Chiropractic + Naturopathic Doctor

Using Performance Reviews to Leverage the CHA Role

By Brandi MacDonald   

Features Business Management

As the calendar year winds down, chiropractic practices often begin to
wind down for the holiday season as well.


As the calendar year winds down, chiropractic practices often begin to wind down for the holiday season as well. Reflecting over the year usually involves analyzing practice targets, reviewing goals and objectives that were set, and celebrating successes with patients and staff. This time of year also presents us with opportunities to review these elements with our team members.

When it comes to staff evaluation, performance reviews are the most misunderstood, and least implemented, tool particularly in chiropractic practices. I think this has happened for a few reasons. Many of us who are the business owners probably, at one time or another, had a “negative” experience with having our performance reviewed by past employers. Therefore, we tend to avoid this process when we have our own staff. Other business owners have never performed or, had a performance review. This lack of knowledge, or personal bias, leads to paralysis, and staff members will ultimately have to endure the consequences of the business owner’s lack of leadership.


Performance reviews are one of many tools used by powerful leaders. The number one reason staff members leave jobs is not money, it is lack of validation and involvement. I speak to CHAs all over North America, and the common question I get is “How do I know if I am doing what the DC wants?” So, I pose these questions to you, the reader, now;

  • How does your CHA know what you want?
  • How does your CHA know what the direction of the practice is?
  • How do you provide feedback, validation, praise and constructive opportunities for growth?

If your answers to these questions are “I don’t know”, this article is for you!

Do-ing a performance review
In order to position your team to maximize their roles in your practice, you must provide clearly defined expectations aimed at specific outcomes.

The question that I ask is “What makes a successful team member?” The answer to this question is a position description. Position descriptions are outcome-based, clear, and simply written. If you don’t have an outcome in mind, what are you measuring when you complete a performance review? Start with the end in mind. If staff have a position description, they become clearer on their roles in the practice. This leads to less conflict, and more clarity for everyone.
If your practice has clear position descriptions, performance reviews become much easier to create and complete. Here are the basic “do’s” of holding performance reviews with staff:

  • Do use the position description to describe areas of success and strength of the last year.
  • Do be open to changing the position descriptions; as our practices evolve, our roles in the practice need to evolve.
  • Do allow feedback on your performance. This meeting
  • requires a reciprocal approach, and staff need to
  • feel comfortable enough to provide feedback to you
  • as well.
  • Do set goals and objectives for the next year. This is
  • pivotal in managing staff performance. Staff members need to know there is opportunity for advancement and further learning.
  • Do talk about areas of potential improvement, and link these to goal setting.
  • Do this meeting away from patient time. This must be dedicated time between you and your staff members. They deserve your undivided attention.
  • Do have a monetary or financial system that matches performance and allows for financial growth. The performance review is the time to provide monetary “rewards” for performance.

What not to air
There are also some basic “don’ts” when giving performance reviews. If these are avoided, the process will be much more rewarding:

  • Don’t use this opportunity to bring up performance issues if you have never talked about them before. This is not the time. You must have mechanisms in place to immediately correct poor performance at the time it occurs and not wait for a year, and then bring it up. If performance issues have been previously addressed, and are still a concern, this can be the time to talk about them.
  • Don’t be unbalanced in your perspective with performance. It should be a combination of strength and areas for improvement.
  • Don’t write a review and file it away in the archives to never see it again. This is a tool for communication between you and your staff. Goals should be reviewed at least one time within the year.
  • Don’t hold a one-sided meeting. Performance reviews are reciprocal meetings done with your staff not on your staff
  • Don’t get caught up in making sure you have the “right forms, the right approach, the right words”. What is important is that a conversation happens between you and your staff, about their roles, goals for the next year and what you can do to support their growth.

It’s about loving your mission
I think we have a human resource crisis in chiropractic. When our staff leave our practices, they leave the profession. If this were to occur in any other profession, there would be public outcry over it! In chiropractic, we just keep hiring and training new staff – which is exhausting! If your practice has staff that you want to retain, performance reviews and good management is paramount to this retention.

The wife of Ken Blanchard, one of the great leadership authors and entrepreneurs (writer of One Minute Manager, One Minute Entrepreneur, etc.) summed up leadership beautifully. She said, “Leadership is love. It is not about love. It’s loving your mission, loving your customers, loving your people and loving yourself enough to get out of the way so other people can be magnificent. That can only happen when you have your priorities in order.”

Make, and keep, your staff your priority. Create opportunities for them to show you their magnificence. This will not only advance chiropractic, but will also enhance the patient experience in your practice. •

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