Integrating an existing MedSpa into a Management Services Organization (MSO) is an exciting opportunity that can unlock operational efficiencies, boost profitability, and enhance patient experiences. However, the integration process is not without its challenges—especially when there is a clash between long-standing habits and the professional systems an MSO requires to scale effectively.
One of the most critical, yet often overlooked, elements of a smooth integration is the establishment of clear lines of communication and a well-defined chain of command. Without these foundational elements, even the most profitable and well-regarded MedSpa can experience internal friction, staff turnover, and leadership burnout.
In this article, we’ll explore a real-world example of integrating a tenured MedSpa into an MSO structure, the challenges that surfaced due to unclear roles and resistance to change, and the proven strategies used to overcome them. For confidentiality, all names and identifying details have been omitted.
Why Communication and Command Structures Matter in MedSpa MSOs
Before diving into the case study, let’s define why these two elements—communication and command—are so essential to a successful integration:
- Lines of Communication define how information is shared across all levels of the organization, reducing miscommunication and aligning staff toward common goals.
- Chain of Command clarifies who reports to whom and where decision-making authority lies, eliminating confusion and preventing power struggles.
“Without both, even the best teams can fall into dysfunction. Decisions are questioned, leadership is undermined, and employees become disengaged as organizational trust erodes.”
The Integration Challenge: A Tale of Legacy Culture vs. Scalable Structure
A decade-old MedSpa was brought into our MSO with strong clinical performance and loyal clientele. At the center of the day-to-day operations was a long-time office manager who had “done it all” since the business’s inception. She had been integral to building the business from the ground up and was known by both patients and staff as the person who made things happen.
However, over the years, the practice had outgrown the manager’s informal style. What once worked in a start-up environment—verbal instructions, undocumented procedures, reactionary problem-solving—was now causing inefficiencies, confusion, and frustration among the growing team.
As our MSO stepped in to implement structure, the manager resisted. Not overtly at first, but through subtle patterns of behavior that signaled deep discomfort with the new chain of command:
- Refusing to follow reporting protocols
- Making unilateral decisions after changes had already been approved
- Bypassing new leaders and going directly to the owner for exceptions
- Dismissing new systems as unnecessary or “too corporate”
- Speaking negatively about MSO leadership to team members
The practice owner, having leaned on this manager for years, felt torn. He appreciated her loyalty and contributions but was increasingly frustrated by the friction caused by her behavior. His growing anxiety and reluctance to enforce the new hierarchy sent mixed signals to the staff, who didn’t know whether to follow the MSO or the legacy leadership.
Understanding the Root Causes of Resistance
Change resistance, particularly during MedSpa integration, is often not rooted in incompetence or insubordination—it’s rooted in fear and identity loss. When a longtime employee has built their reputation and value on being indispensable, a new structure that reduces their scope of control can feel threatening.
They may ask themselves:
- “What happens to me if I’m no longer in charge?”
- “Will I lose my job?”
- “Will I still matter?”
In our case, the manager had no experience working within a structured organization and equated hierarchy with irrelevance. Similarly, the owner felt guilty about “replacing” someone who had supported the practice since day one. These emotions—if not addressed—can stall even the most well-planned integrations.
Our Structured Approach to Rebuilding Communication and Leadership
To restore clarity, morale, and alignment, our MSO implemented a five-part strategy.
1. Publish and Communicate the New Org Chart
We created a clearly defined organizational chart outlining the reporting structure, chain of command, and roles within the integrated model. Importantly, we didn’t just post it—we reviewed it in an all-hands meeting, explained the “why” behind the structure, and committed to transparency moving forward.
2. Deploy Systems That Support Clear Communication
We implemented structured tools and processes such as:
- Weekly leadership meetings with published agendas and follow-up tasks
- Daily huddles for frontline staff
- A centralized task management platform to track decisions and progress
- A standardized protocol for escalations and approvals
These systems reduced ambiguity, encouraged accountability, and limited back-channel communications that had previously been the norm.
3. Coach the Owner to Step into Strategic Leadership
Recognizing that the owner’s discomfort was adding to the confusion, we invested in executive coaching. This helped him understand how his hesitancy to enforce structure was creating dysfunction and empowered him to take a more strategic role—focused on patient care, brand growth, and clinical excellence.
4. Create Space for Honest Dialogue and Reassignment
We facilitated a mediated discussion with the office manager to acknowledge her past contributions and explore her vision for the future. This led to a mutual agreement to reassign her into a role that leveraged her entrepreneurial strengths—such as vendor relationships and patient concierge services—without requiring her to manage people.
This realignment allowed her to retain her identity and value while removing her from the bottlenecks that were holding the team back.
5. Establish KPIs and Scorecards for All Roles
We rolled out key performance indicators (KPIs) and scorecards for every role in the practice. This created clarity around expectations and shifted the culture from opinion-based performance to results-driven accountability. Everyone, from the front desk to management, now knew what success looked like—and how it would be measured.
The Result: From Resistance to Results
Within three months, the entire practice had undergone a cultural and operational transformation:
- The staff began to operate with clarity and unity.
- Leadership was respected and followed without confusion.
- Communication flowed effectively across all departments.
- Patient satisfaction scores improved due to consistent experiences.
- The practice became more efficient, profitable, and scalable.
Most importantly, the emotional tensions subsided. The owner regained confidence in his team, and the office manager found renewed purpose in her new role—without the pressure of managing areas where she no longer felt comfortable or capable.
Key Lessons for MSOs Integrating a MedSpa
Here are the most critical lessons MSO leaders should take away from this experience:
1. Don’t Assume Resistance Equals Defiance
Resistance often reflects fear, insecurity, or identity loss. Approach with empathy and clear communication.
2. Clarity Beats Comfort
An unclear chain of command is far more damaging than temporary discomfort caused by change.
3. The Owner’s Support Is Non-Negotiable
If the owner doesn’t champion the MSO structure, staff will revert to old habits. Provide them with the tools, language, and confidence to lead.
4. Reassign, Don’t Replace (If Possible)
Legacy team members can still contribute—just not always in the same role. Find where they thrive and realign.
5. Systems Are the Cure for Chaos
With the right communication tools, SOPs, and scorecards in place, even the most dysfunctional cultures can transform.
Building a MedSpa That’s Ready to Scale
At our MSO, we believe every MedSpa deserves a future as strong as its beginnings. But the road to scalability is paved with systems, structure, and leadership alignment.
If you’re preparing to integrate your MedSpa into an MSO—or if you’re currently facing resistance from legacy team members—we can help. Our approach is rooted in both strategic planning and human connection. We don’t just optimize operations; we build cultures that last.
Need help navigating MedSpa integration?
Let’s talk about how we can strengthen your structure, stabilize your teams, and set you up for long-term success.
