When One Employee Isn’t Pulling Their Weight: A Guide for Practice Managers

Because ignoring the problem isn’t a strategy – and neither is hoping it fixes itself.

One of the hardest parts of being a practice manager isn’t managing schedules, budgets, or inventory. 

It’s managing people. 

Especially when one employee consistently underperforms while everyone else picks up the slack. 

You know the situation…
Your strongest employees are becoming frustrated.
Morale is starting to slip.
And you’re caught between wanting to support an employee and protecting the rest of the team.

The good news is that addressing underperformance doesn’t have to create conflict. 

When handled well, it can actually strengthen your culture, improve accountability, and rebuild trust across the clinic. 

Step One: Stop Hoping They’ll “Figure it Out”

One of the biggest mistakes practice managers make is assuming poor performance will improve on its own. 

Sometimes it does.
More often…
It becomes a habit. 

If an employee has been consistently underperforming for weeks or months, silence can easily be interpreted as acceptance. 

If it’s bothering you…
It’s time for a conversation. 

Start With Curiosity, Not Assumptions

Before labeling someone as “lazy,” ask yourself:

• Do they fully understand what’s expected?
• Have they received proper training?
• Are they overwhelmed?
• Is something outside of work affecting their performance?

Sometimes what looks like poor effort is actually:

• Uncertainty
• Lack of confidence
• Burnout
• Unclear expectations

Understanding the root cause helps determine the right solution.

Be Specific

Avoid vague feedback like:
“You need to help out more.”

Instead, focus on observable behavior.

For example:

“I’ve noticed closing tasks have been left unfinished several times over the past two weeks.”

OR

“I’ve observed other team members consistently covering callbacks assigned to you.”

Specific feedback is much easier to improve than general criticism. 

Set Clear Expectations

One of the biggest reasons accountability breaks down is because expectations aren’t clearly defined. 

Make sure employees understand: 

• What they’re responsible for
• What success looks like
• How performance is measured
• What timelines are expected

People can’t consistently meet expectations if they don’t fully understand. 

Create and Improvement Plan

Don’t end the conversation with:
“Do better.”

Instead, create a roadmap.

Discuss:

• Specific goals
• Measurable improvements
• Follow-up dates
• Available support

This turns the conversation into coaching instead of criticism.

Follow Up

This is where many managers unintentionally undermine accountability. 

They have the difficult conversation…
Then never mention it again. 

Follow-up communicates two important things: 

1. You meant what you said.
2. You’re invested in their success.

Improvement should be acknowledged.
Lack of improvement should also be addressed.

Consistency builds credibility. 

Recognize Positive Changes

Accountability isn’t just about correcting poor performance. 

It’s also about reinforcing improvement. 

If an employee has made noticeable progress, tell them.

Recognition encourages continued growth and shows that leadership notices effort – not just mistakes. 

Know When Coaching Has Run Its Course

Not every employee who struggles is unwilling.
But not every employee who struggles is willing to improve, either. 

If you’ve:

• Clarified expectations
• Provided training
• Offered coaching
• Followed up
• Documented conversations

…and the behavior hasn’t changed…

It may be time to move from coaching to formal accountability. 

Holding someone accountable isn’t being harsh.
It’s being fair – to the rest of your team. 

Don’t Forget About Your High Performers

While you’re working to improve one employee’s performance, don’t lose sight of your strongest contributors. 

Thank them.
Recognize them.
Support them. 

Because while underperformers require attention…
High performers require retention. 

Look for System Problems, Too

Sometimes one employee isn’t the entire issue. 

Ask yourself: 

• Are responsibilities evenly distributed?
• Is everyone clear on their role?
• Is the front desk so overwhelmed that everyone feels behind?

Sometimes improving performance requires improving the system, not just the individual. 

Final Thoughts

Great leadership isn’t about avoiding difficult conversations.

It’s about having them early, respectfully, and consistently.

Most employees want to succeed.

They want clear expectations.
They want feedback.
They want to know where they stand.

And when someone chooses not to meet those expectations despite support and coaching, addressing it isn’t just about one employee – it’s about protecting your clinic’s culture. 

Because every time a practice manager chooses accountability over avoidance, they’re sending a message to the entire team:

“We value fairness. We value teamwork. Everyone is expected to do their part.”

That’s the kind of culture people want to stay in.