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Practicing Independence

Chapter 5

Growth and Strategy

Evaluate before you expand — grow on purpose, not by accident

90 minutes with your leadership team

Healthcare isn't getting easier. The question isn't if challenges come — it's whether your structure can absorb them. That is the Breakwater.
— From the Operator's Chair

Growth for its own sake is a trap. I've seen practices add service lines, open satellite offices, and chase every shiny opportunity — only to find themselves stretched thin, burning out staff, and losing money on ventures that never should have started.

The practices that grow successfully are the ones that ask three questions before every opportunity: Does it align with our Independence Aim? Can we afford it? Do we have the systems and people to support it? If the answer to any of those is no, the answer to the opportunity is "not yet."

Three questions before every opportunity

  • Does it align with our Independence Aim?
  • Can we afford it?
  • Do we have the systems and people to support it?

Worksheets

A preview of the first worksheet is below. Members get every worksheet, plus saved answers and the 90-day action plan.

Worksheet 5.1

Growth readiness assessment

Lesson:
Evaluate Before You Expand
Purpose:
Evaluate potential growth opportunities against strategic fit, financial viability, and operational readiness.
Participants:
Leadership team, practice manager, and financial staff.

From the Operator's Chair: Healthcare isn't getting easier. The question isn't if challenges come — it's whether your structure can absorb them. That is the Breakwater. Growth for its own sake is a trap. I've seen practices add service lines, open satellite offices, and chase every shiny opportunity — only to find themselves stretched thin, burning out staff, and losing money on ventures that never should have started. The practices that grow successfully are the ones that ask three questions before every opportunity: Does it align with our Independence Aim? Can we afford it? Do we have the systems and people to support it? If the answer to any of those is no, the answer to the opportunity is "not yet."

Section 1

Know it

Answer individually before the group discussion.

1.What growth opportunities is your practice currently considering? List them:
2.For each opportunity, what's driving the interest? (Revenue? Patient demand? Competitive pressure? Partner enthusiasm?)
3.What's the single biggest bottleneck preventing growth in your practice today?

Section 2

Own it

Rate each growth opportunity as a team.

1.Rate each opportunity on a scale of 1–5 (1 = Low, 5 = High)
Growth OpportunityStrategic FitFinancial ViabilityOperational ReadinessTotal (Max 15)
1.————
2.————
3.————
4.————
2.Discussion prompt 1: Which opportunity scored highest? Does the team agree? What concerns remain?
3.Discussion prompt 2: For the top opportunity, what's the break-even timeline? What would need to be true for this to succeed?

Section 3

Do it

This week and beyond — turn this into action.

Action 1: Fix the bottleneck before pursuing the opportunity

  • Identify the single biggest bottleneck preventing growth
  • Assign an owner to close that gap
  • Set a deadline for resolution
  • Do NOT pursue the growth opportunity until the bottleneck is resolved

Action 2: Build a business case for the top opportunity

  • Estimate startup costs, ongoing costs, and projected revenue
  • Define the break-even timeline
  • Identify the operational requirements (staff, space, systems)
  • Present to the leadership team for a go/no-go decision
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