Feedback. Performance conversations. Annual reviews. Say these words out loud and you’ll likely elicit a groan—or perhaps an eye roll—from the person with whom you’re speaking. At least, that’s been my experience as someone working in the HR industry for the last 15 years. I get it: having tough conversations about performance can be difficult. But in my experience, if you avoid those conversations, you’ll face even bigger issues down the road—ones that’ll make tough conversations feel like a cake-walk.

For physical therapists—people who are often empathetic, caring, and supportive by trade—having performance conversations may feel even more difficult. However, if you own or manage a private practice, avoiding tough conversations with employees will ultimately end up negatively impacting their ability to help their patients. Here’s my advice on how to handle these difficult situations in a way that will be comfortable for you—and good for your business.

Recognize the downsides of avoiding performance conversations.

Performance management probably wasn’t covered as part of your PT school curriculum, but if you don’t have performance conversations with your employees, your business will suffer. Without these crucial conversations, the front office employee who arrives 10 minutes late every day, the therapist who makes patients feel unwelcome, and the accountant who makes billing errors will eventually drive your practice into the ground. Here are some not-so-great consequences you can avoid by implementing a strong performance review process:

Low Morale

Contrary to what you might think, most people want to receive feedback about their performance. It might sound cliché, but feedback is a gift—it informs us of what we’re doing well and shows us where we need to improve. Without performance conversations, employees don’t know if they are—or aren’t—meeting expectations. This lack of clarity will eventually lead to low morale—which then leads to performance problems that are even harder to manage.

Negative Work Environment

A byproduct of low morale is a negative work environment. Unsatisfied employees breed discontent. Likewise, when employees who are doing their jobs well witness their colleagues’ performance issues going unnoticed, it takes a toll on the overall office atmosphere. Instead of cultivating a team that works together to deliver excellent service and achieve results, you’ll end up creating a culture that lacks the elements of trust, collaboration, and commitment.

Unhappy Clients

One of the worst repercussions of not having performance conversations is the impact it has on your clients. The front office employee who answers the phone using a terse tone or the therapist who has missed not one, but two appointments both represent examples of performance issues that, if not addressed, will cause clients to walk out and never come back. Not only will you lose their business, but you’ll also lose the potential referrals they might have sent your way.

Of course, any egregious performance issues (e.g., unlawful behavior or conduct) can have an immediate, concrete business impact, and should be immediately addressed and documented.

Approach performance feedback as a process.

Successful businesses don’t grow without discussions about performance. If you want to have an effective and high-performing practice, you must provide feedback to your employees. The secret is to approach performance management as a process—not as a dreaded, one-time event that only happens in extremely negative situations. Use these four steps to create a performance process that works for you and makes the thought of performance conversations less intimidating:

1. Set expectations.

It’s much easier to talk about performance if you set expectations for each role. With clear expectations, both you and the employee have a good understanding of what excellent performance looks like.

For example:

  • Uses collaborative decision-making when working with colleagues and patients.
  • Takes necessary precaution when handling confidential information.

Be sure to document these expectations for future reference (just in case the employee needs a refresher), and keep a copy within your business files.

2. Assess performance.

As mentioned above, when it comes to performance, employees want clarity—in terms of both expectations and feedback. Once you’ve set clear expectations for performance, you’re able to assess each employee’s performance against the expectations for their role.

To continue with the first example from item one, you may ask: Does the employee use collaborative decision-making when working with colleagues and patients?

If the answer is yes, provide positive feedback to encourage continued performance.

If the answer is no, this is an area of opportunity around which you can provide developmental feedback. Offer specific examples of when the employee did not meet the performance expectation. Then, work with the employee to improve that behavior or skill. Follow up with feedback until you notice improvement.

When you complete an employee performance assessment, add specific notes about your conversation in the employee’s file. Note: It’s very important that the information you keep in this employment history file remain unbiased and fact-based. Check out this article to learn more about what should and shouldn’t be kept in an employment file.

3. Reward good performance.

Performance isn’t just about the difficult conversations; it’s also about recognizing great work. Make sure the conversations you have about performance celebrate what your employees do well. Consider having recognition moments at staff meetings or organizing quarterly recognition events; this is one way to establish a supportive work environment. You may also want to reward individuals—or the whole team—financially or otherwise, for achieving certain milestones.

4. Develop goals for performance and personal growth.

Regular performance conversations provide ample opportunity for you to help employees improve the skills that aren’t up to par with expectations. Furthermore, these discussions allow you the opportunity to learn which abilities your employees want to develop. They may have interests you can tap into that will benefit to your business—and that you never would have uncovered without having a conversation about performance and growth goals.

5. Determine next steps.

Even when you set expectations, assess performance, recognize great performance, and provide development opportunities, there are some cases in which an employee’s performance won’t improve. In those situations, a performance process will help you determine next steps.

Many businesses use a performance action or improvement plan to give an employee who isn’t meeting expectations a final opportunity to succeed while still holding him or her accountable. Check out this article from the Society for Human Resource Management to see a step-by-step guide for creating these plans.

If the employee’s performance doesn’t improve after he or she receives feedback, development opportunities, and an action plan, then it’s time to consider next steps. The options depend on the circumstances, but may include transferring the employee to another job in your practice, giving the employee a demotion, or terminating the employee. For empathetic physical therapists, termination may be a difficult option to consider; however, terminating an employee for unsatisfactory performance or misconduct is completely reasonable. If you avoid termination, you risk creating a situation that becomes increasingly difficult for everyone involved.

It goes without saying that performance management requires effective conversations in which people are heard and topics are discussed in an open, honest manner. If you feel nervous about performance conversations, consider practicing your approach with a mentor or trusted advisor.  When you leverage performance conversations in a consistent, caring, and competent manner, they can yield powerful results.


Liz Sheffield writes for Captain401, which provides 401k investment solutions for businesses of all sizes.