Skot Waldron:
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Dr. Carlene does not mess around when it comes to company culture. Company culture is part of their organization. It's part of everybody's organization, but developing company culture is something that Brooklyn Minds puts a super, super big emphasis on. With everything from who they hire, to the patients they take on, and mirroring those, and making people feel involved and included. It's so critical and they understand this, they're using technology to help bridge the gaps of communication and understanding within the organization. They are using all types of tools to help foster that communication. When there's people that have problems, or insight, or lacks understanding, and the way that a group of psychiatrists work to understand one another, is super, super relevant and important.
I really love this interview. She is a company culture, powerhouse, superhero, and I am so happy to have had her on the show and had this discussion. You're definitely going to learn about some things. We talked a little bit about the practice beforehand, and then we get into some really heartfelt discussion about how to use company culture, to make sure that we are all aligned and doing the right things that we need to be doing. So let's do this, I'm super excited. Dr. Carlene MacMillan.
Hey, welcome everybody to an episode of Unlocked. I'm here with somebody that believes in culture, that believes in, not just the culture in the workplace, but the culture outside of the workplace and bringing that into the workplace because of everything they believe. So Dr. Carlene MacMillan of Brooklyn Minds, welcome. Give us a little, tiny rundown of what you do. Why Brooklyn Mines, what does it mean?
Dr. MacMillan:
So, thanks so much for having me. I'm an adult and child psychiatrist by training and about four and a half years ago, formed Brooklyn Minds with my husband, who's also a psychiatrist. We've grown over that time to be a multi-site comprehensive mental health practice, taking care of some of the most complex psychiatric concerns, I would say, in the New York city area.
SKOT WALDRON:
And you deal with the hard stuff. You don't take the soft balls, it looks like. That's kind of something you wanted to focus on, and why is that?
DR. MACMILLAN:
Yeah, so I think we really have a team-based approach to mental health. I think a lot of complex medical concerns require a team. What we found in mental health was really, a lot of people in kind of more of a solo practice model, who really weren't able to take care of some of the more complicated, sicker individuals. So those individuals end up going to emergency rooms, going to hospitals, kind of going into a revolving door type pattern because they're not really getting that help that they need. So, by forming more of a team-based approach where we have multiple clinicians and team members working with an individual patient, we're able to keep people in the community, in their lives in a more meaningful way, more of the time. So that's why we do that, and that's part of why culture is important because we have this team approach. We're not working in our little silos, in our little offices. We're very much working together.
SKOT WALDRON:
Okay. I like that idea, and I like the inclusiveness of what that means because it's not about the individual at the company, it's about how do we best serve the patient, and the best way possible, and bring in multiple ways, multiple people that have different talents to be able to do that and serve that individual, right?
DR. MACMILLAN:
Absolutely.
SKOT WALDRON:
When you are looking for these people to come work for you and mind you, you have grown pretty quick. Four plus years, and what do you say, 50, 60...
DR. MACMILLAN:
Yeah, between 50 and 60 employees, many of whom are full-time.
SKOT WALDRON:
Awesome, congratulations. That's great growth, and way to serve multiple people. To find a way to scale in a way that serves you and the community. So when you're looking, this is a lot of people to go through, you're doing a lot of hiring and you're probably doing a lot of letting people go that aren't fitting to the culture or the environment. What are you looking for? You've had a lot of experience now with hiring individuals. What are you looking for in an individual to fit your team, your culture, your environment?
DR. MACMILLAN:
I think we've definitely gotten more refined over the years and now, if we have someone that we've hired who is really not a good fit, that's really on us. That means that in our interviewing, our onboarding process, we didn't ask the right questions or we didn't help someone find a place that they'd be happy. So we're really looking for people who like that startup mindset, I think medicine tends to be a little bit more traditional. So we'll see a resume from somebody who has 15 years experience in a city hospital, they might be a terrible fit for us because we are growing, we're changing, we're not using some of the older [spectology 00:06:39]. So we need people that want to be in that building the plane while they're flying it kind of culture.
DR. MACMILLAN:
At the same time, which is, I think, tricky is we want people who also have a reverence and respect for science, and privacy, and evidence, and doing things in a very reverent way, as well. So it's a very tricky balance of people that sort of respect traditions and want changed at the same time. So we interview for that, we look for people who aren't afraid to ask difficult questions, people who aren't... Most importantly, I think, aren't afraid to say what they don't know, and say areas that they are weaker in and they look to get help. We're not looking for lone rangers or heroes, we're looking for people that really want to be part of something bigger than themselves.
SKOT WALDRON:
I can imagine you probably get that, when people go into this field. You have a lot of solo people, solo practitioners, people that are doctors and therapists, and they go in and want to do a certain thing. They usually have a private practice of some kind, or they're part of a group, but they still get funneled patients, and then they work with that one patient over time. You found, over the course of your career, that those are not the people that work well, that just want that, that just want like, I want a one-on-one relationship with this one person, and just give me my clients and then I'm good.
DR. MACMILLAN:
That's right. Yeah, that's not a great fit for us. So I would say from a clinician standpoint, we get two groups of people. We get some people who love teamwork, love academic work, love to be in this learning environment, and have worked at area hospitals or, not in this area, but around the country, and have found that there's a lot of bureaucracy there and that it's slow moving, and actually not as innovative and academic as they had hoped. So they're leaving the traditional academia to work with us, which is more of like startup mental health.
Those people work really great on our teams and they bring a wealth of institutional knowledge. Then the other type of person, is somebody who maybe started out in private practice, but found they really liked the more challenging cases. They really liked people that were having a lot of suicidality, and self-harm, or bipolar, and they found that's not a great fit for their solo practice, and they're really craving connection with other clinicians. So they leave their private practice and come to us to be part of a part of the team.
SKOT WALDRON:
Wow, that says a lot about the individual, and it says a lot about you, to try to find that fit and who you're trying to collaborate with. You speak a lot in our conversations, our notes, about technology and how you're using technology to help build culture and collaboration inside your organization. Tell me a little bit about that.
DR. MACMILLAN:
So I think we have always been kind of tech forward. You see some mental health practices that are still using paper, and there's nothing wrong with that, but it doesn't really work when you have these distributed teams, particularly doesn't work when COVID hit. Right? So we were, I think, pretty easily able to pivot into that environment because we were already technologically connected. We do use a program called Spruce Health, we were very early adopters of Spruce, they're a team out in California, and they're great. They originally started for dermatologists to make this communication platform for patients and clinicians, but we really early on worked with them and adapted it more for mental health.
So the way that works is, if somebody is interacting with one of their patients, and the patient is having a harder time, and that clinician needs support, or maybe the front desk associate needs support, they're able to call, kind of like a Slack type situation. They're able to call on their peers within the company to help them and guide them. That allows us also to work with trainees, therapists that don't have as much experience because they're not really alone with the individuals they're working with, they have a team behind them, backing them up.
So we've used that very early on, and then the other things that we do, there's a program called 15Five. I'm not sure if you're familiar with that, but it's really focused on positive psychology within the workplace. It does kind of weekly check-ins with the employees about how they're feeling, what they'd like to be different about their job, issues they're having. They also can give recognition to each other with high fives online, and it's got an HR platform, but it's really positive focus. So it's not just a place to complain, and we have people doing that every week. I think, particularly with a remote workforce, that allows us to keep a finger on the pulse of people that we may not be seeing in the office anymore.
SKOT WALDRON:
You talk about having a mentalized workplace, what does that mean?
DR. MACMILLAN:
It's a kind of a fancy word from this British school of psychology. So mentalization based treatment was started at the Anna Freud center in London, as a way to work with people with personality disorders, people that were finding other therapy to be not helpful, very mistrustful of help. That's an individual type of therapy called MBT, but there's also an adaptation of it for teams. That's called AMBIT, AMBIT means sphere of influence. So basically, we use that approach with our whole team, and the approach is based on taking a curious, not knowing stance, to understand misunderstandings.
The key phrase is seeing yourself from the outside and others from the inside. So if there's a misunderstanding between someone at the front desk and a clinician, we try to take this sort of curious and not knowing, nonjudgmental approach to it, rather than let emotions escalate to the point we're saying, I can't believe she did that, that she did that on purpose. She's always doing that to me, she's always messing up my schedule. Those types of things that happen in workplace, we're able to kind of break them down using that curious mentalized approach.
SKOT WALDRON:
How are you finding out more about the other people in the workplace? The more understanding. So trying to... I really love that, of looking... Let me see if I can rephrase that right. You look at yourself from the outside, of how people see you, but you're also trying to understand people on the inside and why they may behave or act a certain way. What are you doing to dig deep into that and to understand that?
DR. MACMILLAN:
Yeah, so some of it is through regular supervisions, both one-on-one supervisions and group supervisions, that are more like supportive in nature. Where members of the admin team might get together and, instead of just complaining for an hour about the clinicians, would actually have facilitators that are trained in mentalism. We've actually brought facilitators over from across the pond, thanks to Zoom, to help lead these sessions, to teach the administrators to think like we do as clinicians. To think about why a clinician might've done something or why a patient might have done something, because they are also on the front lines dealing with... When you call a doctor's office, there could be frustrations, there can be misunderstandings, emotions can flare. So we're kind of arming them with the tools that we use as therapists, within their workplace. And then the same for the therapist as well, of course we have supervisions and things for that.
SKOT WALDRON:
Okay, that's really cool. I've never heard really put that way, but I can imagine that an office or a workplace full of psychiatrists, you're constantly analyzing each other. Am I right?
DR. MACMILLAN:
Yeah. It's like everyone gets frustrated from time to time, but I think we're better at checking ourselves or we would use sort of a lot of calling out the elephant in the room when we have conflicts. I think the thing about mentalizing is, it's not knowing stance. So someone missed a meeting the other day with, with their supervisor, and instead of what we'd call hypermentalizing and telling all these stories in our heads about why that person missed, we really come from a, well, there probably was a good reason, let's find out what that reason is, let's kind of give them the benefit of the doubt. And no matter what that reason is, that's going to be data that we can now work with. So that's what we strive to do, at least.
SKOT WALDRON:
So innocent until proven guilty.
DR. MACMILLAN:
We recognize that people's actions, they make sense from the perspective they're coming from. We also will ask questions on our weekly 15Five, like what's one aspect of your role at the company you think people don't understand, or you think people commonly misunderstand. That's been a really helpful question to see how people think others are seeing them, and the stereotypes, the biases, and also just some of the blind spots we have. Some people were just looking at the administrative staff as this monolithic thing, I'm just going to ask someone over there to do a thing for me because I don't really know who they are, versus this is what this person does. This is what this person does. This is how they approach their job, and by the way, they have 30 other things on their to-do list today. So helping everyone to kind of seeing each other's shoes, kind of thing.
SKOT WALDRON:
And hold on, did I just hear you say you have weekly 15Fives with the entire group, how does that work?
DR. MACMILLAN:
What a 15Five is, is this a great company. They say that the employee should take 15 minutes to fill out this online thing, and then it takes five minutes for the supervisor to review, I actually think it can take less time than that. That we can put questions on there that have to do with workplace culture, they have some built-in ones you can ask, but you can also customize your own.
So we've put in there some questions that I think take a more kind of mentalized stance. We'll even ask, what was one misunderstanding you had this week at work, and how did you deal with that? So it's getting people to think about things very deliberately about their workplace. I would say the data that we've gotten from that, to be able to actually take action and change things, is quite striking. I don't think we would've gotten it just from a six month employee annual review, kind of thing. I don't think that's particularly effective.
SKOT WALDRON:
Yeah. You got to have this constant reminder, this constant engagement because you miss a lot in six months. If you're waiting every time and then do six months, you're going to miss a lot. So that weekly reminder, that weekly engagement and also, not just observing, listening is a huge part of that and reading and engaging, but action. You said action, which has to be tied to the problem, to the solution, to whatever you're doing. That action is so critical.
DR. MACMILLAN:
Yeah, and I think we find sometimes people, they won't say something to our face, but they'll put it on 15Five. Some people have a lot of ideas and we would have never heard them. Some of them are like, let me kind of complaining? But we take the, we're glad you said that because now we know, and now we can do something. So that's how some of our support groups have formed, we have a town hall every two months. That was a result of people putting stuff on there. We even have these culture committees that we have in the workplace, based on what people were saying on these weekly check-ins.
SKOT WALDRON:
You're kind of a workplace culture superpower. You've got tools in place, you've got these committees in place. That's fantastic, you don't get that all the time within smaller businesses, especially in these medical fields, because a lot of medicine is all about patients and turning through patients because that's billable. We got to get through that, and we definitely don't have time to take an hour or half hour out of every week to focus on company culture.
DR. MACMILLAN:
Right, and that's why I think physician burnout is high, physician suicide is high. It can be kind of a thankless job without kind of paying attention to the culture, and so we're very deliberate about it. I think a couple of years ago, myself and our COO went to the culture summit in San Francisco. I don't think there were any other medical practices there, there was Uber, and Salesforce, and smaller companies, too, but there was just nobody from the medical field. It was just not there-
SKOT WALDRON:
Why is that?
DR. MACMILLAN:
I mean, the culture of medicine is also it's own beast, it's its own thing, it's what we're indoctrinated into. I think it's the hospital-based, quite hierarchical, almost a bit like the military, I would say, in some ways. I think that culture is really important because the stakes are really high in medicine, but I also think there's aspects of it that can be kind of outdated and not particularly innovative, and not really geared towards the workforce, particularly some of the younger workforce that we're working with. It doesn't have as much for them, as we would want.
SKOT WALDRON:
It's hard to connect, they're kind of coming from that old school way of life and thinking, and you're doing different things now. We've talked about a few of those now, and another thing you do that's really, really important for you, your workplace, your culture, your environment, it's on your website, it's on your Zoom label, is the inclusiveness, gender identity, things like that. Talk about that, as relating to why that's so important for you, why you put it out there and what you hope to achieve because of that.
DR. MACMILLAN:
It's kind of in the [00:21:49] and Brooklyn Minds. We live in Williamsburg, this kind of really diverse place with all different types of people, different ethnicities, different gender identities, different sexualities, not everyone's neuro-typical, as well. We have people with different learning styles, people with psychiatric conditions that they're open about in the workplace. I think that our workforce reflects the people that we're caring for, and that makes it go better, and that builds more trust. There's just more connection when we have all these different perspectives. So it's very important to us, and it always has been important to us to try to do that when we're hiring and recruiting.
SKOT WALDRON:
So you hire people that reflect your patients that are coming in.
DR. MACMILLAN:
Yeah. I think empathy is a huge part of what we do, and people that get that in some way, and there's many different ways to get that, that's who seems to want to work for us, as well. So those are the people that stand out in the application process, you can tell that they're... It's not just any job, any office, they really want to be in this field, working in the trenches. Usually, that comes with some kind of personal experience of some kind, especially, I think, around gender identities. We have so many patients in our practice who are having different gender identities, and exploring that, and facing discrimination with that. So having employees kind of across the company with different gender identities just adds a whole other kind of dimension.
SKOT WALDRON:
What do you hear from your patients as a result of that?
DR. MACMILLAN:
I think that they find it refreshing. We're not the only mental health practice that is doing this, I think that there's definitely therapists are becoming more attuned to this. We'll see a lot of patients who are specifically coming to us for that, or wanting to work with a therapist who has a certain type of background, whatever that may be. It could be a certain cultural background, could be they have substance use, so they want a clinician that's in recovery, you see kind of all different kinds of things within our field and we want to be able to serve those needs.
SKOT WALDRON:
That's awesome. Let me read this statement that you wrote, really quick. I asked you this question earlier, what were some of the biggest mistakes companies make when it comes to company culture? And you said not tending to it, not acknowledging the issues within a workplace culture and instead focusing on empty initiatives and buzzwords. There's often a stated culture that differs from reality. Tell me about that.
DR. MACMILLAN:
You see a lot of companies wanting to come up with their list of values, and putting nice things on the website, but then when you're actually asking the people who work there, what the culture is like you're creating a different thing, we recognize that. One of the committees that we have is called the change committee, that really is just very much focused on this idea of like, well, maybe there is this one culture, but then there's also this unsaid culture. If you don't acknowledge that, that unsaid culture, it's going to cause problems, it's going to be kind of this sort of pretend culture situation. I've certainly worked in workplaces like that before, and it's not a great place to work. Every workplace is going to have conflict, every workplace is going to have a changing culture, and you have to go with that, you have to be open to that.
SKOT WALDRON:
In a world of social media and being exposed to a lot of things that seem inauthentic to us, authenticity in the workplace is becoming more and more important. It's not just as an external brand seeming authentic to our customers and clients of saying, hey, we're saying all these things, let's be that, but it's authenticity to the people inside the organization to say, hey, we believe this, we want to do this, we want to represent this. Then those type of employees coming on and saying, yes, I want to be that, too. I want to belong to that, that's real. Then, once you have that agreement of, hey, we want to be this and somebody saying, hey, I want to be part of that, then actually doing it and making it real and being authentic because what happens is that, a lot of companies aren't and they're getting called out on it now.
DR. MACMILLAN:
Yeah. I think we, the people that do our social media, you can probably tell. If you looked at it at a point where we went from having like an external organization helping us with it to having just internal people. We found when we had internal people, they really get the culture and they really represent us better. It feels different, it looks different. I don't have to micromanage it, it just represents kind of who we are. So we've also learned that in terms of working with outside agencies, they just don't get it because they're not here.
SKOT WALDRON:
As a Harvard trained psychiatrist, now being a CEO, making that transition to be the person doing all the work of the treating patients and to helping them, to being the leader of an organization. What's that transition been like? What are some of the pains that have come with that? And what are some of the rewards?
DR. MACMILLAN:
I think in my work as a psychiatrist, I've always liked working with people who maybe started out kind of isolated and building kind of a team around them, building support around them and seeing what potential they have or potential unlocked, you see that in patients. I think when I transitioned more to a business role, it was the same kind of thing, only it was with employees. It was with team members, finding someone who maybe is a little bit unpolished and doesn't have much experience, but really helping them kind of see their strengths and growing within the company, it feels very similar to me.
It feels very similar in terms of building a team and seeing it function on its own because when you're working with a patient, your goal isn't to have them always be dependent on you, it's so they don't really need you anymore. I think that's the thing, as I'm building the company, the more people can do things in the company and more departments can function with much less oversight, it's a very similar and very rewarding experience to see like, oh, well, I wasn't at those meetings this week and they seem to go fine and they were good, that's great. I'm happy to be left out at that point, I'm happy to be kind of peripheral.
SKOT WALDRON:
It's hard to let go sometimes, especially when it's your baby and you've grown this thing and then you're turning it over to somebody else and you're like, are they going to run it like I would? I hope so.
DR. MACMILLAN:
I'm still involved, but I just think that's why the hiring is so important and finding people who you think can contribute to the culture in a really synergistic way, who aren't just also just like clones of me, too, that would not be good if I was just hiring people that were my strengths. So I'm hiring people who like, I don't know how to do what you do. This is great, you need to be here.
SKOT WALDRON:
Yeah, I've learned on my own personal leadership journey that I really suck at some things. And I was like, what? I suck at that? It's like hiring people on that that can help you and carry the organization forward. So this is really great. I'm going to tie this in because you said it beautifully. You used to unlock the potential of these patients, and now you've just transitioned to unlocking the potential of your employees and your staff.
DR. MACMILLAN:
Absolutely.
SKOT WALDRON:
That's beautiful. Not only because it's the title of the show, but because it's awesome. That's what we do on our journey, and sometimes we get scared of leaving that because we're like, but that's why I went into business, to impact those people and to impact the population, but then trying to reframe our minds to say, well, I am, indirectly. I'm impacting the lives of my employees, my staff, helping them learn to impact more people. If you get that, you'll be able to impact more people at scale. You're just going to impact so many more than you could by yourself.
DR. MACMILLAN:
That's part of the thing, I still think most clinician administrators still see some patients and I still always wanted to do that, but I've also just recognize that, that is not going to scale. I really need to be able to train others to do this, too, so that's why we built the practice.
SKOT WALDRON:
Right on. Is there something you can provide the audience? Are there resources that we can find out more about you or things, if we're having issues with certain things and that we need to talk to somebody, what can we do?
DR. MACMILLAN:
Sure. Yeah. So you can go to our website, www.BrooklynMinds.com, similarly finding us on social media, Instagram, Twitter, et cetera. We do have a get connected with us button on the website, very easy to reach out. In addition to patient care, we also do workplace consulting and support for employees within companies, if that's something folks are interested in.
SKOT WALDRON:
Fantastic. Carlene, this has been awesome. You seriously are a workplace culture powerhouse, and it's awesome. I wish we would implement a lot of the stuff you're doing, we do a lot of stuff inside my organization, but the intentionality that you've shown here, is awesome. Sure, it's not perfect all the time, but you're intentional about what you're building and that's what I admire. So well done, hats off to you. Thanks for being on the show, I really appreciate it and have an awesome, awesome day.
DR. MACMILLAN:
Thanks for having me.
SKOT WALDRON:
We didn't cover this in the interview, but in the questionnaire that I sent earlier, she responded with something that was really interesting. A statement that she said, workplace culture is to the workplace, what broadband internet is to doing anything else online. It provides a foundation for everything we do. We can't access our true potential, we cannot... Let me rephrase that. Unlock our true potential without first creating a strong foundation, and that's what workplace culture does.
It creates that foundation for us to flourish, for us to do the things that we need to do, and to embody who we are and who we need to be. Authenticity, we talked a little bit about that. We talked a little bit about growth. We talked a little bit about opportunities, and how you can scale and grow based on bringing people in that think like you. Thank you, Dr. Carlene MacMillan, I appreciate you. And if you want more of these interviews, they're on my website at ScottWaldron.com. You can also find them on my YouTube channel. Go there, there's a bunch of them there, along with some other free resources and tools. Thanks for being here, and we will see you next time.
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