Article Date: 9/1/2001

Regaining Control
See how these two O.D.s set boundaries to foster a better relationship with patients and staff.
By Richard S. Kattouf, O.D.

Q I've heard you lecture and have read some articles on staff control and setting staff boundaries. In my opinion, many patients in today's market are also out of control. Can you address this issue?

Dr. T. L. Cameron via e-mail

A: Optometrists need to set boundaries for both staff and patients. Think of it like raising children. If children don't have structure and boundaries, they'll walk all over you. The same applies with staff and patients. So focus on the following three principles when dealing with them:

1. structure
2. organization
3. discipline.

This month, I'll explain how to set boundaries for both groups in as much detail as space permits.

Out of control

Dr. C. K. Lilly had significant financial problems. The root of all his problems had to do with staff control. Dr. Lilly lacked the state patrolman concept, and so his staffers lacked boundaries, some were embezzling product, time and money and others often came in late to work and abused lunch hours. They also used the phone excessively for personal calls and there was no sign of team effort.

Dr. Lilly's staffers weren't at all income producers; in fact, the percent of salaries to gross was 24%, which is 7% more than the norm for his state. Dr. Lilly's own net income was 18%, which is 20% less than what my company projects its clients to achieve. So did all of these problems "just happen," or did Dr. Lilly allow them to occur?

Too easy-going

Dr. Lilly wanted the practice to manage itself while he tended to his patients, but it was in disarray because it lacked standard operating procedures. No staffer had ever seen the office manual, and it took Dr. Lilly 30 minutes to even find it.

Dr. Lilly and I evaluated each staff member, and I recommended some position shifting among them based on each individual's talent. Dr. Lilly replaced three of the seven original staff members because of their embezzlement.

Some welcome changes

The practice was busy, so putting the entire management responsibility on Dr. Lilly's shoulders was inappropriate. On the advice of my consulting company, Dr. Lilly also hired a business manager, who implemented mandatory daily organizational meetings and weekly training sessions. Dr. Lilly and I dusted off the office manual and amended certain sections to reflect the new order and boundaries. A system of checks and balances was also put into effect to prevent all forms of embezzlement.

He and the manager monitored the staff day-to-day with regard to the new boundaries. The manager's $40,000 salary was offset because each staffer was now learning to become an income-producer. The problem of income loss from embezzlement disappeared, which increased staff production and made the manager's salary affordable. Setting achievable monthly financial targets instantly created a team effort. Staff members earned significant commissions when they met their targets.

Once the boundaries and policies were in place and the office was running smoothly, Dr. Lilly felt much less stress, and his net income increased by 20% in
1 1/2 years. Plus, percent of salaries to gross leveled off at 18% after only 1 year.

The problem with patients

Many modern consumers are unreasonable in their demands on doctors and businesses. The old adage that "the patient is always right" isn't always true in our crazy, modern marketplace. Many consumers want professional services now but they expect us to accept payment later. They don't realize that we must pay rent, office help and lab bills on time.

Notify patients of your boundaries by using forms, scripts and plaques that make it clear exactly what all your policies are prior to any objections from patients.

Setting patient boundaries

Dr. R. Lawson had poor cash flow, high staff turnover and low staff morale. His staff told me that they were constantly being verbally attacked by patients about various money and product issues.

Dr. Lawson allowed his patients to receive professional services and pick up materials but be billed later. At times, he'd set unwritten boundaries for his staff to follow regarding fee collection, but he was the first person to break his policies.

Dr. Lawson was afraid that he'd experience erosion if he set and maintained boundaries for his patients, but I assured him that his fears were unwarranted. My company developed a mail-out to each family of patients explaining the new payment policies in the practice and the reason for the changes.

From my experience, I've learned that typically, 80% of patients will follow a new policy without a peep, and about 20% will complain about the changes. The end result in this case was a normalization of cash flow and a stabilization of staff members with high morale.

Stick to your guns

As a professional, you can't operate under fear of what your patients and staff will do because it'll consume you and will make you miserable in practice. Combat your fear and prevent disorder at the same time by setting a code of conduct for your staff and your patients. Most importantly, stick to your rules. Enjoy your profession by controlling your practice rather than letting it control you.


Optometric Management, Issue: September 2001