Integrity at Scale™

Tara Vossenkemper, PhD
  • 5.0 (3)
  • Entrepreneurship

You've handed over responsibility. So why is everyone still asking you to make the decisions? And why, if you're honest, are you a little relieved that they are? I'm Dr. Tara Vossenkemper, a consultant and group practice owner. On Integrity at Scale™, I teach, think out loud, and get into the practical and human sides of leading a business. That means roles, numbers, culture, and the things that keep happening even though you've already had that conversation. Three times. Some episodes teach something you can use. Others take you into a decision I'm making in my own business, a pattern I'm noticing, or a question I haven't settled yet. You'll also hear conversations with other leaders and responses to listener questions. I want you to leave with a clearer understanding of what's happening and something useful to try. Sometimes that comes with a great idea. Sometimes it comes with, “Well, shit. I do that.” This was previously called the Culture Focused Practice podcast. All the earlier episodes are still here in the same feed, so you can keep listening right where you left off. Watch on YouTube: https://www.youtube.com/@culturefocusedpractice Explore the Model and Working Together: https://www.taravossenkemper.com/

  1. 3d ago

    The Owner's Room: Marketing Has an Owner, but the Decisions Still Come to Me

    You hired someone capable to own your therapy practice marketing. So why are you still approving the decisions? In this Owner’s Room episode of Culture Focused Practice, Dr. Tara Vossenkemper examines why certain marketing decisions continue to return to her—even though she has an excellent marketing strategist who understands the business, takes ownership, and is aligned with the leadership team. This isn’t a performance problem, and it isn’t happening constantly. It’s a leadership pattern Tara has started noticing: sometimes she has delegated the work without explicitly handing over the permission to decide. Tara works through six questions: What am I noticing about the decisions that keep returning? Are they coming back because ownership is unclear, important context is missing, or Tara simply hasn’t said, “You don’t need my approval anymore”?What should be different when marketing has an owner? What authority should a marketing department head have over strategy, timing, priorities, and execution?Why do I still feel responsible for making the whole system coherent? When you naturally see how every part of the business connects, stepping away from one function can feel nearly impossible.Are we holding different pictures of what marketing is for? Or is everyone already aligned—and the founder is simply still standing in the way?What do I want to remain close to? Tara considers how to protect the company’s voice and aesthetics without approving every piece of copy or every visual.What is this pattern revealing about me? At what point does withholding authority, continuing to carry the work, and resenting its weight become martyrdom?Along the way, Tara explores the difference between assigning marketing work and transferring marketing ownership. She also considers when founder involvement is genuinely useful, when occasional audits may be enough, and how growth creates normal information gaps between newer leadership seats. If you’ve handed someone responsibility for marketing—or any major function—but decisions still keep landing back on your desk, this episode asks the uncomfortable question: have you actually let them own it? Timestamps 00:00 Marketing Ownership Setup01:54 Why Marketing Decisions Keep Returning06:53 What Should Change When Marketing Has an Owner?09:17 Feeling Responsible for the Whole System13:29 Are We Holding Different Pictures of Marketing?15:44 Staying Close to Company Voice and Aesthetics17:46 What the Pattern Reveals About Letting Go21:43 Wrap-Up and Next Steps Related Episodes Episode 90: Your Marketing Problem Might Be a Leadership ProblemEpisode 68: The Work Behind Being VisibleEpisode 69: Consistency Is a System Think about one function you believe you’ve delegated. Have you explicitly transferred the authority to make decisions—or are you still waiting for the person to somehow know they no longer need your approval? Subscribe to Culture Focused Practice wherever you listen, and share this episode with an owner who has handed someone a function but is somehow still receiving all the decisions.

  2. 5d ago

    Listener Q&A: How Do You Build the Leadership Team You’re Becoming?

    What happens when your therapy practice is ready for a new leadership structure—but the people, seats, and responsibilities haven’t caught up yet? In the first listener Q&A episode of Culture Focused Practice, Dr. Tara Vossenkemper answers questions from former mastermind clients Amy and Brittany of Tiny Planet Counseling, who are navigating several interconnected EOS leadership transitions. Brittany is preparing to become the integrator. Amy wants to move fully into the visionary seat and out of the clinical director role. A new clinical director needs to be hired. And adding another person to the leadership team raises questions about ownership, overlap, and whether the L10 can remain effective as the practice grows. Tara digs into three questions that many growing therapy practices eventually face: How do you design a clinical director seat without creating more overlap? If responsibilities currently live across several people, where do you begin—and how do you avoid turning the new role into a dumping ground for leftover tasks?How do you prepare someone to become the integrator before the title officially changes? What should they begin practicing, owning, and measuring now?What happens to the L10 when the leadership team grows? Will adding another voice improve the conversation—or make meetings slower, less focused, and harder to manage? Along the way, Tara explores the difference between facilitating and truly owning leadership meetings, why a seat should be designed before a person is placed in it, and what visionary-integrator transitions require beyond handing someone a list of responsibilities. If your practice uses EOS—or you’re trying to build a leadership team that can support the next stage of growth—this episode will help you ask better questions before changing titles, hiring another leader, or restructuring your accountability chart. Timestamps 00:00 Listener Q&A Setup00:51 EOS Leadership Transitions at Tiny Planet Counseling01:54 Designing the Clinical Director Seat06:26 Preventing Overlap Across the Accountability Chart11:01 Practicing the Integrator Role Before the Title Changes12:47 Integrator Training, Scorecards, and L10 Ownership16:53 Adding a Fifth Leader Without Breaking the L1020:06 Keeping Leadership Meetings Efficient24:49 Coaching a New Clinical Director Through the Transition27:00 Why Leadership Transitions Feel Uncomfortable30:47 Seat Clarity, Same-Page Meetings, and Ownership34:15 Trusting EOS to Surface Problems35:42 Submit Your Question and ClosingRelated Episodes Episode 99: The V/I Table: Meetings Are Feedback SystemsEpisode 97: How Leadership Teams Confuse Reporting with OwnershipEpisode 91: You Don’t Have a Capacity Problem—You Have an Ownership ProblemWhat leadership or systems question are you actually wrestling with inside your practice? Send it to Tara at hello@taravossenkemper.com. Your question may become a future listener Q&A episode. Subscribe to Culture Focused Practice for more honest conversations about EOS, therapy practice leadership, accountability, and building a team that can grow with the business.

  3. Oct 22

    How To Read The System Before You Fix The Person

    In this episode of Culture Focused Practice, Dr. Tara Vossenkemper explains why a “people problem” may actually be the point where a larger system problem becomes visible. Missed deadlines, dropped handoffs, sharp interactions, and avoided responsibilities are important data, but they don’t tell you why something happened. Before deciding an employee is lazy, difficult, or wrong for their role, leaders need enough context to understand what kind of problem they’re actually looking at. Tara covers four agenda items: Where the system becomes visible: One person’s behavior may be the end result of unclear expectations, conflicting priorities, missing authority, or a breakdown in communication.Context explains behavior without erasing choice: Understanding the conditions surrounding a mistake helps leaders separate what belongs to the system from what belongs to the person.The diagnosis determines the intervention: Coaching, clarifying ownership, repairing a relationship, redesigning a role, and applying consequences solve different problems. The response needs to match the cause.Your response becomes part of the next system: How leaders investigate, give feedback, repair, train, or react teaches the organization how mistakes will be understood and handled.Using a story about an employer changing Tara’s role without communicating the new expectations to her, she shows how a system failure can make one person look like the problem. She also explains when repeated avoidance becomes a genuine people issue, and why redesigning an entire process around one person’s choices creates new problems for everyone else. The takeaway: choose one current “people problem” and ask, What if it isn’t them? What conditions could be producing the behavior you’re seeing, and what response actually fits the diagnosis? Timestamps 00:00 Welcome and Premise00:45 People Problems or System Signals?02:31 The Four Agenda Items02:57 Where the System Becomes Visible03:49 When an Uncommunicated Role Change Looks Like Underperformance08:40 Context Explains; It Doesn’t Excuse12:02 When It Really Is a People Issue14:21 The Diagnosis Determines the Intervention17:21 Fair Responses and System Design19:44 Your Response Shapes the Next System20:56 Making Space for Leadership Emotions22:54 Key Takeaway: What If It Isn’t Them?25:34 Wrap-Up and Goodbye Related Episodes Episode 104: Accountability Is A Design Problem Before It Is A People ProblemEpisode 86: Designing a Hiring System (Instead of Trusting Your Gut)Episode 66: Accountability ≠ Assholery - How to Address the Problem Without Wrecking the PersonThink about one employee behavior that is frustrating you right now. Before trying to fix the person, ask what information, authority, clarity, or support may be missing from the system around them. Subscribe to Culture Focused Practice and share this episode with a therapy practice owner or leadership team that may be treating a system problem like a people problem.

  4. Oct 15

    When Urgency Feels Like Clarity

    In this episode of Culture Focused Practice, Dr. Tara Vossenkemper explores what happens when one loud, emotionally charged moment makes a leader question an entire system. An angry client, billing disruption, negative review, or sudden dip in metrics can set off leadership alarm bells. The problem is that the intensity of an event can make it feel global—even when it’s specific, isolated, or too early to understand clearly. Tara breaks down four ideas: The loudest thing can feel global: The event demanding the most attention isn’t necessarily evidence that the entire process is broken.Action can soothe the leader: Adding rules, reports, meetings, or approvals may relieve anxiety without addressing the actual problem.Some situations require immediate action: Safety, PHI or HIPAA breaches, and egregious unethical behavior should not be treated as “wait and see” situations.Your response teaches the system: Turning every mistake into a new rule creates bureaucracy, while repeatedly ignoring concerns teaches people that their feedback doesn’t matter.Using an onboarding example, Tara shows how one mistake can tempt a practice owner to step back into delegated work and redesign a process before understanding what actually happened. The takeaway: before changing the system, ask what you know, what you’re assuming, and what will genuinely get worse if you wait. The goal isn’t to avoid action—it’s to make sure your response fits the size and nature of the problem. Timestamps 00:00 Leadership Alarm Bells01:34 When the Loudest Thing Feels Global06:46 When Action Soothes the Leader09:42 The Onboarding Trap12:35 When Safety Requires Fast Action15:24 Your Response Teaches the System18:22 Key Takeaways and Questions22:10 Wrap-Up and Next StepsRelated Episodes Episode 99: The V/I Table: Meetings Are Feedback SystemsEpisode 81: The Owner’s Room: When There’s Too Much Input to Tell What MattersEpisode 61: The Owner’s Room: When the Data Tells You What You Don’t Want to HearThink about the latest situation that made you want to change a policy, process, or reporting structure. What do you actually know? What are you assuming? What would genuinely get worse if you waited long enough to understand the pattern? Subscribe to Culture Focused Practice and share this episode with a therapy practice owner or leadership team trying to respond thoughtfully without turning every loud moment into a system-wide crisis.

  5. Oct 8

    The Owner's Room: When Structure Becomes Control

    In this Owner’s Room episode of Culture Focused Practice, Dr. Tara Vossenkemper explores the messy intersection of structure, control, anxiety, and leadership in a growing therapy practice. Tara loves clear ownership, visible metrics, defined roles, and reliable workflows. But she also acknowledges that a desire for clarity can cross into excessive reporting, rigid processes, and rules created to relieve a leader’s anxiety rather than meet the needs of the business. She distinguishes structure from control: Structure provides flexible scaffolding: It defines the outcome and protects what matters while allowing people to account for nuance.Control requires unnecessary exactness: It dictates every step, demands visibility into every detail, and leaves little room for judgment.Useful visibility supports decisions: More information is only helpful when it allows a leader to make a decision—not when it pulls them back into work they deliberately delegated.Simple systems can carry complexity: The goal isn’t to eliminate complexity. It’s to build the simplest structure capable of holding it.Tara also shares how she processes uncertainty through her integrator, L10 meetings, leadership conversations, and time spent letting ideas “percolate.” Using a simplified PTO policy and a clinician-onboarding failure as examples, she explains why one clear process owner is more effective than inserting the owner into every handoff. The takeaway: when something goes wrong, don’t automatically add reporting, approvals, or rules. Determine whether the problem is a one-time anomaly or a pattern, identify who owns the full process, and fix the structure without putting yourself back in the middle. Timestamps 00:00 Structure and Control01:27 When Structure Becomes Control04:32 Visibility Versus Reassurance09:17 The Structure Tara Reaches For13:34 Rebuilding Sandcastle Processes16:42 Carrying Complexity Simply22:03 The Onboarding Failure Scenario24:43 Fixing Ownership and Handoffs29:12 Wrap-Up and Next StepsRelated Episodes Episode 83: The Owner’s Room: Designing for Emergence, Not ControlEpisode 34: Structure ≠ Control: How to Use EOS Without Becoming a Micromanaging NightmareEpisode 63: The Owner’s Room: When Systems Start Running YouEpisode 97: How Leadership Teams Confuse Reporting with OwnershipThink about one area of your practice where you’re asking for more reports, approvals, or visibility. Is that information helping you make a necessary decision—or helping you feel temporarily less anxious? Subscribe to Culture Focused Practice and share this episode with a practice owner or leadership team working to create structure without slipping into control.

  6. Oct 1

    Accountability Is A Design Problem Before It Is A People Problem

    In this episode of Culture Focused Practice, Dr. Tara Vossenkemper explains why accountability problems are often leadership and system-design problems before they’re people problems. Before assuming someone is lazy, careless, or unwilling to take ownership, Tara recommends auditing four conditions: Clarity before judgment: Define the outcome, quality standard, ownership, and timeline—and confirm that the person understands what success looks like.Ownership with authority and support: Give people permission to act, along with the tools, capacity, information, and coaching they need to follow through.Feedback that closes the loop: Build feedback into the system so people can adjust in real time instead of learning about a problem after it’s too late.Consequences that teach the system: Respond consistently when expectations aren’t met. Your actions show the team whether a standard is real or merely optional.Using practice retention as an example, Tara demonstrates how to establish measurable expectations, define escalation thresholds, and give the accountable leader enough authority to respond. She also explains how stepping in to rescue someone can quietly undermine their ownership and teach the rest of the system that accountability doesn’t actually belong to them. The takeaway: choose one current frustration and audit these four conditions in order. Fix the first missing or weak link before deciding the problem is someone’s character. Timestamps 00:00 Accountability Is Design01:54 The Four-Part Agenda02:16 Clarity Before Judgment05:43 Setting Clear Retention Expectations08:32 Ownership Requires Authority12:16 Feedback Closes the Loop18:38 Consequences Teach the System22:36 Why This Matters24:55 Audit Your Current Frustration25:57 Wrap-Up and Next StepsRelated Episodes Episode 20: The Culture Lab: Is This a Clarity Problem or an Accountability Problem?Episode 66: Accountability ≠ Assholery—How to Address the Problem Without Wrecking the PersonEpisode 97: How Leadership Teams Confuse Reporting with OwnershipThink of one person or outcome that is frustrating you right now. Are the expectations clear? Does the owner have real authority and support? Is feedback happening soon enough to change course? Have your responses shown that the standard actually matters? Subscribe to Culture Focused Practice and send this episode to a practice owner or leader who may be treating a system-design problem like a people problem.

  7. Sep 24

    What Breaks First When A Business Scales

    Dr. Tara Vossenkemper explains that what “breaks first” in a scaling business depends, because growth loads connections: more volume creates more handoffs, interdependence, and strain on decision rights, resources, and information flow.  The first visible failure is usually a loud symptom, not the root cause; for example, a declining conversion rate may reflect client care capacity limits rather than performance. Because domains are interwoven, “domains break together” across structure/EOS, culture, leadership, feedback, financial health, employees, and marketing, so leaders should look for leverage points and make small changes that cascade through the system.  She argues carrying capacity is designed by building roles, workflows, metrics ownership, and decision thresholds for future scale (e.g., assigning inquiry metrics to a marketing seat). The takeaway is to trace one current problem through three domains, identify the weakest connection, and fix that link rather than chasing symptoms. 00:00 What Breaks First 02:46 Scaling Loads Connections 06:29 First Failure Is a Clue 09:38 Domains Break Together 14:56 Design Carrying Capacity 20:24 Key Takeaway and Wrap Up Related Episodes Episode 91: You Don't Have a Capacity Problem - You Have an Ownership Problem Episode 98: The Deep Dive: Financial Lies Leaders Tell Themselves (w/ Carla Titus) Episode 86: Designing a Hiring System (Instead of Trusting Your Gut)

  8. Sep 10

    EOS Is A Structure, Not An Identity

    In this episode of Culture Focused Practice, Dr. Tara Vossenkemper explains why EOS can provide valuable structure for a growing therapy practice, but it cannot define the identity, purpose, or meaning of the business. Tara covers four key ideas: Structure creates visibility: EOS turns the lights on. Roles, metrics, recurring issues, overlapping responsibilities, and organizational friction become harder to ignore.Tools cannot choose meaning: Your VTO, scorecard, and accountability chart cannot decide your values, purpose, or priorities. Those are leadership decisions.Rigidity can hide uncertainty: Adding rules for every exception may feel like control, but it often reflects discomfort with ambiguity rather than something the business actually needs.Leadership keeps structure useful: Leaders must decide which tools and metrics matter, while using weekly L10 meetings to identify patterns and solve issues at the root. Tara also places EOS within her Integrity at Scale model, showing how structure supports leadership, culture, feedback, and financial health without becoming the entire identity of the practice. If EOS has started to feel rigid, exhausting, or like the goal instead of the support, this episode will help you reconsider what the system should actually be doing for your business. Timestamps 00:00 EOS Is Not Identity02:48 Structure Creates Visibility07:24 Tools Cannot Choose Meaning11:23 Rigidity Hides Uncertainty16:21 Leadership Keeps Tools Useful20:26 Why This Matters22:06 Key Takeaway and Wrap-Up Related Episodes Episode 85: Where Teams Get Stuck with EOSEpisode 83: The Owner’s Room: Designing for Emergence, Not ControlEpisode 51: Systems Fatigue: When EOS Stops Feeling Helpful (And What to Do About It) Choose one EOS practice in your organization. What should it help you see—and where might the tool have quietly become the goal? Subscribe to Culture Focused Practice for more honest conversations about EOS, therapy practice leadership, organizational structure, and using systems without letting them run your business.

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3 Ratings

About

You've handed over responsibility. So why is everyone still asking you to make the decisions? And why, if you're honest, are you a little relieved that they are? I'm Dr. Tara Vossenkemper, a consultant and group practice owner. On Integrity at Scale™, I teach, think out loud, and get into the practical and human sides of leading a business. That means roles, numbers, culture, and the things that keep happening even though you've already had that conversation. Three times. Some episodes teach something you can use. Others take you into a decision I'm making in my own business, a pattern I'm noticing, or a question I haven't settled yet. You'll also hear conversations with other leaders and responses to listener questions. I want you to leave with a clearer understanding of what's happening and something useful to try. Sometimes that comes with a great idea. Sometimes it comes with, “Well, shit. I do that.” This was previously called the Culture Focused Practice podcast. All the earlier episodes are still here in the same feed, so you can keep listening right where you left off. Watch on YouTube: https://www.youtube.com/@culturefocusedpractice Explore the Model and Working Together: https://www.taravossenkemper.com/

Information

  • Creator
    Tara Vossenkemper, PhD
  • Years Active
    2025 - 2026
  • Episodes
    109
  • Rating
    Explicit
  • Copyright
    © 2024 Vossenkemper Consulting, LLC
  • Show Website
    Integrity at Scale™

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