Introduction
You know exactly what you want this practice to look like in five years. Maybe it’s a second location. Maybe it’s cutting your hours in half without losing revenue. Maybe it’s finally being known as the practice in town that actually gets people in same-week. You’ve thought about it plenty — on the drive home, at 11pm doing charts, during that one slow Wednesday. You’ve just never said it out loud to the three or four people who work for you.
That’s not a small oversight. It’s the reason half of what your staff does every day doesn’t seem to add up to anything.
A Vision Nobody’s Heard Can’t Guide Anybody’s Decisions
There’s a concept in The System, a book on how growing companies get organized, called the Five-Year Priority — a single, specific target set far enough out to be ambitious, but real enough that people can actually rally around it. The book’s example is PepsiCo, whose Chief People Officer set the company’s five-year goal in exactly two words: “Beat Coke.” Not a mission statement. Not a paragraph about values. A target so plain that employees decorated their own cubicles with war paraphernalia and wore face paint to work. It wasn’t clever marketing — it was just clear enough that people could act on it themselves, without checking in first.
That’s the part practice owners miss. The value of a five-year vision isn’t that it exists somewhere — plenty of owners have one, fully formed, in their head. The value is that other people can hear it and use it to make their own calls. If your biller doesn’t know you’re trying to add a second provider next year, she has no way to know that the way she’s currently batching claims won’t scale. If your front desk doesn’t know you’re trying to shift toward fewer, longer visits instead of high patient volume, she’ll keep optimizing the schedule for volume, because that’s the only version of “doing a good job” she’s ever been given.
Your Staff Isn’t Misaligned On Purpose — They’re Aligning to Whatever You Handed Them
This isn’t a motivation problem. Nobody on your staff wakes up trying to work against where the practice is headed. They’re aligning to something — it’s just today’s chart, today’s phone queue, today’s fire, because that’s the only target that’s ever been made explicit to them. Left with nothing bigger to aim at, everyone defaults to reacting to whatever’s directly in front of them, one decision at a time, the same way a road gets paved over a cow trail — not because anyone chose that path, but because nobody chose a different one out loud.
You don’t need a strategic plan document. You need one sentence, the way Pepsi had one. Something like: “In five years, we’re not the practice that sees the most patients — we’re the practice patients wait for.” Or: “In five years, I’m not doing intake calls, insurance verification, or scheduling — someone else fully owns each of those.” Vague enough to leave room for how you get there, specific enough that your team could repeat it back to you tomorrow morning.
Try This
Say your five-year picture out loud, once, to your whole staff — in a real sentence, not a vibe, the way Pepsi said “Beat Coke” instead of “grow market share.” Then ask each person, separately, what it means for what they do day to day. If your biller can’t connect the five-year picture to how she handles this week’s claims, or your PCC can’t connect it to how she talks to patients on the phone, the vision hasn’t actually landed yet — it’s still just yours.
Once the five-year picture is out loud and shared, you’ll usually find gaps you couldn’t see before — a role that doesn’t exist yet, a workflow that won’t hold up at the scale you’re aiming for, capacity that simply isn’t there. That’s often the real reason practices come to us at The Coordinators: not because today’s problem is urgent, but because the picture five years out made it obvious today’s team can’t get there alone.
