When something keeps going wrong in your practice, it's natural to start looking at the person responsible.
Maybe your intake coordinator isn't following up with prospective clients as quickly as you'd like. Your administrative team keeps making the same scheduling mistakes. Or you've reminded someone several times to complete a task, and somehow, it still isn't getting done.
It's frustrating.
Especially when you feel like you've already explained what needs to happen.
At some point, you may start wondering whether you have the right person in the role.
And sometimes, that's a fair question.
But before you get there, I think there's another question worth asking.
Have we made it possible for this person to do the job well?
Sometimes what looks like a performance problem is actually a process problem.
I've spent a lot of time working with teams, and one thing I've learned is that the problem we notice first isn't always the problem we need to solve.
Let's say your practice has been receiving complaints about delayed responses to new client inquiries.
You've spoken with your intake coordinator about the importance of responding promptly. They understand. They care about doing a good job. They assure you they'll improve.
But a few weeks later, you're having the same conversation.
It's easy to interpret that as a lack of follow-through.
Now imagine you sit down with them and walk through what actually happens when a new inquiry comes in.
You discover that inquiries arrive through your website, several therapist directories, voicemail, and individual clinician email accounts.
Some are forwarded to the intake coordinator. Others aren't.
Your coordinator also needs to confirm clinician availability before offering appointments, but the calendars aren't always current.
And when someone doesn't respond to the first outreach, there's no shared understanding of who follows up or when.
Suddenly, the situation looks a little different.
The employee may still have responsibilities they need to meet. But they're also working within a process that makes consistent performance difficult.
You can continue reminding them to do better.
Or you can address the things that are making the work harder than it needs to be.
Ideally, you do both.
Start by getting curious about what's happening.
When a problem comes up repeatedly, I like to understand the work before making assumptions about the person doing it.
That usually means asking a few questions.
Does everyone understand what's expected?
You may believe you've been clear because you've explained something more than once.
But what does the employee understand their responsibility to be?
Do they know what a completed task looks like? When it needs to happen? Who they should communicate with if something gets in the way?
There's a difference between telling someone to stay on top of inquiries and establishing what timely, consistent follow-up actually means.
Does the person have what they need?
Think about training, access to information, available time, and the tools they're expected to use.
Someone can be motivated and capable and still struggle when they're constantly working around missing information or unclear procedures.
Where does the work get stuck?
Sometimes the problem isn't happening where you think it is.
An intake coordinator may appear slow because they're waiting on a clinician to update availability.
A billing specialist may be behind because documentation hasn't been completed.
An office manager may be struggling to meet deadlines because they're responsible for too many competing priorities.
Understanding where the delay begins can tell you much more than focusing only on where it becomes visible.
Has the process kept up with the practice?
A workflow that worked well with five clinicians may not be enough for a team of 25.
And something that was easy to manage informally when everyone worked in the same office may need more structure once people are working across locations or remotely.
Sometimes the process simply hasn't caught up with the organization.
Walk through the work with the person doing it.
One of the most useful things you can do is ask an employee to show you how they complete a task.
Not how the task is supposed to happen.
How it actually happens.
Choose a recurring issue and follow it from beginning to end.
Who receives the information? What happens next? Does someone else need to respond before the work can continue? How does everyone know when their part is complete?
Pay particular attention to the places where responsibility changes hands.
Those handoffs are often where work gets delayed or forgotten.
You may find that a task doesn't have a clear owner. Or that two people think the other person is handling it.
You may also discover that your employee has developed a workaround because the existing process doesn't account for something they encounter regularly.
That's valuable information.
It doesn't mean you need a complicated procedure manual for every little thing.
It means the people involved should have a shared understanding of what needs to happen, who's responsible, and what to do when something doesn't go according to plan.
A better process doesn't have to be a complicated one.
I think it's easy to overcorrect when you're trying to improve operations.
You identify a problem, create a new policy, introduce another form, or add an approval step to prevent the same mistake from happening again.
Before long, something that used to take ten minutes requires three people and several emails.
More structure isn't always better structure.
The goal is to make the work clearer and easier to manage, not to create unnecessary steps.
Sometimes the solution is as simple as agreeing on who owns the next action.
Sometimes it's documenting the steps for a process that happens frequently.
Sometimes it's making sure everyone is using the same source of information.
And sometimes it's removing a step that no longer serves a purpose.
Whatever you change, involve the people who will be using the process.
They can help you understand what will work in practice, where you may have overlooked something, and what support they need to make the change successful.
Then give it some time and revisit it.
Did the problem improve? Is the process easier to follow? Are there new issues you hadn't anticipated?
It's okay to make adjustments.
In fact, you should expect to.
And sometimes, it really is a performance issue.
I don't want to suggest that every employee problem can be solved by improving a workflow.
It can't.
People are still responsible for doing their jobs, meeting expectations, communicating when they're struggling, and following through on their commitments.
And as a leader, you're responsible for addressing performance concerns when they arise.
But there's a difference between holding someone accountable and expecting them to succeed without the support or clarity they need.
If you've established clear expectations, provided appropriate training, addressed obstacles, and given someone a reasonable opportunity to improve, and the problem continues, then you may need to have a more direct performance conversation.
That's part of leadership, too.
The important thing is understanding what you're actually asking someone to improve.
You can't coach your way out of a broken process.
And you can't fix every performance issue by creating another policy.
Knowing the difference matters.
Before you solve the problem, make sure you understand it.
The next time something goes wrong in your practice, notice where your mind goes first.
Are you immediately thinking about who made the mistake?
Or are you wondering what contributed to it?
Try starting with the second question.
Talk to the people involved. Walk through the work. Look for unclear responsibilities, missing information, unnecessary steps, and places where things repeatedly get stuck.
You may find that the person needs more training or clearer expectations.
You may discover that the process needs attention.
Or you may find a little of both.
Good leadership isn't about choosing between supporting your people and holding them accountable. It's about understanding what they need to do their work well, and being willing to address what's getting in the way.
And sometimes, the most helpful thing you can do for your team is fix a problem they've been working around for far too long.