The State of Work Videocast with Dr. Givona Sandiford (California)

00:09 - Dr. Sandiford

My doctorate is in rehabilitation sciences, so it's a research doctorate. I developed an approach for non-speaking autism out of my initial private practice back in 2008. It's basically an approach that uses music and rhythm to trigger speech in kids who can't speak, who likely also have childhood apraxia of speech. It was highly successful, but that was many years ago.

00:35 - Anthony

Well, you did research, you've done some science. Where did that take you on your career path? Where did that end up?

00:40 - Dr. Sandiford

Yeah. I don't know how far back you want to go, but when I first graduated, I decided I wanted to be able to do everything in my field. So I pretty much held eight jobs at once. I literally ended up in the ER with heart palpitations from working non-stop. I was working holidays - you'd get time and a half. And then the crash of 2008 happened, my whole neighborhood lost their homes, so I worked even harder. But then that all evened out, and I actually ended up starting my own practice during COVID-19, doing telehealth and going into homes. It grew from one person to, at one point, 70 people. We cover multiple states now. I have my own practice, Melospeech Inc. I love my team, they're wonderful, and we provide speech therapy, occupational therapy, and early childhood intervention in the homes and virtually for underserved communities, children birth to 10.

01:46 - Anthony

And as an operator going from a research scientist, are you still carrying a caseload? Are you more in a managerial role these days? What does your day-to-day look like? You started this with a passion, clearly. Do you still get to do your work, or are you more like, "I'm doing reports and helping my employees carry a caseload"?

02:07 - Dr. Sandiford

That's so funny that you ask that, because I really enjoy reading business books from very intelligent people that have MBAs. I do not have an MBA - my background is in therapy and research. One of the things I read early on is that you need to make your business replicable. You need to make it operate without you. So that's what I put my mind to early on - removing myself from the daily operations. I actually am not needed in my business. I've gone a month, I think, without them needing me. But I do enjoy being able to continue to operate. Just yesterday, we had someone call out sick, and the family still wanted to have a session. So I said, "Okay, I will do your session for you virtually." I prepared two different sessions - parent education and then actually interacting with the child - and we ended up doing a session with interaction with the child. It was awesome because he started saying more and more words, even putting two words together. A lot of people don't think telehealth works, but for that little boy, he was saying a lot of words. So I am able to still practice clinically, but usually I just operate on expansion and changing benefits and improving things.

03:23 - Anthony

Wow. Givona, it sounds like you've built a model where local teams can really be self-sufficient and have allowed you some opportunity to pursue some other endeavors. I think that's really courageous. California - the data and the research shows that employees here are a little bit more confident in their own knowledge and they recognize their own skills a little bit better than some other states. Do you see any cultural shifts between employees or individuals in California based on other environments you've worked in?

03:53 - Dr. Sandiford

My industry is very different because we are about 95% female. We have one male clinician working with us now. So when we introduce that, it's a different culture, because we have people going on maternity leave a lot, which is wonderful. They come back and they're looking for roles where they can hold their baby and still do their work, and we provide that. They're looking for flexible roles where they can work anytime they want and still be home with their children, and we provide that. I think that is something that transcends cultures - where new moms are going to want to spend more time with their children if they can. That's why I started this flexible work environment. I had just had my own son, my only child as an older mom, and I wanted to be able to spend time with him. The job I had from 9 to 5 was not flexible. I could not get time off to spend with him, and he was my one child. I don't know too many people that would not value having their own time with their own family over spending all day in the office.

05:08 - Anthony

The data here in California for employees shows that employees are showing up a little bit more to the office, but your clinicians are inherently mobile, which means the questions and connections look completely different. So how do you build a cohesive and accountable culture when you're physically not together? You want to have a tight family, but no one's coming to the office. You're all doing your own caseload. How do you see another employee?

05:35 - Dr. Sandiford

We do operate self-managed teams. Each clinician is in a group with their supervisor and with their scheduling team, and the administrative team is loosely involved. But that small group operates everything within that self-managed team. They get to know each other very well in that team. We have a chat group where they chat daily. We also monitor their location with GPS tracking. So if they're not where they're supposed to be, we will reach out. We have a security protocol - for instance, we had one employee who didn't show up after they sent the message that they're on the way. We require a message saying "I'm on my way." They did not show up in the time it should have taken. We reached out first to them - couldn't reach them. We reached out to their emergency contact - couldn't reach them. So then our procedure at that time is to call the non-emergency police line to say, "Hey, the employee did not show up. We don't know where they are." Long story short, she had gone into labor on the way to her visit.

We actually even have supervisors that monitor sessions virtually. They set up their phone in the home, as long as the parent agrees to this, and they're on a screen. We have a screen of all the sessions going on at the same time. And if they choose "Help," someone comes in within two minutes to help them with something. So we really monitor their locations. We know where they are.

In terms of culture, we announce our policies weekly. We repeat - because what happens is you start to get drift, and this is with any culture. You don't reiterate what's important, people will start to do what's important to them. So we repeat our policies weekly in announcements. And when they join us, they have something called a "guru." The guru is somebody who's been with us at least two years with no issues, and they stay with that person 90 days as their person that can help them with anything. Any question that comes up, you ask your guru. That's their introduction into our culture. But it does work best with people who are autonomous. Not everybody wants someone hovering over their shoulder all the time. Some people need that, but that would not be our work environment.

07:48 - Anthony

Well, it sounds like you guys are pretty up to date with accountability, and you're open to leveraging some new technology - cameras. The TriNet State of the Workforce Report shows us that in California, we're leading the AI adoption. 56.5% of employees in California are using AI weekly, and they've been using it for personal development, for helping with their productivity. But when you choose between having an AI solution and an assistant versus a human person, how do you feel it's better? When is there an appropriate time? For example, if you have an HR question, is it okay for AI to answer that, or does that need to be human? Or if you have something simple like, "How far away is my drive?" - does a human need to answer that? Can AI do that? We've already decided that it's okay to use AI in some things and sometimes we need a human. Do you have any preferences or things your company might do uniquely? Where do you draw a hard line?

08:43 - Dr. Sandiford

That's such a great question, Anthony, because as you know - well, maybe you don't know this - Melospeech is a tech-enabled mobile company. So we first started in 2021. We wrote all of our own algorithms for that. So an algorithm: if this, then this. One of the first tools we made was our MeloSuite. It would determine how far away clients are and group them all together so that you wouldn't drive very far. Now that we have AI and all these different AI providers, we linked that system up to AI, and it's so much faster.

For things like administrative tasks, we will usually replace any repetitive task with AI. We have a chatbot called Arya, and we programmed her ourselves. She basically answers any questions a family might have about scheduling, or a cancellation - say someone late cancels, she can answer with the policy: "Oh, would you like virtual? I'm so sorry to hear he's sick. Our virtual sessions are available." She can handle any repetitive tasks, but we don't put her on clinical tasks.

We've also made most of our technology in terms of our SLP Spot, which does all of our notes. We started that over two years ago. Our team will do the therapy, but when we go into the home, we can talk through the SLP Spot and it will do our notes for us in any language we choose. That's automated. Our screenings are linked up to our AI system, the CMSP:B-5. The clinician goes in and checks off all the things she notices and runs it through the AI to write the report, but it requires the clinician to read over the report and make sure there are no errors within it before signing off. So where we draw the line is about clinical decisions that require a human. Any clinical decisions are a human, and then anything that's a repetitive administrative task can be handled by AI because it can be programmed properly.

10:55 - Anthony

I love it. Oftentimes automation and artificial intelligence can be conflated, and they can be two separate things. Really it's like, "No, I'm just repetitively..." Our mantra internally is "death to clicks." I want to reduce the amount of clicks you'll have in your workflows, because I hate clicking on things. I don't move my mouse. I don't want to be dragging things, dropping things. If we can remove touch points - I couldn't agree more. That's a great utilization.

11:21 - Dr. Sandiford

That's so crazy that you said that. I know we don't have a lot of time, but one of our interns - he started with us as an intern, and then we brought him in as our payroll guy because he's a genius at numbers. Such a unique person, we love him. Matthew, shout out to him. The other day, payroll was so fast, and I said, "Matthew, how did you finish payroll so fast?" He's like, "Oh, I wrote a Python code to copy and paste everything in a second." Then he sent me a video of it, and it was just dragging all the information over, automated. I said, "Where did you store that?" "On my local environment, it's safe, it's safe." I said, "Okay, looks good." And that's kind of our culture. Our team knows, "Hey, if you've got a way to automate something, we'll pilot that. We'll check it for three months, and then if it's good to go, we'll release it to everybody."

12:07 - Anthony

I love it. It sounds like you guys are pretty forward, and you have some cool unique things you do over there. The TriNet State of the Workforce data shows us that California employees rank their benefits - such as paid vacation and pension - as some of the top benefits. But ironically, 37% of those same employees left their job for better benefits. Since you run a distributed business with a bunch of employees, how do you design your benefits? How do you think about the gap between where your benefits are today and what your people actually value, so you make sure you're offering something that aligns with the constituents you're trying to support?

12:43 - Dr. Sandiford

I think it's really interesting. All the data - people always think, "Oh, someone's going to leave a job for more money. Someone's going to leave a job for better benefits." I think in general, most people realize they can't get their time back. So that is the one benefit you can offer people that is irreplaceable - their time. Flexibility to have time off when they need it, no matter what. Flexibility to leave work early or reschedule appointments if they need to go pick up their kid at school because their child's vomiting. If you don't offer people that, they will leave you for a place that offers it, even if that place pays them less. So the biggest benefit you can offer people is their time.

On top of that, things like birthday leave. That's a day that's special to everybody - their birthday. If you give them paid birthday leave, that's a benefit that's not very expensive. It's one day, and they feel good about that because that's their special day. The way we think about benefits - because we're not a huge company, we can't offer a month of paid leave. We can offer paid birthday leave, and that's something people overlook. We can offer paid jury duty. Not everybody gets called for jury duty. If you pay for that first day, that's good, because California will not give them a lot of money. It used to be $5 - I don't know what it is now. Have you had jury duty recently? If you can pay for that one day, that's not every employee in a year going to have jury duty - that's an easy benefit to pay for. So flexibility of time, autonomy to decide when and where they work. If they want to work on a weekend versus a Monday, let them have that. It doesn't hurt the company usually to offer flexibility.

14:34 - Anthony

The data also shows us that over 50% of employees describe themselves as extremely engaged. It was one of the highest things they have back in their series. Yet more than 52% of them are actively looking for jobs. So they're both saying they're very engaged at their job, and the same population is saying they're looking for other jobs. How do you actually know when someone seems engaged in their role? Do you look for anything when you're talking about this activity and traceability you were discussing? And have you learned anything between engagement and loyalty and relationships as an operator as you've grown from just you and your own private practice to the many distributed employees you have today?

15:14 - Dr. Sandiford

That's a really great question, because this is a different generation than, say, my mother's generation, where they stayed at their jobs for 40 years. This generation, they come and they go. So I told my team - if anybody gives notice, they say, "Okay, I've got a lot going on in my life right now." Usually that's the main thing they say: "I've got a lot going on in my life right now, and I need to take some time away." Or with Gen Z, those are the ones that will say "effective immediately, today's my last day." They don't believe in a two-week. I'm telling you, this generation does not believe in two-week notice. That is a millennial and beyond thing.

So we respond the same way - with grace. We see the person, and you know what, Anthony, they come back. We have had many employees leave and come back. We do an exit interview to find out what's going on - is there anything we can improve to make your job easier? Then we look at that data to shape our program. Across the board, those exit interviews have been positive. I think employers that take it personally when someone quits, or they try to block them - that's not a good idea. People talk, and then that person can still come back. We just had somebody who left us three years ago, who remembered us as one of the best places they've worked, ask to come back and work for us in the summer. We had someone leave the field completely, keep their license, they're in another state, and say, "Hey, can I pick up some hours with you all?" They left the field, but they don't mind working for us in the field. That's when you treat people like you care about them, like you see them.

We don't require doctor's notes. We had somebody fall the other day and miss a couple weeks of work, and they came with a doctor's note. We said, "We don't need this. Your word is enough for us. You said you fell, and we believe you. You don't need to bring a doctor's note for that. Take your time off, and come back when you can." I think that's how we keep people - by treating them like people. That is my personal stance: when we treat people like people and not like numbers, then they want to work for us.

17:28 - Anthony

I love it. Dr. S, you're a very accomplished individual. From your research, now pursuing law school - you've learned a lot of what we call tribal knowledge, intellectual capital. What is one piece of advice you would give to another operator of a small business navigating their current work state, especially one who's managing a team and they just can't seem to go remote or slow down? Because you've seemed to accomplish that pretty well.

17:56 - Dr. Sandiford

The number one thing I would say for people in leadership is: you have to let go. When we're in leadership, we take personal responsibility for our people, for our company. Somebody messes up, that's on you. So it gets very hard not to micromanage. You hired someone to do a job, and now that you see they can do it, there's a point where you have to trust them to do that job. If you cannot trust people to do the job you hired them for, you will never be able to step back and form a remote culture, because you have to trust that somebody is at home right now in their office doing the job they said they would do.

18:28 - Anthony

Well, thanks for joining us today.

18:35 - Dr. Sandiford

Thanks, Anthony. It's been wonderful to be here, and I appreciate you all thinking of Melospeech in California.