The 3 broken automations I find in almost every clinic GHL account I open

I work mostly with aesthetic clinics and doctor-led practices, and when someone hands me their GHL account, the same three problems show up so often I check for them first. If you run a clinic (or manage one's account), audit yourself against these:

1. Missed-call text-back exists, but goes nowhere.

Most accounts have the missed-call text-back turned on it's the feature everyone sets up first. But in maybe 8 out of 10 accounts, the reply the lead sends back lands in the conversation view and nothing else happens. No pipeline stage change, no task created, no follow-up trigger. The front desk is busy, nobody checks conversations until end of day, and the lead who replied "yes, tomorrow at 2 works" booked somewhere else by 3pm.

Fix: the inbound reply needs a workflow trigger tag the contact, move the opportunity stage, and fire a notification to an actual human with a deadline. The text-back isn't the automation. The response to the response is.

2. Follow-up sequences that quietly die after email 2.

Someone built a 5-email nurture sequence months ago. Emails 1 and 2 send fine. Email 3 has a broken custom value (usually a deleted calendar link or a renamed field), so the workflow errors out and every contact silently stalls there. Nobody notices because GHL doesn't scream about it you have to open the workflow history to see the pile-up.

Fix: open your longest-running workflow, check execution logs, and look for the step where contacts cluster. That's your leak. Also: any workflow built before a calendar/field rename needs a re-check.

3. Booking confirmations fire, no-show prevention doesn't exist.

Confirmation email on booking? Almost always set up. But the 24-hour reminder, the 2-hour SMS, and the "reply C to confirm" flow missing in most accounts I open. For clinics this is the expensive one. A no-show isn't a lost lead, it's a lost slot you already paid to acquire that patient and then paid again in dead chair time.

Fix: minimum viable version is a 24h email + 2h SMS with a confirm/reschedule option, and a workflow that flags non-confirmers to the front desk by 9am. Takes under an hour to build and it's usually the fastest revenue recovery in the whole account.

The pattern in all three: the account looks automated, but the automations don't talk to each other. Setup isn't the same as a system.

Happy to answer questions in the comments if anyone's stuck on one of these.