Leading by Example: Fostering Feedback and Growth in Practice Management

As a practice owner, you're likely aware of the current challenges facing the industry. Hiring competent staff is a daunting task, maintaining employee accountability is an ongoing struggle, and navigating power dynamics can feel like tiptoeing around a potential explosion. Many practice owners I've spoken to are questioning how much longer they can manage this situation, or if they even want to continue at all.

Hi, I'm Sarah Buino, a former group practice owner. I made the decision to sell my practice after nearly 10 years of ownership. I’m passionate about helping therapists heal on an organizational level so we can provide better care to our clients. Drawing from my conversations with current practice owners and employees, I'd like to share some insights that may offer assistance for this challenging time. 

Power Dynamics

Power dynamics are a significant challenge in today's practices, often causing difficulty in relationships between individuals with differing levels of power. The power dynamic struggle can make the accountability process extra volatile. The Right Use of Power Institute (RUPI) defines power as a neutral force capable of influencing others. It's crucial to understand that power isn't inherently good or bad. But unfortunately, many of us in helping professions have experienced negative power differentials, perhaps due to childhood experiences or encounters with toxic bosses. These encounters can lead to emotional reactions such as fight, flight, freeze, or fawn in subsequent power dynamics and a belief that power is dangerous and should be avoided at all cost.

Practice owners who have suffered from negative power dynamics may aim to avoid perpetuating the same harm. They may adopt a friendly, accommodating approach, hoping employees will recognize their kindness and care. 

Avoiding the reality of power dynamics does not eliminate them; it merely obscures the lines of accountability and can create a culture of ambiguity and inefficiency. Without clear expectations and accountability, practices risk fostering an environment where mistakes go unchecked, and opportunities for growth and improvement are lost. I’ve seen how PracticeVital has emerged as a pivotal tool in bolstering accountability and transparency across practices, offering a way to address these challenges head-on. 

PracticeVital can support practice owners in fostering a culture where feedback is not just tolerated but welcomed, and accountability becomes a shared value rather than a source of tension. It empowers practices to establish clear protocols for feedback and accountability, ensuring that power is exercised responsibly and transparently. This approach not only mitigates the fear associated with accountability but transforms it into an opportunity for strengthening the practice and client outcomes overall. 

Mistakes of a Naive Practice Owner

In my experience as a practice owner, I made several mistakes due to naivety. Initially, I hired friends because I assumed they would understand I had their best interest at heart and I wouldn't  need to hold them accountable for their work. However, once I had their paychecks in my hands, communication barriers emerged and conflicts arose.

Additionally, I strived to be overly accommodating, wanting to be perceived as a likable boss. I assumed everyone possessed the same skills, and I neglected important tasks like tracking finances and metrics. Once I began tracking the business finances, I realized the importance of staff accountability. Unfortunately, I attempted to implement accountability measures without adequately updating my employees on how and why this change was happening. I made the mistake of using annual reviews to implement the new strategy – giving lower ratings to some staff members without communicating these new standards prior to their reviews. (I’m cringing as I type this…) I ended up losing several employees after that review period because of my haphazard approach that lacked an understanding of how power dynamics impact employees when changes happen without proper communication. 

Workplace Trauma Lives On

Employees who have experienced trauma in previous workplaces may bring these experiences into new organizations, projecting their past challenging experiences onto well-meaning practice owners. This can hinder the establishment of a trusting and secure workplace culture unless specific measures are taken to address these issues. 

Healing Workplace Power Dynamics

So how do practice owners navigate these challenges? By practicing what you preach and building a culture of feedback and accountability that recognizes power dynamics. Here are some tips:

1. Practice what you preach: Above all, practice owners MUST practice what they preach. If you’re holding others accountable, but are not accountable yourself, the message will fall flat as employees will quickly sniff out hypocrisy. If you struggle with defensiveness when receiving feedback, take this to your own therapist to strengthen your ability to receive feedback with grace.
2. The tone is set at onboarding: Accountability and feedback should begin at onboarding. This is the period when workplace norms are set. A clear message should be conveyed that not only is feedback tolerated, but it’s welcomed and expected – both top down and bottom up.
3. Openly discuss power dynamics and how they impact accountability: Offer staff training on power dynamics. Having a culture that understands power dynamics is the best way to be prepared when accountability feels challenging. Power is inevitable, not good or bad. When a practice culture openly names and works with power dynamics rather than running from them, it supports a culture of accountability rather than a culture of secrecy and back-channeling.
4. Feedback protocol: Create a protocol for how feedback is delivered and received. Maybe you create a staff survey that is delivered after every meeting. Or maybe it’s a written agreement that is included in your employee handbook. Find ways to allow employees to share feedback on a regular basis, so they know how to come to you when problems occur. Allowing employees to give feedback consistently helps them feel less criticized when they’re being held accountable to metrics and measures.
5. Metrics and data are your friend: Create transparency around easy-to-understand metrics: Help your staff feel like they always have a clear understanding of how they're tracking against a simple list of metrics or KPIs. Consider training your team on a tool like PracticeVital so your clinicians all have a consistent grasp on what success looks like, and are seeing their metrics regularly in supervisor or coaching check ins. Being transparent around progress and issues as they arise (rather than after the fact) helps avoid bigger struggles or power issues down the road.
6. Practice what you preach (yes, I said it again in case you missed it!): I can’t stress this point enough. If we’re not holding ourselves accountable we’ll lose credibility with our staff, which makes holding them accountable an even more difficult task.

In the current landscape, there's a palpable fear of navigating accountability within therapy practices. This trepidation often leads practice owners to tread lightly, avoiding confrontations and sidestepping the crucial aspect of employee accountability. This avoidance of acknowledging your power can inadvertently harm our businesses– clinicians and clients as well. In conclusion, navigating the complexities of power dynamics and fostering a culture of accountability in your practice can be challenging, but it's essential for creating a supportive and thriving workplace environment. 

My mission is to help leaders heal by supporting the emotional and practical aspects of running a therapy business. I provide consulting and coaching to practice owners and leaders in therapeutic organizations. To chat more about power, employee relationships, or building positive workplace culture, reach out to me at sarah@headheartbiztherapy.com.