Sales is an Issue... Now What?

business entrepreneurship fix this next ftn for healthcare providers group practice healthcare hierarchy of needs lifestyle congruence sales level Mar 25, 2021
Being an entrepreneur is hard. It's worse when your business is having trouble and you don't know what to fix first. The Healthcare Hierarchy of Needs can help healthcare providers discover what their business needs most and fix it.


You know the feeling.

You sit with your family at night playing a game, eating dinner, watching tv, hanging out, but internally you’re racking your brain thinking about your business.

Why am I not making more money? Why do I feel strapped every month? Am I paying my employees too much? It doesn’t seem like it. Is somebody stealing from me? No way. Do we have enough clients coming in? I think so. Do I know for sure? No, but I can look at that after the kids go to bed. Do I need to hire more practitioners? Should I start billing insurance? Should I switch entirely to private pay? 

Being An Entrepreneur Is Hard

Your partner, your children, your friends, your family, your employees - nobody really knows what it’s like. Nobody really understands the weight that you carry. They don’t see the late hours, they don’t understand the sheer force of will it can take to keep things going, and they sure as hell don’t know the number of times you’ve questioned whether or not you’re going to be able to sustain another month of payroll.

Dread. Terror. Anxiety. Frantic with worry. It’s a constant, suffocating weight. 

And the worst part? You’re not even sure what’s wrong. You have no idea what the problem is and are thus unable to make the necessary changes. Not knowing what is wrong renders you useless. You react to the candle flame in front of you, rather than finding the source of the fire that is consuming your house.

Not knowing what to do in business is the worst.

You’re in healthcare, right? You, of all people, understand what it’s like to not understand what is wrong with a client (or patient). You understand the level of frustration and despair that people come in with, and you understand the parallel process you go through when you also feel at a loss as to how to help them.

It’s excruciating, at worst, and exceedingly frustrating, at best.

Our purpose is to serve others. It’s to be able to help them to heal, whatever that might look like for them, and to live a life that they feel connected to and invested in. 

And when we can’t do that, we feel the pain in a way that is unique to professionals in healing professionals. We hurt with those we can’t help, and we can’t help those with whom we’re lacking a clear diagnosis.

We are adept at thinking about our clients and patients through a diagnostic and conceptual lens. Why can’t we do the same for our business?

In part, it’s because we haven’t been given the theoretical groundwork to be able to.

We weren’t trained to be business owners. We were trained to be therapists, doctors, dietitians, and more. We were trained to help people heal in a modality that we understand, whether mental health or physical health.

This should all change for you at this point because I’m going to share with you a specific framework for diagnosing your business. And since you’re already in the realm of healthcare, you fully understand that having a proper diagnosis gives you an immediate avenue for healing. 

Diagnose Your Business. Move Forward.

It’s the same in business. Once we have a way of diagnosing the issue, we have a way of moving forward.

Enter the Healthcare Hierarchy of Needs (HHN). You may be somewhat familiar with this already, so I’ll bypass an explanation and go straight into putting it into action. 

We’re going to start with the foundational level of sales. Consequently, sales is also the bottom foundational level, which means that it’s equivalent to oxygen. Without it, we die. #KeepItReal #BusinessesNeedSalesToSurvive 

Okay, so the sales level consists of five core needs. Any need that you can’t say “yes” to with almost 100% confidence should be a “no” until you know for sure. Don’t just breeze through and give yourself a “yes” because you want it to be true. 

When (or if) you say “no” to one of the following questions, you’ve now got yourself a vital need. A vital need is your diagnosis. 

Oh, I hear you. “But Tara, what if I have to or more “nos” in response to the questions?!” Great question, then you would do a differential diagnosis, but the short-hand version is that the lowest-numbered question you said “no” to becomes your vital need. Kasey made it easy for you (because running a business is hard enough!).

The Foundational Level of SALES

Now following along with me for while I go through and hypothetically respond to each of the following questions for the foundational level of Sales.

1. Lifestyle Congruence

  • Do you know what your practice’s sales (billable sessions) must be in order to support your personal comfort level?

2. Prospect and Provider Attraction

  • Do you attract enough providers to support the sales demand, and do you attract enough clients to support your level of needed sales for a profitable practice (20% net or higher)?

3. Client Conversion

  • Do you convert enough of the right clients to support your level of needed billable sessions/services?

4. Delivering on Commitments

  • Do you fully deliver on your commitments to your clients?

5. Collecting on Commitments

  • Do your clients fully deliver on their commitments to you?


And there we have it. So, let’s say that the answers to questions 1 (Lifestyle Congruence) and 3 (Client Conversion) are “no.” Better yet, let’s say that you think, “well, I don’t know” when you answer, which means “no” for right now.

That means our vital need is what, folks? YES, you got it, lifestyle congruence. Our vital need is lifestyle congruence because it’s the lowest-numbered question (1 is lower than 3 - get it?). 

Also, as you’re going through this process, don’t breeze through this. The questions are simple, but they still require some thought (and possibly a little bit of digging). For example, a practice full of W2s versus a practice full of independent contractors is going to have a different answer even if they have the same number of providers.

Lifestyle Congruence Diagnosis

Okay, so we have to have an idea of what our sales need to be in order to support our personal comfort level. If you have no idea how to figure this out, I’ll give you some quick pointers.

  1. Decide the minimum amount of money you would need to bring home.
  2. Locate and record your payroll for your employees or independent contractors.
  3. Locate and record your operating expenses. 
  4. Locate and record the current gross sales (billable sessions) your practice generates.

From there, you have the minimum amount of information you need to calculate the number required for lifestyle congruence. I won’t get super caught in the weeds because I mostly want to stick with the basics, but I'll generally say that you want to subtract payroll and operating expenses from your gross income, and then set aside 30% of that remainder for taxes. Whatever is left is considered “net” and thus “yours.” It can get slightly more complicated than that, but that at least gives you a starting point. 

So we’ve got the diagnosis (vital need) and now we want to figure out how to fix this. I’ll be honest and say I’m choosing lifestyle congruence because it can be done in a straightforward way that’s generalizable across professions. 

We’re running our fake numbers and we’ve realized that it’s actually an issue and that we can’t say “yes” to the question, which means we have to say “no.” Take heart! This is part of the process. 

Now, on to the fun part.

Create A Treatment Plan for Your Business

Presenting Problem

Lack of lifestyle congruence. 


Increase sales such that we feel supported in our personal comfort level, as defined by us.


  • Ensure clinician and office utilization are at 75% or higher. 

  • Ensure clinical retention is at 75% or higher. 

  • Calculate the number of additional billable sessions needed to obtain your required sales for your personal comfort level.

Start Here. Do What Works.

These are simply three starting points. These are not the only options and they are definitely not the only things you should do. The fun part about this is that you get to make it your own, and that might mean taking things and modifying them, or it might be starting from scratch with things that are directly related to your own business and needs. 

The entire point of this is just to give you an idea of what this might look like in action and how a clear diagnosis (vital need) gives you a focus for your treatment plan, which ties directly to your next steps. If you know you need to increase your sales, then that needs to be the only damn thing you focus on for making sure your business is (or becomes) sustainable.

I can’t speak for you, but I can say for myself that having the information to be able to accurately and quickly assess my business gives me an immense sense of relief. It leaves me feeling relieved and like I can, at the very least, assess the current problems. 

Of course, this doesn’t mean that problems are immediately solved (although that would be nice), but it does mean that we can rest easy, knowing that we’re moving in the right direction, rather than feeling overwhelmed and lost. In the most simple form, my hope is that you read this, utilize it, and actually feel grounded and relieved. The HHN and figuring out your vital need have the capacity to do this time and again. Please continue to make use of it.


Tara Vossenkemper, PhD, is the founder and owner of The Counseling Hub, an accidental group counseling practice in Columbia, Mo. Once the practice took off, she dedicated more time to the admin side and found she loved that equally - creating and tweaking the dashboards, formalizing the structures, cultivating the culture, and thinking about the near-endless possibilities for creative growth. Tara has since stepped into consulting in a more serious capacity, setting out to ensure that practice owners know both what they need to do and how to do it. Tara's favorite consulting-related topics center around tracking, culture, structure, and diagnosing core issues.
Tara is known for her colorful language (#PuttingItNicely), love of The Office (#USVersion), neuroticism around dashboards (#FormulasAreLife), and hashtags (#AllDay). When she's not in the office, Tara can be found hanging out with her husband and two young sons, probably drinking a glass of red and wishing it was quiet enough to read.

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