Andrea Gets Schooled

Being a business owner is all about solving problems – and let’s be honest, most of them are completely new to us. If you’re like me and didn’t have any formal business training upon starting your business (that’s changed thanks to my MBA), you’ve probably had to figure things out on the fly. This is especially true in private practice physiotherapy. We don’t learn much, if anything, about running or managing a clinic during school – it was all about patient care.

So, like many clinic owners, I’ve spent a lot of time winging it. A problem comes up, and you just have to roll with it and find a solution. The challenges are endless: figuring out lease agreements, hiring and managing staff, juggling schedules, learning billing systems and financial management – the list goes on.

But out of all the categories of problems, the trickiest and most important ones usually involve people, especially when your in a service-based industry such as rehabilitation. Whether it’s handling staff concerns or addressing issues raised by clients, people management is where the stakes feel highest.

Over the past nine years, I’ve been learning how to process these challenges and have been coaching my leadership team to do the same. Recently, I realized I’ve been using an familiar tool to address these challenges, without even realizing it. It’s the same framework we use in physiotherapy for documentation: S.O.A.P.

If you’ve worked in healthcare, you’re probably familiar with S.O.A.P.
It stands for Subjective, Objective, Analysis, and Plan – a framework we use to document treatment sessions. While charting might not be the most exciting part of the job, it’s essential for tracking progress, organizing our thoughts, and ensuring continuity of care when another therapist takes over.

What surprised me is how well this framework translates to tackling ‘people problems’ – the human resources challenges that come with running a business. In this article, I’ll explain how the S.O.A.P. framework works in patient care and how it can help with problem-solving HR challenges on the business side.

Subjective: The Stories

Most physiotherapy sessions start with what we call a subjective history. This is the part where I ask my client about their week and how they’re feeling. If they mention that their back started hurting, we dig a little deeper to understand what’s going on from their perspective, and welcome any opinions, thoughts, and emotions that may show up.

This part of the conversation usually involves questions like:

• What happened?
• When do you notice the pain?
• How does it feel when you first wake up? Throughout the day? In the evening?
• What have you tried so far?
• What makes it better? What makes it worse?

These questions help me gather the bigger picture while also building trust. Over time, I’ve honed my ability to listen closely, show empathy, and ask thoughtful, open-ended questions that let clients share their story without feeling led or rushed while being mindful of the session time to still allow for treatment. Depending on their answers, I might go further with more specific follow-ups.

This stage also requires some multitasking. While I’m listening and engaging, I’m usually typing furiously to capture all the details for later analysis. But here’s the key: I’m not jumping to solutions or offering advice yet. I’m also trying to minimize any judgment or assumptions that may be forming in my mind. Remember, in the subjective portion, there is no ‘right’ or ‘wrong’; the patient’s experience is true to them and as healthcare practitioners, we must acknowledge this. At this phase of the session, I’m starting to piece together a hypothesis of what might be going on and which physical tests or assessments will help confirm or refine that theory in the next step.

The subjective phase is foundational – not just for physiotherapy, but for problem-solving in general. It’s about slowing down, listening well, and gathering all the context before taking action.

To apply the “Subjective” step to business conversations: let’s explore a common business scenario: one of your staff members approaches you asking for a significant raise.

A typical reaction from leadership might be to immediately start explaining – why the business can’t afford it, why it’s not the right time, or why their performance hasn’t met expectations. While this might feel like the logical thing to do, it often leaves the staff member feeling unheard and frustrated. That’s where the S.O.A.P. framework can come in handy, helping you approach the conversation more thoughtfully and avoid eroding trust.

Instead of jumping to conclusions, start with the subjective step. This means taking the time to understand their perspective before forming your response. Here are some questions you might ask:

• What’s been on your mind lately regarding your pay? Can you share more details about what you’re looking for?
• Why have you been feeling this way?
• Do you have specific reasons or examples that support your request?

These open-ended questions create space for the staff member to share their thoughts and provide valuable context. By actively listening and showing that you’re genuinely interested in understanding their perspective, you’re setting the stage for a more constructive and collaborative discussion.

Pro tip: You don’t need to provide an answer right away! From my experience and conversations with other business owners, requests for raises can be emotionally challenging for both parties (we all have our own money ‘stuff’), and can trigger an owner’s fears around financial scarcity or staff turnover. Instead of reacting in the moment, thank the team member for bringing their request forward and let them know you’ll take time to thoughtfully consider it. This approach gives you space to process and minimizes the risk of reacting defensively or saying something that could harm the working relationship.

Just like with patients, you’ll also have your own subjective insights to consider. For instance, if you’ve worked with a client for a while, you might know they’re a right-handed tennis player adjusting to life with a new baby. Similarly, as a business owner, you likely have context about how this staff member collaborates with the team, handles challenges, and contributes to the workplace environment.

Once we have our subjective perspectives, let’s look for the facts with objective information.

Objective: The Facts

After gathering context in the subjective phase, the objective stage is where we focus on collecting measurable data to guide our next steps. In both physiotherapy and business settings, this step is all about choosing assessments that provide clear insights, while recognizing the inherent challenges of objectivity.

For example, for our patient above who comes in with back pain, the objective stage might include:

• Active range of motion tests: Asking the patient to bend forward, backward, sideways, or rotate while observing their movement patterns. Is a particular motion limited? Do I notice asymmetry or irregularities?
• Passive range of motion tests: With the patient relaxed, I move their joints to check for limitations or differences compared to active movement. This helps determine if the issue is muscular or mechanical
• Palpation: Using hands-on techniques to assess muscle tone, tightness, pain, or fascial restrictions
• Special tests: These target specific areas based on the initial hypothesis. For example, if I suspect the pain is linked to the pelvis, I might perform sacroiliac (SI) joint tests, hip muscle length assessments, or nerve tension tests

While we aim to gather objective, unbiased data, it’s important to acknowledge limitations. Factors like a therapist’s experience, testing technique, or even the power dynamics between therapist and patient can influence results. No assessment is perfectly neutral.

The same applies in a business context. When evaluating a staff member’s request for a raise, leaders need to collect relevant facts while recognizing that personal biases and workplace dynamics may influence their observations. Here’s how this might look:

• Reviewing performance metrics: Common data in rehabilitation clinics includes:
  • Shift utilization: What proportion of their schedule is booked?
  • Patient-visit average: How many follow-up visits does each new assessment generate compared to the clinic average?
  • Booked-to-prescribed ratio: Are patients booking the recommended number of sessions to achieve their goals?
• Considering others’ feedback: This can include patient reviews, team feedback, or even formal 360-degree reviews. Whether this fits better in the subjective or objective stage depends on the situation, but it’s important to consider the broader picture of how this staff member is perceived because no team member works in a vacuum
• Reviewing company policies: What’s the typical promotion or raise trajectory for their role? How often are raises given, and what are the criteria? Cross-referencing their promotion history with these policies can provide clarity
• Comparing pay requests to industry standards: Benchmarking their request against average compensation for similar roles in the field helps set realistic expectations
• Assessing financial feasibility: Examining the business’s current financial health is essential to determine whether their request is feasible

Just as in physiotherapy, it’s impossible to be completely neutral when gathering objective data in business. A leader’s perspective, experience, and relationship with the staff member will shape their interpretation. Recognizing these influences helps ensure fairness and transparency as you move toward analysis and decision-making.

The goal is to confirm or refine hypotheses using facts, creating a solid foundation for the next stage: analysis.

Analysis: “So What?”

The analysis stage is what I like to call the “so what” stage. At this point, you’ve listened to their story, added your perspective, and gathered the facts. Now it’s time to step back and put everything together into a clear and concise summary of what’s going on.

Think of it as creating a working hypothesis. If you couldn’t provide the solution yourself and had to hand over the case to someone else, this is where you’d distill all your detective work into a cohesive explanation.

For a physiotherapy example, for our patient above who’s dealing with low back pain. Your analysis might sound something like this:

The patient’s back pain began after increased duration of carrying her infant this past week due to the infant’s illness. Prolonged asymmetrical carrying likely created compression in the right lumbar area, leading to tightened quadratus lumborum and irritation of the right sacroiliac joint.

It’s a brief but detailed synopsis that highlights why this person may be experiencing their issues, and gives the foundation on which to develop a treatment plan.

In a business scenario – like a staff member requesting a raise – the analysis is less medical but follows the same principle: synthesize the context and data into a clear summary. For example:

This staff member’s performance metrics match or exceed clinic averages, with the exception of booked-to-prescribed ratio which is below clinic average. They are a strong team player who contributed well to the company’s success over the past year. Their last compensation adjustment occurred 18 months ago. Based on this, a raise is justified with some coaching required to improve communication of care plan.

The analysis is your way of aligning the story, the data, and your professional judgment to create a well-rounded picture of the situation. This analysis may be documented somewhere, or at least this is how to communicate your detailed analysis to your fellow leaders in a succinct way.

Now, with your analysis in hand, it’s time to move into the final stage: the Plan, where you get into the nitty-gritty of actionable next steps.

Plan: Taking Action

The plan stage is where you take all the insights from the previous stages and turn them into actionable steps. This phase is all about clarity—specific goals and a detailed to-do list that guides execution. Bullet points are your friend here, helping to lay out the details in a way that’s easy to follow.

For the Patient with Low Back Pain

For the patient with low back pain, the plan section serves as a to-do list for the therapist, particularly when they have a high volume caseload and it’s impossible to remember all the treatment ideas you have planned for the coming weeks. Here’s an example:

Goals:

• Decrease tightness in right lumbar musculature
• Improve spinal elongation to reduce compression on joints and nerves in the lower back and pelvis
• Improve symmetry of sacroiliac and hip joint function

Plan:

• Apply manual therapy techniques (e.g., fascial work and acupuncture) to target lumbar muscle tightness
• Use passive traction, supported hanging, and full hanging techniques to promote spinal elongation
• Perform manual therapy to improve functional nutation of the sacrum and end range hip extension
• Educate the patient on symmetrical, scoliosis-friendly infant-carrying techniques
• Develop a home exercise program (typically you would list the specific exercises to introduce):
  • Strengthen the core
  • Maintain hip flexibility
  • Improve upper-body strength for carrying

Remember, the analysis is a working hypothesis. The plan is dynamic and should evolve as you gather new information during treatment. If the initial approach doesn’t yield results, it’s okay to pivot or even refer to another therapist with a different skillset.

For the Staff Member Requesting a Raise

In a business context, the plan outlines how the situation will be addressed while balancing company resources and the staff member’s needs. The detailed plan also serves as leadership’s reminder of their decision-making process, to use for similar future requests from other staff. Here’s an example:

Plan:

• The raise will take effect on [X date]
• Award a one-time bonus of [$YY] to acknowledge the staff member’s exceptional contributions to [Project A]
• Implement a salary increase of [$ZZ] (75% of the requested amount) and highlight their positive behaviours that resulted in positive metrics
• Schedule extra mentoring sessions to explore why patients are not booking their full care plans
• Follow-up in 6 months to re-assess for improvements in booked-to-prescribed ratio
• This staff member expressed desire to visit their family more often. To address company cash flow constraints, offer a flight credit valued at [$BB], redeemable via company travel points
• [Manager] to follow-up with staff and communicate all the above and hear staff’s feedback; when in agreement, create wage increase letter
• Co-create a timeline and specific goals for the staff member’s next promotion, ensuring alignment between the company’s objectives and their career aspirations

By creating a detailed plan, you not only address the immediate situation but also set the stage for future progress. Whether your challenge is patient or business-related, this stage is where theory turns into actionable steps.

Navigating clinical challenges as a physiotherapist requires a blend of intuition, strategy, and structured problem-solving. Likewise as a business owner, you may be supporting a staff member or addressing any other business challenge where people are involved (customer complaints, vacation negotiation, staff conflicts, shareholder disagreements, etc). The S.O.A.P. framework – originally designed for patient care – offers a surprisingly effective approach to addressing both clinical and HR challenges. By starting with Subjective info to gather personal perspectives, moving to Objective assessments for factual data, conducting an Analysis to synthesize findings into a working hypothesis, and crafting a clear Plan to guide action, you can minimize the risk of jumping to conclusions, and instead, approach these situations with structure and clarity.

Whether helping a patient manage low back pain or responding to a staff member’s raise request, this framework can help you maintain your composure with a thoughtful, organized, and empathetic process that promotes trust and works towards positive outcomes.

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