When a staff member is not following office guidelines, as the CEO and staff manager, I believe having protocols in place for consistently and fairly restating expectations is important.
For example, we have a staff tattoo policy that addresses how tattoos can (or can’t) be displayed for patients. Neither I nor Dr. Yarrow, the other owner, have any issues with tattoos. However, we know many of our patients may view tattoos as unprofessional. Based on this, we have implemented a policy that all tattoos should be covered during office hours when patients are present. I have been surprised at how positive the staff have been about this policy, and how much they have appreciated the guidelines.
So what happens when some staff members consistently forget to cover their tattoos?
As the staff managers we cannot assume the worst of our staff, we must assume that a staff member who does not have his or her tattoos covered is probably busy working and simply forgot. To easily solve this, open up your employment manual and export the page that references tattoos. Then communicate to your staff member with a kind email stating:
“As I have observed you working so very hard at the front desk taking care of patients, I would have to assume that your efforts in complying with office guidelines is just a mental slip up. For your review, I have attached a page from the employment manual for your review. Thank you in advance for reviewing.”
Attach the exported page from the employment manual and send it to the staff member with the above message.
For the majority of staff this simple piece of communication should resolve the problem for a while. Staff members are human and they will probably forget again at a later date. If the later date is months down the road don’t worry, this is part of managing people. Send another reminder.
If the staff member continues with non-compliance, there may be a bigger issue that requires a face-to-face discussion. You then need to have that Crucial Confrontation.
One of my favorite podcasts is ManagerTools. I enjoy hearing the two experts’ ideas about effectively leading and managing employees in a small business.
After years of listening, I recall most strongly their assertion that managing is not for everyone. I feel that is why so many optometrists struggle with leading their staff.
Most practices are too small to afford a highly-compensated office manager, so, like everything else, the task of training lands in the lap of the optometrist.
Unfortunately, when this happens “managing” is merely a term used to denote a hierarchy of leadership. Actual training is not being done. For the optometrist wanting to improve patient care, investing in training is a great place to start, and it can even improve office morale in the process. Here is how to start:
Began by deciding who should attend – In a small office with five or fewer hourly employees, the meetings should include everyone and the doctor. Larger offices may need to divide into teams and schedule different times, like over the lunch hour or right after closing are two possibilities. Our office uses three different teams: dispensary, front desk/insurance, and doctor’s assistants.
Determine the topics to be discussed. – This will be based on who is present and what areas you identify as being weak. Topics like first impressions, phone call etiquette, job description review, employment manual review, and job expectations are all good places to start.
Schedule a time convenient for all doctors and staff. – This can be done easily with an online scheduling site called Doodle. It’s free and you can do away with annoying multiple emails as you all try to find a workable time.
Create an agenda – Start by making a list of everything you notice during the day that does not run smoothly. Observe your staff members interacting with patients and determine what areas need to be improved. Then develop your plan for training. Don’t forget to search YouTube for training videos in areas you would like improvement. Many customer service companies have videos on YouTube.
Show up to the meeting – Sending reminders to your staff members a day in advance reminds them of the additional meeting. Reminders are also a great way to start the team building.
Lead the meeting. – The meeting should be relaxed and allow for open discussion. Remember, you would like to not only train but allow your staff to present the areas they have noticed that could be improved.
In order to walk a thousand miles you must begin with the first step. Training your staff is the first step to reaching the fullest potential in patient care. As noted by the experts on ManagerTools, being a manager is one of the most boring jobs in a company because it requires someone to repeat the same process over and over. Management is repetitive, but it extremely important to the success of an optometry practice.
The ease of selling a product is inversely proportional to the cost of the product. If a patient at your practice wants to buy a bottle of ophthalmic lens cleaner, no one is concerned whether the individual can pay for the $5 bottle. However, if a patient is buying three pairs of sunglasses with all the additions, some may be concerned about the patient’s ability to pay for the total bill.
Now let’s take that to extremes and look at a potential buyer of your optometry practice. Most optometrists who own a practice assume when they are ready to sell, a qualified buyer will come along and buy it. Think again. Buyers are having more and more difficulties putting together resources to purchase a practice, and the larger the practice the harder it is. And even if someone can buy the practice, will he or she be able to manage the financing for you to receive the payoff?
When you are ready to sell, ask yourself these three questions about any potential buyer.
Is his or her financing complete? – Many practice sales have dissolved due to the inability of the buyer to get financing. If a buyer can only come up with 80 percent of the financing, you may consider financing the remainder. Please do remember that if you do this the financing agency (i.e.- bank) will get paid in full before you do.
What is the buyer’s lifestyle? – Look at the history of the buyer and and his or her credit rating. Have loans been paid back? Has a school loan ever gone into default? Does his or her taste of vehicles, housing, and vacations indicate being highly leveraged? If so, you may consider clicking “next” on the buyers page.
What kinds of relationships does the buyer have outside of the practice? – This directly relates to an associate OD that you are considering going into partnership with to buy your practice out. A friend of mine once said, “The most common theme about an individual who has multiple divorces is that individual.” Before agreeing to financially “marry” a potential buyer, remember that the integrity of an individual outside of the office is directly related to integrity inside the office.
Many sellers are so excited at the prospect of selling their practice that they overlook various red flags in the process. This is why all optometrists looking to sell their stock in the corporation should begin the process at least three to five years prior to exiting. Don’t assume your practice will be sold and you will receive all your finances from the practice. Start early for the best chance of finding a reliable buyer.
Have you ever given all your staff members bonuses, and then wondered why it seemed to make no impact on their loyalty or productivity? Did only a few even thank you for their bonus?
Contrary to popular belief, the number one reason good staff members leave a practice is not for more money. Numerous experts have determined the main reason good people leave is they do not feel appreciated.
At work, people express and receive appreciation in different ways. If you try to express appreciation in ways that aren’t meaningful to your staff members, they may not feel valued at all. This is because you and your staff members are speaking different languages.
The list of appreciation languages below are from their book. Take the time to discover the languages of your staff members and review their language of affirmation. This tool can help you start communicating to your staff in a language they understand.
Words of Affirmation – Spend concentrated time on these staff members by sending simple thank you notes or stopping them in the hall to just say “thank you.” People who respond to Words of Affirmation know they are important when they are told exactly that. If you notice they did something good, make a quick note and communicate it.
Quality Time – Not all of my 20-plus staff members require Quality Time, I discovered, much to my relief. However, there are a couple of staff members that I do need to sit down with weekly and give them my time to communicate their importance to me. This knowledge has allowed me to concentrate my time most appropriately.
Acts of Service – Offer to assist a staff member who responds to Acts of Service with her daily “to-do” list and you have communicated you appreciate her. Be ready for her attitude to be positive and encouraged after she watches you help with a couple of tasks. You don’t have to do all the work, but you might vacuum the carpet one evening to help her get home earlier.
Tangible Gifts – Those $10 AMEX gift cards will go much further and it will cost you less if you only give them to the staff members who communicate through the language of Tangible Gifts. These people may be ambivalent to Words of Affirmation, so acknowledging their work well done may not make an impact. Give them a gift and they will know you care.
Physical Touch – if you determine this is the primary language of a staff member, it would be wise to refrain from anything more than a handshake or pat on the back.
All people know they are appreciated when their preferred language is spoken to them. When people are appreciated, they are more loyal, and the workplace environment will be more encouraging and productive.
I think the most difficult aspect of being the CEO of my company is staffing. Like all optometry graduates, I was highly trained for the clinical work, and I enjoy it. I’ve also found the business development and growth to be fun, like a calculated game of chess that rewards those who think ahead. Managing the staff, however, seems to me at times like having 10 wives with unpredictable moods, needs, and expectations. But I want them all to show up for work, because an early-morning text saying someone can’t make it in never bodes well for the day. Managing a staff is draining, and sometimes makes me think about selling the practice early. What can we as CEOs do to decrease the pain of management?
Each situation is different, but many of the experts in management will lean on one of these three reasons people do not stay at their jobs:
Unhappy environment – The majority of individuals hate conflict. Very few people look at conflict as a way to grow. Minimizing the intrastaff conflict that exists is the first step in keeping this out of your office.
• Recommendation – Stop conflict early and make individuals deal with the small problems before they become insurmountable. Schedule a time at the end of the day for the two in conflict to meet with you, the mediator, and address the issue.
Not feeling appreciated – The majority of optometric staff are female. Relationship expert Gary D. Chapman describes five different “love languages” that people use to communicate, and in his research, Chapman determined a high percentage of women respond best to the love language “words of affirmation.” Job satisfaction increases when people know they are needed and appreciated.
• Recommendation – Create a “to do” every week to affirm one staff member. This can be done through email, a traditional card, or sending flowers. Whatever the case, do something.
No job description or expectations – It is difficult for staff members to be successful if they don’t know the expectations. Staff members need to know how to measure their daily efforts, so when they leave each day they will know if they have completed their job and done it well. Many optometry CEOs do not take the time to regularly update job descriptions and review them with the staff. Do your staff members a favor and let them know what you expect.
• Recommendation – Every staff member should have a job description and expectation list that outlines his or her responsibilities. Create one for each staff member and review it a minimum of every 12 months.
So what is the #1 reason staff leave? Experts can’t pinpoint this for your particular setting, so you will need to guess (or ask some of your staff members). The point is, if you are having a problem keeping staff, these three areas are great places to investigate. Then make sure you are consistently giving staff members what they need to be successful at their jobs.
The newest trend for optometrists is having a scribe assist in the exam room. In other areas of healthcare, physicians have been using exam room assistants for decades. Using scribes, however, is relatively new for the optometric profession as a whole. Scribes can relieve a little of the optometrist’s stress by taking care of some aspects of clinical care, meaningful use, HIPAA compliance, and business and staff management.
Adding a scribe sounds like a great idea, but how can it be done without negatively affecting the bottom line?
Three steps to adding a scribe while minimizing the initial costs:
Transition an existing paraoptometric (doctor’s assistant) – Begin by taking advantage of any additional time–patient cancellations, slow days, or the end of the day–for your assistant to observe you in the exam room. Your assistant will begin to get a feel for filling in portions of the exam. Then gradually ask your assistant to fill in certain sections of the exam. For instance, one week fill in only the slit lamp exam. As your assistant becomes familiar and more efficient with this practice, you will be able to concentrate on your patient instead of charting. This gradual approach can take months, but it does allow you to make this transition with minimal overhead cost increase. Once your assistant is fluid with a complete exam, begin looking for an additional assistant. Consider paying your scribe considerably more than the additional assistant, because you want to encourage your scribe to remain with you for many years to come. Many times hourly pay reflects the capacity of individuals to do certain positions. Invest in a scribe who has a high capacity for learning and doing.
Observe other optometrists – The best advice I never took early in my career was to observe other optometrists. Now I am amazed that some of the best ideas have come through observing other offices. In the past I assumed that a three-doctor practice in the Midwest would run about the same as any other three-doctor practice in the Midwest. I was wrong. Details and systems vary widely. By observing offices that successfully use scribes, you will increase your chances of not making expensive mistakes in the transition process.
Calculate the cost – How many patients per day will you have to add to your schedule to make adding an additional staff person cost neutral? If each comprehensive exam averages $300 and your scribe will cost you $17.50/hr then you would have to add 10 comprehensive exams per month.
Monthly production/comprehensive exams = production per patient (in this example $300)
The $17.50 is the “total package hourly rate” meaning that someone who is paid $15/hr and gets health insurance may be a resultant $17.50/hr.
Optometrists are becoming accepted as primary care physicians of the eye across all medical fields. Consequently, optometric practices need to adjust. Changing a system that has run successfully for so many years is difficult. However, the consequences of not adapting are more risky than the investment in change. Adding a scribe may not make sense initially because it seems like added costs with no additional production. Visit with those who have made the investment and you may discover that you should have done it years ago.
As one of two owners in a large optometry practice, I have to face difficult employment issues each week. Like many optometry graduates, I had trained for the clinical aspect of optometry and had what I now see was a naive interest in being a business owner and employer. As job descriptions get more specialized traveling up the practice hierarchy, staff management risk increases. The associate OD position is near the top. I define risk as making employment changes or systems changes that may result in unhappy associate ODs. The only thing worse is having a full schedule of patients and learning an OD just quit. So how do we navigate difficult employment conversations with associate ODs, even conversations that may result in their compensation being reduced?
Warning lights before the danger – When you drive on a major highway and come upon backed-up traffic and a perpendicular state trooper vehicle, you know that there is most likely danger ahead. A well-structured employment manual will provide warning lights to an associate OD. Follow the guidelines outlined in your employment manual and the warning lights will be obvious.
Associate agreement – When an associate agreement is designed with the end in mind, difficult situations like a pay decrease are no surprise to the optometrist. The reason great practices spend a large amount of time putting together a very clear and well-structured associate agreement is so there will be no surprises.
Performance-based compensation – Designing a compensation package that rewards an employed OD for his or her passion, initiative and hard work will not only benefit the optometrist, but will also benefit the practice. When an employed OD is compensated based on performance, there is no need to adjust compensation according to the ebb and flow of the practice financials. Instead, it will adjust itself. If a practice is a successful growing practice the employer may also want to adjust compensation to a percentage of the gross based on performance of the practice. For example, if the compensation is 15 percent less of practice net, then when the practice nets 35 percent for the month the associate OD receives 20 percent of their gross collected production. This motivates the associate to be aware of expenses and work to keep them low.
Managing other doctors is never easy. Many times the threat of an uncomfortable confrontation is enough to make you avoid the situation, which only makes things worse. Vision in staff management is the ability to see potential outcomes and position yourself for the smoothest ride through those outcomes. No one wants to decrease an associate OD’s pay, because that most likely means that the OD is struggling. By envisioning the potential outcomes you have a role as the CEO to assist in helping the associate be successful so that pay decrease may never need to happen after all.
Optometry offices typically do not have the most convenient hours for patients to pick up their glasses and contact lenses. Private practices are usually open 8 a.m. to 5 p.m., Monday through Friday. These hours are convenient only for retirees. In today’s dual-income culture and 5 a.m. to 5 p.m. schedules, patients not being able to find time to do business with your practice may be why you are losing patients. Based on this, you as the CEO have two choices: open up longer hours or weekend hours, or communicate so skillfully that patients can fit you into their long hours and busy schedules. Text messaging is the fastest and most convenient means of communication today. Email is second, and the phone is a distant third because most people under the age of 50 do not listen to their voice mail.
Since you are most likely not interested in expanding your hours, you must use technology to be easy to do business with. Our communication partner, SolutionReach, has positively impacted our “not so convenient hours” by alerting patients through text and email when their glasses and contact lenses are ready to be picked up. What’s more, each patient within SolutionReach can be contacted directly by text during specific times when the office is slow to let them know you currently have no waiting time, similar to when the DMV texts people to notify them when they are next in line. Best technology ever!
Based on the 500+ survey results that Wichita Optometry SolutionReach post-surveys have generated, we know 98 percent of our patients are enthusiastic about our communication and overall technology experience. If your practice is easy to do business with, patients are more likely to stay with you and tell their friends.
Many optometrists believe today’s optometry business requires more and more effort to achieve the same financial rewards. If you agree, you may have fallen into one of these three traps:
Refusing to Change – With decreasing vision care benefit reimbursements, optometrists can operate their offices the way they always have, or they can adapt to the changing environment. Surprisingly, even many optometrists who say they are operating in the new medical model still bill the old vision benefit plans for more than 60 percent of their total billing. Change begins from the top down and requires the optometrist leading their practice to think and act differently.
Poor Communication – The production per patient in the dispensary is a direct reflection of what the doctor is prescribing. Doctors are to remain ethical in prescribing only what will benefit the patients and meet their needs. However, many doctors will not talk about ophthalmic product in the exam room because they say it is not their job. If a patient is suffering from poor vision, it is the doctor’s job to prescribe the best prescription and products to best correct that defect. If the patient wants to compromise visual quality because of price, let that be the patient’s decision, not the doctor’s.
Working IN the Business, Instead of ON the Business – “I see patients five days a week and our practice net is only 28 percent.” I hear statements like this from optometrists who work harder and not smarter. As the CEO, you must get out of the exam room from time to time so you can run the business. This may require hiring an associate sooner than later. Even though it’s a big initial financial investment, I’ve seen many cases where only a year after hiring an associate, the optometrist CEO is seeing fewer patients and profits are up.
Don’t get frustrated in today’s optometry business because you are working harder and making less. Do something about it. My best friend in optometry school and I always said there are two kinds of individuals–those who make things happen and those who let things happen. Individuals who make things happen end up in the destinations of their choosing. Go make things happen.
Marketing can be internal, like when a patient recommends her optometrist to a friend, or external, which includes advertising like billboards, radio ads, and mailed flyers.
Many optometry practice owners put little emphasis on external marketing. Owners tend to believe they are not impacted by marketing, so they see spending money on marketing a waste of time. However, studies show four out of five Americans are influenced by external marketing and make decisions accordingly. Considering this, forgoing external marketing seems like a grievous error.
An often-overlooked form of external advertising is promotional products. Spending money on apparel and gadgets may may feel like a black hole, but when done right over time it can have an exponential impact.
Here are three great resources for promotional products that every optometrist should be aware of when looking for creative external marketing:
4imprint – 4imprint has a good variety of products that can be imprinted with your office logo for competitive prices. We have been impressed by the quality of their regular fare, and 4imprint offers high-end options also. We were pleased with the response we received from our most recent marketing promo item, infuser sports bottles. OptometryCEO does not receive any proceeds or benefits from recommending this company.
GotPrint – They offer the best prices with the “rounded corner” business cards. We had used Vistaprint for years and found their pricing to be a moving target. They would advertise low prices but charge extras that drove up the per-card price. After frustration with them, I landed on GotPrint and haven’t used anyone else since. OptometryCEO does not receive any proceeds or benefits from recommending this company.
CustomInk – If you want a T-shirt that everyone is sure to love, use these guys. They have available the American Apparel brand, which are some of the softest, most comfortable shirts to wear. When you spend the money for great shirts you find that your staff, doctors, and patients love to wear them, and they talk about them to their friends. OptometryCEO does not receive any proceeds or benefits from recommending this company.
Marketing your optometry practice requires you to be resourceful and creative. Most optometrists do not have a large marketing budget, so all dollars must be spent wisely and have the greatest impact. Finding resources that you can use to save money is one of many ways to keep expenses down and profits up.