October 2018

OPHTHALMOLOGY BUSINESS

To the point: simple practice tune-ups for complex times
Letting every worker help your practice improve


by Corinne Wohl, MHSA, COE, and John B. Pinto

“It is not what we get but who we become, what we contribute ... that gives meaning to our lives.”
—Tony Robbins

“Leaders who fail are the ones who do it by themselves. Leaders who succeed are the ones who allow others to help them.”
—Simon Sinek

Years ago, our daughter Rachael had a beloved pet cockatiel. “Celery” went everywhere with Rachael, tiny claws dug into her shoulder. They happily skipped into the backyard one day, only to come upon the neighborhood cat. Celery leaped for his life, but with clipped wings landed awkwardly on the ground. In a split second, the cat was going in for the kill.
Our sweet, kind-hearted 6-year-old instantly and bravely responded by stomping on the cat’s tail, scooping up Celery and saving the day. Celery lived many years beyond that incident, safely in the house. And we learned a lesson from Rachael that applies to your practice: Even the least likely person is capable of helpful action.
The reason for sharing this story is to help you recognize that anyone in your practice could step in and save the day, perhaps less dramatically, and help solve a practice problem, even though no one may have anticipated they would or could—or specifically taught them to do so.
It doesn’t have to be solely the responsibility of the managing partner, a board member, or administrator to be the one who sees and adopts new ideas to improve the practice. As an employee of the practice, no matter what your formal title and role, your voice and action can be helpful.
Here are ways to formalize your ideas and share suggestions you have to help strengthen and improve your practice. This list applies to anyone working in your practice.
1. Identify issues along with the potential solutions. Avoid being the constant complainer who criticizes others’ work but offers no alternate solutions. Complainers eventually drown out their own great ideas, which will be dismissed or ignored by others who have learned to tune them out. Instead, bring your concerns to practice leadership along with ways to make improvements. Constructively identify issues and present ideas and research to help the official problem-solvers of the practice. For example, if you are frustrated with technicians who are generating testing results you feel uncomfortable depending on, take the time to evaluate the situation. Notice if the inaccuracies occur all the time or only when patient volumes are high. Is it just one tech or many? Whose responsibility is it in your organization to train the technicians? Once you have evaluated and researched the root of the problem, present the facts and your problem-solving ideas to the clinic manager or administrator. You could offer to keep track of the times the problem is at its worse, or to attend the next technician department meeting and provide the education needed to improve their skills. Perhaps skill sets and goals for each tech need to be implemented throughout the practice. Making suggestions along with lodging your concerns helps solve the problems faster.
2. Be creative. Most management teams appreciate new ideas, especially when presented with positive intentions. Sometimes it is difficult to see new possibilities, and a fresh approach to a problem will be welcomed. Share creative solutions, especially ones that you’ve seen work in other settings. For example, do some research with peers across the country. Discover various ways the same problem can be approached and share those ideas within your practice. Ophthalmic practices are the same the world over. If you have a problem in your practice, a colleague you know—foreign or domestic—has likely tackled it and would be happy to share the solutions they found.
3. Make it easier to accept change; call it “a trial.” Resistance to change is common, especially if you want to modify a long-standing protocol. Rather than push for a complete overhaul, suggest a multi-week or multi-month trial period and subsequent evaluation to assess the effectiveness of the change. For example, maybe you do not use a testing schedule template for visual fields or OCTs because you have become accustomed to having the freedom to make it convenient for patients (and yourself) and you can’t imagine functioning any other way. If your managers are telling you that total patient wait time is excessive or reimbursement may be impacted, you can agree to an adequate trial period and compare the outcomes.
4. Obstacles to excellence. If you are not in a position of authority and have identified obstacles that may be diminishing excellence in your practice, determine the best person to approach about that. If it’s a clinic flow problem, start with the clinic manager. If it is a broader issue, for example, total transit time for your patients on a daily basis, gather the details and discuss it with your administrator or managing partner. If you detect an overall dissatisfaction among your peers about the lack of educational opportunities within the practice, offer to head a new task force that will develop ideas to solve this problem. It is generally encouraged in well-run practices to follow the chain of command to problem solve. But the best practices also encourage continued, up-the-ladder follow-up if the problem remains unsolved.
5. A safe environment. To feel comfortable offering your opinion or new ideas, the environment will have to feel “safe.” In practices where there is a feeling that “No one makes suggestions here,” a likely contributing factor is a history of leadership not respecting new ideas or setting the scene where suggestions are accepted but not implemented. Micromanaged and over-controlled environments can lead to employees feeling disheartened about the prospect of their ideas being heard or seriously considered. If you are in a leadership position and your practice feels stale or slow in adopting new suggestions, evaluate the environment and practice culture for openness and process improvement.
One way to determine how employees feel is to perform an anonymous employee opinion and general morale survey. Such surveys help assess employee perceptions and provide you with an objective basis for prioritizing and addressing their concerns. And don’t just let such surveys languish after they are completed. Acting vigorously to improve practice problems is the institutional equivalent of a little girl stepping on a cat’s tail.

About the authors


Ms. Wohl
is president of C. Wohl & Associates Inc., a practice management consulting firm. She earned her Masters of Health Services Administration degree at George Washington University and has more than 30 years of hospital and physician practice management experience. She can be contacted at czwohl@gmail.com or 609-410-2932.


Mr. Pinto
is president of J. Pinto & Associates Inc., an ophthalmic practice management consulting firm in San Diego. His latest ASCRS•ASOA books, Simple: The Inner Game of Ophthalmic Practice Success and the Fifth Edition of John Pinto’s Little Green Book of Ophthalmology, are now available at www.asoa.org. He can be contacted at pintoinc@aol.com or 619-223-2233.

Letting every worker help your practice improve Letting every worker help your practice improve
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2018-10-08T14:41:45Z
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