NOV 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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58 Ophthalmology Business November 2013 Pay attention. It pays. by John B. Pinto "An expert is someone who has succeeded in making decisions and judgments simpler through knowing what to pay attention to and what to ignore." –Edward de Bono "Tell me to what you pay attention and I will tell you who you are." –Jose Ortega y Gasset T his past summer I went hiking in the High Sierra, that north/south spine of mountains transecting California. The scenery was sublime. The trails were steep. And the air was quite thin. It was for that reason, around noon one day, that I stopped for lunch in a shady grove, sitting on the ground with my back against a comfortable boulderÑonly about 15 feet from the trail, in plain sight. My lunch was so relaxing that I had a nap for dessert. I awoke a short while later, but remained very still for the next two hours. In that time, about 50 fellow hikersÑsome in groups, some alone Ñwalked past me. Without excep- tion, each person droned on, feet plodding. Eyes focused on the ground ahead. Not one person looked my way or noticed I was there. They also didnÕt notice the two deer that grazed for 30 minutes on the far side of the trail or the family of jays, scratching nearby in the sand. As a kind of Òophthalmic field naturalistÓ for the last 35 years, I can give the same report about most client offices. Far too many ophthalmologists and their management staff trudge along, overlooking the details of their environmentÑone foot in front of the other, oblivious to much of whatÕs going on in their practices. This oversight is costly, both objectively in bottom-line business performance terms, and subjectively, in the medical quality deficits that are ignored and left to blemish patient care. Assembled below, in no particular order or priority, are things you may be overlooking in your slog through each clinic day. This rundown is not meant to be a checklist, but a meditationÑ and a wake-up call. DonÕt race off and see if these things are present or absent in your practice, but rather use these examples to punctuate any dissatisfaction you may have with your own attentiveness and to spur improvements at every level. ¥ How happy is your first-year associate with her posting in your practice? When she let out a sigh about her tech coverage, was she just venting or asking for a solution? Was her last four-day weekend really a vacation, or was she interviewing in another practice? Is there something you could do this month to increase the odds that she will graduate to partnership and contribute to the development momentum of your clinic? ¥ Are your incentives as a provider aligned with those of your staff? What reward do they get for improving their job skills or transiting more patients? How do they feel, one week after another pay freeze is announced, when you drive up with a new car? How does that feeling translate in the interaction they will have a few minutes from now with their work-up patient in room #3? ¥ ItÕs the end of another work day, all 500 or so minutes of it. Are you conscious of how much or little of each minute was engaged in income-producing or qualityimproving activity? Have you stayed on the clinic floor and walked directly from patient to patient today, or wandered into your private office between most encounters? Has every patient needing a supplemental test been so-ordered? Has every patient received a definitive return-to-clinic order? ¥ Nearly half of all doctor and lay staff hires fail. Do you fail more or less often than others? Do you know why? Who in the practice is responsible for the success or failure in this critical area? What are their measurable, accountable goals? ¥ Just about anywhere you stand in a busy eye clinic, if you look and listen, you will observe numerous staff/patient interactions all taking place at the same time, a kind of customer service symphony. WhatÕs the overall tone? Purposeful, friendly, competent? Or chaotic, grim, bumbling? If we could give this symphony a score from 1 (wretched) to 10 (awesome), what would the score be today? What are we capable of? Why arenÕt we there yet? ¥ During your next surgical consultation, try to step away from yourself and observe how you are interacting with the patient in your exam chair. What do you say? How do you say it? How does she react? How about the daughter? Might a subtle shift in body language or a clearer, more affirming turn of phrase mean the difference between a patient settling for standard care or choosing advanced surgery? ¥ As an eye surgeon, youÕve mastered at least one thing, surgery. So you know what mastery feels like. How does THAT level of mastery compare with your understanding of and control over your clinicÕs business affairs? Are you a financial master yet? A project management master? A master at motivating personnel? You went to class to become an ophthalmic masterÑwhat classes are you taking to master your enterprise? ¥ Practices, from year to year, rarely stand still. Is your practice on the way up? Or is it on the descent because the founders are senescing and not being replaced by young doctors of equivalent ambition and work ethic? Can this fall be arrested and reversed? Should it? Your entire professional career will be composed of nothing but successes and lessons. How much you pay attention to the latter will expand the number of the former that you enjoy. Pay attention. It pays. EW ABOUT THE AUTHOR Mr. Pinto is president of J. Pinto & Associates, an ophthalmic practice management consulting firm established in 1979, with offices in San Diego. He can be contacted at 619-223-2233 or pintoinc@aol.com.

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