Is Your Practice Culture Broken? How to Fix the 5 Dysfunctions of a Team
Be honest with yourself for a minute. Think about the real, day-to-day culture in your practice.
Is there gossip? Do the front desk and the clinical staff operate in separate, resentful silos? Do people avoid bringing up real problems in meetings, only to complain about them later behind closed doors?
If you nodded yes, your practice has a culture problem. And that culture problem is costing you a fortune in inefficiency, staff turnover, and revenue leakage.
I truly believe that when you have the right person in the right seat, they come to work with the best of intentions. People don’t want to do a bad job. So why do things fall apart? It’s almost never because someone wants to fail. It’s because the system they’re in is broken.
Patrick Lencioni’s classic book, “The Five Dysfunctions of a Team,” provides a powerful framework for diagnosing and fixing these issues. Lencioni’s model is a pyramid, and if the foundation is cracked, everything above it will crumble. Let’s look at the five dysfunctions through the lens of a medical practice.
The 5 Dysfunctions Plaguing Your Medical Practice
Dysfunction #1: Absence of Trust
This is the foundation. It’s not about trusting people to do their jobs; it’s about vulnerability-based trust. It’s the safety to admit mistakes, ask for help, or say “I don’t know” without fear of judgment. As a leader, you have to go first. You have to be the one to admit to mistakes and talk about your own weaknesses to build that foundation.
Dysfunction #2: Fear of Conflict
When there’s no trust, you can’t have healthy, passionate debate. Instead, you get artificial harmony in meetings, followed by toxic conversations in the hallways. As a leader, you have to mine for conflict. You have to ask for feedback, call out issues, and not let people retreat. You hired smart people; you need to hear their ideas.
This friction between your front desk and your billers is a classic symptom of a dysfunctional team. And it almost always starts with eligibility. If your front desk isn’t getting eligibility right, it creates a cascade of denials that your billing team has to clean up, creating resentment. We created a free guide to help fix this exact problem. It’s our Eligibility & Billing Verification Checklist. It will give your front desk the exact process they need to get it right the first time.
Dysfunction #3: Lack of Commitment
When people don’t weigh in (because they fear conflict), they don’t buy in. If your team hasn’t been part of the debate and had their concerns heard, they will not be committed to the final decision. This leads to ambiguity and a lack of follow-through.
Dysfunction #4: Avoidance of Accountability
This is about peers calling each other out, not just the leader being the sole enforcer. When the team doesn’t commit to a plan, they won’t hold each other accountable.
- In your practice, this looks like: A provider consistently forgets to sign their charts, delaying billing by weeks. The billing manager is the only one who says anything. The other providers see it, but they don’t want to create conflict. The behavior never changes.
This lack of accountability has a direct, measurable impact on your bottom line. When charts aren’t signed, you can’t bill. When you can’t bill, your cash flow dries up. These small cultural issues create huge financial leaks. We’ve seen it all, and we’ve compiled the biggest risks into our Margin Protection Playbook. It’s a free audit to help you find where your practice is most exposed.
Dysfunction #5: Inattention to Results
When no one holds each other accountable, people naturally focus on their own individual needs or the goals of their department, not the collective results of the practice.
- In your practice, this looks like: The front desk is focused on reducing patient wait times, so they rush check-in and miss critical insurance verification steps. The billing department is focused on their goal of clean claim rates, but they are constantly fighting the errors created by the front desk. Everyone is hitting their individual goals, but the practice’s overall revenue is suffering.
5 Strategies to Fix Your Dysfunctional Practice
You have to address these dysfunctions from the bottom of the pyramid up. Here’s how to start.
- Build Vulnerability-Based Trust: As the leader, you must go first. Talk about a professional weakness or a mistake you made. This gives your team permission to be human.
- Mine for Healthy Conflict: During meetings, don’t let people be silent. Call on them directly. “Sarah, you’re on the front lines of this. What are the potential problems you see?”
- Force Clarity and Buy-In: At the end of a decision, go around the room and ask, “Can you support this plan?” People don’t have to agree, but they must commit.
- Create Peer Accountability: The daily huddle is the perfect place for this. When you publicly review key metrics like open charts, you create a structure for the team to hold each other to a shared standard.
- Focus on a Single, Shared Goal: Your practice needs a unifying goal that everyone contributes to, such as “Reduce claim denial rate by 10% this quarter.” When the entire team is focused on the same scoreboard, the silos start to break down.
Fixing your culture is not soft stuff. It is the hardest, most important work you can do as a leader. A dysfunctional team often leads to a dysfunctional revenue cycle. To see how deep the problems go, get our free Margin Protection Playbook and find the leaks in your practice.
