Strategic Planning: Let Your Vision Guide Your Practice


Create a mission, implement a vision, and select a team to meet your goals.

By Ted Kepros, PT, MPT

The Dream

I can remember the day I decided that I was going to move forward and finally open my first practice. Ideas were flowing from all angles. I could not write them down fast enough, and to say that I was excited would have been a massive understatement. I am sure many of you can recall that moment when you decided, “It’s time to do this!”

As with all great endeavors, there are moments of reality that hit us in the chest while we are writing our master plan to greatness. For me that moment came while reading a chapter from The E-Myth Revisited.1 In it, I read the story of an entrepreneur who was so excited about creating her own cupcake business that she failed to see the big picture. Without realizing it, she hadn’t created her dream business but just another job. If she left for a day, or tended to other tasks, who would make the cupcakes? Who would come in early to prepare the frosting? In other words, how would the business ever become profitable and grow if she was consumed with the same day-to-day operations and never allowed to focus on the items required to develop a thriving business?

Creating a mission

From Dream to Mission

This question is the fundamental one that drove me as a new practice owner to ask myself what steps I needed to take to ensure that I was developing a product that would adhere to my own standards. Furthermore, I needed to make sure that I was allowing myself the autonomy to implement the steps necessary to grow my practice. I needed to have the mindset of an entrepreneur versus that of a physical therapist.

You can likely recall the incentive that pushed you to move forward with your own aspirations. Maybe you wanted more freedom in the way you practiced. Maybe you were tired of accepting someone else’s view of how many units to charge, what to charge, and how many patients to see in a day. For me, the motivation was simply that I knew I could do things exceptionally better, and by doing so make an impact on clinicians and clients. More importantly, I knew that I had the ability to create a space where my team of employees could thrive while living their passion—one where we could affect the daily lives of so many people in a positive way.

Knowing the potential impact that our profession has on overall health, I became inspired to create a systematic approach to making our care the best that it could be. Simply put, I wanted to exceed “good” and strive for exceptional. This quest eventually gave rise to my mission: Becoming Better Together!

Implementing a Mission Requires a Vision

I enjoy using stories to create a deeper understanding of what I am trying to explain. If you ask my colleagues about Atul Gawande and the cystic fibrosis story, they will immediately know what you are talking about. In short, they will explain that this is our “why.” Simon Sinek writes in Start with Why and Leaders Eat Last about the importance of identifying the underlying reason we create a business.2,3 It is the reason we are willing to strive for improvement and go to great lengths even when the challenge seems too large. It is what makes 12- to 14-hour days seem like a realistic feat when we are just starting out, and what provides vision for our future colleagues and partners. But just as we do with our patients who have ACL reconstruction, we must establish some smaller, dissectible goals that get us to the end goal. Without this we often simply flounder. I knew that I wanted to establish a few simple pillars that would be daily guides as we made decisions and would also keep us on our path toward “Becoming Better Together.” I began to reflect on some of the great leaders that I worked with and around over the years, and the steps they had taken to achieve success day after day. I won’t bore you with my personal pillars, but what I will tell you is they serve as a litmus of sorts for our entire team both personally and professionally. If a new project, purchase, hire, or development plan doesn’t hold up to our three pillars, then we move on. It’s that simple.

Selecting a Team

You need people who can think and have the time to do it so that they can address issues. As anyone in private practice knows, issues will and do occur! This requires taking a different approach to creating a selection platform that you will use to hire the best. Specialization is wonderful; we have several staff members who have unique backgrounds and talents. Extra credentials are undoubtedly a benefit; they tell me that someone is a lifelong learner and hopes to advance their knowledge. These are all good qualities, right? But there are a few other things that I’m more concerned about learning. Can you speak clearly and communicate effectively? Do you share well with colleagues, and have an attitude of servitude? Are you a problem seeker or a problem solver? Do you change a room when you walk in because of your attitude or mere presence?

These and other qualities are the fundamental building blocks of our practice. Our focus starts and ends here. While credentials are the price of entrance, the little things you do to stand apart from the crowd are what allow you to stay and thrive in your role. What are you able and willing to do for others?

So how do you uncover all this information in an interview? I would argue that you don’t. We have developed a systematic approach to hiring. A candidate first meets with one to three people from our leadership team. We ask the hard questions, and then we dig even deeper. We look for the difference between memorized responses and genuine passion.

Candidates then proceed with a second follow-up interview with our entire team. Our staff asks questions from all angles and hopes to gain a sense of who they really are. Do they fit our culture?

Finally, they’re offered a chance to trail within the clinic. We hope to allow candidates to feel the environment for themselves while we watch them interact within it. This provides us a 360-degree view of the person. As we have all seen, when you put the right person into the right position, they simply shine. If they don’t, it’s a clue that they don’t fit the bill.

My goal is to create a company that stands apart from any other—one where employees want to stay for 30 or 40 years, and where the company and employee-partners are mutually respected. To give some statistics, the Bureau of Labor reported the median time for an employee to stay with the same company from 1957 to 1964 was 12.1 years for men and 11.6 years for women. In contrast, the median time for an employee to stay with the same company in 2018 was 4.3 years for men and 4.0 years for women.4,5 Turnover is costly, but more importantly it is a sign that either your selection process needs to be altered or your vision is not being implemented.

Creating a Common Thread

Over the last few months I started asking my leadership-circle friends the same question to see what different answers I would get: Throughout your many jobs in life, what made the best environment for you to thrive as an employee?

The answer was the same across the board: freedom. Once an employee knows what they need to accomplish, it makes no difference how it gets done, as long as the job gets done.

Whatever your process is now, I encourage you to define the personality traits that will complement your mission, while autonomously carrying out your daily vision. Autonomously is the key word in that sentence. We create a common thread so that we know our direction from point A to point B. And while that thread will always bend, we just cannot allow it to break.

Insurance demands change rapidly. Staff needs are altered. Patients get sick. Your best referral source leaves town. A new competitor comes to the area. Things shift unexpectedly. What never changes is your mission—and your vision of how to get there. This may require adopting new processes, or revising the composition of your team, but the pillars never change. They always stand. I often tell my partner-employees, the only real competitor we ever have to worry about is ourselves.

Rekindling the Fire

When I consult with a business the process is always the same. Whether you are a 20-year veteran owner or just starting out, I encourage you to step back and start with a bird’s eye view. Who are the players, do they have a game plan, does it get executed, and what are the outcomes? Next, I have them ask a very important question: Would you want to work for you?


1Gerber ME. The E-Myth Revisited: Why Most Small Businesses Don’t Work and What to Do about It. New York: HarperCollins e-books; 2017.

2Sinek S. Start with Why: How Great Leaders Inspire Everyone to Take Action. London, England: Penguin Business; 2019.

3Sinek S. Leaders Eat Last. Place of publication not identified: Portfolio Penguin; 2018.

4U.S. Bureau of Labor Statistics. Accessed August 2019.

5Doyle A. How often do people change jobs? The Balance Careers. Published January 29, 2019. Accessed November 2019.

Ted Kepros

Ted Kepros, PT, MPT, is a PPS member and owner of Kepros Physical Therapy & Performance which comprises three practices and 27 employees in Eastern Iowa. Ted is passionate about the development of the health care continuum and the improvement of health across a lifetime. He can be reached at

Copyright © 2018, Private Practice Section of the American Physical Therapy Association. All Rights Reserved.

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