Nicole: Hi, and welcome to Lead Better, the podcast for clinician CEOs who are building something bigger than a practice. I'm Nicole Harlow, and this show is about the real work of scaling — not more hustle, not louder marketing, but better leadership and better systems. Because a practice that relies on you for every decision, every single follow-up, and every fire, it's not freedom. It's a job you can't quit. Here we simplify what works: automation that protects your time, strategies that create predictable patient flow, and CEO-level thinking that lets your business actually grow without you being required for everything.
Nicole: This episode is sponsored by Lead Better HQ, the growth platform for clinician CEOs who want predictable patient flow without being the bottleneck. You can take our predictable patient flow assessment and chat with a business growth strategist to see what's holding your practice back. The links are down in the show notes. Let's get into it.
Nicole: If there's one belief that I see time and time again that's keeping health-based business owners trapped, feeling overworked, feeling over-responsible, feeling stuck at the same ceiling, it sounds like this: If you want something done right, you have to do it yourself. How many people out there are nodding their head, yes, this is me? This was me for, oh, 15 years of running a business. If I'm honest, maybe 16 years. And I have only been running businesses now for 18 years. If you can see, that was really me for a really long time.
Nicole: And if that's a yes, if you are just like, yeah, if you want it done right, you have to do it yourself. No one can do it like I can, no one can outwork me, no one can solve problems like me. That belief is running your practice. You don't have a business. You have a job that you can't quit. Let that sink in. If that belief is running your practice, you don't have a business, you have a job you can't quit.
Nicole: So now that we got that out of the way — that was me for a really long time, right? It's just when you start a business, you start a practice, so you can do things differently. You start it so that you can have freedom. We have this dream of, oh, we're gonna take the summers off and go to Europe. Oh, this business is gonna run without me. And that is totally possible. I want to say that. This is not about making you wrong, or making you feel like everything is just totally messed up and you're not gonna be able to do anything differently. That's not the case.
Nicole: What I want to go through today is five steps that you can do to fix this, basically. And these are all steps that I did myself in my own way, because obviously I'm an agency owner, and so things are gonna be a little bit different than being a clinician, but I also was a clinician back in the day. I ran the Center for Menstrual and Sexual Health. That was one of my first businesses of many, and I loved being a health coach, but the part that I actually love, the part that makes me glow and get really excited, is helping other health-based businesses grow their business, helping them see the bigger picture of what the whole system can look like and then going through it and making that.
Nicole: So today this is all about you and how you can have this five-step system so you can build a practice that creates value without you being required for every decision, every hire, every fire, every dollar, every piece of content that gets made. There's a lot in there, right? Every patient that gets seen. So I'm excited to go into that. And today's episode is really for the clinician who's the main decision maker, the main problem solver, the main closer. You might even be doing sales. I am, like I said, 18 years into business, and I've just in the last three weeks started working with and hired my own sales support. I've never had that before.
Nicole: And so you may be the main closer too, and you're probably the main emotional shock absorber as well, which means that your nervous system, your energy holds the energy of the business as well. For a lot of us as CEOs, entrepreneurs, the business is us. In some ways it's kind of indistinguishable. It's like made from our energy, our DNA. And you have to do all of this. And probably you're still in some of the admin stuff, and you're definitely in some of the team stuff, or you're thinking about building a team, and then you're also expected to be the visionary. Because if you are the CEO, your role is to be the visionary and hold the vision for where the practice is going in the future.
Nicole: So if you've been telling yourself, like no one can grow this, I can, I want you to stay with me because I think this is really gonna help. Because this episode, one thing it's not, is about working harder. It's about building a business that doesn't require your nervous system to carry the entire machine. And yeah, this is sometimes I teach the things that I needed to listen to. These are like the advice pieces, the podcast that I wish that I had when I was first getting started, or even when I was 10 years into business, or maybe even 15 years into business.
Nicole: So let's name this belief. It really sounds like: no one can do it like I can. Never let anyone else handle the money, never outsource sales, never outsource marketing. If you want it done right, do it yourself. It looks really responsible on the outside, but structurally, it really creates a practice that can't outgrow you because you've made yourself so completely mired in all these different threads that everything relies on you. Because the cost is: if you gain revenue, you lose optionality. If you gain patients, you lose your freedom. If you gain momentum, you gain dependency.
Nicole: So when you're just so inside and connected to everything, you feel like you're always losing, even when you're winning, right? When things get better, they get worse at the same time. And you're like, why is this possible? And so psychologically, you start to block all the good stuff because you're like, more money, more problems, more patients, less freedom, a bigger team, more dependency. As the business grows and scales, god forbid you take on a second location, any of that stuff, right? Add more complexity, things just start getting very hairy very quickly.
Nicole: And then what happens maybe is you wake up one day and you realize I built the exact thing I wanted to escape. I've got a job that I can't quit. And that can be a very troubling moment or realization when you just feel trapped in this. And I totally resonate with that. Because the goal of most people who start a business, especially clinicians, isn't just money. And that's why I love working with clinicians, because this isn't just about making more money. This isn't about selling widgets and just making money. Every clinician that I work with, you're here because you want freedom, you want impact, you want sovereignty over your time, you want sovereignty over how you practice.
Nicole: And if you've come out of more of a traditional medical model and you've pivoted into naturopathic medicine or functional medicine or integrative, you want to do things differently. I'm tired of the status quo, right? So the goal of starting a business for most clinicians is helping people. But here's the thing: if the business is valueless without you, it's not a scalable asset. So what we're building instead is an upgraded business, a practice that can run and create value without requiring your constant presence and without requiring your constant micromanagement. Difficult for a lot of us, right?
Nicole: So let's talk about the difference between income and enterprise value in clinical terms. Two practices can look the same on paper. They can have the same revenue, they can have the same profit. But one practice requires the owner to work 60 to 80 hours a week — which is a lot of the clinicians that I work with are right in there — be the lead clinician, be the sales engine, be the final approval for everything. The other practice has clear systems, an empowered team who's able to make decisions on their own, a predictable patient acquisition funnel, documented processes and SOPs, and a real management structure rather than just duct taping everything together.
Nicole: So the second practice isn't just more profitable, it's valuable because it can run with or without you, really. And that means somebody else could buy, invest in, and step into your practice. And maybe you never want to sell it, but that's fine because these principles work whether you want to or not. If you never consider selling your practice, it will still help your life to become better just by following these, right? Because you need more freedom.
Nicole: So here's the thing: most clinicians try to get wealthy through income alone — more patients, more hours, more effort. But the real wealth is building something with value that's beyond your labor. And we hear this a lot, right? It's not trading hours for dollars. But then we start thinking about building online programs or group programs, or how can we scale the business? But we don't often take the next step, which is really about scaling the business beyond just our offerings, right? Every part of it. And where the real freedom comes from is when the business doesn't need you anymore.
Nicole: And that doesn't mean you can't be involved at every step, right? Like you can be. What do you love to do? Do you love the clinical side of it? What I find is the people that I work with tend to fall in a few different camps. One is the clinician who doesn't like the business side of things at all and just wants to work with people clinically. And that's great. Just let everything be awesome in the business so it doesn't really need me, so then I can work with patients, and that's great.
Nicole: Some people want to scale out of patient-facing entirely — patient and business-facing entirely — and work on what I would consider more like thought leadership. Like, I want to write a book. I really want to be known as the go-to expert in my field. These people have a mission to help a million people get things out there in the world, and that's awesome. Some people want to step away from clinical and the business, own the business as an asset, and have freedom, right? That's awesome too. So you just have freedom away from the business. And for some people, it's a blend of all of those three, right? And so these strategies work no matter what the ultimate goal is.
Nicole: But we need to build something that has value beyond your labor because labor is income-taxed, it's limited by your energy, it's capped by time. Enterprise value multiplies. This is why you can have a clinician CEO who makes good money but still feels trapped, right? You can even have a successful clinic, but you still feel trapped because you're rich in revenue, but you're poor in optionality. You're poor in the value of the asset itself, right? And that's some powerful stuff here.
Nicole: So we need to go through these five steps of removing yourself as the constraint. Let's think about this as the remove-yourself-as-the-constraint system. So step one is to do a self-inventory or a time study. This is not sexy, and I will say that right up front, but it's not difficult, right? It's just not sexy, but it changes everything. So I want you to write down next week or this week for a full seven days. I want you to write down everything you do. Be like, Nicole, I don't even know what I do. I want you to do this seven-day time study.
Nicole: So what we're gonna do is every 15 minutes, you're gonna write down in your little notebook or piece of paper. You're gonna set a timer for every 15 minutes, and you're gonna write down one word. It's just what you were just working on in the last 15 minutes. So it could look like this: charting, patient visits, follow-ups, lead calls, payroll, onboarding, Slack with your team, fixing calendars, answering DMs, creating content. So what are you doing every 15 minutes? This will be the most productive week of your life because attention creates behavior change.
Nicole: So here's the key. We're not doing this to judge ourselves. I'm not doing this to judge you. We're doing this to extract you from the machine without breaking it. But in order to do that, we need to know what do you exactly do? Because even myself, sometimes I'm like, I don't know what I do in a week. If I'm working like 40 hours at Lead Better, Brand Better, Podcast Better, one of my three agencies, what am I doing? Am I scrolling on Instagram for 15 minutes? Am I answering client emails? Am I creating deliverables? Am I creating content? This is gonna give us a big picture of everything that you do in any given week.
Nicole: Step two, after you've done that, is we're gonna turn your job into slots: project, process, or person. You're gonna take your list and assign each item into one of three buckets. First one is a project, which has a one-time setup. It often creates a process. So maybe you're creating something new, or maybe you're building an online program, for example. That would be more of a project. So you're gonna have a one-time setup, and then there could be a process that's created from that.
Nicole: So we have a process, which is a repeatable SOP or a checklist or something. Or there could also be a person, right? And those are the three buckets: project, process, person. A role — the person is really somebody who owns it continuously, right? That's a role. It's like this person does this. So most clinician CEOs are doing things that should never be owned by the CEO in the first place, right? This could be things that a front desk or an assistant should be doing.
Nicole: And then we also have the front desk assistants who are doing things that probably an AI assistant should be doing so that they're working at a more high level. And so we can think about these as — I like that now we can put in an AI role or an automated role, right? Things that we do at Lead Better that can help a person so that they can be doing more high-level work, right? So you're gonna take your list and assign each to one of three buckets: a project, a process, or a person. Everything should fall into one of those categories.
Nicole: Step three is we're gonna red, yellow, and green the list. We're gonna label every task. Green means you can hand off now to an existing team. So I can look at my week and put everything on my list and say, okay, what in this list can I assign to somebody else? And generally there's some green items, right? Yellow requires installing a process first and then you can hand it off. So if we do yellow, it means we've got to make something first and then somebody can take it.
Nicole: And red means you don't have this person or the skill yet, or you don't know how to delegate it. It's something that you're doing, but there's nobody else yet who can do it, and there's no process in place, and you're not really sure how to do that, right? And so hopefully there's not too many reds, but we can put some reds in there. And then we've got your greens, your yellows, and your reds. In the order of operation, we want to start with the greens first, then the yellows and the reds, because quick wins build momentum and they reduce cognitive load immediately.
Nicole: Then we're gonna move on to step four, which is where we build decision trees and guardrails. This is where a lot of clinician CEOs get stuck. They delegate the tasks, but they still keep all of the decisions. So you're like, okay, I'm gonna give an assistant, a VA, a front desk support all these tasks, right? But I still have to approve everything and I still have to make all the decisions. So the team is doing, but they're still waiting. And then you're still enmeshed because they're waiting for you. So it still can cause decision-making fatigue and just a bit of a strain and overwhelm.
Nicole: So you need if-this-then-that decision trees for common scenarios, like: if a lead or a patient asks about pricing, this is what we say. If a patient misses an appointment, here's the follow-up rule. If a refund request comes in, here's the policy. If a consult needs rescheduling, here's our boundary. If a new patient's qualified, here's the next step. This is the part that I love because it really dovetails beautifully with what we do at Lead Better, because Lead Better is about building automations and automations are all about if this, then that.
Nicole: Hey, just pausing here in the middle of the episode to let you know that today's episode is sponsored by Lead Better HQ, our all-in-one growth platform built specifically for health-based business owners and clinician CEOs. If you've been listening to this episode thinking, yep, this is me, I'm the bottleneck, here's your next step. At Lead Better HQ, we help you remove yourself as a constraint by putting in the right systems, automations, and decision architecture so your practice can grow without you burning out.
Nicole: The best place to start is our predictable patient flow assessment. It shows you exactly where your growth is getting stuck, whether it's marketing, systems, team, or leadership, and what to fix first. After the assessment, you can chat with one of our business growth strategists to map out what scaling your practice actually looks like for you. You'll find both of those links in the show notes. You can take the assessment, book a conversation, and start building a business that gives you back your time, your energy, and your freedom.
Nicole: Hey, I'm back again. This time we're talking about building decision trees and guardrails. We're on step four. So once we have our decision tree and we're going through — and you don't have to make all of these at once, but even if just every week you thought about creating some if-this-then-that decision trees for scenarios. And just like we have FAQs for our clients, what are the FAQs that your team has for you? So we want them from the patient side, but we also want it from the team side too.
Nicole: And then we're gonna add some guardrails. So the guardrails look like: what decisions can your team make independently, right? If they need refunds or credits up to a certain amount, if they have scheduling exceptions with certain rules, if they're comping a missed visit within a certain parameter. So the goal of the guardrails is simple: fewer decisions land on you. These are pre-agreed upon guardrails. If this is a little bit outside of our script, this is what you as the team member have the authority and are empowered to make this decision. Fewer decisions come up the ladder to you, you have a little bit more time and you're less likely to be decision fatigued.
Nicole: And finally, going on to step five, which is where we do scorecards and graduation tests. So if you want someone to own a function, they need two things. One is a scorecard — this is really how success is measured — and two is a graduation test, so proof they can do it. One thing that can be a really powerful question for a clinician CEO, especially if you have a team, is: how does each role make the company money? Even a non-revenue role has a direct financial impact.
Nicole: For example, front desk. Front desk answers within two minutes, the booking conversion rate, the show rate, the reschedule rate, response time — that's all money, right? These are things that we can use intelligent workflows and AI tools here as well to help supercharge that. Answering immediately, for example, rather than people waiting if somebody's on another call. So all these things are money, right? And we want to make sure that we can look at each role that we have and clearly understand how this role makes the company money, even if it's indirectly, like a front desk staff or an assistant that allows you to move through patients quicker, allows you to bring on another clinician, things like that.
Nicole: So all new team members should really go through a three-stage handoff. The shadowing phase where they watch you, the supervising phase where they do it in front of you, and then the supporting independence phase where you're available but not involved. And then eventually you get to a place where they are just completely independent. They know which decisions they're able to make, they have all of their SOPs. Here's a standard that I love because I think it turns on its head what we think about as the entrepreneur who's like, I can do everything myself or I can do it better myself: you can outwork people, but you can't outwork everybody. And if you can do it well part-time, somebody else can do it better full-time.
Nicole: Before we wrap up here, there's one more thing I really want to make sure is represented in this episode. And this is a special clinician bottleneck, and that's marketing that requires your face. So I want to talk about a bottleneck that keeps clinicians trapped even when they have a team. And that's even working with Lead Better when we're creating our marketing and content for our clients. It's gonna get clinicians trapped. If your practice relies on your face to get customers, you're the key person risk.
Nicole: And there's various stages that you can go through here. Being the face definitely works, and it's actually something that I recommend. But we want to make sure that revenue doesn't stop dropping. Yes, being the face can totally work. And it's actually something — there's some contradictions here, it's this complexity — because I recommend for most of our clinicians that they are the face of the business. And we want to make sure that it has, because health can be a place where there's a lot of mistrust and a lot of, I'm not sure who I'm working with. And so we want to make sure rather than just being a faceless clinic where we're just using all stock pictures and that's it, we want to make sure we've got your face on there.
Nicole: But if revenue drops when you stop posting, you stop speaking, you stop selling, your business is fragile. And so that's the complexity right there. We want to make sure that we have an intelligent system for content creation that has some of your face on there. And maybe these are things where you sit down once a month and you create a couple B-rolls, or we have a photo shoot that we can go through so we can remix some pictures of you. So you're not in there every month, every day going through and creating content, for example. But we want to use other systems and install them into your content creation so that it reduces dependency on you while also increasing trust, because we're showing your face to increase trust. That's really the bottom line of why we would have marketing that requires your face as the clinician CEO.
Nicole: But we want to make sure that we have other systems in place as well. And I can do another podcast episode kind of breaking this down deeper because I think there's a lot of cool stuff here. So some things I want you to think about in terms of systems-based marketing that you can install in your content creation is number one, a testimonial capture system. It's things like screenshots of patient wins, monthly win requests, texts or emails, staff prompts after milestones. So these are things where we're letting the testimonials speak and build the trust. So that's not necessarily your face. It's actually the face of your patients or the words of your patients or video, things like that.
Nicole: We want to have — this is similar but slightly different — a review-to-marketing system. So this is things that turn Google reviews into weekly content. And we want to also make sure we're automating requests and responses so that we get more of those reviews so that we can let the reviews increase the trust. We want to do a little thing like lifestyle marketing. So we want to document the patient journey from inquiry to booking to visit to follow-up to results and turn those real steps into nurturing assets so people can — we can put those out there on our content.
Nicole: We also want to capture key moments like before and afters, right? We want to make sure we stay compliant here, that we have full permission, but things like milestone celebrations, story-based outcomes, these are all great, right? So this is all within, I think, a testimonial way. Even these front desk micro testimonials, like people saying that was so helpful. This is how you build a practice that grows even when you're not constantly on, right? And so we want to have a nice blend of your face.
Nicole: But ideally, this is a time that you set up like maybe a CEO content creation where it's one afternoon a month or something like that, where we get some content of you and your face. But a lot of this is actually led by patient testimonial and patient experience. Now, I know there's some ways you got to think about this a little bit more cleverly if you are in a regulated industry where you're not allowed to share testimonials. But I think there's still ways to get around this, especially with Google reviews, because that's a public access. So that's somebody has decided publicly to put that information out there. And I feel like that's fair game generally. You might not be able to do specific testimonials, but maybe you could do some before and afters as well.
Nicole: So here's the ultimate test, right? I think with this conversation around doing less and really being able to step away in your role as the clinician CEO. My question is, could you step away for two weeks and the business doesn't burn down? For a while, I really lived in that trapped space where it was like, I can't even go away for two days and the business doesn't burn down. That's how much it feels like it needed me, right? So could you go and step away for two weeks and the business doesn't burn down? And what about 30 days? What about taking a summer off and the business doesn't burn down?
Nicole: These are goals that I would love to see you get to. And then a bigger one is: could you step away and come back and things are better than when you left? If the answer is no, that's data there because what breaks is what has to be systematized next, right? So this is how you remove yourself as a constraint. Inventory of what you're working in, installing the right systems, delegating, creating guardrails, measuring, and stress testing. Then the stress test is: would you be able to step away and the business doesn't burn down? And what if you stepped away and the business was actually better than when you left, right? So we repeat this until the business doesn't need your nervous system to survive.
Nicole: So if you take nothing else from this conversation, take this. You can outwork anyone in your practice. I'm sure you can. You built this business, but you can't outwork everyone, right? To scale, you have to trade doing for leading. You build a machine that creates value without you being required. And if you're listening to this thinking, okay, Nicole, I get it, but I don't know where to start. I've got you. If you want our help removing you as the bottleneck through systems, automation, and a real growth partnership, book a free practice clarity call. That link is also in the show notes. All right. Thank you for spending this time with me. I will see you in the next episode of Lead Better.