I wish I had a dollar for every time clients have told me how much they love patients and delivering clinical care and how much they hate managing staff. They see managing staff as a constant hassle, a drain on their energy, and a burden to them. Seeing their staff and their practices in this way, it’s no wonder some of them live for the day when they can retire. I have seen thousands of practices over the past 18 years, and those that attain the highest level of success look at staff in a different way. These practices face the same challenges as anyone who needs a team to deliver services, but they choose a different, positive context in which to address those challenges. They achieve not only financial success but also a sense of fulfillment among all their members óall members, including staff. By fulfillment, I mean loving going to work every day and seeing a group of people come together to perform at the highest level of teamwork to deliver care and caring to the patient. What are successful practices doing differently? Successful practices understand the value of both management and leadership and the difference between them. Management is striving to become more efficient and effective in the day-to-day activities that each team member performs. It focuses on “how,” not “why.” Leadership is setting the direction for the practice and establishing the values and standards from which the practice will operate. It is creating the big picture, the context for the practice, the “why.” While both leadership and management are important, without leadership, the practice won’t attract the right people, and good people won’t stay. Without leadership, the team can’t understand how what they do furthers the practice’s vision. There can be no meaning behind their actions, and therefore no fulfillment. Grumbling among the staff about money often reflects a lack of leadership rather than an actual compensation shortfall. Money is not what staff consider most important in their jobs. People want to have goals, work toward them, and meet them. That brings job fulfillment. Without leadership, without a practice goal to collectively strive for, all that energy and desire to meet challenges turns inward. People start grousing about current conditions in the practice. They mean well, but without that outward focus, the practice becomes more about problems than about solutions. After all these years of coaching clients and leading my own team, I am very clear that nothing we can say as leaders can create sustained motivation in our teams. Leaders can only create an environment 1