115: Exploring the Role of Obesity in Fertility Medicine with Evan Richardson

Obesity plays an important role in the worlds of many struggling with conception, and in recent years the field of Obesity Medicine has grown substantially. Weight loss makes the fertility journey so much easier while increasing the quality of life for the patient.

Today’s episode features Evan Richardson, CEO and Founder of Form Health, a modern obesity practice that remotely connects their patients to dieticians. He speaks with Griffin Jones about a wide range of topics relating to obesity and fertility, from their complicated connection all the way to the future of subspecialties and medical health as a whole.

You can find the episode anywhere you stream podcasts or at our website.

Today’s Episode Focuses On:

• The role Of BMI in fertility

• The importance of medical subspecialties

• The difficulties behind sustained weight loss

• The future of subspecialty practices

• The relationship between obesity medicine and fertility medicine

Social Links:

Evan’s Linkedin: https://www.linkedin.com/in/evrichardson/

Form Health Website: https://www.formhealth.co

FH Facebook: https://www.facebook.com/formhealthofficial

FH Instagram: https://www.facebook.com/formhealthofficial

To learn more about our Goal and Competitive Diagnostic, visit us at FertilityBridge.com

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Transcript

[00:00:00] Evan Richardson: We're a fully virtual program. So everything happens through an app. Then those patients are talking with us almost every day.

We talked to on average, we talk to our patients every day, and that's just not a sustainable model for a traditional primary care practice.

[00:00:55] Griffin Jones: Today on Inside Reproductive Health. I hosted Evan Richardson, who is the CEO and founder of a new tech health startup called FormHealth. Before I get into my show with Evan today, my shoutout goes to doctors, Adam Griffin, and Mike Sullivan from Buffalo IVF, who are the reasons that I got into this field more than seven years ago now, starting from a small rural village in Bolivia for $500 a month, doing organic social media to now something that is unrecognizable to that venture. And so a shout out to those guys. I don't know if they listened to the show, but you have been telling people have been getting the shout outs because you've been texting them.

So if you call on those guys or if you're friends with them. Please text them, let them know that they were in this shout out today show with Evan. I know some people are going to be grumpy with me because they want to come on the show. I've got to be real protective of who I have on the show, because this is the media platform for REI and business people in the field and practice owners.

So I've got to be really careful most of the time, I don't let industry, side folks on, although sponsorship is a different option available, but I thought it was important to talk about the ways that tech can help us. If not triaged patients, at least help you treat the patients that you need to be treating, doing the things that you need and want to be doing.

And then letting more efficient solutions help with that, which you don't. So if I sound incredulous in this interview with Evan, just because I was trying to be a good steward of how you might be combing through their value proposition. I'm not a clinician. I did my best. So you can take a listen to this show with Evan.

He's been in the tech space for a while. The health tech space for awhile. He was an early employee at Castlight health. He's a member of the board of directors of bicycle health. He was part of the founding management team at grand rounds, which is also a telemedical concierge. And so he is now in this VC startup world very much.

And I hope you enjoy the show.

 Mr. Richardson, Evan. Welcome to Inside Reproductive Health. 

[00:03:25] Evan Richardson: Very happy to be here. Thanks for thanks for making time here. 

[00:03:28] Griffin Jones: I've got to tell you that I'm a little bit not looking forward to when this episode comes out for a reason that we've gotten, I've gotten very protective of the audience of this show in the last couple years, because now we're sort of the only media outlet for the business side of fertility, which has a lot of people asking me like, hey, can I come on the show?

Can I pitch this, or can we talk about this topic? And now, like, I also want to get to the point where we're in sponsorship mode. Didn't think that was the realm that you were in, but I just know that people that have asked me to come on are going to be like, what the heck why'd you let that guy on you didn't let us, I do have an explanation, but I, and I want to go back into the I want to start backwards a little bit before.

We'd talk about what form health is, but if we could start. Why fertility, what is the relationship to fertility? Then I'll get my answer and then we'll work back and then forth again. 

[00:04:29] Evan Richardson: That makes, that makes a lot of sense. So I feel like that, to answer that question, I can tell a little bit about form, which is that we are a concierge telemedical weight loss services.

So we work within the realm of medical support. We are we are a medical practice. We treat patients and we work with those individuals to meet their broader healthcare goals within the context of helping them to lose weight. And it turns out that weight loss can be really important for fertility for a number of reasons for a number of practices folks have a BMI cutoff and patients would come in above that cutoff can't receive certain services because risks because risks around sedation for other folks, there's a, you know, a real demand for surrogates. Sometimes the surrogates don't meet a BMI threshold that's required.

And then for the broad population you know, risks around risks around becoming pregnant and then carrying a child to term all go up as BMI goes up from from the sort of obesity level, which is a BMI of 30. We've worked with fertility practices now for for quite awhile to help them to bring patients into the realm of being treatable from a fertility perspective, BMI down below any sort of hard ceilings, they may have to increase. The number of surrogates that they have available. And then also just to improve sort of all of the outcomes related to fertility all by helping their patients reduce their body mass index. And it turns out that, you know, the relation between the relationship between fertility.

And BMI is fairly clear, right? All risks to becoming pregnant or to carrying a child would turn to come down as a patient brings their BMI back towards the sort of clinically normal threshold below a BMI of 30. And that's really where we help. That's where we work with fertility providers to help, to improve not all of their outcomes and broaden the base of patients and surrogates they can work 

with.

[00:06:29] Griffin Jones: What other subspecialties of healthcare, if any, are you working with? 

[00:06:34] Evan Richardson: Yeah, well, so that's a really great question. The answer is is all so, you know, we work with primary care providers. , we work with folks in the orthopedic space and then, you know, kind of everybody else, I would say those are the big the big four with fertility kind of leading the way for the sub-specialties that we work with today.

But we do have referring providers that come from, you know, the broad. Medical subspecialties, because there really is no area of care that at wherein outcomes and patient outcomes are not improved by helping those individuals with a BMI over 30, to bring that BMI down below the obesity. 

[00:07:15] Griffin Jones: Well, I don't really give a crap about those other subspecialties, but what I am interested is a little bit more on how you partner with clinics, but the reason why I was okay with having you on the show is because there a tremendous bottleneck in fertility right now there's simply more patient demand than there are providers to be able to treat them.

And we need other means to help. I dunno if triaged is the right word, but to help with some of the treatment that doesn't need to be going on at a fertility specialist so that the fertility specialist can do what only the fertility specialists can do. And so talk a little bit, but I also brought John because it didn't seem like, you know, you were necessarily.

That you had like this really, oh, I don't know deep monetized partnership with fertility centers. Maybe I'm wrong. How do you partner with fertility center? Yeah. 

[00:08:12] Evan Richardson: So great question. Yeah. And I think, look, you're right. The challenge for fertility centers in a lot of cases is how to be as efficient as possible at delivering the care that they deliver to as many patients possible.

When you have somebody coming in, who doesn't meet one of your sort of basic requirements around care. That's a challenge to you know, to sort of work with that person, especially over a period of time. If they continue to not sort of be within that BMI limited require. What we do in partnering with fertility centers is we try to work as closely as possible with them in support of the patient's goal of fertility.

That means that we try to make the burden. In terms of getting patients to us as light as possible for those referring fertility clinics. And then we try to make sure that when that patient is ready to come back we make that process of coming back to the fertility center as easy as possible. So I would broadly kind of group our partnership into two kinds of patients.

The first one is patients whose BMI precludes them from one kind of treatment or another. So we'll hear frequently that, you know, a center has a BMI cutoff of 35 or 40 or so around IVF as a broad category. And the reasons for that, I have a lot to do risks from sedation and risk of airway collapse.

It's certain a higher BMI and the threshold depends a lot on the facilities that are available and just the, the policies that practitioners are put in place for those patients who have who have a BMI that precludes them from receiving care. We partner with the facility.

Take that patient understand their fertility goals, understand the fertility path forward for them understand the weight target that they need to achieve in order to receive in order to receive fertility treatment and work with that patient over the course of weeks and months, independent from the fertility practice.

And about the only thing that happens during that process is we update the fertility center on a regular basis and that. Frequency depends really on the fertility centers preference for those updates. Usually it's about once a month, we give them an update on sort of the patients that we're working with for them.

And then when that patient hits that BMI threshold, we then with the right amount of notice, cause then in many cases, you know, it takes you know, four to six weeks to get an appointment with a treating provider. We'll say to those patients who were ready, Hey, you hit your threshold or you're about to hit that threshold.

You're ready to go back. Let's get you set up with that care. We a ll work with the fertility, the referring fertility practice to make sure that person who previously was just not eligible for care and previously could not have received treatment. Now it gets back into their practice in a pretty seamless way.

And, and is able to get care. Typically we continue to work with those patients because now they're in the second category of care, which is patients who are eligible for fertility services, but who would but, and who are already sort of receiving those, but who would like to continue to lose weight.

And for those folks, typically we are treating alongside the referring provider. And again, you know, we make that pretty, pretty seamless to the referring provider. There is no change. 

[00:11:25] Griffin Jones: Referring provider in this case, being the REI? 

[00:11:28] Evan Richardson: That's correct. Right. Isn't the fertility is the fertility specialist. It's pretty seamless to their fertility specialists.

They don't have to do anything to change their path of treatment because is actively losing weight. We always are making sure that we're up to date on the path of treatment forward patient, and that we're practicing in line with those care needs. And the patient often, you know, continues to lose a meaningful amount of weight as they go through treatment.

We will stick with those patients oftentimes through pregnancy and then afterwards continue to help them to lose weight when it's appropriate to lose weight again, which of course it's not appropriate during break. 

[00:11:58] Griffin Jones: So while we're on the topic of referring providers. When we say referring providers, we typically talk about OB GYN, sometimes PCPs.

And one thing that I've heard from REIs for as long as I've been in the field is there's often a trepidation of disrupting their referral patterns. They don't want to they don't wanna, they don't want OB-GYNs to perceive that they're taking their patients who have always send them. So that they'll keep getting referrals.

Some, there's probably some threads of this concern that are valid often. I think it's probably not valid. OB-GYNs are just as busy if not busier than REIs. And so our PCPs and very often we're talking about low margin insurance patients which is why I'm interested in exploring this telehealth idea, but I can hear a couple people, a couple REI's in the back of my head saying, well, why would we refer these patients out to a platform like this and piss off the, you know, the, when we could be sending them back to their PCP? Sure. That's a 

[00:13:04] Evan Richardson: great question. Look, I think, you know, For some patients the PCP is a perfectly appropriate place to treat their obesity.

And in many cases, the PCP has already been a part of the discussion, right? So most patients that have obesity are counseled by their PCP, that they should be losing weight. They'll ask that BCP, hey, what should I do? And that BCP will have sort of, you know, taken them through their, their frontline treatment.

I think the reality is. In the vast majority of cases, those that mode of treatment doesn't work. And so just like we work with BCPS and, you know, different side of our business, we work with PCPs is the referring provider, as opposed to fertility as the referring provider. And we do that because the PCP say, all right, I understand that there is this new area of medicine called obesity medicine and that's our subspecialty. That's a specialty in which form health practices, our physicians, our obesity medicines board, they have they typically come from an endocrinology or primary care background, but they've all passed their ABOM. The American board obesity medicine boards.

And they just have a, just like, you know, , cardiologist has advanced experience within their area of specialty. Our physicians have advanced experience for these harder cases in the field of obesity. So while an REI might say, gee, why wouldn't I just send this back to the PCP?

Who by the way, sent me the patient the first place. I think the, the short answer is. Oftentimes those PCPs have already done the work that they're able to do and haven't gotten effective results. And in many cases, when it comes to actively treating these patients for for obesity many PCPs don't feel that they're sort of the right set of folks to deliver that care, which is why we work them as referrals as well.

[00:14:44] Griffin Jones: What evidence supports your idea that the treatment is very often unsuccessful. Obesity treatment is very often unsuccessful with the primary care. 

[00:14:54] Evan Richardson: Well, so, I think the biggest piece of evidence would simply be the continued upward climb of the rates of obesity in the United States.

Even though everybody's PCP who has a BMI over 30, we'll sit them down. You really need to change? 

[00:15:10] Griffin Jones: What are we talking? Numbers wise. And I know that you probably have this like memorize for VCs. So like numbers wise, what are we talking about obesity and that you're 

[00:15:20] Evan Richardson: discussing today, the obesity rate for adults in the U S as close to 45%.

And it depends on what what statistic you want to look at. There's a few, they're not suggesting. The pandemic and the folks that being home there've been some pretty substantial increases in that number, but, you know, here, as recently as 1982, the rates in the us were 10%, right?

This is a this is a health challenge that up until January of 2020, along with opioids was, you know, one of the two major problems at the US phase. And I think, you know, we haven't seen sort of any change there that is despite a lot of healthcare focus in the area and a lot of counseling from BCPS.

I think the challenges that for for many doctors you know, that there is a there's a sense of, Hey, know, what to deliver the right care for obesity medicine to deliver, you know, the right kind of accurate around weight loss. We need to have a very active set of interactions with a patient.

Perform health, for example, meets with our patients once a month with their physician twice a month with a dietician so they're seeing somebody from form health almost every week, and then we're a fully virtual program. So everything happens through an app. Then those patients are talking with us almost every day.

We talked to on average, we talk to our patients every day, and that's just not a sustainable model for a traditional primary care practice. In addition to that for some patients, and then there's an asterisk here because for patients who are maybe pregnant or working to get pregnant, many of the medications in the space, aren't always appropriate.

But for many physicians there's a world of medications that are helpful to. And they're not comfortable in prescribing those for a variety of reasons that have to do with training and history and all this stuff. And so, that's why you know, a lot of physicians today are excited to refer out to specialty focused obesity medicine.

[00:17:13] Griffin Jones: What kind of results are you seeing now? And if you're still in forecast mode, how will you be measuring the results? 

[00:17:19] Evan Richardson: Yeah, that's a great question. So, so, you know, we've seen results that are best in class for obesity clinics. You know, we have our specialty, as I mentioned is obesity medicine.

And so there's a fair amount of research that looks at. The rate at which folks are able to lose weight, you know, for us patients that are doing great can lose up to 25% of their body weight over the course of six months those are the results that we have seen. So very very substantial weight loss.

Typically a patient is losing about a pound a week and, you know, for some patients they'll stop and they'll say, hold on a pound a week. You know, I shouldn't, I be able to lose it faster with a medically engaged program. And the answer is. No, and you're losing weight much faster than that then it's not sustainable weight loss, and you're much more likely to stop.

And you're much more likely to see rebound after that. And so lots of studies today show that you know, about a pound a week is sort of the upper threshold for how fast somebody it's a little, it's a little faster than that when you start weight models. But the sustain rate is about a pound a week and we see that.

And I think the thing that's really important for our field is how long does somebody stay in. This kind of program. So for a lot of more traditional weight loss either self guided or guided through a program, like a weight Watchers, et cetera, people retain on those programs for a very short period of time.

Right? We're talking 20 days, right? 22, 23 days, and sort of average retention there. And if anybody's tried it themselves, you've probably had a similar experience. The first two weeks you're really motivated. Third week you started adding up. I want to keep doing this. By the end of the third, we get a couple of reasons not doing he.

Didn't what we see is that about 75% of our patients are still with us at 6, 7, 8 months. That's a lot. Right. And when somebody sticks around with you for that time, you're really able to help them make material changes in their life, lifestyle, and health. And you're really able to see those folks go from you know, from a very high BMI down to something that's more you know, more clinically help them.

[00:19:10] Griffin Jones: Have you done any abstracts yet? 

[00:19:11] Evan Richardson: We've done a couple of posters. We did a poster at the at the obesity society here last year. And we did one at ASPM, American Society of Pediatric Surgeons here this year.

[00:19:22] Griffin Jones: Summarize a couple of those findings for us. 

[00:19:25] Evan Richardson: Yeah. I think, you know, in line with what we just talked through.

So, you know, typically patients are losing about a pound, right? and that we see that retention that is, you know, very substantial during the forecast period, I think, you know, the results that we're the most proud of you know, are actually coming out of some of our work with fertility centers where, you know, we had just this month two patients who became pregnant who had been having, you know, real challenges or.

Eligible to be getting fertility services because of their weight. And after working with form, went back to their REI and are now working on building a family. So that's the kind of thing that we get really charged up about. 

[00:20:02] Griffin Jones: That's what the audience gets charged up about too. A pound a week and a longer enrollment in the program for the intervention.

What compared to baseline, I guess, what is the average intervention yield? 

[00:20:22] Evan Richardson: The average intervention, self-guided intervention doesn't yield anything. And so I think that's a really important thing to think about. So, you know, the alternative to referring to obesity medicine provider is the tele patient, hey, you know, you should maybe join a weight watchers. You should you know, you should work on this yourself self guided interventions because they don't last long. Don't tend to show great results, you know, weight watchers and others have some good clinical studies where they will show that their population is able to lose weight.

But the live reality of somebody on Weight Watchers is very different from a lot of those studies. And the reality is most patients don't stick around on those studies for very long. And so, I would suggest to folks that are listening to think about their patient population and think about those people who they've said, Hey, you know, if you want to have better outcomes on agent lose and weight and think about sort of what percentage of those folks were actually able to achieve that weight loss in our experience and, you know, sort of more broadly looking at the broader population data, it's very unusual for someone to be able to under sort of self-guidance or under.

A purely behavioral program to lose a significant amount of weight. We're not talking about 10 pounds, you know, but lose 30 plus pounds. And keep that off that's fairly rare. 

[00:21:32] Griffin Jones: Yeah. Well that was going to ask how do you stratify that a little bit more? Because I imagine some people will say, well, these programs work excellently?

And so to say like self intervention doesn't work, it could be, right, but how do you, what are some of the parameters that, show us that's true? 

[00:21:53] Evan Richardson: Yeah. So I think, you know, one of the biggest one is just the overall gain in BMI, across population. And again, that's been, you know, that the rate of obesity has been taking up you know, very substantially over the course of the last decades was really no pause right there, there is not a year in the last in the last 20 where the obesity rate in the country in the U S has gone down and that's generally the case globally. And so, you know, I think that again, if a person is not able to stay on a plan for more than a handful of weeks, they will not be able to achieve results. You know, you can think about a weight gain, typically takes a while. So for many patients, they're, you know, gaining a, you know, a couple of pounds a year on.

And they may have a year or two when they gained a substantial amount of weight. But if you asked them kind of, what was the trajectory of your weight gain over time? Typically it's, you know, it's a couple of pounds a year and just like weight gain can take a while. You know, that weight loss often can take awhile, even when it's medically assisted, right?

The fastest that you can go is about an hour a week. And so, for a lot of patients, what they find is, you know, gosh, if you're staying on that program for 14 days or 20 days, that might be fine. If you want to lose five pounds to go to the beach or for an event or something like. But when you're talking about sustained weight loss, most patients, the vast majority of patients benefit from that intervention. 

[00:25:38] Griffin Jones: How does the formhealth get paid? Is there a partnership from the fertility? Is there a referring fee?

[00:25:46] Evan Richardson: It's a great question. And the answer is no. So no cost to the referring provider and, you know, we look at this partnership as working to help the we're gonna help the individuals, our mutual patient to achieve their broader health goals in the context of fertility, the number one goal at the top of the list is I want to have a baby. And that's the goal that we are working towards together, but just like the fertility, especially just like the REI is not is not paying and is not able to pay. their referring provider. Fee to the provider who refers patients to form.

And you know, we think of this in terms of, you know, what value can we provide to that provider? So that's why we are keeping them updated in an effective and pretty efficient way for their time in terms of how these patients are working. That's why we're making sure that we're treating inline with that provider sort of needs for that patient when we work with them.

And really at the end of the day, this is just about us helping these patients. Together to achieve that fertility goal. 

[00:26:42] Griffin Jones: So is it a monthly subscription from 

[00:26:46] Evan Richardson: the great question? How do we get paid for? So, so, so there's two parts to how how our economics work. We are a we are a reimbursed.

Service. So when a patient sees their physician that service is submitted to their insurance, just like any other physician interaction would be. And then and then that sort of adjudicated through their insurance coverage, et cetera any cost to the patient for labs, any costs, the patients for medication all of that sort of runs through the insurance just like it would for any other medical interaction. And then in addition to that, we have a monthly fee that's $99. And that really covers the cost of the dieticians that patient works with. So there's two parts to that team. One is the physician two is the dietician. And so those dietetic services are covered by the $99 a month fee, which is paid for by the patient.

[00:27:34] Griffin Jones: I want to talk a little bit about the insurance and telemedicine, and that will make this tangent make sense because in February, 2020, I was at a small fertility conference. Very cool. Intimate fertility conference in Colorado. And we were starting to talk about this novel virus that was developing in the east, but.

[00:27:56] Evan Richardson: I haven't heard of it. 

[00:27:57] Griffin Jones: When people didn't really know what was going to happen yet so this is like the first week of February. And at that conference separately. We were also talking about the future of telemedicine, but also kind of how it was a pain in the neck because if you practiced it, if you hadn't, let's say you're in oh, Erie, Pennsylvania, and you're seeing patients.

Just across the border in New York state that you would have to have a law in some states. I don't know if this is true for Pennsylvania, New York, but at least in some states you'd have to have a license to practice in multiple states and. 

[00:28:28] Evan Richardson: That's the case in the majority of states. 

[00:28:30] Griffin Jones: Okay. And so, and then all of a sudden a month later, a lot of these regulations were put on hold and health and human services and office of civil rights I believe is, are the two agencies that that enforce HIPAA. And so they said, you know, you can use zoom, you can use FaceTime, you can use Skype. And so how did that affect or not affect you all at that time? 

[00:28:54] Evan Richardson: Really good question. You know, we have been a purely telemedical business since we got started and so we have been working within the sort of fairly complicated telemedical regulatory regime that exists. And so for us, in some ways, you know, we were already really prepared for everybody to get pretty excited about telemedicine. We didn't change the way that we work with patients.

We already had tools that were HIPAA compliant that were in place. I think some of the benefit to some providers was that, you know, some of the interstate licensing requirements or were waived or otherwise loosened for a period of time. I think, you know, for us that didn't have a big impact either because our providers, you know, were already sort of licensed in these states where they practice, you know, for us as a growing business, our perspective was we never know how long these waivers are going to last.

And they are really important for some of the emergency or near emergency medical treatment that had to happen around around COVID. But we didn't want to build our business on some of those sands that could shift pretty quickly. And so by and large, you know, everything that we did was highly compliant with the pre waiver world of telemedicine. 

[00:30:09] Griffin Jones: Your explanation of how you get paid from patients and from insurance companies and not from centers is part of the reason why I had you on the show. People sell to centers, then they're going to be more likely in that sponsorship category. I know that some other people are still going to say to me, oh, that's me too.

Why can't I come on show? Listen, sometimes I'm in a good mood, keep trying me. And but I am really interested in the idea that we just have to be doing, we have to be getting people to other solutions that are found in tech and do you think that we need to be propagating that for the triage aspect?

One concern that I've seen is, we've seen people come in and there's been a couple of them that thought, oh yeah, they're going to be great. They're going to stick around. And then it's like what? They burnt through that money pretty quickly. I didn't know you could burn through $60 million that quickly, but apparently you can and  VC is a cutthroat world. 

[00:31:07] Evan Richardson: Great parties. 

[00:31:08] Griffin Jones: So what challenges are you on the lookout for? 

[00:31:13] Evan Richardson: Yeah, look, I think, you know, we think that not surprising the world of obesity medicine, the specialty of treating treating folks in BMI north of 30 or in some cases be north of 27 with certain comorbidities. We think that is a big growth area in healthcare broadly today only about 1% of individuals with a BMI north of 30 are receiving medical treatment for their weight.

If you look at any other major medical condition type two diabetes, high blood pressure depression. Typically treatment rates settle out for reimburse services at about two thirds. And and I think, you know, we are entering a world with AMA recognizing here about seven years ago, that obesity was a medical condition with the creation of the American board of obesity medicine in a world where treatment of obesity will be more the norm. It is the exception today. It's absolutely the exception and, and I think, that's part of why, fertility, for example, has been a big growth area for us because patients weight so directly impacts their ability to to, to conceive and to carry a child.

And so I think, you know, we are headed over the next 10 years towards a world where treatment is more than normal, where we start to see treatment rates north of 50. For individuals with a BMI of 30. And that doesn't mean that all those people go to obesity sessions, right? Primary care will start to treat this more frequently, et cetera, et cetera.

But you know, in that world, what we are really looking at over the next 10 years is an incredible period of growth. And I think, you know, for us as a result, some of the biggest areas of concern are really just, you know, how do we grow effectively? How do we support that? In a way that matches with our very high level of standards for the care that our patients receive.

And how do we continue to do that as we scale out larger and across more states. So I think, you know, the the question for folks in our space is you know, as awareness grows, as referrals grow, as practitioners start to say, well, I'd refer out. If I saw high sugars, I'd refer, you know, for treatment, for what looks like it might be, know, a case diabetes.

If I saw high blood pressure, I'd probably refer out for that for treatment as well. I'm seeing somebody coming in with a BMI of 30, that is a medical condition. Of course, I'm going to refer out for that. But then as that becomes more of a norm of thinking, you know, I think the real questions are, you know, how do we as a.

As a specialty of medicine, how do we make sure that we support that growth in a way that's going to be effective and high quality for all of our patients?

[00:33:47] Griffin Jones: So what are some of the obstacles look like? Like you as the visionary of this burgeoning company, when you are thinking that six months to a year, what are the things that you're saying, this is what we're getting over as a company in the next half a year so? 

[00:34:01] Evan Richardson: Yeah, well, look, I think you know, I think supporting demand is always a big challenge as a growing company, right? So, you know what we have seen in working with and working with fertility providers and other physicians more broadly is the impact we've been able to have not really has been positive for their patients and as a result we, you know, we'll often with a as an example with a fertility provider and they'll say, great, I'm going to refer you. The folks that come in and their BMI is over 45. I can't do anything with them unless we bring that BMI down. And within a couple of months, we're seeing everybody with a BMI. 30. And they're actively treating those patients between 30 and 45, but they've seen such great results with the patients that have a very high BMI that may start to say to everybody else along the path, Hey, let me just toss these folks over to form because they know the support is there and they know the results are going to be there.

And this is something that the patients want to achieve along with their fertility. And so I think, you know, for us, we look to growth and we look to making sure that we continue to support those patients in the best darn way that we possibly can. I think, you know, the world of COVID is an interesting challenge for us as well.

Are, as I mentioned, purely tele medical patients never come into an office. That's really comfortable for patients because now they don't have to leave their home. And even as they go back to work, they don't have to leave the office. They can sit in a conference room like I am now and have that conversation with their with their practitioner receive treatment and go on about it per day.

But I think that, you know, we're going to see what changes in people's expectations, you know, w what we've seen across our business is a lot of folks have had some pretty material unplanned weight gain during COVID. And so I think that is you know, an opportunity and a challenge, because there's more folks that need help, but at the same time there's a lot more obstacles in their way that are causing the gateway to.

So I think, you know, there's some challenges from the medical side there's some challenges.

[00:35:51] Griffin Jones: I thought of two more questions that the audience will be grumpy with me. If I let you off the hook, then I've got it right. Then I've got a selfish question for myself that is of zero value to the audience.

And then lastly you can conclude with however you want. So, but I know that some people. There is sometimes a referral paranoia in this. And again I think most of it is unwarranted most of the time because of how busy we all are, but some people may see you've had luck, at least building the beginnings of relationships with a couple of groups.

They see another group on they're like, well, yeah, Person is two miles away from me. If I refer patients to form health, they're going to refer them back to this other group. 

[00:36:35] Evan Richardson: That's interesting. So, so, you know, I think all of these are things that we work really hard to just make sure for our referring physicians, when we receive a referral from a from a physician, you know, we mark that down.

 And we are working with that physician at the very least, keeping them updated on their patient's progress. And then sometimes if that patient's actively receiving treatment, then we'll kind of get the the note from the from the referring provider to make sure that our treatment path is still in line with their path of care for that same patient.

And when it comes time to send that person. We are already queued up with that. with that the referring physician, the one that sent us the patient in the first place, and we just sort of naturally send them right back and we keep we keep pretty good records on that internally, mostly. So that weekends stay in line with that physician's path of treatment.

But this isn't something where, you know somebody sends a patient. And we said, okay, well, who do we like in, you know, in the city of Boston to that referring provider? I do think, you know, we, we do have growing relationships with a number of providers nationwide and you know, we have been excited to support our relationship with those providers.

So, you know, we have a bunch of providers and say, great, know, we, help generate some content with you. We're always happy to, you know, lend or medical experts out to a little bit of content with them. We've got, you know, mutual, a webpage that we stand up. There's the opportunity to do you know, some, some joint work in building sort of practice volume.

And we're always supportive of that you know, I think we want to do whatever we can to help differentiate our practice partners, our referring partners, and help make it clear to patients that, you know, incoming to this specific REI. It's not just, Hey, you're here for one thing and one thing only, but it's a holistic solution that can include weight loss that can include all the things that patient needs to make sure that they can have the best chance possible of fertility 

[00:38:26] Griffin Jones: Hopefully, that's the more superficial concern, the more sincere concern that they will not let me off for letting you off is what are you doing with the data and what are you going to do with the data? 

[00:38:38] Evan Richardson: Good question. What we do with the data now is make sure that we're treating our patients appropriately and effectively.

I don't think that we have any plans around you know, looking at referral patterns or selling that data to other to other, you know, sort of like larger data entities or anything like that. I think, you know, there are opportunities, the things that we are really interested in with that data is publishing and making sure that the ways in which we are working with patients and the centers that we are working with you know, are really able to show the difference between those patients that, you know, that they worked with and help bring the BMI down. Some success rates they had there versus those patients who, for whatever reason were appropriate to referral or what there asking.

So we are actively working on a couple of paths now to start to publish with some of these larger opportunity groups. And if any of your viewers out there want to be part of something like that, where we can really take a look at the impact of of weight management around fertility treatment, you know, that's something where we're looking to add additional practitioners in groups into some of that work that we're doing.

[00:39:38] Griffin Jones: Okay. I think I've poked you to the extent that most of them would I think most has been filled. This is totally just for me. My two favorite influencer docks outside of the fertility field everybody's this is outside of the fertility field. My two favorite influencer docs outside the field are Jason Fung and Peter Attia and for their research and work on longevity.

And specifically with fasting protocols. This is just me. This is just me really curious how much of your protocols involve fasting or is that in your purview at all? 

[00:40:15] Evan Richardson: So not really. And I guess the first, the first thing that I'd put next to that, I think Fung and Attia are often working with folks that have very different health challenges than those people who are dealing with obesity.

Right. You know, to the extent that I've read some of their stuff. And I think they're pretty interesting, but they're really working on folks that are, you know, kind of already, you know, pretty far down the road of hitting all of the basics of helpfulness and are trying to kind of tweak and do a little bit of biohacking and really make sure that they're squeezing the most they can out of their know, out of their lives and their physical bodies.

And I think that's pretty interesting. We certainly do work with patients on multiple different protocols that help them to control calorie intake. And so, know, there's two big pieces of our care one is working with that physician. Two is working with a dietician intermittent fasting is absolutely one of the tools that our dieticians use, not so much for, you know, some of the outcomes that Attia and Fung might be you know, really focused on, but just because there's a lot of data around IF that suggests that for some people it's really helpful with controlling caloric intake. I think we're a little bit more skeptical on data suggesting that your body is burning more calories when you're doing intermittent fasting or that you have sort of increased metabolic activity when you're on IF.

But we absolutely see that it's super effective for a lot of people and helping them to control which helps them to control calorie intake. So given that, the reason I said that it's not really part of our program, this is not a required part. What we do is we try to work pretty pretty carefully with each patient to make sure that the dietetic approach we take with them is built for them.

And for some people IF just as ineffective for other folks. You know, they want to try, they want to try a different kind of restriction and I want to try, you know, meal replacement, or we may believe that's going to be highest impact for them. And so we work within those within those protocols, but there are a number of our patients that do IF and many of them find it to be pretty, pretty impactful, but they apply it and it is applied a little bit differently than what Attia and Fung are typically doing up.

[00:42:22] Griffin Jones: Well, we got to do is get you a show so that you can have those guys on your show and then they can see if they see it the same way. But that's just for me, this audience is mostly REI is mostly execs in the fertility field, a lot of practice owners. So how would you like to conclude with, to that audience Evan?

[00:42:41] Evan Richardson: Yeah, I think, you know, first it's been fun to have the opportunity just to chat with you. I think to those folks that are listening form is a practice that is really built to support your patient's outcome. And we work today with with dozens of practices across the country to help their patients to achieve better fertility outcomes, to achieve more pregnancies and carry more pregnancies to term.

And we strive to do that in a way that has as little friction to their practices as possible. What helps them to work with more patients and deliver better outcomes. And so I think, you know, to the extent that is something that folks are are excited about, and at least in our experience, a lot of practitioners are excited about working with more patients and improving outcomes for all their patients.

We're ready. And, and we'd love to hear from you and you can track us formhealth.co 

[00:43:36] Griffin Jones: I mean, I think this is the trajectory that we need to. At the very least look a lot more into, in the field to help expand text's use of applying the rest of the health treatment that we might not do. And thank you very much for coming on Inside Reproductive Health.

Thank you.

114: Fostering Better Communication Standards in the Workplace with Lisa Duran

In this week’s episode Griffin Jones and Lisa Duran talk about the challenges that leaders face in the ever-growing infertility field as their clinics’ needs change and develop. They discuss consistency and coaching methods that can help make a professional team stronger.

Lisa Duran is a consultant who has worked with a multitude of organizations with the focus of bringing teams and customers to the forefront of care. She has worked as the Chief Experience Officer for Inception, Reconceived,  the DiJulius Group, VP of Patient Experience with Vivere Health, and was Formerly Chair of the Association for Reproductive Managers through ASRM. She is an experienced public speaker that has spoken at a range of fertility and health conferences. 

Today’s Episode Focuses On:

• Efficient Delegation Practices

• Consistency in Behavioral Standards

• Navigating Through Negativity in the Workplace

• Utilizing Different Personality Types Effectively

• Healthy Communication Strategies

Lisa’s Social Media Links:

Linkedin Handle: 

https://www.linkedin.com/in/lisa-d-4025494b/?trk=public_profile_browsemap_profile-result-card_result-card_full-click

---

Transcript

Griffin Jones: [00:00:40] On today's show of Inside Reproductive Health. I've got Lisa Duran back with me and we talk about leadership and the struggles that leaders are facing in the fertility field right now -  being so insanely busy, crying out for help. We talk about some of the things that they can do and the tools that they need for support. Before I get into today's show with Lisa. I know who I'm going to give today’s shout out to. It’s to  Terry and Ed Malanda from Mandell’s Pharmacy. And the reason why is because if you ever hear, when I welcome somebody onto the show and I say, Hey, Dr. Smith, welcome Joe. And I do it in that order. It's partly because of Ed Malanda. I did it like one time and Ed commented that he liked it, that it was the right mix of formal and familiar. And so because of that positive encouragement, that became the tradition for the show. So if you think that super annoying, you've got Ed to blame from it. But today’s  shout out is for Ed and Terry at Mandell’s Pharmacy.. Today's show with Lisa is about leadership. We talk about how sometimes there's mutual mystification between partners.

You know what I'm talking about  - sometimes there's negativity. People complaining that management level and that seeps through because somebody is allowed to get away with it and talk about change, not being enacted because sometimes it's just a conversation with no follow ups. So we talk about the resources for what leaders need to impact that positive change.

 Lisa has been in this field in different corners in solid stints for a while. She was the chief experience officer at Inception. She's been a consultant for the DiJulius Group, she was the chair of the association for reproductive managers, which is how I met her so many different years ago. She's been an individual consultant, so if you want her help, she has that experience and I recommend reaching out. And so I hope you really enjoy this episode with Lisa Duran.

Ms. Duran, Lisa, welcome back to Inside Reproductive Health. 

Lisa Duran: [00:02:47] Thank you. I'm so happy to be back.

Griffin Jones: [00:02:49] By the time this airs it’s going to be like episode 114, somewhere around there. And I looked just for giggles of when you were on last, and it was episode 24.

So you were on  90 episodes. It was pretty early on into the show. The audience has grown a lot since then.  Overdue to have you back and glad you're here again.

Lisa Duran: [00:03:11] Wow. Well, thanks so much for having me. What an honor it is to be back. And after so many episodes, you clearly are doing something right and something well, so thanks Griffin. 

Griffin Jones: [00:03:19] Well, you too, because you had different tenures around the field and not just like a short little stint here, but you've done good yeasts multi-year blocks in different roles as a consultant in house for a clinic at the executive level of a larger company. And so you've gotten into so many different clinics.

You've probably seen the insides of more than I have, and you have also done it in very different business models. So I'm curious as to, if you could even come across commonalities being that some of them are so different. What are some of the biggest challenges that you're seeing leaders face in fertility centers?

Lisa Duran: [00:04:05] Yeah. That is such a good question. And such an important question that we ask right now. It's interesting because when I started consulting again, I wasn't sure if I would be consulting more on the patient experience side or more on the team member experience side and and the consistent ask is for the leadership experience really, and equipping the leaders because what's happening is that pretty consistently across the board? What an amazing time it is to be in the field of infertility? What we're seeing across the board of course is great. And people are realizing that they want to have a family. And so we're seeing, you know, great growth in the industry and that is, gosh, just such a blessing and such a great thing.

What has happened in the clinics is with great growth, comes different challenges. And you know, the clinics are trying to ramp up their staff. They're trying to hire appropriately. They're trying to onboard and train while navigating, you know, the explosion of growth that they're seeing.

And what we're finding is leaders are just asking to be equipped. Equipped to lead and to go from doing to leading and, you know, the challenges are pretty universal out there. It's navigating the growth. And while keeping, you know, your team morale up and keeping the standard of care where it needs to be.

Griffin Jones: [00:05:26] What are the differences that you're seeing between things that are involved in building the patient experience versus building the team or leadership experience. What are the differences? 

Lisa Duran: [00:05:37] Well, you know, certainly in the leadership experience, you know, you're equipping them with leadership skills and we'll talk a little bit about those probably in a little while, you know, you really are trying to influence one to influence the many, right?

And then with patient experience, you know, you’re really pouring into everybody, you know, typically at one time, and then the leaders would follow up, you know, with the standards and coaching and rewarding recognizing, and then coaching for behavioral change. So it's really teaching the skills to the leaders to do all those things.

And I've been really enjoying it. I, most of my consulting lately has really been in leadership and I'm really enjoying it. 

Griffin Jones: [00:06:21] What are the skills that they need help with? 

Lisa Duran: [00:06:24] Yeah. So pretty universally, there are three things that they are asking for. They're asking to learn how to delegate well. And again, it's going from doing to leading.

That's not an easy transition. So how do they transition that and not make their team feel like they're trying to shove work on them. Right. And we can talk about that a little bit more in a bit, but the second one is coaching for behavioral change because what's happening is they are so afraid of losing good people and losing people because it's hard enough trying to hire the right fit, you know?

So they're so afraid of losing people, what happens is that at times - it’s natural - sometimes we let behavior slide that, that, you know, the behavior that doesn't exactly meet our standards. Sometimes we let it slide or we make allowances or where we give special attention or circumstances, we allow circumstances to dictate what the decisions are and sometimes we'll give people a little bit more. And then you know, and not stick to the standard. And so what happens.

Griffin Jones: [00:07:29] What you just said, Lisa is the reason why there is a crabby office lady or crabby office, man, in so many practices across the world because of what you just said well, but he's really good with the, you know, he's really good with balancing the books. She's really good with billing and or they're the only person that knows this darn EMR as a super user. So we'll let this behavior, I see it all the darn time. And I got to tell you, even as hard as this job market is, we have had some conversations with people that we, you know, we use something called the people analyzer and it's saying like, Hey, this is where you're being rated on. This is where I'm rating you. They give their input and ultimately letting them say, okay, maybe this isn't for me. And even in a hard job market like this, it's been so worth it, even being a bit understaffed because even when you're understaffed, if everybody else feels like everybody else has their back, they're willing to put through the grime of being understaffed. But if you have somebody that even if they're good at the technical aspects of their job, then it's, they're saying, well, why the heck am I going the extra mile? If this person gets away with it, I think that's what you were pointing out.

Lisa Duran: [00:08:53] Yeah, very much. And when there's lack of consistency, on what is okay and what is not, you know, what one person can do versus another and what one person can get away with versus another, that creates resentment. And then with resent, you know, when there's resentment in a team, right, that's not exactly a positive environment.

And then we're asking those teams to deliver a great patient experience. And so that consistency and adhering to the standards and making sure that you're not giving special allowances to people because you're afraid of losing them. So that coaching for behavior change in a very positive way is very important.

And you, people will respect the leader more. And when you know what's expected of you and that's very clear it, people perform better, right? 

Griffin Jones: [00:09:39] I want to zoom into the delegating part of that, you mentioned, what trouble are they having with delegation?  

Lisa Duran: [00:09:45] Yeah. So, you know, the biggest thing with delegating is first of all, the stigma and delegating people think that delegating is pawning off my work to somebody right. And then, so that, you know, it's letting go of responsibility, it's assigning work and forgetting about it and so. 

Griffin Jones: [00:10:01] For some people, it is some people that's it. That's an earned stereotype. 

Lisa Duran: [00:10:08] Yeah. I have to tell you that. Being in the centers and being with the leaders, there is not a group of harder working individuals that truly have a heart, not only for their patients, but for their teams and their heart is to keep morale up. Their heart is to deliver a great patient experience. Their intentions are in the right place and they want to learn how to lead. And this is part of it. And they're so afraid to delegate because they don't want their teams to feel like they're giving them more work when they're already feeling a little overwhelmed and you know, so that's really the heart of it. And so it's really changing the mindset that really delegation is sharing work and it's really sharing authority, which can be very exciting to somebody. Who's possibly, you know, who has thoughts and ideas on things or who may want to move up, it's sharing that authority.

And it's also providing team development, right? What a great opportunity to pour into people and develop and raise up that, you know, that next leader. And so it's really changing the mindset and then giving them tools on how to do that. 

Griffin Jones: [00:11:15] Where are they getting caught up then? Is it that? Well, my team's already overworked and I just don't want to add more to them, is that the only place they're getting hung up?  Where else? 

Lisa Duran: [00:11:25] That there's a, yeah, that's a great question. Another place is that they're afraid to give it to them because they are fearful that if that person drops the ball, it's going to affect patient care and that's a valid concern, but done in the right way.

Yeah. With, you know, checking it as a leader checks in on the progress and making sure that before it's, you know, delivered that things are going in the right direction. It won't go there, but that's a big fear they have, you know, “I know how to do it, I can do it”. Right. You know, and I don't know that this person can do it like I can do it. You know, they all have such high expectations and standards for themselves. And that's why they're in leadership positions. 

Griffin Jones: [00:12:05] Sounds like that might be in the tool set that they need. What are the tools that they need to delegate? 

Lisa Duran: [00:12:11] Well, and I actually take them through some very simple steps that helps them to do that and it would certainly identify the things that you need to let go of and making sure that they're getting the commitment and the buy-in from the team member, but teaching them the process, sitting down with them, you know, a 10 to 15 minute conversation of teaching them the processes, if they need to learn it will be beneficial in the long run.

And so teaching them the process and then having regular check-ins is essential to making sure that again, that it's not going to affect the outcome and accountability. And then also it's an opportunity to encourage that person you're delegating with and, you know, give them encouragement and that they're really doing well and that's, and the teams need that right now. 

Griffin Jones: [00:13:02] How often is it that you see positions not having outcomes because I can't speak to the rest of the clinic, but at least in the marketing sales biz dev side, I'm so often seeing no outcome for the position. I think that's a problem. I wrote an article called should I fire my fertility center’s marketing director.

So if you're looking for outcomes, I break it down at each level of marketing. This is what this marketing role can be responsible for. In outcomes because I'm seldom seeing these are the outcomes that I'm expected to fulfill as a marker, which makes delegation a lot harder. Is that how common is that in the rest of the practice?

Lisa Duran: [00:13:43] You know, it really just depends on what they're delegating, you know, they can deligate, things from patient care to administrative tasks. And that is, and that's part of what I teach them is how to discern what to delegate and how you discern that is really knowing that team member that you're delegating to knowing their strengths.

Knowing their sweet spot, understanding are they detailed, are the big picture, right? Are they thinkers? Are they feelers? You know, really knowing them and discerning what you can and can't delegate to. So yes, if you delegate, you know, something very administrative and detailed to somebody, who's a big picture person, the outcomes aren't going to be there and it's going to backfire right and so, that happens.

Griffin Jones: [00:14:26] It happens all the time on the marketing side, where people are given responsibilities and in the practice owner's mind, they're thinking I want profits to increase by X, but the person has no authority over influencing X.

They are given a responsibility or a set of responsibilities that may or may not contribute to X. At all, but they probably do partly, but there are probably other things that are necessary to actually influence the outcome, but their responsibilities are, if not entirely divorced from. They're not entirely unified with those outcomes.

And so can you talk a little bit about the relationship between outcome and authority to affect the outcome? 

Lisa Duran: [00:15:16] Yeah, well, and again, that goes back to the responsibility of that goes back to the leader and being very clear on expectations and getting mutual, understanding on expectations and those constant check-ins.

If those check-ins aren't happening, if it's not going the direction that it should have, you will see it along the way. If you're not checking in then and, and the outcome doesn't happen, right the way you expected it to really, it's kind of a shame on you. You haven't checked in and making sure that, you know, the needle was pointing up or, you know, things were moving along the way they should have been moving.

And then you know, As you work with that person and can trust that person more, the check-ins become less and less, but that's essential and making sure that the outcomes are exactly what you are expecting and making sure that the person is very clear on the outcomes. 

Griffin Jones: [00:16:06] I think that's a huge reason for, well, just a lot of conflict between leaders is one, the outcome isn't spelled out too, even when it is the person doesn't necessarily have the ability to impact it. And you have to give somebody that seat to own that outcome. 

Lisa Duran: [00:16:26] That's right. They've got to have the authority, but you know, it's I think when I talking about delegating probably more in the centers probably it's more of those things that a leader can let go of more probably administrative things. Those things that, that really. Bog them down and stop them from being able to give them the bandwidth to lead and to develop, and rather than big outcomes of whether it be profitability or whether it be patient retention or things like that. You know, that's a whole different level of delegation and right now, these leaders are just are trying to function. They're trying to do so they're trying to be nurses and they're trying to be patient services, you know, advocates. And they're trying to, because they're still doing that as well. And they're trying to lead people and they're trying to hire and onboard and all those things, so really the delegation the tasks that we talk about are probably smaller projects that we'll just take some things off their plate that will allow them some bandwidth. 

Griffin Jones: [00:17:30] Do you find that resistance or if not resistance, just difficulty to delegate is more acute where it's an independent practice owner versus a group that is within a large network that supposedly, maybe does or does not have a lot of the corporate support?

What's the difference in the ability to delegate between those two different profiles? 

Lisa Duran: [00:17:58] Gosh, you know, that's another really great question. I, as you were saying that, I was thinking about that there really isn't a big network versus a single or practice or one practice owner,there really isn't a consistent I guess pattern, if you will or strength, if you will.

I think it really depends on the leader. You know, there are some leaders that are doers and really just have a hard time prying their hands off things, you know, whether they be in a network or in a smaller practice. And there are others that, you know, that are like, yes, come and help me and so it really just depends.

It really depends on the leader. It's not necessarily. A large network with maybe more support, more corporate support versus the smaller practices. It's really very individual. 

Griffin Jones: [00:18:42] So with those leaders, and I was thinking about what you said is that sometimes they may be smaller projects, but I think maybe sometimes they're not smaller projects.

I try to write about where I really, think someone can walk away and where a leader can not walk away. Example in marketing is that I do not believe that the principal of a company can walk away from positioning Fertility Bridges positioning is set by Griffin Jones and I can bring it down to a level that my creative director then makes the brand guide with me.

And then beyond that, I can move out of some of the some of the things, but the positioning has to be set by the principal. That's an example in marketing. How do you help people determine where the leader must be involved versus what they can delegate? 

Lisa Duran: [00:19:34] Again, it's really, it's helping them to discern what the desired outcome is and knowing the people, knowing what they can delegate, you know what they can delegate into who, you know, the teams are. So yeah, every team is so different, you know, you walk into a practice and you've got a leader that's been there 20 years that, you know, does this in her sleep. And she's got a team of people that she can delegate those bigger projects to and be very confident in the outcome.

And then you've got a leader that is a new leader. That's really, frankly, is just buried in trying to, to keep their head above water and trying to function. And so, you know, it's, again, it's very individual and just really teaching them discernment that is so big on what the one with the desired outcome is and then and then two who they can delegate to. So, but, you know.

Griffin Jones: [00:20:26] It's a vicious cycle, aren't it?

Lisa Duran: [00:20:27] Yeah, it really is.

Griffin Jones: [00:20:29] If, when your time is so consumed, it is so difficult to step away to actually do the things that the leader needs to do like, you know, when we are in between hiring for positions, guess who's back in helping out in that creative director role Griff guess who's back into the senior digital role sometimes at least for parts of the things.

And that prevents me from building out more of the things that's just part of. Building a business. It's two steps forward. One step back, you get yourself back together and you keep moving forward as a leader. But it really is a vicious cycle that I think many people, I don't know if they've attempted to escape it.

My whole career is about attempting to escape that so that I can build these systems so that other people can do them. But if you can't, if you can't step away to be a leader, then you can't. To delegate those things, which in turn fulfills the prophecy. 

Lisa Duran: [00:21:27] Right it's the prophecy. Well, and you know, typically you would say you've gotta be okay to let some things fail.

Right because that's where the learning happens and that's where the accountability comes. And that is really where, you know, again, where the growth happens. And what's challenging in infertility is those, if some of those fails are results in patient care, of dropping the ball on patient care, right, that's not okay. And that's not okay with the leader. And that's exactly what I find is that leaders are so afraid and rightfully so that tells you, you know, about their heart, know, they really want patients to be well taken care of that. They're not willing to risk a patient, not being taken care of with the standard of care that they're wanting them to, or that they need to, right? And that their practice promises.

And so that is exactly why, you know, when you start to delegate, you delegate those projects that are not necessarily going to affect directly. Patient, perhaps it's something, you know, in the process of patient care, but it's not necessarily directly you know, the fail is not affecting a patient, you know, communication or care that and so those are the things that we talk about.

But one of my favorite things to do is when I'm working with like, I do a pre-assessment. I asked him, what are the pain points? Where are the, tell me some of the tasks that really prohibit you from giving you bandwidth to lead.  And then when I go in, I'll ask them to identify someone and together. We will sit there and we will go through the conversation of delegating that task and we will do it together. And so that she, or he can watch it in action and feel good about it. And then I will follow up with them. And how did that go? What results are you seeing? Are you doing your check-ins and things like that?

And I'm telling you when they see the results of that, and when they see, you know, how much they can start to let go and when they start to see the growth of their team and how it just really made people feel valued it's powerful.

Griffin Jones: [00:23:24] So you've got an assessment that helps people to measure them.

How else can we help leaders during this time of  growth? 

Lisa Duran: [00:23:31] Yes. So, you know, the second thing that I was talking about is that coaching for behavioral change. And so, yes, so I teach them, you know, how do you coach for behavioral change? How do you turn that around in a positive way, but yet holding them accountable and keeping consistency in what you expect from everybody.

So that's and that is a skill that is good in life. Right. And especially in leadership if you expect the phone to be answered like this, if it's not answered like that, right. It needs to be a quick one minute coaching you know, a redirect and making sure that the person understands the standard.

They've got their commitment, they've got the tools they need, and that they know that, you know, people don't do what organizations expect they do. What's paid attention to. And also that one minute coaching right away, all the way. Really powerful. And so that's the second tool that I teach them.

Griffin Jones: [00:24:23] That's something that you taught me six years ago, that I still think about people pay attention to what their managers pay attention to. And absolutely true for my team. If I'm not paying attention to it at a high level, it will go away. And if I'm firmly paying attention to it, then they are definitely making sure it gets done.

But some of that sounded like procedural change. When I first, when we were exchanging notes and we were talking about behavioral change, I was thinking skeptically to what degree is that even possible to change someone's behavior. So can you talk a little bit more about behavioral change? Because I often find, maybe it's, I don't know if that what evidence supports or is it against my presupposition? That many personalities are not so malleable. 

Lisa Duran: [00:25:10] Yeah. Well, you know, I think about it, I'm a parent that, you know, my kids are older now, but I think about how different my kids' personalities were and one was very malleable and the other one, you know, really pushed on everything that I, you know, that I tried to direct her on and and you know, I had to be much more intentional with her and I had to be much more diligent on not letting anything go by if I, you know, if I expected. You know, a tasks to be done and I didn't follow through with it. It's my fault again, that it didn't get done. And so I don't believe that the people can't change their behavior.

I think that there's, you know, there are two reasons why people complain and there are two reasons why people's behavior don't change typically why it doesn't change and that's, you know, they don't want to, or they don't know how to, it's just become. Right. And so, you know, so figuring that out now that I don't want to, and digging in the heels, that's not acceptable in a business and especially in a business of care.

And so that person should not be on your team. That person should not be working in a company. Right. And but the one that just doesn't know how to, or the one that's been allowed to get away with it for so long that it's just become habit or there's no consequence to it. That's changeable. 

Griffin Jones: [00:26:28] I remember you saying your daughter was a J on the Myers-Briggs J which means, which is judger on the Myers-Briggs scale, which means which, and I know because I'm a hard J which means like, we like a plan and that's a different index than like the detail.

I don't need a detailed level of planning. But if I, you know, if I'm making plans with somebody, I'll see you next Thursday at here at seven o'clock, you don't need to send me a text reminder. I'm going there at seven o'clock. And if something changes, you better let me know so I can adjust my whole schedule. And so that's something that you mentioned that you learned about your daughter, and I think that's what you're using for behavioral change.

How much are personality tests involved in the assessment? Are you using it for this purpose?

Lisa Duran: [00:29:45] Very much, absolutely in everything. Absolutely. You know, that, that is such a great tool of Myers-Briggs is such a great tool for teaching communication skills. Right. And for teaching understanding, and being able to delegate based on strengths and certainly in coaching for behavioral change, because if you know, you've got a J or a P, or if, you know, where you have to be a little firmer or, you know, where you can be a little bit more lenient or a little bit more broad.

And so, yes, those every clinic I go to, we start with those, we with those perspectives.

Griffin Jones: [00:30:18] I think I talked about it in episode 24. So, but people probably haven't listened to it in a while. And  just liked the story so much that I've got to say it again, but there was a year at, oh, it was at ASRM or something and you separated the group into two and you said, all right, all my big picture folks, if you described yourself as big picture, go over here.

If you described yourself as really detail oriented, go over here and then. Picture. And it was like a picture of Christmas and all of the big picture people were asked to describe it. And we said things like it's a snowy winter's night and Christmas. And someone is finally come home to, to lie against the fireplace.

And the rest of the group was like, there are 12 candles, there are four rings on the rugs. There are three logs in the fire. And I was like, oh my gosh, they really do see the world differently than we did. Yeah. Talk about that with regard to behavioral change, to getting people to use to see, okay, this is how this  personality profile might need to receive communication.  

Talk about that with regard to behavioral change, to getting people to use to see, okay, this is how this  personality profile might need to receive communication.

Lisa Duran: [00:34:09] Well, and again, it's, you know, leadership, I love quoting Spider-Man or a leadership with great power comes great responsibility. There's a responsibility as a leader to know your people and to know their strengths and to ask them, listen, are you detailed?

Are you big picture? You know, do you, or do you make decisions based on thinking or do you make decisions based on feeling so they can adapt their coaching if they don't already know. But it plays a big part in how you coach and it plays a big part in how the person receives it, most definitely.

I recently did a different exercise as it relates to communication with Myers-Briggs and it was the best one. And I thought I'm going to do this everywhere. I go now, where where separated the judgers and separated the perceivers so that remember the judges as, you know, want to make a plan and stick to it.

And that they typically yes, they're more organized and more structured where the peas are a little bit more spontaneous and typically a little bit more on big picture, but much more spontaneous. And I had each of the groups, they had to create a poster of a party invite, but they had to create the poster in the other person's language.

So the Js had to do a poster that would appeal to the Ps. And the peace had to do a poster that appealed to the J's. And it was so great because the J's poster was like, Party starts whenever,  ends whenever, you know, food is going to be great. We're going to swim sometime, you know, and you know, and we're going to have a guest, we're going to have a guest, a celebrity guest, and then the Ps how they made the Js invitation, the Js invitation was party starts at seven ends at 12, right? And here's the schedule 7 0 5. We mingle and we have cocktails. I mean, they went all the way through the schedule and at the very end, you know, 11:30 Ubers come and pick you up. And it was just such an eye-opening experience for the way people communicate differently and how they receive communication.

And that it, you know, again and as leaders, it's our responsibility to understand that with our teams. So that's part of this coaching. 

Griffin Jones: [00:36:12] It's funny because I described myself as well.  I am a big picture person and I'm also a J because I like to know when things are, because I want to move things around, but it sounds to me like the P’s poster would be more or it'd be more interesting to me. Or,  I don't know, but I know with Myers-Briggs either you take these four different combinations and then you ultimately end up with four times four, you have six, 16 different profiles and it's pretty remarkable how. When you have yours, that it really gets you, you know, one of the things that mindset is I do like to I sometimes get discouraged if I feel like I'm pushing people, because one of the talents that I have is I'm a motivator, but also I have found in my life that it’s sometimes led me to try to get people riled up about things that they don't really give a crap about. And so, and I'd sometimes get like, emotional about that, of like, well, why don't you want to conquer this? And so really strongly that profile hit me. How do you walk people through their profile. 

Lisa Duran: [00:37:22] Well, I deal with the entire team so I always do it with the entire team, including the doctors. That's, it's so much fun and to really be able to dialogue communication styles. And I hope we get to talk about physician support in this too, because that's really key in a lot of this and what's happening throughout the industry.

But I do it in the entire group. The ideal is get the entire team together and we do the profiles together and, and I have the table share their profiles, and then we take some common profiles and we stand up and we really. Then we dialogue them and then we do some you know, some different activities based on what some of the objectives are for that day but it's powerful.

Griffin Jones: [00:37:58] That personality finding might've been the reason that I started the goal diagnostic. Cause I was like, I just want to find out. Off the bat. Do I care about this person's problem more than they do? Because if I do, I'm not moving forward. If they don't care enough about it at this tiny little level, then I am not investing a darn thing left and it's been super helpful, it allowed me to totally emotionally divorced from that and run a much more profitable and well organized business.

But so you're doing this with the teams. You wanted to talk about the lessons and support, and I think I'm gonna set you up for that subtopic with a bit of a loaded question. When you were saying with great power comes great responsibility, a saying that I have is, ”the fish rots from the head”. So I wanted to ask where you see the most, where at what points of the leadership chain you’re seeing the most help.

But my view is that if it's not coming from the top. There's no hope so can you speak to that a little bit? 

Lisa Duran: [00:39:06] Yeah. And I'd like to touch on one thing before I speak to that, because it really feeds right into it, you know the which was the third thing that people are asking for, and it's positively navigating negativity in the workplace.

And you know, what happens is when everybody's busy, everybody gets, you know, of short and negativity happens. And then the physician is frustrated because, you know, they're sending attitude and, but yet the teams are frustrated because they're being asked to do things 5 billion, different ways.

And so that, you know, it kind of goes hand in hand, but I'm going to speak to the positively negative navigating negativity first. And then I'll answer the question on the physicians, because again, it really ties in,you know, I talked about earlier how there, you know, there are two reasons why people complain.

This is from the John Gordon book, the no complaining role, it's I absolutely love it. And he talks about how, you know, people complain because they feel helpless, hopeless, like things aren't going to change or it's become habit. And so, so I absolutely love whether it be with leaders or teams. And we talk about that and I have them write down all the things that you complain about, you know, no one's going to see it.

I give them little journals, write down all, everything you complained about. And then John, in his book, he goes through three steps and how to turn a habit or a mindset. And do you know how to change that just with very simple steps. And and so, you know, first of all, teaching the team, that concept, and then teaching the leaders, how to expect that from them and how to condition them.

You know, one of my favorite quotes from the book is complaining is like vomit. You feel better afterwards, but everyone else around you feels sick right and isn't that the truth. 

Griffin Jones: [00:40:52] A hundred percent and it spreads and it's very common in office environments. It might be even more common in, healthcare office environment.

So how do, so what, how do we support the physician in a way that? 

Lisa Duran: [00:41:09] Yes. And so what I found I've actually had some really amazing meetings with some physicians where they've, you know, I've had one on ones where they've said, gosh, I don't know what I'm doing wrong, but I feel like I'm complaining or I'm yelling at them all the time because they're not doing things.

And you know, my, because I'm a pleaser my first reaction is like, oh no, Fine. But I have found myself in, in, in these years, the older I get, I guess the more season I get, I find myself a little bit more bold you I, you I tell them, I said, you know what? You are such an amazing physician because you do things the way you do them.

And you putting your personality into your spin, you know, fighting for what you feel is right. Whether it be a process or a protocol or a delivery, whatever it may be,  and I need you to understand what that does to the team, you know, can you imagine, I tell them, can you imagine starting a new job and saying, this is how you schedule an appointment and then you have four different physicians saying my patients, this is how it's done.

And you have four different ways of things and then you wonder why three months later, that person leaves and you're frustrated because now the ball's being dropped because your patients are being taken care of it's because there are, these teams are having to navigate not only how to, how to do everything and how to, how to give a great experience, how to give great care, but they're learning how to navigate different processes with each doctor.

And especially in those larger clinics, it is so challenging. I feel so bad, you know, I keep thinking, you would never hire me on patient services because you would fire me. I don't know that I could remember how everybody wants to do, how differently everybody wants to do it. So, I tell them you've got to let go of some stuff and, and, and the team of doctors need to come together and you guys need to try and create some continuity.

What are some things  that you can let go of to create some consistency, to help the teams out? That's how you can support them. 

Griffin Jones: [00:43:10] But that's a leadership issue in and of itself, iIsn't it of having, this is my way. This is our way. That's not a united kingdom. That is a different section of fiefdoms controlled by different warlords that allied together sometimes for certain resources that is not a United front.

That's where I really push people when I've had people like Dr. Eckstein on the show and I'm pushing people. And I'm saying like, how do you rule by committee and consensus? And there's some people that have good and like Dr. Washington has good thoughts on that, but I really am just skeptical of the whole thing. It's part again with like this little gold diagnostic thing that we do, what we're doing in the very beginning is can we get all of these people on the same page in the beginning? Because what I used to find, when we would get into agreements with people, we would find out three months, four months, That the other partner is a totally different idea and it would just,lik, throw a wrench in works and what the hell man.

Like if you're not successful, I'm not successful. And that affects my reputation. And so, that was an issue of leadership. It's like, okay, we have to get people in the same damn room talking about the shame. Damn.

How do you get that united front? 

Lisa Duran: [00:44:30] You know? So to be honest with you, Griffin. I I have just barely started having these conversations with physicians, but I will tell you that I'm dying to have them have me back because I, you know, I tell them, I'm like, look, you know what I will facilitate, you know, let's get the four of you in a room, let's first identify before we do that, let's get the team together and identify the top three things that are very inconsistent with all of you. And where consistency will make a huge impact. Once those are identified, then get the four of you in a room and let's look at those processes or those protocols and figure out where you can create some consistency, but having someone facilitate that again The out the objective being to make the lives easier for everyone to lessen their frustration as physicians and to, you know, for team retention.

So we're not turning our teams so much. And you know, in boosting them around and also having less things to have to be frustrated with them about, you know, let's do that together. And I've had a lot of, you know, a lot of physicians say, that's great. I'm willing to do that again. It's just, let's do it.

Right. Let's do it. Let's take that step now. It's going to be just a little, you know, I mean, that's it's a huge issue. Right? And so I'm not claiming that I, you know, that I can even begin to try to fix it, but I figured, you know, what, if we fix, you know, if we can fix three things and create some continuity there, then let's start there.

And then three months from now, let's visit another three, you know, or six months from now, let's visit another three and let's visit another three. And let's just try to make some progress because we've been talking about this for years, right? Right. 

Griffin Jones: [00:46:15] Yeah. There's a lot of mutual mystification between part.

I hear it all the time. Like, well, you know, I'm talking about selling to this group or I'm talking about hiring this person, but I don't want to tell Dr yet, because. They own X percent of the company. You might want to bring it up before the last minute. And I think of all the groups that we've worked with, there's been one where we have been like their mediator in this way, but I haven't a  hard conversations is a part of leadership, isn't it? Yes. Isn't it like the most important part of leadership, because otherwise you end up leadership is about getting all the boats to row in the same direction. If you can have hard conversations, you can't get the boat rowing in the same direction.

I have a key team member that within the last month or so we had to have an uncomfortable conversation and it was important because there was just a bud of resentment on each of our ends and we're able to nip it in the bud and come to, but if we didn't have that conversation and we had to have two of them, then just that little resentment would have grown more and more. And so  how.

Lisa Duran: [00:47:29] And that is exactly how it happens. 

Griffin Jones: [00:47:30] How do you facilitate  the, all I do is just get them in the same room and act like a dick. And they either team up against me or, or realize, oh yeah, maybe we should be doing this, but how do you do it more constructively? 

Lisa Duran: [00:47:45] Frankly, to be honest with you, a conversation is not going to do any.

I'm just being transparent with you. You know, we can, I can, you know, bring people into a room and have a conversation with them and say, Hey, you need to line up and you need to be, you know, whatever. Or I wouldn't say that, but I'd facilitate that conversation of how, you know, how are you feeling? How does this make you feel?

But really it's going to be in the action. So, and that's exactly what I'm talking about the, you if, if you've got buy-in to going, okay, let's look at the processes and then you walk away right. Then they don't have time, facilitate that, you know, that exercise and you know, the, again, the practice administrators and the leaders, they're the most hardworking, amazing people, I know, you know, they are trying so hard. And so, so it's really investing the time. It's really investing, you know, a couple hours, you know, every three or every six months. And to not just talk about it and not just get agreement, but, and maybe not even get agreement, but really just talk about it and big and not just talk about it, but figure out the solutions, take a very specific protocol or a process.

And do it right there. And then have it be, you know, when everyone walks out the door, whether you like it or not, you know, some things you’re gonna like some things you're not, and this is how we're going to do it. We've all done. This we've all worked on this together. And so, know, really it's gotta be a lot more than just conversation. 

Griffin Jones: [00:49:10] Because that's the solution to one of their two reasons for complaining, which is it's helpless, nothing's ever gonna change, or it's always but the other one has always been this way. That by changing it and reducing that negativity. And when you brought that up, it made me think that my people almost never complain about clients and it's because I almost never complain about clients. And that wasn't the case in the early days, I notice that my team would like, complain about clients a little bit.

And they were getting that from me. It's ‘cause I would make like a snide comment about something. How do they not have this together? And then I zoomed in and realized, well, it's one of two things - either I'm a know it all and I'm not appreciating what somebody else is going through in their business, or we have a saying in our company where there's no such thing as bad clients, there's only bad prospects and bad process. And I had to look at myself and be like, what is it about my process that is allowing these relationships to manifest in that way, and it wasn't easy to fix it. I really had to change how people come into the company, but once they do, like, we have a really good relationship with them and now I'm not complaining anymore, which means my team isn't complaining anymore, which is good because we should not be complaining about our clients who are working their fricking tails off.

But it was something that I had to fix at a fundamental level. So what are those to do's that you're giving people? They can take a while. 

Lisa Duran: [00:50:40] Yeah, they really can. And I'll share those to do's with you. But I want to tell you that this was a very personal journey for me as well. And I picked up that book because cOVID really got me in a funk. You know, I'm an extrovert on steroids and I love being in the clinics. And for me to be, you know, in my home office, by myself for 10 hours, I was like in the fetal position, you know, when people and I found myself chronically complaining and it just became habit. And that is not who I am.

And it was really ugly and I began to not like who I was. Right and I'm like, who is that? That's not you. And I love, you know, there's a, there's a saying that I absolutely love, and it says. Of your heart. So your mouth speaks and so, you know, I realized a lot of this was a heart issue and a head issue.

And so when I picked up the book, you know, I was like, okay, I gotta change my heart. And I got changed my head, you know? And so, you know, the hearts, one thing, the head is another. And so what are those tools? So those tools, there were three things, he gives you three things which were so great, number one is  you start with the they get two versus the half two instead of I have to do this by five, you know, I get to do this by five, right. Instead of I have to stay home in my home office, well, I get to work from home and you know what I can be in my yoga pants and a t-shirt all day, you know, replacing and changing the mindset. And so you replace half two with get to, and that's a very practical thing.

And so I did the exercise where I wrote down all the things that I typically complain about. And then I  crossed out half two and forgot two and so that became, you know, what I did. So step two was racing the butt and doing the and, you know, and not saying something great. And then saying the but right. But this really sucks so this really stinks, you know, replacing them and seeing him saying things like, you know, wow. I'm just, yeah, I've got so many projects right now. You know, and I'm, I'm going to get them done, not, but I don't know how I'm going to get these done. So, you know, again, replacing that and so changing some of the verbiage helped change my mindset, but the third one was the most  powerful. And that is the one where there are boundaries set in place that I had to get people on board with me, people that I would talk to all the time. Tsey-Haye, she's a good friend of mine from Inception. I'm gonna tell her, I'm like, you gotta help me keep these boundaries, you know?

And the boundaries, we're you know, you're not allowed to just complain any time. You're not allowed to vomit on me all day long and leaders. And that's why I tell leaders. I said, if you're walking across the floor and you're going to see a patient and you let one of your team members come up and vomit on you about something, and you're going to go see that patient unacceptable, they may not vomit on you while you're, you know, needing to go do something. So, so how do you know when can they, you know, people should be able to complain, but turning complaining into productive solutions. And so, you know, that is the key. So creating the boundaries on how they do it, and we've all heard the don't come to me with a complaint without being part of a solution, but he really breaks it down very nicely.

 And really holding people accountable for being part of the solution so one of the things I work on with leaders is how do you actively listen, validate their feelings of their complaint and saying that is, you know, those are some great points. And tell me what ideas do you have to fix this?

And what part are you going to play on this? I want to support you right. And then holding them accountable for that. I'm telling you when you make people be part of the solution, not just say it, but make them be part of the solution. You're good, they're not going to come back and complain to you very much.

Griffin Jones: [00:54:19] Yeah. My operations manager says you have something you want to do at Fertility Bridge, bust out the mirror because that's the person that's going to be doing it. But as you're talking, Lisa I'm seeing the reason of the importance. For this reason as connected to each other, meaning it's so important to not have complaints and be complaint driven only, and to be solutions focused, partly because of how sensitive the self-awareness has to be to improve as a leader. Like the things that you're talking about, I don't have to, I get to -  that’s counted all joy. That is a very difficult mindset to get in and there's just so much of a leader where you have to be brutally self-aware about everything that you've built.

It's like everything I’ve built like this still, is that good or this still needs to be improved, this particular part. And because you have to be so introspective. It can feel like salt in the wound when somebody just comes on like, well, why aren't you doing this? And we had somebody, we had a candidate, a job candidate last week that was like, well, why don't you have this type of social media post is like, oh, I don't know, because I'm busy making payroll from a company that I built from. Absolutely nothing. When I called Lisa Duran from a fricking orphanage in 2015, and I'm building all these systems and serving nineteen different clients and building a point of view for everything, because I never took a dime of that's why,

like just as you're talking, I think that they're reciprocal, the solutions orientedness has to be what makes. Wound not stinging so much when you are being introspective enough to actually pursue the change. 

Lisa Duran: [00:56:13] No you're so right about that. And it seems overwhelming to a leader, but, you know, I used the example of, you know, you've got, let's say you've got a group of team members that are gossiping or that are complaining about something.

How powerful is it? And, there's kind of a ringleader in it is when a leader takes that person aside in their office privately, and just saying, Hey, listen, I know I heard a lot of that going on. And you know, I know that we all want this to be a great workplace and you know, I know that I trust you and I want you to trust me.

And in order to trust you, I need to know that you're going to have my back on everything. And I want to have your back on that. Let's talk about that, to talk about that hard stuff, but the reward. Yeah, the relationship and the strength of the relationship, the reward, and that the leader walking away going.

I just taught somebody to, you know, to navigate some negativity, to possibly do that. And I just strengthened a relationship. I talked about something really hard and, and I got a partner. Right. And so intentional. It's hard, right but the reward is just so great. And  I would just, you know, when people do it and they feel it and they see it's powerful. 

Griffin Jones: [00:57:29] You've given us some you've walked us through personality assessments. You've given us the framework for getting leaders on the same page, how to support the leaders so that they can support the next leaders and to delegate. How do you want to conclude with supporting leaders in the fertility field?

 Lisa Duran: [00:57:47] You know, my heart really went when I go into a clinic, I just want to grab them and hug them and just say, you're doing amazing. You're doing amazing because again so many of the leaders out there are just really struggling with feeling like they're doing enough. And so, you know, part of, you know, what I love doing is inspiring them and equipping them first, inspiring them to them to know that they're doing enough and then equipping them to do the things that are going to make a difference in, you know, it's going to help give them bandwidth and help their teams just feel so good about, you know, what they're doing.

And so, I, you know, I think that's, I just want to conclude with I'd love to tell leaders out there. You're amazing. And you know, this time, this busy-ness and the craziness of the growth is just so wonderful. And the season will pass. They'll be some low leveling off, or you'll be able to breathe.

But the growth, you know, the hard times don't produce heroes, the hard times bring out the hero in you. And so I think that I love just watching the hero being brought out in people who've, who it's always been in fight of them. 

Griffin Jones: [00:59:00] I get to become a hero.

Lisa Duran: [00:59:02] Yes I get to become a hero, that's right.

Griffin Jones: [00:59:03] I get to become a hero. There's probably a lot of people that could use that right now. Thank you so much for coming back on us. 

Lisa Duran: [00:59:11] Oh Griffin, thank you for having me. I'm always so honored. I have to tell you, I was talking to a clinic today and I said, I've got to go. I said, I got to quit. I'm on a podcast with Griffin, from Fertility Bridge.

And they're like, oh my gosh, you get to do that. And I was like, yes, I get to do that. So I think you're kind of famous there Griffin so. 

Griffin Jones: [00:59:29] There really is full circle. Thanks so much for coming back on, Lisa. 

Lisa Duran: [00:59:32] Thank you. Take care.