Before You Assume It’s a Staff Problem
You’ve got a physio whose diary never quite fills up.
Their APV is low. Cancellations keep creeping up. Something about their numbers just doesn’t sit right.
So what do you do?
Most clinic owners go straight to the same conversation.
“Your numbers need to improve.”
But before you even have that conversation, there’s a question worth asking first.
Is this actually a staff problem at all?
Because underperformance in a clinic almost always comes down to one of a few things, and the fix is completely different depending on which one you’ve got.
Training problems need training. Belief problems need clarity. Capability problems need honesty. Get the diagnosis wrong and you’ll fix nothing.
Stop Blaming the Physio for an Empty Diary
One of the easiest mistakes a clinic owner can make is looking at somebody’s diary, seeing gaps, and deciding they’ve got a performance problem.
But an empty diary doesn’t automatically mean you’ve got a staff problem.
It could mean you’ve got a clinic problem.
Here’s a simple example.
Say your physio has capacity for 36 appointments a week, and their APV is 6.
Roughly speaking, that means you need to generate them 6 new patients every week just to keep the diary full.
Now say their diary is only 60% full.
It would be very easy to sit them down and say their performance needs to improve.
But what if their APV really is 6? What if their cancellations are low? What if the patients they do see are getting great outcomes?
And what if you’ve actually only been generating them 3 new patients a week?
That’s not a physio performance problem. That’s a clinic performance problem.
You haven’t generated enough demand.
This is exactly why knowing your numbers matters so much.
Without the data, you’re guessing.
And you can end up holding somebody accountable for something they had virtually no control over.
Start With the KPIs, Not the Conversation
Now imagine the opposite scenario.
You are generating enough new patients.
But one physio consistently has a low APV and high cancellations.
Now you’ve got something worth investigating.
The important word there is investigate. Not blame.
Because the numbers will tell you there’s a problem, but they won’t tell you why it exists.
That’s where you come in.
And from here, I’d be asking whether this is a training problem, a belief problem, or a capability problem.
Work Out Which of the Three Problems You’ve Got
The training problem…
In my experience, this is by far the most common one.
I’ve employed a lot of physios over the years, and when somebody has a low APV and high cancellations, it’s very rarely because they’re a poor clinician.
Most physios have spent years learning how to assess, diagnose, and treat. The gap is almost always communication.
The patient doesn’t properly understand what’s wrong with them.
They don’t understand how you’re going to help.
They don’t understand the treatment plan.
And most importantly, they don’t understand why they need to come back, so they disengage.
One of the most common places this breaks down is right at the end of session one.
The physio does a brilliant subjective assessment.
A brilliant objective assessment.
They identify the problem, maybe even deliver brilliant treatment.
And then everything falls apart at the finish, because they’ve never properly learned how to go from “here’s what I found” to “here’s how we get you from where you are to where you want to be.”
That’s a communication skill. And communication skills can be trained.
This is exactly why we built the CLOSE framework for our physios:
C — Confirm the problem L — Link the findings O — Outline the plan S — Sell the plan E — Establish the next step
It gives a physio a simple structure for turning everything they’ve found in an assessment into a plan the patient actually understands.
So if a physio’s patients keep disappearing after session one, I’m not going to tell them to increase their APV.
That’s useless. I’m going to watch their session one closely.
Are they confirming the problem?
Linking their findings back to the patient’s goals?
Outlining a clear plan and explaining why it matters?
Does the patient leave knowing exactly what happens next?
Find the gap. Then train the gap. That’s staff development.
The belief problem…
This one is completely different.
Sometimes somebody knows exactly what you want them to do, and they’re capable of doing it.
They just don’t believe in it.
Maybe they consistently undersell what a patient actually needs.
Someone comes in with a long-term problem that genuinely needs a course of treatment, but the physio feels uncomfortable saying so.
They don’t want to book multiple sessions because it feels like “selling.”
So no matter how much training you throw at them, they keep doing things their own way.
That isn’t a skills problem. It’s a belief problem, and you need to understand where it comes from.
Sometimes education fixes it.
You can explain that recommending six sessions isn’t about extracting more money from someone, if six sessions genuinely gives that person the best chance of getting the outcome they came in for, then recommending six sessions is simply good clinical care.
But sometimes the beliefs are too far apart, and you have to ask whether that person is really the right fit for your business.
Which is why this conversation should start before somebody even joins your clinic.
Our physios know what success looks like in their role, which KPIs we measure, why we measure them, and that they’ll be held accountable to them.
If somebody fundamentally disagrees with that before they’ve started, they’re probably not right for you.
The capability problem…
This is the hardest one to deal with.
Sometimes somebody wants to do it.
They believe in what you’re trying to achieve.
They turn up to the training, they listen to your feedback, they genuinely care.
But they simply can’t consistently perform at the level the role requires.
You identify the problem. You train them. You role play it. You shadow them. You give them feedback. You support them. And nothing really changes.
These are hard conversations, because you might have a genuinely brilliant person who desperately wants to succeed.
But wanting to do the job and being capable of doing the job are two different things, and eventually you have to be willing to recognise that.
That said, I think a lot of clinic owners jump to this conclusion far too quickly.
Before deciding somebody isn’t capable, make sure you’ve actually found the real gap, and given them the training and support to close it.
Being the Boss Is a Privilege
I think this bit gets forgotten.
Being the boss is a privilege.
You employ people who are trusting you with a huge part of their career.
Your job isn’t to look at somebody’s numbers once a month and tell them they’re not good enough.
Your job is to understand why those numbers look the way they do.
The best physios I’ve worked with actually love this level of accountability.
They want to know how they’re performing. They want you to find their gaps. They want feedback, training, and to get better.
Build that culture, and KPI tracking stops feeling like a horrible management exercise.
It becomes staff development.
What I’d Do on Monday Morning
If you’ve got a physio you think is underperforming, don’t start with a conversation.
Start with the data.
Look at their APV. Look at their cancellations. Look at how many new patients they’ve actually been given.
Then pull a report of the patients who’ve left their diary and look for a pattern.
Are patients disappearing after session one?
Are they reaching session three and disengaging?
Is there another obvious point in the journey where things consistently break down?
Once you’ve found the pattern, go and watch it happen.
Shadow the physio at that exact point in the patient journey.
Listen to the communication. Look at what’s actually happening.
Then decide: training problem, belief problem, or capability problem.
Build your support around what you’re seeing, not what you’re assuming.
That’s how you actually develop people.
The Bottom Line
Training problems need training.
Belief problems need clarity.
Capability problems need honesty.
Get the diagnosis wrong and you’ll fix nothing.
That’s how you turn underperforming staff into some of the best people in your business.