Article Date: 1/1/2007

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 have proven.

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?   

You 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. 

Networking 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.

4. 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."

5. Educate patients

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.

6. 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?

7. 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 

enthusiastic 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 health.

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 paid.

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.

Dr. 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