When Leadership Changes, the Numbers Follow

One of the experiences that shaped how I think about leadership happened early in my career, when I got the chance to turn around a struggling physical therapy clinic. I'd built several clinics from the ground up before that, taken them from zero to full throttle, but this one was different. It wasn't a blank slate. It was an established clinic that was struggling financially and culturally, and if you'd asked five people on staff that week who was actually responsible for what, you probably would have gotten five different answers.

The clinic was seeing about 80 visits a week with two full-time therapists. One of them was technically a co-director but had no real interest in leading anyone. At the front desk, the person handling scheduling and collections wasn't comfortable holding patients accountable for showing up or paying their copay. The whole office had a kind of lackadaisical energy to it. I remember walking in and seeing patients AND staff watching game shows on TV when people should have been focused on getting patients moving toward their goals.

The financials told the same story. Month after month, the clinic sat at the bottom of the regional P&L rankings, and profitability had been in the negative double digits for over a year.

What I figured out fairly quickly was that the real problem wasn't that the clinic was too slow. It was a leadership problem. There wasn't a real culture of accountability or a clear sense of purpose, direction, or ownership. Nobody was connecting what happened in a treatment room on a Tuesday afternoon to what showed up on the P&L at the end of the month.

So I started there. Mostly that meant spending a lot of time with the team. I coached, I mentored, I sat through some genuinely uncomfortable conversations, and I set expectations and then, this part mattered more than anything else, I actually followed up on them. I worked with people individually instead of assuming a "let's all do better" speech would change anything.

The front desk is probably my favorite example of what shifted. That clinic had one of the highest amounts of copay "left on the table" in the region, meaning patients were walking out without paying what they owed and the clinic was just absorbing it, waiting for the company to eventually send it to collections. The person responsible wasn't a bad employee. She'd simply never been taught how to hold a patient accountable with any confidence, and nobody had ever expected her to. Once that changed, she went from running one of the worst clinics in the region for collections to one of the best. Cancellations moved too, from a routine 15 to 20 percent down to a consistent 6 to 8 percent.

Those numbers were nice. What mattered more to me was watching her change. She got more confident. She stopped seeing "collect the patient’s copay" as being a confrontational task and started seeing it as doing her job well and helping the clinic thrive. She smiled a lot more.

Volume moved too. The clinic had been stuck around 80 visits a week and hadn't hit triple digits consistently in over a year, going back to when the original owner left. Within six months we were regularly seeing well more than 150. The clinic climbed from one of the worst performers in the region to one of the top three and went from negative double-digit margins to double-digit profitability.

Honestly, though, the rankings weren’t the part I was proudest of - although that felt pretty good too! But that was actually a side effect of the true win. The team that had felt scattered and disconnected became a group that actually wanted to win together. They cared where the clinic ranked. Once they hit the top three, they wanted to stay there. And it kept holding after I left, which might be the best validation I've ever gotten. I hadn't just pushed a group of people toward better numbers for a few months. We'd built something they were able to carry on their own, and happy and proud to do so.

That clinic was my first real leadership turnaround, and it's what led to my promotion to Divisional Vice President, from running one clinic to a much bigger operation.

The funny part is I had no formal leadership training when any of this happened. I learned it by trial and error, feeling my way around and seeing what worked - and what didn’t. It wasn’t always easy, or pretty. I learned how differently people respond to coaching and feedback, when to push and when to just listen, and when the actual problem wasn't a person at all but the system around them.

That's a big part of why leadership development matters so much to me now. We promote people because they're good at their jobs. We hand them a title and a P&L and quietly assume they already know how to coach, build a culture, and handle conflict - or that they’ll figure it out on their own. I know this happens because it happened to me. I figured it out because I had - and wanted - to. But I also know now how much faster and smoother that climb can be when someone actually teaches you how to lead instead of leaving you to stumble into it.

The lesson from that clinic has stuck with me ever since: if you want different numbers, you have to change the behavior and culture producing them. And if you want that change to last, you have to develop the people carrying it forward. That clinic didn't really go from 80 visits to 150-plus. It went from a scattered group of people who had no particular concept of what the place could be or their part in it, to a cohesive team that believed in a vision and made it happen. The numbers were just what that transformation looked like on paper.