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The underlying, big hairy goal of eye care


How long does it actually take to form a new habit? Is there any science to back this up? And what does all of this mean for 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 Medica.

“It requires a minimum of about 21 days for an old mental image to dissolve and a new one to jell.”

-Maxwell Maltz

Almost monthly, I offer goals for consideration and challenge you to set goals for your staff. As you do this, remember to keep striving longer than you think should be necessary. For example, reaching out to former patients who have a diagnosis or family history that would benefit from a routine eye health appointment, but, who just don’t come in for a visit.

A goal of asking technicians and administrative staff to make what I refer to as ‘regular recall’ phone calls daily is an appropriate tactic. I think no one has such a full day that 25 phone calls can’t be made. So I could have an accurate benchmark for this blog, I made regular recall phone calls to 25 people in my telephone’s contact list. My test subjects were 25 people to whom I don’t speak to regularly-not my ‘besties,’ people I see regularly, or clients.

Here are my results and how long it took for each call:

1.     Call no answer: 30 seconds

2.     Call and left message: 1 minute 15 seconds

3.     Call and spoke to individual: 3 minutes

All my phone numbers were good and only 3 people had a voicemail that was not set up and/or full. What this means to you is it might take your employee even less time to make 25 calls than the 59 minutes I spent reaching out and leaving messages about the importance of routine eye care.

Summary of my 25 calls

1.     3 were a bust because there was no way to leave a message.

2.     5 individuals answered the phone.

3.     Left messages for 17 people.

4.     By close of business, all 17 of those that I had left a message for called me back.

What motivates patients to call back


What motivates patients to return outbound ‘regular recall’ calls

The big hairy goal of healthcare is building a relationship of trust that causes the patient to be open to following your good advice.

My test subjects called me back because I have a relationship with them. They all thought I had read an article in an eye-health trade journal that caused me to think they were in danger of losing their vision and needed to call their eye doctors.

Not wanting your patients to lose vision because of a progressive eye condition, injury, or eye disease is the big hairy underlying goal behind every patient reactivation tactical goal I outline.

The relationship and trust you have with your patients means you have their best interests at heart. The conversation isn’t about using recall to achieve an 80/20 patient mix or patient volume in your clinic. The conversation is about eye health. It’s about preventing preventable blindness and the patient having crisp visual acuity in his or her most visually challenging situations.

What does it look like when you accomplish this goal? Is it when 100% of your patients call you back and are willing to listen to why he or she should give up time to come to your office for an eye health examination? It will look like a busy office with happy employees because they know they are performing meaningful tasks.

Are you all in? Is your staff all in? How do you know?

Look at being all in as a scale from 1 to 10 with 1 being “I don’t want to do this,” and 10 being “Yes, I am all there. I am focused and willing to do what it takes.” Where is your new hire on this scale? What about the lead technician?

This mental commitment is important because 10 is where the magic happens. It is where you begin to see happier patients, less stressed staff, and a by-product of increased profitability.

Being all in begins with the owners and management staff. First day of work, all in begins with making it clear to new hires that while data entry must be accurate, listening and engaging with the patient is paramount. All in also means that this process of engagement doesn’t drag on and on. Studies find that intake times become shorter, not longer. I want your door-to-door wellness eye exam time to be no more than 90 minutes.

Goals worth having aren't reached quickly


Goals worth having aren’t reached quickly

Change is never easy. It often feels worse before it gets better. Human nature being what it is-introducing change to your staff will not be accepted. You will get push-back. Extroverts will begin what experts call ‘inviting others to his or her side of the change.’ Those with natural leadership abilities might stage a mutiny, meaning someone may come to you and say, “We have talked about it and none of us want to do this. We want to go back to the way things were. Oh, and if you say no we are all going to quit.”

Not changing isn’t an option. When emotions are high, it is important to continue to take small steps forward. Just as important, management must be able to empathize with the emotions employees are feeling.

This is especially true when introducing a change that is linked (in the employees’ minds) with an emotional event or one in which there is a strong cultural attachment. Thus, it is important to keep moving forward. Keep tracking compliance for longer than you think you should. As my initial quote indicates, many experts think change happens in 21 days.

This observation was first published by Maxwell Maltz. Dr. Maltz, a plastic surgeon, noticed it took patients about 21 days to get used to seeing his or her new face. Similarly, when a patient had an arm or a leg amputated, Maltz noticed that the patient would sense a phantom limb for about 21 days before adjusting to the new situation.

These experiences prompted Maltz to think about his own adjustment period to changes and new behaviors, and he noticed that he also took about 21 days to form a new habit. In 1960, Maltz published the above-stated quote and his other thoughts on behavior change in a book called Psycho-Cybernetics.

Maltz’ work influenced nearly every major “self-help” professional from that era-Zig Ziegler to Brian Tracy to Tony Robbins. And as more people recited Maltz's story-like a very long children’s game of ‘Telephone’-people began to forget that he said a minimum of about 21 days and instead shortened it to, It takes 21 days to form a new habit.

But the problem is that Maltz was simply observing what was going on around him and wasn’t making a statement of fact. Furthermore, he made sure to say that this was the minimum amount of time needed to adapt to a new change.

What’s the real answer? How long does it actually take to form a new habit? Is there any science to back this up? And what does all of this mean for your practice?

How long it really takes to build a new habit


How long it really takes to build a new habit

Phillippa Lally, in a study published in the European Journal of Social Psychology, examined the habits of 96 people over a 12-week period. Participants chose one new habit for the 12 weeks and reported each day on whether or not they did the behavior and how automatic the behavior felt.

Some people chose simple habits like drinking a bottle of water with lunch. Others chose more difficult tasks like running for 15 minutes before dinner. At the end of the 12 weeks, the researchers analyzed the data to determine how long it took each person to go from starting a new behavior to automatically doing it.

The answer?

On average, it takes more than 2 months before a new behavior becomes automatic-66 days to be exact. And how long it takes a new habit to form can vary widely depending on the behavior, the person, and the circumstances. In Lally's study, it took anywhere from 18 days to 254 days for people to form a new habit. 

In other words, if you want to set your expectations appropriately, the truth is that it will probably take your employees anywhere from two months to eight months to build a new behavior into their life-not 21 days.1

Where to go from here

At the end of the day, how long it takes for your employees to get into the habit of reaching out to patients who haven’t been seen by the practice in 2 to 10  years doesn't really matter that much. Whether it takes 50 days or 500 days, you have to put in the work and celebrate their progress, not just the results. Do this by remembering the following and working on being a better coach and leader every day.

1.     Know your practice is making the patient’s world a better place.

2.     The practice values helping patients see clearly and not go blind. This value undergirds all your plans, decisions, and actions.

3.     Employees’ thoughts, feelings, needs, and dreams are respected and listened to while management demands their best.

4.     Coach them through their mistakes. Allow them to learn and move ahead.

5.     Cheer each other on. This brings enthusiasm to the change process.

In conclusion, the only way to get to Day 500 of a new habit is to start with Day 1; forget about the number and focus on doing the work. Measurement shared with everyone generates excitement. You cannot use your degree, your office’s amazing diagnostic technology, one of the array of digital spectacle lenses your optician knows how to select, or prescribe vision-altering pharmacology if you never see the patient it would benefit.

Throughout the change process, feed your team’s spirit with congratulations.

I’m cheering you on!




1. Adapted from James Clear’s article in Behavioral Psychology, How Long Does it Actually Take to Form a New Habit? (Backed by Science) http://jamesclear.com/new-habit


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