Using EOS to Create Clarity and Traction in Your Practice with Tom Restivo

Adam Cmejla:
Welcome back to another episode of 20/20 Money, The Business of Optometry. Joining me on today’s show is Tom Restivo. Tom, good to see you. Thanks for being here.

Tom Restivo:
It’s a pleasure to be here. Thank you.

Adam Cmejla:
As a recovering CEO now turned EOS implementer, I’m excited to unpack EOS because it is one of those systems that I feel is making its way around the profession of optometry in a couple of different ways. I’m excited and curious to explore EOS with you from your vantage point and your experience.

I thought we’d begin by giving a little context. Give us the backstory on being a recovering CEO.

Tom Restivo:
For 17 years, I was the CEO of an eye clinic in Bloomington, Illinois. We followed a rapid growth model, and over that 17 years we grew to 12 locations and almost 300 people, usually in that 275 to 300 range. It was fantastic until it wasn’t, and that really happened during COVID.
When I tell you we couldn’t make a great decision for anything, I mean it. Every decision we made seemed to leave half the team thrilled and half the team upset. I might be slightly exaggerating, but it was such a confusing time. Candidly, it started to expose some cracks in the system we had built. This was prior to EOS, and that’s why EOS is such an important part of this story.

I call myself a recovering CEO because I was trying to do it the hard way. We had some really smart people on the team and a lot of drive and ambition, but we were just trying to bolt on whatever seemed to make sense at the time. We didn’t have a real system. That made things very difficult for me as the CEO, but when I look back, it was even more difficult on our team. We burned out some really good people. Many of them are still there and I hope they’re doing well, but it was unnecessarily difficult to get to the level we wanted to reach.

Adam Cmejla:
This might be an unfair question, but I’d like to unpack that a little more. COVID was obviously a huge curveball in all of our lives. If you look back on that time period, was the problem already there and COVID exaggerated it, or were things pretty good prior to COVID and then COVID caused the issue?

Tom Restivo:
It makes perfect sense. I’d love to say it was COVID’s fault, but that’s not the truth. COVID exposed the cracks.

We were seeing, I think, around 104,000 patients a year with 19 doctors. Everyone on the outside thought we were a well oiled machine. I heard that all the time, even from some of the doctors when we purchased their practices. We used the metaphor of a duck on water. Calm and composed on the surface, but paddling hard underneath. That was how we wanted to present ourselves to patients and to each other.

But going back to your question, COVID really exposed the cracks that had developed through rapid growth. We were constantly working on having a better system, and customer service was our rallying cry, but if you grow too quickly without a great foundation, cracks are inevitable.
I hope no one ever has an event like COVID that exposes those cracks, but realistically it could be anything. It could be COVID, new competition, decreased reimbursements, or any other challenge. That’s why now is the time to shore up your foundation.

Adam Cmejla:
That’s a good segue into talking more about EOS. I want to shift the conversation to the more common listener for this episode. There are many more practices in that $2.5 million to $7 million top line revenue range with maybe three to six providers that are going to be listening to this. There just are not many organizations in eye care that scale to over 100,000 encounters, 19 providers, and 300 team members, so first, kudos. Cracks in the foundation and all, that is one heck of a structure to build.

As we distill down the concepts of EOS through the lens of the more typical practice owner listening, let’s level set. What is EOS? I mentioned in the introduction that it stands for the Entrepreneurial Operating System, so unpack that a little more for us.

Tom Restivo:
Absolutely. Before I do, I don’t want to lose the listeners who may have only 8, 10, 15, or 20 staff members, because the time to build a great foundation and system is early on. Most of my clients now range from very small teams up to around 131 people. I even have one client with a team of four. They were wise enough to say, let’s build the foundation correctly from the start.

So what is EOS? There are a lot of ways to describe it. It’s right in the name. It’s a system. Sometimes I call it a framework. Sometimes I even say it’s a recipe.

Gino Wickman created it a little over 20 years ago. Through his own experience in his family business, along with ideas he learned from other wise thinkers like Pat Lencioni, Jim Collins, and Dan Sullivan, he pulled together some of the best concepts and turned them into a system anyone can implement in their business.

Very simply, it breaks the business down into six key components: vision, people, data, issues, process, and traction. Within each one, there are one or two tools that help someone become about 80 percent strong in that area.

Here’s the thing. When we have people self analyze, they usually come in around 20 percent strong. Imagine if you could move from 20 percent to 80 percent strong in each of those six areas. That’s a game changer.

Why not shoot for 100 percent? Because the return on the extra investment of time and effort between 80 percent and 100 percent usually is not worth it. That’s perfectionist thinking. But if we can get to 80 percent, that changes everything. If I had been 80 percent strong in my company, I would still be there and we’d probably still be growing.
One of the biggest issues for me was not being able to keep the board aligned around the vision. That’s why it’s always important to start with vision. Whether your listeners are one provider or 12, you have to know where you’re going and how you’re going to get there. You’ve got to get the entire organization behind you. I failed at that at different times in my 17 year journey by not keeping everyone well informed on why we were doing things. You have to get buy in if you want people to truly want to be part of your organization and give it their best.

That’s EOS in a nutshell.

Adam Cmejla:
How do you think about vision? I heard you say there was a disconnect around vision. So when you have a practice with one owner, or maybe a few partners, how do you think about setting a vision and where does that responsibility lie? How much of vision setting is ownership’s responsibility versus bringing everyone together and trying to cast the vision by committee?

Tom Restivo:
That’s a great question. Casting the vision by committee is better than what some organizations do, which is not have a vision at all. But ideally, if you have one owner, that owner should have a leadership team. If they don’t have one yet, that would be a great next step.

Usually that includes your office manager, maybe the person handling finances, HR, and your tight group of key people. One way to think about it is this: if things really hit the fan, who are the two or three people you’d be calling to ask what you should do? That’s your tight team.

In EOS, we get that team together with the owners and start to chart the vision. It starts with core values, and that is one of the most important things they can do because everything else ties back to core values. This matters when you’re hiring, retaining, and unfortunately sometimes firing. It all needs to tie back to core values.

We had wonderful people in our organization, but there were some who did not fit our core values. In hindsight, I do not care how technically strong someone is. If they don’t match your company’s core values, they are not a bad person, they just are not a great fit for your team. So in casting that vision, it starts with asking what our core values are and what it means to be part of our team.

Adam Cmejla:
When you were describing the people involved in vision casting, I was laughing because some owners listening are all of those things right now. Have you had experiences where businesses bring in external partners as part of that vision casting process or leadership team? For example, a financial partner who knows the business well.

Tom Restivo:
I haven’t experienced it yet, but it’s plausible. If you have someone external who really knows your business well, I could see bringing them in. But often, even in relatively small practices, there are still two or three key internal people who can get in the room with the owner.

My job in that room is to do three things: teach, coach, and facilitate. I’m not there to give them the answers. I’m there to pull the answers out of them. That’s especially important when someone is defining their core values. Never be tempted to look at the core values of another organization you admire and copy them. Your core values are already in you. We need to pull them out and use them to guide decisions.

Adam Cmejla:
The takeaway for me is this: be the best first rate version of your own business rather than a second rate version of somebody else’s. Be authentically true to yourself and the vision you want for your practice.
I think the challenge for some practice owners is knowing where to begin. They might say, I want to provide a great patient experience and take great care of my team, but what is my vision beyond that? Do you have any thought exercises that can help people start grounding themselves in that work?

Tom Restivo:
Absolutely. In EOS, we use a very simple two page tool called the Vision Traction Organizer. It literally walks them through the exercise.
We start with honest conversations about core values. One way to begin is by asking them to think of three people in the organization who really exemplify who the company is. There is always someone who comes to mind right away, and once they start describing those people, the ideas begin to flow.

Then we define those core values clearly. I do not want core values that get written down and then put in a drawer. These need to be living values. With my clients, everyone in the organization can explain the core values and give real life examples of them. When they’re interviewing candidates, they are already talking about core values. Someone may try to say all the right things in the interview, but eventually, if they are not a fit, it will come out.

That’s what so many organizations miss. They never set the expectation, and then a year later they wonder why the person is not a good fit. We need to know our core values. Then we need to know where we want to be in 10 years. We can’t predict perfectly, but we can take a good shot at it. Then we look at three years. What do we want the business to look like? What revenue do we want? Another office? Another provider? Better marketing? I love talking about patient psychographics and knowing how your patients think. Are you attracting people who want the lowest cost and highest convenience, or are you attracting people who value high touch service and a premium optical experience? Both can work, but you have to know who you are.

Then we look at one year. Where do we want to be in one year? One of my favorite tools is Rocks. Think of a five gallon bucket with rocks, pebbles, sand, and water. If you start with the rocks, everything else fits around them. In business, Rocks are your three to seven biggest priorities for the quarter.

So often people sit down to work on something important and get distracted by emails, calls, and all the little things. Before they know it, the quarter is over and they have not made progress on the big thing. With EOS, we hold each other accountable. We ask, are you on track or off track? If you’re off track, fine. We drop it to the issues list and work through it.

The final part is the issues list. Instead of laying in bed at 2:00 in the morning thinking about all the problems you need to solve, put them on the list. Then when the team gets together for a Level 10 Meeting, we solve them.

That’s the VTO in a nutshell.

Adam Cmejla:
The funny thing is, when you mentioned the issues list, in our firm we literally call it the parking lot. I want to talk about implementation. When you think about the leadership team versus everyone else, how much of the organization is involved in the implementation and execution of Rocks? Is that typically limited to the leadership team, or do they assign projects more broadly across the organization?

Tom Restivo:
The leadership team sets the Rocks, and there are usually three to seven each quarter. There is always one person who owns each Rock, but owning the Rock does not mean that person does all the work. That is a really important distinction. If someone owns a Rock, they are responsible for making sure it gets done, but they may pull in people from across the organization to help.

That gives people more responsibility and more buy in. Those are leadership team Rocks. Once the organization gets more comfortable with EOS, then we start to push it further through the organization so that everyone has one Rock each quarter. That usually happens nine months to a year in.

I’m glad you brought up time commitment too. If someone wants to take EOS seriously, the leadership team needs to commit five to six days a year to working on the business. I know that is hard for providers, because if you are not seeing patients, you are not producing revenue. But it is such a great investment in the long term success of the organization. If you solve the right problems and build the right systems, eventually there is less chaos, fewer headaches, and more capacity.

Adam Cmejla:
Can you talk a little more about those meetings? What are we doing in those five to six days a year versus when are we actually doing the work on the Rocks?

Tom Restivo:
The first time we get together, ideally it is offsite, away from the practice, and for about seven hours. We start by talking about hitting the ceiling, because every organization hits the ceiling at some point. Then we build out the Accountability Chart, which is like an org chart but focused on roles. We identify the five major roles in the organization. Then we set Rocks, work on a Scorecard so everyone knows their numbers, and teach the Meeting Pulse, which is the Level 10 Meeting.

That first day gives the team the basic tools of EOS. Then we get together again in 30 days and start building out the VTO. During those 30 days, they are already implementing what we discussed. They start meeting as a leadership team and making progress on Rocks. It is a crawl, then walk, then run process, and I’m there every step of the way.
My most successful clients are the ones who reach out between sessions. They’ll text me and say, we ran into this issue while setting a Rock, what do you think? With 30 years in eye care, I have some perspective there, but I always remind myself to pull the answers out of them rather than just hand them answers.

After that first 60 days, the team has spent time together three times, and by then they are rock solid on the basic tools. After that, we get together once a quarter, review, and set new Rocks so they are constantly moving forward.

Adam Cmejla:
Going back to the six key components, should practices follow the system in order, or can they focus first on the area where they feel weakest?

Tom Restivo:
Ideally, you start with vision and follow the cadence that has been proven to work. But if someone is self implementing and they need to start somewhere else, I am not opposed to that. Maybe they start with process. Maybe they start with meetings. And I have to come back to meetings, because the Level 10 Meeting is one of the best places to start.

The reason they call it a Level 10 Meeting is because after a couple of months of doing EOS, you actually rate your meetings. At the end of the meeting, you ask, how did we do? Were we open and honest? Did we solve problems? Over time you start getting eights, nines, and tens.
That’s huge, because when I ask organizations how they would rate their meetings before EOS, I hear twos, fours, maybe a six, and often zeros. Zero means they stopped having meetings because they were such a waste of time. If you can turn meetings into something people rate a 10, that means they are a valuable use of time. You are solving problems, getting things done, and working better as a team.

Adam Cmejla:
Is there a usual suspect that makes meetings ineffective? Something someone listening right now could self diagnose?

Tom Restivo:
Absolutely. First, you have to start on time and end on time. If you don’t end on time, it creates a domino effect for the rest of the day. Second, you follow the same agenda every time. The issues will vary, but the structure stays consistent.

One of the biggest killers of a good meeting is when people are not open and honest. In my world, being open means being willing to hear everyone’s perspective, even if at first it sounds like the craziest idea you’ve ever heard. You never know who has the best idea in the room. Being honest means if something is bothering you, say it.

That is so important because I didn’t realize early enough that healthy conflict is necessary. I’m the youngest of five, with four older sisters, and I’m a natural peacemaker. I did not understand the role of healthy conflict in a business setting. Now I encourage people to say when they disagree. Just because someone is the highest ranking person in the room does not mean they have the best idea.

Another important part of a great meeting is how you conclude it. We always define cascading messages. If we decide to change office hours or change a policy, before we leave the room we ask who is announcing it, when, how, and what are we saying. Otherwise information starts to leak out and get distorted. Something like, we are opening a new office, can suddenly become, I heard we are closing three offices. It turns into the telephone game.

Also, if we disagree in the meeting but land on a solution, we walk out united. That is critical. A great way to hurt an organization is to walk out divided and then tell staff you didn’t really agree with the decision. That creates camps, division, and resentment. I saw that in my own company, and sometimes it was my fault. So if there is one takeaway here, it is this: always walk out united. Otherwise it becomes a cancer in the culture.

Adam Cmejla:
That is exactly right. It introduces resentment into relationships, and that is cancerous for culture. As an organization grows and you add more humans into the mix, it becomes exponentially more important to have scaffolding around this. You just cannot wing it.
Let me take a right turn here. One of the frustrations I heard in my profession when talking to advisors about growth was that they understood the strategy, but did not know how to implement it tactically. So to what extent do you see a chasm between going through this exercise and then actually saying, okay, how do we do this? How do you help practices through that?

Tom Restivo:
It’s not easy and it doesn’t happen overnight. Part of the answer is this: put the issue on the issues list. Then we use a tool called IDS, which stands for Identify, Discuss, and Solve.

Let’s say the issue is opening a new satellite office and the team is not sure where to start. Great. That becomes the issue. We identify it clearly, then discuss it together and start writing down all the pieces that need to happen. Once we solve it, we break it into smaller actions. Maybe one person is responsible for contacting the building owner. Another person is handling something else. Everyone leaves with a clear to do.

Then in the next Level 10 Meeting, we ask if it got done. That is where accountability comes in. We come up with a solution, break it into its smallest components, assign responsibility, and then follow up weekly. That’s how it starts to move forward in lockstep.

One more thing I want to mention is politicking. I was very guilty of this in my own company. If I thought I had the right answer, I would keep coming back to it and trying to influence everyone toward my position. That is politicking. It is when you keep hammering your point until other people eventually just say fine, let’s do it your way. That is a bad way to lead, because someone else in the room may have had the best idea. So no politicking, open and honest discussion, clear accountability, and then process.

Adam Cmejla:
As we wrap up, is there an organization that is just not ready for this yet? Is there a litmus test where someone should say, not yet?

Tom Restivo:
Yes. You really have to be at the stage where you want to change. There are always pain points, but you have to be ready to do something about them. You also have to be willing to dedicate time to it.

If someone is not ready to dive all the way in, I’d still encourage them to call me. I’ll gladly give them a few tips they can start working on in their practice. But to really go all in, you have to be ready.

It’s not really a quantifiable number. It’s more of a trait or a mindset. Even a cold start can implement these concepts early. I actually like to have one pro bono client each year, and mine is a startup nonprofit with one person. I taught her all the tools so that as her nonprofit grows, it starts with a rock solid foundation.

Usually, though, it’s organizations of about 10 people or more because you also need resources to invest. But the biggest factor is mindset. Just like going to the gym, it starts with saying, I’m ready for change. When the business starts to feel like it’s running you, and you’re ready to do something about it, that’s when EOS can really help.

There are some practices that are doing well, with good margins and a strong team, and they do not want to rock the boat. That’s fine. But I would still encourage them to give me a call so I can at least share some Level 10 Meeting tips, because that is a great area to improve. For the people who are really ready to change, EOS is fantastic. I just wish I had it when I was running my company.

Adam Cmejla:
Tom, this has been a very enjoyable and enlightening conversation. I appreciate you taking the time to share this with me and with the listeners of 20/20 Money. We’ll also include your contact information for anyone who wants to have an exploratory conversation and learn what it means to work with an implementer in our show notes.

Whether we said it explicitly or not, I think you alluded to the fact that yes, you can do this yourself, but there are also EOS implementers who can help. One of my favorite ideas is that the value of a great advisor or coach is not necessarily in the answers they give, but in the questions they ask. You mentioned that yourself. You do not want to give them the answers. You want to lead them to their own answers.

Tom Restivo:
Absolutely. We always say the answers are in the room and we want to pull those answers out. Working with an implementer will usually help you go further faster, but some people just are not ready for it. If they are not, pick up some tips from the book or call me.

They can also call me if they just want to talk about what is going on in their business. I was in eye care for 32 years. I have seen a few things and made a few mistakes. If anyone is thinking about acquiring other practices, that is one area I would especially love to talk with them about. We purchased maybe 25 practices in that 17 year run, and there were a few that involved wonderful people who simply were not aligned with our core values. I could have saved us a few headaches there. So if you are thinking about expanding, talk to me. I can help you think through what to look for in order to make sure it is a strong culture fit.

Adam Cmejla:
Fantastic. Again, we’ll put contact information for you in the show notes of this episode. Tom, thank you so much for being here. I appreciated the conversation, and we’ll catch everybody on the next episode of 20/20 Money, The Business of Optometry.

Tom Restivo:
Thank you, Adam.