Donna Suter is president of Suter Consulting Group.

Donna Suter

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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.

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. 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.

Donna Suter

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Patient expectations can blossom in four summer-friendly steps

Episode 7: How do you clean your bathroom mirror?

Build a better work environment in 4 easy steps

Three time management skills to achieve financial success