Building a Practice That Holds Under Pressure
Coach Curt Cignetti built winning programs by installing standards and discipline before chasing results. Paul applies that same mindset to practice leadership, recruiting, and growth that holds under pressure.
Full transcript
Generated from the episode audio and lightly edited for readability.
Hello and welcome to another episode of the Martin Rehab M&A Advisory. I'm Paul Martin, founder and president of Martin Healthcare Advisors, and I am coming back to you with a follow on or a followup to an episode that we did just a few short weeks ago when we studied Curt Cignetti and how he built a championship program at Indiana by installing discipline, standards, and control before he chased winds. So this episode today is about application. How to take that sign standard and apply it directly to the way a physical therapy business builds teams, tests leadership, grows with discipline, and stays composured under pressure.
This is not just about doing more. This is about doing things right in that order without ever letting growth get out of control. And this is the way Cignetti built. He built his championship team. So now let's move forward on how you're going to build your championship team. Cignetti did not build teams by just simply collecting talent. It wasn't about five stars. In fact, he had less five stars than many of the other teams in the playoffs. He built teams by defining roles and standards first, then finding the people who can execute inside them.
That distingu distinction matters in a physical therapy business. I know there is a real difficulty right now hiring professional staff. There is a shortage. But many owners hire because someone is simply available or they're credentialed in their state. The high-erforming organizations that we see, they hire because expectations are clear for the professionals they're hiring and they're non-negotiable. Depth matters at every size, but depth with the right professionals will always win over depth with just bodies and positions that are filled. If one person leaves and performance drops, the system is fragile and that naturally leads to testing the system under pressure.
When you've been tested under pressure and someone leaves, you are far better built for those difficult times. So, let's talk about pressure testing. It needs to be intentional. Remember, Cignetti did not wait for big moments to learn how he and his team would handle pressure. He creates pressure early so he can observe and study that behavior. Many physical therapy business owners protect people from stress and hope that leadership will show up later. Pressure testing means controlled exposure to situations that will cause stress. Temporary responsibility but real problems.
And we need to create clear expectations on how you would want your staff to manage and handle those problems. Then you observe behavior closely after it has been taught. And guess what? That behavior from your staff will reveal who are your future leaders. Is every single person and every single professional in your clinics going to be handle be able to handle pressure the exact same? Of course not. That's why we have quarterbacks that lead the teams in football. That's why we have clinic directors. That why that's why we have team leads.
That's why we have offensive offensive team captains, defensive team captains, linebackers that call the plays. It's very similar as you see when you're looking at how we build our leadership team. And again, leaders are not revealed, okay? And not simply just appointed. Leadership shows up in those moments of stress. Cignetti identified leaders by behavior, not title or tenure. He didn't care what high school talent that he brought in, whether they were captains or not in high school. He wanted to see how they would be under pressure in his system.
The people who stay calm, take ownership, and stabilize the group, they will earn influence. In a physical therapy business, those people often exist before the title does. Your job is to recognize them and develop them intentionally. They will typically show up rather early in their careers with you. And that clarity makes recruiting far more effective because you can now build a criteria by which you're going to evaluate the therapists and the professionals and the support staff that you hire. Recruiting protects culture. Cignetti recruited for production and coachability.
He wants proof someone can perform inside of a system. In a physical therapy business, recruiting is not about filling roles quickly. It's about protecting standards as the organization grows. Interview for behavior. Ask those difficult questions on how they got through certain challenges in their life. It takes very careful feedback response and structure tolerance. When recruiting protects culture, growth stays stable. I'm going to say that again. When recruiting protects your culture that you have built for your people, growth stays stable. I know when someone is brought into a physical therapy practice that just doesn't fit.
They just aren't willing to go that extra mile for their patient. That brings down your culture. And when it does not and when we when we're when we have that instability, that can create chaos when we try to grow. So that brings us to disciplined growth. And this is a very important part of this. Look, going back to Cignetti, Indiana never chased wins. They chased execution. The best physical therapy businesses grow the exact same way. Discipline growth starts with defined goals. We talk about that one year, three year, five years out, very specific outcomes, not vague expansion.
And once the goal is clear, you can clearly see what this business looks like one, three, five years out, you have that picture in your head. Then a path, a plan can be built with very clear boundaries and clear criteria can define what qualifies a good growth decision. Whether it's a startup or it's an acquisition. If an opportunity does not meet the criteria that you have built, it does not get pursued. It will save you a lot of time and it may cost you another six months to get to the stage that you wanted to get to by the time you had planned it.
But you have to make sure that you stick to that discipline. I can tell you that we had three clinics and this was in 1993. Our goal was to grow from three to 20 clinics from 1993. And we had looked at a five-year plan. I was responsible for growth. We created a criteria for startups and acquisitions. Folks, in the first nine months of us moving forward, we did not do a new startup or an acquisition because we did not and we would not chase things that did not meet that criteria, did not fit in the box that we created for those opportunities from that nine month out until two years out from the start.
So another 15 months out, we had six more clinics. Okay, we had did a three clinic acquisition and we had three new startups that we did and we were on our way to the 21 by 1996. Okay, so in three years we ended up getting to 21. But we grew with discipline. And again, going back to Cignetti, Indiana showed this game after game. Always moving forward, but never out of control. That is how sustainable growth works. And it's all built by leadership composure. Watch Cignetti on the sideline.
This is looking at you and how you behave in times of crisis. He was calm, observational, corrective. I mean, I just watched a documentary on the 1980 USA hockey team and they talked about Herb Brooks and his eyes. Those eyes reminded me of Curt Cignetti and Herb Brooks, his son, because Herb Brooks passed away 20 years ago. His son in this documentary said, "Oh, you don't want to see those eyes." And it was the eyes he had at the game where he made them skate back and forth, back and forth about a hundred times after the game because the players were looking around at Carl's.
Anyway, look, you need to be that leader. You don't need to be nasty, but you need to be calm, observational, and corrective. Cignetti understands the team mirrors the leader. Same in a PT business. The same rule applies. When pressure rises, your response becomes the template. Calm leadership creates clarity. Clarity allows execution. Moving to the next slide. You know, we're talking about running your week, not just by crisis and by putting out fires. Champ Championship Cro Championship coaches. I was a coach. I was a coach. I was a high school wrestling and football coach and I was a college football coach.
When I worked at Lehi, the head coach at Lehi, he scripted the entire week, every hour, not only what he was going to do, but what his assistant coaches were going to do and obviously what the team was going to do. Championship coaches and leaders, they script the week. They don't wing it. The week is where performance is built. For PT owners, this means a consistent operating rhythm. This means consistent leadership check-ins. This means weekly looking at your metrics against targets. This means ongoing recruiting pipeline discussions.
When the week is clear and everybody knows where we're going this week, execution improves. Now, look, your therapist may have a full week of schedules, but I'm sure there are some other things built into that, whether it's weekly or monthly, and those disciplines are important. Discipline creates readiness before big moments arrive. So, how do we build readiness before you need it? Well, said Netti, he prepared teams for big games long before they happened. In fact, I think in some interviews before that, he said he began preparing his team for the national championship game on the first day of summer practice.
The same applies to your business. Readiness is not about selling. It's about control and choice. Clean data, clear roles, strong leaders, documented systems. Readiness gives owners options instead of forcing decisions. Your staff will respect that you have prepared your business for many options. You will have control of that steering wheel when you are ready. And readiness is all about preparation. And it's about preparation focused on a plan, systems, and adding value in your business. All right. So, let's talk about applying that Cignetti standard. We're going to start bringing that into our consulting.
Are you applying the Cignetti standard? Curt Cignetti builds programs, not just teams. He stress tests early. He recruits wisely. He leads with composure. He grows with discipline. Folks, we have used words that I also am embracing in these last few weeks since that national championship game. Recruiting wisely. We're recruiting right now. And we're recruiting wisely, leading with composure, growing with discipline. The same principles work in physical therapy business regardless of where and the size where you are right now. Build the program first and the performance will follow.
That is discipline growth in a physical therapy business. So for any of you out there today who are looking to achieve growth in a disciplined manner and you have questions or want to talk to me about this video that we did today, just click below and let's talk. I appreciate your participation and I look forward to talking to you in the very near future. Thank you. Have a great rest of your day and a great weekend.
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