Run with the Leaders
7 essential steps
for the high-performance practice
BY BOB LEVOY O.D., Roslyn, N.Y.
A high-performance practice is defined as having:
above-average patient satisfaction, patient loyalty and referrals; above-average
practice productivity, profitability and growth and above average staff motivation
and loyalty. That's a tall order, but it's definitely doable, as countless O.D.s
Here are seven ways you can achieve a high-performance practice:
1. Engage in long-range strategic planning
Strategic planning is the fundamental process by which an organization
determines specific steps to achieve its future goals. It's the map that guides
your activities on the way to your destination by identifying what each individual
needs to do, with what resources and by what date. Strategic planning allows an
organization as a whole to focus on the right priorities and activities to accomplish
its goals and is one of the key manage- ment activities that allows an organization
to proactively manage its growth.
To begin your strategic planning, decide where you and your
practice are at the moment, where you're headed, where you'll be a year or two from
now and how you'll get there. Will the focus of your practice be the same? Will
the priorities be the same? Will you be serving the same patient base or entirely
different segments of the population? Will you continue to offer the same mix of
services or shift gears or add more? Will your practice be dominated by vision plans,
or will you opt out of some (or all) of them?
Your answers to such questions influence everything in your practice
starting with what you do and how you do it; the kinds of patients you attract,
your standards for quality and service, the location of your practice, your fees,
equipment, continuing education, staff, practice promotions, the pace of the practice,
the overhead and on and on. Choose your strategy carefully. There's no point in rowing har-der if you're
rowing in the wrong direction.
2. Offer something different than average practices
Offering something unique gives you a competitive advantage. If
what you're doing in your practice is no better or different (or perceived to be
no better or different by patients) than what other practices do, then what incentive
do patients have to be in your practice especially if comparable services
(or again, what's perceived as comparable services by patients) are available elsewhere,
at lower fees?
can differentiate your practice in numerous ways. You may want to start by developing
a niche specialty, such as corneal refractive therapy, computer vision care, ocular
disease care and management, sports vision, vision therapy or a specialty design
contact lens practice, among others.
Adopting a specialty can also help you uncover new treatments
for your existing patient base. "By incorporating computer vision syndrome testing
into our comprehensive exam," says Phil Smith, O.D., of San Diego, "we are uncovering
a large number of patients whose symptoms can be easily minimized or eliminated
with a pair of computer-specific eyeglasses," he says. "Providing superior computer
vision care has resulted in some of our most satisfied patients and our greatest
number of referrals."
3. Excel at networking
"What's the worst thing you can say
about another doctor?" asks otolaryngologist/allergist Martin H. Zwerling, M.D.,
of Aiken, S.C. "That he's incompetent, lazy, dishonest? No the worst thing
you can say is, 'I never heard of him.'
Building your practice, means developing effective relationships
with your colleagues in the community," he says.
is one means of developing working relationships with colleagues and other healthcare
practitioners. It often leads to the sharing of information and reciprocal referrals.
Potential sources include primary-care physicians, ophthalmologists, other optometrists,
neurologists, pediatricians, plastic surgeons, pharmacists, psychologists, athletic
coaches, occupational therapists, hospital emergency room personnel, school nurses
and teachers among others.
A networking avenue to consider: Oculoplastic comanagement. This
may prove to be lu- crative for optometry as more types of surgeons branch into
eyelid surgery, says Eric Schmidt, O.D., of Elizabethtown, N.C. "You'll get involved
with not only oculoplastic surgeons, but the regular plastic surgeons, some oral
surgeons and maxillofacial surgeons. Most of them don't have visual field instruments,
so the patients will end up paying full-fee for the surgery," he says. "You can
inform these doctors that the patient may be able to get insurance to cover a portion
of the surgery by having a visual field test done to prove that the blepharoplasty
will improve his field of vision and hence, improve his lifestyle. This is an avenue
to increase referrals to the optometrist's practice."
You can jump-start the networking process in numerous ways,
such as sending exam reports to teachers, school nurses, principals, pediatricians,
allergists, psychologists, physical or occupational therapists says Anne Barber,
O.D., from Fullerton, California." Be sure to send a copy of the report to the patient/parents,"
she adds. "In addition to providing information about their patient/student, this
also introduces many of these professionals to behavioral vision care. Even though
many will not refer patients, it lays the groundwork for personal communication.
And sometimes," Dr. Bar- ber says, "After many reports, a pediatrician comes across
a case that does get referred to you. Never give up communicating what you do."
Low vision specialist Randall T. Jose, O.D., F.A.A.O., of Houston,
offers an example, "[Don't just contact] retinal specialists, but once you have
their interest, bring in lunch for the staff, and spend 30 minutes with them describing
the type of patients who will most benefit from low-vision services."
Networking is not a quick fix for an ailing practice or shortage
of patients. Relationships require nurturing and a long-term outlook, it's more
like farming than manufacturing.
Set a realistic fee structure
It's no secret that overhead costs in optometric offices are on
a steady rise. You need to set realistic fees that enable you to pay a top-notch
staff excellent wages, have state-of-the-art equipment and a first-rate office,
spend quality time with each patient and not feel pressured to overbook yourself,
and in the final analysis, generate a reasonable profit.
Charge private-pay patients for what you do based on your overhead,
time and expertise especially your expertise. "Clinical expertise," says
Jack Schaeffer, O.D., of Birmingham, Ala., "is the most significant income-producing
asset in your practice."
"Many optometrists are reluctant to raise their fees, fearing
patient loss," says Dwight H. Akerman, O.D., director, professional programs at
CIBA Vision. "However surveys of vision-care patients that ask about reasons for
selecting an eye doctor or about reasons for switching eye doctors consistently
reveal that few patients cite fees as an important influence on that decision."
He adds, "If low fees attracted patients and high fees scared
them away, then there would not be any large practices with high fees. Clearly,
that is not the case."
Nothing happens in optometry until the patient says "yes." And
patient education holds the key to achieving that "yes." The more educated patients
are, the more they comply with home-care instructions. And, the more they'll say
"yes" to periodic comprehensive exams, refractive sur-gery, vision therapy, silicone
hy- drogel contact lenses, prescription lenses for occupational and vocational purposes,
premium lens options, etc.
"Take the time to teach," says Joseph T. Barr, O.D., and Timothy
B. Edrington, O.D., editor and contributing editor respectively of Contact Lens
Spectrum (a sister publication of OM). "With contact lens consumerism at an all-time
high (or low, depending on your perspective), it's critical for you and your staff
to make a greater effort in educating your patients about eyecare and eyewear options.
If you don't, your competition will."
"Education is the key to sunglass success for contact lens
patients," says Sheila Wood, O.D., of Washington, D.C., who estimates that 65 to
75% of her contact lens patients have purchased sunwear from the practice.
Utilize marketing research and patient feedback
Achieving patient satisfaction and practice growth without feedback
is like trying to learn target shooting with a blindfold. It can't be done.
You can get patient feedback in numerous ways. A patient survey
with just one question is an example. An outpatient survey from the Williamsport
Hospital in Williamsport, Pa. asks, "Have you used the Williamsport Hospital Services
before? If yes, has the quality of the services improved, remained the same, or
declined?" How would your returning patients answer such a survey?
Master the techniques of hiring, managing and retaining great employees
The hiring of employees is the single, most important management
task you do. A staff that is knowledgeable, efficient and
about their jobs can literally make the difference between a failing practice and
one that is successful in all aspects from the quality of patient care to its financial
Keeping staff motivated, however, is the next, all-important challenge.
The law of individual differences states that no two people are alike. They have
different needs, different skills, different attitudes and different mo- tivational
triggers. There's no one management style that works across the board; no pat answers.
What works with one employee may have a negative effect on another.
For some employees, having the authority to purchase materials
for the dispensary, make decisions or manage others can be extremely satisfying.
But it's not for everyone. Some employees don't want responsibility, leadership
or risk. The fact is: They'd rather be told what to do.
Optometrists who are aware of these varied needs better understand
the seemingly contradictory behavior of a newly hired, bright, energetic, ambitious
person who loses interest in her work and perhaps quits, even though she is well
One of the many ways to identify employees' job-related needs
is to simply ask them. Put the questions in writing. Give employees time to think
about their answers, perhaps discuss their responses with someone else. Explain
also, that if she'd like to do so, you'll schedule a one-on-one conference to discuss
the results. Such questions might include:
What part of your job do you like best and why?
Are there additional things you would like to be doing?
What (if anything) frustrates you about your job?
What (if anything) would you change about your job to help
you get more of what you want from your work?
Job satisfaction is as unique to each of us as our fingerprints.
One employee wants autonomy, and another craves recognition. Others want a promotion
or work/life balance.
The more you can identify and address the job-related needs of
your employees, the more prone they'll be to engage in what psychologists call motivated
behavior. And the longer they'll stick around.
Building a high-performance organization requires a special blend
of leadership, strategy and teamwork. Remember: The rec-ipe for success is different
for every practice, but the ingredients are much the same.
Levoy's newest book, 222 Secrets
of Hiring, Managing and Retaining Great Employees in Healthcare Practice, is now
available. For details, visit
Optometric Management, Issue: January 2007