Introduction
You found out about the billing backlog three weeks after it started, from a denied claims report, not from your biller. You found out the front desk had been double-booking a specific time slot for a month, from a frustrated patient, not from your receptionist. None of this is new information to your team — they’ve watched it happening the whole time. They just didn’t tell you.
That’s not a communication problem you fix with a memo asking people to “speak up more.” Something already taught them it wasn’t safe to.
Silence Isn’t the Absence of a Problem — It’s Usually the Result of One
Nobody starts a job planning to hide things from their employer. People go quiet about problems for a specific reason: at some point, raising one didn’t go well. Maybe it wasn’t dramatic — a slightly defensive reaction, a “why didn’t you catch this sooner,” a sense that admitting a mistake or a struggle made them look less capable rather than more honest. It doesn’t take many moments like that before someone quietly decides the safer move is to handle it themselves, or just not mention it, rather than risk that reaction again.
The tricky part is that this often looks, from the owner’s side, like a staff that just doesn’t notice problems or doesn’t care enough to flag them. It’s usually the opposite. They noticed. They just did the math on what happens if they say something, and stayed quiet instead.
People Only Risk Honesty When They’ve Seen It Modeled First
There’s a story about a small business where a new employee is falling behind and terrified to say so — convinced that admitting it will get him fired or make him look incompetent. He doesn’t say a word, and the struggle just compounds quietly in the background. What actually changes things isn’t a policy or a meeting about “open communication.” It’s the owner openly talking, in front of the team, about his own mistakes and the things he’s struggled with. Once the person at the top has visibly gone first — admitted something real, without spinning it — it becomes safe enough for everyone else to do the same.
That ordering matters. Nobody wants to be the first person in the room to admit they’re behind or that something’s not working. Someone has to go first, and it has to be whoever has the least to lose by doing it — which is almost always the owner, not the newest hire.
What This Looks Like in a Practice
This doesn’t require a big culture initiative. It requires noticing your own reaction the next few times someone actually does raise something — a biller admitting she’s behind, a receptionist flagging a scheduling pattern that isn’t working, a PCC saying a process isn’t landing with patients. If the instinct is to explain why it happened, assign blame, or move straight to “why didn’t you catch this sooner,” that reaction is the thing training your staff to stop bringing you things. If the response is closer to “thanks for telling me — let’s figure out what’s actually going on,” that’s the version that gets repeated.
It also helps to go first yourself, occasionally and genuinely — mentioning a call you should have made differently, or a decision that didn’t pan out the way you expected. Not as a performance, but because it’s the fastest way to signal that being honest about something not working isn’t a liability in this practice.
Try This
Think back to the last time someone on your staff told you about a real problem — a mistake, a backlog, something not working. However you responded in that moment is very likely shaping whether the next person speaks up or stays quiet. If it wasn’t a genuinely welcoming response, the next time something small comes up, practice saying “thanks for telling me” first, before anything else — and mean it.
Then, at your next team moment, mention one thing you got wrong recently, plainly, without softening it. It’ll feel unnecessary. It’s usually the fastest way to find out how much your staff has actually been sitting on.
