The Number 1 Reason Why Clinics Fail

I talk about core lessons inside Steven Bartlett's "Diary of a CEO" and translate them into how you can apply them as an osteopath.

Podcast Episode Transcript

Do not skip this episode if you want to be more business-minded, develop yourself as a person and make better decisions for your business, the people you work with and most importantly, your patients.

Steven Bartlett’s book called ‘The Diary of a CEO’ combines the most important lessons he learned as a wildly successful young entrepreneur with great stories and the thousands of interviews he’s had with incredible people from all sorts of backgrounds on his Diary of a CEO podcast, which is the number one podcast in the UK and other countries.

These are business and personal development lessons rooted in psychology research and were chosen specifically because they stand the test of time. There’s no fad or trendy things that are only relevant at the time it was published in 2023. It’s evergreen, meaning that it will always be helpful whenever you decide to pick the book up again.

Welcome back to Behind The Osteopath. If you’re new, my name is Alan Zaia, I’m an osteopath, Founder of Osteohustle where we plan, build and grow dream careers for osteopaths.

This podcast is all about my belief that you should never open a clinic without fully understanding what it takes. So, I’m translating a bunch of business, marketing, entrepreneurship and self-help books into how you can use them as an osteopath just like I did when I first started my practice and they’re the foundation of what we do here at Osteohustle with building brands, websites and offering tailored business coaching exclusively for osteopaths.

I want to say a huge thank you to everyone who’s listened so far because last week we hit 2000 plays, which is massive!

The thing is about this podcast is that it takes about 8-10 hours to create each episode, I love talking about the hard things in our profession to make meaningful discussion about how we can all be better osteopaths and business owners in the most ethical forward-thinking way possible, so if you like this format, if you can, leave a 5 star review. The more reviews and subscribers we get, the more likely I am to continue making more episodes.

Alright! Let’s dive into The Diary of a CEO by Steven Bartlett.

The Four Pillars Of Greatness

Steven says that if you want to build amazing things and develop yourself into the best version of yourself, you need what he called the four pillars of greatness. Cheesy I know, but there we are!

Pillar 1: The Self

Steven says: “This pillar is about you. Your self-awareness, self control, self-care, self-conduct, self-esteem, and self-story. The self is the only thing we have direct control over; to master it, which is no easy task, is the master your entire world.

Straight forward enough, this is everything self development. As you know if you’ve listened to episode two: We’ve Got Being an Osteopath All Wrong, self-development beyond practitionership is a massively under-looked part of being a great osteopath.

Pillar 2: The Story

Steven says: “This pillar is about storytelling, and how to harness the laws of storytelling to persuade the humans that stand in your way to follow you, to buy from you, to believe in you, to trust you, to click, to act, to hear you and to understand you.

This one sounds a little more traditional business, but I can assure you that it’s coming from a good place. And that’s the thing with these kinds of books, if you research into the author, you can tell whether it’s worth valuing their opinion or not. You can tell if they’re slimy!

Pillar 3: The Philosophy

Steven says: “This pillar is about the personal and professional philosophies that great people believe and live by and how those philosophies result in behaviour that leads to greatness. Your philosophy is the set of beliefs, values or principles that guide your behaviour – they are the fundamental beliefs that underpin your actions

If you’ve followed Osteohustle or this podcast for any length of time, you’ll know how strongly I feel about this. If you know your values and echo them throughout your actions, your business, marketing, the patient experience, how you take your team from strength to strength and so much more, you need branding. You can build your brand with Osteohustle in just 8 weeks and it will transform your business ten fold. 

Pillar 4: The Team

Steven says: “At their core, companies and businesses are groups of people. This pillar is about how to assemble and get the best out of your group. Assembling any group of people is not enough; for your group of people to become a truly great team, you need the right people, bound together by the right culture.

I’ve spoken heaps about clinic culture throughout this podcast, and it may seem obvious to those of you who already have a team, but it’s just as important to think about if you’re working by yourself. More on that later.

Alright, so that’s the self, the story, the philosophy and the team. There are 33 laws in this book, and I’m going to talk about my favourite ones from each of the four pillars. Let’s get started!

The Self – Law 5: You Must Lean In To Bizarre Behaviour

So in this law, Steven explains this idea of leaning out, which refers to a phenomenon where you ignore new and helpful information because of what’s called cognitive dissonance.

For those of you who are hearing about cognitive dissonance for the first time, it’s described as a psychological phenomenon where your actions are different than your thoughts. It’s like knowing that smoking is absolutely bad for you, but you do it anyway. So when you experience cognitive dissonance you have two options: you either give up or justify your behaviour.

The way I want to relate this back to being an osteopath is by using the context of keeping up with changing times as a business owner. Times are changing faster than what they ever have done before in many ways.

What people expect of small businesses is changing, especially with technology and people’s want to associate themselves with brands that share their beliefs.

Marketing is changing. The first website was created in 1991. Google was founded in 1996. Google Ads started in 2000. Facebook 2004, Instagram 2010, TikTok 2016. Web design, copywriting, the user experience, photography all are always evolving and getting better.

The economy always changes. The competitive landscape always changes with local businesses opening up and closing down all the time.

How we run our clinics is changing. Cliniko was founded in 2011. Ruby, a popular virtual receptionist company was founded in 2003. What principles expect of their associates is changing and what associates expect from working at someone else’s practice is changing, both are changing with every generation.

All these changes means that the chances of you experiencing cognitive dissonance will increase. This is why leaning in is so important.

If you refuse to keep up with changing times, you’ll get left behind with a downward spiralling business being like ‘how the hell did I get here?’ I’d even go as far to say that it’s the number one reason why clinics close down. I know that may be hard to hear, but please know that it’s coming from a place of love. Catching up from way behind is so much harder than opening yourself up to the idea that you need to adapt to the world around you in the moment. Here’s what to do.

We all know that accepting new solutions means putting your pride to one side.

So, when something new appears and it challenges you in some way, this creates cognitive dissonance. It’s your responsibility to not instantly lean out, judge, attack and reject, but instead lean in and listen. Try making sense of what’s in front of you and decide if it would benefit you, your business, your team or your patients to implement it.

Steven and I aren’t suggesting that you need to accept everything that challenges you, but you owe it to yourself to give it a fair trial.

The Story – Law 13: Shoot Your Psychological Moonshots First

Steven explains a psychological moonshot as a relatively small investment that drastically improves the perception of something. Here Steven is saying that perception is a great way to improve how people experience something, rather than the reality of improving something.

An example of this is when Steven interviewed Rory Sutherland, who’s a giant in the advertising space, who said “It’s hard to increase customer satisfaction by making a train 10 times faster; it’s much easier to increase customer satisfaction by using psychological principles to make it feel 10 times more enjoyable. I don’t think the UK government would need to spend £50 billion on faster trains if they just made the Wi-Fi work better at while you’re on it. It seems likely that the biggest progress in the next 50 years won’t come from improvements in technology, but in psychology and design thinking.

So again, focusing on how something is perceived (better WiFi) rather than the reality (the trains are still running at the same times).

Here’s a simple question you can ask yourself. What’s a small psychological improvement you can make for your patients?

Now, you can make investments like rebranding, hiring a business coach, bringing on a new practitioner, receptionist or practice manager and giving your website a facelift, but they’re quite big psychological moonshots. Here’s some tiny ones.

  • Every time you come to work, you pick up the litter on the street and outside your practice.
  • Replace your waiting room chairs for more comfortable ones.
  • Declutter your treatment rooms.
  • If there’s poor signal, create a sign that explains where to get good signal.
  • Instal different scent diffusers in different parts of the practice.
  • When a business sends you a patient, give them a call to thank them.
  • Write down the names of your patients family and events they have coming up.
  • Reword your appointment reminders to be in your voice rather than the standard.
  • Have fresh flowers delivered to the practice reception every week.

All these psychological moonshots don’t change the reality of your business in terms of where you’re located or that you’re working inside someone else’s practice, they’re often free or superficial changes that beautifully improve the experience for your patients.

The Philosophy – Law 23: Don’t Be An Ostrich

As we all know, ostriches bury their head in the sand when it senses danger. We may not want to admit this, but Steven says: “When dealing with difficult information, situations or conversations, we tend to bury our head in the sand too”. The bottom line is that we need to acknowledge being uncomfortable when it happens and confront it.

A great quote here is “In business, the person with the fewest blind spots stands the greatest chance of victory…We think better, make better decisions and achieve better outcomes when we’re closer to reality.

Here’s a few examples.

  • We don’t know our business financials.
  • We don’t know about marketing, hoping on word of mouth and luck.
  • We’re too shy or embarrassed to ask for help.
  • We don’t know how our associates actually feel.

I want to highlight that last point, we don’t know how our associates actually feel because in our business coaching, we ask this to every principal we work with. Steven says “Pain in every walk of life is unavoidable, but the pain that we create by trying to avoid pain is avoidable.

Ask yourself this: What’s more painful, the pain when an associate says they’re leaving to increase their hours at a different clinic or the talk you could have with them to better understand how they feel, where they’re at and how you can improve things at the clinic?

What about if you’re an associate and you want more control over attracting new patients, what’s more painful, the pain of leaving the clinic to start over again from scratch or having a transparent conversation with your principal about building a personal brand with a website that links with the clinic’s booking system?

Choose your pain carefully. Steven says: “You have to get used to accepting truths as fast as possible. Avoiding uncomfortable realities means accepting an uncomfortable future”.

The Team – Law 28: Ask Who Not How

All osteopaths wear different hats. We have our practitioner hat, accountant hat, website hat, manager hat etc. Steven shares an interesting story by Richard Branson who admitted that he’s always been bad at maths but that it didn’t matter because he had someone who was better at the finance and stats side of things that what he was.

You may be thinking, is this just a lesson about needing to delegate? In someways, yes, but not really.

Steven says: “We’ve all been trained to ask ourselves: ‘how do I do this?’ when it should be ‘who is the best person that can do this for me?’ While this is an excellent question because every osteopath out there could get better at trusting others to do certain things.

However, as you all know, when I first started out I couldn’t afford getting others to do things for me. I still can’t with many aspects of Osteohustle. Even many of the osteopaths we work with are unable to either. So I’m going to add to what Steven said.

The first question should be ‘who is the best person that can do this for me?’ And if you can’t afford that person, whether it be a business mentor, website builder, Google Ads manager, accountant etc, the next question you should ask yourself is: ‘who is the best person that can teach me to do this?’

This is where you turn to books, podcasts, YouTube, cheap courses, friends, other osteopaths, etc. Get recommendations. Ask ‘where did you learn x y z?’ And start your journey.

If you’re time-poor and can’t afford to get paid help, you’re in a tough spot and the answer is to go back to the drawing board and have a serious discussion about how you’re using your time, how you’re spending your money and how you’re earning money.

As long as you trust the people around you, there’s no reason to know or do everything yourself. Delegation is liberating. When you find someone who’s more capable, experienced and confident than you, let them get on with what you’ve brought them on to do.


We’re over half way into season two and I’m looking to reach 50 5 star reviews and 200 followers on Spotify.

We’re at 48 reviews and 190 followers, so if you haven’t already and you find the podcast helpful, hit the follow button and leave a 5 star review – it really does mean a lot and it’s the best way to tell me you want more.

Share the podcast with your osteo mates, stick it on your social stories and I’ll see you for the next episode. Cheers.

Written by Alan Zaia M.Ost

Founder & CEO of Osteohustle. You’ll find Alan coaching osteopaths, travelling in a van or writing our weekly newsletter, The Hustle.

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