At Carolina Eye Associates (CEA), we have a successful practice that offers patients the best care and the latest technology, while at the same time utilizing the highest standards of efficiency.

Here I’ll discuss how through standardizing our offices, hiring the right staff and purchasing the latest equipment, we’ve grown from one small-town location to 12 sites in two states.

I completed my corneal fellowship in 1975 and returned to the Southwestern Medical School as the Director of Residency Training. After 2 years in this position, I realized it would be easier to provide more efficient, high quality ophthalmology in a private practice setting instead of a university center. In 1977, I resigned my position and moved to Moore County, N.C., my home state, to begin my practice in the Pinehurst/Southern Pines area.

At that time, Moore County’s population was approximately 25,000; the town of Southern Pines was 6,000 and the village of Pinehurst was 3,000.

My plan was to establish a private practice that would combine the best features of a private practice and a university center. The goal was to bring in associates with subspecialty training in different areas so that they could provide the best care possible for any eye problem.

I also wanted to research, develop and utilize the latest technologies for our patients. The underlying business rule was to treat the patients like family — to not do anything for a patient that you wouldn’t do to your family members. I felt it was extremely important to always put the patient first, the personnel second and the surgeon third.

I realized that in order for me to reach my goals, I would need to have an office that was geared to the care and treatment of patients needing ophthalmic care.

My objective was to have staff trained specifically in ophthalmic care, equipment designed with the latest technology, surgeons who were highly trained and dedicated to the patient, and an operating room designed specifically for ophthalmic cases. This would give us more control of our patients and how they were handled. Therefore, we gave extra care in the way we developed these different areas. Now I’ll discuss in more detail the five key areas on which we’ve focused.

Initially, I started my practice with one R.N. as a technician and one front-office person. When seeking our personnel, we attempted to hire individuals who were intelligent, dedicated, hard working, who had love in their hearts and who believed in putting the patient first. These employees had to be willing and able to adapt quickly to change.

We created a system in-house to train personnel and put them at the highest level possible. We chose administrators who not only met the job qualifications but who also had strong leadership, integrity, a strong worth ethic and the willingness to lead by demonstration. All of our leaders and doctors needed to be willing to do anything that they asked of their personnel.

All of our personnel were to be shown respect and groomed into a cohesive, effective team. In order to reward that team we set up retirement programs that let many of our employees generate more income from their monthly retirement growth than they would at their salary levels.

In addition, we moved toward a program of profit sharing, letting employees receive a monthly check based on a share of the clinic’s increased productivity. Employees were encouraged to use their expertise to improve productivity, efficiency and quality of service. They were challenged each day to make our patients more satisfied and to offer better care. If an individual wasn’t really working in a productive fashion or was working in a negative fashion, their fellow employees would see this immediately and encourage their fellow employee not to hurt the organization and their pocketbooks.

This approach strongly encouraged employees to be more efficient and productive. With this program, we didn’t have one leader with one mind; we had literally hundreds of leaders who used their expertise to make our organization better. I’ve felt that in order for a team to be effective, members had to be shown respect and encouraged on a regular basis by physicians. Criticism, if necessary, was be done in a constructive fashion.

Our technicians are all required to be Certified Ophthalmic Assistants (COA) and strongly encouraged to become Certified Ophthalmic Technicians (COT) or Certified Ophthalmic Medical Technologists (COMT). All of our technicians were trained to perform refractions, keratometric readings, topography, visual fields and all of the other tests that were usually done on surgical patients so that, when the patient presented to the doctor’s lane, many of the preoperative tests had been performed.

The patient was then given a complete exam by the optometrist. After that exam, the operating surgeon reviewed all of the findings and discussed with the patient the risks and benefits and determined what procedure would be appropriate. This markedly increased our productivity, efficiency and quality of care.

The foundations of staff management that we initially established are still paying off. One of the most important recent changes for our quality of patient care has been the reduction of Medicare-regulated waiting time, from 2 months between eyes to only as long as it takes for the first eye to achieve refractive stability.

We’ve determined that, in North Carolina, Medicare was once wasting $15.5 million per year because of the longer delay between eyes. The extra costs were associated with extra office visits, lost time from work and second medical work-ups to document medical stability. In addition to that, we literally had hundreds of patients who were injured because of anisometropia and having to wait 2 months before the second eye could be done.

Now, because of the shorter waiting period, North Carolina surgeons don’t have to do such an extensive second work-up, including unnecessary lab studies. Reducing these visits will eventually lead to more efficient care of our patients in North Carolina.

Our early practice development produces benefits to this day. We encourage all of our new doctors to follow the Golden Rule — putting the patient first; personnel, second; and themselves, third. In addition, the doctors we chose have the highest possible qualifications and they’re required to contribute to the overall organization.

When recruiting new staff, we look specifically for doctors with fellowships and high morals. They’re encouraged to grow and practice the highest quality of care, and to become partners. I feel that for a surgeon to be successful, efficient, productive and able to provide the highest quality surgery, he must live an appropriate lifestyle that includes a sound program for spiritual, psychological and physical health and well being.

If any one of these three break down, he’ll have a difficult time providing the appropriate concentration, attention and strength that’s required to do quality, repetitive surgery and patient care.

For example, if things aren’t going well at home with his spouse and children, these distractions can create complications and, certainly, loss of efficiencies and quality in surgery, not to mention patient relationships.

The initial office site we chose for rental was a 2,000-square-foot space in Southern Pines. When we were furnishing this first office, equipment was considered a key to the ophthalmic practice.

I started performing my surgery in a local hospital. The hospital where I operated initially wouldn’t agree to supply a vitrector, so I personally borrowed money to purchase a vitrector that I had to carry to and from the hospital in my 1969 Volkswagen Bug.

Eventually, the hospital saw the vitrector would pay for itself and purchased it from me. It was instances like this that helped enforce my commitment to having the best equipment available to me in my own practice.

Our practice has, for 22 years, always sought out the best equipment, as well as the best service for that equipment. We’ve made sure that employees are trained to properly utilize the equipment. Any equipment that’s been considered crucial, along with any required backup, have always been procured.

With continued growth at the mother clinic, we’ve established the first free-standing ambulatory outpatient eye hospital and clinic, which has grown from 26,000 to 42,000 square feet. Our facility exceeds all requirements — not only for surgery but also for taking care of our patients.

Every examination room at CEA has the same equipment located in the same place, so that any surgeon moving from center to center will be in familiar surroundings. Not only does this reduce your cost of equipment due to quantity discounts, but it increases the physician’s efficiency and productivity, if and when he moves from facility to facility.

We’ve standardized other areas to improve our ability to survive and prosper into the next millennium. We try to use uniform stationery, forms and other supplies in all of our offices so that we’ll have better purchasing power.

It’s important, but difficult, to avoid having multiple "private practices" with several different surgeons under one roof. Anything you can do to unify the personnel so they’re not one doctor’s personnel but the personnel of the organization is a plus for the organization and all of the doctors.

The operating room has maintained a very efficient group of nurses and technicians dedicated to providing the highest quality of patient care. They have managed a system to keep the cost of a surgical procedure to $120 (including the lens), primarily by using reusable equipment. There’s no waiting time between patients in surgery other than the time it takes the surgeon to move from one operating room to the other.

I use three ORs in tandem every afternoon with the other surgeons using the ORs in the mornings. The technicians and nurses are all cross-trained and help us to provide the highest possible quality of care.

We conduct patient surveys on a regular basis to ask how we’re doing and to find out what aspects of the facility and procedures could be improved. We have ongoing programs of checking the results of surgery to determine how accurate we are with the intraocular lens and surgical outcomes. We are continually trying to improve our efficiency and quality of care in the clinic. Our main problems have been patient waiting and parking, which we are constantly trying to improve.

In short, my practice is our practice. I’m basically nothing without the secretaries, clerks, technicians, nurses and the other doctors working together as a team to provide the highest quality, most efficient and productive care for our patients. I feel grateful for this large team pulling in one direction.

In the future, if we aren’t efficient and productive in providing quality of care, I don’t think that we’ll be able to continue in the practice of medicine. I think we’ll continue to grow and improve and make a good home for not only the doctors but the employees of CEA into the next millennium.