20 AE Fall 2012

the Hawaiian Eye Foundation. Thevoyage was at the behest of titlesponsors Compulink and Slack Inc.,and the generous support of practices and individual surgeonsthroughout North America for the

As this column goes topress, I’m just back fromspending 22 days alone atsea, sailing solo from SanDiego to Honolulu on a

24-foot sailboat as a fundraiser for

One Word, “Improvement,”Sums Up Your Job As PracticeAdministrator or Surgeon-Owner

Running the Practice Current Tactics, Future Trends

John B. Pinto

Foundation’s work in the PacificBasin.

The voyage—more than 500hours afloat instead of the usual 5hours aloft a trip to Hawaii takes—provided a lot of spare time for me

“Almost all quality improvement comes via simplification of design, manufacturing ... layout, processes, and procedures.” Tom Peters

“Although personally I am quite content with existing explosives, I feel we must not stand in the path of improvement.”

Winston Churchill

AE Fall 2012 21

to think about what counts andwhat doesn’t, not only in sailing but also in eyecare management.

Everything important is captured by one simple word:“Improvement.”

It’s easy to fixate on makingimprovements when you’re out atsea:• For any given wind and waveaction, there’s an optimal way toset the sails … and because thewind is always changing, you’reconstantly tweaking the rigging.

• Navigational tactics change withthe weather … skirting squalls andlarger weather systems to optimizeperformance and safety is critical.

• Beyond all that’s done to keep theboat at its best, there’s a lot to dowhen solo sailing to make sureyou’re getting enough sleep, eatingenough, and thinking throughevery maneuver to avoid injury orfalling overboard. As the “skipper” of your prac-

tice, you must contend with thesame dynamics as any captain,whether you are an administrator ora surgeon-owner providing directpatient care.

The potential practice improve-ments you can make are endless, ofcourse, which is why running a prac-tice is such interesting work, but themost important improvements breakdown into 10 basic areas, below.

As you read through these, ask,“In our meetings, do we talk aboutpractice improvement in theseterms? Are we making steadyprogress in each of these areas? Dowe have objective ways of measuringour progress, and are these ‘scores’tracked over time? Are some areassliding backward, either throughneglect or due to the competingdemands of a few crisis areas?”

Objective clinical and surgical outcomes This should obviously be at the topof your checklist. But astoundingly,

ophthalmology is still operating at afairly primitive level in measuringthe work we do. In any one grouppractice, partner surgeons can havewidely divergent care pathways, andthe opinion of what constitutes“good-better-best” care is even morediverse. If you feel a bit behind inthis area, focus on one metric at atime—cataract surgery complicationrates or outcomes by provider, orcontinuity of care for your patientswith glaucoma.

Patient comfort and convenience While the surgeons in your practicemay be more comfortable thinkingabout the quality of their work interms of finite acuity outcomes aftersurgery, this is not the way mostpatients and their family membersmeasure the quality of your work.What standards do your patientsapply? How do they judge a proce-dure like cataract surgery where thecontemporary objective outcomesare 99% terrific? They’re concernedabout the service they got. They’rethinking, “Was I able to get anappointment? Did the doctor listen?Was the procedure as pain-free aseveryone promised?”

Patient understanding of andinvolvement with their care Strides that you can practically makein this area vary widely from onepractice setting to the next. The variance is not so much patient-based (their intelligence, interest,and education level) as provider-based. For practical economic reasons, many practices are seeingmore patients in the same 60-minutehour than previously, to stay evenwith rising costs and falling fees.Consequently, surgeons are obliged

to snip off the last few minutes ofeach exam slot. This time can beeffectively replaced by technical andsurgical counseling staff. In the bestsettings, patients are more thorough-ly oriented than ever before becausea harried minute of surgeon time(worth about $10 in lost production)is replaced by 15 minutes of gentlelay staff education costing a lot less.

Better employment conditions This goes for everyone, not just theemployed staff. A doctor once said tome, “I didn’t start enjoying my jobuntil I gave myself permission to fireunpleasant patients.” All of us, to areasonable degree, should be able tocontrol our work environment, con-tinuously migrate toward the taskswe enjoy most, and shed nonessen-tial job elements that suck the pleasure out of work. What answerdo you get back when you ask yourstaff, “Do you enjoy your job morenow than a year ago?”

Better tools and techniques Just walk the vendor floor at theASCRS•ASOA Symposium &Congress. You can tell from the wall-to-wall smile on every attendee witha doctor’s badge that ophthalmolo-gists love technology. While futureeconomic conditions may continueto taper the pace of adopting newclinical equipment, you and the surgeons in your practice have noupper limits on what you can learnby visiting vanguard colleagues inother practices. Make it a habit tovisit at least one more-advancedpractice each year and copy whatthey do.

continued on page 22

Only you can keep your practicefrom sailing over the edge.

22 AE Fall 2012

your relationship with them, andwhat you’re going to do to make animprovement (Table 1).

Better, tighter business systems We could subtitle this “The 5%Solution.” In the typical practicetoday, one finds a 5% no-show rate.About 5% of potentially collectablepatient accounts is never actuallycollected. A bit more than 5% of thepatient-responsible amounts is notcollected by the front desk at check-out. And in most practices the utilization of testing is about 5% lessthorough than it could be becausethe staff is overtaxed and the doctorsays, “Don’t worry, Mrs. Arnold,we’ll take care of that test next visit.”All of these individually innocentgaps add up to one big opportunityfor improvement in your practicetoday.

Better, more workable facilities In the world we’ve now enteredmedico-economically, this doesn’tmean brocade curtains and Englishantiques in a 10,000-square-footoffice for just a single doctor. We’reall now feeling our way toward arevised balance between form andfunction. It’s now “beautiful” toengineer patient flow so as to be ableto have one doctor see 80 patients aday in a three-lane office—and tohave patients comment on howmuch they enjoyed their visit.

Ever-better relationships This extends to all audience seg-ments: patients, of course, but alsofellow workers, vendors, and evencompetitors and institutional playerswho drive you mad. Make a three-column list: all the various partiesyou deal with, the current state of

Running the Practice Current Tactics, Future Trends

Regulatory complianceimprovements That “ducks in a shooting gallery”feeling that every practice has nowwith respect to federal regulatorycompliance is only slated to grow inthe years ahead. Washington is tak-ing more pot shots at medicine everyyear, and they’ve taken to shootingscatterguns, injuring the guilty andinnocent alike, rather than just aim-ing narrowly at those few who trulydo abuse the system. Even the small-est practice is now obliged to knowand follow the law and to engage thebilling and legal experts needed todo so. If today you feel like you’redoing a great job staying on top ofthis area, it probably actually meansyou’re barely keeping up.

A clearer view of the horizon If you’ve been reading the headlinesfor a few years, you know that wenow seem to be sailing toward theedge of the ophthalmic planet. Weare at the nexus of long-ballooningmacroeconomic and demographicchallenges that our national leadershave unfortunately chosen to ignoreuntil the bursting point is reached.It’s up to you as your practice’s navigator and captain to understandwhere the brink lies and how toavoid it. Only you can keep yourpractice from sailing over the edge. AE

F w

x h 1

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John B. Pinto (619-223-2233,pintoinc@aol.com) is presi-dent of J. Pinto & AssociatesInc., an ophthalmic practicemanagement consulting firmestablished in 1979, withoffices in San Diego. His new

book, Ophthalmic Leadership: A Practical Guidefor Physicians, Administrators, and Teams, isavailable from the ASOA Bookstore(shop.asoa.org/ophthalmic-leadership-practical-guide-physicians-administrators-and-teams).

Segment CurrentRelationshipStatus

Goal and Tactics

The 25optometrists whopractice in ourcounty

Only five refer tous grudgingly dueto the anti-ODposture of thefounding partner,who has recentlyretired.

“Within 2 years to enjoyenthusiastic referral supportfrom at least 10optometrists” • One-on-one meetings withdoctors who currently referto learn our strengths andweaknesses in this area,and learn more about thecurrent optometric community

• Survey calls to practicesnot referring to us at present

• Administrator and manag-ing partner outreach

• Semi-annual continuingeducation meetings

Table 1.