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Episode 168 | The Evolution of a Leadership Team



  • Episode 168 | The Evolution of a Leadership Team 00:00


Hey Group Practice listeners! In this episode, I discuss how leadership teams evolve in group practices over time. This episode covers the different leadership needs of a growing group practice and helps to conceptualize how leaders can function in your practice.

In this episode I cover:

  • How to know when it’s time to create your leadership teams
  • Leadership needs for group practices according to size
  • The different stages of leadership in a group practice
  • The difference between delegating and leadership
  • Leadership in silos vs collaborative leadership
  • Shared decision making with practice leaders
  • How to know your leadership team is working

This episode is sponsored by TherapyNotes. TherapyNotes is an EHR software that helps behavioral health professionals manage their practice with confidence and efficiency. I use TherapyNotes in my own group practice and love its amazing support team, billing features, and scheduling capabilities. It serves us well as a large group practice owner.

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Maureen Werrbach

Good morning, I hope you’re having a great day today. Today, I’m going to be talking about how to know when it’s time to create or start your leadership team. And I want to chat a little bit about the qualities that group practices have in terms of size, when thinking about bringing someone into leadership, because obviously, depending on the size of your practice, what leadership support looks like is going to vary. So I’m going to start at the basics and move my way up to larger scale practices. And hopefully, if you’re new to group practice ownership, or you are a small practice, you’ll get a sense of what is likely going to happen if you decide to grow. And for those of you that are medium to larger practices, give you a sense of where are you on the right track, are you paying attention to leadership structure as much as you should? And so my general ideas on how to get to a space where you have the right amount of leadership on your team to support you, as the business owner, as well as support the growth of your business. 

So when it comes time to creating a leadership team, typically when practices are starting off, they will have potentially zero to one people in leadership outside of themselves. Oftentimes, they’re the person leading in all areas, administratively, clinically, business wise, everything right. And some are lucky enough to think about bringing one person on that can support them typically, in the clinical sense. So whether that’s a clinical director or supervisor, most often in our field, the first type of leadership support that you’re going to see is in the clinical world, whether that’s around providing supervision, or support around hiring your clinical team. And I want to note that this is different than delegating for support. So you might have or see a group practice that has admin support, or someone who they delegate certain things to whether to a VA, or a part time or full time admin. And that’s different than having someone on a leadership team leaders build up, they empower the teams that they work with. And they represent themselves in the decision making that they have. Whereas if you’re delegating, you’re assigning tasks or specific type of work to someone, and they are representing you in the completion of those tasks. There’s a real difference between delegating to someone versus having someone truly leading and so I want to make that distinction clear, especially in the beginning, that you might have someone administrative who’s supporting you. But that doesn’t constitute leadership. Getting leadership support really feels different, because they are your partner in making really important decisions in the business, and owning and representing themselves in that decision making without you needing to sort of handhold and guide and check on the work that they’re doing. 

Okay. So typically between zero and 10 employees or contractors, you’ll see practice owners either having no one in leadership aside from themselves or just bringing on that first leader. And like I said, it typically is clinical lead position, usually around providing supervision, because that’s one of the first things that practice owners tend to want to let go of is providing clinical supervision so that they can spend more time on all the business stuff that’s in the back end. And additionally, providing some level of hiring support, where they can be another person that provides like doing interviewing, decision making, collaborative decision making on whether or not to bring that person on. You might see a little bit of that being added in sprinkled into the role of that first leader. And that’s usually between zero and 10 staff that you have. 

And then between 10 and 20 staff, you’ll see that there’s usually between one and three people on the leadership team aside from you. And you’ll see here where that distinction between clinical and administrative leadership happens. So a practice that has between zero and 10 employees–typically, it’s by the time they reach upward of 10 employees–they’re having an admin, usually full time admin working in their practice. This is not the same as leadership, you start to see once you’re between 10 and 20 employees, that you have a couple of administrative people on the team, whether that’s one full time admin and one part time admin Typically, that’s the point where you’re going to see a couple of administrators. And that’s the point where you might have someone who’s leading the administrative team, and leading the clinical team. So between 10 and 20 employees, you’ll start to see that shift from having people in leadership on the clinical end and on the administrative end, so that the admin team can ensure that, you know, someone’s watching over ensuring that what is being done is appropriate, and that they’re tracking the metrics that they need to track and that the systems, administrative systems and structures are organized the way they need to be. Because as you grow your practice, administrative policies and procedures are gonna start to shift as well. And having someone who leads the administrative team helps you in having them be able to start restructuring those processes, as you likely have probably stepped out of the administrative role. And just the more you step out of certain roles, and put other people into it, the less you know, the day to day of those roles. And the better it is to have someone leading within that or that part of the organization, who knows what needs to happen to shift any of the procedures that are going on administratively. 

And then you’ll see once you hit 20 plus people, this real creation of a leadership team versus having an individual, one or two clinical lead people, and maybe one administrative leader, where they’re still probably working in their own silos, ensuring that they’re doing leading in the department or the area that they’re supposed to be leading. Once you hit 20, maybe 30 employees, you’ll start to see this shift to creating this leadership team where there’s this collaboration. 

And so as an example, for our practice we have, I think it’s eight people on our leadership team, including myself, who all focus on a different area of the business that they lead. But we come together several times a month to collaboratively discuss what needs to be worked on in the business as a whole. And we get the perspectives of all of the leadership kind of corners of the business. And so when you’re hitting that 20-30% mark, you’ll start to just see the shift of not having individual people leading, but a team of leaders that literally work together, even though they might be leading different departments like a clinical department or an administrative department or location specific departments, right? But they’re coming together to make decisions and collaborate on what is best for moving forward in the business to keep the trajectory that is, hopefully positive one, or two reroute and fix or pivot trajectory that’s not working in the best interest of the business. This is, I think one of my favorite places to be at is having a leadership team that works together in making decisions, important decisions for the business, because you get a lot of voices and it allows you to get different perspectives before making a final decision. 

But it also is a real big pivot as a business owner who more than likely starts the business alone, right as a solo owner, unless you’re a partnership, which then this is all going to be much easier. But if you’re starting this business solo, you’ll start the first probably year plus, before you have 10 or so employees really making every decision yourself. And as you grow, you realize that in order to really have the business really be successful, you need to have the input and feedback and collaboration of everyone on leadership, which means that your own voice, your own input, your own feedback is–not watered down, and not less valuable. But it holds a different sort of weight. It’s has less weight to it than when your team was smaller, and you were the only person leading the business, right? As you gain people in leadership each individual voice is part of a collective voice. And it’s a pivot and an adjustment that a lot of business owners need to make when they start to kind of take that step into creating a team of leaders that all have an equal voice in making decisions on the business. 

Now, that doesn’t mean to say that, at the end of the day, there’s no decisions that you as a business owner can make on your own. Not at all. But especially if you’re working from an anti racism lens, this idea–sharing in decision making becomes even more important as your team grows. And as you create a leadership team in and of itself, really the bottom line or the way you know that leadership is really functioning as a leadership team is when you see them collaborating and making decisions as a group, and being accountable as a group to making sure that the decisions that are made are the right ones for the business. And so generally speaking, that’s how I view kind of the evolution of a leadership team. 

So just to recap, between zero and 10 employees, it’s usually going to start off with being just you leading that business making all the decisions. When you get towards the end, closer to that 10% mark, might be the time that you have started bringing on someone to do some kind of clinical leadership, whether that’s supervising or helping with the interviewing and hiring of new staff. When you hit when you get between the 10 and 20, employee mark, you’ll start to see either a shift from one to maybe three people who are leading in some capacity. Again, you’ll you’ll notice that they’re still leading sort of in silos in that they are really just in charge of managing and leading the team that they’re working on or the thing that they’re supposed to be leading on. But at the end of the day, it’s likely that most of the bigger business decisions are still being made by you, the owner of the group. And you might see that the leaders, the 1, 2, 3 leaders that you’ll have, are likely going to be in the both the clinical and the administrative parts of the business. And then once you hit 20, maybe 30 employees is when you start to see the shift of meeting not only just individual leaders, but that those leaders are coming together collaboratively to make decisions for the business as as a team, such generally the trajectory that you likely will see when it comes to creating and maintaining a really good leadership team. 

Let me know what your leadership team looks like and how many employees you have for that leadership team and whether there’s admin or clinical leads. I’d love to see–I always collect this kind of data to see what are the trends. What are people doing? So if you want to email hello at the group, practice exchange dot com and let me know how many people are on your team clinically and administratively and how many leaders do you have for that size of a team? I love collecting this kind of data. It gives me good information for future podcast episodes and seeing where trends are! Alright, I’ll see you next week.

Thanks For Listening

Thanks for listening to the group practice exchange podcast. Like what you heard? Give us five stars on whatever platform you’re listening from. Need extra suppor? Join The Exchange, a membership community just for group practice owners with monthly office hours, live webinars, and a library of trainings ready for you to dive into visit www dot members dot the group practice exchange dot com forward slash exchange. See you next week.


Here are the resources and guides we recommend based on this episode

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therapy notes

*Need a good EHR for your group practice? TherapyNotes is it. I’ve been using it for years in my own group practice, and it does really well when it comes to having the features group practice owners need. Try it out for FREE for 2 months by clicking here.

* I am an affiliate for some of the businesses I recommend. These are companies that I use in my own group practice, and make recommendations based off of my experience with them. When you use some of these companies through my links, I receive compensation, which helps me continue to offer great free information on my podcast, blog, Facebook group, and website.

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Meet your host


Maureen Werrbach is a psychotherapist, group practice owner and group practice coach. Learn more about her coaching services here:


The show

The podcast is structured so that you get practice building tips in small doses, where an episode can be listened to (and a group practice building lesson can be learned) in a single car ride.

Episodes are structured into categories: coaching sessions where I coach a group practice owner on a specific topic, tips of the day by yours truly, real talk where you get to be a fly on the wall while an established group practice owner and I talk about the highs and lows of ownership, and trainings done by experts in the field.

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* The content of this post is intended to serve as general advice and information. It is not to be taken as legal advice and may not account for all rules and regulations in every jurisdiction. For legal advice, please contact an attorney.

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