Best Practice Management
The Domino Effect Within Practice Management

Perhaps you’ve never seriously given thought as to how your actions (or non-actions) made early on, affect the current status of your practice, for better or worse. You carry on, day after day, week after week, repeating behavior that generates that predictable outcome day after day, week after week. You are making payroll, paying bills, fixing feet – yet working harder, longer hours, more patients (or fewer patients), revenue down, compromised business model, etc. Utilizing some fundamental management tools can often change that dynamic and start shifting the outcome.

Your Objective

While the phrase “domino effect” is based on the setting up of dot-designed domino tiles, it doesn’t really follow the rules of the game. It has more to do with a strategy involving tiles that are placed in such a way that with a gentle tap, the first tile knocks down the next, and then another, and another, starting a chain reaction, until no tiles remain standing.  

For our purposes, let’s assume that everything we do relates to the domino effect and your first tile is staff training. You have a choice to make regarding how to arrange this tile in order to get the best result. Will you choose “effective training” or “halfhearted training”? If you go down the ideal path and choose “effective training”, it will lead to a series of preferred outcomes such as staff independence, uniformity in task implementation, routinization, fewer mistakes, less decision making, additional quality DPM time spent with patients, increased productivity and efficiency, more teamwork, less stress, improved staff and patient satisfaction, and staff retention. Conversely, if you choose the easier, cut-rate, ill-advised ‘halfhearted training’ option, well, let’s just say you’ll get out of it what you put into it…a cut-rate, ill-advised outcome.   

If you chose “effective staff”… congratulations, a great start. Don’t rest on your laurels! This is just one example and hardly the only area of practice management that can have a positive or negative effect based on that simple initial decision. Here are just a few other examples of choices that can set in motion harmful outcomes.

Inconsistent patient policies – This leads to erratic schedules, negative patient behaviors, uneducated patients, loss of control, flow disruption, patient dissatisfaction, negative reviews, fewer patients, and hello stress. Ouch! Create policies for co-pays, no shows, billing, compliance, etc. and make sure everyone sticks to them.

Fixed wage increases – Raises that are based solely on seniority or an employee’s anniversary each passing year will only create an uncontrollable payroll ratio, unmerited wages and employee expectations, resentment towards/amongst staff, complacency and stress. Make no mistake, I do advocate for fair wages for employees, especially if they put forth the effort and show progress from one year to the next. In this regard, the annual performance review is a critical tool to determine if a raise is well earned. I am happy to email a complimentary performance evaluation form to you. Send your request to

Lack of protocol (or routinization) – Tap this destructive tile and it will domino into inconsistent outcomes, a tiring repetition of orders and instruction, wasteful efforts, constant interruption, and dwindling professionalism. Before you know it, you’re a victim of decision fatigue. Patients see and feel the chaos. Your office appears disorganized and mismanaged. Fix this!

End Game

Sure, this was just a fictional game, but the reality of it is hardly fantasy. It takes a lot less effort than you think to put your practice on autopilot – and have it function in a more productive, less exhaustive way and yet, too many times, sensible management practices are disregarded.

Once initial decisions and choices involving structured policies and protocols are accepted, established and routinely enforced, your practice becomes fueled by the positive energy generated from those choices. And the domino effect begins. Standardized processes result in less slipups, fewer managerial decisions, minimized stress, and time saved (read: increased profit…time is money).

Are you willing to let the dominoes fall randomly concerning specific aspects of your practice? While management of your practice is not a game of Dominos, it shouldn’t be the disorder of ‘Pic-Up-Sticks’ or the chance of Boardwalk in ‘Monopoly’ either. There’s a lot to win and too much to lose.