The Operational Lessons Sara Cole Wishes She Learned Earlier

When Sara Cole, MSN, AGACNP-BC, CANS, launched Siren Medical Spa in Glassboro, New Jersey, she found herself balancing two demanding roles. She was building a business while continuing to work as a full-time nurse practitioner, caring for patients every day. Like many owners, she spent her time moving between treatment rooms, operational decisions, staffing needs, and marketing efforts.

As the practice grew, Cole began paying closer attention to what was actually driving progress. The answer wasn’t what she expected.

“Looking back, the turning point came when I stopped focusing on growth for growth’s sake and recommitted to what mattered most: delivering exceptional patient experiences and outstanding clinical results,” she says.

That realization changed how she approached the business.

Rather than centering every conversation on expansion, Cole and her team focused on the patient experience. They paid attention to outcomes, communication, and the trust they were building with each person who walked through the door. Marketing remained part of the equation, but it no longer occupied the center of their strategy.

“We intentionally built our practice around patient outcomes rather than marketing tactics,” Cole says. “Our most meaningful growth came from something far more powerful: patients who trusted us enough to refer their friends and family.”

For medical spa owners, referrals often feel like the result of good work. Cole views them as evidence that patients believe in both the care they received and the people who provided it. As more patients returned and recommended the practice to others, the business continued to grow.

The Systems She Wishes She Had Built Earlier

Looking back, Cole can identify one investment she would have made sooner.

She would have spent more time creating operational systems during the early stages of the business. At the time, her attention was focused on serving patients and managing the daily demands of a growing practice. Formal processes seemed less urgent than the work happening in front of her.

As the organization expanded, she began to see how much easier growth becomes when expectations are documented and workflows are clear.

“If I were starting over, I would focus on building operational systems and processes much earlier,” she says.

Cole points to areas such as scheduling, patient communication, follow-up procedures, front desk operations, and cancellation policies. Clear processes in those areas helped create a more consistent experience for patients and staff alike.

“What I learned is that scalable growth requires a strong operational foundation from the beginning,” she says.

Today, she sees checklists, standard operating procedures, and documented expectations as practical tools that support consistency. Staff members have a clear understanding of how work should be done, and patients receive the same level of service regardless of who assists them.

Cole also learned that patients appreciate clarity. Expectations around scheduling, communication, and cancellations help reduce confusion and strengthen the overall experience. Establishing those standards early would have saved time and eased some of the challenges that came with growth.

Investing in People

When Cole reflects on the decisions that delivered the greatest long-term return, she talks about people.

“Investing in people has delivered the greatest long-term return for our practice,” she says.

That investment takes several forms. Education remains a priority. Leadership development is encouraged. Team members are given opportunities to take ownership of their work and contribute to the direction of the practice.

Cole describes a workplace where employees are expected to think beyond their individual responsibilities. She often jokes that there are “many bosses” at Siren because team members approach their roles with a sense of ownership.

The approach has helped create alignment across the organization. Employees bring different skills and perspectives, but they share the same commitment to serving patients well.

“When you invest in your team through education, leadership development, and trust, they become deeply invested in the success of the practice,” Cole says.

That commitment influences everything from patient interactions to day-to-day operations. Over time, it becomes part of the culture.

What Surprised Her Most About Growth

As the business matured, Cole gained a different perspective on revenue and profitability.

“The biggest surprise was discovering how much genuine patient relationships influence business success,” she says.

Patients notice when providers take time to listen. They notice when communication is thoughtful and when outcomes reflect careful attention to their goals. According to Cole, those experiences often lead to stronger loyalty and long-term relationships.

“When they feel valued, heard, and confident in their results, they become loyal advocates for your practice,” she says.

Cole also became more attentive to the financial side of growth. Small expenses can accumulate over time, and even well-intentioned promotions require careful consideration. Understanding where money is being spent helped the practice make more informed decisions about future investments.

She believes profitability creates opportunities. A healthy business can continue investing in staff education, technology, services, and patient care. Those investments help strengthen the practice and improve the experience patients receive.

Learning to Lead Differently

One lesson emerged as the practice expanded: the leadership style that helps launch a business may not be the same leadership style needed to grow it.

In the beginning, Cole stayed closely involved in nearly every aspect of the organization. Like many founders, she felt responsible for solving problems and making decisions across the business.

As the team grew, she recognized the importance of sharing responsibility with others.

“One of the most important leadership shifts I made was moving from being primarily a doer to becoming a leader who empowers others,” she says.

That shift required delegation, trust, and a willingness to allow talented team members to take ownership of important work. It also created more time for strategic planning and long-term thinking.

Cole’s view of leadership evolved as a result.

“I also came to appreciate that successful leadership is not about having all the answers. It’s about building a team of capable people, understanding their unique strengths, and creating an environment where they can thrive,” she says.

When employees feel empowered to contribute, they become more invested in the future of the organization. Cole believes that investment supports stronger culture and more sustainable growth.

Building a Culture That Can Grow

Culture remains one of Cole’s primary areas of focus.

She believes employees need a clear understanding of the organization’s goals and the reasons behind them. That understanding begins during hiring and continues through training, communication, and professional development.

“We hire for character and alignment with our core values, then invest heavily in training, communication, and professional growth,” she says.

At Siren, every role contributes to the patient experience.

“Every team member must understand that creating a positive patient experience is everyone’s responsibility and our ultimate goal,” Cole says.

From a patient’s first interaction with the practice through long-term follow-up, Cole wants each touchpoint to reinforce trust. Employees are encouraged to take ownership of that responsibility and make decisions that support both patients and the organization’s mission.

As the business has grown, Cole has found that shared values help keep people connected. Staff members understand what the practice stands for and how their work contributes to its success.

For owners working to build successful practices, Cole’s advice reflects the lessons she learned through experience.

“If you don’t genuinely love what you do, patients will notice,” she says. “Stay true to your values, remain patient-focused, and build a reputation rooted in trust.”