Eyeworld

26 Ophthalmology Business • December 2017 "Because practices often depend on their administrator for guidance, it is imperative that the goals are clear. When an administrator is pointed in many different directions by the board, it's challenging for them to be as effective as they can." Among the ways Ms. Wohl has seen practices avoid such disjointed approaches is for the practice to add partner-track physicians to the group who have similar long-term career and practice goals. "Ideally you are hiring doctors who have the same desires about practice growth and culture," Ms. Wohl said. "But even if you hire two doctors who started out on the same path, people change over time and they could still end up being drawn to different goals." Changing career goals can be addressed through better communi- cation. "Without open communica- tion and compromise you can expect constant conflict," Ms. Wohl said. Whether a practice has two physicians or 20, all practice sizes are vulnerable to the impact from a lack of strategic coordination and planning. Practice partners developing or updating strategic plans can benefit from data-driven research, such as identifying realistic growth opportu- nities in a specific geographic area. "Skilled administrators can assist owners in the development of their strategic plan in this way. Anoth- er example includes meeting with regional hospital systems to under- stand the local healthcare market- place," Ms. Wohl said. OB Contact information Pinto: pintoinc@aol.com Wohl: Czwohl@gmail.com Partner splits In cases of partners disagreeing on strategic plans, Mr. Pinto has found it helpful to offer practice boards five different strategic ways to look at the issue. Practice board members can then have a pre-vote on the options. "We draw up for the board up to five different strategic destinies for the practice. Then we take a vote and see where each partner stands on these five destinies, and that will help us see where the center is," Mr. Pinto said. "If we have agreement on some areas, we draw up the descrip- tion of what that might look like, then we have another vote on these consensus options." A majority vote allows the board to finally take an agreed strategic direction. In practices with just two partner physicians it can become more dif- ficult when they can't find common ground. In such cases, Mr. Pinto sets the strategic planning process aside and works to make progress on obvious tactical priorities, which are likely indicated under any strategic plan. "We then circle back to the stra- tegic plan and say, 'We've had some success taking care of a few tactics; now let's return to the strategic plan with our renewed confidence and make decisions about the longer-term future.'" Conflict impacts Differences between the career goals of practice partners and the practice's strategic plan can cause frustration for administrators whose efforts are impacted by this incongruence, said Corinne Wohl, MHSA, COE, presi- dent, C. Wohl & Associates Inc., San Diego. "They can be frustrated for years without having a clear strategic direc- tion from the board," said Ms. Wohl, a former practice administrator. For instance, "Dr. Smith is nearing retirement so maybe we don't have him invest in the building because he is less risk tolerant," Mr. Pinto said. "There are ways of block- ing individual doctors from risk and giving risk opportunity for doctors who are risk tolerant." Practice responses When Mr. Pinto talks to practices about that kind of approach, the compliance rate is high because only 5–10% of practices have a written strategic plan. It's also important to draw a dis- tinction between strategy and tactics. Strategy is typically a 5- to 10-year plan that includes determining the service area, service mix, provider mix, growth rates, institutional struc- ture, and succession plans. Tactics are nearer term. For example, the strategic plan may aim to annually grow the prac- tice at 10% rather than 5%, and tac- tics would aim to increase marketing to drive that level of business growth. Few practices have created strate- gic plans for numerous reasons, Mr. Pinto said. The most common reason is what he calls "the ophthalmic personality." "This personality flows from hav- ing been guided by the people in his life: parents, teachers, and professors, pushing him along a medical career pathway," Mr. Pinto said. "Many ophthalmologists tend to be more outer directed than inner directed as far as planning their life and career, so when they get back in the world post-graduation, they haven't had a lot of practice at deciding their own long-term destiny. They've put one foot in front of the other. This reso- nates with the work schedule of their average day." Ophthalmologists are not trained in long-term thinking, as is empha- sized in business or political science educations. continued from page 25

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