A private practice can look successful on the outside and still feel exhausting behind the scenes. In this episode, Gordon talks with Lisa Permar about the small friction points that quietly drain your time, attention, and energy, and how better systems can help. They explore what happens when everything still depends on the owner, why hiring alone does not always solve the problem, and how clearer processes around intake, scheduling, billing, delegation, and documentation can create a calmer, more sustainable practice.
Meet Lisa Permar 
Lisa Permar is an operations architect and the founder of Zero Friction Practice, where she helps private practice owners build the systems their businesses need to run smoothly without relying on memory, constant oversight, or late nights. Drawing on years of experience building the operational backends of businesses across multiple industries, Lisa specializes in helping clinical practices improve intake, scheduling, billing, cash flow, delegation, and documentation. Through the Zero Friction Method, she works alongside practice owners to install practical infrastructure, create clear playbooks, and remove the owner as the bottleneck so the practice can operate with greater clarity, consistency, and freedom.
When Everything in Your Practice Comes Back to You
One of the biggest challenges I see with private practice owners is that the practice can look incredibly successful from the outside while still being exhausting to run behind the scenes.
Clients are coming in. Schedules are full. Revenue is there. But every question, exception, reminder, and loose end somehow finds its way back to the owner.
That is where the real friction starts.
Most of these things are not huge problems on their own. Answering a scheduling question might take two minutes. Checking whether an invoice was paid might take another minute. Following up on documentation might take a few more.
But when those little things happen over and over again, they start taking up a whole lot of mental space.
And if something is constantly occupying your mental space, it drains your energy.
The Small Things Are Usually What Create the Overwhelm
We tend to think overwhelm comes from one giant problem that needs to be solved.
Most of the time, it is the opposite.
It is the dozens of little things that keep repeating themselves.
You answer the same intake question again. You go back and forth trying to schedule someone. You remind a clinician about documentation. You check on an unpaid invoice. Someone asks you how to do something in the EHR.
None of those things feels especially significant in the moment.
But when they happen every week, sometimes multiple times a day, they create constant context switching. Your attention gets pulled away from the work you were actually trying to do.
That is why it is helpful to stop looking at these things simply as tasks and start looking at them as systems problems.
If something keeps reappearing on your to-do list, there is probably an opportunity to create a clearer process around it.
A Task Is Not the Same Thing as a System
This distinction is important.
You can become incredibly efficient at remembering to do something and still not have a system.
If you are the one who has to remember that a reminder needs to be sent, an invoice needs to be checked, or documentation needs to be completed, the process still depends on you.
A good system answers some basic questions.
What triggers the next action?
Who owns it?
What happens next?
What happens when something does not go according to plan?
When those answers are clear, the process does not have to live inside your head anymore.
That gives you back attention, energy, and mental bandwidth.
Are You a Firefighter, Builder, or Operator?
One framework Lisa shared in our conversation was the idea that practice owners often fall into one of three operational stages: firefighter, builder, or operator.
The firefighter stage is exactly what it sounds like.
Most processes are manual, the practice depends heavily on the owner, and the owner spends a lot of time reacting to whatever problem comes up next.
At this stage, the goal is usually to reduce repetition and interruption.
The builder stage looks a little different.
Systems exist, but they do not always work together consistently. One client might have a seamless experience while another falls through the cracks.
The goal here is to connect and standardize the pieces.
Then there is the operator stage.
At this point, the practice generally works. The problem is that much of the knowledge about how it works still lives in the owner’s head.
The owner might be able to step away for a day or two, but taking an entire week off still feels a little scary.
That is where documentation, clear ownership, and decision-making authority become really important.
Hiring Someone Does Not Automatically Fix the Problem
A common response to feeling overwhelmed is, “I just need an assistant.”
Sometimes that is absolutely true.
But hiring someone does not create clarity where clarity did not already exist.
If your processes are unclear before you hire someone, you can end up managing the same broken processes while also managing the person who is trying to understand them.
That can actually create more work instead of less.
Before you delegate something, the person taking it over needs to understand what outcome they are responsible for, what process they should follow, what decisions they can make independently, and when something needs to be escalated back to you.
Otherwise, you have not really removed yourself from the process.
You have just become the process manager.
“It’s Faster If I Just Do It”
I think nearly every practice owner has said this at some point.
“It’s easier if I just handle it.”
And sometimes it is.
If something happens once, taking care of it yourself may be the fastest option.
But when the same thing happens three times every Tuesday, we have a different problem.
Every time you immediately solve something for someone, you also teach them that the solution is to come back to you the next time it happens.
One small change I have made in my own practice is pointing people toward the resource that answers their question instead of automatically fixing the problem myself.
If someone has a question about our electronic health record, for example, I might send them the appropriate knowledge-base article rather than going into the system and fixing it for them.
That seems like a tiny change.
But those tiny changes compound.
You begin building a practice where people know how to find answers and solve problems without everything automatically getting routed back to the owner.
Systems Should Make Your Practice More Human, Not Less
Talking about systems can sometimes make people think we are trying to automate every interaction and remove the human element from private practice.
That is not the goal.
Therapy practices should feel human.
The goal is to automate what is predictable and document what is repeatable so that you can protect your attention for the moments that actually require judgment, care, and human connection.
You do not need your best mental energy going toward remembering whether you sent a reminder.
You need it for the conversations, decisions, clients, team members, and situations where your presence genuinely matters.
Good systems make room for that.
Could Your Private Practice Run Without You?
This is also where proactive planning becomes important.
What would happen if you suddenly could not work?
Maybe you got sick. Maybe there was a family emergency. Maybe you simply needed to take some meaningful time away.
Would someone else know what needed to happen?
Could they see how your systems work?
Would they know how to keep the practice moving?
Ideally, your private practice should not require you to be available every single day in order to function.
And this does not apply only to group practice owners.
Solo practitioners have intake processes, scheduling, documentation, billing, and dozens of recurring decisions too.
Even if you never plan to delegate those responsibilities to another person, having structure means you are not reinventing the process every time or relying entirely on memory.
It also creates a backup plan if someone ever does need to step in and help.
You Do Not Have to Rebuild Everything at Once
If you are reading this and thinking about all the systems in your practice that need work, the answer is not to overhaul everything this weekend.
Start with the friction.
Pay attention to the questions you answer repeatedly.
Notice the tasks that keep returning to your to-do list.
Look for the moments when someone on your team automatically comes to you to fix something.
Identify the place where your time, revenue, energy, or attention is leaking the most.
Then work on that one thing.
Create the process.
Test it.
Document it.
Clarify who owns it.
Then move on to the next point of friction.
Over time, those small improvements begin compounding in the opposite direction.
Instead of dozens of little problems steadily consuming your time, dozens of small systems begin giving that time back.
That is how you create a private practice that feels calmer, more predictable, and much less dependent on you being the person who holds everything together.
Gordon: Well, hello everyone, and welcome again to the podcast.
And I'm really looking forward to you hearing from Lisa Permar today. Hi, Lisa, glad you're here.
Lisa: Thank you. So glad to be here. Mm-hmm. Thanks for having me on.
Gordon: Yes, and so we were chatting a little bit before we, we started, and this is, I think, gonna be a great topic for folks. And I know it's one of the, one of the things that when I'm doing consulting with people that I really put a lot of emphasis on, and that's just having the right systems and processes in place to make the s- practice run smoothly.
But Lisa, as I start with everyone, tell folks a little more about yourself and how you've landed where you've landed.
Lisa: Yeah, absolutely. So, um, I do operations, and that's really it. Uh, and most of the practice owners I work with are clinically successful. Um, so their schedules are already full, and revenue's already coming in, and the practice looks like it's working.
But behind the scenes, you know, they're still answering every question, fixing every exception, and following up on loose ends. So my focus, and what Zero Friction Practice does, is teaching practice owners how to s- build the systems that support the clients and work they already have. Mm-hmm. You know? And think things like intake workflows or scheduling rules, billing and cashflow routines.
Um, really just all about clearer ownership across the practice. Mm-hmm. And really what is different about what I do, um, is that I'm not just handing people information or, like, a folder of templates and hoping that they get around to implementing it someday. Um, what I do is I like to call it a guided implementation experience.
Mm-hmm. So in short, we kind of figure out where the practice is too dependent on the owner, and we build the systems together inside their actual practice. And so long story short, how I came to this is, uh, really the work grew out of Grounded Light Counseling, which is, um, the virtual Colorado practice that I helped build from the ground up with my husband, Glen.
So he's an LPC. I'm not actually a therapist.
Gordon: Mm-hmm.
Lisa: But, um, I have built the ... You know, I've been able to build and continually test much of what makes a practice work behind the scenes, uh, w- with Grounded Light Counseling. And, um- It's been a great process to really test something that looks perfectly reasonable on paper, but then- Mm-hmm
really doesn't survive like an actual Tuesday. Right. Um, yeah, so it's just- Yeah ... been a really great, like, testing ground for the processes I now teach.
Gordon: Right.
Lisa: Yeah.
Gordon: Yeah, that's, that's great. And so yeah, I guess the question that comes to mind for me is it sounds like you've broken it down into different processes.
What, what would you say you've identified as the different processes we need to kind of hone and perfect, uh, in running a practice?
Lisa: Yeah, that's a really good question. Um, so I don't actually say, like, that there's one, you know, one s- clear starting point necessarily. Mm-hmm. Um, I normally do start with intake- Mm-hmm
um, as like, as like the first system to look at. But, um, really it's just- Sorry, give me a second here
Gordon: Mm-hmm. Mm-hmm
Lisa: Really it's just about, um Finding the friction underneath everything. Mm-hmm. So, like, I use the word friction to describe, like, a small repeated point of effort, you know, that makes running the practice harder than it needs to be.
Gordon: Mm-hmm.
Lisa: Um, so it's really about starting not so much with the tool, but with, um, where, where the, the repetition and the, um, the compensation is coming from and starting.
Right. So that could be things like answering, you know, the intake questions repeatedly or, like, going back and forth to schedule someone or checking whether an invoice was paid or things like that. It's just those individually, those moments don't feel particularly serious or, like, time-consuming. Um- Mm-hmm
most take only a few minutes, but when they happen repeatedly, they just consume so much time, interrupt concentration. There's that context switching. Um, and it just creates those revenue and energy leaks.
Gordon: Right.
Lisa: Um, so it's really about, uh, you know, identifying those repeated patterns basically that are just- Mm-hmm
continually to happening, um, and getting to the source of it. So it- it's not necessarily one particular thing, 'cause I look at several different systems and find the one where the- the friction is costing the most essentially.
Gordon: Right. Right. Yeah, I think about, um, I guess one thing that comes to mind for me that I know a lot of clinicians struggle with, and that's documentation.
Um, particularly, you know, getting their clinicians to get their documentation done, but also, um, just how that can hold up, particularly if you're insurance-based, can hold up getting paid. And so the- Yeah ... cash flow piece. Yeah. Yeah.
Lisa: Yep.
Gordon: Mm-hmm.
Lisa: Yeah, exactly. Um, and that is really one of the most, um, kind of common admin mistakes too that you can think is like- Mm
treating documentation or, um, any set type of admin mistake as kind of like a to-do list rather than a set of systems. Mm-hmm. So, you know, s- it's not ... If sending that reminder or, um, or following up on an invoice or finishing that documentation just is constantly recurring and reappearing on your to-do list, like that's just
You may be managing that task efficiently, but it still is depending on you, you know, remembering it and putting it down and, and closing it and finishing it. Um, and so a system for that is, like defines what that trigger is, triggers that action and what happens- Mm-hmm ... next, who owns it, and how to-
How the exceptions get handled is what, is what the system can, like, solve, and take that out of your brain.
Gordon: Right.
Lisa: Or off the to-do list.
Gordon: Right, right. Yeah, 'cause it, um, if it's, uh, if it's occupying our mental space, it just drains our energy. Mm-hmm. Because it just feels like it's... Yeah, and like you said, it's most of the time it's not gonna be something that takes that long to do.
Lisa: Right.
Gordon: Right, right. So can you give us some examples of, um, maybe friction points that you've helped people with, and just how you kinda solve the problem of, of that?
Lisa: Yeah. So, I mean, we can talk a little bit kind of about what, um, the Zero Friction Method looks like, which is the, the implementation experience that I'm creating, and I've been working kind of one-on-one with some practice owners- Mm-hmm
um, and doing some case studies with that. Uh, so I guess some of the things that we can look at is kind of, I talk about, um, three stages that practice owners kind of often move through, kind of like a progression. Mm-hmm. Mm-hmm. Um, and I don't, these aren't judgments. Um, they're simply, they simply kind of help identify the kind of operational work that is needed next.
Um, but there's, there's typically like a firefighter, a builder, and an operator stage. Mm-hmm. And so we, we start there to see where, what we need to prioritize. Um, and in the firefighter stage, most things are manual, um, and depend on the owner extensively. The work is often reactive, and the priority is usually just reducing repetition and interruption.
Um, and then in the builder stage, you know, some systems exist, but they don't consistently work together necessarily. Um, one client can have like a seamless onboarding experience while another may fall through the gap. And the priority for builders is really about connecting and standardizing the pieces.
Mm-hmm. And then, then we've also got the operator stage, which the practice generally works, um, but the owner's knowledge has not been made transferable, I said. It's like everything is like institutional knowledge. Um, so the process lives primarily in their head. Mm-hmm. Uh, so she, you know, that owner can typ- typically step away for a day or two, but a full week might still feel risky.
Mm-hmm. Um, so in that stage, the goal isn't necessarily, you know, more automation. That could be about just documentation, uh, like decision rights and just clearer ownership.
Gordon: Mm-hmm.
Lisa: Um, and so with the Zero Friction Method as an implementation experience, um, that is for the practice owners who are ready to move beyond recognizing the fri- the friction and like actually rebuild the systems underneath their practice.
Mm-hmm,
Gordon: mm-hmm.
Lisa: Um, so, you know, the diagnostic that we start with breaks down what to address first, and then the method piece guides them through the deeper work of building, connecting, testing, documenting, and ultimately transferring those systems, um- Mm-hmm ... so that the practice no longer depends on the owner to compensate every gap, you know?
Gordon: Right.
Lisa: And, um, and I know- That, you know, rebuilding systems can sound like an enormous project- Mm-hmm ... when you're already overwhelmed. Um, but with the method, it's, it's specifically designed to obviously make it more manageable by focusing on one high impact point of friction, um, at a time within the week that they're actually already living in.
Um- Mm-hmm ... so, you know, I, how I teach is that, like, you know, each week we have a, a 60-minute kind of build call we, we call it, um, where there is like a teaching component of like- Mm-hmm ... identifying the system, um, and uncovering what's causing the friction, prioritizing the right structural fix here in that moment.
And then, um, then there is, later in the week after they've had some time to process and digest and kinda work on it, um, an implementation lab, which is an actual 90-minute live session as well, um, where together we can troubleshoot, feedback, you know, test the solution, make sure together that it can operate reliably outside of the owner's head.
Um, so how I work with folks is not just about learning the systems. You know, they're leaving each week with another working part in their practice rebuilt. Mm-hmm. Um, and there's a whole framework and, um, you know- Mm-hmm ... I'm still refining it and working with folks, um, very closely one on one now. So this isn't like a, you know, a, a easily accessible, um, evergreen program at the moment.
Mm-hmm.
Gordon: But
Lisa: we're getting there, and it's going really great. Um-
Gordon: Yeah. Well, good. That's good. Yeah. So, I, I'm sure people would be curious to maybe get hear a, a case example of maybe a practice that you've worked with, and what was kind of the transformation. And I know there are probably several different areas within the practice you work with, but can you, uh, give us an example of just maybe one area that you worked with that maybe was causing a lot of friction for the, for the practice, and then what the transformation was?
Lisa: Yeah. Um, so one practice that I worked with, uh, they thought that hiring was the solution with where they were at the moment. Um, and- You know, practice owners do often just say, like, "Oh, I think I just need an assistant," which sometimes they do, and sometimes that is the, the, the solution that they're looking for.
Mm-hmm. Um, but a new, you know, as we found with this particular person, a new person didn't create clarity for them that had not yet existed. Um, so hiring d- um, hiring ended up causing a lot more work for this particular practice than they were expecting. They were essentially- Mm-hmm ... already managing, um, the systems in place at their practice, but then they were managing the person who was trying to manage the systems that they didn't understand.
So with that owner, we worked on things like, you know, specifically how to bridge the gap for this new hire, 'cause it was, they, the owner hadn't thought about the outcomes that this person was gonna be responsible for, um, the processes that they needed to follow. Um, we, we had to design, uh, you know, kind of a- outline and, and, um, illustrate the decisions that that new hire could make independently, identify when something needs to be escalated, and, um, and even, even identify, you know, how we know the processes are working with that new hire.
Gordon: Mm-hmm.
Lisa: Um, so that was primarily what we focused on, which led to, you know, um, diving in deeper to other, to, to, like, their onboarding systems between new clients and scheduling. Um, there was some billing that got tend to- tended to as well through that. But the number-one priority for this practice was, um, you know, the, the delegation, I guess, the handoff- Mm-hmm, mm-hmm
the clarity. Mm-hmm. Um, because del- sh- she had realized that delegating under, you know, unclear processes didn't remove her from anything at that point. Right. It just turned her into a process manager.
Gordon: Mm-hmm.
Lisa: Um, so yeah, when-
Oh see You know, I, I guess She, like her practice looked incredibly stable and successful from the outside. Mm-hmm. And she just knew she needed her own help for when clients were coming in and sessions, you know, were happening and everything. Mm-hmm. The work was still being accomplished- Mm-hmm ... but she needed to be in a position that didn't, no- that no longer, like, required her to supervise every step- Mm-hmm
so that the practice could become calmer and more predictable. Um, yeah, and so essentially, like her, uh, she would've fallen under the operator category. Mm-hmm. And so it was all about moving everything out of her head, documenting, um, it, it was SOPs, you know, there was a piece of everything that is how to write the most efficient and effective SOP, which only- Mm-hmm
has to be one page, not a binder of everything.
Gordon: Right.
Lisa: Um, and that was able to just finalize the hand-off. Mm-hmm. It was like the playbook hand-off for her.
Gordon: Right. Right. Yeah. And I, I think that's a typical, a typical problem for a lot of practice owners in that we, there might be all, a lot of different tasks that we do, um, day in and day out, and we just, we, we're used to doing it, and we don't even have to think about it.
It's just- Mm-hmm ... autopilot, and we do it, and then the thought of handing that off to someone else, uh, somehow or another feels terrifying, and that- Uh-huh ... you know, okay, it's gonna, it's gonna be totally messed up, and it's just better, just better if I handle it, you know, kind of mentality. Yeah.
Lisa: Exactly.
Gordon: Uh-huh.
Lisa: Yeah. Yes. That is a phrase I hear all the time. "It's just faster if I handle it. It's easier if I just do it." Uh-huh. But that's that compounding piece that I'm trying to highlight, is that, that when that happens once, fine. When it happens three times every Tuesday, we're starting, you know, I have questions at that point.
Like, it does compound.
Gordon: Yeah. Yeah. And I think, I think, uh, too, uh, and I've learned this, uh, as I say all the time on the podcast, I've learned a lot of stuff the hard way. Um, but, um, I think, um, not empowering people to fix things on their own as opposed to always coming to you, um, whe- when there's a problem and saying, okay, you know, I, uh, I, I can give a little example of that is, is that- Mm
um, with our, uh, electronic health record system, every now and then they'll run into, "Well, I don't know how to do this here," and that sort of thing. "What do I do if this happens?" kind of thing, and then they contact me. Um, what I'd, what I ended up doing instead of trying to go in and fix it and tell them how to do it is I just went to the knowledge base and pulled the link and said, "Here you go."
Lisa: Yeah
Gordon: Yeah
Lisa: Perfect
Gordon: And so, yeah, yeah. And so, yeah, so that's just a small example of, you know, you know, and the, the problem is is that, you know, the more we do, the more we fix it, then that's the fix, is they come to- Exactly ... the owner and fix, to fix everything.
Lisa: Exactly. Mm-hmm. And even those small fixes compound in the same way, is that that frees up a little bit more time each time- Mm-hmm
and it does compound. And, like, that's why, you know, I, I take things in small stages. It's just starting with the, the highest priority point and letting it compound slowly, slowly. Mm-hmm. So this isn't a giant ho- overhaul. It isn't rebuilding everything from scratch. Um, and, and along the way, keep, you know- I, I know I also recognize that the goal isn't to remove every human interaction.
You know, I'm not all about like- Mm-hmm ... automation, automation, automation, like pull yourself out of everything. Um, I 100% agree and believe that therapy practices should feel human. Um, so- Mm-hmm ... I'm not trying to remove that aspect. Um, it's really just about, like automating the predictable, documenting the repeatable, and like preserving your human attention for those moments that actually require judgment and care.
Um-
Gordon: Right. Right.
Lisa: Yeah, and so it's just, yeah, t- like removing that compounding effect of those little friction points and compounding it the other way by giving you- Mm-hmm ... more of that time back, and attention, and mental bandwidth, and-
Gordon: Right.
Lisa: Right. Mm-hmm.
Gordon: Yeah, and that's a, uh, you're exactly right. There's the little things that compound that create the overwhelm for people, and not that just, yeah, I've, again, I've experienced that myself.
And- Yeah ... you know, a- another thing too, and we've addressed this topic a lot of times on the, on the podcast, is to be able to think proactively, uh, particularly if something happens to you as the practice owner, how things are gonna be maintained and-
Lisa: Yeah ...
Gordon: and run, you know, if you're not in the picture for whatever reason, whether you're out for an illness, or a sickness, or, uh, something going on in your family.
And I personally s- have experienced that. And, you know, and fortunately, I think my... I've got pretty good, my, my practice pretty much runs on autopilot. Nice. Uh- There's a lot of things that I do need to let go of, and I probably, maybe will eventually, but also it's things that I enjoy doing, so I mean, it's not like it's-
Lisa: Yeah.
Gordon: Yeah.
Lisa: Mm-hmm. And you made a really good point there about, like if something happens to you and things still need to, you know, keep running is something that I always say with this too, is that all of this matters just as much for solo practice owners too, you know? Yes. Mm-hmm. I mean, 'cause sometimes people hear the word systems and assume that we're talking about like building a team, or preparing to scale, or like having to have an admin that you're transferring stuff to.
Mm-hmm. But I mean, a solo practice obviously still has intake, and scheduling, and you know, documentation, and just dozens of recurring decisions that are competing with that owner's clinical work. So-
Gordon: Mm-hmm ...
Lisa: I mean, the goal may not be to ha- like to hand those responsibilities to another person, but they should be working to create enough structure that, you know, they're not reinventing processes, or making the same decisions, or like relying on memory for everything.
Um, and God forbid, if something does happen, that somebody can- Step in and, and see what, what the systems are, you know? See the- Yeah ... the, the, what's in their head is out, and that they can help step in, you know?
Gordon: Right, right. Yeah, exactly. Yeah, it's always, uh, always good to have a backup plan, for sure.
Lisa: Yeah.
Gordon: Yeah, yeah.
Lisa: Absolutely.
Gordon: Well, yeah. Well, Lisa, I've gotta be respectful of your time, and this has been a great, uh, conversation. Tell folks more, a little more about the friction method, how they can get in touch with you, and what you have to offer with all of that.
Lisa: Yeah, absolutely. Um, well, so the best place to start is at zerofrictionpractice.com/diagnostic because there I have, I do have a free diagnostic that will help you, um, identify where your practice is losing that time, revenue, mental energy, and, and where to begin with that.
Mm-hmm. Um, and it does also include a friction log, which I do think is the first step that anybody who's listening now can take, um, to help begin identifying those repeated problems and interruptions that keep coming back to you. Mm-hmm. Um, and then you can also find me on Instagram at the practice architect, where, um, I'm doing my best to make private practice operations more fun than they have any right to be.
Gordon: Mm-hmm.
Lisa: Um, and then yeah, for owners who want to go, you know, beyond that step of just identifying the friction, um, I am still, you know, in testing mode of Zero Friction Method, that guided implementation experience, but, um, they can hear, you know, be the first ones to hear about what's coming with all that, to hear about resources, workshops, a masterclass coming soon.
Um, if you take that diagnostic, you pop onto my email list, and you'll get all, all the updates there.
Gordon: Yeah, yeah, and we'll have links in the show notes- Cool ... in the show summary for folks, uh, to be able to get to that easily. But, uh, well, Lisa, so glad you joined me today, and, um, look forward to hopefully having another conversation soon.
Lisa: Awesome. That sounds so great. Thank you so much for this.
Gordon: Mm-hmm.
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