How to make your New Year’s resolutions last the whole year

How are you doing with your 2016 resolutions? Making New Years' resolutions is a time-honored, end-of-year tradition. Every year I'm encouraged by the idea that in a mere twelve months I will have become a (marginally) better person. While you may think this ritual doesn’t apply to a modern eyecare practice, consider resolutions as a synonym for process improvement and the word goal. Management by Objective (MBO) has been touted as a valid way to achieve corporate change since the early 1950s.

Editor’s Note: 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, Suter Consulting Group. The views expressed in these blogs are those of their respective contributors and do not represent the views of Ophthalmology Times or UBM Medica.

How are you doing with your 2016 resolutions? Making New Years' resolutions is a time-honored, end-of-year tradition. Every year I'm encouraged by the idea that in a mere twelve months I will have become a (marginally) better person.

While you may think this ritual doesn’t apply to a modern eyecare practice, consider resolutions as a synonym for process improvement and the word goal. Management by Objective (MBO) has been touted as a valid way to achieve corporate change since the early 1950s.

Merriam-Webster defines resolution as the act of finding an answer or solution to a conflict or problem: the act of resolving something. That same dictionary resource defines goalas something that you are trying to do or achieve.

The question for you and your management team, then, is how are you going to lead your team toward success? To be a leader today requires more than knowledge. Tomorrow is coming quicker than ever before and people are looking for leaders who can provide competent direction and consistent encouragement.

One characteristic of a successful leader is modeling change. This means that today’s successful leaders have to be moldable; you personally must change fast or you will be left behind. (This doesn’t mean you have to change your core values, beliefs or convictions. In fact, that will work against you these days. People would rather be on your team and disagree with you at times-a difference of opinion is more acceptable today-than for people to think you are whimsical in what you claim to believe.)

Every year I'm hired by eyecare practices as a business coach to assist bright professionals in meeting a goal or keeping a resolution. “Nothing seems to be effective,” potential clients lament.

I help clients create new habits. This is how I do it.


How Habits Create a Practice Culture

Think back over your day’s activities. Did you smile and greet your coworkers in a friendly manner? Did you have a snack before lunch or dinner? Did you check your email or social media after receiving a notification on your smartphone?

While these activities may not appear to have much in common, they all share a common feature: they are usually done out of habit.

A habit is a recurrent, often unconscious, pattern of behavior acquired through frequent repetition. Habits, whether good or bad, are practices that have become so ingrained that they are often done without conscious thought. If we look in the breakroom refrigerator and cabinet drawers at 3 p.m., it’s likely we have developed a habit of having a mid-afternoon snack. If someone were to confront us and ask why we were eating a cracker or drinking a soda, we’d say that we were hungry. But the truth is we are simply re-enacting a pattern of behavior that has become ingrained in our daily routine.

Habits drive our behavior, which in turn forms the culture of a practice. No practice owner wakes up one day to find they’ve suddenly developed either an impersonal, cold office, or a service-oriented practice.

The culture of a practice is shaped by the responses we make to thousands of decisions. Most of the time we interact with patients and employees without consciously thinking about how to act. We tell the truth because we’ve made a habit of truth-telling. Over time we become honest and trustworthy because the habit of truth-telling has become ingrained in our character. Because of the role habits play in practice growth (or decline), it’s important to understand how habits work, how they’re formed, and how positive habits can be created. 


How Habits Work

Habits emerge because the brain is constantly looking for ways to save effort. Our brains automate mundane and rote tasks (such as starting the car and driving to work) in order that we might have more mental energy to spend on professional or cultural tasks (such as patient care or recommending spectacle lenses that help solve the patient’s most visually challenging dilemma.) 

Every habit starts with a behavioral pattern called a habit loop[1], which consists of three parts: a cue, a routine, and a reward.

The cue is a type of trigger that tells your brain to go into automatic mode and begin the routine, which is the behavior itself. The final step is the reward, an internal or external stimulus that satisfies your brain and helps it remember the habit loop.

Consider, for example, one of our culture’s most frequently practiced transportation habits. As you prepare to leave for work (this is the cue) your brain reminds you to start the car and point it in the direction of the office (this is the routine). Arriving at work on time and without having an accident is the result that provides a positive experience (this is the reward). If you forget to follow this routine, you may find your brain sending you a reminder or a signal that something is wrong (usually after the low fuel light comes on or you’ve taken a wrong turn). This is because habits satisfy a neurological craving - our brains look forward to the sense of fulfillment that comes with completing the routine.

A habit loop is why it becomes so hard to not check our email when we receive a notification. Even if we know the email is something that can be handled at a later time, our brains want us to “close the loop” by completing our habitual routine. 


How to Create a Habit

To create a habit that leads you toward your practice goals, apply the following four steps:

1.     Identify the habit loop - The new pattern of behavior you want to create, such as one based on a resolution, will consist of the habit loop: a cue, a routine, and the reward.

Take a few minutes to think through and write down the details of each part of the loop. For our example, let’s use the habit of answering the phone during clinic hours. To set up the routine - the main action of the habit, such as actually answering the telephone - we’ll need to identify the materials that are needed (e.g., strategically placed telephones or headsets and employees who are told this is an expectation) and establish a time frame in which to consistently carry out the habit loop (e.g., within two rings). The more the tasked employees understand the habit loop you are encouraging them to create, the easier it will be to identify any barriers that might prevent them from making it a habitual behavior.

In this example, understanding the habit loop also requires communicating why it is important. In marketing terms, the more point of access the practice creates for potential patients as well as returning patients, the easier it is to increase its market share. What this means in the example of answering the telephone is that while patient portals, Facebook pages, and automated telephone trees all get the job done, the telephone and speaking to a caring human is the habit most deeply ingrained in the brains of the consumer/patient. By not answering the telephone, the practice is creating a psychological barrier.

Understanding how to use the telephone/equipment is also a key element of the habit loop. Not knowing how to transfer a call or switch between hands-free and the landline are all reasons employees would rather not answer the phone. Barriers commonly cited include completing administrative tasks surrounding patient intake or billing activities, and face-to-face interaction with an on-site patient. These types of reasons for not habitually answering the telephone suggest that the employee is uncomfortable with communicating the need to multi-task to the patient in front of him or her or does not know how to juggle two very different activities.

2.     Isolate the cue - Cues are signals that tell us to begin the habit routine. In his book The Power of Habit, Charles Duhigg says research has shown that almost all habitual cues fit into one of five categories: location, time, “emotional state,” “other people,” and “immediately preceding action.”

Choose a cue for the habit loop you want your team to develop that takes advantage of as many of these categories as possible. For instance, our cue in the example of answering the telephone could be eliminating the beeping of the Bluetooth device in one’s ear (location and immediately preceding action) after two beeps (time) when we are pleased to assist the patient (emotional state) and when no one else answered the telephone (other people). 

3.     Create a reward - When creating a habit that impacts the culture of your practice, the reward stage can be the most difficult step of the habit loop to develop. “Why should employees be rewarded for doing something they were hired to do?” And isn’t the habit - such as answering the telephone and helping patients - a reward in itself?

It’s understandable that you may feel push-back about creating a reward for your work team or a marginal employee. You may think it is their responsibility to develop a good habit and your part in the process is to simply point out the area that needs improving.

Keep in mind that you are not rewarding employees for doing the right thing; you’re training their brains to create a neurological craving. If we have a “reward” (such as you or your front desk supervisor giving the individual a thumbs up) after answering the telephone within two rings, it isn’t to actually reward the individual for his or her accomplishment; it’s merely a way to directly affect how their brain will respond to the habit loop.

4.     Plan and evaluate - The reason habits are difficult to consciously create is because they have not yet become a habit. It’s the conscious part-making sure the brain is actively focused on the habit loop-that becomes the stumbling block. 


For the habit loop to become an ingrained habit requires effort and persistence. This is typically when the employee will start to fail. You and your management team need a plan that outlines how you’ll handle obstacles and what action steps you will implement when the front desk is not answering the telephone and needs to get back on track. Studies suggest it takes 21 days to form a new habit. Expect setbacks.

Similarly, you’ll need to continuously evaluate the habit loop you have created to ensure management has chosen effective cues and rewards. 

On its own, resolutions can be a helpful tool in pointing the practice in the direction it wishes to go in 2016. But, by combining them with habits you create a powerful means for transforming your office culture and helping your team experience less stress on the job. By doing so, patients enjoy better care and the owners enjoy greater profitability.

What happens if you fail? The secret lies in the English word resolutions. Notice how it can be broken in two? Re Solutions? Try again. Re-examine the process and re-communicate its importance to employees in a different manner. For example, print out this blog and discuss it at your next departmental staff meeting or team huddle.

One way of celebrating your success is posting it on this website!

Donna Suter (423-400-3626; is an internationally recognized authority on the unique practice management issues that face dispensing eyecare practitioners.    

Suter Consulting Group

Duhigg, Charles. The Power of Habit: Why We Do What We Do in Life and Business Kindle Edition page 55.


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