Developing a positive practice culture

You can build a positive practice culture that not only works but also makes you and your employees genuinely happy to show up every day.

Culture is the beating heart of a thriving practice; this is the one thing I’ve learned after decades of coaching DCs and multidisciplinary healthcare teams.

You can have the best marketing, the most advanced therapies and a steady stream of new patients, but if your team doesn’t function well together, growth will stall and morale will tank.

One of the most powerful frameworks I’ve come across for understanding how teams succeed is Patrick Lencioni’s “The Five Dysfunctions of a Team.” While the book is written with business teams in mind, its insights translate beautifully into chiropractic and multidisciplinary practice settings.

Why culture matters in healthcare

Culture is how your team behaves when no one’s watching. It’s what makes a new hire instantly feel like they belong or not. It’s what turns a front desk receptionist into a patient relationship rockstar, or a provider into a burnout case waiting to happen.

In chiropractic and multidisciplinary practices, where providers and support staff work in close quarters and emotions run high (because let’s face it, patient care can be intense), your culture determines whether your team collaborates or collides.

So how do you create a culture where people trust one another, communicate openly, take responsibility and share in wins and losses? That’s where Lencioni’s five dysfunctions and how to overcome them come in.

The five dysfunctions and how to turn them around

Let’s break them down one by one and talk about how they apply to your practice.

1. Absence of trust

At the base of Lencioni’s pyramid is trust. Not the kind built on familiarity, but vulnerability-based trust; the kind where team members feel safe admitting mistakes, asking for help and saying, “I don’t know.”

In many practices, staff feel like they have to wear a mask of competence. This leads to silos and secret-keeping. Instead, create a space where it’s okay to be human.

Example: In a multidisciplinary setting, your nurse practitioner might feel unsure about how to handle a tricky hormone replacement therapy case and hesitate to bring it up. If your culture encourages curiosity and vulnerability, she’ll ask for a collaborative case review and patients benefit from a better outcome.

Pro tip: Start team meetings with “check-ins” where each person shares something personal or vulnerable. This isn’t fluff; it builds the foundation of connection.

2. Fear of conflict

Once trust is established, healthy conflict can happen. Not yelling or drama; but productive debate. Many teams avoid conflict to “keep the peace,” but end up simmering in frustration.

In chiropractic offices, this might look like a CA getting frustrated that the associate doctor never updates the schedule but staying silent. Or a physical therapist feeling like their input in case management is ignored but never speaking up.

To fix this: Normalize disagreement. Praise team members for speaking up. Lead with curiosity instead of defensiveness.

Example: One of our coaching clients, a large multidisciplinary clinic, created a “red flag” system. Anyone can raise a clinical or operational concern, anonymously if needed. The issue is then reviewed in a weekly leadership huddle; not to assign blame, but to find solutions.

3. Lack of commitment

When there’s no healthy conflict, decisions may be made—but not truly bought into. Team members leave meetings nodding, but later do what they want. Sound familiar?

In practices where people are afraid to speak up, they also don’t feel ownership of outcomes. That leads to a lack of follow-through.

How to change this: After every meeting, end with a clear “Who’s doing what by when?” Make sure everyone voices agreement or their concerns before moving forward.

Example: In one successful chiropractic clinic, the team has a standing “Friday 15” huddle where everyone reports on their commitments from the week and shares one win and one challenge. That simple ritual keeps everyone aligned and accountable. According to Lencioni, “Consensus is not necessary, but clarity and buy-in are.”

4. Avoidance of accountability

Once decisions are made, team members need to hold one another accountable; not just have the leader doing all the policing. This is where many practices fall apart. The doctor is the only one who calls people out, which breeds resentment and burnout.

Peer-to-peer accountability is a hallmark of high-performing teams.

Example: In a multidisciplinary practice with DCs, PAs and PTs, case notes were frequently incomplete. Instead of the clinic director being the “bad guy,” the team implemented peer review groups. Now, providers review each other’s notes and offer feedback weekly. Errors dropped, and so did tension.

Create shared scorecards for things like patient satisfaction, re-exam compliance or collections and have the team discuss the numbers together. Not to blame, but to improve.

5. Inattention to results

The final dysfunction is when team members put personal ego or departmental success above collective results. In practices, this might look like a front desk employee only caring about check-ins, not collections. Or a provider being more concerned with how busy their schedule looks than how effective their care is.

In a strong culture, everyone is focused on practice-wide success.

Example: One of our coaching members created a monthly “Results Roundtable.” Every department shares their key performance indicators (KPIs)—billing, visits, revenue, retention, reactivations. Each win is celebrated. Each shortfall becomes a problem the whole team owns.

When everyone sees the big picture, they start acting like stakeholders, not just employees.

Building your culture: Start with core values

All of this comes together when your culture is rooted in real, lived core values—not just words on a poster in the breakroom.

We recommend that every practice has three to five core values that define how you hire, train, reward and even let people go. Some great examples we’ve seen in practice include:

• Own the outcome: Encourages accountability and follow-through.
• Positive energy only: Creates a culture of solution-seeking instead of gossip.
• Patients first, always: Keeps everyone aligned on the purpose.
• Be coachable: Reinforces a growth mindset.

Once defined, these values should guide hiring decisions, performance reviews and day-to-day behaviors.

Final thoughts: From dysfunction to delight

You don’t need a PhD in organizational psychology to build a thriving team; you just need intention, consistency and a willingness to lead with humility. As Lencioni says:

“Success is not a matter of mastering subtle, sophisticated theory but rather of embracing common sense with uncommon levels of discipline and persistence.”

Start with one small step. Maybe it’s a team check-in. Maybe it’s clarifying roles and responsibilities. Maybe it’s confronting that one thing no one wants to talk about.

Culture is not built overnight. But every conversation, every meeting and every moment of accountability adds another brick to the foundation.

And the payoff? A practice where people love coming to work. Where patients feel the energy and refer their friends. Where you wake up excited to lead your team. That’s a culture that works—and it’s absolutely possible.

Mark Sanna, DC, ACRB LEVEL II, FICC, is the CEO of Breakthrough Coaching, a practice management company for chiropractic and multidisciplinary practices. He is a Board member of the Foundation for Chiropractic Progress, a member of the Chiropractic Summit and a member of the Chiropractic Future Strategic Plan Leadership Committee. Sanna is the author of “Cracking the Code: Marketing Chiropractic—How Chiropractors Align Spines and Minds,” available on amazon.com. To learn more, call 800-723-8423 or visit mybreakthrough.com.