For Growth-minded, independent, specialist physician-owners.
Why You’re Probably Solving the Wrong Problem in Your Practice
Faster, Simpler Goal Achievement Series, Part 3 of 4
GOAL ACHIEVEMENT
6 min read
Most practices feel busy because they are busy. Nothing wrong with busy - it will also be rewarding and profitable.
“Busy” is not the same as “constrained”. Constrained means the practice is not functioning to its potential. It’s not as rewarding, profitable or sustainable as it should be.
Where a constrained practice might have been OK in the past, as reimbursement continues its downtrend, and coding audits, even for traditionally safe coding practices (like CMS’s new attention on -25 modifier use) increase, there’s precious little room for revenue and profit loss.
There’s a huge and significant difference between “busy”, “symptoms” of practice problems, and practice “constraints”. If your practice is constrained in any way, you better get on it.
Symptoms vs. Constraints
Symptoms are loud and easy to see:
* Long days
* Overworked staff
* Backlogs
* Frustration
Constraints are often hidden:
* A single bottleneck limiting throughput
* A decision the owner won’t make
* A system that no one owns
Practices that chase symptoms spend more money and get more tired. Practices that identify constraints get leverage.
The Mistake Almost Everyone Makes
Owners often assume the most visible problem is the most important one. For example: Hiring because everyone feels stretched, marketing because the schedule looks uneven, or adding space because rooms always feel full.
But if the true constraint lies elsewhere, like documentation time, hand-offs, scheduling logic, or owner dependency, those fixes don’t help. They might just make things worse. And might dig into profit for no ROI.
A Simple Constraint-Finding Exercise
Finding your true constraint isn’t about guessing or choosing what feels most painful in the moment. It’s about identifying the single factor most directly blocking your primary objective at this moment in time.
Managing by fixing the single constraint blocking the attainment of your single, most important objective is the difference between profitable, easy practice management and what most practice owners hate about being practice owners.
Sometimes, identifying the single constraint IS easy; for example, if a doctor simply refuses to see patients, you don’t need to look any further to know why revenue isn’t up to industry standards. Of course, most of the time, practice owners don’t have this obvious an issue, and chase symptoms, not root cause (the constraint).
Here’s a practical, step-by-step way to make sure you find the true constraint, even if you’ve never done this type of analysis before.
Step 1: Get clear on your most important primary objective
Before looking for a constraint, define the outcome you want most right now. For example: “Increase annual revenue by 15%”. Keep it specific. “Do better financially” or “fix the chaos” is too vague to diagnose properly.
Step 2: Identify the gap between where you are and where you want to be
Ask, “What might be preventing this goal from happening?”
Write down everything that comes to mind, without filtering.
Common answers to not having enough revenue might include:
• Not enough patient visits
• Low collections
• Poor payer reimbursement
• Documentation taking too long
• Too many interruptions
This list will mostly be symptoms, and that’s okay. This is your starting point.
Step 3: Use the “Why?” drill-down to move past symptoms
Take each item and ask: “Why does this happen?”
Then ask “why?” again to the answer you just wrote. You’re digging toward the underlying cause, not stopping at surface frustration.
Continue asking why for each thread of the list of symptoms until multiple symptoms trace back to the same root issue. This is your root cause, or constraint. You’ll solve only for this.
As an example, I’ll show the process using only 1 symptom, for clarity.
Example:
Problem: “We don’t generate enough revenue.”
→ Why don’t we have enough revenue? “Charges are low.”
→ Why are charges low? “We don’t see enough patient visits”
→ Why don’t we see enough patient visits? “No Marketing”
→ Why aren’t we marketing? “We don’t know what to do that would work and be cost-effective”.
There’s your answer. If you asked “why” again, it probably wouldn’t be helpful nor actionable (like “we were never taught how to market”. Duh). That you don’t know what to do that would work and be cost-effective does provide a way forward and is a very basic root cause.
So, you’d solve for that, either by DIY research and learning, or hiring it out.
This is obviously a very simplistic example.
Usually there are several symptoms when you ask why you have the problem. With “charges were too low”, in addition to not enough patient visits, you might have symptoms like “the doctor not treating what he sees”, or “not charging what he treats” or “seeing patients with brutally poor payer reimbursement”.
Each one of these symptoms is its own thread. You’d ask “why” for each thread until you get to a root cause for each one.
This process is typically diagrammed out. Here’s what a diagram might look like (this is a partial diagram. You can see the full diagram in my free download: Faster, Simpler, More Cost Effective Goal Achievement. Get it HERE).
As you can see here, each symptom is tracked further down on its own thread. Each subsequent “why” is also traced further down until each thread ends at something for which there are no more “whys” (this isn’t shown here, but is in the free download).
Surprisingly, the end of each thread often has the same root cause, and is something very, very fundamental.
Step 4: Pressure-test for the real bottleneck
Once you think you’ve identified the constraint (root cause), ensure that the following is true:
• The constraint directly limits revenue, capacity, or execution of your goal
• If this were fixed, several other problems would naturally improve
• Solving other issues without fixing this one would not have much direct and significant impact on the problem
A real constraint usually affects many areas at once, and may have multiple syptoms, even though it's root cause is often just one thing (like missing policy or protocol). Real constraints hold back overall performance
Step 5: Confirm it’s actionable
A true constraint must be something you can influence. It is ALWAYS an internal problem. It's ALWAYS a problem you can fix. ALWAYS. ALWAYS. ALWAYS.
Symptoms that end at an external cause for which the practice has no effective control are not constraints, and so not a root cause. Constraints must be addressable – something the practice can actually do something about.
Examples of things that are not constraints:
• “Patients are sometimes late”
• “Reimbursements are lower than years ago”
• “Healthcare is changing”
There are also some “internal” problems that are NOT constraints. They aren’t external to the practice but are not “solvable”. Here’s an example:
Symptom: “We don’t generate enough revenue.”
→ Why? “Revenue per visit is low.”
→ Why? “Appointments are rushed and not all care is delivered or coded.”
→ Why? “Appointment book is over-booked by more than 125% of capacity, all the time”
→ Why? “Doctor wants it that way”
→ Why? “The doctor believes that more patient volume equates to more practice revenue, is spite of all data to the contrary".
Now, this last answer might certainly inhibit revenue per visit, but would only be a root cause, or a “true” constraint, if it could be fixed.
If the doctor was shown evidence that his decision to overload the book resulted in less gross revenue due to revenue per visit loss (and created other undesired results), he might then change his protocol, and thereby turn this answer into an actionable constraint.
However, if there is no solution possible because the doctor doesn’t want to change it, then it is not a “constraint”, by definition.
We call issues (whether external or internal) that are not under the practice’s control “facts of life”, or "limiting factors", not solvable bottlenecks.
Symptoms that end at the practice owner’s personal decision, preference, or a belief he won’t change are considered facts of life, or limiting factors.
True constraints look like:
• Missing or broken scheduling protocols
• Poor hand-offs between staff
• Inefficient use of doctor time
• Lack of training or clear processes
• Policy decisions that slow flow
If you can execute a plan to fix it, it’s likely valid.
Why This Matters
Practices that chase symptoms:
• Hire more people they probably don’t need
• Spend more on marketing they might not need
• Add technology they don’t need
• Expand space they don’t need
…and still be stuck.
Practices that solve constraints:
• Get immediate leverage
• Improve results with less effort
• Create sustainable growth
They’re not doing more. They’re fixing the right thing first.
👉 My full guide provides a step-by-step method (with examples and pictures) for identifying the true constraint without endless debate. Download it for FREE, HERE
If you missed parts 1 or 2 of this series, you can read them here:
Part 1: Why Most Practice Goals Fail (and the One Shift that Changes Everything)
Part 2: The 3 Forces that Decide Whether Your Practice Goal is Real or Just a Wish
Faster, Simpler, Goal Achievement: Part 3 of 4
