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The Culture Focused Practice is where business and humanity collide. Hosted by Dr. Tara Vossenkemper (group practice owner and consultant), this podcast dives deep into how practice culture drives business success. Learn actionable strategies to shape a thriving team, implement and use the Entrepreneurial Operating System (EOS), and tackle the tough leadership decisions that come with growing your group practice. Whether you’re scaling up or streamlining, this show offers real-world insights to help you build a people-powered practice that lasts. Join Tara for candid conversations, expert interviews, and no-fluff coaching that puts your culture first.
Hey, Dr. Tara Vossenkemper here. You're listening to the Culture Focus Practice podcast. Thank you for being here with me today. I am recovering from a lovely bug, so my voice has not caught up. Apologies, but I still wanted to get this recorded. I have been like living in systems related thought lately, so I've been bouncing back and forth between a handful of different books about complexity theory and emergence and systems related thinking, and I just keep thinking about all of the things I am reading and how they relate to practice, like how they relate to leadership and group practice ownership and businesses in general. I already think about businesses as being living systems. They're full of feedback loops. They're full of, you know, non-linear behavior. They're full of unintended consequences. And so when I think about a core component of my business, which is EOS it makes me question, what does EOS look like or traction look like when it's part of a business that is dynamic and evolving and alive? You know, what does vision mean and a system that is constantly evolving? That's what I'm here for today. This is an owner's room style episode, so we'll do a series of questions.
Five for today, and then one scenario. And much like any other owner's room episode, this is less about me having an answer and more about exploring some questions. So that's what I have for you today.
Question number one. What's the difference between building a system for control versus building one for emergence? That is so interesting to me. Okay. So when I'm talking about emergence, what I am talking about, and this is the best that I understand it right now. So if you talked to somebody who studied this for a living, I am 100% positive they would have a much better way of describing this. Compared to what I'm gonna say right now, but just to get us on the same page, I'm going to share with you what I understand emergence to be. Emergence is this idea that whenever you put things together, even based on simple rules, if you're putting agents or elements or pieces of something together, you're going to get properties of that that you didn't expect to get. There are things that will emerge from the layering of different elements and agents or a better example. In one of the books that I read, he talked about H2O, and if you're looking at an H2O molecule, I think it's called a molecule by itself.
You don't see fluid, you see H2O, but as it starts to bind together, what you start to see is fluid. You see the movement of water. You see the way that it looks when it's, you know, like a water sloshing around in a cup as you're like shaking it or something, or you pour a bunch of H2O on a slanted table and you see it all run down and then drip off on the other side.
The way that fluid looks and acts is an emergent property of multiple H2O molecules, again, I'm not sure if that's the right word, coming together, but if you look at one by itself, you don't see the same behavior. So the idea is that as we're doing more of something, there are properties that will emerge as a result of more of that thing that we couldn't anticipate before we did it.
So the notion that I think of it as like, oh shit, there's stuff that emerges as a result of complexity or of multiple elements being bound together or coming together.
So then what's the difference between building a system for control versus building one for emergence?
I mean, I don't think you can build a system and not have emergent properties as a result of that system. If I was building a system for control, I would try to keep everything very siloed. I would try to not have a lot of overlap or wiggle room. I would have real cut and dry SOPs. But even as I say that, I don't know if it's actually possible to have a system built for control without there being emergence from the system.
I'm thinking about like the military, you want a much higher level of control in any sort of military system. I would think so anyway. Fuck. I mean, not only are there like rules I'm assuming or there's like expectations around behaviors and accountability and direct reports and language that's used and.
You know, permissions granted based on your rank within the field that you're in. But I think even when that is the case, there are likely still changes within the systems related to, I don't know. 'cause I'm not in the military, so maybe this is a bad example, but I cannot imagine that there are not changes as a result of.
System growing period. And whether that's the way reporting transpires, whether that's the amount of oversight somebody might have, whether that's access changing or not changing based on tenure of service. Like there's gotta be things that take place that. Change that emerged from the number, the sheer number of people involved in the military, period.
So I don't, I don't really know if it's possible to have a system that you're
building for control without emergence taking place. Like I think it would still transpire. I think if you were trying to build a system for control, maybe you just spend a lot more energy on accountability and tracking like output. I think it would just be a lot more like top down focus. But my point is that I still think even with that top down focus, there are still emergent properties that will show up that will emerge, that will then need to be responded to and like tended to.
And honestly, I think any system, whether built for control or that doesn't allow for emergent properties to take place or for emergence to take place. I think that they end up stagnating. To me that's a pond without any water filtration happening. That's like, you know, like that pond scum on the top.
Ugh. Like there's no movement here. It's getting murky and sort of like fucking nasty, you know? I think there's also a difference between trying to build a very clearly structured system versus building one four control, because I think EOS is very structured.
I think the way you build it is really, I mean, there's an outline for how to build it. There are parameters and like constraints for what you're building and within that process, there's also flexibility within each of the things that you're building out. And you can also, of course, make it unique to your own group or your own business, but that is not the same thing as exerting control on the system, like ultimate control, you know?
So having structure is not the same thing as control, and I don't think in general, I'm not really sure that it's possible that you can build any system without. Emergence taking place as the system grows. And I think I'm done with that question. Okay.
Question number two, how do feedback loops actually operate inside a leadership team?
I love this question. They operate everywhere all the time. At any point in time, like to me, feedback is like a nerve system. It's like, um, you know, like your peripheral nervous system is all about sort of sensation, like, temperature, you know, it's like there's something about your
sensory system in particular that to me feels like feedback in a living practice, you know? So when I think about. How feedback loops actually operate inside a leadership team. I'm thinking that they operate all the time. Like it's hard to answer this without being like all the time, because truthfully, like all the time, that's how they should be operating.
Where you are, you know, you're getting feedback from each other on a weekly basis. At L 10, anytime shit's coming up, whether or not. There's an emotional reaction to something or, you know, I might get feedback from my colleague or from one of my staff directly where they're like, yeah, I think you kind of overstepped and I think, fuck, I did.
Sorry. Okay. That's feedback. Getting the feedback directly, it's more of informal I guess, but getting feedback directly from people, from leadership. Within leadership, there's also feedback by way of. Scorecards. There's feedback by way of rock review. Whenever we look at our rock sheet and we say if something's on track or off track, there's feedback when we're looking at our to-do list.
And we are saying if something is done or not done. This is all built into the structure of an L 10 meeting for the record. There's feedback in fuck talking through issues. We're talking about things that need to change or be addressed or you know, be tended to. That sometimes is related to other people.
Sometimes it's us. We're taking in feedback. When we send monthly surveys, I send out. Consistently at least one monthly survey. And then there's an open call for feedback. On our in-office website, we do feedback from clinical leadership. We do feedback from clinicians explicitly on a biannual basis, like in a sit down formal sort of way.
There's quarterly conversations that take place. I mean, there's so many ways in which feedback is. Being taken in and responded to. You know, we're talking about EOS and traction today, but I'm also thinking about my living practice framework. You know, this concept of leadership being the poorest membrane of the whole system,
that membrane has to be. Tuned in to feedback within the system and also has to be taken in feedback outside of the system. What are the norms for the industry? What's the direction of the industry? What are the behaviors of either competitors or colleagues, referral sources? Like what are things also happening outside of us?
All of those things are feedback. Anything happening inside the system that we are hearing about, whether it's directly from somebody or indirectly via data sources, you know. But also feedback outside of the system, period. In my mind, one of the leadership roles is taking in feedback.
It's an important fucking role. And also if there is feedback taking place, that is part of the system being dynamic. If we're taking in feedback about something that allows us. Opportunity to respond to that feedback. And of course, maybe there's an assessment, we're sort of assessing whether or not this is global feedback.
Like we're hearing from one person, is it specific to them? Is there a problem with this person? Is there feedback based on some frustration they have about something? Or is it like, no, their feedback is pretty global.
Any feedback we take in, it doesn't mean that you respond to it right away in terms of we do exactly the thing that someone is giving feedback about, like we change it right away. It means that we take in the feedback, we juxtapose that data, whether it's. Verbal or written or metric. You know, we juxtapose that data with the vision of the practice, with the current state of things, and then we respond appropriately.
Sometimes that means responding and doing, something directly related to the feedback itself. Sometimes that means adding something to the vision slash traction organizer, our VTO. Sometimes that means holding steady, like, ooh, that's great feedback. But that's not something we actually are going to do based on our core focus, based on our, you know, vision and core focus.
That that feedback is fantastic, but that's not the direction we're going so. I think how feedback loops actually operate inside a leadership team.
I mean, I think I just gave you multiple examples, but also these are taking place constantly. I, I don't know if this is the case. I feel like people think about feedback as this. I don't know, like we have to sit down and receive feedback or give feedback. Yeah, sure. Like that's a style of feedback, but feedback is any sort of data that you're receiving about the business, about the practice.
So again, can be metrics, can be informal, can be, you heard something in passing and it gave you pause and you're like, Ooh. Wait, what hap, what did that person say? I wonder why they think that. And then you bring it to leadership and you discuss, you know, it can be any of those things. It also can be sit down more formal, you know, experiences.
That's also feedback. But I think, I just wanna clearly state here, feedback is any sort of data you're receiving about the group, any sort of data you receive about the practice, all of that is feedback. I would say also including. Your own felt sense of things. Your own felt sense of the health of the business, the health of the practice, the trajectory of the vision, the leadership team fluidity, adaptability, you know, all of those things.
Okay, I think that wraps up question two. Let's do question three. This is a great question. Is traction about predictability or about adaptability? I don't think it's about either. It's actually about both.
Traction is about predictability and adaptability. It's about predictability in that we're using traction to in a way ascertain, are we going to be able to do the things that we set out to do? But it's about adaptability in that, oh fuck, things are going wrong. We need to adjust. It allows us to see what is happening, and also in knowing what's happening, we are able to. More successfully predict where things will go.
Are we actually on track for the vision? For example, the metrics that we need to hit? Is it realistic? Are we on track to hit them? Is it realistic that we set that as a metric? Like, Ooh, we've actually had to fire three clinicians. Like I don't think that is predictable or that's not on track anymore.
Adaptability is we've had to let go of people, whether they're not cultural fits or let's just say they're not cultural fits, you know, and they have parted ways with us. So then that informs the predictability of. Are we gonna hit these numbers? Well, no. Not unless we hire three more people and get them filled in a matter of a month.
Probably not likely. So that's what I mean by, it's about both.
I'm trying to think of if there's another word. It's about predictability and adaptability. What other word would I say? Because that's kind of a quick answer. You know, it is about predictability and it's about adaptability.
I think traction is also about stability. Maybe that's like the third thing I would say here. It's about predictability, it's about adaptability and it's not one or the other. It's both of those things. And then also it is about stability. It's about what is right now, it's about having, you know, an eyes wide open view of what's the current state of the business, what's the current state of the group.
Knowing the information, knowing the data, knowing what is going on at any given point in time. At least high level, especially, you know? And then if you need to dig into details, of course you can. That should be stabilizing. You might not like what you see at first, but still stabilizing in that now you know where you stand.
That's what I mean. And then of course, the predictability and adaptability from there.
And I think that's it for question three. Let's move on to question number four.
What does vision mean in a system that is constantly evolving? God, I also like this question a lot. What does vision mean in a system that is constantly evolving?
Okay. So I think both can be true. I think that in EOS you have a five or 10 year target, or 20 if you're really going big. So target is like sort of a broad, you know, general kind of direction. Like we're, we're thinking this, and then it's not super vague or general, but I mean it's like bigger in scope.
Then we do a three year picture and that's where you get real clear on like specifically what are things gonna look like in three years. Then you do that one year plan. So when I'm thinking about vision, I do think about target, like that five or 10 year target. But I also thinking about that three year picture, the picture in my mind is the thing that is the most clear vision.
Because it's not only the most like feasible and realistic to look at and see, but also it is connected to the target and it's directly connected to the one year plan. So if we are living in a system that is constantly evolving, I think we can have a vision and still be evolving within that.
Framework, like I can have a vision in place and that doesn't mean that the inner workings of the business and the way that we are operating are not evolving. They're not related in my mind, what might happen? This is kind of tied in with that emergence piece. I think what might happen or what can happen is that if you have a vision and part of that vision includes, you know, you want to double in size, cool.
Much easier at, if you have like four people than when you have like 30 already, you know, so, and double in size in a matter of a year or something. Let's give a constraint to that. I think what might happen is that as you work to like secure that goal.
You're hiring a fucked ton of people. You're working to double in size. There's going to be things that emerge that you didn't anticipate. And so that to me is where the evolving comes in. It's not that the vision of doubling in size needs to. Change it is that the systems required to support the structure, to support the business are going to need to evolve because at an operation of four people, doubling in size might not really entail big shifts in the business framework or the structure or needing to like, you know, redo things.
But when you're at 30 people and you go to double in size, or if you're at, let's say 15 people and you go to double in size, you are highly likely going to need to
evolve the infrastructure of the business to support the number of employees that you now have. That's the evolution piece to me, which is not separate from the vision. Like you might be on track for the vision and be constantly evolving. So I think vision constantly gives us the direction that we're going.
It gives us, a shared goal or a shared purpose. And then the evolution of the system is to ensure that all of the pieces are appropriately and accurately supported to continue movement in the direction of the vision.
I think that that's what vision means in a system that's constantly evolving, that these things can exist, they can, and they should coexist, and that having a vision doesn't mean that the system won't evolve by any means. I would say that having a vision almost ensures that the system is going to need to evolve to get you to that vision, you know, to get you to that final destination, at least until you have a new vision in place.
Once you arrive at that destination. Okay. Let's do question number five. How do unintended consequences show up in well-structured organizations?
I mean, honestly, I feel like that is emergence like there is dare I say always going to be unintended consequences in well structured organizations. There are just going to be things that. You slash i slash we cannot anticipate. That to me is not a sign of failure. That is a sign of the system evolving, the business evolving.
So even if you have the most in intentioned and most structure, you know, you're super well structured. There's still gonna be shit that comes up as an emergent property. It's gonna arise. You know,
That would be an unintended consequence in a well-structured organization.
And honestly, I think that unintended consequences can highlight the effectiveness or the health of the group. So if your feedback systems are solid, if the vision is steady, if you understand. There's gonna be shit that comes up that we don't anticipate. There will be emergent properties. Then when they show up and not if, but when they show up, then you will be able to respond quickly because you have a bunch of feedback systems set up, so you're gonna catch wind of it early on.
You have. Your vision in place. You know where you're going and you know what you're seeking to do. You embrace evolution of a system. You're sort of like, okay, we know this is gonna happen. What do we need to do to address it, to keep us going there and to ensure that we're still receiving feedback consistently.
So I don't even actually know if I like this question very much. How do unintended consequences show up? They just do. I don't even think, how is a good question. It's just a matter of like when, and then specifically the how is just so specific to each business. You know, like whatever change you make, whatever.
Layer of complexity you add, something's gonna come up as a result. I think the better question is how do you respond when unintended consequences show up in a well-structured organization? That is the better question. And if the answer is well, we respond by taking in the data, and then fix the problem in a way that respects the new layer of complexity that has
shown itself or that has been added. Then that's it. Like that is what should take place. I think also that unintended consequences have a way of highlighting if your organization is well structured and dynamic and feedback informed, or if it's chaos, you know, if there's a consequence and it starts small or it starts relatively small and then it just wreaks havoc and all of a sudden you've got half your team quitting over something.
Like, to me, that is typically reflective of a chaotic organization that's reflective of something's not healthy within the practice. Like that's not about this unintended consequence. That's more about the culture and the practice health than anything else, which might be hard to hear.
I don't mean that in any sort of like coming at you way, and maybe it is hard here, but I
can't think of
any other way that wouldn't be true, if that makes sense. Like if there was an unintended consequence. And it wreaked havoc over the entire system to the extent that like maybe multiple people are leaving or you know, it's like, yeah. I think that's actually a probably more reflective of the system health than anything else.
Which again, might be hard to hear. And I'm sorry if it is. I think that wraps us up for the questions. Okay, let's go ahead and move on to the scenario. So I'm gonna read through this and then we will basically riff from there. Scenario: you implement EOS and things genuinely improve.
Yay. Meetings are tighter, accountability is clearer. Rocks move and they get done. Issues get solved on paper. The system is working. And yet something unexpected starts happening. Instead of becoming more predictable, the organization feels more dynamic. People start speaking up, more tensions surface faster.
Cultural friction becomes visible instead of hidden. You notice that as structure increases, so does volatility. Not chaos but movement. Now you're sitting with a question you didn't anticipate. Did EOS create instability or did it create the conditions for emergence? And if emergence is what's happening, how do you lead inside it without trying to clamp it down?
This is a great scenario for anybody who has ever implemented EOS or who has started going through that process.
You know, as well as I do that upon implementation or relatively soon thereafter.
You start to feel like there's fires everywhere. Like you see way more of what's going on. You see way more of the issues. You might feel them more intensely because there's no real hiding them, like they're just present there in front of you. Everything is vying for attention. Everything is fucking vying for gosh.
Prioritization and focus and, you know, solve me, I'm most important, I hate saying this, but I really do feel like when you're implementing l tens especially, you're clear on scorecard. You've got rock set, you've got your accountability chart set. You're working through issues. It's almost like all of the issues are reactionary. All of the things you're working through are reactive, not forward focused, not vision focused, like probably what you had anticipated. When you get more clear on things, when you have better accountability, when you have better meetings, when issues get solved.
Faster.
All of this other stuff also takes place. You will hear from people more. You want to hear from people more. You want feedback. You can figure out how to keep it contained, but the reality is that you still want feedback. You want tensions surfaced faster. Then they get tended two faster. You want cultural friction visible instead of hidden.
This feels volatile, but the reality is that it had been taking place prior to EOS. It was already happening. It's only now visible because you have structure, and now with that structure you get to be able to tend to it. Without that structure in place, you might have thought things were fine, or you might have thought, well, something's off, but I don't really know what, like nothing's really showing up, so I guess it's fine.
And then you were just able to let it go, but now you can't. So with EOS. It's almost like, um, it's like you're, you're getting what you asked for. You want to be able to see what's happening. Now you do and you don't like it, it doesn't feel good, and you kind of question like,
are we doing this the right way? Is this actually accurate? Like are we implementing EOS the right way? Do we do it right because things feel more unstable?
Assuming that you implemented EOS relatively accurately and that you're holding true to kind of the spirit and the letter of the law of EOS. It does create conditions for emergence, so EOS doesn't create instability. It might feel like it because it surfaces shit that's been hidden, but that's a function of now things are more clear and tight.
That's not a function of EOS created this. No EOS allowed for this thing to finally come to the foreground. Now you can finally see something that had been happening the whole time. And let me just get back to the second question. So if emergence is what's happening, so we're assuming that it is, that that is the case, the emergence is taking place.
How do you lead inside it without trying to clamp it down? That to me is where you would lean back into EOS, where it's like, well, these are the issues that are coming up. Tensions are surfacing, cultural friction is visible. That to me is stuff that then goes on the issues list in an L 10 meeting. And so instead of trying to shut everybody up from giving feedback, which I would be horrified, like, don't do that.
We're not trying to shut people up or shut people down instead of trying to deescalate or like, you know, anticipatory, deescalate, any sort of tension, like we don't need any tension. Let it fucking rise. Tension surface faster. Good. They're inevitable, period. So let it surface that tension gets added to the issues list.
Hey, issues list for next L 10. Tension between these two key players is now an issues list item or cultural friction in this context or cultural friction period is just the issues list item. Now, leadership team comes together and you start working through these issues and trying to figure out what is it, what's at the crux of this?
You know, what's the root cause? What's the root issue? What do we need to do to help solve this issue for good? That's the core of IDS. That's the core of the issue solving track is. Identifying the issue and figuring out how to solve it for good. So when emergence happens and you have shit come up as a result of implementing something like EOS, my call to you would be to lean back into EOS to tend to the issues, because that is kind of one of the points of having the US in the first place, is having a structure for dealing consistently with issues as they arise. I think that's it. I think that that's it for that scenario then, and that's actually it for today. I'll probably be talking more about system stuff as it's coming up. It really is like.
Sticking in my brain. I don't have a very clear way of talking about systems related things yet, at least from a higher level systems is what I'm thinking. It's easy to talk about systems within a business, you know, that's. Sort of my brain is a systemic brain. I don't think linear very often.
I'm very much more like systems oriented, just period. But there's something about like complexity theories or chaos theories or emergence. Like there's something about a style of systems thought and like theory that I haven't ever gotten into before. And as I'm doing more reading in that direction, I am fucking hooked, bro.
Like I am really interested and it feels really, really important. But I'm pulled, like there's some gravitational field there. You know, like I'm being pulled in that direction, but I don't yet know what that is translated to or like how that translates back into business ownership world.
So there's something happening. I'm not sure what, but I am sure that I'll be talking more about systems related stuff as we go. So that is all for the day though. Thank you for letting me nerd out a little bit here. And thank you for your time. If you are new to the podcast, make sure you hit subscribe.
That way you can be up on any episodes that are dropping if you're not new, but you haven't subscribed. Go ahead and do it so you can easily binge listen to previous episodes as well as stay up on new ones coming out. And for anybody listening, please share this with a friend who is
in a space where you think they might benefit from hearing this message. Other than that, it was great seeing you here and I will see you on the next episode. Thanks. Bye.