Get great at one thing

Get great at one thing and keep being great at that.

Too many businesses do too many things. This may be especially true in addiction treatment. The typical provider offers dozens of interventions or types of care. This is done with good intentions. To meet people where they are – and where they are is in the middle of a complex web of symptoms, conditions, and desired pathways.

(we're setting aside the rats-nest that is reimbursement and insurance for another time)

How can you be good (forget about great) at one thing if you’re doing 12 things?

The Local Donut Shop Case Study

This weekend, my wife and I did a hike in the Adirondacks and visited a favorite spot: a laundromat with a donut shop. The donuts are simple, traditional donuts, but they may be the best donuts I’ve ever had on this planet (and I’ve tried a lot of donuts in a lot of countries).

Now, before I undercut my own argument … the laundromat is the primary business for both the local community and the summer vacationers. There’s also a gift shop. But the laundromat and gift shop are mostly on autopilot. Good machines that always work. Consistent prices. Clean facility. Autopilot.

The donut shop was a quirky addon. The owner’s daughter liked making donuts and got really good at it. Why not try and sell them in a space you already own with foot traffic? Making great donuts is a different beast than maintaining and running a laundromat. Donuts are finicky. Maintaining consistency over 1,000s of handmade donuts … well, that’s some sorcery kind of stuff. It’s art and magic.

This NCPR story explains how to get a really good donut .

If you come anywhere near the central or high peaks area of the Adirondacks, you are likely to hear about the Tupper Lake Washboard and Donut Shop.

The donut shop is consistently busy. When we stopped by this weekend in the morning before our hike, a family was getting a dozen and a couple coffees. We ordered, and another car drove up. In the 10 minutes we sat there eating our donuts, it was a steady flow of donut-needing customers.

All knew what they wanted, and all knew that all they could get was one style of donut with the choice of 8-10 frosting types and a drip coffee.

You get donuts and a coffee – that’s it. No lattes or frappy-whatever. No apple fritters or bear claws. A traditional fried donut made great with a schmear of frosting.

Do maple because it’s the law in these here parts. Do vanilla because it’s just incredible.

They have gotten great at this one thing, and it drives their business and their reputation.

What are you known for?

The mindset in business and culture today is to constantly expand and grow. This has resulted in what are known as Swiss Army Knife companies. Think General Electric. Recently GE restricted their financial services division to focus on the energy sector. And it got rid of its healthcare business to focus on manufacturing . Why’d they do this? Simple: A volatile stock price .

Better answer: No one knows what GE is anymore. See bargain basement stock price.

With so much venture capital flowing into the addiction, behavioral health, digital health, and healthcare space generally, companies are seeking growth, diversifying their revenue streams, and vertically integrating service offerings. (sorry for the VC word salad) This is likely due to investor pressure to see returns despite poor success of the core business venture. (thanks for coming to my quarterly earnings call).

Healthcare is hard. Addiction treatment is really hard. Everyone wants outcomes and they want to move to value-based care. But value demonstration requires laser focus on being very good at what you do. If you do 10 things in a really hard environment, my guess is no matter how hard you try, you’re not going to be great at any one of them.

And worse, you'll be known for none of them.

The donut shop has a single core competency. They make a simple, traditional fried donut. This is what they are known for. Their focus is on maintaining that reputation. Period. To maintain that reputation, they must ensure that every batch of donuts hits a certain standard. If they fail that standard just once, word will get out and people will stop coming for donuts.

Who sets the standard? First, it was the donut maker. They made a donut they thought was better than anyone else. Now, it’s the customer. The customer, by continuing to tell their friends, creates an expectation of greatness – a higher standard – that the donut maker must continually – every single day – hit.

What would happen if an addiction treatment provider decided to narrow their focus and get very good at doing one type of treatment for one (maybe two) types of people? What I think would happen is that word would get out and they would soon become the dominate provider for that specific need.

But David, what about everyone else that needs care? Well, the market and the community are going to have to figure that out.

If addiction treatment and recovery services want to transform their reputation around quality of care and success rates (which are wildly unknown), it needs to get out of the diversification business and into the focus business.

You might be inclined to read between the lines and conclude that personalization of healthcare is creating a challenge to providing really great services. I think you might be right.

A lot of providers are attempting to create personalized workflows for too many patient profile variations. It’s complicating an already complicated situation. And it’s not resulting in better referrals or better outcomes.

The Washboard Donut Shop doesn’t have a social media presence. They haven’t hired someone to run a TikTok account or paid influencers to do Reels about their donuts. No. They make really great donuts in a tiny village in the Adirondacks and people show up in droves because one person told one person who told another person.

Old fashioned donuts. Old fashioned business.

Get great at one thing then keep being great at it.