Donna Suter is president of Suter Consulting Group.

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,” a blog series featuring contributions from members of the ophthalmic community. These blogs are an opportunity for ophthalmic bloggers to engage with readers with about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by 

, president of Suter Consulting Group. The views expressed in these blogs are those of their respective contributors and do not represent the views of 

Confession number one: I am the queen of making promises.

“I am going to change beginning right now.”

Many such promises are forgotten within hours. At the heart of most of us is the desire of change.

Confession number two: Sometimes, I feel like a loser.

However, once I mentally review the facts and hang out with people who value my worth, I’m able to snap back. I need to remind myself that there is a bigger picture, and discouragement is only a temporary setback.

Often, false promises and self-doubt can rear their ugly heads when it comes to practice management.

Being successful as a small business owner in today’s healthcare climate takes hard work. The small things that hinder our progress add up, yet we tend to ignore these things: personal use of time, personnel, and money management. These three things will make or break most practices.

Let’s begin with personal time management. When I was working toward my master’s degree, one of my professors began the course by making us track, then graph, the use of our hours for five days.

Can you imagine what a PITA it was to set a stop watch and record what I’d done for the last hour, for every waking hour, from Monday through Friday? The professor ensured compliance by tying a full 1/3 of our grade to this assignment.

Taking the raw data and charting it revealed that, while I couldn’t fabricate more hours in a day, I could eliminate or reduce certain activities and make time to study and make an A in my classes. (Why I needed to end up with a 3.96 GPA in my master’s studies, I still don’t know.)

You invested much more time and money into opening up your practice than I did getting a master’s degree. Doesn’t the dream of being self-employed deserve your best? Given your intellect and history of determination, you can be successful. Your best ideas can move from soon-forgotten to agents of change with enough time.

So, what’s holding you back? Do you have a list of things you want to change? Do you think about the concrete steps needed to achieve the desired change?

Don’t blame practice management frustrations on the work ethic of differing generations. Just like rock and roll didn’t destroy my moral fiber, hiring millennials to work in your office won’t cause your practice to go bankrupt.

In an ideal world we would all understand each other and accept everyone’s unique approach to life-recognizing the positive intent behind behaviors. But let’s face it, when it comes to communication we all get triggered by something.

Books are written on how communication blunders cost businesses. By failing to recognize and adjust communication habits that are not serving you well, you may be jeopardizing the tenure of your peak performers and enabling your less-than-loved employees to continue down a path of disrespect. Unfortunately, this path often leads to embezzlement of practice time, resources and eventually money.

Communication habits causing you the most problems now are the very ones that led to your greatest successes in the past. The trouble comes when these are the only communication habits that you use. Pay attention to how your communication patterns impact your employees.

If you are wondering why your coaching sessions aren’t motivating employees to change, it may be how you are packaging the message-meaning, word patterns, and body language.

What might motive you to change how you speak to others? Carefully consider the consequences of not changing-refusing to evolve and grow, staying stuck in the loop created by today’s healthcare delivery system and your own sense of a “right” and “wrong” way of doing things.

Take time to weigh the benefits of choosing to access a greater range of more resourceful, productive behaviors that affords you a higher quality communication and generate a positive response from others. Read books about communication styles; practice your emerging skills on family members and strangers; hire a communication coach.

Be patient. You started talking around the age of two and communicating before that. It takes time to develop new habits. (This is where that group of people I mentioned in paragraph two-those who value your worth-come into play. Share a change goal and give them permission to hold you accountable.)

Have you ever realized you’ve been completely unaware of something you should be thinking about? Money management and budgets based on projections are two of those fundamental assumptions of successful practice management that a successful small business owner has to get her or his arms around. When you do, you begin to realize that it affects your practice in so many ways.

Hacking your financial management system and re-working it allows you to function at a higher profit level. Basic accounting has a tendency to focus on the what: what areas of the practice are spending the most money, what are fixed versus variable expenses, etc.

Until recently, healthcare has completely ignored consumer preference and a marketing budget was just as optional as money set aside to build teamwork among employees.

Become a student of business management. A little light reading will help you to identify your practice’s most important problems, add them to your change list, apply durable fixes, and enjoy the professional life you deserve. (I just quoted a tagline from the front of a book written by John B. Pinto.)

I have no financial interest in his books and only a professional, colleague relationship with Pinto. However, the reason I have never written a book about practice turnaround is because every tactic I have used for 25 years is described in detail in this little gem of a book.

Are you thinking about the changing seasons and changing? Perhaps picking back up that dearly held dream of running a successful practice while maintaining life balance? Your feelings motivate you more than facts. Just like you don’t tell someone with a bad health habit their lifestyle is going to kill them, challenge yourself to use truisms from practicing medicine to achieve professional success.

Acknowledge that if you loved and admired yourself as much as your core group of family and friends do, you’d never keep those habits that are not working to build the practice of your dreams. The truth is that your perception of yourself and your ability to change may be limited by your fear of failure.

Truthfully, my mental promises are not my goals and I don’t run my business nor professional career without thoughtful planning and attention to goals.

It’s amazing how gifted professionals underestimate what can be accomplished in a year. Figure out what you love that happens to be working, focus on doing that regularly; and, with the help of your support group, prioritize and devote an hour a day to one thing on your change list.

Articles

Time is everything. How are you spending yours? 

Three time management skills to achieve financial success

Are you wondering if other practices are charging for adding pupillary distance (PD) to prescriptions and adjusting glasses purchased online for free? If so, how does this fit into your mission statement and strategic goals?

I’m reminded of my neighbor’s college-age daughter and my banana nut bread. She loves it so much that she asked her mother to get the recipe. I gladly provided it and her mom thought I had left out the “secret sauce” because her daughter prefers mine to her own.

Throw out the advice that the customer is always right. There are three different ways to provide a PD measurement to patients who take their prescriptions, purchase eyewear from somewhere else, and then bring the eyewear to you for adjustments.


If your cost of goods is calculated properly and it is 33% or lower, then your complimentary services are not hurting your bottom-line. This metric suggests that patients who want to purchase eyewear are waited on promptly. Consumers express displeasure by leaving the building. Patients are less likely to become annoyed when they are attended to, so employees should always provide a patient with a PD.
 


Disney business leadership courses often emphasize the importance of employee happiness. Often, providing PDs and adjustments to patients who purchased eyewear elsewhere annoys optical employees. The emotion attached to the task is the real issue. Mac Anderson (founder of Simple Truths and Successories Inc.) might say you can’t send this optical duck to eagle school.

So, do your employees have a bad attitude or should you “fire the patients”? This speaks to office culture. How does your practice’s core values suggest this issue be handled? If your office charges patients who are late for exams a fee, then I suspect that charging patients for PDs is something that in all fairness might be considered

On the other hand, the auto refractor used during pre-testing provides a PD without overloading busy opticians.

Your employees wanting to drop tasks without a change in job description might mean that both they and you need to re-read your employee policy manual or handbook. If it is not legally, morally or ethically inappropriate the question becomes one of office harmony and profitability versus what an employee wants to do or his or her preference.
 


If you haven’t thought about your practice brand, here is your chance. An Internet search of healthcare branding advice confirms that both big and little issues influence the patient.

Adjectives like “friendly” and “helpful” describe someone who does something for nothing. In Louisiana and other Gulf states the word “lagniappe” could be used to describe the practice of giving a patient who pays for an eye-health examination their PD and adjusting eyewear purchased somewhere else.

Especially in Louisiana, “lagniappe” is a way of thanking customers for their patronage. It came from the Spanish word “la Ã±apa,” which means “free bonus.”

In a book published in 1883 by Mark Twain, there was a section regarding the custom of giving patrons something for free when asked for lagniappe. There are still grocery chains and bakeries in 2018 that pass out cookies and donuts to children with their parents. Deli departments offer samples of meats and cheeses to patrons while their orders are being cut, weighed and wrapped.

It is said that shopkeepers tried to put an end to the practice of lagniappe in the 1800s, but the people strenuously objected. They had no choice but to keep giving a little something extra. (It is not certain whether this story is true.)

Although the tradition of a free gift is not nearly as widespread as it once was, it is still observed in optical dispensaries. Stop giving patients their PDs (which are not by law included in their prescription) and they may join their ancestors and object strenuously.


Because baking isn’t something I do all the time, I’m a lot like you. You perform more exams and surgeries than your optical sells glasses.

When I bake I want to make a good impression. I use quality ingredients and always start with fresh. (I admit I have no choice but to use fresh because the baking powder and baking soda usually expire between batches of bread.) I typically begin my baking session by watching a few instructional videos on America’s Test Kitchen, or a cooking show.

My neighbor, also named Donna, tells me she bakes all the time and just doesn’t understand why her family prefers my finished product. She is using my recipe!

Attention to detail has turned my neighbors into raving fans of my cooking. They talk about it and look forward to their free mini-loaves at Christmas. (This year, I skipped Christmas and made chocolate chip zucchini muffins in June.)

My neighbors like me. You want your patients to like you. My neighbors say nice things about me. You want your patients to say nice things about you. I didn’t put my son through college or fund my retirement accounts baking. Optical is a revenue stream that will never equal the combined surgical and clinic revenue of the practice. However, the good will that it creates will be something that you can bask in all year long. (My family thinks it is hilarious that neighbors wait on my food gifts. THEY know the truth.)

Just like I don’t give my neighbors the ingredients for my yummy treats, giving patients a PD for new eyewear isn’t enough to allow them to experience the awesome sauce of quality lenses. In fact, eyewear that provides clear, sharp vision has your opticians taking and passing along to the lab about as many measurements as my not-secret-at-all recipe has ingredients.

So, quality is hard to communicate in one sentence and surely this is a time management issue, maybe? Consider educating the patient about your quality eyewear (7 Reasons Why... pictures and quick bullet points) with a brochure when you hand the budget-minded patient “just the PD.”

Another low-cost/no-cost idea is to ask your spectacle vendor for a brochure about their patented, branded lenses versus private label/no name knock-off. Give this to the patient with a friendly smile.

Internet glasses shoppers and loaves of banana nut bread

: Welcome to “Eye Catching: Let's Chat,” a blog series featuring contributions from members of the ophthalmic community. These blogs are an opportunity for ophthalmic bloggers to engage with readers with about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Donna Suter, president of Suter Consulting Group. The views expressed in these blogs are those of their respective contributors and do not represent the views of 

What is an optical trunk show? Like the phrase “a broken record” or the act of getting up to change channels on an RCA-color television, the industry phrase “trunk show” harkens back to an era when ophthalmic frame representatives sold frames from the trunk of a car. It is my understanding that this back lot event was often paired with liquid libations, VIP patients, and friends of the practice gathering round and previewing the latest offerings from Paris and Milan. So why not bring trunk shows back to 2018? Here’s a handy guide to getting your feet wet into this fun model of business.


	
	Nimble fingers and a robust search engine should be able to answer all your “how to promote your event” questions so let’s skip right to the success tips that you, a planning committee, and your frame representative can discuss and customize. Know your goal and who you want to attend. Details increase your ROI (return on investment). By focusing on a particular theme, the better you can spend your promotion time and money. While women over age 45 might purchase more optical products, that is not a very narrow audience.

: Extremely lightweight modern materials pair well with larger lenses. Just like trade-show events and booths, add in-optical, short lectures throughout the day on surgical vision-correction options (premium IOLs, LASIK, etc.)

: In addition to having the latest in kids’ frames and sunglasses, bring in a pediatric specialist from another discipline. This also builds a relationship with a referral source for future patients.

: Organized sports are the new neighborhood sandbox for toddlers to teens. All kinds of specialized sports frames can be highlighted with a polycarbonate or trivex tie-in. Is there a sports star in your town? Bring the local hero in to create excitement.

Behind-the-scenes preparation is imperative. Most failed trunk shows begin with a poorly thought-out decision made weeks before the event. Thinking things through and planning wisely is imperative. (Example: make sure the event isn’t the same day as local high school play-offs or the run-off date for a heated mayoral election.) Another planning step that is important is building a profile -watch a few episodes of “Criminal Minds” and build a profile that would make the BAU at Quantico proud.

: Are you trying to sell more frames? Increase visibility in the community? Promote a new frame line?

: The practice will need invitations and stamps, flyers, decorations, refreshments, and media attention across all platforms. A shoe-string budget just means being more creative, knowing how to tweet and use Instagram, and spending more time reaching out to your target audience. One practice I coach has an eyeball costume, where one of the lucky employee goes to a high foot-traffic area and hands out DIY published flyers.

: One client raised $10,000 from a cadre of business partners for a trunk show. This client’s method? No one-from the IT guy to the founder’s mom-was off limits in terms of her asking for donations. Some suppliers have co-op options and offer incentives for the practice to partner with their sales reps.

: Remember, the goal is to create an image through your trunk show. Whether you are trying to establish yourself as a fashion expert or office-wear, spectacle lens specialist, talk the talk. Ensure your staff is properly trained. Booking patients for well-eye exams that match your profile is very, very important to your success. Having someone who knows how to measure new eyewear is as important as being able to verbalize the fashion elements of a featured frame.

Often the best advice goes unspoken because the giver assumes you already know. Simple steps often overlooked might be found in the following:

Shortly after your media campaign begins the phones may start ringing. Be prepared. Train your telephone handler to take incoming reservations and set up a special recorded message that specifically tells callers how to take full advantage of the event. – Some practices pay someone to answer all your RSVP calls 24 hours a day, seven days a week.

The best day for a show is generally your slowest doctor day. Schedule employee work-hours so that your salesforce has time to set up and decorate, get through lunch, clean up, and place orders all on the same work day. This might mean two overlapping shifts of workers.

 Don’t let your staff take a break or go eat during the business time of the trunk show. For some practices this might be 4 to 8 pm.

Ensure that employees have fun. Depending on your culture, this is going to be different for every practice. Giving employees a reason to enjoy the day adds that contagious enthusiasm element.

Make sure your office is clean and that everyone dresses beautifully. Your doctors’ appearance can’t be overlooked: hair, wrinkle-free scrubs, that ratty sweater and what’s worn under the white coat should all be taken into count.

Featuring lenses with frames works better than lenses alone. Fabrication of demos can’t be put off to the last minute.

Don’t call patients picking up finished eyewear the day before or day of or accept optical shipments the day of the event. Sales and VIP service have to be your focus.

While some greet and walk patients to frame collections that complement the patient’s face shape, consider using dispensing tables and counters as activity stations.         

: frame selection and comfort adjustments
		

: pricing, vision plans and finance options
		

: collect co-pays and deductibles and set pick-up dates

Be sure to have multiple samples of no-glare lenses, photochromic and polarized options scattered around optical.

Ask customers who purchased for feedback and inquire about friends they know who might want to attend future events. It is a more personal touch to ask face-to-face when eyewear is being picked up than a survey.

Send thank you notes to sales reps and anyone who contributed co-op funds.

Include your staff in a planning luncheon and feedback celebration. They are your greatest resource.

Your least successful optical event might become a stepping stone for future success. Even if, from an economic standpoint, you lose money, make sure everyone involved has a good time (#workplacefun.) To succeed as a small optical means showing the world daily your collection of hand-curated frames and featured lenses.  Build team pride and applaud attention-to-detail.

A well-orchestrated optical event sends a loud message of exclusive service to patients that had exams event-day (as well as to those members of your staff who secretly think patients can see just as clearly out of OTC readers or from lenses purchased online or at a discount chain) that seeing clearly and fashionable frames at several price-points is available in your office.

The one summer event your optical should be hosting

. The views expressed in these blogs are those of their respective contributors and do not represent the views of 

Garden Musings: “Every man is a darn fool for at least five minutes out of every day. Wisdom consists of not exceeding the limit.” -Elliott Hubbard

 to showcase the purple flowers on my tree-like butterfly bush. And then it bloomed white. I decided I might be becoming like the patient who emphatically insists, “These are not the glasses I ordered! I distinctly remember they were…”

Unless my mischievous garden fairies have moved into your optical lab and changed spectacle lens design details or the model number or color of the frame, you know beyond a shadow of a doubt the patient is confused. What happens next either wins the practice a patient for life or opens the door for more nasty online reviews than I have blooms on my purple (oh yes, it is white) small flowering tree.

Sometimes, people take your ophthalmic practice's prescription and 

buy glasses online or at a discount outlet

. They post that they are cheaper than your practice’s. Price is an issue when value has not been established. Rewarding confusion or complaints with fast, accurate and polite service is why the patient buys from you and not online. 

 who understands and forgives memory lapses.
	
	

Counter with kindness, empathy and solutions

 to irate patient encounters is to smoothly execute a VIP, hands-on way of treating the complaining patient. “Wait,” you say. “The upset patient isn’t my fault. They were wrong!”

I agree, the patient who forgets what he or she ordered is probably wrong. This is why it is a golden opportunity to do something a virtual selling site can never do!

Listen to how the confused patient feels. Not getting what is expected stirs up lots of emotions (surprise, frustration, anxiety) I want you to encourage him or her to be honest: “WOW, this is a surprise. Tell me what you remember about your order.”

Sometimes, in an effort to demonstrate no error was made by the practice, employees or doctors jump straight to the facts and empirical evidence. Stop and listen to understand. You are trying to form a relationship with the patient, not ace a test.

Letting the upset patient speak first demonstrates respect. It allows him or her to speak without feeling manipulated. Because you work in a service job, irate patients come with the territory. What the patient is upset about usually isn’t your fault. But they don’t care about that. They are just mad, and you represent the practice that is causing all the misery.

Whenever you encounter an angry or defensive patient you have a choice. Are you helpful or indifferent?

(PODCAST) Episode 7: How do you clean your bathroom mirror?

Really listening means not allowing your body language or tone of voice to suggest you think the patient is wrong. Quickly showing the patient your original order notes without listening might soothe his or her anger but he or she probably won’t be back. Why? People come back to buy when they feel good. The next time someone insists the product is wrong, keep the following ideas in mind and put them to work.

Acknowledge the emotion-upset people say all kind of irrational things. Listen for information and for areas of agreement. To stop yourself from jumping in with a rebuttal, take notes. Jot down notes on a piece of paper or in the patient notes section of your practice management software. I recommend using a notes screen that is not in exam notes. Be consistent as to where you record these types of encounters.

For example: “I’m sorry for this misunderstanding. To prevent further misunderstanding, I suggest we go over all the paperwork from the original sale together.”
	Service recovery and continuous improvement

Treat upset patients as learning opportunities. Everyone gets confused, so encourage people to talk and grow as a problem solver. Build a culture that rewards employees for resolving encounters with upset patients successfully. Complaints give you a second change to provide service and satisfaction to an unhappy patient. Service industry tracking of complaints reveals that most complaints are caused by the consumer. Your job is to resolve the complaint that allows the patient to keep his or her dignity intact without making financial concessions on behalf of the practice. Do the best you can and jot down word patterns that worked and which ones didn’t.

A patient complaint is one of the most direct and effective ways for them to tell the practice that there is room for improvement.
	If a large percentage of your patients appear to struggle with mental confusion or forgetting details, protect your employees from verbal assaults by adding structure, routine and predictability to the selection process.

Take a picture of the patient in the new frame with his or her phone. By having the patient look slightly to the side the frame temple details are visible.

Write down the brand and model number on the back of the Lensguide. Circle the lens technology that the patient purchased in the guide and give it to the patient. Example: “I know you are excited about today’s purchase. Feel free to show this to your friends and family.”

In addition to the credit card receipt give the patient a dated receipt from your practice software that shows product details.

Complaints are a wonderful opportunity to strengthen patient loyalty.


	
	Your pain is real, and I don’t want to trivialize the patience it takes to deal with a confused patient. I cannot imagine how you must feel sometimes. I suspect it feels like the patient is taking advantage of you and the practice. It is not pretty when the patient screams. Not only does it leave you shaken but the patient may be embarrassed and cover the embarrassment by becoming even angrier and more self-righteous.

Prepare for the worst, practice your communication techniques

It is essential that your entire team be trained to handle the volatile patient. Angry people do not typically get any angrier than they initially present if handled well. Also, while certain people are conditioned to ask for a full refund, it is possible to defuse the situation before those words are spoken.

An explosion must be acknowledged before a problem can be resolved. This is why 

. They obviously feel they have something to say and listening without interrupting moves the patient toward resolution. In order to become an expert at listening (and asking questions) to angry customers, you need to memorize a technique and practice it in role-play situations. Develop alternative questions and demonstrate how something positive can happen.

Remember, you are trying to take the angry energy and turn it into such a positive feeling that this person becomes a #ravingfan of the practice. Please don’t expect to win them all. No matter how patient, helpful and understanding you are, there will be a small percentage of irate patients impossible to satisfy.

Unfortunately, some patients really do get their satisfaction from giving others a hard time. If a patient shows definite signs of becoming hostile or violent, don’t try to handle it alone. There should be a procedure in your policy manual about how to handle these folks. Dealing with upset patients takes a wealth of self-control and is a tough job. Reduce internal stress by 

, taking conflict resolution classes regularly, and don’t expect to be perfect in dealing with every patient every time. You are human too. 

Tending to an angry ophthalmic customer is the golden opportunity to foster a better relationship with him or her-here's how.

Patient expectations can blossom in four summer-friendly steps 

Each day we stand in front of the mirror and prepare for life in the public eye. Often, we must consider the mechanics of cleaning up said mirror. Whether you pay a cleaning service or choose DIY, we all have our favorite way of erasing evidence of life and restoring the mirror to its intended function. (Clearly reflecting an image.)

Are you thinking of transforming these 60 words into an analogy for explaining cataracts and post-surgical results? Not me. I am thinking about something else.

Communication is a tricky two-way street shaped by many things. In my first podcast for the 

, I presented a broad overview of how to brand your practice no matter what stage of ownership.

My cautionary note can be illustrated with five tips on cleaning any bathroom mirror.

1). What gets dried toothpaste off may not polish its surface.

  Diversify how you allocate each quarter’s marketing budget and target just your ideal patient. Your market can be segmented by age. A good marketing message reflects who you are “IRL.” (If you are a millennial, you don’t need me to define IRL. For all you baby boomers, IRL stands for “in real life.”)

Millennials-Americans born between 1980 and 1994-are the largest generation in the United States

, and represent an annual spending of over $200 billion. Don’t be fooled and target all your marketing dollars toward millennials. However, always be mindful that you are building a brand-a reflection of who you are. People 39 and younger self-report being heavily influenced by a brand and price is less of a deciding factor. (If you don’t believe me, spend a Sunday morning in Starbucks and send me flowers as an apology.)

Because aging affects the health of the eye, the age demographic that will most likely spend the largest portion of their income (or managed care dollar) in your practice are baby boomers. Baby boomers are currently between the ages of 75 and 40-you may be a baby boomer or you may have purchased your practice from one.

 Cleaning a mirror is best not rushed. Be intentional about communicating with mature patients. Just because you prefer to promote with Instagram and Twitter doesn’t mean everyone you wish to reach will see your awesomeness. Reality check: the unhealthier the eye, the more challenging it is to read digital messages on a handheld device.

 Your best advertisement is a very happy patient. It takes effort. I am thrilled when my mirror is “polished to perfection.” I see me and I can become my best. I don’t think about my mirror for a few days and suddenly it isn’t so great. Never take your patients for granted. 

The phrase “take for granted” is failing to properly appreciate (someone or something), especially as a result of overfamiliarity. A successful practice requires winning your patients every time they make contact. The older the patient, the more they prefer calling your office and speaking to a human being-not a machine.

dubbed the people who are now over the age of 75 as the "Silent Generation" because they were more cautious than their parents. The Silent Generation needs your services the most. Win their trust. They have influence. No member of the Silent Generation has served as president. However, their vote has been wooed in every presidential election since 

4). Don’t be blind to the grime that distorts and covers.

 Mystery shopping your clinic once a year is recommended. The practice may have processes or systems in place that cause patients to feel continually talked over. Haven’t you visited a store or a car dealership where everyone acted like they knew exactly what you were going to say before you said it? Don’t be that provider.

Avoid mindreading. Even if you or the employee assigned to spend your marketing dollar thinks they are good at branding, avoid assuming you know and understand consumer use patterns.

It’s very frustrating when someone else acts like they know what you’re thinking better than you do. Your message is trying to say something about your practice. When the message is put out there without considering differences, the potential patient (target market) might feel disrespected.

 may report the shortcomings in your practice. Most alarming is when the mystery shopper reports something you did not at all expect to initially improve.

Two examples of failure I report when I mystery shop is back and forth communication about health concerns and calls about eyewear pick up.
	You have trained employees about these two processes and think all is running smoothly, right?

In truth, your front desk doesn’t get messages from the service until lunch (which could put you over 12 hours behind) and your techs do not return routine calls the day they become aware of them.

Then there is the optical, which must handle all those “Are my glasses ready?” calls. They are busy putting out fires, and often just keep pushing returning calls to the end of a never-ending To Do List.

Who changed the rule? That isn’t the image you want your patients to experience!

My rule is to clean the bathroom mirror before it looks like a mirror in a gas station on a country road leading to nowhere. You ask the glaucoma patient to bring in the drops because you want to confirm he or she is taking it properly.

In practice management, this type of reality check against overstating efforts has to do with the stages of practice maturity.

The forming–storming–norming–performing model of group development was first proposed by Bruce Tuckman in 1965. Tuckman said that these phases are all necessary and inevitable in order for the team to grow, face up to challenges, tackle problems, find solutions, plan work and deliver results.

Just as you build upon Sir Nicholas Harold Lloyd Ridley’s amazing 1949 surgical breakthrough every time you use an IOL, lean heavily on Tuckman and team building truths. The truth is summarized below:

a. A newly formed team needs guidance, lots of training and boundaries.
	b. There is a lot of conflict during the storming phase, and without strong leadership turfs develop.
	c. The norm becomes what management monitored and offered correction about. Norm is also the level of effort employees figure out will keep them
	off your radar. (These are the processes which might now be perceived by your target market as a hot mess.)
	d. Performing is as good as it gets. If you don’t like what you have, rebuild the team. (Not the people, how they perform the processes.)

As you and your team take a good hard look at the practice in your mirror, keep cleaning.

5). Everyone who uses the mirror cleans and polishes.

 Train constructively and listen without being defensive. Practices owned by doctors of all ages have employees. To lead, one must lead without getting defensive. This skill and mastering the art of how to express negative feelings in a constructive manner are challenging.

Just like polishing my mirror, practice makes perfect. Elbow grease must be applied in order for change to occur. For your practice to reflect a polished image of your practice the same focus that you approach a surgical technique pioneered in 1949 might be necessary.

Invest in employee training. This is like the 360-degree look I recommend you give your reflection at the start of your day.

Don’t look for the cheapest training options. There is value at affordable options. Keep training and looking for alternatives that give you the results you want at the price points that fit your budget. (Employees and training should equal about 20% of gross.)

Communication skills change slowly and require lots of coaching. Your reputation is on the line every time the phone rolls to service or a patient is ignored when entering the optical.

You will never regret working on your IRL image. Love your patients and they will promote your practice for free.

Like polishing glass, there are different ways to make your practice shine

Episode 7: How do you clean your bathroom mirror?

Do you want better days? Here's how you can improve in 4 easy steps!

"I want better days." This line from an episode of “The Good Doctor” holds the key to your success as a practice owner. I suggest that the following are as true for you as they were for the characters in the episode, titled “Aftermath.”

You want to be respected as a doctor and your day shines a little less bright when someone second-guesses your decisions.

You aren’t really ‘friends’ with all of your co-workers, but it would be nice to ‘do lunch’ together.

You feel like you don’t really have any close friends. No one you can have a big belly laugh with or be silly.

You feel you’re forced into putting work and patient care in front of important personal relationships.

If the show writers of this series can resolve these heavy emotions you are feeling in 50 minutes, 

 can offer corresponding rules and guidance in 1,200 words or less.

Rule #1- If it wasn’t documented, it wasn’t performed!


	
	Be careful of “cloning” previous visits, “pulling forward,” or defaulting all fields to “normal” when charting patient care.

Proper charting documentation is crucial. There is a difference between wellness coverage vs. medical visits, and the way these are charted may be reviewed, as OIG has identified this as a target area for audits. The move toward expanded “wellness” coverage that began several years ago has become a sweeping trend. It’s a great trend and prevents preventable blindness.

A quick internet search will show that health plans are encouraging their members to include the use of the benefit as part of their preventative routine each year. The challenge is for those of you who are seeing wellness visits from those who are diabetic or glaucoma candidates, which can morph into more than a wellness check.

Establish triage guidelines and how to communicate your intentions to either diabetic or glaucoma candidates using wellness eye benefits or diabetic or glaucoma patients returning for medical exams as part of their follow-up care.

Asking for copays and deductibles should not be a big emotional hurdle for employees. Being properly paid for your complex problem-solving abilities and medical acumen is paramount to practice success.

Rule #2– Lunch with the boss is never just ‘lunch’

There is a lot that goes into running a practice, a great deal of which is the help you get from others.  While leadership as a discipline is very, very important, the personal and interpersonal sides of leadership are every bit as important as the great leadership themes of vision and/or execution, strategy, and the like.

For what actually happens is that no matter how great a vision or a strategy is, the doctor must get it all done with and through people.

And that is where lunch comes in. You have to find your way. I want you to be friends with employees without employees taking advantage of you. Sadly, I could write a pretty thick book about stolen money, stolen time and stolen ophthalmic product. And each true story would end with “… and I thought he/she was my friend.”

Build a culture that allows employees to feel appreciated-it has more to do with success than your business acumen.

People’s hearts and minds are constructed to perform best under certain conditions. No pressure, but they all depend on your style and behavior. For your team, it might be lunch that brings ‘the secret sauce’ to practice dynamics.

I’m not really sure your bestie should be someone who works for you. Henry Cloud, PhD, writes in his self-help books about boundaries. According to Dr. Cloud, a boundary is a structure that determines what will exist and what will not-so keep this thought in mind.

Success magazine named Dr. Cloud as one of the top 25 of 2014’s most influential leaders in personal growth and development. He is a frequent contributor to CNN, Fox News Channel, and other national media outlets. Folks, he is a rock star and we all should take advantage of his wisdom.

Rule #4 – You always get what you create and what you allow

This is a quote Dr. Cloud uses a lot; but I heard it first from another and somewhat lesser-known psychologist, Nancy Martin, PhD. Dr. Martin showed me that how I carried myself taught others how to treat me in about 15 minutes. This great woman helped me learn to coach without being bossy and share criticism without shattering egos.

Most importantly, she taught me the same communication basics that (ones that Dr. Cloud also uses)-on how to pick up the pieces when we mess up. Part of gaining all this communications expertise is learning how to say you are sorry and forgive yourself. You have to accept that it takes time to allow yourself to retrain its neuropathways. Be patient with yourself.

Another personal friend that helped me and can help you too is Beverly Inman-Ebel, MA, CCC-SLP. She wrote a book that I really do think I can quote from memory. “Talk is Not Cheap, Saving the High Cost of Misunderstanding at Work and Home.” Beverly, whom I am honored to call my friend, wrote a book proving that it is possible to never upset anyone by miscommunicating. (I know what you are thinking: She has never been to your practice during a full moon.)

That full moon and all my brilliant clients who trust me to retool their communication patterns are the reasons I keep reading and applying her excellent strategies and tactics to real-life situations.

When you make a financial investment in stocks or mutual funds, you can see the return. If you invest well, the return on being a better communicator is positive. (I shared insights on how to have more good days in just 956 words.) When the investment climate is bullish or soft, knowing you are investing wisely means a greater peace within because of your internal positive attitude.

There is a tremendous personal power in knowing you control your attitude. It rings a balance that creates a harmony which allows you to handle the practices ups and downs.

Support is important. Having a supportive friend not in the practice is a valuable connection. Later, you will be one radiating success. A rewarding and pleasurable career grows from your meaningful achievements. Small steps achieved through becoming a leader that creates a culture that supports your team.

When people exclaim that they just don’t know how you do it all, tell them it all started with wanting to have more “good days.”

Supportive leadership creates a culture that benefits your whole team.