Practice Management begins in the Exam Room

To effectively run an eye care practice, many active processes, run by a variety of people have to be coordinated and constantly honed.  It is important to avoid duplication and contradiction in the process.  From Scheduling to Check-in, from Pre-Testing to Exam Room; from Contact Lenses to Optical and to Check-out.  It all has to work together.
Not to mention all the work to be done after the patient leaves to order product and to get paid.  

Where do you start?
Most practices have a set of processes that “evolve” over time.  As times change and as our practices grow, we make changes to our processes.  Sometimes a new employee comes along who “does it a little differently.” Inevitably, these small changes lead to problems in other zones because it is all connected.  In reaction, adjustments are made or breakdowns occur.  

Decrease Variation (starting in the exam room)
There are a multitude of vision tests that can be done to help us with our diagnosis and treatment plan for any given patient.  Some of these tests are typically performed by doctors, others can be delegated to staff members. All variations in technique decrease your efficiency in the exam room method.  

Some examples of exam technique variation are: 

• Stereo testing on all patients under 17

• Applanation tonometry if over 50

• Pinhole if VA less than 20/60

• Color Vision on all boys - new patients - under 10(*)

All rules of variation are put in for good, logical reasons.  The problem is that we keep adding variations without fully considering the impact on the entire exam flow.  This leads to inconsistencies and discombobulation that spills into every aspect of the practice.

There is a good argument for not performing stereo on an 84 year old, one-eyed, exotrope, (**) but I would like for you to consider the benefits of keeping the test in the routine for the sake of decreased variation.  This is an excellent exercise that should be completed by the entire team periodically to continuously refine the exam process.  

Consider your scheduling methods.  How much time is spent trying to match a particular type of patient with the corresponding slot in the schedule?  Do you instruct your team to schedule “older patients” earlier in the day because they take longer? (“Besides, they like to get up early.”)  

Consider pre-testing technique.  We all recognize that kids, contact lens wearers, glaucoma suspects, presbyopes, cataract survivors and esophores all have different needs.  But many of our patients fit into multiple categories…..then what? Sometimes more time is spent trying to decide if you need to do topography, then just doing topography.  

Consider exam room technique.  The advent of EHR has made the idea of an exam room scribe become the norm.  By always doing the same tests, in the same order makes it easier and quicker for your in-room support.  Not to mention - more accurate. Develop a system so everyone knows what everyone else is going to do.  

This is just the beginning.  
You can see where the decreased variation helps the exam flow better.  You can also see how it bleeds into other areas of the practice. After the Patient Care zone is addressed to your satisfaction - move to the Front of the House.  

(*Three variations in one)
(**I recognize that you can’t be “one-eyed” (aka monocular) AND an “exotrope” - but sometimes you just have to write things that make your point. Just imagine her prosthetic is misaligned.)

Will you just shut up?

I like to talk.  

Sometimes I find myself talking about things that nobody cares about but me.  It is not unusual for me to be in the middle of a riveting explanation only to realize that friendly face is looking back at me with a completely blank stare.

I am not the only one.

Most optometrists talk too much.  We do this out of a desire to better serve our patients in three different ways:

1. We want them to know everything they “need” to know about their condition.  

2. We want them to know all of the options that can treat this condition.  

3. Most of all, we want them know how smart we are.  

What do our patients need to know?  

I heard a leadership consultant recently present on being more effective in meetings.  My favorite point that he made was to “tell them what they need to know - not everything that you know.”  The reason most meetings are unbearable is that we give our report then why we are reporting and how we know the information that is in the report.

Similarly, there is an art to educating your patients without over-educating them.  I recommend practicing this art by limiting what you tell them to what they need to know. Then asking if they have questions.  

If your patients never have questions, you are over-educating.

Which choice do they “like” best?

Almost every condition comes with treatment options.  It is a slippery slope when you start offering your patients all of the available choices to remedy their condition.  From vision correction to prescription medications to therapy solutions - it is our job to offer what we derive as a single, best option for this person.

Without getting wrapped up in the difference between “recommending” and “prescribing,” become diligent in offering one best solution for each patient’s unique situation.  To make strong choices for your patients, you need to use the clinical findings AND what you know about the patient as a person.

And to know who the patient, you have to LISTEN.

Like us, most patients like talking about themselves.  

They don’t like answering a bunch of health questions about every condition ever known, but they do like talking about their lives.  They like talking about hobbies, kids, work and sports. Getting a patient to talk about what they love is both easy and gives you a lot of information about how they use their eyes.  (It also makes them like you.)

Ask open ended questions about how they spend their day.  When they answer, say “Wow, that sounds really neat.”  And ask another question.  If you will listen instead of thinking about your next question, you will be better able to make strong recommendations before you know it.  

Patients know you’re smart, they just want to know you care.   You can show them you care by showing that you hear them.

Let us hear from you: How do you make sure your patients know that you are listening to them?  

Easy is Better Than Good.

This news article really caught my eye. 
 
Pizza Hut has been losing business to Domino’s in the last year.  The new CEO sends the management team on a retreat to clearly define their vision and create a clear brand identity.  The result:  Pizza Hut has put so much energy into being "better," they have fallen behind in making it "easier." 

Have you seen the recent tv ads for Domino’s?  They hardly mention the product they sell.  The focus of the ad is on the many ways you can place an order from Domino’s – so easy!  Is it any good?  Who cares – it’s easy. 

Pizza Hut is losing ground to its competitor and is being forced to react and play catch up.  It will be interesting to see what happens next in the Pizza Wars.
 

The Lesson for Us

The motto for my practice has always been “Quality Eye Care You Can Trust.”  Like many of you, I have always strived to be better.  Should we be worried that our competitors are finding ways to make it easy?  Are we willing to sacrifice the quality of care we provide so it can be easy?  If we don’t make it easier for our patients, who will?

Some areas of our practices that could be “easier”:

• Contact Lens Fits– If you are still insisting that your patients return in 1 week to evaluate the fit of a daily disposable lens before you finalize the prescription – you are not being easy.

• Contact Lens Dispensing – We mail almost all contacts to patients’ homes. We tried mailing to the workplace...too much trouble.

• Eye Wear Turnaround Time – It is not acceptable to tell people buying eye wear from us that they need to wait two weeks. The “specialized, high tech” argument is no good.

• Available Appointments – Our target is to be booked at 80%, not 100%, to always have some openings today.

• Appointments – I am not ready for this, but someone is going to solve the problem of needing appointments for eye care. Why can’t I go when I am ready?

• Wait Time in the Office – From the time they walk in for an exam, if your patients aren’t shopping for eye wear in 30 minutes, you have room to improve.

• WiFi Available – Give it to your patients. You can do it safely without a password.

• Easier / Faster “Paperwork” – that feeds into the patient record – We have to collect a lot of information that we need to give a complete eye exam. Ask it once and make it easy to answer.

• Online Scheduling that’s easy – I can book a trip to San Diego in January, with hotel and rental car, easier than I can schedule an exam at most optometry offices.

• Online Information – We need to be the “go to” when people have questions about their eyes. Easy to find, easy to read and easy to get help.

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Greg Creed is the CEO of Yum! Brands, the parent company of Pizza Hut.  He is the one who locked the Pizza Hut executives in a room until they figured it out.  Creed, no relation to the famous boxing dynasty, has a leadership style that I like a lot. 

When the facts show that his company is losing ground to the competition, he faces the facts and is not afraid to admit the weaknesses of his company.  I don’t know what this means for Pizza Hut, but I am interested to see how they change their tone.

Creed is also responsible for Taco Bell’s “Think Outside the Bun”campaign.  

-Mike