Eyeworld

EW NEWS & OPINION 40 March 2017 To the point: Simple practice tune-ups for complex times by John B. Pinto and Corinne Wohl, MHSA, COE your shoulder as you exit the office) "Thanks for a great clinic this after- noon" is not very motivating. It is far more effective to call your head tech into your office, point out spe- cific examples of what went right, and thank your supervisor for her contributions to a great session. Rules without consequences are mere "guidelines" and no one follows guidelines. Ask: • Do we have a consequential en- vironment? Do we actually apply punishments to offenders or too liberally grant exceptions? • Does a partner experience an adverse consequence when they cancel a day of clinic with little notice? • Is there a consequence for staff who arrive late? • What happens when a technician forgets to write down thorough work-up results? • Are repeatedly inaccurate or tardy bookkeepers allowed to keep their jobs? If discipline is not consistently and fairly applied, not only will of- fending members of your staff slide further in their performance, but even the best staff will take this as a cue that they can relax their efforts. Being accountable for tasks and performance standards has to start from the top. Diligent administra- tors and practice owners foster these habits down the ranks. EW familiar? It's the business equiva- lent of a patient chart, and just as essential to your practice's health. • Personnel manuals and conduct codes. These are often written and forgotten rather than used as live documents to mold behav- ior. Written codes of conduct are largely aimed at providers and cover such things as arrival time, interaction with patients and staff, and obligations to help with staff training and outreach. • "Discuss-with" files. It helps if people know that you never let things slip through the cracks. An old-fashioned "Discuss-with" file folder on each provider and subordinate, in which you put notes regarding your discussions and their commitments, sends the signal, "I'm not going to forget." This is especially important if you are the kind of doctor or execu- tive who motors along at such a fast pace that you forget who you asked to do what or when. • Confirmation notes. You may al- ready be doing this, but when you have a meaningful discussion with a staffer, in which they agree to do something for you, ask them to send you a quick follow-up note memorializing what they agreed to do. • A "chief accountability officer." In larger settings an executive assistant often plays a vital role to log and check in on agreed tasks, which can help you reposition, as administrator or managing part- ner, from being the company nag. All of these help move tasks beyond oral "Could you please do this?" to electronic and paper trails that can be audited, countering lazi- ness, upping the pucker factor and boosting compliance. It is important to have a conse- quential environment: When people do their agreed tasks, they get lots of positive feedback, and when they don't, they get progressive, propor- tionate discipline. Rewards can take every imag- inable form and are best if they are timely, individualized and related to specific actions rather than gener- al behavior. Simply saying to the techs at the nurses' station (over In the regulatory canons of medicine there are a number of practical tools to induce discipline. Doctors can make millions or lose licenses. ASCs can be stripped of ac- creditation. Patients can sue a clinic into oblivion. All of this helps keep providers in line when it comes to matters of gross health and safety. However, on the materially less critical business side of medicine, we don't have the same carrots and sticks to make sure today's charges are posted, or tomorrow's patients are called. So every practice owner and administrator needs a collection of gentle tools, pry bars, and mild explosives to get things done. The core concept is the use of so-called "accountability docu- ments," which take many forms: • Operations manuals. It may feel like overkill, but even the small- est practices benefit by writing protocols down for each depart- ment. These provide the texts for initial training and orientation, force insights into potential im- provements and form the basis for periodic process audits. A ham- burger franchise like McDonalds has hundreds of pages of proto- cols. Should your practice—where mistakes can be blinding—have anything less? • Checklists. Even the most experi- enced pilots use a written check- list to safely go aloft. The same tool can be used to make sure that your practice doesn't crash. Without going overboard, develop daily/weekly/monthly checklists for each area of the practice. It is easier to be an administrator if you only have to glance over the front desk's weekly checklist than to remember to ask about the sta- tus of dozens of receptionist tasks. • Public action lists. In less-disci- plined settings, we see managers keeping their own ad hoc "to-do" lists and no place where these lists are collected so the admin- istrator and board can see which projects are still open. Create a simple four-column Word or Excel file, password protected, on your practice's shared drive. Label the columns "Action," "Person responsible," "Deadline," and "Dated progress notes." Sound "Laziness is nothing more than the habit of resting before you get tired." —Jules Renard "Laziness is a secret ingredient that goes into failure…but it's only kept a secret from the person who fails." —Robert Half T he most enduring lament in our combined 70-year careers as health care exec- utives and advisors comes from doctors and adminis- trators who in one way or another ask, "Why can't our people simply do what we ask them? What they have agreed to do? What they are supposed to do?!" This complaint is registered up and down the ranks, and it occurs just as much at the top of the com- pany as at the bottom: • Doctors who don't follow practice rules • Administrators who skip hard priorities to focus on easy optional tasks • Supervisors who have learned how to say "It's not done yet" in the nicest way • Front-line staff who put more ef- fort into looking busy than doing their jobs Why are most people so lazy? It turns out that laziness is rooted in humans evolutionarily as a practical survival skill. As Neel Burton, MD, wrote in Psychology Today, "Our nomadic ancestors had to conserve energy to compete for scarce resources and to fight or flee enemies and predators. Expending effort on anything other than short-term advantage could jeopardize their very survival … our instinct is still to conserve energy, making us reluctant to expend effort on abstract projects with delayed and uncertain payoffs." So there we have it. In order to fight our slothful human heritage, all but the most naturally motivat- ed of us need to be goaded to do more than is absolutely necessary to survive. Getting people to follow through with timely discipline on their agreed tasks is especially difficult in a field like ours where the standards are "perfect." Tools, resources, and habits to get things done Mr. Pinto is president of J. Pinto & Associates Inc., an ophthalmic practice management consulting firm in San Diego. His latest ASCRS•ASOA book, Simple: The Inner Game of Ophthalmic Practice Success, is now available at www.asoa.org. He can be contacted at pintoinc@ aol.com or 619-223-2233. Ms. Wohl is president of C. Wohl & Associates Inc., a practice management consulting firm. She earned her Masters of Health Services Admin- istration degree at the George Washington University and has more than 30 years of hospital and physician practice management expertise. She can be contacted at czwohl@gmail.com or 609-410-2932. About the authors

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