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Tips for improving a practice's performance when it just isn't cutting it


Change is inevitable. But that doesn’t have to mean the beginning of problems and stress at your practice.

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, president of 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 Advanstar


Sometimes a dip in any or all of those five key metrics you monitor regularly indicates not a hiccup in the market, but a serious problem with team morale.

In the optical, for example, the acceptable range for remakes in peak performing dispensaries is 95% to 99.9%. Jobs ready to be picked up should be picked up by the patient in ten business days or less.

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How does your office stack up?

Let’s face it, the eye healthcare sector-like all other healthcare organizations-has been forced to change.

Restoring productivity and profitability in a practice hit by change doesn’t come easy. Employees are distracted, confused, stressed out. Some get angry, some jockey for position. Some simply give up. They are all looking at you to “fix things.” And even the people who are pumped up and willing to help can’t agree on how things should be fixed.

Change damages the trust level, drives morale south, and gives organizational loyalty a beating. How can you protect productivity, quality, and profitability under these conditions?

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The hard truth? Nobody can say how much time your practice has before it gets hit with even more changes.

Next: Biggest obstacles

Photo credit:  ©Tyler Olson/Shutterstock.com


A rise in remakes and a slow-down in the delivery of goods from the optical may be indicators that your team does not have the natural skills and abilities needed to adjust to rapid change. I mention remakes because offices often continue to accept a higher percentage of errors as a routine part of daily processes.

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But the “nobody’s perfect” justification for mistakes should not be taken too far. In fact, accepting mediocre performance may be a symptom of the elephant in the room that is keeping you from achieving the success you say you desire.

Biggest obstacles

The biggest change facing practices today is the rate of change. Before the shockwaves of one upheaval subside, another hits. This relentless change mangles team effectiveness. Employees begin to make rookie mistakes.

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Unless you make quick repairs and mobilize employees, your office will remain off balance, in a never ending “transition period.” This makes the practice more vulnerable to a slow-down and, eventually, puts your reputation at risk.

Sometimes the simplest indicator of the practice’s lack of consumer confidence can be seen in the optical. Optical eyewear not being picked up indicates a lack of enthusiasm in his or her selection. Remakes often lead to angry consumers and refunds.

If the number of comprehensive exams per day, week, month, and the number of new patient exams (per day week, month) is also down, there is a strong possibility that the management style that has served you well for years may not contribute enough for rapid organizational change.

Look at it this way. When the situation changes, so should the focus of your efforts. New problems usually call for new responses. Even good intentions and a great effort won’t get you very far if you are doing the wrong things right or the right things wrong.

Next: Lack of team vision and failure to lead


Wait! I am not suggesting that you fire everyone and start over or that you sell your practice and go work for a retail chain.  Don’t think of change management as a nuisance. Consider it the heart of your job.

If you are too busy to carry out the tasks of leading your team through change, you are busy being wrong.

Lack of team vision and failure to lead

Reality says you will hit resistance. Do not expect the existing culture to be on your side. More often than not, the established culture actually gets in the way during transitions from the old to the new.

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Go ahead and do what needs to be done. Your practice cannot afford the paralysis of inertia and inaction. People rally behind a leader that acts confident and decisive.

Don’t confuse respect with popularity. Better for you to be accused of bossiness than to lead in a leadership vacuum. But change efforts are crippled if you are mean-spirited, arrogant, demeaning, or unfair in the way you deal with others.

Being a decisive leader also means being a good listener. Solicit your employees’ perspectives and opinions. Your employees need to have a voice, but you need to call the shots. Otherwise, you can expect anarchy. Consider one-on-one lunch meetings with key employees once or twice a week.

Next: Watching geese can improve performance


Clear priorities

Clear priorities are one of the first casualties of change. Some previously hot projects (like using a lens guide during pretesting) die a sudden death, and other high priorities (reducing remakes) get put on hold.

Because of the blur, employees head in different directions, their efforts too random to produce much good. Some people simply disengage and drift. Others may work hard individually but accomplish little collectively, proving that good intentions can result in wasted motion unless they are tightly coordinated.

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In his book, Gung-Ho, Kenneth Blanchard encourages managers to model a work team after a flock of geese. It sounds crazy, that private practices can learn a lot from watching a flock of geese.

Every aspect of the flock organization is focused on the achievement of a common goal. Consider:

1.     Each member is responsible for getting itself to wherever the flock is going. Each member looks to itself-not the leader-to determine what to do.

2.     Every member knows the direction of the flock. Having a common direction makes assuming the leadership role easier.

3.     Every member is willing to assume leadership when the flock needs it. When the lead goose gets tired, a fresher goose from back in the pack assumes the leadership position. This allows the flock to maintain the fastest pace possible.

4.     Followers encourage leaders. Members honk from the rear to encourage leaders to maintain a fast pace.

5.     Members look after each other, helping all members achieve the goal. If a wounded goose goes down two geese follow it and protect and feed it until it either recovers or dies.

6.     When the nature of work changes, the geese reorganize themselves for the best results. They fly in a “V,” land in waves, and feed in fours.

Next: Concise tactical goals


Concise tactical goals

It stands to reason that your team can’t perform well without clear direction.  Especially when changing (transitioning to EMR, for example) your employees can’t be effective without being reminded of their performance goals.

You defuse a lot of potential resistance when you consider your team’s input and then give instructions that are unequivocal, easily understood, and have a deadline. Map out new priorities and overlay them onto performance, or tactical goals.

Your plan of action should outline crystal-clear tactical goals. Keep them pure and simple and tie them to a specific timetable.

Expect some mid-course adjustments. That’s just the nature of organizational change. Adapt your agenda without losing focus. Keep instructions clear and communicate your expectations constantly.

Office processes abandoned or ignored

This is perhaps the most dangerous by-product of organizational change.  The success of your practice is shaped as much by group process as by the raw talent that makes up your team. Even highly competent employees who are committed and hardworking can’t succeed as a group if their efforts are unsynchronized, ineffective, or off target.

During extended periods of change, employees become notorious at sidestepping or overlooking processes.  Instead, they are looking out for themselves. They get really good at “doing” and not so good at patient relations and taking responsibility for key practice metrics that monitor your processes.

Confrontation is the only productive solution. Before confronting just one employee, stop and bring it to the entire office’s attention. This conversation is neither punitive nor lecturing in nature. This process improvement conversation could be as simple as saying, “Let’s look at what’s going on here. Now, how do you think patients feel about that? Let’s analyze how we’re working together as a group.”

Next: Off the hook equals bigger problems


Take a hard look at the metric in question. Don’t let people dodge the hard issues, gloss over sensitive points, or turn the conversation into a gripe session about patients or an outside vendor. Make them face the facts and come up with constructive ideas on how to handle the process.

 Be prepared for the conversation to get tense.  It is important to realize that if you let them off the hook your office is headed for bigger problems.

Process analysis is powerful stuff. It can turn performance around in an office that appears to be losing ground during a season of change.

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