Focus on the business side of your practice with these six questions
“Asking a question is the simplest way of focusing thinking ... asking the right question may be the most important part of thinking.”
– Edward de Bono
“Ask the right questions if you’re going to find the right answers.”
– Vanessa Redgrave
Every clinical exam starts with questions: “How are you feeling? Where does it hurt?” Young doctors in training are drilled on the importance of asking the right questions. But these same doctors, many years later in their careers, often fail to remember the value of smart questions when applied to the operation of their practice businesses.
The best questions in a business vein are just like excellent medical questions:
- Know why you are asking: Think first about what you are trying to understand.
- Be clear and specific: Don’t be vague or ask in ways that might be misunderstood.
- Ask the right person: Tailor your question to the right person.
- Ask neutrally rather than asking leading questions: Don’t bias the response.
- Use a mix of questions: Ask “how” and “why,” not just “yes” or “no” questions.
- Ask follow-up questions.
With that as a guide, here are six questions you should ask on the business side of your practice. Some of these are best asked in the boardroom, some at management meetings and perhaps some are best asked while looking in the mirror.
Are my surgical and clinical outcomes at least equivalent to my average colleague’s outcomes? If the answer is “no,” what am I going to do about that? While this may sound like a clinical question, quality assurance is at the heart of business success. Great business and marketing management will only serve to make a fundamentally flawed service fail faster. By definition, half of all the ophthalmic care provided in America today falls below the national average. The good news is that ophthalmologists are notoriously generous in sharing their talents with colleagues. We have never seen a gifted surgeon who was too busy to help a peer. Don’t be shy. Ask for help.
What do patients think about the quality of our services? While you may get some insights about the perceived quality of your care and caring by asking staff, your truest understanding of the subjective quality of your practice will only come by asking patients themselves. However, the usual approach to this, online and even in-person written surveys, provides little actionable insight in our experience. Yelp and similar reviews will generally just inform you about what your biggest fans and biggest detractors think of you, leaving out the middle majority of patients who often have the most constructive criticism. The best approach is live phone survey calls to patients you have recently served, asking open-ended questions such as, “What could Dr. Smith or staff have done during your examination to improve your experience?”
What is the global quality of our support staff? Is that quality sufficient? Just behind you as the surgeon, your support staff are the costly beating heart of your practice. One-third of every dollar you collect is spent on your team. And yet, clients often ask questions about staff performance that are too oblique to be of real value. Here is a better approach in five simple steps:
- Choose any staff member.
- Without overthinking, what is their global performance score on a 0-10 scale, in which 0 is terrible and 10 is perfect?
- What higher score is this person capable of, and what would they have to do to reach it?
- What minimum global score does a staffer in this position need to be effective?
- Based on your answers to these questions, what action are you going to take with respect to this worker?
Here is an example of how these five steps might go in a practice like yours:
- Becky, our head tech, has been here 12 years.
- Becky’s global score is a 7.5.
- She is capable of reaching a 9, and she could reach it by a) becoming a better leader, b) anticipating clinician needs better and c) holding her staff to higher standards.
- Our head tech has to be at least an 8, so Becky is below the mark now.
- Based on this, our action plan is to let Becky know what we think about her current and potential skill level, hire a coach to help her improve her leadership and standards-setting skills, and we will give her more positive feedback whenever she anticipates our needs to encourage her development in this area.
As an owner, what do I earn per hour? How does that compare with peers, and how might my hourly income be improved? The typical hard-working anterior segment surgeon earns about $250 per hour, leaving aside surgery center profits. That figure is closer to $400 or more for diligent subspecialists. Work with your management staff and advisors to assess your own number and brainstorm improvements, which might include seeing incrementally more patients, increasing testing and surgical utilization (within contemporary bounds), improving your payer mix or tapering expenses.
How well are we retaining patients, and what steps are we taking to encourage long-term loyalty and patient-to-patient referral? The most common marketing mistake is not faulty promotion but faulty patient retention. The typical general practice will increase its number of established patients by around 5% a year. If your established patient growth rate is below this figure, the common drivers for this are either poor perceived quality (reread the discussion about measuring patient perceptions above) or gaps in recall and continuity of care protocols. It is easy to audit this. For a given provider, pull records from the last 20 random encounters. Was the return to clinic (RTC) interval appropriate to the patient’s condition, age and payer? Was the RTC actually recorded in the chart? Did staff use this written entry to accurately make the patient’s next appointment (at least for all RTCs up to 1 year out)? In our experience, a 20+% error rate is not unusual to see in this kind of audit but is easy to improve.
Do we have a clear succession plan for leadership and ownership transitions? A practice lifetime passes quickly. Mid-career managing partners reach 68 years old in a blink. Vital administrators eventually retire. It is hard enough to manage the day-to-day minutia of your practice much less find the time to think about the big, long-term picture. But you must do so. Every department head should have a “No. 2” in training. Every administrator should have a written succession plan. And every managing partner should be public about their tenure desires and curate an understudy.
- For more information:
- John B. Pinto is president of J. Pinto & Associates, Inc., an ophthalmic practice management consulting firm established in 1979. He is the country’s most published author on ophthalmology management topics, including John Pinto’s Little Green Book of Ophthalmology, Simple: The Inner Game of Ophthalmic Practice Success and Ophthalmic Leadership. He can be reached at 619-223-2233; email: pintoinc@aol.com; website: www.pintoinc.com.
- Corinne Z. Wohl, MHSA, COE, is president of C. Wohl & Associates, Inc., a practice management consulting firm. With 35 years’ experience, her firm specializes in leadership, operations enhancement, financial benchmarking, executive and provider coaching, and management team development. Her book, co-authored with Pinto, is UP: Taking Ophthalmic Administrators and Their Management Teams to the Next Level of Skill, Performance and Career Satisfaction. She can be reached at 609-410-2932; email: czwohl@gmail.com.
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