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OPHTHALMOLOGY BUSINESS 66 December 2018 by Corinne Wohl, MHSA, COE, and John B. Pinto their actions. Examples include operations manuals by depart- ment that help formalize training new staff and advance continuous quality improvement and position descriptions, so every staffer knows their role and can be directed and evaluated by management in ways that can improve performance. 5. Communication is at the heart of business accountability. In even the smallest practices there are hundreds of opportunities a week to clearly or poorly communicate. In our consulting work, we common- ly find that communication gaps and misunderstandings are really what has driven poor financial performance, high turnover rates, or clinics running behind. • Too many practices allot too little time for meetings. Some practices avoid meetings because uncomfortable topics may arise. Managers and doctors in such practices sometimes think in error that meetings are unproductive. Running an effective meeting is one of the most important skills a managing partner or admin- istrator can possess. Running a productive meeting is at the core of how executives add value to their companies. This is a learn- able skill. • Here are meetings typically held in the average practice with a handful of doctors and 20 to 40 lay support staff: > Monthly with the board > Weekly with the managing part- ner and administrator > Bi-weekly with the Management Committee, including the ad- ministrator, mid-level managers, and the managing partner > Weekly with the administrator and individual department managers > Monthly department meetings > All hands staff meetings; fre- quency varies depending on the size of the practice 6. Professional growth and train- ing helps newer staff learn, and keeps your most talented employees engaged in their jobs, while at the same time reducing the vulnerabili- ty in a practice by making sure that 3. Financial vigilance covers nu- merous areas for incremental steps for business improvement. • Revenue cycle management: This includes accurate coding and timely billing and follow-up on denials. Often overlooked is cross training and educating the whole practice team in ways that aid the billing department. • A/R aging reporting: Track bench- marks to determine where delays or improper payments reside. Know how to read this report and where to look for the underlying problems. Your goal for open accounts over 90 days should be 12% or less in most settings. • Profit margin sufficiency: Perform- ing monthly financial and volu- metric data analysis provides the ability to spot adverse trends early, so you can react to challenges quickly. Typical profit margins for general ophthalmology practices are 30–45%. The higher the profit margin, the more resources you will have to seize opportunities and weather unplanned storms such as the unplanned loss of a provider. 4. Written protocols are essential to streamlined processes. Protocols provide clear guidance and hold staff and providers accountable for advance. Share case histories, dis- cuss how to improve your clinical services and develop a camaraderie among all providers that ultimate- ly helps to improve patient care. Include your clinical staff in the improvements process, too. Make sure you have an oversight process in place to handle adverse patient outcomes. 2. Customer service expectations have grown in every business setting. Customers have been conditioned to demand far high- er standards than they accepted a generation ago. And there are more avenues for patients to express their adverse opinions. Your practice must be very specific about the customer service behaviors you desire from your staff. Each new staffer arrives with their own definition of great service until you set the standards for them to uphold. Each employ- ee's personal life and previous bosses have shaped their own expectations and experiences, so you must set institutional expectations for con- sistency. To help coordinate the effort, provide sample scenarios, preferred wording, role playing to make your points, plus directions for when it's time to involve a manager to resolve patient satisfaction concerns. "Order and simplification are the first steps toward the mastery of a subject." —Thomas Mann "A real decision is measured by the fact that you've taken a new action. If there's no action, you haven't truly decided." —Tony Robbins R evolutionary discoveries happen in every field, al- though evolution is more common than revolution. Excellence in ophthalmol- ogy over the years has resulted far more from incremental improve- ment rather than huge leaps. Sometimes looking for big "gets" is not as effective as simply fine-tuning all areas in your practice. Streamlining processes, goal-setting, and prioritizing communications throughout will help patients, pro- viders, and staff alike. Here is our top 10 checklist for practice leadership to prioritize and apply. 1. Clinical excellence is the main driver for providers and patients alike. Measure your outcomes, set practice-wide goals for quality improvements. Prioritize provid- er meetings by scheduling them at least bimonthly for the year in Checklist for leadership priorities in successful practices To the point: simple practice tune-ups for complex times

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