Why Most Chiropractic Team Evaluations Fail (And How to Build a High-Performance Team Instead)

[00:00:00] Usually, um, when we talk about a clinical diagnosis in practice- Yeah … there’s this expectation of total precision. Oh, absolutely. Total clarity. Right. It’s engineered to be clear. Like a patient walks in, you take an X-ray, the film shows a structural issue, and you just point at it. Yeah. You literally just point and say, “There’s the problem.”

Exactly. You say, “Here’s the exact adjustment required.” Yeah. You have a clear baseline, a clear methodology, and well, a clear outcome. Because it’s entirely objective. I mean, the clinical side of a practice relies on systems that are visible and quantifiable. Which is very comforting. It provides a massive amount of comfort for a practitioner, you know?

You’re trained to s- spot the subluxation, correct it, and just move on. But, the moment you step out of that treatment room and walk over to the front desk to handle team dynamics- Mm-hmm … or staff evaluations- Oh, it’s a completely different world … that X-ray machine suddenly vanishes. Yeah. We find ourselves looking at a management landscape that is incredibly murky.

It’s subjective, it’s messy, and honestly, it’s where a [00:01:00] lot of highly skilled doctors start to feel, um, entirely out of their depth. It really is the definition of diagnostic muddy waters. Yeah. I mean, we see incredible top-tier practitioners who can literally change a patient’s life with their hands.

Right. But they find themselves completely paralyzed when it comes to sitting down with their chiropractic assistant for a performance review. It’s wild. The confidence they have in the adjusting room just evaporates in the manager’s office. Completely evaporates. Well, if that dynamic sounds familiar, welcome to the Chiropractic Deep Dive.

This is a special part of the Successful Chiro podcast, and, uh, we’re thrilled you’re joining us. Glad to be here, and glad you’re listening. And I wanna mention right out of the gate that this deep dive is brought to you by Five Star Management. That’s a chiropractic consulting company. And we’re both incredibly proud representatives of Five Star Management.

Absolutely. Our entire focus today is helping you scale your practice, lower your administrative stress, and really get back to actually enjoying running your [00:02:00] clinic. Because we are tackling a universal pain point today. I mean, you are already phenomenal at treating patients. But when it comes to team member reviews and evals- Totally, right

the process is often totally broken. Neither the leadership nor the team members really understand how the process is supposed to work. Which just creates all this underlying tension, right? It stunts practice growth and drives high-quality staff right out the door. It does. It really does. So to solve this, we’re pulling from a phenomenal source today.

We are unpacking an exclusive master class Zoom call led by Dr. Noel Lloyd. And this call was focused entirely on resolving this team member review and evaluation crisis. Yeah, and what immediately caught my attention in this master class wasn’t, like, a specific form or a spreadsheet. It was a complete philosophical shift.

The paradigm shift. Yes. Dr. Noel Lloyd states that his ultimate goal for evaluations is simply this. The goal is that everybody gets As. Wow. I mean, that changes the entire premise of an evaluation, doesn’t it? It really [00:03:00] does because in traditional corporate environments, a performance review is, um, it’s treated like a pop quiz.

Right. Like, it’s designed to catch employees making mistakes. Exactly. But Dr. Lloyd argues it should be an open book test. Which means leadership’s fundamental responsibility is to tell the team exactly how to ace the evaluation. Using clear KPIs and KPAs. You literally hand them the study guide on day one, and your job as a leader is to coach them toward that A grade.

So good. But I guess if we’re gonna build this perfect open book system, the first logical step is tearing down the broken ones most clinics are currently running. Yeah. We have to clean house first. During this Zoom call, Dr. Noel Lloyd asked the participants, who by the way are clinic owners and office managers themselves, to identify the most common evaluation mistakes.

He wanted to highlight the anatomy of a failed review so we can kick these habits out. Right. And when you look at the five fatal flaws these participants brought up, you start to see a clear narrative of how [00:04:00] management inadvertently destroys team morale. Let’s analyze the administrative failures first because these are the unforced errors that set a terrible foundation before a word is even spoken.

Okay, let’s unpack this. What was the first one? A major flaw participants identified is not knowing the when. Like, team members often have absolutely no idea when or if a review is happening. Which is crazy to me. Best practices dictate they should happen at 90 days and then annually. But in a lot of clinics, it’s treated as a spontaneous event based on, you know, the doctor’s mood.

Yeah, which ties directly into another fatal flaw raised on the call, the lack of follow-through. Oh, this one is so common. A clinic owner will sit down with a brand new hire, look them in the eye, and promise a 90-day review. And then what happens? Month three rolls around, the schedule backs up, the waiting room is overflowing, the doctor is exhausted- Yep

and the review just quietly drops off the calendar. The owner usually rationalizes this, right? Yeah. They think, [00:05:00] “Well, things are fine. They know they’re doing a good job. We’ll get to it eventually.” But they completely fail to consider the psychological impact on the employee. It is a devastating impact. It really is.

Think about this from a clinical perspective. Imagine a patient comes in, you take an X-ray, and you tell them to sit in the waiting room for the results. Okay. But you get busy and you just never bring it up. Yeah. You let them go home without ever mentioning the film. What does that patient assume? Oh, they default to the worst case scenario immediately.

Exactly. That silence is immediately interpreted as terrible, catastrophic news. Mm. For a team member, skipping a scheduled review breeds massive self-doubt. They’re sitting at the front desk wondering, “Am I failing? Am I about to be fired?” “Does the doctor just not care about my career?” And that highlights the massive disconnect between intent and impact.

The doctor thinks they’re just delaying a meeting, but the employee thinks their job is in jeopardy Which is a terrible head space to be in. And when you compound that anxiety with the [00:06:00] next flaw conducting reviews without any written forms, you have a recipe for disaster It’s just winging it Yeah.

Participants noted that owners often just pull a CA into a back room and start talking. There’s no system, no tool, no documentation to anchor the conversation in reality It just devolves into a subjective venting session Exactly. Which brings us to the emotional and communication failures Right, because when owners go into these unstructured meetings, participants noted they almost exclusively focus on the negative They do.

They go in emotionally charged about like a scheduling error that happened on Tuesday And they spend 30 minutes hammering on that one mistake, completely failing to acknowledge the 50 things the team member executed perfectly that week We really have to look at why chiropractors are so prone to this specific mistake.

Think about your diagnostic training Okay. Yeah You’re highly trained to look at a complex system. The human spine scan it for the single thing that is misaligned, focus entirely on that anomaly, and [00:07:00] fix it Which makes you a brilliant healer Exactly. But when you apply that exact same seek and fix the flaw mentality to human resource management, it is catastrophic.

Oh, wow. That’s such a good point. High-performing chiropractic assistants thrive on collaboration and momentum. If you only point out their misalignments, they leave that room entirely deflated You essentially take your most motivated team member and convince them they’re incompetent It’s heartbreaking.

And the final fatal flaw raised by the participants seals the deal, making the review a one-way street. Leadership completely fails to ask the team member for feedback, or they fail to ask the simple question, “How can we support you better?” Which is wild because the front desk CA is the quarterback of your entire operation They really are They hear the tone of a patient’s voice when they look at a bill.

They hear the phone ringing while you’re in the adjustment room. They understand the friction points in your waiting room Right. So if you’re [00:08:00] monopolizing the review and treating it as a lecture rather than a conversation, you’re leaving incredibly valuable business intelligence completely unmined You’re just throwing it away So if that erratic anxiety-inducing process is the pathology The obvious question is how we treat it.

How do we fix it? Yeah. How do we lock in a baseline of clear communication from day one, so by the time the evaluation happens, the team member already knows they’re getting an A? The conversation on the Zoom naturally shifted to how Dr. Noel Lloyd eliminates ambiguity the moment an employee is hired. He used this youth sports analogy that perfectly frames the solution.

I loved this part. He pointed out that if you’re coaching kids on a youth baseball team, you don’t just dump a bucket of balls on the field, walk away, and tell them to figure it out. That would be chaos. Complete chaos. You have to tell the shortstop exactly where to throw the ball when it’s hit to them with a runner on first.

Right. And in a clinic, your front desk needs that exact same level of spatial awareness. They need to know their exact [00:09:00] expectations. What is the protocol when a patient asks a complex insurance question? Where do they throw the ball? Dr. Lloyd’s solution to this is the concept of the job book. Ah, the job book.

The governing rule of the practice becomes if it’s in the job, it’s in the book. All of the phone scripts, the daily checklists, the opening and closing procedures- Mm-hmm … they no longer live solely in the doctor’s head. They are externalized into this physical comprehensive binder. And one of the participants shared a brilliant implementation strategy for this.

On a new hire’s very first day, they aren’t just thrown behind a computer screen. No. They’re presented with a beautifully organized job book broken down week by week. But it’s paired with intentional culture building. They get welcome gifts like a quality water bottle, nice pens, their favorite candy. It makes such a difference, and most importantly, they’re assigned a designated lead to train them.

That structural choice of assigning a lead [00:10:00] changes everything. It really does. It means the new hire isn’t a burden on the entire office. Right. They have a specific mentor whose explicit responsibility is to present that new hire as fully trained at the end of their 90-day probationary period. But I know some doctors struggle with this.

Well, yeah. I actually have to challenge the core premise of this job book for a moment. Okay. Lay it on me. We’re talking about scripting every single patient interaction and putting every procedure into a rigid binder. Don’t we run a massive risk of turning our warm, empathetic clinic staff into literal assembly line robots?

That is the most common hesitation doctors have when implementing heavily systemized protocols. It feels restrictive. It feels that way, sure. But if we look at the cognitive reality of a busy front desk Scripting achieves the exact opposite of making someone robotic. Ah . When a CA does not know the policy, their brain is burning massive amounts of energy trying to invent a safe answer on the spot while a patient stares at them.

Oh, they’re [00:11:00] panicked internally. They are entirely focused on survival, not service. Wow, that makes a lot of sense. Precisely. But when you provide a scripted baseline, you free up their cognitive load. They already know the words they’re gonna say, which means they can actually afford to be human. They can focus on their tone of voice, their eye contact.

Mm-hmm. Exactly. Showing genuine empathy to the patient standing in front of them. The system doesn’t restrict their humanity, it protects it. So you have to master the baseline before you can perform the art of the job. That’s a great way to put it. And having that baseline clearly established in the job book allows for a management technique a participant called in-the-moment coaching.

Because the standard is universally understood. Right. The lead trainer can provide micro-corrections throughout the shift rather than saving up a massive list of grievances for a six-month review. But there is a very strict rule attached to this coaching. Crucial rule. You never correct a team member in front of a patient.

Never. The psychology behind that rule is critical. If you publicly correct [00:12:00] a staff member, you trigger an immediate threat response. Their cortisol spikes, they feel humiliated. And their performance for the rest of the shift will just plummet. Mm-hmm. Furthermore, it completely undermines their authority in the eyes of your patients.

Yes, you wait. You wait until the shift is over or until the front area is entirely empty. And you don’t frame it as a reprimand. No, you frame it collaboratively. You say, “Hey, I notice how you handled that insurance question. It was really close, but let’s look at the job book. How else could you have handled that to stay a bit closer to the script?”

It’s gentle, it’s immediate, and it treats the symptom before it becomes a deep-seated behavioral pathology. Okay, so let’s assume the team member is thoroughly trained, they’ve received excellent in-the-moment coaching, and their initial ninety-day learning phase is complete. It’s time for the actual formal evaluation.

Yes. How do we execute this without falling back into the trap of subjective venting? This is where Dr. Noel Lloyd introduces a [00:13:00] brilliant structural flip. I love this part. The doctor doesn’t fill out the evaluation form first. The team member evaluates themselves. They are given the blank form ahead of time.

And taking it a step further, the employee is the one responsible for tracking their own anniversary date. Wait, really? They track it? Yes. If they want their review and the potential raise that’s attached to it, they have to formally request the meeting from leadership. Oh, that completely rewrites the power dynamic of the meeting.

It shifts the environment from, like, a principal calling a delinquent student into the office- To a professional requesting a performance calibration with their mentor It puts the employee entirely in the driver’s seat of their own career progression. Exactly. But, um, there is a highly specific detail regarding how Dr.

Lloyd scores these evaluations that requires a deeper look. The scoring system. Right. He scores out of ten, but he enforces a strict rule. Oh. He never gives out tens in the first three years of someone’s employment. Which trips [00:14:00] a lot of people up. Yeah, I mean, I have to push back on the mechanics of that.

If I have an incredibly eager, highly capable new hire who is objectively crushing their daily tasks, and I artificially cap their score at an eight just because of their tenure- You’re worried it’ll backfire … aren’t I going to destroy their motivation and drive them to quit? That is a very real risk if you don’t contextualize what a ten actually means in your clinic’s culture.

Okay, so what does it mean? Dr. Lloyd’s rationale is that a true ten requires substantial long-term stability. A ten isn’t awarded because you completed a task correctly on a random Tuesday. Right. A ten means you’ve executed this role flawlessly through the ups and downs, the busy seasons, and the slow seasons over a period of years.

So you have to explain to that eager rock star that a ten represents ultimate mastery, not just competence. Exactly. So walk me through the dialogue when that inevitable collision of expectations happens. It, it will happen. You have a [00:15:00] highly confident new CA- Hmm … who fills out their self-evaluation, slides it across the desk to you, and they’ve given themselves straight tens across the board.

Yep. How do you handle that without causing deep resentment? Well, you treat it as a calibration moment. You don’t get angry or dismissive. Okay. One of the participants in the master class had a fantastic, highly relatable clinical analogy for this exact scenario. I remember this. They said a premature ten on an employee evaluation is exactly like a new patient walking into the clinic with a minor stiff neck, claiming they are experiencing ten out of ten pain.

Yes, and the participant said, um, “Unless a badger is actively chewing your arm off right there in the waiting room, it is not a ten.” I laughed out loud at that. It’s hilarious, but it perfectly translates the concept. It forces a necessary reset of definitions. So as the leader, you look at their self-scored ten and you say, “I love your confidence.

I currently have you at a six for this metric. Make your case [00:16:00] for why it should be a ten.” You ask them to provide specific data-driven examples of how their performance impacted the practice. Because these evaluations aren’t based on vibes, they’re tied to objective metrics. Right. A participant noted that they use their monthly performance stats, like the total number of new patients handled or the conversion rate of the report of findings.

And the team member tracks their own daily conversions, so when this calibration conversation happens, the data is already sitting right there on the table. It removes all the emotion. You either hit the KPIs or you didn’t. It creates an incredibly productive, objective dialogue. But the evaluation isn’t just about whether the staff member is checking the right operational boxes, is it?

No, not at all. A massive component of Dr. Lloyd’s system is determining if the employee is still on the right bus culturally. Yes, checking the cultural fit. Dr. Lloyd utilizes a tool called the Team Member Update Questionnaire, which is given to the employee prior to the review. And it specifically checks for fit, [00:17:00] connection, and engagement.

The questions he requires owners to ask go incredibly deep. Like the first question. It asks the team member to articulate the overarching vision and goals of the practice, and then to explain exactly how they see their specific role fitting into that larger vision. Which is a phenomenal diagnostic tool for the owner’s leadership.

Oh, absolutely. Because if you hand that form to your CA, and they leave that question blank, or they get it completely wrong, that’s not an employee failure. No, that is a massive leadership failure. You cannot expect a team member to pull the rope in the right direction if you’ve never bothered to show them where the finish line is.

Preach. The questionnaire then asks them to look inward. They must list three things they do exceptionally well at the clinic, three tasks that are genuinely fun for them, and three natural talents they possess that fit well into their current role. It forces self-reflection. But there are two specific questions on this team member update that I think are the secret weapons of this [00:18:00] entire system.

Oh, I know which ones you’re talking about. The first one is, “What do you think I appreciate most about you?” And the second is, what do your coworkers think of you? Those questions are brilliant because they uncover the hidden psychological dynamics of your office. They really do. Think about the vulnerability required for an employee to write down what they believe their boss appreciates about them.

It forces them to articulate their own value. Right. But more importantly, it gives the doctor a silver platter opportunity to validate that employee. Yeah. When the CA writes, “I think you appreciate my reliability when the schedule gets chaotic,” the owner can look at them and immediately say, “Yes, I see that.

I value that, and it’s a massive asset to this clinic.” It builds incredible trust. And asking, “What do your coworkers think of you?” is the ultimate radar for hidden office drama. It really is. Everyone lives in their own specific reality within a workplace. A CA might think the rest of the staff finds them overbearing while you, as the owner, had no idea that anxiety even [00:19:00] existed.

Asking that question allows you to square up their internal perception with the objective reality of the clinic floor. Ultimately, all of these tools, the job book, the objective KPIs, the perceptive questions, they serve one central leadership mantra that Dr. Lloyd champions. What’s that? You have to make absolutely sure your team knows that you are actively working to help them hit their personal goals.

That is exactly why the final part of the update form asks the employee about their one-year, three-year, and five-year personal financial and professional goals. This is where you create unbreakable retention. Yes. If you, as the clinic owner, know that your CA’s three-year goal is to buy their first house, you can map out the exact clinic performance bonuses required to help them build that down payment.

If you are actively working to help them achieve their life goals, they are going to work tirelessly to help you hit your clinic’s goals. It transforms a transactional job into a true partnership. We have covered a massive amount of ground today. We really have. We’ve [00:20:00] diagnosed the administrative and psychological flaws that make traditional evaluations a nightmare.

We’ve explored how the job book removes ambiguity and protects the cognitive load of your staff. And we walked through a clear open book evaluation system where expectations are calibrated objectively. It is a complete roadmap to fixing that broken X-ray machine in your management systems. You no longer have to leave your team in the waiting room wondering what the results are.

But recognizing the problem Is only the first step. Implementation is where the real growth happens. That’s right. If you’re tired of the fogginess and you’re ready to build a management system that runs like a well-oiled machine so you can get back to focusing on treating patients, Five Star Management has your back.

We want you to book a completely free practice-building call with Dr. George Birnbach. Yes. You can find the direct link to schedule that call right in the show notes. And if you’re ready to completely transform your practice operations in a highly immersive in-person environment, you [00:21:00] absolutely need to attend our live two-day event in Chicago, Illinois.

It is called Streamline Scale Succeed. The strategies and operational blueprints shared at Streamline Scale Succeed are absolute game-changers for chiropractors who want to multiply their impact without multiplying their stress. Check the link in the show notes to secure your spot for the live Chicago event before it fills up.

And while you’re down there in the show notes, make sure you hit subscribe to the Successful Chiro podcast so you never miss another deep dive or practice-building strategy. Because the health of your practice is directly tied to the health of your management systems. Which leaves us with a final concept to consider as you head into your clinic this week.

Right. Throughout this deep dive, we’ve focused on aligning your team’s goals with the clinic’s vision to create ultimate retention and growth. But what happens when your open-book test and your dedicated coaching create a team member so incredibly capable, so driven, that their five-year personal goals actually outgrow your practice’s organizational chart?

Oh, that’s a tough one. [00:22:00] If your front desk CA evolves to a point where they need to leave your clinic to achieve their ultimate career ambitions, is that a failure of your retention strategy? Or is it the ultimate proof of your success as a leader? It’s a profound question about the true purpose of mentorship.

Something to mull over before your next staff meeting. Until next time, keep adjusting, keep leading, and keep growing.