Are you managing problems or leading people?

If you're a practice owner, this question matters more than you think. Most chiropractors who find themselves overwhelmed, frustrated with team performance, or stuck in the daily chaos of their practice aren't dealing with a people problem—they're dealing with a clarity problem.

The difference between leadership and management isn't just semantics. It's the difference between a practice that drains you and one that energizes you. Between a team that needs constant supervision and one that takes ownership. Between feeling like you're herding cats and actually building something extraordinary.

Let's be clear from the start: You need both leadership AND management. But knowing when to lead and when to manage—and understanding what each truly means—will transform how you show up, how your team performs, and ultimately, how your practice grows.

The Critical Difference: Leadership Creates Culture, Management Executes Systems

Here's the truth many practice owners don't realize until it's too late:

Leadership is about vision, inspiration, and people development. Management is about processes, systems, and execution.

Neither is superior to the other. They work together. But confusing the two—or relying only on one—creates the exact frustration you're experiencing right now.

What Leadership Actually Looks Like

Leadership isn't about your title. You don't become a leader the day you hang your shingle or hire your first employee. You become a leader the day others watch how you behave.

Think about that for a moment. Your team is always watching:

• How you communicate under pressure
• How you respond to mistakes (yours and theirs)
• How you treat people when you're frustrated
• Whether your words match your actions

Leadership is influence, responsibility, and consistency. It's not what you say in team meetings—it's what people experience from you every single day.

Connected leaders possess these core qualities:

Self-Awareness – They know their strengths, weaknesses, and blind spots. They understand that leadership isn't "allaboutme.com." Your team needs an authentic leader who sees them and understands their needs.

Trust – The pandemic taught us to let go and trust our teams. Ask yourself: Are you checking in or checking up? Checking in empowers. Checking up restricts. Trust creates ownership, and ownership creates results.

Reflection Over Deflection – Strong leaders have a growth mindset. They're open to feedback, willing to apologize, and comfortable being uncomfortable. They ask "What can I learn?" instead of "Who's to blame?"

Truth-Telling – Great leaders create cultures of truth. Not two-faced cultures, but truth-faced ones. This means clear, sincere, respectful communication where speaking your truth (facts that move everyone forward) trumps speaking your mind (opinions about being right).

What Management Actually Looks Like

Management is process-focused and system-driven. It's analytical, methodical, and structured. Management implements the plan that leadership creates.

Good management:

• Uses checklists and standard operating procedures
• Values predictability and planning
• Focuses on efficiency and consistency
• Measures outcomes with data
• Holds people accountable to defined standards

Here's the key insight: Manage things. Lead people.

You manage your schedule, your inventory, your billing processes, your patient flow systems. But you lead your team members, your culture, and your vision.

When you try to manage people the same way you manage things—with rigid control and micromanagement—you kill morale, creativity, and ownership. When you try to lead systems without structure—hoping inspiration alone will create consistency—you create chaos.

Why Your Practice Needs Both (And How They Work Together)

Strong cultures need both leadership and management working in alignment. Here's what that looks like in practice:

Leadership sets the vision → Management creates the systems to execute it

Leadership inspires growth → Management tracks and measures progress

Leadership develops people → Management ensures accountability

Leadership asks "Why are we doing this?" → Management answers "Here's exactly how we'll do it"

Think about it this way: Leadership without management is all inspiration and no execution. Management without leadership is all process and no purpose. Your practice needs both.

The Boss vs. Leader Trap (And Why "Please Micromanage Me" Said No Employee Ever)

Let's address the elephant in the room: being in charge doesn't make you a leader.

Being a boss means:

• Controlling outcomes
• Micromanaging tasks
• Demanding compliance
• Creating dependency

Being a leader means:

• Connecting with people
• Trusting your team
• Inspiring commitment
• Creating capability

The question isn't "Are you in charge?" The question is "Do people want to follow you?"

If you find yourself constantly frustrated that things aren't getting done, that you're the only one who cares, that your team needs you for every little decision—you're likely managing when you should be leading, or leading when you need better management systems.

Job Role Clarity: The Foundation of Effective Leadership AND Management

Here's where most practice owners completely miss the boat: People don't fail—unclear roles fail.

If a role is unclear, performance will always be inconsistent. Your team members aren't mind readers. They need to know:

• Why their role exists
• What winning looks like
• How they're measured
• What happens when they succeed (or don't)

You Don't Hire People—You Hire Roles That Solve Problems

Before you post another job listing, answer this in ONE simple sentence: Why does this role exist?

Examples:

Front Desk: "To greet patients, room patients, and schedule patients."

Associate Doctor: "To nurture and grow the practice, create more CEO time, and expand patient care."

Chiropractic Assistant: "To support patient care and create an efficient, smooth office flow."

Biller: "To collect the income we already produced."

If you can't say this clearly, don't hire yet. You'll just add another body to a chaotic system.

Define What Success Looks Like (Remove Emotion From Management)

Every role needs a clear finish line. Vague expectations like "be professional" or "do your best" create confusion and conflict.

Instead, define specific, measurable outcomes:

• Claims submitted within 24-48 hours
• 95% appointment confirmation rate
• Zero unexplained account balances
• Daily task completion checklist at 100%

When roles are clear, performance reviews become calm, factual conversations—not emotional confrontations. You can coach to improvement or make clean decisions about fit.

The "Willing and Able" Conversation

Before finalizing any hire or role transition, ask this critical question:

"Now that you fully understand this role—are you willing and able to do this job as described?"

• Willing = mindset, attitude, commitment
• Able = skill, trainability, capacity

If either is missing, do not proceed. You'll save yourself months of frustration.

How Organizational Structure Supports Leadership

Many chiropractors resist creating org charts because they feel hierarchical or corporate. But here's the truth: Org charts aren't about control—they're about clarity.

High-performing teams don't happen by accident. They happen when people know where they fit, who they serve, and how decisions get made.

Two Common Models (And Why One Is Gaining Momentum)

The Hierarchical Model (Traditional)

• Owner/CEO at the top
• Office Manager or Clinic Director below
• Team members (associates, front desk, CAs, billers) at the base

This works when leaders are highly relational and intentional about communication. The challenge? It can feel rigid, and younger team members may disengage if they feel unheard.

The Cooperative Model (Modern)

• Owner/Visionary sits at the center (not the top)
• Team collaborates around shared goals
• Leadership becomes influence-based, not authority-based

This model is gaining momentum because the younger workforce does not respond well to rigid, top-down leadership. They value purpose over position, collaboration over command, and being heard over being directed.

The owner still sets the vision, protects culture, and makes final decisions—but the team feels ownership, engages deeply, and brings solutions.

The "Is/Isn't" Framework for Role Clarity

When rolling out a new role or realigning responsibilities, use this powerful framework:

This job IS for you if:

• You like clear expectations and consistent feedback
• You enjoy structure and follow-through
• You're open to coaching and growth
• You're hungry, growth-minded, and willing to do whatever it takes

This job ISN'T for you if:

• You dislike accountability or measurement
• You resist systems and prefer "going with the flow"
• You take feedback personally
• You're frequently late, blame others, or check out mentally

This conversation saves you MONTHS of frustration. It gives people permission to opt out early or lean in with full commitment.

Creating a Culture of Accountability (Not Punishment)

Let's be clear: Accountability is not punishment. Accountability is clarity + ownership + follow-through.

Great leaders:

• Set expectations early and specifically
• Follow up consistently (not sporadically)
• Address issues directly (not passive-aggressively)
• Praise progress publicly
• Coach privately

The Performance Conversation Framework

Your performance reviews should NEVER be a surprise. Base them on:

1. The written job description
2. Daily duties checklist completion
3. Defined success metrics
4. Core values alignment

Ask these questions:

• Are the role results being met?
• Are daily duties being completed consistently?
• Where is support or training needed?
• Is this still the right role fit?

When roles are clear, reviews are calm. Feedback is factual. Decisions are clean.

Measuring Behavior (Yes, It's Possible)

Many practice owners ask: "How do I measure attitude or culture fit?"

Here's how: Create behavioral expectations tied to your core values, then evaluate them on a scale.

Example behavioral metrics:

• Ownership & Accountability: Do they take responsibility without excuses? Accept feedback without defensiveness?
• Coachability: Do they implement feedback or resist change?
• Teamwork & Communication: Do they support others or create factions?
• Patient Experience Excellence: Do patients feel valued in every interaction?
• Integrity & Trust: Do their words match their actions?

Score each area on a 1-5 scale during quarterly or annual reviews. This removes emotion and creates objective conversations about performance and fit.

The Leadership Behaviors That Build (or Break) Trust

Here's what kills trust faster than anything:

• Micromanaging every detail
• Being inconsistent in your standards
• Avoiding hard conversations
• Deflecting blame when things go wrong
• Failing to acknowledge effort and progress

And here's what builds it:

• Trusting your team with real responsibility
• Being consistent in your expectations and support
• Addressing issues directly and kindly
• Owning your mistakes openly
• Celebrating wins and recognizing growth

Trust is built when words and actions match. Period.

The Highlight Leader: Catch People Doing Things Right

Want to transform your culture overnight? Become a highlight leader instead of a spotlight-on-mistakes manager.

C.E.C. Framework:

• Communicate clearly and often
• Educate through coaching and development
• Celebrate progress, effort, and results

Here's a sobering stat: 79% of employees quit because they don't feel valued or acknowledged.

You could have the best systems in the world, but if your people don't feel seen, appreciated, and developed, they'll leave—or worse, they'll stay and check out mentally.

Connected Leadership in Action

Connected leadership isn't soft. It's strategic. It means:

Leading with heart AND standards. You care deeply about your people AND you hold them to excellence.

Being vulnerable AND decisive. You admit mistakes AND you make tough calls when needed.

Developing others AND protecting your vision. You invest in growth AND you don't tolerate toxicity.

This is the leadership your practice needs. Not boss energy. Not buddy energy. Leader energy.

The Hard Truth About Culture

Culture isn't created by ping pong tables or pizza parties. Culture is what you tolerate.

If you tolerate lateness, you're creating a culture of disrespect for time.

If you tolerate gossip, you're creating a culture of toxicity.

If you tolerate mediocrity, you're creating a culture of low standards.

Your A-players are watching. They're asking: "Does excellence matter here? Does leadership follow through? Will toxic behavior be addressed?"

How you answer those questions—through your actions, not your words—determines whether top performers stay or leave.

Your Action Steps: Moving From Chaos to Clarity

If you're ready to step into true leadership while building management systems that actually work, start here:

1. Define Every Role in Your Practice Write out the "why this role exists" statement for each position. One clear sentence.
2. Create Job Descriptions with Daily Duties Not a task list—a results-focused description of what success looks like, plus a checklist of 10-20 daily actions.
3. Set Clear Success Metrics Define the numbers, behaviors, and outcomes that indicate excellent performance in each role.
4. Have "Willing and Able" Conversations With every current team member and new hire. Get commitment or clarity.
5. Build Your Org Chart Decide whether hierarchical or cooperative fits your vision. Make roles and reporting lines crystal clear.
6. Implement Regular Check-Ins Not micromanaging—empowering. Ask "How can I support you?" not "Why isn't this done?"
7. Create a Culture of Feedback Make it safe to speak truth. Model receiving feedback gracefully. Address issues early and directly.

The Bottom Line

You can't manage your way to an extraordinary practice. And you can't just inspire your way there either.

You need leadership to create the vision, build the culture, and develop your people. And you need management to execute consistently, measure results, and maintain standards.

The practices that thrive are led by chiropractors who understand this balance—who can cast vision on Monday, review KPIs on Tuesday, coach a struggling team member on Wednesday, and celebrate wins on Friday.

That's what it means to move from practice owner to practice CEO. From doing everything yourself to building a team that owns outcomes. From feeling trapped by your business to creating true freedom.

Leadership creates the culture. Culture determines results. And results give you options—to grow, to scale, to step back, or to sell.

It all starts with getting clear on who you need to be as a leader, what your team needs to succeed, and how you'll measure and celebrate progress.

Your practice is waiting for you to lead it—not just manage it.

 Want help assessing your leadership style and get recommendations that help you lead your team to greatness? Check out our FREE Leadership Assessment AI Tool here. 

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