Switching electronic health record systems is one of the riskiest projects a growing specialty practice will take on, and the danger isn't always where teams expect it. On this episode of Scaling Specialty Growth, Joe Zboch sits down with Ken Takenaka, Director of Operations at Orthopedic + Fracture Specialists, a 32-provider physician-owned ortho practice in Portland, Oregon. Ken came up through the clinical side, more than a decade as a certified athletic trainer and a first assistant in the operating room, before moving into operations leadership. They get into what it took to run an EHR conversion this year without losing referral volume, how Ken decides when to move fast and when to hit the brakes, and why honesty beats optimism when you're asking a whole organization to work in two systems at once. If you're scaling referral operations while keeping the day-to-day running, this conversation is for you. Hatch sponsors the show.

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👤 Guest Bio

Ken Takenaka is Director of Operations at Orthopedic + Fracture Specialists, a physician-owned orthopedic practice serving the Portland, Oregon metro since 1933. He spent more than a decade as a certified athletic trainer and a first assistant in the operating room before moving into operations leadership, which gives him a clinical fluency most operators don't have. Today he oversees operations for a roughly 32-provider practice that runs its own ambulatory surgery center and in-house MRI, and he helped lead the practice's recent EHR conversion.

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📌 What We Cover

• How a clinical background changes the way you read operations and talk to physician owners
• The brakes-on-a-car model for supporting aggressive growth without becoming a blocker
• Running an EHR conversion with a team that already trusts each other
• Why honesty about a rocky road beats overselling a smooth one
• Protecting referral channels when community partners are faxing to old numbers and using old portals
• Knowing what to measure, and which dips are direct signals versus indirect ones
• Treating your system's data structure as a goldmine your team can actually use
• The career advice: growth happens after hours, and complete strangers will help if you ask

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🔗 Resources Mentioned

• Hatch — referral operations software, sponsor of Scaling Specialty Growth
• Ken Takenaka on LinkedIn

Referrals are how an independent specialty practice grows, and right now most of that work still runs on spreadsheets, paper, and someone's memory. This episode looks at what happens when a practice gets serious about the referral process and treats it as a growth driver instead of a cost of doing business. Joe Zboch sits down with Misty Sullivan, care center administrator at Proliance Rainier Orthopedic Institute, to talk through balancing aggressive growth goals with operational excellence. They get into why customer service has to come first, why access to care is part of the growth conversation, and why manual tracking quietly scales a practice backward. Misty also explains the visibility gap that keeps her up at night, the metrics she wishes she could track, and where an operations leader should actually start. The episode is brought to you by Hatch.

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👤 Guest Bio

Misty Sullivan is care center administrator at Proliance Rainier Orthopedic Institute and the Surgery Center at Rainier, a seven-physician orthopedic private practice in the Pacific Northwest and part of the larger Proliance Surgeons group. She oversees roughly 70 employees across a clinic, MRI, X-ray, a four-room surgery center, and a satellite location. She has spent years improving the referral process inside the broader Proliance organization and has also helped primary care clinics learn to process referrals.

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📌 What We Cover

• Why customer service and access to care sit at the front of every growth decision, and why promising referrals you can't see for three months breaks both ㅤ
• How manual tracking on Excel and paper stops working as a practice grows, and why it costs time, manpower, and money ㅤ
• The visibility gap leadership often can't see: no single view of how many referrals came in, where they came from, or who worked them ㅤ
• Why SharePoint and Teams aren't built for processing referrals, including no keyword customization and no way to flag urgency ㅤ
• The four metrics Misty tracks: referrals received, receipt to first attempt to contact, receipt to schedule, and the reason a patient couldn't be scheduled ㅤ
• How a process map and training documentation help a lean team onboard, cross-train, and promote from within ㅤ
• Where to start when getting serious about referral operations: staffing first, then process, then technology

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🔗 Resources Mentioned

• Hatch referral database
• Qlik (data and reporting)
• Microsoft SharePoint and Microsoft Teams
• Excel
• Puyallup Sumner Chamber of Commerce
• SWOT analysis
• Contact Misty: m.sullivan@proliancesurgeons.com

Most specialty groups treat growth as the goal and figure the operations will catch up. This episode is about why that order is backwards. Host Joe Zboch of Hatch sits down with Michelle Winfield-Hanrahan, Chief Clinical Access Officer at the University of Arkansas for Medical Sciences, to work through one idea she opens with and never lets go of: not all growth is good growth. They talk through what it takes to actually support volume, the capacity, the workforce, the financial backing, and the quality of care, before anyone says yes to it. You'll hear how she breaks down a problem when ten people in a room can't agree on what it is, why a referral is a wealth of data most groups ignore, and what changes when you treat the front door as a growth driver instead of the cost of doing business.

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👤 Guest Bio

Michelle Winfield-Hanrahan is Chief Clinical Access Officer and Associate Vice Chancellor for Access at UAMS, Arkansas' only academic medical center and the state's only adult Level 1 trauma center. There she oversees enterprise access, care management, utilization, transfers, clinical command operations, and oncology nursing. She came to the role from a nursing foundation and years as a healthcare access consultant, which is where she watched a lot of the patterns she talks about play out across institutions.

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📌 What We Cover

• Why not all growth is good growth, and the four things volume has to line up with before it counts: capacity, workforce, financial backing, and quality of care. ㅤ
• The hidden gap that sinks a rollout: a group opens a new practice but nobody budgeted the two people needed at the registration desk to check patients in. ㅤ
• How Michelle triages a problem when a room can't agree, by starting with what most people name rather than jumping straight to the goal. ㅤ
• The people, process, technology order she works in, and why technology is sometimes the wrong place to start. ㅤ
• The legacy-work test: figure out where a workflow came from, then ask whether it's still relevant today. ㅤ
• Why a referral is a wealth of data about what your community and referring providers actually think of you. ㅤ
• Her 24-hour rule: every referred patient gets reached out to within a day, and why closing the loop with the referring provider keeps volume coming. ㅤ
• The failed phone line: a competitor's payer went out of network, the institution blasted flyers and a dedicated number, then put one person on a line taking 100 calls an hour.

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🔗 Resources Mentioned

• Service Fanatics: How to Build Superior Patient Experience the Cleveland Clinic Way by James Merlino, MD (the book Michelle's team was reading) ㅤ
• MyChart, referenced as one of the channels for reaching referred patients ㅤ
• Hatch, for scaling referral operations to drive growth and efficiency