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Image of two women smilingHappy Staff = Happy Patients
Your staff’s attitude affects patient retention.
Keep them happy!

By John V. Wood

When patients walk into a doctor’s office for the first time, they are searching for anything to make them feel more comfortable.

The first person they come in contact with is one of your staff. If that staff member emits a happy demeanor, patients are reassured of their choice. And reassurance leads to patient retention.

But if your staff member appears dour, patients get a less-than-warm feeling about their choice of physician.

Chiropractic Economics talked with a mixture of chiropractic and human resource experts about the importance of good staff morale. They outlined what makes a staff happy, warning signs of a morale problem, and ways to put morale as a top priority.

Those experts were:

• Keith Maule, CEO, Integrity Management,;
• Beth Silver, managing director, Doubet Consulting,;
• Mark Sanna, DC, CEO, Breakthrough Coaching,;
• Michelle Geller-Vino, founder and president, MGV Marketing,;
• Kim Klapp, founder and coach,  A.C.E. (Assistants for Chiropractic Excellence),; and
• Ken Freedman, senior consultant, The Masters Circle,


It is extremely important for your staff to be happy because they determine the best mood and pace of your office, says Maule. “Your CAs are the first people that your patients come in contact with when they enter your building. If they are happy, they will pass this feeling along to your patients.

“Have you ever been traveling and heard the airline staff complaining about their jobs? As a customer, it doesn’t make you think very highly of the airline, and it usually causes you to have a lower opinion of the staff, too,” Maule continues. “The same is true in a chiropractic office.

“If your staff is unhappy and they complain about their job to other co-workers, your patients will hear it. This will taint their view of your staff and ultimately your practice.”

Silver ties happiness directly to office production. “A happy staff is vital to the growth of any business. If the team does not want to be at work, they are not going to be focused in moving the company and themselves forward,” says Silver. “You have to be happy to do anything well.”

Freedman attributes patient retention, job performance, and work attendance directly to the happiness of a clinic’s staff. “When a person is in a state of happiness, they resonate at a higher level. This improves their job performance individually and fosters a climate for the team to be more productive and creative, especially when confronted with challenges that may occur,” says Freedman.

“Happy people are healthier, so there are fewer missed days from work. Most importantly, a happy staff is more attractive to generating return visits and new patient referrals because patients love to go to an environment that makes them feel good,” he continues.

Remedies to staff unhappiness

Mark Sanna, DC and CEO of Breakthrough Coaching, brings up an old adage: Chiropractors should lead by example. “Best-selling business author Ken Blanchard says, ‘None of us is as smart as all of us.’

“Effectiveness is greater than the sum of its parts, but the effectiveness of a team can be no greater than the effectiveness of its leader,” says Sanna. “Leaders set the pace. Great leaders know that team members don’t care what their leader says — they care what their leader does!”

The best remedy, according to Michelle Geller-Vino, founder and president of MGV Marketing, is communication. “Weekly team meetings are a must, allowing staff members to discuss patients’ needs, office challenges, successes, and other strategies for internal and external marketing,” says Geller-Vino. “You can even discuss staff needs, likes, and dislikes. Communication is very necessary to keep everyone centered and focused on the same goals.”

Beth Silver, managing director of Doubet Consulting, utilizes “getting-to-know-you” meetings as a way to alleviate team unhappiness. “I often lead strategic planning sessions for my clients, in which we discuss the business and where we want it to go,” says Silver. “It's a place for the team to discuss issues that need to be addressed and areas to be worked on. During this time, we have fun and we learn about each other as people — not just by the jobs they perform.”


“When you hire a new employee, realize your job description must include adding to their development as a person,” says Sanna. “When you expand their self-respect and self-perception, you allow them to better understand their personal responsibility for their corner of the world.”

“Happiness comes from you, not to you. It is a choice in how a person views the world and how they respond to the things that happen to them,” says Freedman. “That aside, I believe the most important thing a DC and staff can do to foster this type of positive climate is to focus on their purpose.

“Many people love knowing they make a positive difference in the lives of others, and how they serve their community,” he continues.

“One of the biggest things that can make a staff happy is being acknowledged. If the doctor rewards the behavior that he or she wants, then the staff is kept happy,” says Geller-Vino. “Employee bonuses are also a great way to keep a staff happy. Everyone wants to make more money!”


“I believe the single greatest cause of turnover is the staff person’s feeling that they are not being fully appreciated by the DC,” says Freedman. “Therefore, the most important thing a DC can do is to display appreciation for their staff.”

Maule thinks a possible cause for turnover is having the wrong person in the wrong job. “Often this person doesn’t have the skill set you need for that particular job. This causes the staff member to feel frustrated and unhappy,” says Maule. “The important thing to keep your turnover rate down is to match the right staff person with the right job.”

Klapp agrees with Maule, and thinks a clinic should invest in team training. “Training without adequate systems causes new CAs to feel overwhelmed, as they’re thrust into positions without the skill sets to effectively handle their responsibilities,” says Klapp.

She adds, “Invest the time it takes to create a thorough how-to guide for your office procedures, put responses to commonly asked patient questions, and scripting for financial consultations, missed appointment calls, and similar situations.”

A lack of a unified focus across a clinic’s team members, according to Sanna, will cause a high rate of turnover. “DCs need to build a climate of trust, openness, and honesty. High-performing teams welcome ongoing coaching in the skills, procedures, and attitude that generate success.

“Teams share a common game plan and continually train, drill, and practice. They share responsibility and take credit for the success of the entire team,” says Sanna.

5 ways to prevent staff morale problems

According to Ken Freedman, senior consultant for The Masters Circle, ensuring staff happiness is as easy as a simple five-step process.

“One of the most proactive things a DC can do to avoid morale problems is to create opportunities for great communication and understanding,” says Freedman.

1. Know the individual. Before you hire anyone, find out how he likes to be shown appreciation.

“Not all people like being appreciated the same way. Some people want a monetary reward, like a raise or bonus. Instead of a monetary perk, some staff members may appreciate a special gift they wouldn’t normally buy themselves, such as having their car detailed; hiring a cleaning service to clean their home for a day; or getting the snow shoveled from their driveway; or perhaps giving them a gift certificate for a personal service, such as a manicure, pedicure, or haircut; lottery tickets; movie tickets; or dinner with a companion,” he says.

Some people prefer a special perk, such as paid-time off, paid specialized postgraduate education, or additional new responsibilities to perform that are only trusted to the highest level employees. 

2. Maintain an “open door policy.” This type of communication policy encourages staff to approach you and feel comfortable about doing so.

3. Take the lead. You are the leader; show it! Let your staff know what you expect of them and when you expect it. Give them training and tools to do their jobs. And provide regular reviews of their jobs to discuss progress, performance, expectations, training, advancement, and rewards. 

4. Conduct weekly staff meetings. These allow consistent communication, individual and team recognition for a job well done, and the ability to nip potential problems in the bud.

5. Start the day with a group affirmation. Saying a daily team affirmation improves energy and gets everyone focused in the right direction.


“You do the math,” says Klapp, “and you’ll see that turnover costs a great deal.”

She suggests compiling all the expenses incurred in placing a classified ad, interviewing, training new hires (both employee and trainer time), additional overtime required to get work done that wasn’t finished due to training (or worse — the enormously devastating costs of duties being left undone, such as missed appointment phone calls and claims tracking), negative patient perception, as well as unrecouped investments in health insurance, payroll taxes, and similar things.

“As you can see, the numbers are staggering,” she says.

Sanna points to some staggering numbers to prove high turnover rates are extremely costly. A report, “The Real Cost of Turnover,” by, a staffing agency, examined 23 cost-of-turnover measures and studies.

The results: “Turnover can cost a practice as much as 200 percent of employee compensation,” says Sanna. “A survey — ‘The Retention Dilemma’ — by the Hay Group, another HR consulting firm, estimated that as many as 33 percent of employees had planned to quit their jobs within two years.

“What’s more, of those employees planning to leave, between 30 percent and 40 percent have already checked out emotionally, focusing instead on their next job rather than their current one.”

Research by the Center for Creative Leadership, according to Sanna, indicates that “within the first 18 months, up to 40 percent of new hires leave, and costs associated with losing these new hires could be even higher.”

“Turnover is felt economically by how much it costs to find a new person and train them, but it also costs you from a marketing perspective,” says Silver. “When patients see staff coming and going and see smiles or frowns on their faces, they associate that with the practice and their care.”


Maule believes staff happiness directly affects patient retention. “When your staff is happy, they pass this attitude along to your patients, causing them to feel happy with the services they are receiving.

“When your patients receive quality care from your staff, they will want to keep coming back,” says Maule. “When your staff talks about how great the office is, it will reinforce the way your patients feel about your office.”

Silver agrees with Maule, and even gives this level of happiness a name. “If people see other people having fun and enjoying their jobs and wanting to be there, they will too,” says Silver. “I guess I would call that emotional care.”

Sanna not only agrees retention is affected by staff happiness, but points out retention is tied directly to clinic funds. “Dissatisfied patients don’t return and discourage others from trying your practice,” says Sanna. “Think of what just a small improvement in patient retention could mean to your bottom-line profits.”

Geller-Vino connects staff happiness to patient relationship-building — not just for right now, but for the future. “When the staff is happy, the patients tend to be more engaged in the practice, tend to refer other patients more often, and typically share more with the staff,” says Geller-Vino. “This further solidifies relationships and hopefully helps make them lifetime chiropractic patients.”


Image smiling womanTo keep staff happy, you have to recognize the signs of disquiet. Freedman says some signs of a staff morale problem include lackluster performance, infighting, tardiness, a time-clock mentality, not smiling, unhappiness, challenges accomplishing tasks in a timely fashion, complaining, and difficulty adapting to change.

If you have seen any of these signs in your clinic, then you probably have a morale problem.

Maule encourages keeping your eyes open — on your staff and your clinic’s work schedule. “You will be able to sense off feelings and see it in the tone and mood of your staff members,” says Maule. “But, the No. 1 sign of a morale problem is when your employees start missing work.”

Geller-Vino believes unhappiness is contagious, and may not always emanate from the staff.

“A staff member who is not happy will definitely affect the rest of the team, so it is very important to watch for signs and fix them before they bring the entire practice down. Sometimes if a practice is usually very busy and all of a sudden it is slow, that could have something to do with the morale of the team,” says Geller-Vino. “Another factor may be the doctor. If a DC has personal problems or is not focused on his or her patients, then that, too, may affect the morale of the practice.”


Sanna emphasizes a clinic should not hire a person on task competence alone. Everyone needs to be on the same page as the DC. “Your practice team members must communicate a strong, consistent patient-first message to your patients.

“This process begins by hiring only team members who explicitly embrace your practice’s values, and then by emphasizing these values through ongoing training and reinforcement,” says Sanna. “A candidate who identifies making a difference in someone’s life as his or her proudest moment may be more in tune with your practice’s values than one who focuses on a career milestone.”

Maule believes a DC should form a five-year achievement plan, and have the staff buy into it. “[The staff] needs to have passion, determination, and a vision for the future. They need to feel inspired. Let them know the great impact that their work has on their patients’ lives,” says Maule. “They help create the high-quality service environment that their patients deserve. This will help to create a happier staff, which will ensure more satisfied patients.”

Sending staff members to the local library is something Silver recommends. “I have employees read Now, Discover Your Strengths by Marcus Buckingham. It’s a survey that shows a person their inherent strengths,” says Silver. “When they are having a problem in their job and not having fun, I show them things at which they are inherently skilled, and then we look at the job, career, and environment from that perspective. I believe you have to have fun — at least most of the time!”

Image Headshot John V. WoodJohn V. Wood is a freelance writer from North Carolina. A frequent contributor to Chiropractic Economics, he can be reached by e-mail at

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