The Hidden Cost of High Turnover, The ROI of Staff Empowerment, and the Psychology of Retention

Don Adeesha: We invest hundreds of thousands of dollars into the latest aesthetic technology. But why do we spend so little time optimizing the psychology of the people operating in? Welcome back to the Business of Aesthetics Podcast. I’m your host, Don Adeesha. And to help us bridge the gap between human behavior and practice profitability, we are joined by Melissa DelFino. Melissa is the founder of Modern Distinction LLC and the practice manager at Geria Dermatology. With a Master of Science in Psychology and years of experience building businesses from the ground up, she specializes in organizational psychology. She transforms high-turnover clinics into high-performing, empowered environments that drive revenue and protect the patient experience. Today we are discussing the economics of training. We are going to be talking about the strategic staff empowerment, the true meaning of psychological safety, and how your internal culture dictates your external retention. This episode is brought to you by Ekwa Marketing, the digital growth partner behind this podcast and a trusted resource for aesthetic practices looking to dominate their local markets. Now, let’s optimize the team, Melissa. Welcome to the show.

Melissa DelFino: Thank you so much for having me. It’s my pleasure.

Don Adeesha: Absolutely. So, Melissa, let’s dive right in. Psychological safety is often misunderstood by executives as a lack of accountability or lowering of standards. From an organizational psychology standpoint, how do you build a clinic where staff feels completely safe to admit mistakes while still holding them to the highest standard of operational performance?

Melissa DelFino: Absolutely. You know, psychological safety has like a pretty broad term. I would say one of the biggest factors is emotional regulation. And, you know, mistakes are bound to happen in any clinic, really, like medicine in general is a very fast-paced environment, really, no matter what specialty you’re in. And when mistakes happen, it’s how do leaders or practice owners, doctors, providers, what are they doing in that moment to either teach their peers or their staff member, or are they just emotionally reacting to the situation? You know, understood if it’s a patient safety issue, sometimes it gets a little hairy where we’re kind of in the moment and just, you know, have a jerk reaction. But being able to step aside and not reprimand a staff member in front of a patient, in front of a peer and say, hey, this is what I would have done differently is one way to really execute psychological safety. Because now the staff member doesn’t feel afraid to make mistakes because they seek them as a learning opportunity. So that’s really how you build a culture of psychological safety. Additionally, other things that practice owners can do is have huddles, you know. I like to use an exercise called Rose, Bud, Thorn. I kind of mentioned this in like every, everywhere I’m showcased. It’s something that I took from the department of education that really does work. It’s how do we talk to the staff on a regular basis and ask them, Rose, what is something that you’d like to grow or learn? You know, actually, I’m sorry. Rose is something what you would like to reflect on that was a positive experience in your previous day or week. Bud is something that you’d like to learn or grow. And thorn is a difficult moment you may have had. And how do we share that and learn from it? And you kind of like have a conversation with either your peers or the doctor, business owner, and get guidance on how you could have handled it differently. So these are ways to kind of develop that psychological safety in a practice.

Don Adeesha: How long does a huddle, you know, that has these parts of Rose or Bud and Thorn involved? And that’s another challenge, right? Like, how do you carve out the time to do that?

Melissa DelFino: You know, try to have a little bit of a longer lunch break or something like that, or maybe ask staff members to come in a little early. It also depends on the size of your team. If you have a few people that are willing to share, you can kind of just gauge who’s willing to share and then allow people to share. And then sometimes in the next meeting, people that were not willing to share might feel safe to share.

Don Adeesha: Right. Now, there is a fine line between safety and complacency. How do you address someone who is psychologically safe but simply incompetent without destroying the safety of the remaining team?

Melissa DelFino: Yeah. So we want to make sure that we have measurable SOPs put in place, right? How do we have a buddy system? I like to kind of designate a lead that is helping oversee the like a team member or like a front desk member and having measurable success and having touch bases with that staff member. So like if they’re new, for instance, right? We have guidelines put in place and we have to be clear on what the patient experience is supposed to look like. So whether that’s written down or if you have scripted guidance, having someone to also help you execute that is an extremely important part, especially if we’re a solo practitioner trying to oversee that. You’re not going to be able to do that because you’re seeing patients all day. So having someone that you can put some trust into where you can let go a little bit and say, hey, is this team member easy to work with? Are they following the instructions? Are they regularly asking questions? In my opinion, if someone is not asking questions, that requires additional touch points because no questions is, you know, it’s never really a good thing. We want to encourage questions. So if we’re measuring incompetency, typically there’s an onboarding process. So you want to give them a timeline and kind of give them some sort of assessment. You know, some practices it’s like, have you been able to draw blood for PRP, right? How many patients have you seen? So kind of running reports of what they’ve participated in and seeing how that patient experience was. Has the patient come back? You know, being able to see our new patients coming back when they’re with that medical assistant is also important to measure their success.

Don Adeesha: Okay. Now, practice owners often complain that they train their staff constantly, right? But when it comes to the daily execution, it still falls flat. Where is the specific operational breakdown between what a CEO thinks they are communicating during onboarding and what the staff actually executes on the clinic floor?

Melissa DelFino: Yeah. One of the biggest pitfalls that I see in that is that there’s really lack of clarity in what the experience is supposed to look like for the patient, or there’s a lot of flip-flopping in the decision-making with leadership where they might not be able to be consistent with the rules and regulations that they put in place, whether it’s like with their schedule or even just like getting certain pictures, like consents and just the day-to-day operations, staff sometimes get confused. So when I speak with business owners, I first ask them, what does the patient experience look like to you? And how have you communicated that with the staff? And if they are telling me, you know, various things, but in, you know, it’s not consistent, then I know, okay, it might be a miscommunication issue. Or if they’re showing me this like 50-page booklet that is not going to get read, then we’re like, okay, maybe we need to digitize this and give it, you know, like give it a way that the front desk or the medical assistant is able to reference it quickly. That’s like an extremely important, just quick pivot that you can do is digitize the onboarding a little bit so that they are able to reference it in their day-to-day or condense it. If it’s a matter of what’s actually executed on the clinic floor, each day is a different bag. It really depends on what each patient brings, what complications may arise. So it’s leadership’s role to be emotionally regulated in those moments and ensure that they’re modeling good behavior during any clinic issues so that the staff are able to also be supportive in that time.

Don Adeesha: Melissa, now you have a background in sociology. Do you find that groupthink plays a role here? Do staff agree with the CEO in the meeting just to end the meeting and then go back to doing it their own way?

Melissa DelFino: Yes, I see that all the time. I see that all the time. I think what sets at least me apart and what I’ve been able to do with business owners is I’m really quick to tell them, that’s not really the best practice, you know? And listen, at the end of the day, doctors, providers, they are going to school for so long, right? And none of their education actually is business development and operations. And to be honest with you, like staff are pretty intimidated when they’re speaking with doctors and providers. They don’t always feel that their opinion is valued. So yeah, being able to kind of make sure that you have a manager that is safe enough to say, hey, that might not work because given my experience, that didn’t work in a previous practice or vice versa. You really need to kind of lean into a leader, whether it’s a manager, team lead, medical assistant, or supervisor that can really like be an advocate for staff, right? Hear their concerns during any difficult times that they have, but also being able to have that experience to say, hey, that’s not going to work. Please hear me out. And this is why.

Don Adeesha: Advocate for the staff. How important is that role?

Melissa DelFino: It’s extremely important. It really affects morale when there is no one to advocate for the staff. A lot of the times I find that, you know, smaller operations, they have no one to really advocate for staff. And a part of my onboarding process is like, I’m not just working alongside the business owner. What I do is I’ll usually hold like a staff meeting, whether it’s virtual or in person and see how much they’re willing to share. If I hear crickets, I automatically will go to the business owner after and say, have you noticed that no one was willing to share during that meeting? Why do you think that is? And then, you know, we have a reflect, like let’s reflect maybe during a mistake, right? Maybe during a mistake, you lashed out on them or corrected them in front of a patient or in front of their peers. Maybe they were called out during a meeting and you embarrassed them. These are small things that business owners might not recognize as an issue with the culture.

Don Adeesha: Right. Now, many founders struggle to empower their staff because they are terrified, terrified of losing control over the brand reputation. What is the specific framework an owner must use to delegate authority to their team without compromising the clinical standard of the practice itself?

Melissa DelFino: Yeah. So in, in such a saturated field in med aesthetics, especially you really need to focus on your brand. So like your brand is everything, but yeah, your team is actually your brand, if you think about it. They’re the ones that are going to be the first touchpoint, right? So let’s say we get a lead coming in through our website. The first touchpoint is your front desk. If your greeting’s not consistent, if the tone of their voice is not consistent at that first touchpoint, or the timeframe that they’re getting back to a patient is not consistent, it’s going to affect the brand. So as much as we want to talk about the beautiful space that we’re seeing patients in, the gorgeous logo and colors, you really want to focus on what is your staff able to execute because they will be your highest expense. So you want to make sure that you’re investing in them and they’re returning that investment by executing your brand. So specific framework, again, is consistency, making sure you’re really communicating what the vision looks like and staying consistent with that. Don’t change it. Like if you feel like you need to change it, let’s do that in six months, right? Let’s run some reports. Let’s look at our new patients coming back consistently before we change anything. Because like, that’s your biggest thing is we can’t just blindly change our brand and blindly change any of our operational methods without real numbers, you know? So I think that is a really important framework to go by is being consistent and having training set in place that the staff are able to follow. So it’s clear to them what their role is and how important it is to really just be your brand. They’re a walking version of your brand.

Don Adeesha: Melissa, you emphasized on real numbers. Why did you do that? Are there practice owners using fake numbers up there?

Melissa DelFino: You’ll be surprised. Some people, they just blindly, or they might not know how to run reports in their system, right? Like they might not have either the time to, or they are just looking at their schedule and saying, you know what? My schedule’s empty today. And that’s their basis, right? So it’s not a matter of what is the schedule looking like in terms of, it might be an off day. Sometimes in med aesthetics or just medicine in general, certain seasons are kind of slow, right? So what do we do during that time? But we can run reports, we can look at patient retention items. So let’s say in my EHR system, I’m able to look at new patients, what they came in for by diagnosis, and see if they have an upcoming appointment. If they don’t, I might on a slow day recommend a staff member reach out to everyone and say, hey, how was your last visit? We haven’t seen you in a while. We’d love to get you back in our office, right? So yeah, running real numbers is important rather than just looking at the schedule and making an assumption.

Don Adeesha: Is there a… Is there a cultural part to that? How does that affect the team?

Melissa DelFino: Um, I think awareness helps build the culture, right? It communicates to your staff that they have an important role. And when we talk about the business side, you know, a lot of practice owners are like, they don’t need to know that, right? They don’t need to know certain things about the business. Like the, you know, we don’t need to tell them everything about the revenue and, and costs and things like that. But it’s really important to share with them how important and integral their role is for the growth of the practice and how they can help grow the practice. So I think being transparent with hey, we’ve only seen 20 new patients. How do we incentivize them to potentially get more retention, retentionable patients on the schedule, right? So even if it’s like a matter of running report of all of the cosmetic consultations that we’ve had in place and converting them to their actual procedures, right? You know, not everyone is able to, especially in their first year, they’re not able to utilize certain softwares that is integrated with their EHR to kind of automate that process. But if you have a front desk or medical assistant that might be able to reach out to a cosmetic consultation and say, hey, I saw that you were scheduled or had a consultation for a RF microneedling. Did you have any questions for me about pre or post-care procedure? I’m happy to answer your questions and get you scheduled. Or maybe you had questions on financing options, right? So how do you develop that relationship with your patients? Because sometimes patients can walk out the door and they might feel either misheard or they might feel like, okay, maybe I didn’t have the greatest consultation with the provider and getting that feedback, even as a medical assistant or front desk talking to that patient is important because now we have to have an open dialogue with the provider and say, I did speak with this patient and they expressed that they were not satisfied with their consult, right? And now leadership should talk to the provider and ensure that we’re working on those skills as well.

Don Adeesha: There we go. Before we continue, I would like to share a quick message from our sponsor, Ekwa Marketing. Ekwa Marketing are offering our listeners a complimentary 60-minute digital strategy session. This is a one-on-one consultation with the senior strategists to help you map your 12-month high value patient acquisition roadmap. You will get a personal diagnosis of your online presence and patient funnel, uncover untapped growth levers across SEO and social, and walk away with the clear actionable plan tailored just for your practice. You can check the availability and reserve your spot in under two minutes at www.businessofaesthetics.org/msm. That’s businessofaesthetics, one word, dot org forward slash msm. Melissa, you draw a direct line between clarity of internal training and the external patient experience. What is one measurable indicator a practice owner can look at today to prove that poor internal staff communication is directly costing them their high ticket patient retention?

Melissa DelFino: Absolutely. And this really goes back to, again, patient retention, keeping your new patients on your schedule. A lot of the things that I’ve implemented with some of my clients is kind of going back to an old-school paper route, right? So we create this checkout slip ticket where if a patient has a visit, the provider, one, has to communicate to the patient, I want to see you back, not like as needed or, you know, for this in a year or whatever it is. I really want to see you back, right? Now the medical assistant writes down what the follow-up appointment should be or the procedural appointment should be and hands it to the front desk. There’s a lot of times where front desk will check out a patient and they’re not sure what to book them for. And it kind of leaves it as an option to the patient. And they’ll say, oh, I’ll call for that. No problem. No, you want them to book immediately while they’re there. Say time actually, you know, it’s pretty tight. So we want to put something on the books. This way we can ensure that you got something scheduled. And if we need to make any adjustments down the line, please do feel free to give us a call and we’ll go ahead and make an adjustment. So I’ve actually gone from, you know, like this old-school ticket system. It’s literally a sheet of paper and you can even give it to the patient. Please give this to the front desk so that they can help check you out. And just doing something that simple, you know, helps practices really retain their patients. And you don’t even have to chase them with a phone call to say, Hey, I noticed you didn’t book because now I know you definitely booked. So it’s measurable. And it also kind of provides that next level care where the patient feels that they want to be seen, you know, they’re not being dismissed and they’re not just leaving without any, you know, framework of what’s my plan. I don’t even know what my plan is.

Don Adeesha: And speaking of the plan, where does the plan come from?

Melissa DelFino: So with social media, I would say social media has really changed the business of aesthetics, right? It’s been one of the biggest thorns in my spine in a way because patients come in so informed and they’ll literally come in with their cell phone like, I want to look just like this, you know? So it’s like, actually, that’s not something that is attainable because facial structure is different, right? We can use this as kind of a guideline of like what you’re looking to achieve, but realistically it’s not what you need, right? So the framework starts with patient expressing what their concerns are and the provider now has to be part of the treatment plan and say, here are your options to get the results you’re looking for, explain the risks, explain everything that is required to achieve that result. And inform and educate the patient, manage their expectations and make sure that they’re aware that, you know, results are not instant, right? Sometimes it takes multiple treatments to achieve the results you’re looking for. And I think with social media, we’re living in this world of like instant gratification. So making sure that we’re empowering, not just the staff to know these things because they’re not supposed to be giving medical advice, but empowering your patient to be part of the decision-making process in their care is like one of the most, I think, pivoting things for a practice to do. So the provider needs to educate them, manage the expectation and also follow through. And then the medical assistant and front desk can answer any like very basic questions. Sometimes even them getting procedures themselves, they’ll be able to speak to their experience. And that can be really beneficial for the patient to hear their experience because it’s an outside opinion, right? Versus what they’re seeing on social media. And they’re seeing in real time what the staff member looks like.

Don Adeesha: Absolutely. Now, you have managed massive teams and built businesses from the ground up, including your leadership at Geria Dermatology. When interviewing a new provider or administrative leader, what is the single most important psychological trait that you screen for to ensure that they will thrive in a high-growth aesthetic environment?

Melissa DelFino: That is an extremely difficult question. And I will say, everyone presents differently in an interview. The interview process in general is a very high anxiety-inducing thing no matter what, right? Sometimes I find if it’s easy to have a conversation with someone, that already is like a green flag in my opinion. I think it shows that you’re able to manage multiple personalities, especially during a high pressure conversation. So that’s something that I immediately look for. If I have to pull answers out of a person, whether it’s an administrative leader or provider, then I kind of like pull it back a little bit and say, okay, like maybe did you have any questions for me? If they don’t have questions for me, it makes me feel like maybe they didn’t prepare for the interview, which is also something that tells me that they might not be a great fit because they might not take the role seriously. I will say, you know, in my career, I have gotten duped a few times, like people can present very well in an interview. And then when it comes to patient care, we might see that there’s a shift in their attitude or a shift with the team because they might not know how to really communicate well in a team setting. So one thing I do like to do when I’m interviewing for either providers or even upper management is a shadow, basically like a working interview where I allow them to spend an hour or two with the team and either shadow the owner seeing patients or even work alongside the team and get to ask them questions see how they interact with the team and if you know it works out and their references are really solid then they may get the job. Um, so that’s that’s really important but in the interview process it really is one of those things that is extremely difficult to navigate because some people can be just like a really good talker and then when they’re put in the situation it might, after a certain period of time, they either can get comfortable or they just go on and try to do their own thing. And that’s why it’s really important for your onboarding to be solid because they are given a timeframe to execute what their role really is supposed to be within that 90 days, right? So they should be trained, even though training is ongoing, medicine is ever evolving, but to really get what is the patient experience supposed to look like? What are our standardized SOPs? You have that 90 day period to really understand that. And if you are not able to understand that within your 90 days, have a touch point. Where do we correct and pivot? And then if it’s not a good fit, then we have to, you know, part ways. But usually most people do their 90 days and they supersede their 90 days. So that’s good.

Don Adeesha: Right. And this shadowing, you do that after an initial screening or is it like everyone gets that opportunity?

Melissa DelFino: Pretty much everyone gets that opportunity if… If they get to the second round of interviewing. So like I’ll usually do a touchpoint screening on the phone to do like an introduction, see if their goals are aligned with the practice goals. And then they’ll come in and meet me. And then the third round of interviewing is essentially the shadowing.

Don Adeesha: There we go. Do you also use, you know, Myers-Briggs or any kind of personality profiling tool?

Melissa DelFino: I don’t, actually. I kind of just like to have a general conversation and identify goals for them personally. If we’re talking about medical assistants or even front desk, I like to hire pre-med, pre-PA students, people that are in school that are one willing to learn and two they know that what they’re getting out of the experience here they’re going to apply in real life like in their real life application of either being a provider um because they know that it’s you know one hand washes the other at the end of the day so that’s really important. In your framework of interviewing you, you’re not just interviewing for someone to just work for you. How can we support you? And I think when practice managers or owners kind of frame their interviewing in that way, you have one more employee retention and you have more of a willingness to learn.

Don Adeesha: Okay. How important is that? I mean, you mentioned it translates absolutely into one of the most crucial aspects of, you know, more retention from the employee side, as well as their willingness to learn. But why are we, as the practice owner or the practice itself, trying to sell this position, right?

Melissa DelFino: Well, if you go back to sociology, exchange theory really drives everything, you know? So I always look at it in that way because, you know, at the end of the day, we are, it is exchange, right? People don’t just work for free and they’re not going to execute your vision for free. So it’s like, yes, we’re going to pay you. But at the end of the day, you’re not, the longevity of the employee also matters, right? You see high turnover when an employee doesn’t feel supported. So how can we support you and how do we make you thrive in your role? Whether that’s with educational resources or, you know, you’re going to get real life experience that you’re able to apply on the outside world when you go to med school and you start seeing your own patients, you know?

The episode concludes with a reminder to claim Ekwa Marketing’s strategy session and connect with Modern Distinction.

Don Adeesha: There we go. So, Melissa, we have arrived at the end of the episode here. I would like for you to give our listeners a final golden nugget, a key takeaway from our conversation.

Melissa DelFino: Yeah, key takeaway. Oh, there’s so many. What I will say is it’s really important for practice owners to understand lean into an expert and lean into their team to help guide them, because at the end of the day, they’re busy seeing patients. They are not going to be able to manage it all. So having someone that you can truly trust. Trust and say, hey, I have this expectation and I want you to execute it. And let’s set time aside to discuss it and really oversee this together. That’s, I think, one of the biggest ways a practice can succeed, especially in a super saturated field like med aesthetics. You know, patients are not always going to come back if they don’t feel safe and secure and that their experience is inconsistent every time they come in.

Don Adeesha: There we go. That was a powerful conversation with Melissa DelFino. Thank you very much for that, Melissa.

Melissa DelFino: My pleasure.

Don Adeesha: And if you have been struggling with team alignment or high turnover, I hope this episode gave you the operational clarity you need to start empowering your staff tomorrow. Building a strong culture isn’t a soft skill it’s a measurable driver of your practice’s profitability. So there you go. Now before we sign off a quick reminder Ekwa Marketing is offering their complimentary 60-minute digital strategy session… Check the availability and reserve your spot in under two minutes at www.businessofaesthetics.org/msm. I’m Don Adeesha and this has been the Business of Aesthetics podcast. Thanks for listening and keep on leading. Bye.

Melissa DelFino: Thank you.

Don Adeesha: Oh hold on before I let you go Melissa a quick debrief session if you don’t mind um just to know your thoughts how was your experience and yeah what did you think about the flow of the questions and any areas for improvement you know we would be much obliged.

Melissa DelFino: Yeah no I think it went well um I think that the questions that you asked were pretty wonderful and very informative. So I don’t have any negative feedback. So that’s good.

Don Adeesha: Okay. We don’t have any buds or thorns.

Melissa DelFino: Um, I mean, buds, I would say, I mean, do you typically allow for people that like myself, like consultants to kind of like do a plug where we can offer our services in any way?

Don Adeesha: I know you’re doing that with Ekwa. We can plug you in the outro and also in the show notes as well. We usually, yeah, we usually drop details of our guests in the show notes on our podcast website itself um and then of course I can also um talk to the product manager and then plug you in at the outro as well.

Melissa DelFino: Okay, cool. That’ll work for you. Yeah, no, that’s beautiful. Um, yeah, buds, I mean, any other opportunities, like I’m so happy to talk about there’s so many topics, you know what I mean? Like I’m so happy to be a part of it. So any other opportunities I would love to continue the conversation and like keep top of mind. Cause I truly believe like this is such an important thing for pretty much any practice.

Don Adeesha: Yeah, absolutely. Thank you so much, Melissa, for taking the time and, uh, really uh giving such great answers I was just thinking to myself you know they’re fantastic like you were speaking straight from your heart and really appreciate the energy as well so we’ll get in touch with you once the marketing material is ready and it would be much appreciated if you could share it around with your network uh when that’s done and dusted. Okay. Well, Melissa, thank you very much once again. Well, we hope to see you again, perhaps in another sort of format. We’ll keep in touch. Take care.

Melissa DelFino: All right. Thank you so much. Have a wonderful day.

Don Adeesha: Absolutely. Likewise. So that was a powerful look at the human side of scaling a practice with Melissa DelFino. If you’ve been struggling with high turnover or constantly feeling like your team isn’t on the same page, we hope this conversation gave you the permission to look at your clinic culture differently. Empowering your staff isn’t just a soft skill, it’s truly a measurable driver of your practice’s profitability. If Melissa’s approach to leadership resonated with you, we highly recommend you connect with her and explore her work at Modern Distinction, where she helps practice owners build psychologically safe, high performing teams from the ground up. And as we wrap up, if you’re looking for some clarity on the digital side of your practice, Ekwa Marketing is offering our listeners a complimentary 60-minute strategy session. It’s simply a one-on-one conversation to help you map out a realistic 12-month roadmap for attracting high-value patients. You can easily grab a time that works for you at www.businessofaesthetics.org/msm. I’m Don Adeesha and this has been the Business of Aesthetics podcast. Thanks for listening. Keep on leading.