You’ve probably said it, or at least thought it: “My entire team is full of drama.” It’s one of the most common frustrations among med spa owners, and also one of the most misdiagnosed.
Cathy Christensen, founder of Christensen Consulting and host of the Medical Spa Mastermind Podcast, has spent years coaching practice owners through exactly this. Her take is direct: the drama you’re watching unfold on your team floor is almost always a symptom of something happening at the leadership level.
Yes, that means you.
Drama Is Usually a Symptom, Not the Root Problem
Before you post that job listing or start writing a termination letter, it’s worth asking a harder question first. What role have you played in creating the environment that allowed this to happen?
"Oftentimes, it's uncomfortable to think that you've actually probably very much unintentionally created this kind of whirlwind of drama by maybe doing something as simple as avoiding something, because you think you're trying to be nice, or trying not to spark a fire. Sometimes those avoidance issues can actually result in a lot of harm to your practice." - Cathy Christensen
A med spa owner recently came to Katlin Cauffman, Diamond Accelerator’s founder and CEO, convinced her entire team was the problem. No one took ownership. Everyone was gossipy. No one cared about the business but her. She was ready to clean house.
Instead of jumping to solutions, Katlin started asking questions. How often are you holding one-on-ones? Do your employees know exactly what’s expected of them? Do you address performance issues immediately, or do you avoid them? Are all employees held to the same standard?
The answers told a different story. By the end of that conversation, the owner had a revelation: she was the root of the problem. She came in wanting to replace her team and left knowing she needed to change the way she led.
The Leadership Behaviors That Quietly Create Chaos
Most of the patterns that erode team culture are not dramatic or intentional. They’re small, repeated behaviors that compound over time. Here are the most common ones Cathy sees across med spa practices:
- Lack of reliability. Showing up unpredictably, physically or emotionally, chips away at your team’s ability to trust you.
- Lack of transparency. Your staff needs to know the “why” behind what they’re doing. They don’t need your full financials, but they need to understand the purpose behind their role.
- Inconsistency and unfairness. Different rules for different people will always create resentment. As Cathy puts it, think of it like your kids. If you do something for one, you have to do it for the other.
- Emotional unsteadiness. Your energy is contagious. Walking in stressed, reactive, or checked out sets the tone for everyone else.
- Avoiding hard conversations. Letting issues sit to keep the peace creates far more damage over time than the discomfort of addressing them directly.
- Micromanaging or poor listening. If you’re listening to respond rather than to understand, your team will stop bringing you what you need to hear.
- No feedback or advocacy. Without acknowledgment or growth, your people quietly disconnect.
"Leaders in this space are often unintentional leaders. They decided to go out on their own, they wanted to start something they believed in, and when you grow, you actually have to become a leader. You don't just get born into knowing these things." - Cathy Christensen
Many med spa owners became providers first and leaders second. The skills that make you an excellent injector or clinician do not automatically transfer to managing a growing team. That gap is where most med spa hiring mistakes begin.
How Small Tolerated Behaviors Compound Into Big Culture Problems
Culture problems rarely arrive all at once. They accumulate through small things that get overlooked, usually because you were busy, because you were being kind, or because it just didn’t seem worth the fight that day.
Here’s a simple example: an employee doesn’t follow the uniform policy. You let it slide once because she’s tired and you’re in hustle mode. Then it happens again. Then it becomes the norm. Now you’re frustrated at her for something you never enforced. She doesn’t even register it as a problem anymore.
That pattern plays out in a hundred different ways across a growing practice. The fix isn’t just a hard conversation. It requires documentation.
"If you don't necessarily have handbooks, or SOPs, or if you're not having written job descriptions, if you're not having growth paths, it's really hard for these things to stick. You have to start putting these things in place so that they understand this isn't just your whim or your want, this is actually the rule of the business." - Cathy Christensen
And Katlin is quick to add: documentation without accountability is just paper. You need both. Written standards and the willingness to hold people to them. Getting this foundation right is directly tied to how you onboard and offboard team members and how effectively your injector training translates into ROI.
What Happens When You Let One Person Slide
When one person breaks a rule and nothing happens, the entire team takes note.
Your top performers get frustrated. They see someone getting away with something they would never do, and over time, they start to question whether their effort even matters. Your low performers take it as permission to let off the gas. And trust in leadership quietly disappears.
"If you've done all that work to create a handbook and create SOPs and all of that, then it's absolutely important for you to enforce it." - Cathy Christensen
As Katlin points out, when you eventually try to enforce standards after a long period of not doing so, your team won’t take you seriously. You’ve trained them not to. That’s also why understanding what top injectors really want matters so much. High performers will leave an inconsistent environment before they ever tell you they’re unhappy.
Accountability is exhausting. Nobody pretends otherwise. But it is the foundation everything else is built on, and it only gets harder the longer you wait.
Where to Start When You Think You Might Be the Bottleneck
If any of this is landing close to home, Cathy’s advice is clear: start with a self-assessment, and make it honest.
"If you're a leader, you've probably been a bottleneck. That's part of being a leader, especially of a small business. But you have to realize where the bottleneck is happening, you have to do a self-assessment, and then again, a trusted assessment from people you know." - Cathy Christensen
Here are the practical steps she recommends:
- Take an emotional intelligence assessment. Emotional intelligence has four components: self-awareness, social awareness, self-management, and relationship management. None of these is fixed. All of them can be developed. Cathy has resources linked through her site at cchristensenconsulting.com and covers this topic regularly on her YouTube channel.
- Ask someone who will actually be honest with you. Not just a supportive friend, but someone who will tell you what your communication patterns look like from the outside.
- Lead by example before you demand anything. As Cathy puts it, if you want your team to arrive on time, look professional, and bring the right energy, you have to reflect that first. If you’re not putting in the work, it doesn’t matter how many SOPs and handbooks you have.
Katlin uses a personal check: when she catches herself mentally complaining about a team member’s behavior, that’s her signal to ask what behavior she’s been tolerating that got them there, and what conversations she’s been avoiding.
"When I start feeling myself complaining about people in my head, that is when I know it's time for me to do some self-reflection as a leader, and ask myself, what behavior have I been tolerating that has got us to this point? What conversations have I been avoiding? Where have I been inconsistent?" - Katlin Cauffman
Getting clarity here also directly shapes med spa goal setting and your path toward building a truly profitable practice. You cannot set meaningful targets when the foundation underneath you is unstable.
When It Really Is a Toxic Employee
Sometimes you do everything right. You build out the documentation. You have the hard conversations. You hold the standards consistently. And one person is still actively corroding the culture. That is a real situation, and it happens.
But here’s the part most owners don’t see clearly until it’s too late: that person is holding your entire team back. Other team members are afraid to succeed, afraid to ask for more, afraid to grow because of the environment that person creates around them.
"That person is affecting you, your team, and probably your patients. Yes, you're going to take a hit if that person leaves, but it will also allow your other injectors or your other clinicians to grow, because when you have someone like that on your team, they're actually holding others back. The toxic culture is just not worth it to your overall business." - Cathy Christensen
And if you’re thinking, “but she generates too much revenue for me to let her go,” Katlin has seen that exact situation play out. A Diamond Accelerator client kept a top injector for three years longer than they should have. She was generating a million dollars a year in revenue. Letting her go felt financially impossible.
When they finally did it, they took a hit for a couple of months. The new injector needed time to ramp up. But the negativity that had been creating a ceiling over the entire team was gone. Every clinician on the floor had room to grow again. The practice came out ahead. The only regret was not doing it sooner.
That’s a story worth keeping in mind when you’re thinking through injector compensation structures or evaluating whether your revenue is truly a team effort. One person should never hold the key to your entire practice’s growth or culture.
The Bottom Line on Med Spa Team Drama
Team drama rarely starts with the team. It starts with:
- Unclear expectations that were never put in writing
- Small behaviors that got tolerated until they became the norm
- Hard conversations that kept getting postponed
- Inconsistent standards that quietly eroded trust
- A leader who was too busy or too uncomfortable to address any of it
None of that makes you a bad leader. It makes you a human one, running a complex business without a roadmap. But recognizing it is what separates the practices that stay stuck from the ones that scale. Solid med spa operations and a real handle on what drives profitability always trace back to this layer first.
The work is fixable. All of it. But it starts with being willing to look at it honestly.
Ready to Stop Running in Circles and Start Building Something That Scales?
If something in this post resonated, that’s worth paying attention to. Diamond Accelerator works with med spa owners across the country to identify exactly where the real growth blockers are, whether that’s leadership, team structure, operations, or all three.
Book a free strategy session and get a clear, honest look at where your practice stands and what it will actually take to grow without the chaos.
This post features insights from Cathy Christensen, founder of Christensen Consulting. You can follow her on Instagram, connect on LinkedIn, subscribe to her YouTube channel, or tune into the Medical Spa Mastermind Podcast.
