We haven't talked about delegation for quite a while. My articles in the past on this topic have mostly focused on what procedures to delegate and how go about it. Delegation is so poorly utilized in eye care that I would like to take a more fundamental approach in this article to illustrate why it is so important to practice growth.

Assumptions
For the purposes of this article, I will assume the following:

• You want to build a practice that is busy and generates a high net income.
• You are currently not busy enough. If you had more patient demand (at reasonably good fees), you could find a way to see the patients.

I would estimate that this describes about 90% of optometric practices in the United States.

What can you control?
We know that delegating duties to staff is a key requirement of the practice described above. There is simply no way to generate a large net income if the practice has a small staff and the doctor performs most tasks herself. Of course you can't begin with a large staff right away, so how do you get there? You begin with a mental approach that embraces the concept of delegation because you know it must be in your future. You must continually look to delegate more and more to your staff and try to seek ways to make your staff larger.

It may seem like you can't control the patient demand aspect of your practice, although you do have some indirect control and I'll cover that below. But I understand the feeling that for the immediate future there is not enough demand and it's growing slowly. You can, however, control how much delegation goes on in your office. If the dream practice uses delegation, then your practice should also.

Your practice operations and your staff must reflect the current level of demand. That means the doctor/owner performs many tasks that she would not do in the dream practice. That's perfectly fine and the doctor/owner should take on those roles temporarily, but I believe it becomes permanent in most practices and that freezes the practice into a non-growth mode. The doctor/owner comes to accept that she must do these things and that no one else can do them well enough. It just seems easier and more practical to do them yourself. It can even seem economical; like doing some tasks yourself is saving the cost of another employee. That is false economy and it could be stopping you from reaching your goals.

Step-by-step growth
Growth must occur in a step-by-step fashion for most practices. Stretch as much as possible to invest in your practice in ways that you feel will help the most. You must have a vision of what you want your practice to look like and then make it look like that as much as possible.

It's fine to have a plan for delegation, but actually much of it will occur on a trial and error basis. Who does what in your practice will evolve until you have developed a good system that maintains high quality service and protects your financial interests.

Here is an oversimplified example of what I mean by step-by-step growth.

• You might begin by delegating all optical dispensing and pretesting duties to a technician and optician.
• You raise your fees as you add additional instruments and tests.
• Then you shorten your appointment slots and see more patients per day.
• You hire more staff with the increased revenue from the extra appointments per day.
• The increased staff allows you to delegate more tasks, giving you more time to train staff and work on customer service. The increased staff also helps customer service because there are more people to take care of patient needs.
• The improved customer service results in more referrals and better retention and gross and net revenue increase.
• You raise contact lens fitting fees and optical prices.
• You remodel and expand the optical and increase your frame inventory.
• The new optical creates more revenue.
• You hire more staff.
• You move to a larger office and equip more exam rooms, allowing you to be more efficient.
• The larger office signals to the community that your practice is a strong player in the local eye care market. More patient referrals occur.
• You hire an associate OD and take yourself out of the appointment schedule one day per week, which you spend on management. The new associate works two evenings per week plus Saturday mornings, which fill with appointments very quickly.

All this will take a few years, but it is fantastic model for growth and it all depends on delegation.

Delegation is not just optical and clinical
As you look at delegation and the role of staff members, look at the administrative aspects of your office as well. Try to design a system for your practice that does not depend on the doctor / owner. This will require a good office manager who can handle virtually all administrative duties. The practice owner can and should have close control over the practice finances, but that doesn't mean she must make the bank deposits and print all the checks to suppliers personally. It takes time to train and trust an office manager, so the tasks you delegate will evolve, but set a goal to transfer the duties.

Here is a list of some of the duties to work on transferring to the manager or other staff.

• Ordering supplies and products
• Fixing and installing things around the office
• Arranging for contractors
• Bookkeeping
• Payroll
• Taxes
• Marketing
• Accounts payable
• Interviewing and hiring employees

The end result of all this delegation to others is increased productivity. You are able to see far more patients and generate far more income when you have multiple people doing it. And ultimately, this process allows the doctor/owner to spend time on practice development; researching and thinking about what to do next.

What about building patient demand?
The only way to build patient demand is to provide great service. How does a restaurant become the place that is always packed with people? Great food. In our field, we must provide exam and treatment services that are different from the pack, outstanding experiences with contact lenses and eyeglasses and fantastic customer service. If you and your staff do that, word of mouth referral and patient loyalty will cause demand to increase.