The Relationships Inside Your Practice Are Either Making You Money or Costing You a Fortune. Which Is It?

You have heard it your entire career. Relationships build your business. And that is true. But nobody talks about the other side of that equation.

Relationships can kill your business just as fast. Sometimes faster.

I am not talking about your relationships with patients or referral sources. I am talking about the relationships inside your own team. The ones that are so familiar, so comfortable, and so entrenched that you have stopped seeing what they are actually costing you.

As you read this, I can guarantee you are already thinking about someone on your team right now.

The Comments I Hear Every Week

She has been with me for 20 years. Patients really love him, but he is so slow. She is fantastic at her job when she is in a good mood, but that is not very often.

Every practice owner I work with has said some version of one of those sentences. Most have said all three. And every single time the person saying it already knows what the problem is. They just haven't been willing to act on it yet.

That unwillingness has a price. And it is a much larger number than most owners have ever sat down to calculate.

The Nick Saban Standard

Think about what Nick Saban did when he took over the Alabama football program. He did not inherit a championship roster and maintain it. He made hard decisions, consistently and without apology, that were centered around one objective: putting the best possible players on that field. The ones who gave the team the highest probability of being in the championship game.

He was not running a loyalty program. He was running a winning program.

You are running a practice. And you have team members who are holding your revenue and your profitability back. In some cases they are not just holding it back. They are actively killing it.

Where You Start Is Not Where You Think

Before you assume this is headed toward a conversation about termination, let me stop you. That is not where this starts.

Any great coach works on the individual first. Training. Systems. Coaching. Understanding what makes that person tick and what they need to perform at their potential. You give them every tool available. You build them a development plan that creates a clear path to improvement, a clear standard of performance, and a clear understanding of what success looks like and what it earns them.

That is not soft leadership. That is the right sequence. You have to see the potential in a team member before you invest in developing it. And once you hand someone a genuine recipe for success the outcome of that process tells you everything you need to know about what comes next.

Here is an analogy that cuts through the sentiment. When your phone starts dropping calls, losing its WiFi connection, and running at half the speed it should, do you keep it anyway out of loyalty? Of course not. You replace it. You replace it because you do not have a relationship with your phone. It is a device.

People are not devices. That distinction is exactly what makes this complicated. And that complication is precisely why I have watched clients suffer through years, and in some cases decades, of underperformance because the relationship felt too close to address.

Too close does not have to mean personal friendship. It can simply mean you have been avoiding the conversation long enough that having it now feels harder than it actually is.

What Avoidance Is Actually Costing You

Let me put some numbers around what these relationship-driven decisions are producing inside your practice right now.

Your treatment acceptance rate suffers when you have someone in a patient-facing financial role who is uncomfortable talking about money. That is the wrong person in the wrong seat, and every case that does not close because of that discomfort is revenue that never existed.

Your collections suffer when you have someone processing accounts receivable at half the pace a more capable person would manage in the same seat. Every day that money sits in your AR, it becomes less valuable. You write off more the longer it ages, and you spend more to collect less. That is a compounding loss that runs quietly in the background every single month.

Your schedule runs light when you have team members who consistently prioritize other tasks over keeping the providers productive. An empty chair is not a scheduling problem. It is a performance problem dressed in a scheduling problem's clothes.

Any one of these costs you hundreds of thousands of dollars annually. Put them together and it is entirely plausible that relationship-driven avoidance is costing your practice $500,000 or more every single year.

Compound that over 25 years and you are not talking about an operational inconvenience. You are talking about a monumental and permanent impact on your profitability, your quality of living, your retirement fund, and your ability to reinvest in the business you spent your career building.

What This Is Actually About

I want to be clear about the intent of everything I just said.

I want you to have the best team you have ever had. I want you to pay your team members extremely well. And I want you to build a strong relationship with your team, one that goes both directions, where the practice delivers on its commitments to them and they deliver on their commitments to the practice.

This is not about removing people. It is about communicating the standards of performance you expect clearly, consistently, and without apology. It is about giving every team member a fair and transparent path to success and then holding them to it.

The goal is a team that earns exceptional compensation because they are producing exceptional results. A practice where relationships are an asset rather than a liability. Where loyalty is built on mutual performance rather than mutual avoidance.

Put your relationships to work. Maximize your production and your profitability. Minimize your stress.

That version of your practice is available to you.

Let's talk.

Written by Kevin Johnson, CEO and Founder of Leverage Consulting.