Radical Accountability With Your Team: Why Lowering Your Standards Costs More Than Money With Adam Robin and Nathan Shields

Most clinic owners don’t struggle because they don’t know what to do…
They struggle because they wait too long to do it.
In this episode of the Private Practice Owners Club podcast, hosts Nathan Shields and Adam Robin break down one of the hardest leadership decisions in business:
When is it time to let someone go?
This isn’t just about performance.
It’s about culture, values, leadership, and the hidden cost of tolerating the wrong people.
Through real stories and firsthand experience, they unpack what happens when a single team member starts draining leadership energy, creating tension, and slowly eroding the foundation of your business — even if they’re producing.
And more importantly… what happens when you finally act.
In this episode, you’ll learn:
● Why high performers can still be the biggest liability in your business
● The real reason most owners wait too long to fire someone
● How toxic behavior spreads and impacts your entire team
● The difference between performance issues vs. cultural misalignment
● Why “exhausting every option” is often a trap
● How leadership avoidance creates bigger problems downstream
● The role of standards, accountability, and clear communication
● Why raising your standards always leads to better outcomes
● How strong culture attracts the right people and repels the wrong ones
● What happens to your team, energy, and performance after you make the hard call
You’ll also hear how one decision shifted an entire organization — improving morale, alignment, and long-term growth.
If you’ve been holding onto someone you know isn’t the right fit…
this episode will give you the clarity (and push) you need.
🎙️ Learn how to protect your culture, lead with conviction, and build a team that actually moves your business forward.
👉 Join our upcoming workshop and learn how to build a stronger, more aligned practice:
https://ppoclubevents.com/04-17-26-workshop
👉 Want help identifying gaps in your team, systems, and profitability?
Book a discovery call: https://calendly.com/ptoclub/discoverycall
💡 Love the show? Subscribe, rate, review, and share!
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Listen to the Podcast here
Radical Accountability With Your Team: Why Lowering Your Standards Costs More Than Money With Adam Robin and Nathan Shields
I’m thinking about someone we had to let go who was not meeting productivity expectations on a consistent basis, and we gave him support, but he was not acting out towards other people. He got along with the rest of the team pretty well.
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Where do you want to start the conversation?
Leadership Capital: When It’s Time To Break Up
I am sitting here thinking about. When you know, what is the trigger? When do you decide it is time? I do not know if I even have a clear answer for that. Maybe I do not know if there is an objective. When do you break up with the bad girlfriend or the bad boyfriend? Eventually, you just get tired. Eventually, you just get tired, and you feel like, I know for me, having been here a few times.
I get to this place where I am really tired emotionally, and I feel like there is nothing left that I can do. I am out of answers. I have exhausted every amount of leadership capital that I have. At this point, the only way to satisfy this person is to change who I am as a person, or, another way of saying it, to sacrifice my values. If it is money-related, then sometimes it is like I have to sacrifice the financial health of the business.
Unfortunately, it never turns out well.
No one wins at that. You know, like, "It is time."
Can I share my experience? You say, "When is it time?" It is easier in our positions when we are looking at other owners and their employees and their stories. Even in my individual cases, I have been around enough that I start getting inklings. Something rubs me the wrong way. It could have been some experience, either firsthand or from someone else, or frankly, seeing some metrics like, "That is not right." Not that there is a red flag, but my ears perk up. I need to pay attention to what is going on here and see if this starts becoming a trend. You are really good at addressing those situations of addressing it immediately.
I have to.
I am not as good. I take my time, maybe I am quiet. I am the type that is like, "Let us see how this plays, let us see what happens here," where I could probably use more of your go-straight-at-it value.
Maybe it is a bad thing, too, sometimes.
We go with it. We work with it. I think that is where it starts. Where does this land on the scale of acceptability? Which value are we maybe straining a little bit to accept this action? Be mindful, be observant, watch, see what happens. Usually, by the time owners come to us about it, it is frankly time. When it gets to the point where they are talking to us about it, it is time to cut the ties. I always have to remember the adage. I have never fired somebody too soon. We will always give them a leash. We will always try to be empathetic, even blame ourselves for the person's mistakes or inabilities, before letting them go.
The more that we can keep our ears perked towards what is happening, be observant, and watch the objective metrics as they come to us. I think we are going to be better served to let people go quickly, and that would be in the best interest of the business. In your situation, what would you have done differently? If you were to look at a judge, how you guys did things. Do you think you did it well? Did you follow a good process? Were you maybe turning a blind eye towards some of those activities because they were a good producer?
I was a little bit disconnected from the business last year, but that is not an excuse. I did not fully understand the gravity of the situation with this person because I was a little bit disconnected, maybe a little bit more disconnected than I should have been.
Would you say your leadership team then was you gave him too much of a leash?
Yeah. I think that they had a hard time understanding when it was time to have the conversation. We learned that lesson. We have acknowledged that together, and that starts with me modeling that better and also holding them accountable to that better.
Were they withholding some of the issues coming up from this person? I recognize that some of my team members, whom I found out after the fact had had experiences with these people, that I did not find out until after I let them go. I am like, "Dude, if I had known that you experienced that with that person, I would have let them go three months ago, because that is not acceptable." It sounds like maybe they were not sending up all the appropriate information to you.
Subtle Hints Vs. Direct Accountability
It was just a confusing thing. They were hinting at things.
I know exactly what you are talking about. Hinting, like hoping that you would get the message.
I had to tell them, "No, I am never going to get the message." I am so squirrel-brain. I do not have time for small talk. You just got to tell me. If something is important, I have to train my team. If something is important, it is like, "Nathan, I need you to sit down because we have to have a conversation about something important." That is how you address it with me. I had to teach them that, and that never happened. It was like these subtle little things. I blew it off like, "We will just handle that or whatever." I never really gave it the attention that was probably needed.
If they do not make it worthy of a conversation, you are going to blow it off with the same amount of importance as their subtle hints. If it is a subtle hint, you are just like, "It is not worthy of a conversation. I guess you got it handled."
It was a weird thing because what happened was, and hopefully we are not getting on too much of a tangent, but my leadership team started to get overwhelmed. I started to have a little bit of like, "Why are you overwhelmed?" I started blaming them. "You are the one who is not overwhelmed. You need to get your stuff together. What is going on here?"
I started looking at them, and then it snowballed into a weird thing that we had to rally around, but it all stemmed from this one person. One person who ruined everything that we had. We learned a lot about that. I came in, and I cleaned the shop and basically said, "Great person, I do not know anything about you, but you are about to learn a lot about me, and we are going to get to the bottom of this. What is going on?"
You handled it personally. You did not leave that up to your leadership team. I am assuming that in the future, they would handle this, but since it had gotten to this point, you handled it.
This was one where I had to step in. My thoughts are like, "I am going to approach this person, and I am going to hear them out. I am going to hear their concerns. If there is an ounce of opportunity for me to serve this person and to improve what we do to help this person, I am going to do it. I am going to go all in on this person. “
Talk to me a little bit more about what your mindset was, and did you have a structure of how that was going to go? What was your mindset going into it, and how did you frame yourself, like, “This is how I want this to go, or this is the structure I want to use?”
I just looked at it from a place of full service.
“How can I help this person? We are obviously out of alignment with our values.”
“I take full accountability, full ownership. Something has happened underneath my watch. I do not fully understand it. That is on me. I do not care. How can I help you? I am going to show you how much I care and how committed I am to trying to find a way to make this work.”
When you come in, what are some of the first things you say?
"Listen, I understand that this is happening. First thing I want to do is apologize."
I was wondering if you were going to go there. At some point, you have got to come in with, "Listen, it has gotten to this point, so I have to take responsibility." I find myself in that frame of mind or starting the conversation off like that frequently.
"By the way, I am taking full ownership of this. I am not here to argue what is right or what is wrong. Does it matter? All I want to do is show up today. I am going to serve you. I am going to show how much I care about this relationship. How can I help?" I got all the demands, and I was like, "Fine. Action item." I got my VAs, boom, spreadsheet, and mailed it over to him. "Here are my action items. Here are the things we are going to do. We are going to put all this together." It was things like the schedule, the communication, and just little petty things. Moved it all forward, put a lot of energy behind it.
That was after the first conversation.
After the conversation. It was not enough.
This was not the we need to let you go conversation. You were not necessarily going to say, "If we do not get these results, I am letting you go right now." How can I make this best for you so we can work?
I am going to have to draw a line. I want to make sure that I deposit into this relationship enough so that I can draw a line and feel like I have done my part to be able to ask for that boundary. That is basically what I did. It is like, "Man, I have exhausted all of my resources at this point. At this point, it is either you are going to hit the standard, or you cannot be here anymore."
Was this a situation where productivity standards were not met, or was this the way he was interacting with team members?
Team members.
You provide him this support, thinking, "This is going to calm you down and help you be an adult in the room.”
I am going to show you how committed I am to hearing you and serving you.
He was still not interacting appropriately with team members.
Values Vs. Ideology: Finding The Line Of Professional Misalignment
No. It really came down to the fact that he had this idea of what ethical care looked like. After repeated conversations with him, it became very apparent that he had this ideology that was not going to be. There was no wiggle room with him.
It did not work with him.
From my perspective, he did not realize how compromised his judgment actually was, and how blinded he was by his own depth. It is not possible to do what you are asking. It is just not.
There is no world in which that happens.
It just does not add up. It became apparent to me that there was no way to serve him anymore. It was like, "What if you just paid me by the visit and changed the structure and gave me my own special thing?" I was like, "I think we are done. I think it is pretty clear that you are not happy, and I am not happy. It is time to part ways."
Did you see that you were making changes, and he was not? Did he make much effort?
We just were not aligned. That is all it was. I do not think it was personal. I think it was that he viewed the world through a lens that I would never see, and vice versa.
We all know where that ends. I am thinking about someone we had to let go who was not meeting productivity expectations on a consistent basis. We gave him support, and he was not acting out towards other people. He got along with the rest of the team well. I remember Will shared from his exit interview. Will was talking to him, but he shared that he is like, "Some of the stuff you have been talking to us about, like how you manage people and whatnot, yeah, I do not like that."
We were like, "Cool. This is not going to work. Let us find a place where it will work for you. Will you give us four weeks to find your replacement? In the meantime, we will help you find yours. Where are you going to go next?" We literally did that. We reached out to friends who had clinics near his house and said, "We have got this great provider, and he is not working out for us, but he could definitely work out for you."
He is like, "You guys would do that for me?" We are like, "Dude, we want to serve you. Just because it does not work for us, does not mean you are a bad person. We just do not align, and that is okay." I say that not only to share how we did it, but also to recognize that I would not be surprised if he went somewhere else and met those production standards. He was more aligned.
Just because it doesn’t work for us doesn’t make you a bad person—we’re just not aligned.
He is a hard worker. He was a very hard worker.
It comes down to values. We had another person on the call talking about how a certain process was not being followed by the providers in getting patients to show up. They have a process between the front desk and the providers to get patients who did not show. There are the same culprits who are not getting it done. Somewhere along the way, you have to recognize that they are not doing it. I shared this before in the show, the Alex Hormozi thing.
They are not doing it for one of three reasons. Either they do not know what the expectation is, they do not know how to meet that expectation, or they do not understand why it is important or how it affects them personally. Why is it in my best interest to do this? A lot of it comes down to that third one. Are we just aligned? We talked about production, and the other owner talked about her provider. It was about production, but also the values just were not there. This provider was more focused on other things. We can move on from that. That is all right.
The Toxic Drain: Protecting The Emotional Health Of The Company
The challenge that I have is whenever drama starts. Whenever the toxic behaviors start. Talking behind the back, belittling the company, creating animosity, and draining the energy of the people around you. That is for me like I am a bull that is all red whenever that happens. I do not tolerate it. I get angry. It is so disrespectful.
I would never do that to another person, especially someone on my team. That was the case here for me. I noticed that not only was my leadership energy being drained, but so was the leadership team. We were doing 30 and 60-minute meetings about this guy over and over. Trying to solve this riddle that could never be solved. At some point, you've got to just pull the plug. Basically, I continued to watch him erode our culture. At that point, when I am firing somebody, I want to make a very clear statement to the team as well.
I want to do this in a respectful way, but at the end of the day, I ask myself, "What would my team think of me? What message do I want my team to receive?" That is going to determine how I fire you. In your case, it sounds like this guy was just not aligned, but was not causing the disruption. That is a professional misalignment. When you are eroding the emotional health of the company, you are fired immediately.
If someone is eroding the emotional health of the company, they need to go immediately.
If he were doing something like you are talking about, there would not have been this grace period. “Let us make amends, and things work out for you. It’s a nice transition.” No, it would have been, "Pack your stuff. You are out."
You are done, man. I have got too much riding on this. I care too much about this team, and there is not a lot of upside for you being here anymore, unfortunately.
“We cannot tolerate you being here anymore.”
“I am done.”
Do you see where maybe you could have or should have taken an off-ramp sooner in that relationship?
Had I been connected to the company a little bit more? Absolutely. One of the things that did cause me to hesitate, and when I say hesitate, I mean like three or four days, was financially.
I was going to go there, man.
The ROI Of Accountability: Why Recruiting Changes The Power Dynamics
“He was productive.”
I know. That is where many other owners and I hesitate. Usually longer than three or four days. Kudos to you. We hesitate because that is going to make my life really uncomfortable. It is going to make my team's life uncomfortable. I appreciate the revenue that they are bringing in. What am I going to do with all these patients now? How am I going to fill that spot? How much more can we tolerate of this person to maybe find the replacement or find the solution? That is where everyone gets stuck. You are an amazing recruiter. You are like a world-class therapy recruiter.
I got to add to that, too.
Now you are like, because I have been there. It s***. You are just like, "My employees hate being around this person. I hate being around this person. Maybe I just need to tolerate this person for a little bit.” It almost feels like a no-win situation. However, on the other side of it, it has always worked out better. My team rallies, our efficiencies improve, the environment is like butterflies and rainbows, and everyone's happy to be there. That shows up to our patients as well. You are in the middle of it. I know it is not totally easy, but it is better.
It is necessary.
What is the feedback from the leadership team?
They were nervous. I have got to remember this is a leadership team that has been beat up by their team for twelve months. They have been held hostage by this toxic thing for twelve months. They were tired. They did not really have the fortitude to make that call. They feared that if I fire that person, then that is going to trigger this person to quit, and that person to quit. We were going to start creating this. I had to stop. I was like, "Let them. We will start over. Whatever we have to do. We just cannot do it anymore."
Lock the doors.
We will shut down one of the clinics. I do not care. I had gotten to that point. All of this came back to, I knew that this year was going to be a rebuild year because of the turnover that we experienced. I knew that this was going to be a rebuild year. Going back to the book, Science of Scaling. We talked about that during our annual strategic planning workshop a little bit.
That is a good book.
We had to raise our floor. Raise our floor and narrow our focus and raise our floor. Essentially, what that meant was there was less that in order to grow and rebuild, we were going to have to tolerate less. That was my theme going into the year. I had that as a principle that I was committed to following. That pushed me through, helping me find clarity that I knew that this was the right decision.
The other thing is, it was like Monday or Tuesday, and I am stressed out because I am rebuilding this together. I am talking to Katherine, and this was a speech therapist. I am talking to Catherine, and she pulls up her phone, and she is like, "Look, that speech therapist we just offered just accepted the position." That was on Tuesday.
When did you let him go?
I got the offer on Tuesday. I let him go on Thursday. When you can recruit, you can push through. I was like, "It is a new grad. They are going to start on April 1st. I can push through for a couple of months without this guy. I am going to be low.” Guess what? That is why we keep cash in the account. That is why we have the line of credit. That is why we are here. We have prepared for this. Freaking go. We can make it happen. Just hired a PT. We have got a couple of OT interviews coming in. Let us do it.
The power of recruiting, man. We shared it at the workshop in January as well, but if you had a bench of available people, you would tolerate less on your current team. It shifts the power dynamics to the point where "You are being a jerk. You are productive, but we do not need to tolerate this because we have other people whom we have already interviewed. We know they are aligned with us. We are happy to bring them in. Here is the door."
Let me continue because this is important. There were a couple of other fringe people who were involved in this little fiasco in the clinic. One other PT, one other OT, and I had individual meetings with them. They were the first to find out that this guy was fired.
You went from one room to the next room. Just like what I did.
It was like the next day, one-on-one. It was like, "This is broken. What is happening is broken. You are a part of that. I am letting you know." I had a meeting with them on Friday. I said, "This guy is no longer with us. He has been terminated as of yesterday." "On Monday, I am going to get an email from you.”
Drawing The Line: Leveraging The Recruiting Bench
“It is either going to be your resignation letter or a letter telling me why you want to stay here and how committed you are to helping us grow this year. You decide." That was the end of the meeting, and they both stayed. You've got to draw the line, man. It’s because they were a part of it. They fed into it. They were still on the fringe. It is like they wanted to be here, but they were being pulled into it. I had to let them know things are going to change this year.
Going back to it, I know you can say that because you not only are committed, but you are leveraging your recruiting capacity to say, "You do not have to be here." I am assuming, and I think I have got a pretty good inkling, that they did not just submit their letter and say, "I am super committed." They still might be on the fence, but they just need a couple of months to find their next job. Just have to maybe go off the studies.
What do they say, 35% of your current team is actively looking for work right now as you speak, no matter what they say. I have been in your exact situation before. We cut off the head of the snake, but it was just a matter of time before the other people who were part of that and got the poison left. I know what you are actively doing is not because of them, but you are actively looking for their replacements, not because you are expecting their resignations over time, but you are actively looking for their replacements because that is what you do.
It is what I enjoy doing. I like the chase. I like the recruiting thing.
That was my experience. We cut off the main person, but the other people in time left. I should not say in time, within a few months. They left as well. I know you are in a prime position to replace them because we are looking for it. Not that you are inviting them out the door, but inviting them the other way. "Come join us. The water is warm over here.” There is that out there.
I have never had a negative ROI on higher levels of accountability and standards. It has only been whenever I have lacked accountability or bent or eased the standards that have always come back to get me. Holding a standard is scary. It is scary, but it is also free. It is remarkably freeing, and it will transform. It has always transformed my people. The right ones rally.
These conversations, I know I tell these stories with a lot of passion on the show, but I am not being a jerk to my team. I am trying to be diplomatic and fair and clear, but that is a scary thing for me to do. It takes a lot of courage, and I lose sleep over that stuff. Every time that I show up authentically and I draw a clear line, and I tell them that I will serve them with every ounce that I can, but there is a boundary that they are going to have to fall within, the people who want to be here stay, and they get focused, driven, and directed every time they get realigned.
They get refocused. I feel like that is really critical. I think of somebody like Spencer. I always talk about Spencer, but the way that he moves people with his leadership is really inspiring. That is one thing that he does really well. He has a standard, and he is not afraid to fight for it. He is not afraid to tell people, “This standard is worth fighting for. If you do not like it, you can hit the road." It works.
It actually attracts the aligned people. It not only strengthens your team, but you will start attracting like-minded people. I do not know exactly how that works, but you start getting clear on your values and how that is lived out in your organization. You get better at filtering out those people who do not work. Even during working interviews that we would have, team members would come back and be like, "I am not sure that person is a fit" because they know what a successful person in your organization looks like, acts like, feels like.
They can tell you better than you can sometimes that this person is a good fit or this person is not right. You start attracting those other people. As we started working a lot with the PT students in our area, the ones who worked well in our organization will start talking to their fellow classmates about, "I am in a great place over here." Usually, the ones that they are friends with, birds of a feather flock together, usually worked well in our organization as well. That starts to expand. Your values, your culture, start to get known and start attracting people into the organization.
Tip Of The Spear: Fierce Love And Protecting The "Bus"
The main point is, do not compromise your standards. Do not sacrifice your culture. Do not do it. Your values. I think about my children, my kids. For those who have kids, they find out a whole lot of things in this world that you would let compromise your kids. You would kill for them if you had to. How do we protect our company with that type of tenacity, fierce love, and unapologetic love and commitment towards it? Do not get on your heels with that. Get out in front and be the tip of the spear with that. If it is not a yes for them, get them off the bus. Get them off the bus. If you have got that person in your company that you are on the fence with, it is time for a conversation.
It’s often better for the business to let people go quickly.
Do not compromise your standards. Do not sacrifice your culture.
We only had like five owners on the call. Interestingly, this person brought up their issue, and everyone else had gotten through the same issue and could share the same experience. They are just like, "I have had that, suffered them for too long, tolerated them for too long. Once we let them go, things significantly improved." Not just the environment, but the numbers and the efficiencies, and life was just better. That is all we could say to this owner. It is scary, but it is going to be better.
I saw Craig Groeschel. I do not know if you have ever seen his podcast. You should check out Craig Groeschel's podcast. It is a really good podcast. He had a Facebook reel. One of the reels that I saw last night said, "If there is somebody in your organization that is causing a problem and you are not doing anything about it, you're the problem."
The Long Game: Modeling Standards For The Next Generation
I was like, "Ooh," and then I copied it and sent it to that person. I sent it to her, and she was like, "You are damn right." The one other thing that I wanted to share because I think there are a lot of people who are tuning in to this that can learn from my experience. You do not have to make the same mistake that I did. If there is anything, do not do what I did. I did not do it the right way this time.
That is what we are saying to everybody, “Listen to our mistakes so you do not suffer them.”
You can get away with these things when you are in the clinic every day. You can get away with it. You can move things. You have influence, and you can hide it with your energy and your leadership. When you try to open up three clinics, and you have 40 employees, and you are not there as much, you cannot hide it. It is going to be the standard that you set and the expectation that you have with your team that controls that.
I did not do a good job of making that standard known. Now we learned that lesson. That will not happen again. The point is that if you are an owner with a single practice and you have any ambitions, maybe you want to grow your team and take a vacation now and then, maybe open up a second location, or maybe you want to sell to your team one day.
If you ever want to build a business where you can create some distance from it, you have to be able to model that standard and get the right people on the bus and get the wrong people off the bus. You have to train your people how to model that standard as well. It starts with you. This is not even about you, really. It is about who you are being for the next person in line so that you can train them up. There is a longer game for the players, what I am trying to say.
If you want a business that runs without you, set the standard—get the right people on the bus and the wrong people off.
Out of curiosity, did you happen to have any members of your leadership team in on those discussions with this person?
Every single one. All of them.
It’s because you are modeling, right?
Totally.
This is part of your development process as a leader. You are going to sit in on these difficult conversations and watch how we do this at our organization. I think that is vital. We did not share that in our group call, either with the guy who was talking about someone who was not following the process or with the other owner who is dealing with this person. We should have made that recommendation that they have a member of their leadership team in on those conversations so that they can coach them and model what that conversation looks like. I think that is vital.
I think it is also really important because your leadership team is smart, and it is good to work with them because they can give you insights and perspectives that are within your blind spots that you cannot see. It is good to have them counsel you as a leader as well.
They can give you feedback, right?
Correct.
Also, in these disciplinary situations, which is what you are doing, legally, it is good to have a witness. Good stuff, man. I am sorry to hear that you had to go through that, but I am feeling like you guys are better off on the other side of it now.
Dude, Q3 and Q4 are going to be great. We are coming.
Here we go.
Coming back, baby.
Good stuff, man. Good talk. We will talk to you later.
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