Article Date: 9/1/2004

fix this practice
For the Good of the Office
Are you enabling bad conduct in your office? Drop everything and read this.
By Richard S. Kattouf, O.D.

Q As an optometrist and part owner of an O.D./M.D. practice, I have a staffing problem. I feel that my staff (especially the technicians) hold us hostage because their knowledge is so expansive that they're difficult to replace. They resist any change, refuse to be team players and don't adhere to standard operating procedures. I'd appreciate any solutions or suggestions .

Dr. S. W. Swartz, Via e-mail

A: Part of the problem with the "hostage syndrome" is that you, as an owner/manager, enable certain employees or departments to behave in such a manner. But in this role, you can manage in two ways:

1. Manage from the bottom up. Examples of this form of management are the staff and/or department structuring, organizing, internally policing and developing consequences to improper behavior. You can accomplish this by scheduling weekly organizational meetings to ensure that the staffers are acting as their own "state patrolman." The employees make sure that tardiness, no use of cell phones during work hours, attention to detail, increased patient flow and implementation of positive change are all taking place.

If the above technique of management is unsuccessful, then ownership has no recourse but to:

2. Manage from the top down.

For lack of a better term, this is more of an autocratic form of management. (The first form is more democratic in nature.)

In essence, you can give your staff the choice of managing themselves or having you manage them. I've seen both systems work successfully. The top-down approach gets the best results with strong leadership. With this method, the owners/managers set tight boundaries with specific consequences without exceptions for breaking the rules.

A bad situation

A group of three O.D./M.D. offices called me: Highly trained ophthalmic techs felt they were above the other work family members. This "sorority" of staffers challenged the ownership in areas of scheduling, vacations, sick days and embezzlement of time. They worked at their own pace -- many times at the expense of keeping patients waiting -- while they huddled together to talk about social issues or to spend time on their cell phones on personal calls. The front office, opticians and insurance coordinators resented this clique because of their arrogant behavior.

The owner/manager must take responsibility for keeping behavioral patterns in line.

Strengthening the practices

I taught the owner(s) of these offices to manage from the bottom up as well as from the top down. The ownership attempted the bottom-up method, but the staff was unable to police themselves. I then implemented the top-down method. I warned ownership that this new approach would identify the "anchor(s)" of the group (the person[s] who holds back the group).

A strong personality attempted to anchor and sabotage our new methods of managing. I personally counseled this individual by telephone and e-mail once I got authority to do so from the owners. I defined what the practice expected of her and placed her on probation for two weeks. She continued to be defiant and we terminated her. In anticipation of a review from the employment agencies, we had also kept an extensive file on this person that detailed all of the facts.

By terminating her and not deviating from the standard operating procedures, the top-down system had sent a definite message and brought the entire team into proper bounds of behavior.

It all relates

The profit margins are smaller in today's ophthalmic market. This is why we need strict management techniques. Stand your ground and you'll benefit from higher profits and reduced stress.

Dr. Kattouf is president and founder of two management and consulting companies.  For information, call (800) 745-EYES or e-mail him at The information in this column is based on actual consulting files.


Optometric Management, Issue: September 2004