Sterling Carter and Stephen Carter of Cartera Health on Strategic Referral Networks, Operational Standardization, and the Discipline of Scaling

As a part of this series, we had the pleasure to interview Sterling Carter and Stephen Carter.

Dr. Sterling L. Carter, DPT, co-author of “The Business of Healing: How to Build Profitable, Mission-Driven Healthcare Businesses,” is a licensed physical therapist with over 20 years of clinical experience and a decorated U.S. Army Major who served for more than 25 years. He co-founded Cartera Health, where he leads clinical operations and quality initiatives. Stephen Levi Carter, co-author of “The Business of Healing: How to Build Profitable, Mission-Driven Healthcare Businesses,” is co-founder of Cartera Health, where he oversees business strategy, acquisitions, and operational scaling across the company’s portfolio of healthcare ventures. Carter is also a U.S. Army veteran who served as a combat medic during Desert Storm. He holds a bachelor’s degree in business administration and an MBA in change management and finance.

Thank you so much for joining us in this interview series! Can you tell us a bit about your ‘backstory’ and how you both got started in your careers?

Sure, let’s get started. We both went to college together at Langston University in Oklahoma. Sterling majored in pre-physical therapy and Stephen majored in accounting. We both graduated and went in completely different directions. Stephen went on to get his MBA and started working in corporate America. Stephen worked for a staffing company early on and then went into oil and gas.

Sterling went on to finish his physical therapy degree and eventually his master’s and doctorate in physical therapy. We were both working in our own lanes. Sterling was working for a major hospital in Houston, Texas, and Stephen was working at a major oil and gas firm.

In 2007 or 2008, Sterling decided that Sterling wanted to do more with physical therapy and provide a bigger impact to the community, so Sterling opened a private practice called Sterling Physical Therapy and Wellness. During that period, Sterling developed a pretty strong brand and started getting a lot of requests for contract work, along with many requests from home health agencies that needed therapy services delivered in the home environment. Sterling thought that opening a healthcare staffing company could be a viable opportunity for us.

Sterling talked to Stephen about it, his twin brother and business partner. We decided to go into business together and open a therapy staffing company. We called it Sterling Staffing Solutions simply because we already had a recognizable name that had been out in the market for four years, and we decided to capitalize on that.

Fast forward: we’ve started a lot of different companies and pursued a lot of different opportunities, but ultimately Stephen opened his own business, an in-home hospice company called White Orchid Hospice. In 2018, we started receiving several awards and were approached by Forbes Books, asking if we were interested in writing a book about our story. We wrote our first book, an Amazon bestseller titled “Double Your Success: Principles to Build a Multi-Million Dollar Business.”

We continued growing and building the brand. We have just launched our second book, titled “The Business of Healing: How to Build Mission- and Profit-Driven Healthcare Practices.” We are blessed to say that all three of our companies are currently on the Inc. 5000 list of fastest-growing businesses. More importantly, we have made a huge impact and left a footprint on the community and in the world.

Can you each share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?

Probably the funniest mistake Sterling made when he first opened was thinking that if he advertised and marketed to the community and to the consumer, we could fill our clinic up. Sterling started off with a shotgun approach to marketing the physical therapy practice. We had magazine ads, radio ads, postcard campaigns, email campaigns, and all these different things, all focused on the consumer. We were really focused on the wrong target audience.

Our target audience, at the end of the day, is doctors. So, we flipped our emphasis and started putting more emphasis on our referral sources, which are doctors, and everything changed. It was funny that Sterling was hitting his head against the wall trying to figure out why Sterling couldn’t get more patients in the door, when the biggest value was not in marketing directly to the consumer, but in marketing to our top referral sources.

What do you think makes your company, Cartera Health, stand out?

What makes Cartera Health stand out is that we have truly created an industry all its own. Our mission is to become the biggest player in the extended healthcare space, and what we define as extended healthcare is anything outside of primary medicine. We’re not focused on doctors; we’re focused more on allied health. We have physical therapy practices. We have a staffing company that provides staff, specifically: physical therapists, occupational therapists, speech-language pathologists, nurses, social workers, case managers, CNAs. We also do in-home hospice, where we’re providing end-of-life care, but we don’t focus on the medical doctor locum tenens space. That focus is really what makes us different from most of our competitors.

Which three character traits do you think were most instrumental to both of your successes?

The three character traits that were most instrumental? Sterling would say the three are: strong work ethic, very driven, and committed.

Leadership often entails making difficult decisions or hard choices between two apparently good paths. Can you share a story with us about a hard decision or choice you had to make as a leader? I’m curious to understand how these challenges have shaped your leadership.

One of the hardest decisions Sterling had to make as a leader was to terminate his vice president of operations. She was really the second-in-command and was extremely loyal and dedicated to the company, but she was not the right fit for us to grow to the next level and scale.

It was really tough because Sterling knew that this person depended on our business. Her family depended on the business. She was a single mom, and she put everything into the company, but there were just things that did not line up with being able to scale. She didn’t have the skill set to do that, and often she spent too much time focused on the problem instead of moving us toward solutions.

It was probably the toughest and also the most important decision we ever made. Once that happened, we moved forward and never looked back. Things have been growing and scaling ever since.

What does Operational Scalability mean to you?

What it means to me is that to scale quickly and effectively, you must have the right operations in place. You must have strong standard operating procedures. You must have strong processes that are repeatable, that are going to provide a consistent, quality outcome, and that are going to produce results.

Which types of business can most benefit from investing in Operational Scalability?

I truly, truly believe that every business would benefit from investing in operational scalability. Sterling doesn’t think there is a single business out there that couldn’t improve if they invested more in operations and scaling.

Why is it so important for a business to invest time, energy, and resources into Operational Scalability?

It’s important to invest time, energy, and resources into operational scalability because it directly 10x’s your business. The time you put in on the front-end results in exponential returns on the back end. Taking the time to really work on standardizing those processes and making sure they’re in place is essential and 100% worth it.

In contrast, what happens to a business that does not invest time, energy, and resources into Operational Scalability?

Well, without operational scalability, you’re not going to be able to grow and you’re not going to be able to create a consistent, repeatable result. If you’re not growing, you’re dying. If you don’t invest in operational scalability, then Sterling really thinks eventually your business will fail.

Can you share a story from your experience about how a business grew dramatically when they worked on their Operational Scalability?

One of our own businesses, Sterling Physical Therapy and Wellness, is a good example. We spent a lot of time working on certain things in the business, like having effective job descriptions and hiring the right people. What we weren’t doing was focusing on the processes as much as we needed to in the very beginning. We then invested in outsourcing and in finding a business coach and mentor who had already built out the operational procedures that are standard for a physical therapy practice. We were able to take those outlines and create our own processes and our own operations, and that absolutely catapulted our ability and improved our outcomes.

Based on your experience and success, what are the “Five Most Important Things A Business Leader Should Do To Set Up Systems, Procedures, And People To Prepare A Business To Scale”? If you can, please share an example for each.

1. Document Every Day

The only way to create processes is to start by writing down the steps you do every day. Record them and put them into some type of note taker.

2. Refine Your Processes

Organize those processes and really hone in on them, making sure that they work, that they produce great results, and that they are clear.

3. Build A Manual

Put all that information into a manual and set it up by department.

4. Leverage Existing Systems

Don’t reinvent the wheel. There are procedures and processes already out there, and businesses all pretty much run the same way. You’re going to have key areas that every single business requires, so use what already exists and adapt it to your business.

5. Test and Reassess

Test those policies and procedures and make sure they work. Then you always must reassess, because you’re always going to be updating them time and time again.

What are some common misconceptions businesses have about scaling?

One of the common misconceptions businesses have about scaling is that it’s too hard, that you can’t do it, or that it’s going to add too much work and too much to your plate. Really, as you scale, it should get easier because you’re putting the right people in place, you’re empowering them, and you’re getting more into the strategy level. You’re not so stuck in the weeds with the meetings and all that kind of good stuff.

How do you keep your team motivated during periods of rapid growth or change?

This is a great question. You must continue to pour into your people, check on them, make sure that they’re okay, and provide them with the support that they need. Even when there is rapid growth and change, try to make sure that they’re part of the process, so they know that they matter in the whole growth process and that they’re being considered.

How can our readers further follow your work online?

You can find both of our books on Amazon.com. Just search “The Business of Healing” by Sterling Carter and Stephen Carter, or you can also search “Double Your Success” by Sterling Carter and Stephen Carter.

You can also find us on Instagram, Facebook, and our other social media handles. The handle is @thecarterbrothers. Our website is www.thecarterbrothers.com, or our master brand site is www.carterahealth.com.

Thank you so much for the time you spent with us. We wish you continued success!