Your clinic is growing. Not a bad problem to have. But a growing practice does pose some challenges when it comes to maintaining your already great company culture. In fact, it poses quite a few challenges. After all, it’s easy—well, easier—to create and keep a cohesive culture in a small, core team. Once you start forgetting names, however, it’s a whole different story. There’s hope, though. Here are four ways to maintain company culture as your practice grows

1. Listen, Then Communicate
In 2012, just three years after launch, marketing software HubSpot had grown by 800%, and during the years preceding, there was frustration in the ranks about a new company policy. How did CEO and CO-Founder Brian Halligan handle the situation? According to HubSpot Project Manager Karen Rubin, the author of this article, Halligan took the “influencers and loudmouths” out to dinner. During dinner, he listened, asked questions, and then listened some more: “He spent time just listening, not interjecting his own thoughts, so he could learn more and find effective solutions.” Once it was time to communicate, Halligan ensured that he and his entire leadership team were on the same page—that they could all “articulate the reasons” behind the decisions.


According to consultant Carlo Demaio, “As a business grows, there is the potential for company hierarchy to dilute healthy communication and an individual’s perception of impacting the business through access to senior leaders.” In other words, as you add more levels between the owner of your practice and the staff, employees may begin to feel less and less involved—and that will definitely take away from the culture you’ve worked so hard to create. To keep everyone connected, Demaio says it’s all about opening the lines of communication.  It “might be as simple as an ‘open-door policy’ or more structured methods like scheduling time for employees to share improvement ideas.” Just keep in mind that even though your employees may be aligned in culture and values, each of them may have his or her own individual communication style. Try to tailor your processes to address these differences.

According to this article, when Foursquare Co-Founder Dennis Crowley started his company, “he hired friends he knew could foster the kind of open sharing that continues to be a core value, with 135 people now working in three separate offices.” Today, Crowley holds office hours once a week to hear from anyone who wishes to bring “ideas and feedback straight to the boss.” Crowley also uses technology, like iPads, to conduct virtual meetings for anyone not based in his New York office.

2. Measure Morale
With a team you can count on your fingers, it’s pretty easy to gauge employee morale. After all, you probably have time to have at least a few conversations with each person throughout the week as well as watch their interactions with one another. Once your numbers begin to climb, however, this level of observation drops significantly.

That’s why HubSpot implemented a measurement system. “Measuring culture is hard, but finding ways to gauge employee happiness helps us understand when we’ve hit a speed bump and if we have successfully moved beyond one,” Rubin writes. HubSpot uses the Net Promoter Score method every six months, asking employees two questions: “How likely would you be to recommend working at HubSpot to a friend?” and “Why?” (For reference, here’s an article about how Phillips uses the NPS tool to measure customer happiness.)

3. Lead by Example
As Demaio points out, “culture is your brand,” it is the way in which you “differentiate yourself from your competitors,” so live the values you’ve set, across the board, in all interactions, both inside and outside the office. “As leaders,” he says, “You will initially have the most impact on shaping the culture,” so shape it right. And it’s going to take more than just saying the words. Your employees will look to you for guidance and to gain a better understanding of what behaviors align with the company’s values—and what behaviors don’t. If you’re not a model example, not only are you sending confusing mixed messages to your staff, but you’re also appearing rather hypocritical—neither of which is good for your culture or morale.

4. Hire and Structure Well
We’ve touched on this in several previous articles (like this one and this one), and we’ll continue to do so because, well, it’s just that important. The people you bring into your company can make or break your company culture—and fast. This is especially important to note as you’re growing because you may not feel like you have the time to spend on diligent hiring. After all, you’ve got openings to fill and money to make. But in the long run, you’re going to spend even more time and money tending the weeds—those employees who don’t align with your company values. “While experience and professional background is always crucial,” Demaio says, “Seek like-minded individuals who aspire to a similar company vision, beliefs, and way of working.”

In addition to hiring the right people, it’s also crucial to put people in the right roles. When WebPT Co-Founders Brad and Heidi Jannenga began to grow their company—from three employees to almost 200 in five years—they were determined not to let it become another heartless corporation. But they knew they couldn’t manage the company’s culture along with their own ever-growing responsibilities. So, they hired a Culture Captain, whose sole responsibility is to ensure that the company never loses its employee- and customer-centric core values.

Seattle-based Urbanspoon has grown from three employees to more than 70, but it also still manages to stay true to its roots. According to Kara Nortman, SVP of consumer businesses for Urbanspoon’s parent company IAC, much of their cultural success comes as a result of the company keeping team sizes small. “Even if you become bigger,” she says, “You should size your teams so they have a clear feeling of ownership. That’s instantly more important than a boss telling you what to do.”

Looking for a few more tips? Inc. published Chief Culture Officer Paul Spiegelman’s strategy for maintaining culture as he took his company from three to 400 employees. He:


  • Only hired leaders who believed
  • Showed people he really cared
  • Rewarded and recognized consistently
  • Created a “recipe book” (his version of a culture handbook)
  • Established customs


How have you maintained your practice’s culture as you’ve grown? What do you wish you had done that you didn’t? What might you do differently in the future? Tell us your thoughts in the comments below.


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