Let’s say you want to order a custom cake from a small bakery, and you plan to swing by to place your order after work. Unfortunately, your work day turns into a total stress-fest, and you barely have time to run into the bakery before it closes. You slip inside with five minutes to spare. The baker is annoyed that you came in so close to closing time (she had a bad day, too), and you can hear her tapping her foot as you fill out your custom order. You snap that you’re filling out the form as quickly as you can, and a few seconds later, you finish up and leave. What you don’t realize is that, in your haste, you failed to write down all of your instructions—and the next day, the baker (who doesn’t like you very much) notices this, but decides not to reach out to you for further clarification. When you get the cake a few days later, it’s mostly right, but it’s not exactly what you wanted—so you don’t tip very well—and both you and the baker leave what should have been a mutually beneficial interaction thoroughly unhappy. 

This situation is a little exaggerated, sure, but it really demonstrates how one instance of mishandled communication can sour relationships and derail an entire work operation. A misunderstanding like the one from this example could irrevocably damage your staff’s morale, affect how they feel about their position in the clinic, and change how they approach their work in the future. So, where could communication in your clinic be going wrong? Well, keep reading to find out the five different ways that your clinic’s communication is totally failing—and get some advice directly from some of this year’s Ascend speakers.  

1. Failure to outwardly recognize your therapists lowers morale. 

One of the first and biggest ways you can bungle communication with your therapists is by, well, not communicating—more specifically, not communicating about the wins you see in your clinic. Though it’s self evident that you need to address your clinic’s problem areas, you can’t stop there. You need to address your successes, too. 

Introducing a Recognition Program

“79% of employees who quit cite lack of recognition as the main reason,” said Dr. Brian Hartz, DPT, MPT, OCS, CSCS, during his session at Ascend. He also said that 82% of employees don’t feel like their managers recognize them for their work, and 60% feel motivated by recognition. In other words, a little appreciation can go a really long way. 

Enstating a recognition program can boost morale and improve employee engagement, which will ultimately improve the effectiveness of your business and boost your bottom line. The important thing to understand here is that—while creating a recognition program in your clinic might take an initial, upfront investment—employee engagement has a phenomenally high ROI, and it’s something worth investing in. Hartz also shared these words of wisdom: “People always ask me, ‘I have to spend money on this?’ You spend money on everything else; why don’t you spend money on employees—and keeping employees?”

Recognizing Employees on a Budget 

If your clinic can’t afford to allocate funds into a recognition program, don’t worry. You don’t have to break the bank to make your employees feel recognized. You just need to let them know that you’ve noticed their hard work. If you see a therapist come in early or stay late to help out during your busy season, if a few members of your team collaborate to create a new, more efficient process for the clinic, if the team pulls together and reduces churn rate or improves the clinic’s NPS®—make a pointed effort to thank them. Buy lunch for the team one day, or give a hardworking employee a small gift card to say thank you.

2. Poorly interpreted metrics can cause resentment. 

Measuring metrics is one of the single most important things you can do at your clinic. They help you keep a pulse on your business and find your clinic’s specific pain points (e.g., your customer acquisition costs are too high, or your billing process has too many cash-flow clogs). However, while you may be steeped in metrics day-in and day-out, your therapists are not, and it falls to you to correctly interpret and explain your metrics to your staff (the relevant metrics, at least). This is precisely where your communication could go awry.  

Looking at the Whole Data Picture

During his Ascend session, Brandon Seigel, the President of Wellness Works Management Partners, told a story about a time he almost misinterpreted some metrics in a clinic. He was tracking workplace productivity and overall cash flow, and he was comparing a few months of one year’s statistics to a few months of the previous year’s. Even though he knew his therapists had been working extraordinarily hard that year, the metrics didn’t look so great: it appeared that the clinic’s performance was significantly worse that year. 

Luckily, that conclusion didn’t sit right with him; he dove deeper into the clinic’s metrics and looked at two full years’ worth of data. In doing so, he realized that his original analysis was wrong. His clinic was actually performing better than it had the previous year (and was closer to its annual goals) because the therapists had gone above and beyond during the earlier months in the year. Seigel followed up the story with some sage advice: “If you don’t read the right story [in your metrics], you can really invalidate the good things that are happening.” That, quite frankly, can cause resentment among your therapists, and a feeling that their work will never meet your standards. 

Delivering Data Tactfully

Once you know that your metrics are unequivocally telling the right story, you need to find the right way to communicate them with your therapists. Numbers don’t motivate most people—and many will have a hard time getting on board with striving to increase productivity by X percent, for example, without understanding what that means for their work day. The best move is to find a way to contextualize the numbers you want to share—and figure out how that aligns with each therapist’s individual goals. This is where it helps to know what motivates your staff. “Find out what makes your people tick before you use the metrics so you don’t invalidate them—and so you empower them in the most effective way,” Seigel recommends.

3. Carelessly worded emails can muddle messages and carry unintended meanings.

Emails and other forms of digital messaging form the cornerstone of communication in most modern places of business. The problem with emails (and writing in general) is that it’s difficult to communicate tone and meaning through a screen, and it’s ridiculously easy to muddle your message. You can’t always stick an exclamation point on the end of a sentence to show that you’re feeling peppy—especially if you’re addressing something serious. Hartz says he always tries to have face-to-face conversations with his therapists for this exact reason: “I think communication has suffered dramatically with technology—especially with the younger generation.” 

Perfecting Your Written Communication

The reality, though, is that having vis-à-vis conversations isn’t always an option, and you will have to communicate through writing at one point or another. So, start by double-checking your important emails; don’t send them out first pass until you really look at them and ensure that your tone and message are absolutely crystal clear. 

4. A lack of collaboration quashes your clinic’s innovative process.

Now don’t get me wrong—top-down leadership has its place in a clinic; you need someone at the helm of the ship who has the authority to course-correct when necessary. But, a purely authoritative environment is frustrating for employees, and it completely quashes innovation. An environment that encourages open, collaborative communication will foster strong, new ideas that can help solve problems that crop up in your clinic, thus improving your overall efficiency. And if you think about it, encouraging collaboration is a no-brainer. Your therapists are on the front lines at your clinic each and every day. They will probably be the first people who identify big snags in the workflow. Here’s how an HR resource recommends creating a collaborative environment: 

  • Listen to (and respect) your employees’ suggestions.
  • Acknowledge and reward successful innovations. 
  • Encourage creativity. 
  • Don’t micromanage. 
  • Encourage your employees to learn new skills. 

5. Having only surface-level conversations prevents you from getting on the same page as your therapists. 

Many people are loathe to mix their professional and personal lives—and honestly, I don’t blame them (I’m in that camp, too). So, when I say that surface-level conversations are inhibiting your clinic, I don’t mean that you and your colleagues have to discuss your deepest, darkest secrets with each other in order to make your clinic more successful. Instead, I mean that you should make an effort to really talk and connect with your therapists. When Judy Cirrulo, PT, ACC, CPC, ELI-MP, spoke at Ascend, she explained that there are three levels of conversation: 

  1. transactional,
  2. positional, and
  3. transformational.

Identifying Transactional Conversations

Transactional conversations occur when you tell people something (e.g., we are getting a new EMR), and when you ask for something (e.g., can you stay late on Thursday to get trained on our new EMR?). They are the most surface-level conversations that humans have—and they are the conversations that prevent people from actually connecting. That’s not to say that they don’t have their place, but if all you’re doing is asking and telling your therapists to do things, then you have a communication problem. 

Identifying Positional Conversations

The second level of communication is positional—in other words, when you advocate or inquire about something. This is the level of communication where you have skin in the game. You are trying to convince someone of something (advocate), or you are trying to figure out where that person stands in regards to something (inquire) so you can change his or her mind. Again, this level of communication has its place in conversation, but it does not really allow you to connect with your therapists. 

Identifying Transformational Conversations

The final level of communication is transformational. This is where you share and discover. On this level, you aren’t making a request, digging for information, or trying to get something done. You’re simply communicating to connect, to innovate, to collaborate. According to Cirrulo, this form of communication allows humans to forge the most positive relationships, because their brains literally tune in to each other. But it’s also the most difficult level to get to. 

In Cirrulo’s words, “You cannot access the innovation, the trust, the prefrontal cortex when you’re in [a negative] state.” So, if you’re in a bad mood or having a difficult conversation, this is probably not the type of conversation you’re going to have—even though this is the most constructive style of communication. And even though it’s difficult to communicate transformationally, it’s definitely something to work toward. 


Good communication is a tricky, fickle thing. Everyone has their own experiences that color their interactions—and those interactions are often interpreted differently from person to person. So, the best way to keep everyone on the same page (and the best way to make sure the cake gets baked correctly) is to really focus on and put some effort behind refining your communication methods. I’ll leave you with one last quote from Cirrulo: “Patterns of communication were found to be the most important predictor of a team’s success.”