The list of things that need fixing is rarely short. A front-desk workflow that slows down check-in. A referral handoff that routinely falls through a gap between departments. A billing step that staff have been patching with workarounds long enough that nobody remembers what the original process was supposed to look like. Any one of those problems deserves attention.
But a clinic that tries to address all of them at once usually ends up making partial progress on several things and real progress on none.
This is one of the most common leadership problems that Jeremy Fairbanks, a Tennessee-based healthcare consultant, encounters when he begins working with a new facility. The issue isn’t that clinic leaders fail to see what’s wrong. It’s that they see too many things at once and don’t have a clear method for deciding where to start. Fairbanks founded Clearpath Health Consulting in Nashville and has spent roughly a decade working with independent clinic groups, rural care cooperatives, and specialty outpatient facilities across the mid-South. The shape of that particular problem, too many competing frustrations and too little capacity to address them all, shows up consistently across settings.
What he’s developed through that work isn’t a rigid formula. It’s a way of thinking about which problem deserves the team’s focus first, and why that decision matters as much as the fix itself.
Why Familiar Workarounds Are Worth a Closer Look
One of the clearest signals that a process needs attention isn’t a dramatic breakdown. It’s the slow accumulation of small accommodations that staff have built around something that no longer works.
Repeated workarounds are worth taking seriously. When the same step in a workflow consistently requires an extra action, a phone call that shouldn’t be necessary, or a manual correction that nobody has been asked to document, the process itself is probably the problem. The same is true of recurring staff questions. When new and experienced employees alike keep asking how to handle a particular situation, the answer usually isn’t more training. It’s that the process isn’t clear enough or doesn’t fit the way the practice actually operates anymore.
Growing practices are especially prone to this pattern. A documentation habit that worked fine with a smaller patient volume becomes a bottleneck as the practice scales. A handoff that was manageable when two people shared responsibility for it becomes fragile when the team expands and those two people aren’t always in the building at the same time. The process didn’t fail suddenly. It simply outgrew the context it was built for, and nobody went back to revisit it.
The practical question for clinic leaders is whether the processes currently in place were designed for the practice as it exists today or for an earlier, smaller version of it. Signs that an update may be overdue include:
- Staff routinely completing extra steps to move work forward that the process should handle automatically
- The same questions surfacing repeatedly despite prior explanations or documentation
- A step in the workflow that depends entirely on one person’s institutional knowledge
- Complaints that cluster around the same part of the patient experience across multiple weeks or months
None of those signals require a consultant to identify. They’re visible to anyone paying attention to where the friction lives on a given day. The harder part is deciding what to do about it when several signals are competing for the same limited attention.
Jeremy Fairbanks on Choosing One Actionable Priority
Selecting the right first priority is not the same as selecting the most visible problem or the one that generated the most recent complaint. Jeremy Fairbanks Tennessee clients often discover that the loudest issue isn’t the one with the clearest path to a fix, and that distinction matters when resources are limited.
A useful starting comparison between competing problems looks at two dimensions: how much recurring disruption the problem causes, and what resources are actually available to act on it. A billing gap that affects revenue daily may rank higher on disruption than a scheduling friction that slows one type of appointment. But if resolving the billing gap requires a staffing change that won’t be possible for several months, while the scheduling problem can be addressed by clarifying ownership within the current team, the scheduling problem may be the better first priority. A problem that’s important but currently out of reach is not an actionable priority. It’s a future project.
The questions worth asking when comparing options include:
- How often does this problem disrupt daily work, and for how many staff or patients?
- Does the team have the capacity, within current staffing and budget, to work on this now?
- Is there a clear decision that would move this problem forward, and does the leadership have the authority to make it?
- Would a fix here be specific enough that the team can tell, within a few weeks, whether it’s working?
That last question is the one most often skipped. A priority has to be specific enough for the team to act on and then review. “Improve care coordination” is not a priority. “Assign a named owner for the referral step between the intake form and the scheduling confirmation” is. The first statement can’t be reviewed. The second one can.
Context also shapes which priority is practical for a particular facility. Jeremy Fairbanks Tennessee engagements span settings with very different constraints. A rural cooperative with a lean administrative team can’t execute the same scope of change as a specialty outpatient group with a dedicated operations role. What counts as a manageable operational priority in one facility may be genuinely out of reach in another. The right first problem is the one that fits the actual resources available, not an idealized version of the organization.
Keeping the Decision Moving With a Focused Check-In
Choosing a priority is only half the work. The other half is making sure that decision doesn’t stall between the moment it’s made and the moment it’s resolved.
A short, decision-focused check-in is one of the more practical tools for keeping a selected priority moving without creating another layer of meeting overhead. The structure is simple. Each check-in addresses four things: the unresolved question standing in the way of progress, the decision needed to move past it, the person responsible for making or carrying out that decision, and the date of the next review. That’s it. The check-in isn’t a status report or a project debrief. It’s a mechanism for surfacing the one thing that’s blocking forward movement and making sure someone is accountable for clearing it.
This kind of focused review works precisely because it’s narrow. It keeps the team’s attention on the selected priority rather than allowing the conversation to drift back toward the full list of problems that were set aside. One of the fastest ways to lose traction on a first priority is to let check-in conversations expand to include everything else that’s still on the list. A useful check-in holds the boundary.
It also creates a record of movement. When the team can point to a specific decision that was made and a specific next step that’s now underway, the priority stays concrete rather than becoming an abstraction. That concreteness is what makes it possible to eventually evaluate whether the fix held.
One Problem, a Clear Owner, and a Next Review Date
The goal of this kind of prioritization isn’t to ignore every other problem on the list. It’s to make sure the first problem actually gets resolved before the list grows longer. A clinic that works through one well-chosen priority, assigns clear ownership, keeps a focused review cadence, and builds a fix the internal team can maintain is in a meaningfully better position than a clinic that starts four initiatives and finishes none.
Jeremy Fairbanks has described his approach to client work in terms of durability: the measure of a successful engagement is whether the improvement holds after the outside support ends. That standard applies equally to a clinic leader working through a prioritization decision without any outside help. The question isn’t which problem is most interesting to work on. It’s which one the team can fix completely, with the resources available right now, in a way that’s specific enough to review.
Start there. Name the owner. Set the next review date. Then finish it before moving on.
FAQs: Prioritizing Clinic Operational Problems
How should a clinic decide which operational problem to address first?
Compare problems by two factors: how frequently each one disrupts daily work, and whether the clinic has the staff and budget to address it now. The best first priority is specific enough to act on, visible enough to review within a few weeks, and realistic given current resources. An important problem that can’t be acted on yet is a future project, not a first priority.
What makes an operational check-in useful rather than just another meeting?
A useful check-in focuses on a single question: what decision is needed to move the selected priority forward? It identifies the unresolved obstacle, names the person responsible for clearing it, and sets a next review date. That narrow structure keeps attention on the priority instead of expanding back into the full problem list.
How do staffing constraints affect which improvement a clinic should tackle first?
Significantly. A lean administrative team or a facility without a dedicated operations role can realistically pursue a narrower scope of change than a larger practice. The right first problem fits the actual capacity of the team that will carry it out. Choosing a priority that’s beyond current staffing reach doesn’t speed up improvement; it stalls it.
