The matrix scores functions, not suppliers
This library assesses clinics, not the organisations that serve them. It publishes no list of suppliers, no ranking, no comparison and no recommendation, and it will not. That position is stated on the about page and it applies here more than anywhere, because the capability question is the one where a publication would be most tempted to point at somebody.
What can be assessed without pointing at anybody is the structure of the decision. Should a given function sit inside the clinic, outside it, or across the boundary. That question has a defensible answer derived from properties of the work itself, and those properties are assessable by the clinic.
Six factors do most of the work. Frequency, because infrequent work never develops internal skill. Clinical proximity, because judgement about clinical claims cannot be delegated to somebody without clinical training. Consequence of error, because high-consequence functions need internal accountability whoever executes them. Skill scarcity, because some skills are not reasonably acquirable. Transferability, because some work leaves knowledge behind and some does not. Coordination cost, because managing an external supplier consumes clinic time that is frequently omitted from the comparison.
The output is not a total. It is a pattern, and the pattern points to one of four structural answers.
How to use the matrix
List the functions separately rather than as one thing called marketing. A workable list: writing treatment pages, technical website maintenance, photography, social media publishing, paid advertising, enquiry handling, review management, email, measurement and reporting, and compliance approval.
Score each function against the six factors, 0 to 3. Use the scorecard on this page once per function, and record the six scores rather than only the total.
Read the pattern rather than the sum. High clinical proximity or high consequence of error means accountability stays internal regardless of everything else. High frequency plus high transferability means internal capability will develop if you let it. High skill scarcity plus low frequency means buying. High coordination cost erodes the case for buying even where the skill is scarce.
Some functions will produce a split answer, and that is the useful result. Paid advertising typically scores high on skill scarcity and high on consequence of error, which means execution outside and approval inside.
Record the decision per function with the reasoning, and revisit annually.
Common scoring errors
Scoring marketing as one function. The factors differ enormously between writing a treatment page and maintaining a website, and a single answer for the whole is always wrong somewhere.
Omitting coordination cost. The clinic time spent briefing, reviewing and chasing is real and it is the factor most often left out of the comparison entirely.
Scoring clinical proximity too low. Anything that makes a claim about a procedure is clinically proximate, including a social caption.
Treating scarcity as permanent. Some skills are scarce in the market and easy to acquire for a specific narrow use. Score what the clinic actually needs, not the profession in general.
Concluding that a high total means internal. It is the pattern that matters, and two functions with the same total can point in opposite directions.
What has to stay internal whatever you decide
Three things sit inside regardless of the matrix, and they are worth stating plainly.
Approval of anything making a clinical claim. A person without clinical training cannot substantiate a claim about a procedure, and the responsibility for what is published sits with the clinic whoever drafted it. The advertising compliance self-audit assumes an internal approver.
Accountability for personal data. Suppliers process data on your behalf and the obligations remain yours, as the data protection readiness assessment sets out.
The specification of what good looks like. A clinic that cannot say what it wants will accept what it is given. This is the practical use of the instruments in this library: each one is a written specification and an acceptance test, and handing one to a supplier before work begins changes the conversation from opinion to criteria.
Everything else is genuinely open. The matrix will tell you which way each function leans for your clinic, which will not be the same as for a clinic down the road with different volumes, different staff and a different service mix. Pair this with the internal capability readiness assessment, which asks whether the clinic can support the functions the matrix places inside.