In a recent solo episode, Nico Misleh breaks down exactly how clinic owners and small business practitioners can build simple systems that cut pain, save time, and make growth possible. Nico speaks directly from experience running hormone replacement therapy (HRT) and testosterone replacement therapy (TRT) clinics. He keeps the advice practical: start with what repeats, write it down, delegate, test, and make everything easy to find.
Why Systems Matter
Nico opens with a clear idea: systems are ways to reduce pain. Running a clinic means fighting fires all day if you don’t have reliable systems. That stress comes from doing too many repetitive tasks and trying to remember steps that should be automatic.
When Systems Are in Place, They Deliver Real Value:
- Reduced stress and fewer daily fires to put out.
- Less time wasted on repetitive work, which saves money and energy.
- More time and freedom to focus on revenue-generating work.
- Improved patient outcomes because staff can follow reliable processes.
- Better chance to scale, whether that means taking on more patients as a single provider or hiring staff to expand.
Nico frames it plainly: the earlier you systematize recurring tasks, the faster you can grow without burning out.
Step 1: Start With Repetitive Tasks
The first step Nico recommends is simple: list what you do over and over. Examples from clinics include ordering labs, scheduling, billing, prescription refills, intake paperwork, and cancellations. If you do a task more than twice, it should have a written process.
If you ever do anything more than twice, it needs to be an SOP.
That rule keeps things practical. You don’t need perfect systems on day one. You just need reliable ones for the tasks you repeat. These systems stop you from wasting the provider’s time on admin tasks that don’t directly bring income.
Step 2: Document The Process
Once you identify a repetitive task, document it. Nico suggests creating Standard Operating Procedures (SOPs) that are short, clear, and easy to follow. He recommends two formats:
- Written SOPs: Bullet points, one sentence per step. Short and minimal so a new hire can pick it up quickly.
- Video SOPs: Record your screen and voice to show exactly how a task is done. Tools like Loom or even a simple screen recorder work fine.
For example, a lab-order SOP could list the exact fields to collect, how to enter them in the EHR, the LabCorp workflow, and how to confirm the order with the patient. Keep the language simple and avoid long paragraphs. Nico emphasizes that SOPs aren’t decorative; they are operational tools.
Use AI To Help You Write SOPs
Nico strongly recommends using tools like ChatGPT to organize your steps into a clean SOP. He suggests speaking the steps out loud to ChatGPT (or typing them plainly) and asking it to format the steps into bullet points. This speeds up the documentation process and creates a readable template you can copy into Google Docs, Notion, or Asana.
Step 3: Delegate, But Delegate The Right Way
Delegation is where many clinic owners fail. Nico points out a common mistake: expecting new hires to memorize what’s in the owner’s head. Without documented SOPs, employees make repeated mistakes, and owners get frustrated.
Good delegation requires:
- Clear SOPs that the employee can follow.
- Training materials: written guides plus a Loom walkthrough.
- Tools to automate repetitive interactions where appropriate.
Nico also highlights technology as a delegation tool. Examples include:
- AI chat agents on your website to answer common patient questions and help people book. These can reduce incoming calls and filter leads.
- Automations that trigger lab orders, appointment reminders, or follow-up messages.
Spend money on tools that save hours of admin time. The return on investment is often immediate when the tool replaces repetitive manual work.
Step 4: Test, Refine, And Improve
Systems aren’t set-and-forget. Nico explains that you must test every SOP and refine it over time. He recommends two testing methods:
- Run the process yourself and evaluate the flow.
- Have an outsider, someone not in your field, go through it and give feedback. They’ll flag unclear language or steps that assume too much industry knowledge.
Testing will reveal bottlenecks: points where steps fall apart, where patients stop showing up, or where lab orders get lost. After spotting these weak areas, update the SOP to remove confusion and add clarity.
Training others to test is key. Weekly or daily huddles help teams flag problems and suggest fixes. Nico suggests daily huddles are best, with weekly meetings at a minimum to update SOPs and keep systems current.
Step 5: Make Systems Accessible And Organized
Even great SOPs are useless if people can’t find them. Nico urges owners to build a logical folder structure so every SOP is easy to access. He suggests an approach like:
- SOPs (top folder)
- HRT SOPs (subfolder)
- Intake
- Lab Ordering
- Cancellation Policy
Use Notion, Google Drive, Asana, or a similar tool to organize documents. If you’re not naturally organized, use ChatGPT to help categorize and rename files so everything is intuitive.
Common Clinic Systems Every Practice Should Prioritize
To make the guidance practical, Nico lists the systems that typically matter most for small clinics:
- Intake and initial consultation workflow
- Lab orders and lab follow-ups (e.g., LabCorp procedures)
- Scheduling and appointment confirmations
- Billing and invoicing
- Prescription refills and medication management
- Cancellation and no-show policies
- Patient follow-up and retention procedures
Start with the tasks that take the most time or cause the most errors. Prioritize those first.
A Simple SOP Template To Get Started
- Name the SOP and give it a one-line purpose.
- List the tools needed (EHR, LabCorp portal, phone scripts).
- Step-by-step actions in short bullet points (one sentence each).
- Include a Loom video link or recorded walkthrough.
- Notes: troubleshooting tips and common exceptions.
- Last updated date and owner (who maintains the SOP).
Mindset Shifts Nico Recommends
Nico shares a few mindset principles that are as important as the mechanics:
- Assume responsibility first. If something goes wrong, assume it’s your system that failed, not the employee. This mindset leads to fixing the system.
- Focus on the signal, not the noise. Build systems that solve the core outcome you want, better patient care or reliable cash flow, rather than trying to automate every tiny task.
- Do the boring work now. The founders who do system work early win. It’s not glamorous, but it’s what sustains growth.
Always assume whatever is going wrong in your business is your fault first.
Real-world Example: Lab Orders
One example Nico uses is ordering labs for new HRT patients. This task is repetitive, essential for care, and often causes delays if it isn’t handled well. An SOP for labs should include:
- Which lab company to use (LabCorp, etc.).
- Exact fields and formatting required in the ordering system.
- Scripts to tell patients what to expect and how to prepare.
- How to confirm orders and troubleshoot missed lab appointments.
- Where to find billing or authorization documentation if needed.
By documenting this once, the provider frees up time to focus on clinical work while staff or an AI agent handles the admin flow.
Final Thoughts And Next Steps
Nico’s big takeaway is simple: create systems now, not later. Start with repetitive tasks, document them clearly, delegate properly, test and refine, and keep everything accessible. The work is not glamorous, but it unlocks time, reduces stress, and improves care.
If you want daily tips, clinic-level business insights, and practical tools for growing a health practice, sign up for Nico’s Daily Newsletter! Yes, it’s sent out every day, and yes, readers stay subscribed for all the tips, tactics, and methods to help you increase profit and productivity in your clinic.
FAQ
Q: What should I document first?
A: Start with the tasks you repeat most often or tasks that cause the most errors. Common starting points are lab orders, scheduling, billing, and prescription refills.
Q: How detailed should an SOP be?
A: Keep SOPs short and clear. Use bullet points and one-sentence steps. Include a video walkthrough for complex tasks. The goal is usability, not perfection.
Q: Which tools are best for documenting SOPs?
A: Google Docs, Notion, and Asana are all good options. Loom is great for videos. Use ChatGPT to convert spoken or messy notes into clean SOPs quickly.
Q: When should I hire someone?
A: Hire when repetitive tasks take too much time away from the provider’s revenue-generating work, or when errors start harming patient outcomes. Before hiring, document the process so the new person can follow a clear path.
Q: How often should SOPs be updated?
A: Make updates an ongoing process. Daily huddles or weekly meetings are useful to spot problems and adjust SOPs. Include a “last updated” date and an owner for each SOP.
Q: Can technology replace staff?
A: Technology can handle many repetitive queries and booking tasks, but it often works best in concert with trained staff. Use AI agents to reduce basic load, then have humans handle complex or sensitive cases.
Systems aren’t a silver bullet, but they are the backbone of a clinic that can scale, deliver better care, and keep the owner sane. Start small, document clearly, and keep improving; those steps will change a practice faster than almost any marketing tactic.
