Great systems mean nothing if your team does not consistently execute them. In this episode of the Chiropractic Deep Dive, we explore why accountability breaks down inside chiropractic practices and how clinic owners can fix it without micromanaging their teams. You’ll discover how written expectations, clear deadlines, cross-training, regular inspections, and simple accountability systems can help your team take greater ownership while reducing the amount of chasing, reminding, and frustration that falls back on you.
Is your team clear on exactly what they own, when it needs to be completed, and how success will be measured?
In this episode, we break down the accountability mistakes that quietly create chaos inside chiropractic practices and the systems you can use to correct them.
You’ll learn:
The goal is not to constantly watch your team. The goal is to create a practice where accountability is built into the system.
Ready to Build a Stronger Practice?
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Note: This episode was created using AI-generated voices based on original Five Star Management content and insights.
[00:00:00] You know, when a patient comes into your clinic, like with a subluxation, there is this certain expectation of precision. Oh, absolutely. It's almost like engineering, right? You do the exam, you find the exact spinal misalignment, and you make the adjustment. Yeah, and the body just responds. Exactly. It's this visible mechanical process that we literally treat with our own two hands.
But then, you know, you step out of the adjustment room- Right into the chaos ... yeah, you look around your front desk and suddenly that precision just completely vanishes. It really is. You're staring at this completely different kind of misalignment, and honestly, the diagnostic waters just get incredibly murky.
It is the absolute definition of, um, operational muddy waters. Yeah. Because the precision of the adjustment room, it rarely translates to the front desk without some serious, like, intentionality. Welcome to the Chiropractic Deep Dive, everyone, officially a part of the Successful Chiro podcast. We are just d- diving straight in today.
We really are. [00:01:00] And this deep dive is proudly brought to you by our team at Five Star Management, a premier chiropractic consulting company. That's right. Our mission today is to explore what I call the ultimate clinic killer, which is the accountability problem. It's a huge issue for so many owners. It really is.
And we are pulling our insights today from some notes and takeaways from this incredibly powerful exclusive Zoom call that was led by Dr. Noel Lloyd. It's such a vital resource, honestly, because Dr. Noel Lloyd really gets to the heart of this contradiction that so many chiropractors just live with every single day.
Yeah, they just accept it. Exactly. Like, you can have these wonderful systems in place, right? Yeah. Systems you've spent hours, maybe even years designing. Oh, well, for sure. But if your team simply doesn't execute them, those systems are basically worthless. Right, and you just get this compounding cycle of, uh, confusion and slipshod work.
Yeah, and massive frustration. Oh, massive lingering frustration for both you and your staff. To look at it mechanically- Hmm ... [00:02:00] having great systems but zero accountability is kind of like having a half-million-dollar sports car. Okay, I like this. You know, it's got this massive engine and a full tank of gas, but it has a completely broken transmission.
Oh, wow. Yeah. Right. The engine is your systems, the gas is your patient volume. But the transmission is accountability. Exactly. If the transmission doesn't connect that power to the wheels, you aren't going anywhere. You just sit in the driveway revving the engine until it, like, overheats and blows a gasket.
That is the exact mechanism of clinic burnout right there. It really is. And what's fascinating here is that before we can even begin to repair that transmission, we really have to look in the mirror. Uh-oh. Yeah, I know. Dr. Noel Lloyd and the participants on this Zoom call, they identified that clinic owners often actively destroy accountability completely by accident.
Wow. And it all starts with their own psychology. Let's get right into the psychology of this then because I [00:03:00] guarantee every clinic owner or, you know, office manager listening is gonna feel a little bit called out here. Oh, they definitely will. The overarching theme of these first few mistakes they discussed is how an owner's natural empathy is actually...
Well, it's weaponized against them. Exactly. I mean, think about the mindset of a chiropractor. Right. You're caregivers. You're healers. Yeah. Your default setting is empathy. And in the adjustment room, that empathy is your superpower Because it's how you connect with patients Exactly. But when you step out of that room and you put on your clinic owner hat, that same empathy becomes a massive liability if you aren't careful Which brings us to the very first massive mistake identified on the call, which is accepting excuses This is such a common one Yeah.
A participant noted that their staff always had these fantastic, airtight, highly logical excuses for why a project wasn't done Or why they were late again Right And because of that healer's mindset, the owner just empathizes. They say, um, "Oh, I [00:04:00] understand. Traffic was bad." Or, you know, "I know the software was glitching today."
Exactly. But here is the psychological mechanism at play. When you accept a fantastic excuse, you are subtly training your team that the deadline you set wasn't actually real Oh, man You are actively teaching them that an excuse is an acceptable substitute for a result That is a really harsh reality to face.
So once an owner realizes their empathy is being used to bypass deadlines, they often just over-correct Yeah, they swing the other way Because they hate the conflict of dealing with excuses, which leads right into the second mistake, which is not inspecting what you expect It's a classic hand off and walk away maneuver Yeah It's totally a conflict avoidance mechanism.
You give a task to a smart team member, and you know they know how to do it So you just assume it's gonna get done Right, and you purposefully walk away so you don't have to, like, micromanage or face any potential friction if they're struggling But, I mean, why is that assumption so dangerous? Like, if I hire [00:05:00] a highly competent front desk person, shouldn't I be able to trust that they'll just execute?
Well, Dr. Noel Lloyd made a really crucial distinction here. Just because someone knows what to do, how to do it, and why to do it does not mean you never have to check on it again Really? Yeah. One participant shared a story on the call where they handed off a whole plate of billing responsibilities Okay They assumed the competence was there, so they didn't check on it, and then weeks later, they looked at their clinic stats and saw this massive unexpected crater in their revenue Oh, no.
Because the follow-through just wasn't there The follow-through had completely vanished Mm-hmm Handing off a task without a verification mechanism is just setting yourself up for a deeply disappointing experience Okay. I actually want to push back on this next part a bit- Sure, sure ... because it kind of falls under this whole umbrella of trusting your team, and it introduces the third mistake, which is not having things written down Ah, yes Dr.
Noel Lloyd shared this... [00:06:00] They called it a Lloydism on the call He said, "You have no right to expect anything that isn't written down and discussed or trained on." That's the quote. But let me just challenge that premise. In a busy clinic, isn't it incredibly tedious to write down every single little expectation?
It feels tedious, sure. It's like if I'm paying top dollar for an experienced office manager or a really smart front desk hire, shouldn't I be able to rely on some basic common sense? That's the trap right there. I just feel like I shouldn't have to write a manual on how to empty the trash or, you know, when to smile at a patient.
It is a very common pushback, and it's a trap so many owners fall into. Why does relying on common sense fail so spectacularly in a clinic environment? Why? Because your common sense is built on your years of experience as an owner. Okay, fair. It's built on the financial risk you carry, the late nights you've worked, the overarching vision you have.
Their common sense is built on their experience as an employee. Oh, I see. Those are two totally different [00:07:00] paradigms. So their baseline of urgency is just fundamentally different from mine. Exactly. Without written standard operating procedures, your SOPs, you basically create shadows. And accountability problems thrive in those shadows.
They thrive in the shadows of unwritten expectations. One participant on the call was actually preparing for maternity leave and realized this firsthand. Oh, wow. That's a wake-up call. She had to meticulously write down every single checklist, procedure, and script for the front desk. She realized that assuming a temp or a backup just knew to put specific patient notes into a specific digital folder was a total recipe for disaster.
Yeah. They wouldn't just guess that. Exactly. If the expectation isn't physically documented, you cannot hold someone accountable to it. It simply doesn't exist. Wow. Okay, when you frame it as two different paradigms of common sense, the danger becomes really obvious. It's a huge shift in perspective. And I can see how that lack of clarity bleeds right into the fourth mistake, which [00:08:00] is no deadlines or clear delegation.
Yes. This is like when an owner walks into the clinic with a burst of inspiration and says, "Hey, guys, we should really start doing patient appreciation videos." But they never assign a specific who or a specific when. Right. It's tossing an idea into the room and just hoping someone catches it. And no one does because when everyone is responsible, no one is responsible.
Exactly. Or conversely, the owner does assign a who, but they completely micromanage the how. Oh, that's almost worse. A participant shared a great example of this. They told a biller exactly how to track down a denied claim. Like step by step. Yeah, call this specific person, email this specific department, check this specific board.
By the time the owner finished dictating this overly complex multi-step process, the biller had already just emailed a different, faster contact and gotten the answer. Right. So the owner basically became the bottleneck by focusing on the steps instead of just the outcome. Exactly. The mistake is [00:09:00] failing to clearly delegate the desired end result and the deadline.
So you just write down the expectation, you set the deadline, and then you let your smart hires figure out the path to get there. Let them do their jobs. Exactly. Which perfectly sets up the fifth mistake they discussed, which is expecting people to work the exact way you work. This is a tough one for a lot of docs.
Yeah. This was brought up by a participant who admitted to being highly Type A. If they assign a task, they expect it done immediately at a full sprinting pace without any follow-up. Because that's what they would do if the roles were reversed. Right. And this requires a serious moment of self-reflection for you as the listener.
Right. Are you punishing your staff for not having an owner's mentality? That's a great question. Because you have an intrinsic entrepreneurial drive. Your brain chemistry is literally wired for urgency because your livelihood depends on it. Yeah, the stakes are different. Expecting a 20-something front desk hire to operate with your exact brain chemistry is just a fast track to [00:10:00] burnout for them and endless frustration for you.
Okay, this all paints a very clear picture of what not to do. Stop doing those five things immediately. Right. We have to stop accepting excuses, stop relying on our own common sense, clearly document expectations, set deadlines, and just respect that our staff are not clones of us. Mm-hmm. But how do we actually systemize this?
Because if I'm a clinic owner or even a really busy office manager, what I do not want to do is spend my entire Tuesday chasing my staff around the clinic to see if they did their jobs. Well, you don't. You shift the burden of accountability from your shoulders to the systems themselves. Okay, I like the sound of that.
And the Zoom call participants shared three brilliant mechanical solutions to actually do this. Let's hear them. The first is a redundancy concept. It's the first string, second string, third string system. Yes, the sports analogy. Walk me through the mechanics of how this actually operates in a real clinic.
So in this system, every single position in the clinic has designated [00:11:00] cross-trained backups. Okay. Let's say your front desk, your first string wakes up with the flu. In a normal clinic, absolute chaos ensues. Right. The staff texts the owner asking who's covering the front. Yeah. And the owner has to scramble.
It ruins the whole morning. But with this system, the owner is completely removed as the emergency contact. Yeah. The second string automatically knows it is their contractual responsibility to step up. They walk in, they grab the absent person's written checklist because remember, everything is written down, and they just own that position for the day.
Wow. It builds this incredible layer of armor around the clinic's workflow. Like nothing drops just because one person gets a flat tire. Exactly. But I mean, that covers absences. What about the day-to-day delegation? If I have a new project, how do I hand it off without falling back into the trap of micromanaging or, you know, interrupting them while they're with a patient?
That brings us to a physical tool Dr. Noel Lloyd called the Kramer Clipboard. The Kramer Clipboard. Yeah. It's an adaptation by a [00:12:00] participant on the call. Picture a specialized physical clipboard- Hmm ... sitting permanently on the manager's or owner's desk. Okay, I'm picturing it. On it is a piece of paper with a grid featuring everyone's names and their assigned tasks.
Wait, wait. Why a physical piece of paper on a clipboard? We live in a digital age. Why not just drop a message in Slack or Microsoft Teams? Wouldn't that be way faster? Well, it might be faster for the owner, but it is highly disruptive to the clinic. How so? Think about the physical environment of a busy chiropractic office.
If you send a digital ping, that employee's phone buzzes while they are actively trying to schedule a new patient or, you know, process a payment. Oh, true. It breaks their concentration. It totally pulls them away from the patient experience. A physical clipboard centralizes the tasks in one quiet location.
Yeah. But the real genius is the psychological shift in power. What do you mean by that? The owner doesn't hand the task to the employee. The crucial element is that the staff has the [00:13:00] written responsibility to walk into the manager's office periodically throughout the week and check that clipboard. Oh, wow.
It forces the employee to proactively seek out their responsibilities. If they miss a task, they can't use the excuse, "Well, you didn't ping me." Because checking the clipboard is literally part of their job description. Exactly. Oh, that is a massive shift. The owner just offloads their mental clutter onto the clipboard instantly, and the burden of retrieval is entirely on the staff.
It's so freeing. I love that, and it pairs perfectly with the other massive mindset shift introduced on the call, which is the BYLT rule. Oh, yes. Before you leave today. This is a reporting mechanism. Direct reports must proactively find their leader to give a status update on their assigned projects before they leave the building for the day.
This BYLT concept is arguably the most powerful mechanism we've discussed today. Let me give you an analogy to explain why it works so well. Go for it. Think about working in a really high-end restaurant [00:14:00] kitchen. When the dinner service is over, a line cook doesn't just take off their apron, throw their knives in a bag, and walk out the back door.
No way. The station has to be scrubbed, restocked, and meticulously prepped for the next day. But more importantly, nobody goes home until the executive chef physically walks over, inspects the station, and gives the nod. Right. The line cook has to present their finished work. Exactly. BYLT brings that exact same discipline to the chiropractic clinic.
It puts the onus entirely on the employee to close the loop. It's so effective. Right. So if I'm the manager, and I'm walking out to my car at the end of the day, and I haven't heard from my front desk staff about whether that missing patient log was updated- I don't go hunting for them. No, you don't. The staff member has failed their accountability check.
Because they aren't just responsible for doing the work, they are responsible for communicating the completion of the work. You don't chase the report. The report finds you. Exactly. One participant [00:15:00] mentioned a high school girl who handles some basic insurance tasks for them. Oh yeah, I read that. She is trained so deeply in this BYLT culture that on the first Tuesday of every month, her insurance report is just sitting in the owner's physical mailbox.
That's amazing. The owner doesn't chase her. The owner doesn't remind her. The system drives the behavior. Okay, so we've got the strings for emergency coverage, the physical clipboard for delegation, and BYLT for reporting. We have successfully shifted the burden. We really have. But going back to mistake number two, Dr.
Noel Lloyd was very clear that you still have to inspect what you expect. Mm. Because a system is really only as good as its verification. So how do we audit this execution without falling back into the trap of micromanaging? You build scheduled, highly targeted inspections into the fabric of your weekly routine.
Okay. And on the call, they broke down some very specific, highly effective ways clinic owners are auditing their teams right now. [00:16:00] Let's talk about the missing charges audit because the example shared on the call perfectly illustrates why relying on human memory is just a complete disaster. Oh, the baby example.
Yes. Yeah. A participant explained that they run a daily missing charges report in their software to catch billing errors instantly. They shared a story about how occasionally a doctor will adjust a baby in the clinic and just completely forget to tell the front desk. Happens all the time. Yeah. Mom is holding the baby.
The doctor does a quick check and an adjustment, and because there's usually no separate co-pay for that quick check- Yeah ... Mom just walks right out the door without stopping at the desk. Right. And the doctor gets busy and just forgets to mention it. Which means there is no new patient note, no charge, and basically no record that a medical procedure just occurred.
None. The baby is in the system, but the front desk is totally in the dark. But by auditing that specific report daily rather than waiting for the end of the month, they catch that error the very next morning while the memory is still fresh. That makes total sense. It's a simple five-minute check [00:17:00] that prevents a massive compliance issue and a big revenue leak down the line.
Now, here is an audit that caused a major stir for me when I read the notes, and I really wanna push back on it heavily. I think I know which one you mean. Timing the doctors. Oh. A participant mentioned that they actually use the clinic's security cameras to time exactly how long their associate doctors are spending in the adjustment rooms.
Yep, that's the one. I understand efficiency, but doesn't watching cameras to time your doctors feel incredibly punitive? Like, how does an as- associate not feel like they are working on a factory assembly line with Big Brother watching their every move? It is a very natural reaction to feel defensive about that, and it's a completely valid concern.
But the participant on the call clarified the true why behind this audit, and it really requires a complete reframing. Okay. Frame it for me. It is not punitive at all. It is purely mathematical, and it exists solely to help the doctor hit their own personal goals. Okay, I [00:18:00] see the math part. Yeah. But how do you actually present that to an associate without them feeling like you're just trying to squeeze more money out of them?
Well, it's all about how you frame the conversation. Hmm. Let's say you sit down with your associate doctor and you ask them what their financial goals are. Okay. They say they wanna hit a certain bonus tier, which requires seeing three patients every 15 minutes. They want that volume and the profit that comes with it.
Sure. Well, the math dictates that if you wanna see three patients in 15 minutes, you have to keep your adjustments to five minutes or under. So the audit is literally just tracking the reality of their goal. Exactly. If the audit shows the doctor is consistently taking 10 minutes in the room, the math is broken You don't approach them and say, "You're too slow."
Right. That would be punitive. You approach them as a coach and say, "Hey, we're timing this so you can hit your bonus. Right now, you are taking ten minutes, which means we can only schedule you two patients every fifteen minutes." "So you aren't gonna hit your financial goal at this pace." Exactly. "Let's work on your speed [00:19:00] and your verbal transitions so you can get what you want."
Ah. So you align the audit with the doctor's personal professional goals. It becomes a coaching tool, not a disciplinary one. Right. And the notes mention that to make it even less big brother, another clinic simply has the front desk staff manually write down the times on a sheet. Yeah, a simple time sheet.
Like when the doctor goes in, when they come out, and when the notes are finished, then they review those sheets weekly. It brings it out of the shadows. Exactly. And that leads us to the final and perhaps most cutting-edge solution discussed on the call. Oh, this is the tech part? Yes. Because if auditing human behavior is time-consuming, how can we leverage modern technology to enforce accountability automatically?
This blew my mind. A participant shared a piece of tech called Plaud, P-L-A-U-D. It is this incredibly thin credit card-sized device that snaps right onto the back of your smartphone. It essentially acts as an AI executive assistant. It records meetings [00:20:00] and yes, it is fully AI compliant, which is crucial, and then uses AI to instantly generate action item lists and full transcripts.
Think about how this directly attacks mistake number one, accepting excuses. You have a weekly staff meeting. You delegate tasks. And in the past, someone might drop the ball and say, "Oh, my bad. I completely thought you were gonna call that patient." Right. But with Plaud, the AI listens to the meeting, parses the conversation, and automatically drops a specific itemized to-do list right into each team member's digital folder.
It completely obliterates the, "I thought you were doing that" excuse. There is a transcript. There is an assigned task. The clarity is just indisputable. But the most impressive part for me is how they are using it in the clinic with patients to automate documentation. Like how does it actually format SOAP notes?
It's brilliant. During a day one consultation, the device records the discussion. Okay. And the AI is trained to literally categorize the natural flow of the [00:21:00] conversation. Hmm. So when the patient describes their pain The AI pulls that into the subjective section. That's wild. When the doctor verbalizes their physical exam findings out loud, the AI places that directly into the objective section.
It builds the structure of the day one SOAP note while you speak. Talk about a system that ensures the documentation is done accurately every single time without relying on a tired doctor's memory at the end of a 10-hour shift. It's a game changer. It's incredible. So what does this all mean for you and your clinic?
Let's distill this down into our core mission takeaways. Let's do it. To solve the accountability problem, you have to start by getting out of your own way. Stop letting your empathy get weaponized into excuses, and stop relying on your own common sense. Assume absolutely nothing. Write your expectations down clearly.
Then you build the systems that shift the burden of reporting away from you and onto your staff. Right. Use the first string system to cross-train your team so absences are handled automatically. Implement the physical Kramer [00:22:00] clipboard so tasks are centralized and staff must actively seek them out. And enforce the BYLT rule before you leave today, so your team brings their completed results to you rather than you having to hunt them down.
And finally, you consistently audit the transmission. Whether it's running daily missing charges, reports to catch dropped balls, or timing your doctors to help them hit their own volume goals. Or even using AI tech like Plaud to create indisputable records of your delegated tasks. It's all about protecting the practice's goals.
Absolutely. Because when everyone knows what they own, they know what winning looks like, and they know exactly how they are being measured, the frustration vanishes, and the clinic can actually scale. Which brings me right back to our sports car analogy. Writing down your systems and having a great vision, that is building a beautiful, powerful engine.
But creating a culture of built-in accountability. That is the transmission that finally takes all that potential power and propels your clinic forward. I want to leave you with this final [00:23:00] provocative thought experiment to just mull over tonight. Okay, let's hear it. Imagine you woke up tomorrow morning, and you had completely lost your voice.
Oh, man. You couldn't speak a single word to your staff for an entire week. Would your clinic survive the week based purely on your written checklists, your cross-training, and your built-in accountability systems? Or would the entire operation grind to a halt by Tuesday afternoon? That is a chilling question, but a deeply necessary one.
If the honest answer to that makes you sweat a little bit, it is time to take action. Definitely. To solve these accountability problems and truly grow your clinic, you need to book a free call with Dr. George Birnbach. You can find the link to schedule that free call with Dr.
Birnbach right down in our show notes. And if you are ready to immerse yourself in these kinds of high-level operational strategies, we wanna personally invite you to attend our live two-day event happening in Dallas, Texas this November 14th and 15th. It is going to be an [00:24:00] absolute game changer because we actually have two separate events running concurrently under one roof.
Two for one. Exactly. First, we have the new Patient Edge event, which is going to teach you exactly how to get more new patients into your clinic fast. Super important. And second, running at the exact same time, is the Win Win Associates event. This track is entirely focused on our Win Win Associates system, designed to give you more growth, more freedom, and massive success as a clinic owner.
The link to register for the Dallas event is also right there in the show notes. It's a vital investment in the operational health of your practice. Absolutely. And don't forget to hit subscribe on your app so you never miss out on more of our weekly deep dives from us here at Five Star Management on how to build a highly successful chiropractic practice.
Get those systems written down, fix that transmission, and we will see you on the next deep dive