How to Turn a Struggling Physio’s Numbers Into the Exact Training They Need (Instead of Just Applying Pressure)
You’ve started tracking your numbers.
You’ve finally got some proper visibility over the clinic.
And now you can see something you probably already suspected.
One of your physios is underperforming.
Their average patient visit is low. Patients are dropping out of the diary. Cancellations might be high. Something just doesn’t look right compared to the rest of the team.
But this brings you to the next question.
What do you actually do about it?
Knowing somebody is underperforming and understanding why they’re underperforming are two completely different things.
And this is where I think a lot of clinic owners get stuck. They finally get visibility over the numbers, spot the problem, but then don’t really know what to do with that information.
The answer isn’t to start putting more pressure on the physio.
The answer is to work out where the breakdown is happening.
Because once you can do that, the numbers become one of the most powerful coaching tools you’ve got.
“Visibility tells you there’s a problem. Pattern recognition tells you what the problem is. Good coaching fixes it.”
Stop Using KPIs to Catch People Out
I think we need to change the way we think about KPIs and performance tracking in private practice.
This isn’t a negative thing. It’s a positive thing.
Having proper visibility over somebody’s performance gives you an unbelievable opportunity to actually coach them on the things they’re struggling with.
Rather than sitting in a monthly meeting saying, “Your numbers need to improve,” you can actually start saying, “This is where patients are dropping out. This is why I think it’s happening. This is what we’re going to work on.”
That’s completely different.
Of course there’s a commercial benefit. Patients stay in the clinic. They’re more likely to get the outcome they came in for. Your marketing works harder. The business becomes more profitable and more predictable.
But there’s another massive benefit.
You can become a much better coach to your physios.
The clinic gives you data every single day about what your team are good at and what they need help with. You’ve just got to know how to read it.
And from my experience, when a physio is underperforming in private practice, clinic owners very quickly assume it’s a clinical problem.
Very often it isn’t.
Most of the problems I’ve seen have been communication problems. The key is pattern recognition.
As your clinic grows, you can’t watch every treatment session and you can’t be involved in every patient journey. So your ability to recognise patterns becomes really important. You need to see the pattern, work out what it’s telling you and then train accordingly.
Start With Average Patient Visit
If I was going to start tracking one number for clinician performance, I’d start with average patient visit.
For a private MSK clinic, I think an APV of around six is a really solid number.
Obviously there are exceptions. If you predominantly treat young, healthy athletes with relatively minor injuries, they might genuinely only need two or three sessions.
That isn’t an underperforming physio. That might just be the type of patient you’re attracting.
And that distinction is really important.
If your APV is three because patients are getting brilliant outcomes in three sessions, great. If your APV is three because patients are disappearing halfway through their treatment plan without getting the outcome they came in for, you’ve got a problem.
So if I spotted a physio with a low APV, I wouldn’t immediately jump into training. I’d run a report for the month and look at the patients who have left their diary. Then I’d go through them.
Did they leave because they were sorted?
Or:
Did they leave before the plan was finished?
They are two completely different things.
If they’re getting better and leaving happy, I’d probably start looking at who we’re marketing to and whether we’re attracting problems that actually require much treatment. But if patients are regularly leaving before getting the outcome they wanted, now we’ve got something to investigate.
And the next thing I want to know is when they’re leaving. Because there are a couple of really common break points in a patient journey.
Work Out Exactly Where Patients Are Dropping Out
After session one…
The first big one is session one. A patient comes in, has their initial assessment and then either doesn’t rebook or books another appointment and cancels it.
From my experience, this is nearly always a communication problem.
The physio might have done a brilliant subjective assessment. They might have done a brilliant objective assessment. Their diagnosis might even be spot on.
But the patient has walked out without enough certainty around what happens next.
The bit a lot of physios struggle with is taking everything they’ve found and turning it into a really clear plan. How are we getting you from where you are now to where you want to be? What needs to happen? Roughly how long is this going to take? What should you expect? What are we doing first?
The patient shouldn’t leave overwhelmed with information. They should leave with clarity.
I always think they should understand the plan well enough that they could go home that evening and explain it to their husband or wife. If they can’t do that, there’s a good chance we’ve overcomplicated it.
And uncertainty kills commitment.
After session two…
I’d put patients dropping out after session two in a very similar category. Sometimes they’ve simply given it one more go to see whether they get the clarity they were missing from session one.
This is why we teach our CLOSE framework around how to finish an initial assessment properly.
When I see this pattern with a physio, that’s where the training goes. We role play session one. We teach the framework. We replicate real patients they’ve recently seen. Then we watch the numbers.
Around session three…
The next big break point I look for is around session three. And there are usually two completely different things happening here.
The first is somebody who isn’t getting better. They’ve given treatment a fair crack but nothing is really changing. Sometimes the physio just carries on doing the same thing. Same treatment. Same exercises. Come back next week.
The problem is that the patient is sitting there thinking: “This isn’t working.”
The physio hasn’t read the room. Something needs to change. That might mean changing the treatment approach. It might mean imaging. It might mean getting another opinion. It might mean referring them somewhere else.
But something has to happen. Otherwise trust starts disappearing.
And very often these patients aren’t actually lost cases. They might need an MRI, an X ray or another opinion and then come straight back into the clinic to continue their treatment. But if we just keep asking them to come back while nothing changes, eventually they lose confidence completely.
The other session three patient is almost the opposite. They are feeling better. Pain has reduced. They’re moving better. They think they’re sorted.
So they disappear before actually getting the outcome they came in for. Then they go back to running, football, the gym or whatever they wanted to do. Two weeks later it breaks down again.
Again, this is usually communication. The patient hasn’t understood what has changed, what still needs to change and why the next stage matters.
That’s why we teach our RECAP framework for finishing follow up sessions. Every session should finish with the patient understanding what has happened today, what happens between now and the next appointment and what we’re progressing towards next.
If they can’t see where they’re going, it becomes very easy for them to take things into their own hands.
Train the Pattern, Not the Person
Once I’d gone through the diary, I’d expect to find a pattern somewhere. You might even find multiple patterns. That’s when the training starts.
And I wouldn’t make the training generic. I’d use the actual patients.
If somebody is losing loads of patients after session one, I want to role play session one. If they’re losing people around session three because they’re feeling better and leaving early, I want to role play how they’re finishing follow ups. If they’re struggling when patients aren’t responding, I want to replicate those conversations.
This is where frameworks become really powerful. We teach CLOSE for the initial session and RECAP for follow ups because it gives the physio something repeatable to work from rather than just telling them to “communicate better.”
You can also go another level deeper. Is there a particular type of patient they struggle with?
I’ve seen physios who are brilliant with one demographic and really struggle with another. It could be younger females. Older males. Serious weekend warriors. Acute backs. People who are very anxious. People who want loads of detail. People who want absolutely no detail and just want to know what they need to do.
Look for the patterns. Because once you identify them, you can deliberately recreate those situations in training. You can role play them. You can observe the physio with those patients. You can coach the specific weakness rather than throwing generic CPD at them and hoping something changes.
When it actually is a clinical skills problem…
There is one other possibility here. It actually could be their clinical skills.
But in my experience, this is much rarer.
I’ve employed a lot of physios and I can only really remember one obvious example where somebody had poor performance stats and it genuinely came down to their clinical skills. We ran communication scorecards across multiple initial assessments and follow ups and they were actually scoring really well.
Their communication wasn’t the issue. When we looked closer, their actual physio skills were poor. Their hands on skills weren’t good enough. Their manual therapy wasn’t good enough. Patients basically felt like they were paying for an expensive massage without getting much from it.
So that’s what we trained. We did loads of hands on training and worked on their clinical skills. Their stats improved.
But that is much rarer than clinic owners think. Don’t automatically assume poor performance means poor clinical skills. Find the pattern first.
Why This Matters For You
This is ultimately where I think clinic owners need to get to.
The first level is visibility. Who is performing and who isn’t?
But that only gets you so far.
The next question is: why aren’t they performing? Where are patients leaving? After session one? After session two? Around session three? Are they leaving because they’re better? Are they leaving because they’re not getting better? Is there a certain demographic the physio struggles with? Is there a particular pathology? Is it communication? Or, much more rarely in my experience, is it actually their clinical ability?
Once you know that, you can get really specific with the training.
That’s when KPIs stop being numbers on a spreadsheet and actually become useful. You’re using the numbers to identify a pattern. You’re using the pattern to identify the problem. And you’re using the problem to decide what needs training.
That’s how I think about performance management in a clinic. It isn’t about catching people out. It’s about giving your physios the support they actually need to get better.
And when they get better, everybody wins. The physio becomes better at their job. The patient is more likely to get the outcome they came in for. And naturally, the clinic becomes more profitable and predictable as a result.
The Bottom Line
Visibility tells you there’s a problem. Pattern recognition tells you what the problem is. Good coaching fixes it.
If you want to go much deeper into the communication side of this, I cover the whole thing in much more detail in my Communication Masterclass, the frameworks we use, how we structure initial assessments and follow ups, and how we train physios to communicate a really clear treatment plan that patients actually understand and want to follow. You can find it in my free resources section.
And if you want to automate a lot of the visibility I’ve talked about in this blog, that’s exactly what we’re building with NoteSense.
NoteSense is an AI scribe, but there are two features in particular that are really powerful from a performance point of view. NoteSense Perform automatically pulls your key clinician KPIs so you can see who’s performing and where there might be a problem. NoteSense Coach looks at the communication inside the actual consultation and runs a communication scorecard against it.
So rather than just knowing that somebody’s numbers are poor, you can start understanding why, and it gives the physio practical coaching points around what they need to improve, and gives you a much clearer direction on where your training needs to go.
The choice, honestly, is yours.