How to use standardization to prevent growing pains

Adding a third clinician to your mental health practice is a big step. When it’s just two of you, things feel simple. Communication is easy, responsibilities are clear, and you can adapt quickly. But when a third person joins the team, everything changes. Miscommunication starts to happen, roles can get blurry, and it’s easier for things to fall through the cracks.

At this point, your small, flexible group can start to experience growing pains. What worked for two people might not work anymore. Differences in how you handle care or run the practice can create operational, financial, and even clinical problems. Many practices try to fix this by adding lots of rules and policies, but that can make things overly complicated.

The key is to set up straightforward standards that help your team grow while keeping things efficient and high-quality. In this post, we’ll cover what to standardize as you expand to three clinicians, so you can build a strong foundation for your practice without losing what makes your team special.

Standardize clinical workflows

When it’s just you and a partner, you can easily stay updated on each other’s caseloads. With three or more clinicians, that informal system breaks down. It becomes impossible to memorize every patient’s status, leading to potential gaps in care. Standardizing your clinical workflows ensures everyone is on the same page, delivering consistent and safe treatment.

The most critical step is getting everyone onto a single electronic health record (EHR) system. Juggling separate paper files, different software, or parallel systems is a primary barrier to effective team-based care. A single database is the source of truth for your entire practice. The hard part will be to find the right balance between not overpaying for bloat your clinic doesn’t need while it’s still small, while having enough room to grow that you won’t need to switch software every year. Consider how much you’re expanding, and whether you plan on expanding further. The right EHR should alleviate the increase in administrative burden and offer helpful features like automated billing, telehealth, a client portal, and HIPAA-compliant AI tools.

Next, documentation is a major time drain, contributing to clinician burnout. Create standardized EHR templates for common encounters that include essential tools like the PHQ-9 for depression, GAD-7 for anxiety, and a suicide risk assessment scale. This not only speeds up note-taking but also ensures you consistently capture crucial data for both clinical and billing purposes. Think about the clients you see most often, and the data you usually need to care for them properly. Be sure to occasionally review and modify these templates as needed.

Once the software and documentation run smoothly, you should define a clear, four-phase client journey: 

1. Identify: This phase involves recognizing potential clients who may benefit from your services, often through referrals, screenings, or initial outreach. It’s about ensuring the right individuals are matched with appropriate care pathways.
2. Engage/Transition: Once identified, clients are formally introduced to your practice, onboarded, and transitioned into active care. This includes scheduling, assigning clinicians, and setting expectations for treatment.
3. Treat: The core therapeutic work happens here: clinicians deliver evidence-based interventions tailored to the client’s needs. Documentation, progress tracking, and collaboration among providers are key during this phase. 
4. Monitor/Adjust: Treatment outcomes are regularly reviewed using tools like PROMs (e.g., PHQ-9, GAD-7), and care plans are adjusted as needed. This phase ensures ongoing effectiveness and prepares clients for discharge or continued support.

This structure clarifies who is responsible for what at each stage, from the therapist and prescriber to an administrative coordinator. It creates a predictable path for clients and prevents tasks from falling through the cracks.

Finally, consider implementing a daily huddle. A simple 15-minute virtual stand-up meeting each morning can be transformative. Use this time for the clinical team to review a shared dashboard of high-priority cases and tasks. This brief check-in prevents “split-brain” errors where clinicians are unaware of each other’s actions, ensuring a tight loop of communication and care.

For example, imagine a client being seen by both a therapist and a psychiatrist in your practice. Without a unified EHR and a daily huddle, the psychiatrist might adjust a medication without the therapist being immediately aware, leading to conflicting guidance. With standardized systems, the medication change is noted in the shared record, and the huddle provides a space to quickly align on the treatment plan.

Outside of care coordination, a huddle could help you identify bottlenecks or issues in your workflows, or make sure that documentation and billing are done on time.

Secure your bottom line

As your practice grows, so does the complexity of your revenue cycle. Payers begin to view you as an organization, not just an individual provider, which often triggers more intense scrutiny. Minor billing errors that were once manageable can now multiply across three clinicians, leading to significant revenue loss.

You need to centralize credentialing. Keep all provider credentials meticulously updated in a single source of truth, like a CAQH ProView profile. Set a strict schedule for re-attestation (every 90 days is a good benchmark) to ensure your clinicians are always ready for payer enrollment. Delays in credentialing mean a new clinician can’t bill for their services, directly impacting your cash flow.

Don’t let clinicians guess which codes to use. Create a standard charge master that maps every service you offer to the correct CPT codes, including time-based codes, complexity add-ons, and service codes. Some EHRs allow you to pay for an AMA license to access CPT codes within the software to simplify billing and notes. It can be a good idea to attend the occasional webinar or training session when CPT codes change as well.

Define your RCM strategy. You need to decide whether to handle billing in-house or outsource it. A good rule of thumb: if your annual revenue is under $1.5 million, outsourcing to a reputable firm on a percentage-of-collections model (typically 4-7%) is often more efficient. If your revenue is higher or you have complex specialty coding, hiring an in-house biller might provide a better return. Smaller practices with simple billing can easily do it themselves, especially with modern EHRs automating much of the process and guiding even beginners to become solid billers.  Still, time is valuable, and some providers prefer to outsource or hire a biller to remove the billing headache entirely. Talk to your staff and evaluate how much time everyone has, and whether their billing competency and software is good enough for DYI billing.

Implement a denial prevention system. Your goal should be a clean claim rate of 98% or higher. Many modern EHRs include a rules engine that automatically checks claims against payer requirements before submission. This proactive approach is far more effective than chasing down denials after the fact. Aim for a time-to-payment of under 20 days. Attend trainings, and use your EHR’s dashboard to periodically review your most common denial reasons to train clinicians to avoid these mistakes. Prevention is key here.

Build a foundation for the future with technology and culture

The right technology and a strong team culture are the glue that holds your standardized practice together. Your choices in these areas will directly impact clinician satisfaction, burnout rates, and your ability to adapt to the changing healthcare landscape.

Choose a high-usability EHR. As we discussed earlier, clinician burnout is a real threat, and a clunky, hard-to-use EHR can be a contributing factor. When selecting software, prioritize usability scores and clinician feedback. Research shows that a user-friendly EHR can significantly improve job satisfaction for medical professionals. Consider leveraging tools like ambient AI scribes, which can cut note-taking time in half and allow clinicians to focus more on the client. Get together with your clinicians and make a list of must-haves and nice-to-haves. We have an evaluation guide you can use here. Don’t be shy about attending demos and doing trials, since you’re going to be using your EHR every day.

Standardize onboarding and training too. Create a formal onboarding process for every new clinician. This should include a shadowing protocol (e.g., a minimum of six supervised sessions) and comprehensive training on your EHR and workflows. This Forbes article states that companies lose 17% of their new hires within the first three months due to a lack of effective onboarding, so you can see how important this process is. Designate one clinician as a “super-user” who can act as the first point of contact for technology-related questions.

Transitioning to measurement-based care is no longer optional. You need to measure and monitor outcomes. Consistently use a minimum set of Patient-Reported Outcome Measures (PROMs) like the PHQ-9 and GAD-7 at baseline, regular intervals, and discharge. This data is not only essential for demonstrating clinical effectiveness to payers but also provides tangible proof of your practice’s value for marketing.

Prepare for telehealth compliance.  The rules for telehealth are constantly evolving. Maintain a matrix that tracks multi-state licensure requirements and be prepared for the federal policy changes affecting the prescription of controlled substances via telehealth. Make sure your clinicians are licensed to provide telehealth services in the states your practice serves. If your practice is telehealth-only, we have some tips for you.

Your next steps

Growing to three clinicians is a critical juncture. It’s the moment to pause and intentionally design the systems that will carry your practice into the future. By standardizing your clinical, administrative, and technological foundations, you build a resilient organization that can reduce burnout, improve patient safety, and secure its financial health.

Start by mapping your core clinical workflow. Select a unified, high-usability EHR and begin creating your encounter templates. Tackle credentialing and billing next to protect your revenue cycle. It’s a process, but institutionalizing these standards early will provide an outsized return on investment, positioning your practice for sustainable success. And if you’re looking for more tips for your group practice, check out these 7 admin habits for a thriving group therapy practice.