4 of 13 things that annoy your staff: Unpredictable policy exceptions.

In many ways a great practice has some of the qualities of a jazz band. While there is an element of improvisation, there is an underlying structure that provides inspiration for the musicians.

A high-performing practice is a well-choreographed dance. Without a word, everyone is in sync, anticipating the next move. Hand-offs are flawless. In short, it's magical.

Until a standard procedure is ignored or modified on the fly.

Until an established policy is changed for a particular patient.

Until your customary fee is discounted without explanation.

It's difficult to deliver excellence when things are fluid and unpredictable. In fact, it's exhausting trying to figure out what to do when forced to reverse engineer unsettled circumstances.

While some observe "consistency is the hobgoblin of little minds," it's essential for referrals—so patients feel confident risking their reputation on yours.

Bill Esteb has been a chiropractic patient and advocate since 1981. He is the creative director of Patient Media and the co-founder of Perfect Patients. He’s been a regular speaker at chiropractic gatherings since 1985. His 12 books explore the doctor/patient relationship from a patient's point of view. His chiropractic blog, coaching program, patient focus groups and consulting calls have helped hundreds of chiropractors around the world. Since 1999 Monday Morning Motivation has been emailed to over 10,000 subscribers each week.