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Technology may be important, but employees are the real key


What can we ophthalmologists in the wealthiest country in the Western Hemisphere learn from the success stories of ophthalmic institutions in other countries with different cultures, histories, and degrees of wealth? A great deal, notes Peter J. McDonnell, MD.

“I am not led. I lead.”

-Motto of the city of São Paulo, Brazil

Dr. McDonnell

By Peter J. McDonnell, MD

The country of Brazil has changed dramatically in the past two decades. After emerging from a military government, a succession of democratically elected governments have overseen dramatic economic growth-Brazil is now ranked 5th or 6th in terms of gross domestic product-and an unemployment rate lower than that in the United States, plus the emergence of an extremely large middle class.

With this economic success has come much greater demand for health-care services.

My friend, Mauro, is an ophthalmologist in the largest city (by population) in the Western Hemisphere. In 2010, he opened the first large eye hospital in this city of 16 million-plus people.

Before doing so, Mauro studied successful eye hospitals in the United States as well as the Aravind hospital system in India.

After 3 years of experience, Mauro recently discussed some lessons he had learned.

By all measures, this new eye hospital has been a great success. From 2010 to 2012, surgeries increased by 68%, emergency referrals by 600%, routine examinations by 376%, and the number of ophthalmologists using the hospital grew from 13 in 2010 to 198 in 2012. Any eye hospital in the United States would be delighted with such numbers.

Mauro lists the elements of success as follows:

  • Assembly-line efficiency

  • Strict quality norms

  • Brand recognition

  • Standardization

  • Consistency

  • Ruthless cost control

  • Economies of scale that accompany high volume

“What is the key element that explains your success?” I asked my friend.

“Having the best technology is important,” he replied, “but the real key is having the best people.”

Investing in employees

Mauro has devoted a lot of attention to attracting and retaining the best employees for his hospital. He has a formal orientation program to train employees as they join, and continuing education for everyone. Every employee is to have a career plan within his organization.

The educational programs he has developed are intended not simply to enhance the skill level of employees, but also to help them feel that they are engaging in personal development.

“Our goal is not to get them to perform a little better, but to encourage critical thinking and problem solving,” he said.

Educational programs must have excellent trainers, mix employees from different areas of the hospital, be less than 2 hours in length, and be formally assessed and improved with time.

The trainers are required to make sure their sessions are informative, interesting, and participatory. Teamwork is emphasized.

Mauro regularly measures employee satisfaction in an effort to determine the effectiveness of various employee development and retention initiatives.

In his research of the literature, he finds that an overall satisfaction score of 45% is considered quite high, and his hospital has exceeded this with a score of 65%.

Also, he has found that employee satisfaction scores are correlated with age. Employees aged fewer than 30 years consistently report lower satisfaction scores than do older workers.

In the largest country of South America, as in the largest of North America, there is the belief that younger people, and younger physicians, have a different approach to thinking about work and work-life balance. People in Mauro’s position must recognize and respond to that reality.

Lessons to learn

What can we ophthalmologists in the wealthiest country in the Western Hemisphere learn from the success story of ophthalmic institutions like this in other countries with different cultures, histories, and degrees of wealth? A great deal, I believe.

As downward pressure on health-care reimbursement continues in the United States, the institutions that survive and thrive will be the ones that adopt many of Mauro’s strategies.


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