Article Date: 7/1/2008

Develop a High-Grossing Staff
practice management

Develop a High-Grossing Staff

Here are seven tips on how you can create a staff that will help take your practice to the elite level.

Munster, Ind.


The mean gross practice income per optometrist is $530,914, according to the latest American Optometric Association (AOA) data (2006). But, single location group practices report gross income as high as $7,500,000, and the top 5% of practices gross $2,230,000 and more. In my experience, it's quite possible for each O.D. in a practice to generate more than $1.2 million in gross revenue.

Interested in joining this elite group of practices? Then realize that great employees are integral to creating a high-grossing practice.

In this article, I present the key elements for developing a high-grossing staff.

1 Demand outstanding customer service

You must rely on patient referrals to achieve a high-grossing practice. To accomplish this, practice outstanding customer service yourself, and demand it from your staff.

Outstanding customer service is hard to define, as it's something one has to experience to know it has occurred. Typically, however, it revolves around an unexpected act of sensitivity, kindness or generosity.

An example: A contact-lens technician just completed training a new and somewhat nervous contact-lens patient in insertion and removal techniques. The technician then schedules the patient for a follow-up visit for the next week and instructs her to call, should she experience any lens-related problems.

The next day, the technician calls the patient to check in on her progress. In the patient's mind, the technician went above and beyond the call of duty by phoning her. This type of outstanding customer service becomes a vitally important competitive advantage that results in patient loyalty and word-of-mouth referrals of new patients.

To ingrain the outstanding customer service mentality in your staff, explain to them that in order for the practice to grow, prosper and succeed, which in turn will help them to grow, prosper and succeed, the practice must attract and retain patients and set itself apart from other local practices through its customer service. Then explain how, specifically — both verbally and with a sheet of paper — they should handle certain staff-patient encounters, such as patient check-in, to achieve outstanding customer service.

Finally, invite staff to keep a running log of staff-patient encounters not yet listed and their ideas for how to handle them, so the patient continues to experience your unparalleled customer service.

2 Delegate

To create a high-grossing staff, you must break away from your "do-everything" roots. The primary reason: You can't achieve the type of productivity and efficiency needed to become a high-grossing practice unless everyone is working at their highest level. Your highest level is developing the vision for practice growth and performing high-level eyecare procedures, such as assessing the risk for age-related macular degeneration. You can't do this if you're imputing patient data into your EHR, for example.

I realize that delegation is easier said than done, as trust and the need for control play roles in your ability to become mentally comfortable with the process.

To establish trust in your staff's ability to do what you've been doing, train them to perform the task to your specifications, and establish checks and balances as a means of retaining control.

The Role of The Office Manager
Because patient care and staff training, among other duties, consumes your job as optometrist and practice owner, you don't have the time needed to effectively "mind the store." As a result, you'll likely miss, for example, the opportunity to quickly correct a staff member regarding a patient encounter gone wrong. This, in turn, could lead to future poor encounters and possibly the loss of patients and referrals. The office manager is a crucial piece of the high-grossing staff because you need someone who can supervise on a day-to-day basis that your staff is performing up to your standards.
Train the office manager to train others. She should share your vision to always provide legendary customer service and to that end, observe staff/patient interactions and continuously correct deficiencies.
Educate this individual, in no uncertain terms, that she owes her strongest allegiance to the practice and practice owners, and, that as a result, she must avoid close friendships with staff members. Good office managers are caring and sensitive to employees (the counselor and peacekeeper), but they know their boundaries.
Simply hiring an office manager, however, isn't enough to ensure success. You have to give her the authority and responsibility to do the job. To do this, introduce this individual to your employees as the "go-to" person for any questions, concerns or problems. This action makes the line of authority very clear.

For instance, if you'd like to delegate visual acuity testing, show your staff how to do it, have them practice on each other before performing the test on patients, and check that they're obtaining accurate results.

To achieve comfort when delegating administrative tasks, retain a distant supervising role. For instance, should you decide to allow one of your staff members to make bank deposits, have that staff member leave the receipt for you. (See "The Role of The Office Manager," below.)

The trick to delegating: Start with what you deem as "the little things," and work your way up as you achieve trust and maintain a comfortable level of control.

3 Foster a positive practice culture

You create staff attitude — which influences your bottom line — with your practice culture. This is a set of unwritten rules that employees learn while working for you. A positive practice culture develops through time, and you're its biggest influencing factor. This is because in being the natural leader of the organization, your core beliefs and behaviors typically dictate the culture.

For example, if you truly respect and care about your employees, they'll truly respect and care about you. Staff doesn't just want to be financially compensated for their hard work, they want to be emotionally compensated by you. This requires you, through your actions in the practice and verbally, to make them feel that their job is important and that you appreciate their work. (If you think that employees don't leave a "good-paying" job for one that offers emotional validation, you're fooling yourself.) You and your office manager should offer sincere praise to your staff, as this can go a long way toward improving performance and attitude — both of which will turn your staff into a high-grossing one.

Another example: If you believe customer service is paramount and that the customer (patient) is always right, your employees will become comfortable with that mentality as well.

Often, the root cause of an undesirable practice culture is simply that the doctor/owner doesn't make the time to pay attention to the details that can adversely affect outstanding customer service, such as a poor attitude, and rectify them. In some cases, however, the O.D.s personality and business philosophy play a role.

For example, if you reveal your inner feelings of anger, frustration and annoyance with staff or patients, you're hurting the financial health of your practice and therefore, impeding your staff from becoming a high-grossing one more than you realize. This is because your staff members will mirror those emotions and carry them into their own situations with their fellow staff members and patients. Similarly, if you don't play by the rules with health insurance companies or corporate vendors, don't be surprised if your employees exhibit the same less-than honorable behavior.

If you believe customer service is paramount, your employees will become comfortable with that mentality as well.

Once a positive practice culture is in place, staff training occurs naturally and continuously. Employees who take pride in their work and their job apply slight peer pressure when a co-worker steps beyond the bounds of what you expect. Senior staff members typically step up to this role, but even employees with short terms of service who have a strong sense of confidence, ambition and what is right are willing to help their fellow employees. This is the best training in the world because it occurs with respect and support. Your office manager facilitates the effort by expecting consistently high standards.

4 Provide proper preparation and training

New staff members typically have orientation meetings on the first workday with the office manager about day-to-day procedures, such as readying the diagnostic equipment, and separately with you about your organized practice culture (technical excellence and a passion for great service).

Have your office manager provide a copy of the office manual to the employee, and make sure she explains that it's constantly evolving. Also, have this person give the new hire a small notebook so she can take notes as she learns, and assign a senior staff member to act as a mentor.

Typically, the new employee shadows the senior staffer for about one week. During this time, the new staff member should practice patient-care procedures, such as visual acuity testing, on co-workers, as time permits. During the second week of training, the new hire should perform patient–care procedures, among other duties, while her senior staff mentor observes.

The new hire should have a senior staff member mentor and a notebook, so she can take notes as she learns.

As the old proverb goes, "the weakest link in the chain is also the strongest." Translation: If you don't provide a new employee with the proper preparation and training, she can inflict harm that could easily cancel out all the good the rest of your staff has done. The outcome: Lost revenue, hindering your staff's ability to become a high-grossing one.

5 Hold staff meetings

Use weekly, one-hour staff meetings to discuss practice issues. An example: In reviewing the paper work from the last week, you've noticed that a large number of patients who purchased their spectacles from your practice are returning to have their glasses re-made. Upon further analysis, you discover that this problem has occurred because some of your staff members are incorrectly measuring the seg height. To rectify this problem, you decide that this week's staff meeting will focus on seg-height re-training.

Make sure these meetings are weekly, so you can quickly resolve a problem or improve upon a circumstance that you, your office manager and other staff members observed in the prior week. I choose to hold staff meetings for no longer than an hour, so I can spend one half hour with my business staff and the other with the clinical staff. I've discovered that this amount of time is usually enough to discuss any problems that may have arose during the previous week.

Staff meetings are the perfect forum to discuss in-practice problems and pose questions because you have the input of the entire group to decide on the best course of action. In addition, clearing up practice issues fast not only ensures your practice continues to run smoothly, but satisfies your employees and affords you the opportunity to make staff improvements and changes that may set you apart from other practices in your neighborhood. This, in turn, may attract new patients and referrals taking your practice to the financially elite level.

Schedule some staff meetings as in-service training sessions that focus on specific clinical, optical or administrative topics, so you can streamline the operation of your practice. To do this, have a veteran staff member give the in-service presentation, which may include printed handouts and hands-on practice. An example of an in-training session: Sales techniques applied to optical dispensing.

6 Discuss personal price/value bias

Some employees have an aversion to presenting products, such as high-end eyewear, that they themselves wouldn't be willing to pay for in the marketplace. Others, meanwhile, pre-judge the patient's financial ability by assessing his clothing or the car he drives. As a result of these attitudes, the staff member avoids recommending the best products and services. I call this "personal price/value bias." This can be a huge obstruction to creating the high-grossing staff.

To ensure that your employees don't do this, openly discuss it at a staff meeting. Begin by reminding them that in any industry or professional field, a wide range of prices is typically available, which should relate to the level of quality of a product or service. An example to provide: high-end and low-end restaurants.

Then, explain that all patients want their eyecare provider and his staff to offer them the best, without judging whether they can afford it because it shows them that the practice keeps abreast of the latest technology, and, therefore, has the ability to provide the best care.

From there, say: "When you decide not to offer a product because you think it's too expensive or you presume to know how another person wishes to spend his money, you may not only be doing a disservice to the patient, who may have benefited from the product, but the practice as well. This is because if the patient hears about the service or product elsewhere, even if he couldn't afford it, he's going to assume our practice doesn't provide the best care, and we could lose him to another O.D."

Optometrists who educate their employees about the pitfalls of "personal price/value bias" have a high-grossing staff.

7 Don't rely on bonuses and incentives

I understand the logic behind staff bonuses and incentives. By rewarding desired behavior and specific goals, you infer that employees will naturally want to comply. This, in turn — many of you reason — will afford you a way of being released from the increasing burden of management, as the employees will align their behavior with your goals and effectively "manage themselves."

Although many high-grossing practices offer staff-bonus and incentive programs, I don't think they deserve nearly the credit most practice owners give them for increasing practice revenue because they don't always work.

In many cases, staff bonuses and incentives won't fully accomplish aligning a staff ‘s behavior with your goals because other factors, such as emotional validation, motivate employees. In addition, I've discovered that these programs can easily become expected regardless of job performance. In the worst case, they can create a negative organizational culture that breeds employee competition, abuses patient trust and schemes to bypass the rules. So, you may actually inadvertently stimulate the wrong behavior by offering staff bonuses and incentives.

If you already have a staff bonus and incentive program in place and it appears to be working, great. Just don't expect it to do the managing for you.

As, with champions, a true high-grossing staff is made, not born. Follow these seven tips, and you may soon find yourself in the company of the aforementioned financially elite optometric practices. OM

Dr. Gailmard is in private group practice at Gailmard Eye Center in Munster, Ind. and he is president of Gailmard Consulting, based in Nokomis, Florida. E-mail him at

Optometric Management, Issue: July 2008