looks like. It's your choice to show up and represent that because if you can't, you can't be successful here. And I've had that conversation in the organization and it means one of two things, which is you can decide that this isn't for you and that someplace else is a better fit, which is okay. Like listen.
There's no judgment, right? Everybody has a fit for themselves and this is not the fit for everybody. This is a super engaged team, like we're all in it together and that's not for everybody. Or alternatively, right? Like if you can't come along, I owe it to the team, actually. I owe the organization the best team and I have a strategy or I have, it's not a strategy, it's just my way.
I will fully invest in you as a leader. You get everything for me. You get one on one time. get, know, like call me when you need to bump something off of me. You know, like you will get it. And I will heavily invest in you. But if you can't come along and overcome the challenges that are natural to trying to, you know, step up into leadership, then there will come a time when I actually owe the team the decision. And I have to shift my thinking and my perspective from.
okay, what do I owe this individual in terms of supporting their leadership growth versus what do I owe the team in terms of the leaders that are leading them? And you never like to have to get to that point, but it is a reality. And if you're not ready to make those decisions, like you're just not ready to be in an executive position. It means making tough decisions.
Griffin Jones (48:45)
Alison, I want to talk about how that parlay's to your team and then how you help your team to make arguments that are that keep the organizations, the other needs in the organization in focus. So as opposed to just thinking of this is beneficial because it impacts my lane, here are other areas and not to pick on XiltriX, but you gave that example of XiltriX's customer service.
customer service is something where I could see a lot of executives, maybe even myself, if my team members were just like, but they have great customer service, I'd be like, that's nice. These guys are 20 % cheaper over here, or whatever it might be. Or these guys let us do annual terms as opposed to monthly or vice versa, or some other business consideration. That they would have to make it make sense from a business.
perspective. And customer service, I'm not just picking on Zilltrix. I do think there are organizations that have really, really good customer service out there that doesn't end up being as much of a competitive advantage as it should be. How do you make the business case for something like that? Why is that important?
Alison Bartolucci (49:52)
Well, from a customer service specifically standpoint, mean, the thing to keep in mind is that a lot of, know, Murphy's law is that these things that will happen in the lab will happen on a Sunday at seven o'clock at night and or on Christmas Eve or something. so customer service does end up playing a really important role because oftentimes the person that's in the lab, you know, either
needs help or doesn't understand how to work the, know, or something's happening with the equipment so they can't reach the lab director so they call the manufacturer. Or even like, even from a, you know, like for PGT, for example, like so many times we were like, I gotta call the lab. I don't know, like they didn't send me a box to ship the samples or they didn't send me a shipping label. And being able to like just pick up the phone and get in touch with someone.
ends up having a real material impact on the operations of the lab. I mean, I see your point. It can't be that like it's double the cost, but the customer service is a really important part because the embryologists, you know, it's not like they have somebody just sitting there answering the phone, filing paperwork. I mean, they're also in the middle of doing ICSI and performing important procedures. So they don't want to be stuck trying to get through to somebody and they want to
somebody that they can just count on to help them. Yeah.
Griffin Jones (51:20)
What is one thing that has really benefited you that the other person does or has done? So, I'll start with you. What's one thing that Cara does or has done that has been a big help to you?
Alison Bartolucci (51:36)
Well, in case you hadn't picked up on this, the concept of leadership has been transformative. And I've been able to, I hope, really convey that to the people that I work with. But I started this position thinking like, yeah, I'm a really good leader. I'm a lab director. I know what I'm doing. I am really good at ICSE and I can biopsy an embryo and therefore I am a good leader.
But there's a book and a saying that the skills that got you into this position are not necessarily the skills that are going to make you successful. And I think what Cara has brought to me in my professional career is that she has driven home the importance of leadership and that it is something that we can teach and that you can.
that you should be, or we all should be learning as we go and paying it forward to everyone else.
Griffin Jones (52:31)
What you, Cara? What's something that Alison does or has done for you that has been a big help?
Cara (52:37)
Alison's biggest responsibility is to ensure that she keeps her fertility out of the news. you know, we have an incredible group of, you know, centers and professionals that are part of the organization. And of course, everybody believes that they're doing all the right things. And yet,
Griffin Jones (52:45)
you
Cara (52:58)
Alison is able to spend time with those team members in those environments and immediately identify areas that people didn't even realize either were risks or were potential areas of affecting their lab environments. And who would even know that those circumstances exist?
if you didn't have somebody who was responsible for that. And so I'm thankful every day. mean, Alison got on a call with us the other day, one of our team meetings, and she was in her scripts. And I was like, oh, where are you today? And she was in the lab with the team. And so being able to have the visibility into those environments for the purpose of ensuring that we just understand what do they look like? Are they aware?
you know, of different developments that have happened or different standards or different risks, because who knows who they were trained by and, know, what did that look like for them? You know, now we're setting our own standard. And so, you know, I'm very thankful every day that I have somebody who is at the helm for us in that regard. And it just comes back to that appointment of the chief scientific officer role, which is if not that, you know, then then what you're relying on everybody's different perspective.
of what quality, value, risk, et cetera means. But now with Alison here, you get to formulate that perspective together and establish it together and ensure that it's consistent. And everybody then has an opportunity to learn from that. So she's also, again, just very much present with her teams. She's not just sitting.
in an ivory tower somewhere. She's traveling, she's spending time. She's developing leaders the way that I invest in developing our leaders in the administrative world. And I just think it makes for a good environment and experience and commitment to purpose for everybody.
Griffin Jones (55:07)
And now that I know that each of you are interesting enough to have your own podcast episodes, that's allowed now. We'll have each of you back on. You deserve your own shows because I could keep talking to each of you for a lot longer. Cara Reymann, Ellison Bartolucci, thank you to both of you for coming on the Inside Reproductive Health podcast.
Cara (55:12)
Yeah.
Alison Bartolucci (55:12)
Thank
Cara (55:25)
was a pleasure. Thank you.
Alison Bartolucci (55:26)
Thank you.
