Growing your chiropractic practice means growing your team, but poor onboarding can quickly turn growth into chaos. In this Chiropractic Deep Dive, we break down Dr. Noel Lloyd’s 90-day onboarding system for turning new hires into confident, capable team members. Discover how to set expectations from day one, train in the right order, use job leads and job books, certify performance, and build a team that supports your practice instead of slowing it down.
Hiring the right person is only the beginning. The real challenge is getting that new team member trained, confident, and productive without creating months of disruption inside your practice.
In this episode of the Chiropractic Deep Dive, we unpack a training led by Dr. Noel Lloyd and explore a structured approach to chiropractic staff onboarding designed to develop a capable team member within 90 days.
You’ll learn why successful onboarding starts before an employee's first day, why core values and scripts should come before software and mechanical tasks, and how setting higher expectations early can help establish the standard for your clinic. The episode also explores the importance of pairing new hires with a designated job lead and creating a job book that preserves the systems and knowledge required for each position.
We also cover how your management style should evolve as an employee becomes more competent, why ongoing certification matters, and how connecting employees to real patient success stories can help them understand the deeper purpose behind their role.
In this episode, you’ll discover:
Ready to strengthen your systems and build a practice that can grow without chaos? Book a free call with Dr. George Birnbach to learn how Five Star Management can help: https://myfivestar.com/book-consultation/
Join us in Dallas November 14–15 for Win Win Associates and New Patient Edge and learn proven strategies for building your team, growing your practice, and generating more new patients: https://myfivestar.com/events/win-win-associates-new-patient-generation/
And be sure to subscribe to The Successful Chiro Podcast for more actionable strategies to build a successful chiropractic practice.
[00:00:00] Usually, um, when you hear clinic owners talking about practice growth, the conversation is just entirely focused on the thrill of it all. Oh yeah, the excitement. Right? You picture this packed waiting room, uh, a huge surge of new patients, and a schedule that is just completely maxed out. I mean, it's the ultimate goal.
It's the dream scenario for sure. Yeah. But, you know, that dream comes with this, uh, mechanical reality that rarely gets discussed with that same level of enthusiasm. Yeah, because the moment you step into the reality of what that growth actually requires, specifically like the immediate need to hire and train new staff to handle all that volume, that initial excitement just vanishes.
It really does. For a lot of clinic owners, the prospect of managing a growing team is... Well, it's the absolute definition of administrative dread. Right. Because it creates a very specific bottleneck. I mean, you might have the marketing completely dialed in, but if your internal systems cannot absorb the new personnel needed to serve [00:01:00] those patients, the growth just stalls.
Absolutely. So welcome to the Chiropractic Deep Dive. This is a special focus session of the Successful Chiro podcast, and we are proudly brought to you by Five Star Management. Yes, we are. And speaking directly to you as a fellow member of the Five Star Management family, our entire focus is on helping your chiropractic practice thrive- Mm-hmm
which means, uh, tackling these exact bottlenecks head-on. Head-on. Exactly. Today, we're pulling back the curtain on this exclusive internal Zoom training session that was recently led by our very own Dr. Noel Lloyd. Yeah. And our core mission for this deep dive is to unpack the ultimate onboarding blueprint for chiropractors that Dr.
Lloyd laid out on that call. It's a game changer. It really is. The goal is to figure out the exact mechanics of taking a brand-new hire and transforming them into a highly capable, trusted team member in exactly 90 days. Wow, 90 days. Yeah, 90 days effectively eliminating all that chaos that usually dictates the hiring process.[00:02:00]
So if you've ever felt that knot in your stomach, you know, that dread of bringing someone new into the clinic just because of the sheer disruption it causes to your daily workflow, you are definitely not alone. Oh, not at all. Dr. Noel Lloyd kicked off this Zoom session by highlighting just how pervasive this pain point is.
Like chiropractors are often so terrified of the chaotic onboarding process that they will deliberately delay adding key positions. Even when the practice desperately needs the help. Right. Now, the downstream effect of that fear is honestly even more damaging. Clinic owners will consistently keep toxic, poor-performing employees on the payroll simply because they lack the operational confidence to train a replacement.
Which is just wild to think about. It is. They convince themselves that the friction of managing a bad employee is somehow, like, more tolerable than the disruption of bringing in someone new. Yeah. Okay, let's unpack this because- Keeping a bad employee just because you're scared of onboarding, it's like continuing to drive your car on a flat tire just [00:03:00] because you think pulling over to put the spare on will take too much time.
That is a perfect analogy. You're just destroying the whole car. You're damaging your practice culture, you're alienating your good staff, and you're definitely degrading your patient experience. Right. And what's fascinating here is the psychological trap of this avoidance. To fix that dynamic, Dr. Lloyd introduced a very specific benchmark to the participants on the call.
Which totally shifts things. It does because the traditional approach to hiring is usually this vague, uh, "Welcome aboard. Here is your desk." And- Right. Good luck. Exactly. And that approach forces the new hire to try and figure out their role through sheer proximity, just hoping they absorb the workflow by being in the building.
Which never works. Never. So Dr. Lloyd's solution replaces that ambiguity with a structured, strict, 90-day incentive. On day one, the new hire is given a measurable mission. I love this part. Yeah. Their goal is to learn the position inside and out in 90 days, and if they can pass a certification test proving their [00:04:00] competence at that 90-day mark, they actually earn a small raise.
That immediately changes the psychology of the relationship. Totally. It shifts the dynamic from a passive orientation to an active mission. But, you know, having a 90-day target is really only part of the equation. To hit that target, we have to look at what usually goes wrong. The landmines. Right, the hidden traps that derail the process.
So Dr. Lloyd had the clinic owners on the Zoom call share their most painful onboarding mistakes, and the first major landmine was the danger of basic assumptions. Ugh, this is a huge one. One participant shared a highly practical example regarding patient cancellations. They realized it was a catastrophic mistake to just assume a new front desk hire instinctively knows that a canceled appointment needs to be rescheduled immediately.
Which to a veteran clinic owner seems like total common sense. Right. But you forget that a new person doesn't share your operational logic yet. I mean- If you assume they understand the baseline [00:05:00] philosophy of patient care, that an adjustment missed is progress lost, you're skipping the foundational premise of the job.
Exactly. And if you assume they know step one, they will be completely lost on all the subsequent steps. Right. If they don't understand that foundational step, any training you provide on step two, like, uh, how to use the scheduling software, is just built on sand. The software training becomes useless because they don't even know why they're clicking the buttons.
That makes so much sense. And that actually leads directly into the second massive mistake the participants discussed, which is setting the initial performance expectations way too low. Yes. Another doctor on the call realized that giving a new hire a full month to learn the basic front desk phone scripts was actively hurting their integration.
A full month is just way too long. But wait, let me pause you there because I can hear clinic owners listening to this and thinking, uh, "If I demand a brand-new person memorize complex phone scripts in week one, I'm gonna trigger a panic attack." Sure, I hear that. Right. Like, isn't pushing a brand-new person that fast [00:06:00] just gonna scare them right out the door?
Well, it's a valid concern if you are hiring the wrong people. Yeah. But the psychology of high performers, you know, the A players you actually need running your clinic, it operates differently. Highly motivated individuals actually crave clarity, and they want to be challenged. That's a great point. When you push them early, you establish a high standard of excellence as the baseline reality of your clinic.
If you start off with a slow, overly relaxed first month, you just cement that slow pace as the cultural norm. Right, and you cannot do that. Exactly. It's nearly impossible to suddenly flip a switch in month two and demand high-level execution. So by pushing early, you're essentially weeding out the people who want to hide while engaging the high performers who want to prove their competence.
That completely reframes the entire first week. But there's a third failure point that participants brought up, and this one focuses heavily on the emotional side of onboarding. Right, the team dynamic. Yeah. You can have the checklists and the scripts ready, but if you ignore getting the existing team excited about the new hire, [00:07:00] the procedural training will just fail.
This is a critical vulnerability. The most dangerous moment for a new employee is the drive home after their very first shift. Oh, wow. Yeah. They're sitting in their car, processing the day, and deciding if they made a massive mistake taking this job. That's so true. If your existing team treats the new hire as, like, an annoying interruption to their busy workflow, if they sigh when asked a question or isolate the new person in a corner, that new hire is going home feeling entirely alienated.
Right. They should drive home feeling uplifted and supported, not terrified and isolated. Exactly. The operational onboarding might have been flawless, but if the emotional onboarding was a failure, you will likely lose them. So if the goal is to prevent that day one alienation, the solution actually starts before they ever clock in.
Yes. One participant on the Zoom call shared an approach to pre-onboarding that completely addresses this anxiety. It is the ultimate hack. It's a brilliant psychological pivot. Right. So after the candidate [00:08:00] accepts the job, but before their first official Monday morning shift, the clinic sends a comprehensive welcome email.
Yeah. And this isn't just a quick see you at eight AM message. It includes the employee handbook, the specific dress code, the cell phone policy, and crucially, the exact phone scripts they will be using. Consider how this shifts the neurochemistry of the incoming employee. Instead of walking into a chaotic environment completely blind, carrying all that anxiety of the unknown, they can actually review the rules of engagement over the weekend.
Right. It gives them control. Exactly. You are reducing their cognitive load for Monday morning, and you're non-verbally communicating that your clinic operates at a highly organized professional level. And the payoff for this is incredible. The result of that pre-onboarding email is that some participants reported having new hires literally walk through the doors on day one and immediately pass their phone script certification.
That's amazing. They used the weekend to prepare because the expectation was just so [00:09:00] clearly set. But to achieve that kind of velocity, you have to have strict discipline regarding the sequence of training. The participants on Dr. Lloyd's call detailed a non-negotiable hierarchy of what a new hire must learn and in what order.
Okay, let's go through that. Number one on that hierarchy is core values and principles. Exactly. This has to be the absolute foundation. If the new hire does not understand and align with the core mission of the practice, nothing else matters. I mean, if they don't fit the culture, you're done. Right. You can train someone on a billing software, but you cannot train them to genuinely care about the patients walking through the door.
Precisely. And once that cultural alignment is confirmed, step two in the hierarchy is memorized scripting. Ah, yes. Before they touch a computer, they need to know what to say Across all positions, everyone gets the same fundamental questions, and the practice requires the exact same answers to be delivered.
No improvisation. No improvisation in the first 90 days. Okay, [00:10:00] and then step three? Only after the core values and the scripts are locked down do you move to step three, the mechanical tasks. This is where you introduce the scheduling software, the physical flow of check-in and check-out, and handling phone calls.
And when you enforce that strict hierarchy, the timelines for producing a capable team member become much tighter than most owners think is even possible. Oh, absolutely. One participant outlined their specific benchmarks based on this system. They expect a back office therapy bay position to be functioning independently in just fourteen days.
Wow. Right. For the front desk, they expect mastery of the check-in process within three weeks and the full check-out process mastered between four to six weeks. But hitting a three-week timeline for front desk check-in requires a really dedicated transfer of knowledge. You can't just instruct a new hire to stand behind the desk and watch a veteran employee for three weeks.
No, definitely not. Which brings us to the actual tools Dr. Noel Lloyd advocates for to facilitate that rapid transfer. The toolkit. Exactly. The first critical piece of [00:11:00] infrastructure is the job lead. Every single new hire must be paired with a designated job lead within the practice. We really need to define the boundaries of that role because a job lead is not a manager, and they are definitely not someone who does the work for the new hire.
Right. They act as a dedicated navigator. They facilitate the daily learning process. They're a cheerleader, and they ensure the new hire is tracking against those fourteen-day or three-week benchmarks. And a critical insight from a participant was that the most important function of the job lead is explaining the why.
Yes, the why is everything. A job lead must systematically explain the why behind every single task. They gave this highly specific example on the call. When training a new hire in the back office, they don't just point and say, "Put the trash can in that corner." Right, because if we connect this to the bigger picture, understanding the why powers the how.
They explain the mechanism behind the instruction. Exactly. They explain that placing the trash can in that exact spot [00:12:00] optimizes the doctor's physical flow through the treatment room. It prevents the doctor from having to step around an obstacle which shaves seconds off the visit, which keeps the entire clinic running on time.
And ultimately means less waiting for the patients in the lobby. Exactly. It's the difference between compliance and ownership. Like if you just say, "Put it in the corner," it's a meaningless chore. But when you explain the why, that new hire suddenly understands that where they place a piece of plastic directly impacts the doctor's ability to treat patients efficiently.
It changes everything. And the second tool in the system is the physical anchor for all this training, the job book. Oh, this is huge. Every position in the clinic needs a dedicated job book. It's the compiled collection of all the checklists, the exact scripts, the objection handling sheets, meeting notes, all of it.
It acts as the physical manifestation of that specific role. Right. And here's where it gets really interesting. A job book is basically your practice's external hard drive. Yes. [00:13:00] When you have a phenomenal, highly trained employee who has been with you for years and they suddenly move away, you don't want all their institutional knowledge walking out the front door in their noggin.
Definitely not. It lives in the book. The book stays even when the personnel changes. But building those books is often a sticking point for clinic owners. It sounds like this massive administrative burden. Oh, totally. So Dr. Lloyd shared a highly practical technology tip to solve this. Instead of staring at a blank page, he suggests taking all your raw, disorganized positional data, your messy clinic notes, your rough drafts, and feeding that raw text right into ChatGPT.
Wait, really? Yes. You just dump it all in? Yes. It eliminates the friction of staring at a blinking cursor. Okay, so you have the job lead guiding the process, and you have the job book housing the knowledge. But how do you manage this new employee once they have the tools? Do- Well, Dr. Lloyd addressed this by introducing an empowerment template, pulling from one-minute manager concepts.
It maps out how a doctor's [00:14:00] communication style must shift based on the employee's level of competence. Okay. Let's break down the extremes of that template, starting with stage one. So stage one management is categorized as high direct, low support. Okay. This is the mandatory stance for brand-new hires.
The communication here is highly rigid. "I want you to do it exactly this way." Which is crucial for brand-new hires. Exactly. You provide the structural why, like with the trash can, but there is zero room for creative interpretation. Right. You do not want a person on day three trying to reinvent your patient intake flow.
Precisely. But as that employee proves their competence over months and years, they eventually graduate to stage three management, which is low direct, high support. Okay. This is reserved strictly for your veteran staff who have proven themselves. The communication completely flips. You might say, "What do you think the best way to handle this is?"
You give them autonomy. And the danger is when clinic owners mix those stages up. Like if you use stage three communication with a stage [00:15:00] one new hire, asking them how they think the phone should be answered, you are going to manufacture total chaos. Total chaos. And conversely, if you micromanage a stage three veteran employee, they'll resign in frustration.
Right, which perfectly explains the need to verify that development over time. We talked about testing them at the 90-day mark. But a major revelation from the Zoom call was that certification is not a one-time event. No, definitely not. You can't just certify a team member once. You must recertify them.
You have to build a system of recertification. One participant noted they recertify their entire team quarterly. Wow. Another clinic owner tests their staff monthly on phone scripts. If you don't continually recertify, entropy sets in. Employees get slightly sloppy, they paraphrase scripts, and they ruin patient interactions.
Right. Recertification ensures that the standard of excellence you set in week one remains the reality in year three. To maintain that standard, Dr. Lloyd shared one final onboarding requirement that serves as the [00:16:00] ultimate cultural anchor. Oh, the testimony hack. This is brilliant. Yeah. During onboarding, new hires are required to take a binder of actual patient testimonies.
Read through these real-world stories of patients getting their lives back, write a one-page report on what they learned, and then present it at a team meeting. Which brilliantly anchors the new hire to the profound life-changing nature of chiropractic care. It provides the ultimate why. It really does.
By engaging with the clinical outcomes, they realize that effectively managing the schedule is what facilitates those exact testimonies. Dr. Lloyd also recommended having clear documentation like a path to success document and a how to get fired document to clearly outline expectations from day one.
Which is just radical transparency. I love it. We have covered a massive amount of strategy today. We really have. And I wanna leave you with a provocative thought. Think back to the flat tire analogy. Yeah. What if the biggest bottleneck limiting your practice's [00:17:00] growth isn't a lack of new patients, but simply your inability to quickly and effectively duplicate your best team members?
Wow. That is powerful. Master the onboarding, and you remove the ceiling on your growth. That is the exact friction point we wanna help you eliminate. If you're listening and realizing your onboarding process is holding you back, Five Star Management is here to help you implement these exact systems. We want you to book a completely free call with Dr.
George Birnbach. George Birnbach is incredible at identifying these bottlenecks. He really is. The link to book that free call is right there in the show notes. It's an invaluable opportunity. And we also want to enthusiastically invite you to join the Five Star Management team live in Dallas, Texas on November 14th and 15th.
We have two massive events happening simultaneously. New Patient Edge, teaching you how to get more new patients fast, and the Win Win Associates event focused on maximum growth, freedom, and success. You absolutely need to be in that room. The link to secure a [00:18:00] ticket is in the show notes. Go click it right now.
And finally, be sure to subscribe to the podcast for even more actionable practice-building tips. Thank you so much for joining us, and we'll see you on the next deep dive