1. The Disruption (Challenge the Model)
You think retention is about Grand Gestures.
- Bonuses.
- Christmas parties.
- Team trips to Cabo.
These are nice (like a painkiller). But they don't cure the disease.
Employees don't quit the Practice. They quit the Process.
2. The Anchor (The Familiar Experience)
Imagine you are hiking a beautiful mountain. The view is amazing. The weather is perfect.
But you have a tiny, sharp pebble in your left shoe.
For the first mile, you ignore it. By the third mile, it's annoying. By the tenth mile, every step is agony.
You don't care about the view. You just want to take the shoe off.
If I offered you $100 to keep walking with the pebble, you might do it for an hour. But eventually, you will quit the hike.
3. The Reorganization (The "Oh" Moment)
Your office is the Hike.
The "Pebbles" are the low-value, repetitive tasks that interrupt their flow.
- For the Front Desk: Having to stop everything, find a list, dial 20 numbers, leave voicemails, and get rejected. That is a sharp pebble.
- For the Assistant: The Sterilization Backup.
They aren't burnt out from the work. They are burnt out from the friction.
4. The Why (The Mechanism)
This is "Cognitive Erosion."
High-friction tasks release Cortisol (stress). Doing this 5 times a day creates a chronic stress state.
No amount of bonus money removes the Cortisol. Only removing the task removes the Cortisol.
5. The Solution (The Friction Removal Rule in Practice)
Identify the task your team dreads the most. Automate it or Delete it. Here are the exact playbooks.
Playbook 1: The Dread Audit (Find the Pebble)
What you do:
Ask every team member one question: "What task do you hate the most?"
Not in a group meeting. One-on-one. Privately. Let them be honest.
Common answers you'll hear:
- "Cold-calling the recall list."
- "Calling patients who owe money."
- "Chasing insurance claims on hold for 45 minutes."
- "Confirming appointments when nobody picks up."
Write every answer down. Rank them by frequency. The task mentioned most is your biggest pebble.
Why it works:
- You stop guessing what's wrong. You get data.
- Employees feel heard. That alone improves morale before you've even fixed anything.
- You now have a prioritized list of friction to eliminate.
Playbook 2: The Automation-First Rule (Replace the Pebble with a Machine)
The Rule: Before asking a human to do a task, ask: "Can a machine do 80% of this?"
Common pebbles and their automation:
- Recall cold-calling → Automated text/email sequences. The system sends reminders. Humans only call patients who responded but didn't book.
- Appointment confirmations → Automated text confirmations. "Reply Y to confirm." Humans only handle the non-responders.
- Insurance claim follow-up → Auto-tracking dashboard that flags claims over 30 days. No more manually checking every claim.
- Cancellation filling → Automated waitlist system (like Chairfill) that texts available patients. No more dialing 20 numbers from a sticky note.
Script to introduce automation to the team:
"I know [task] is the worst part of your day. I'm removing it. Starting next week, a system handles this automatically. You'll only step in if the system needs help. Sound good?"
Why it works:
- You removed the Cortisol trigger. The task that drained their brain by 2 PM is gone.
- Energy freed up for high-value tasks: patient relationships, case presentations, handling complex situations.
- Retention improves because the job actually becomes enjoyable again.
Playbook 3: The Elimination Test (Delete the Pebble Entirely)
The question: "If we stopped doing this task entirely, what would actually happen?"
You'd be surprised how many tasks exist simply because "we've always done it."
Examples of tasks to challenge:
- "We call every patient the day before to confirm." → If you switched to text-only confirmation, would outcomes actually change? (Usually no. Often they improve.)
- "We print paper charts for the Doctor." → Does the Doctor actually need them, or is it a comfort habit?
- "We fax referral letters." → Can this be emailed? Or handled through the PMS?
How to test it:
- Pick one task you suspect is unnecessary.
- Stop doing it for 2 weeks.
- Measure: Did anything bad actually happen?
- If nothing broke, the task is eliminated permanently.
Why it works:
- Many pebbles are legacy habits, not actual requirements.
- Deleting a task is infinitely better than optimizing a task that shouldn't exist.
Playbook 4: The Team Feedback Loop (Prevent New Pebbles)
The problem: You remove one pebble. Six months later, new ones appear. Growth creates friction.
How to prevent it:
Run a quarterly "Pebble Check." 5-minute anonymous survey. Two questions:
- "What task is wasting most of your time right now?"
- "If you could change one thing about your daily routine, what would it be?"
Review results at the next team meeting. Pick the top pebble. Assign someone to automate, delegate, or delete it within 30 days.
Why it works:
- Friction gets caught early, before it becomes burnout.
- The team sees that their feedback leads to action. Morale stays high.
- You create a culture where processes are always improving, never stagnating.
Friction-Removal Micro-Actions
Time your team's tasks for one day. Literally. Have each person log what they do in 15-minute blocks. You'll discover 2-3 hours per day spent on tasks that could be automated or eliminated.
Watch for the sigh. When a team member sighs, rolls their eyes, or says "ugh" before a task — that's the pebble. Don't dismiss it. Note it.
Celebrate removals. When you automate or delete a hated task, announce it: "We just killed cold-calling recall. The system handles it now. Thank your teammates for speaking up." Public celebrations of friction removal motivate the team to flag more pebbles.
Real-World Example
Dental practice with 8 team members. Turnover was 40% per year. Exit interviews all said the same thing: "Too much busy work." "I didn't go to school for this."
The Pebble: Recall reactivation cold-calling. Every front desk person spent 1-2 hours/day dialing, leaving voicemails, getting ignored.
The Fix: Automated text-based recall system. System sends 3 texts over 2 weeks. Only patients who respond but don't book get a human call.
Result: Cold-calling dropped from 2 hours/day to 15 minutes/day. Team morale skyrocketed. Turnover dropped to 10%. Two team members who had been "quiet quitting" became top performers again.
The pebble was small. The damage was massive. The fix was simple.
The Rule That Stops Turnover
Your team doesn't quit because of pay. They quit because of pebbles.
Grand gestures are painkillers. Friction removal is the cure.
Find the pebble. Remove it. Watch your team come back to life.