For Growth-minded, independent, specialist physician-owners.
The 3 Forces that Decide Whether Your Practice Goal is Real or Just a Wish
Faster, Simpler, Goal Achievement Series, Part 2 of 4
GOAL ACHIEVEMENT
7 min read
Every practice goal sounds good on paper: “Higher profit.” “Better staff.” “Less stress.” “More growth.”
The problem isn’t the goal itself. The problem is whether the goal is actually achievable in the real world of your practice. And that comes down to research and more importantly, alignment.
The Three Forces Every Achievable Goal Must Balance
Every goal that actually gets accomplished balances three components*:
1. Wealth – the financial result you want (profit, revenue growth, ROI, cash flow)
2. Impact – the effect you create, not only from a service view, but also operationally (workflows, patient volume, services, systems, staffing and physician behavior)
3. Commitment – the effort, persistence, time, and resources required
When these three aren’t aligned, the goal quietly turns into a “wish”. Wishes only come true in fairy tales.
* This specific component breakdown comes from Danny Iny, founder and CEO of Mirasee. Brilliant, thoughtful guy.
Where Most Goals Break Down
Common goal component mismatches look like this:
Wanting more revenue (wealth) without treating everything you see or coding what you treat (impact)
·Wanting better staff performance (impact) without implementing systems, training, and accountability (commitment)
·Wanting growth (wealth) without working to capacity (impact) or expanding provider resources (commitment)
These may look obvious, but they happen constantly anyway.
One of the most common alignment problems lies in commitment: the commitment required is higher than the owner (or stakeholders) truly agree to and/or anticipate. If they underestimate the commitment needed, momentum quickly fades when they encounter resistance.
Stakeholders Are (Usually) Part of the Equation
Most goal attainment doesn’t just rely on the owner.
Partners might need to adjust strategy, capital, or risk. Associates may need to change productivity or workflows. Staff might have to adopt new responsibilities or systems.
Misalignment leading to failure rarely shows up as open refusal. More often it shows up passively as: “delays”, “forgetting”, half-implementation or passive resistance. If left unaddressed, this quietly kills execution.
So, proper alignment often must include everyone implicated in the goal. They at least need to buy in enough to not be an active or passive barrier to success. This step has to be expertly managed at the front end of any goal attainment project.
There is more than one way to overcome buy-in resistance on the front end of change, and should be thoroughly addressed by leadership before getting into the weeds of execution. “Change Management” is often an expert-led process, and can be tricky. I’ll detail some tips and process steps you can take in upcoming blogs.
In the case of AI driven tool builds and implementation, getting buy-in and agreement pre-demonstration or trial use might not be the most effective sequence, so in some cases, you can bypass the typical resistance to change by just using the tool and getting feedback over trying to manage pre-use supposition and fear.
As development costs decrease and build speed increases, it’s easier to demonstrate the effectiveness of an AI tool IRL (in real life) than it is to try to convince people to take a pre-demonstration leap of faith with you.
So, “hands-on” use by stakeholders before decision-making can be the turning point for successful implementation. Note that this is only advisable where pre-decision tool use would be simple to try and would not affect critical work flows if it failed in trial.
Vendors should provide working models and ample “play” time for any tool, software or AI assistant you are considering instead of just offering a polished presentation that might hide difficulties (who can forget the “miracle” of the EHR?). And owners must allow stakeholders plenty of time to become familiar with the tool under consideration.
A Clear, Practical Alignment Check
Use this simple process to choose and get alignment for your primary goal and objective. A real example follows this section to provide more clarity.
Step 1: Define your goal and note whether it is an impact or wealth type goal
For growth-minded practice owners, most goals are “wealth-type” - to increase revenue, growth or profit. For example, if you wanted to increase annual gross revenue, write down:
• Current reality (e.g., $500,000 annual FTE provider revenue)
• The Goal and Objective (e.g., Increase Gross Revenue [the Goal] to $650,000 annual FTE provider revenue within 12 months [the Objective]). This is a “wealth” goal.
Step 2: Identify what might have to happen to the other corner (say, the “impact” part) of the goal component to balance the named goal
For example, to increase annual revenue per FTE physician:
• You might need to increase new and/or total patient visits
• You might need to generate higher revenue per visit
• You might need to change service or payer mix
• You might need to schedule patients for better utilization
• You might need to improve collections
• You might need to reduce time and resource waste
Look at your metrics and reports to find potential areas such as these. Talk with your biller, manager and staff. Talk to colleagues or a consultant, or research industry reports to see what’s possible. Base this on reality, not guesses.
Write down what these different scenarios might be, with numbers based on comparing what you do now with benchmarks and what appears reasonable for you.
Step 3: Map who must change behavior
For each potential change, note who must do something differently. Include yourself. This often reveals where hidden, potential resistance or overload may exist.
Step 4: Evaluate commitment honestly
Now ask:
• Who absorbs more work, discomfort, or risk?
• Are they truly willing and prepared to do so?
• Are resources (time, money, training) in place to support it?
If not, either:
✔ Increase commitment/resources
✔ Or adjust the goal to match reality
There’s no failure in adjusting - only in ignoring misalignment.
A Real World Alignment Example
Let’s walk through how a practice owner might use this process with a common goal: increasing annual revenue.
Step 1: Define your goal and note whether it is an impact or wealth type goal
The owner writes:
Current annual revenue per provider: $500,000
Target revenue: $650,000
Timeframe: 12 months
At first glance, a $150,000 increase feels aggressive.
Before moving on, the owner decides if the goal seems realistic given current resource availability, payer mix, and facility capacity by reviewing reports, industry benchmarks, and doing a little research with colleagues, a mentor or consultant.
The owner decides that $650,000 per FTE physician in 12 months is achievable if operations improve. So, the goal is realistic, and the objective is specific, measurable, achievable, relevant and time-bound.
Next, the owner asks, “Where might there be opportunities to increase revenue by $150,000 per FTE physician?” He looks deeper into different areas of the practice and finds some potential opportunities:
· Average revenue per visit is currently 20% below industry standard
· Schedule utilization is 78%, and should exceed 95%
· Documentation delays are causing missed charges
· There is capacity to see more patients if flow improves
He looks at these options to see what revenue could come from these different areas:
· Improving scheduling utilization from 78% to 90% could add ~$60,000 per FTE physician
· Increasing revenue per visit by improving pathology capture and care could add ~$50,000 per FTE physician
· Better documentation/coding could add ~$30,000 per FTE physician
· Reduced collection leakage could add ~$20,000 per FTE physician
Together, this exceeds the $150,000 per FTE physician target.
Step 2: Identify what has to happen to the other corner (say, the “impact” part) of the goal component
Now the owner looks at each driver to see what would have to change operationally to produce the revenue increase. For example:
Scheduling utilization improvement requires:
Front desk tightening confirmation processes
Changing how no-shows are handled
Adjusting template blocks
Documentation/coding improvement requires:
The provider completing notes same day by refining templates
Possibly adopting new documentation workflows
The Biller flagging missing charges quickly
Reducing leakage requires:
Clear hand-offs between clinical staff and billing
Regular audits
Better A/R management
The owner realizes this isn’t just “wanting more revenue.” It requires daily behavior changes from staff and himself.
Step 4: Evaluate Commitment Honestly
Now comes the reality check.
Is the owner willing to change? He'll need to change how he documents. He'll need to be held accountable to new systems (it's not just ensuring everyone changes around him, and he stays the same). Is he willing to actually spend time and energy making sure everyone else is doing their part, building new habits?
What about staff? Will this increase their workload? How can it be done?
Does everyone need training, systems, or consulting support?
He recognizes that the front desk will have more responsibility. His associates will need to change some of their habits, and he'll have to spend more time managing the change. There's definitely going to be some short-term discomfort all around.
But he decides he’s willing to commit resources and attention to make it happen and staff seem willing as well. If he wasn’t, the goal would need adjusting.
The Result of the Alignment Check
Instead of a vague goal: “Increase revenue this year”, the practice owner now has:
✅ A clear financial target
✅ Specific operational drivers
✅ Named behavior changes
✅ Honest commitment assessment
Which leads to a real strategic focus: “Over the next 90 days, we will fix scheduling utilization and documentation workflows as the first drivers of revenue growth.”
Why This Works
Without alignment, the owner might have spent more on marketing, hired prematurely, or blamed staff performance, all in error. These are expensive, unnecessary errors.
With alignment, everyone knows exactly what must change and who must change it. Successful execution becomes far more likely.
When Alignment Is Done Right
When wealth, impact, and commitment line up the goal feels challenging but achievable. Resistance is manageable. Execution becomes far smoother.
When they don’t, you fight the practice constantly. Progress stalls and frustration grows. This really is where burn-out starts.
The Next Critical Step
Whenever your activities involve operations (most of them will), there is likely to be a constraint blocking effective process or productivity.
So while getting alignment between wealth, impact and commitment is necessary, if you aren’t clear about the root cause of what to change to achieve that balanced goal, you’re still at risk for failure.
On the other hand, if you take the next step, getting to your goal becomes much easier, faster and less stressful.
This next step is pretty simple and works like magic: BEFORE you decide what to change to achieve your objectives, find the constraint inhibiting that achievement (aka root cause) and only solve for that.
This process is your strategy to goal attainment: find the current constraint hampering your goal, find its root cause, and only solve for that root cause.
In this way, your strategy is laser-focused, highly leveraged, and potentially very simple to address.
👉 Identifying the biggest barrier, the first single constraint preventing your goal from happening is exactly what we’ll cover in Part 3: “Why You’re Probably Solving the Wrong Problem in Your Practice.”
👉 My full “what to do and how to do it” E-book: Faster, Simpler, Goal Achievement provides a step by step, concrete alignment diagnostic to surface these issues before momentum is lost. Download it for FREE HERE.
If you missed the first post of this series, you can read it HERE: Part 1: "Why Most Practice Goals Fail (and the One Shift that Changes Everything)"