September 2018


To the point: simple practice tune-ups for complex times
Setting the tone of your practice culture

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

“There are people who make things happen, there are people who watch things happen and there are people who wonder what happened. To be successful, we have to be people who make things happen”
—Jim Lovell

“The role of a creative leader is not to have all the ideas; it’s to create a culture where everyone can have ideas and feel that they’re valued.”
—Ken Robinson

We’ve all had the experience of walking into a place that makes you feel welcomed, where the employees appear happy and competent, and you are served well. Whether it happens in a doctor’s office, restaurant, or boutique clothing store, the result is that you will be happy to return, and you tell your friends about your positive experience.
Positive experiences are greatly impacted by the culture of your practice, and your practice culture affects your employees’ behavior and performance. Your patients’ experience is an accumulation of the many touch points they have throughout their visit.
Is the patient experience in your office a result of intention or an accidental accumulation of various, sometimes incongruent, efforts?
Investopedia defines a corporation’s “culture” as the beliefs and behaviors that determine how a company’s employees and management interact and handle outside business transactions. Often, corporate culture is implied, not expressly or overtly defined, and develops organically over time from the cumulative traits of the people the company hires.
Purposeful, ongoing efforts to set the tone and create a culture you and your patients will enjoy and appreciate not only results in a pleasant environment and great customer service, but can improve your bottom line. When your staff and doctors are marching in the same direction, we see efficiency. When your staff cares and feels cared for, they take the extra steps, go above and beyond their general position descriptions to ensure smooth processes and less material waste, and offer ideas for improvements. When the culture your staff work in does not feel personally rewarding, they may show up for work, perform well enough to keep their jobs, but not contribute to their full capacity.
Creating and reinforcing the practice culture you desire starts at the top. It won’t be enduring if your management team is gung-ho to implement but the owners are lukewarm and not committed. As a leader you have to set the expectations and clear goals and model the behaviors you want to see in your employees.
Here are 10 steps to help you reinvent or take your practice culture up to the next notch.
1. You don’t have a coherent culture unless you can describe it in words. Identify and describe your current culture as a collaboration by the owners and management team. Writing this description should be done by people in your practice who believe in the improvement process and will be in the position to influence others as you make changes.
2. Document the changes you desire. Written formality is needed as a guide to be referred to and followed. For example, “Our patients comment that we have lost ‘that personal touch,’ and they now feel like a number. We want our patients to feel recognized and appreciated.”
3. Identify the existing barriers that stand between your new goals and current culture. Perhaps there are unhealthy relationships between certain employees that have been tolerated for years, or your hiring practices and onboarding methods are hit or miss rather than formally orchestrated. Specifically list each issue and brainstorm with your team to develop ways to redo behaviors and values that are holding you back.
4. As you identify issues and barriers, be sure to look deeply and find the root cause of the issues. The problem behind the problem is what likely needs addressing, not the surface issues. For example, if some technicians work non-stop and some are not as busy, perhaps that behavior comes from a legacy tech manager who encouraged techs to only be of service to the doctor they are assigned to each day, rather than be trained and willing to assist with patient flow no matter whose patient it is.
5. Try to only hire new employees who possess the new values you have set. If your customer services are rated low, help create a new culture of amazing patient satisfaction by hiring staff with great customer service instincts and train them for ophthalmology skills. If you have staff that do not get along with others, hire new employees with an eye for their people relations skills and reference check closely for how they got along with coworkers.
6. If you are in need of a major overhaul of attitudes and behaviors, you may have to replace employees and managers who don’t see the benefits of the changes you want to make. New employees can bring fresh ideas to the team and arrive relatively baggage-free. Hanging on to employees unwilling to convert will be discouraging to the enthusiastic and willing staff.
7. Onboard new employees with written formality and a department-by-department orientation plan. One day with the supervisor and the rest on-the-job training with any employee in the department doesn’t work. A written operations manual containing policies and procedures for each job duty along with a written training schedule that includes timelines for skills development works better. Written protocols can be enforced consistently and provide managers a way to hold staff accountable to the standards you and your management team set.
8. For a successful long-term impact, you have to change behaviors, not only attitudes. Team-building efforts and workplace enjoyment strategies have their place in this transition but will not be the key success factors. Those efforts or enthusiasm will fade, and you don’t want the culture improvements to slip backward.
9. Engage in quarterly reviews to evaluate the impact of the changes you are making. As a general problem-solving method, we want to:
• Collect data and information
• Make a data-driven decision
• Take action
• Review the action and results, and repeat
10. Be patient. Creating a change in your practice culture does not happen overnight. Your challenge is to eliminate behaviors and attitudes that have been embedded for years. Recognizing which issues are holding you back and applying resolutions is the first step. Hold the new course you set, making step-by-step changes and not slipping backward during the inevitable frustrations that attend every cultural change.
Ultimately, you have the ability to develop a practice where you love to spend time, your patients are well-served, your employees are professionally fulfilled, and the bottom line benefits from efficiencies and reputation.

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 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 available at He can be contacted at or 619-223-2233.

Setting the tone of your practice culture Setting the tone of your practice culture
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