Struggling to Find Real Success?
Follow the leads of two surgeons who forged different paths.
By Alan Aker, M.D., F.A.C.S., Boca Raton, Fla., and Brian R. Will, M.D., Vancouver, Wash.

LASIK is transforming ophthalmology. Surgeons are reinventing themselves and their practices to provide quality care under circumstances they're not accustomed to -- an elective procedure sought by a different kind of patient.

To complicate matters further, the market has evolved with lightning speed, throwing more roadblocks in the way, including price-slashing corporate LASIK providers, rapidly evolving technology, a new focus on marketing, and the need to teach staff members new patient-interaction skills.

All of these factors have combined to make success with LASIK elusive for many. But some practices have found their way through the maze, making changes that have brought notable success.

In this month's cover story, we bring you two such practices. One doctor re-created his practice environment to accommodate both cataract and refractive care under one roof, despite being told it wouldn't work. The other chose to build a refractive-only center from the ground up and, against significant odds, created a remarkable success story.

Struggling to Find Real Success?
Redesigning to Incorporate LASIK Into a Large Cataract Practice
By Alan Aker, M.D., F.A.C.S.

Our practice, currently known as the Aker-Kasten Vision and Laser Center, came into being 15 years ago. It began as a center designed exclusively to treat elderly patients with cataracts and glaucoma. At one point we offered radial keratotomy (RK), but because of the geriatric and surgical focus of our practice, we discouraged routine examinations and saw few young patients.

Then, sometime around 1989, the surgical possibilities offered by the excimer laser became obvious to us. By the late 1990s, the FDA had approved several procedures, and we were ready to incorporate refractive surgery into our practice. However, we had no intention of giving up our cataract and glaucoma practice. We wanted to provide all of our care in one facility. We knew this wouldn't be easy because our practice and staff had increased dramatically over the years. Space in our 15,000-square-foot facility was now extremely tight. But we tried our best anyway, starting with a laser that we rented once a month.

This didn't work out. And purchasing our own laser created new problems. (See "Why Our First Attempt to Add LASIK was Problematic," .) It was becoming clear that one of the biggest barriers to adding refractive surgery to the practice was our physical plant. The layout simply wasn't adequate; we'd have to make changes. Furthermore, any new design would have to appeal to and meet the needs of younger patients, and help us manage a whole new paradigm of patient flow.

They said it couldn't be done

As we began planning the renovations, we considered hiring a consultant to help us. However, we had the opportunity to talk with several consultants who were involved with the laser companies we worked with. We found that their opinions were nearly unanimous. "You can't mix old and young patients," they said. "You need to create a separate site for refractive surgery."

Although we understood the reasons for their opinion, we respectfully disagreed. We were determined to integrate the new procedures and patients into our existing practice.

Because of the disagreement, we opted not to hire a consultant to help with the project. But as it turned out, the negative feedback from the consultants was a blessing in disguise, for two reasons:

• It made us sensitive to the problems inherent in integrating two very different practices into one facility. That helped us make better choices during the planning process.
• It increased our motivation. We were determined to prove the consultants wrong.

I believe we have, and the results have been both spectacular and educational. In this article, I'd like to share the story of our practice's transformation over the past year, including many lessons we've learned and some excellent ideas that may inspire positive changes in your practice.

The planning begins

Our initial expansion plan was to acquire additional land and build a 10,000-square-foot addition to the center. The addition would have wrapped around our existing facility, providing separate parking and a separate entrance for refractive patients.

However, we began to see potential drawbacks to this plan:

• A separate facility would eliminate some of the efficiency that comes with being able to move quickly from the operating room to the clinic.
• A separate facility would result in some staff redundancy.
• The land acquisition and construction would be time- consuming. In view of the rapidly growing interest in refractive surgery, we felt we needed to move more quickly.

It seemed reasonable to us that a truly well thought-out design could make far better use of our existing resources. And, of course, working with our existing space was a far less expensive alternative.

Once we decided that building an addition was not the way to go, our next challenge was to decide what specific items and characteristics we wanted our transformed physical plant to include. We began by analyzing what was wrong with the current building layout.

As a result of shifting various activities to different locations over the years, the work environment was less than ideal for many of our staff; we needed to rescue them from "rat maze and cave environments." So, to make sure we had their input, we asked each of our teams to develop a "wish list" for the new facility. The staff responded with valuable suggestions regarding patient flow, location of exam rooms and layout of areas for specialized testing. Most of their suggestions were eventually incorporated into our construction plans.

The plans themselves were initially roughed out -- during a 6-week period -- as modifications to the existing floor plans. Then we began a month of formal planning, including numerous meetings with our architectural advisors. As we developed the plans, we shared them with various staff teams to get their comments and make sure their wish lists were being addressed.

Maximizing space

One of our biggest concerns during the design phase was maximizing all available space within the center. (After all, we had downgraded our plans from a 10,000 square foot addition to an aggressive renovation of our existing space.)

Happily, we discovered that the center really did have a lot of poorly utilized space. For example, while some staff members had been working in overly cramped quarters, the switchboard had been in a larger room than was necessary.

Also, we found that we could eliminate some parts of our business altogether. We'd been providing a small pharmacy for our patients' convenience, but we realized it took up a lot of space. It was also just breaking even financially, and many of our patients had begun getting their medication through managed care plans. So, we decided to phase it out.

Modifications like these resulted in a much more efficient use of the space available within our facility.

Preparing for construction

Once planning was complete and everyone was satisfied that their needs would be met, we moved into the construction phase. We wanted to accomplish this in such a way that the center would be closed for as little time as possible. To that end, we divided the work into three phases:

• In phase one, a new laser suite would be constructed in a prominent location on the main floor. Because construction would be restricted to a specific area, we felt this could be accomplished without closing the center.
• Phase two would include most of the interior demolition and rebuilding. This would force us to close the center briefly.
• In phase three, six garage spaces would be enclosed to create a central business area, offices and room for our records. Because this would take place on the periphery of the building, we expected to remain open during this phase.

Phase one: creating the laser suite

We decided that the new laser suite would be in the front half of our business area. We would replace a series of small, separate rooms with one large, friendly room enclosed by glass walls on two sides, an idea we had first seen used by our former partner Dr. Brian Will. (See related story) The walls would have floor-to-ceiling curtains that could be lowered to allow privacy. When the curtains were raised, other patients could see into the room -- and watch any activity taking place inside.

To minimize downtime and loss of clinic and surgical activity during this phase, we scheduled it during the relatively slow month of July. In addition, to minimize disruption:

• We arranged to have all demolition work done after clinic hours so patients and staff were spared the noise. We also made sure the workers were meticulous about cleanup each evening after they finished working to minimize any dust problem.
• We left all the external walls in place until we were ready to install the new floor-to-ceiling glass walls. As a result, patients were actually unaware of the ongoing renovation.

The old walls were taken down after clinic one Friday. During the weekend, the laser and new glass walls were installed, although much work besides the demolition (such as installing the dedicated A/C unit and plumbing and electrical work) had been done behind the old walls during the preceding 2 weeks.

On Monday, patients arrived to see a beautiful glass-enclosed laser suite that seemed to have magically appeared over the weekend!

When the last details were finished, the result was truly beautiful. The room, which was decorated by Dr. Kasten-Aker to create a high-tech, yet warm appearance, features:

• the two new glass walls
• a new floor
• specially designed woodwork, attractive paintings and sconces on the two traditional (nonglass) walls
• warm lighting
• a beautiful Amish quilt on top of the laser
• an attractive sink area, specially designed to look "homey," not clinical.

(For a picture of the new arrangement, see "Letting LASIK Sell Itself,")

Construction: phase two

The next step in the renovation process involved redoing much of the remainder of the building. This took place over 3 or 4 weeks. Because it involved significant demolition and hauling away of material, we realized we'd have to close the center for at least 2 weeks. August was another traditionally slow month, so we caught up on our surgical cases early, allowing us to close down the entire center later in the month. We encouraged staff to take their vacations during this period, which worked out well, as many of our staff members were able to enjoy time with their children during the summer break from school.

During this phase we made numerous major changes:

• We replaced all the old carpeting.
• We replaced all of our dropped ceilings with a new grid and tiles.
• We replaced almost all the wallpaper in the center.
• To help achieve the desired separation of cataract and refractive patients, we redesigned a portion of our center to allow for a separate refractive waiting area.

In contrast to the more traditional waiting area for cataract and glaucoma patients, Dr. Kasten-Aker set out to give the refractive waiting area the feel of an upscale living room. Instead of elder-friendly chairs with arms, Dr. Kasten-Aker placed designer chairs, a comfortable couch, a coffee table and some nice art and accent pieces in 

the new refractive waiting area. Magazines geared to this younger, more affluent population were provided instead of copies of Reminisce and Reader's Digest. (See photo)

• Offices for members of the LASIK team were constructed adjacent to the new waiting area. Before the renovation, our refractive coordinator had no private office and had to do consultations in one of the exam rooms. She now has her own office, with a small adjacent room expressly for consultations.
• We created a central open area in the practice for special testing, with separate cubicles for our EYESYS unit, Orbscan, IOLMaster and other instruments, and a waiting area inside the room. This was a big improvement over the small, crowded room previously used for testing.
• We created an attractive separate area for our staff optometrists.
• We had connections for our computer network installed in every room -- including rooms with no computer. As a result, we're prepared for any future needs that may develop.
• To replace our inadequate lunch area, we enclosed three of nine covered garage spaces. The result was a much larger lunch area complete with tables and seating for at least 40 staff members. We provided two large refrigerators for employee use, along with several microwave ovens, a traditional oven and stove, a dishwasher, sinks with disposal units and vending machines.
  The new lunch area also serves as a large staff meeting area for showers and birthday parties, as well as a large bible study class that's held Friday mornings before clinic hours.
• Before the construction, the billing team worked in the old patient education theater, which was small, dark, hot and had no windows. Construction of the new lunch area enabled us to move the billing office into the old lunch area, which is larger and has several sunny windows.

With the new office layout, patient flow is straightforward and family-friendly. Refractive patients wait in their specially designed, uncrowded waiting area, where they receive their eyedrops. When ready, they simply walk across the hall to have surgery, and the glass walls allow any family members to watch, if desired. (When surgery was performed on the second floor, space was at a premium, so we rarely invited families to watch the surgery.) After surgery, they return to the waiting room for more drops, and then they're sent home.

Phase three

The final phase of construction -- enclosing six of the remaining covered parking areas to create a central business area -- is still to come at this writing. Even though this phase of construction won't force us to close the center, we decided to postpone it until summer 2001 to avoid having to deal with any possible disruption during our busiest time of the year.

Moving several offices and our records into this new area will not only provide more comfortable spaces for the people using the new offices, it will also free up space that we plan to use for an optical dispensary and/or audiology center. (This area will be enclosed with glass walls on two sides as well.)

Outcome: excellent

The reviews are in for phases one and two, and they're glowing. Our staff is thrilled with the improvement in their working environment, and the change in patient flow has made everyone's job easier. Our staff members have been empowered by the process, because each of them had a hand in determining the design and layout. And they're visibly proud of the first class environment we've created for the patients.

Even more important, our patients are dazzled by the new surroundings. They "ooo" and "ahhh" about how beautiful everything is. And make no mistake -- this pays off in a concrete way. The tasteful, friendly, state-of-the-art environment -- combined with our thoroughly trained and completely professional staff -- regularly makes patients out of people who only meant to be passing through.

Profiting from experience

Here are some of the things we've learned from this experience that may help you if you're thinking about making a similar kind of change in your practice:

• A grandiose plan isn't necessarily best. Our original idea to build an addition that would wrap around the existing building wasn't a bad idea . . . but we're all glad we changed our plan. If we'd followed Plan A, the cost of purchasing land and building the addition would have been between $2 and $2.5 million. Plan B is producing a streamlined result that meets everyone's needs and impresses the heck out of our patients, for about half a million dollars -- one fifth of the cost. Also, Plan A would have taken 9 months to a year to complete. During that time we would have had to deal with truckloads of dust, mud and inconvenience.
• If you plan to combine refractive surgery with an existing cataract and glaucoma practice, keep both within one building. You'll achieve great economies in time and effort because of the proximity, and you'll save by not hiring redundant staff. At the same time, do provide your refractive patients with a different waiting area so you can create the most appropriate atmosphere for each group of patients.
• Include all staff members in the planning process. This will ensure a better result because your staff picks up on lots of things you may miss. It also empowers them and makes them part of the process, so they'll be happy to make accommodations during the construction period.
• Make your laser suite visible to other patients. This is one of the best ways to market your refractive surgery services. However, make sure the room looks as inviting as possible; otherwise the positive effect will be undercut.
• Plan construction to minimize patient and staff inconvenience. Arrange for the work to be done after hours, during the summer, and whenever possible behind walls and out of sight. If you have to close your practice for a period of time, schedule the closing when your staff will be glad to get the time off.
• Be prepared for future developments. If you have a computer system, make every room accessible to the network.
• Don't forget staff accommodations. Better working conditions (including the lunchroom) make for a happier, less-stressed out staff.

Looking ahead

Do we have any regrets? None, so far. It would have been nice to have finished the entire project last summer, but the results of phases one and two have been so positive that everyone is anticipating the rest of the construction with pleasure.

What about the long-term future? Our practice continues to grow, so it's possible that some day soon we may consider opening satellite offices, and our existing center may need additional space. If we do build an addition at that time, we've talked about creating another building like this one, connected by a large working corridor with exams rooms along the side. But we should be able to function effectively in this space for at least several years.

As for me, I enjoy coming to work in the morning, even more than I did before. And that's a good thing, too. 

Dr. Aker is Ophthalmology Management's chief medical editor.

Principles for a 21st Century, Refractive-Only Center
By Brian R. Will, M.D.

In 1997 I left a highly rewarding practice position performing cataract and refractive surgery in South Florida to move more than 3,000 miles across the country with my family. I was driven by a simple but resolute desire: to launch a practice of my own in the beautiful Pacific Northwest. The only real assets in my possession were the skills and knowledge that I'd learned over the years from interacting with some of the most successful and influential ophthalmologists in the world.

Despite getting off to a slow start, we've grown our fledgling refractive surgery practice into one of the most successful refractive surgery providers in the nation. I believe our success is the result of honoring a number of principles that have long been core values of our profession.

If you're developing a refractive practice, I suspect you're encountering many of the same problems and choices I was faced with. Here, I'd like to share some of the principles that have led to our success -- and how we've implemented them at the practical level.

Principle one: Actively work toward zero-defect surgery

During the years of my residency, I had the opportunity to visit and observe several high-volume cataract surgical centers. My concern at the time was whether true quality care could be provided under such circumstances.

To my amazement, I found that the quality of these surgeons' work was extraordinary (and very different from mine!). They either never produced serious surgical complications, or they managed them so effortlessly that the patient and optometrist hardly knew the difference. That experience demonstrated to me the power of an uncompromising pursuit of surgical excellence, and led me to commit myself -- and my practice -- to a "zero-defect surgery paradigm."

Two strategies, in particular, have helped us make great strides in this direction:

• Following the principles of "kaizen." "Kaizen" is a productivity model sometimes referred to as the Total Quality Improvement Process. ("Kaizen" is Japanese for "continuous improvement.") It involves asking people to perform a task tomorrow better than they did today. It starts with the belief that everyone can be inventive and innovative.
  Here are a few of the kaizen principles that we follow:
  • We never accept avoidable surgical error.
  • Our surgeons make the effort to learn as much as possible from other surgeons.
  • We study our complications diligently. (You can't fix what you don't understand.)
  • We encourage our staff to help us understand why a particular surgery went well or poorly. We teach them to always look for ways to improve the care we offer -- including changes that we, the surgeons, need to make.
  • We question the value of everything we do and eliminate what has little or no value.
  • We make a point of being observant. We try to learn from every patient, and we track the results of every system change that we implement.
  • We anticipate potential problems. We give careful preoperative examinations and work to prevent complications before they occur.
  • We require that each staff member implement a system change each day that makes the organization and/or a process better. Uncritical repetition of a routine learned from someone else leads to stagnation.
• Minimizing human error. Maintaining quality in a high-volume refractive practice requires exquisite attention to detail. This means eliminating the opportunity for transcription errors, laser programming errors or other sources of human error that can mar surgical outcomes.
  We've accomplished this by planning for all contingencies in advance; we build firewalls to prevent potential disasters. Because we're a high-volume center, doing the right thing the right way every time -- while following a plan to manage resources -- requires the use of advanced information technology. For that reason:
  • We've developed sophisticated computerized validation algorithms and error-checking routines that eliminate the potential for clerical error during data entry.
  • We've equipped our computer program with all of our personal treatment protocols and nomograms. Our laser settings, microkeratome selection and adjustments, ablation depths, blend zones, pupil sizes, drug allergies and other treatment factors are all organized by the computer system before the procedure. As a result, I can review treatment plans the evening before surgery on a computer in the office or at home.

The bottom line is that this is essential if you hope to avoid disaster in a high-volume setting.

If your volume is smaller, and your practice is less computer-savvy, you can go a long way toward accomplishing the same goal by creating a system of checks and balances to catch errors in measurement or transcription. Before we had our computer system, two technicians took each crucial measurement independently; both of them filled in blanks on a form. The patient wouldn't go into surgery until the form was complete and our most experienced person checked the numbers to make sure everything was in agreement.

Regardless of the size of your practice, you need to implement controls at the front end, and make this your motto: Avoidable mistakes are simply not acceptable.

Principle two: Use the best available technology, regardless of cost

We currently use two Alcon LADARVision excimer laser systems and one VISX Star S3 for all of our LASIK surgery. (Our Summit Apex Plus is "archived" in our basement.) Many of my colleagues, concerned about competitive LASIK pricing, say they simply can't afford technology like this. However, when it comes to patient care, I always prioritize medical concerns over personal financial ones. My experience has taught me that you should never compromise on surgical quality or technology because of supposed economic considerations.

The simple fact is, low-end equipment produces more complications. Many surgeons make cost control their highest priority, but this backfires. If you do whatever is necessary to purchase the best equipment, you'll eventually leave your competitors behind.

For example, several LASIK chains have tried to move into our area. Every one has failed to penetrate the market. Patients know that we have tracking lasers and can treat large optical zones; most of them simply can't rationalize having their surgery done anywhere else. Buying the tracking systems was expensive, but it was one of the best decisions I've made.

Principle three: Hire the right people

Your staff is the ultimate expression of your practice personality and character. In our practice, our character and reputation begins and ends with compassionate care.

I've learned two key ways to ensure that our staff delivers that kind of care:

• Hire most employees from the customer service sector. In the refractive surgery business, customer service is of paramount concern. Unfortunately, it's been our experience that employees who've worked in the medical field often see patients as an inconvenience, and tend to avoid or even ridicule problem patients.
  In our practice, except for one or two highly technical positions, virtually all of our employees come from a customer service background. In fact, we avoid hiring people with a medical or ophthalmic background.
• Choose employees for character, not training. Over the years I've learned that you can always teach talented, bright, caring people to perform skilled ophthalmic tasks. However, you can't teach uncaring, indifferent, highly trained, skilled ophthalmic technical personnel to care about patients.

And remember: A caring staff is also your first defense against an unhappy patient becoming an unhappy lawsuit.

Principle four: Treat staff members like family

Don't expect your staff to care about you or your patients if you don't care about what happens in their lives. To attract and keep the best employees, tangibly demonstrate that you care about their personal success as much or more than your own.

• Educate your staff at every reasonable opportunity. Provide the resources to make them experts in their respective fields. (You're never any stronger than your weakest employee.)
• Empower your staff. Make it clear that you expect staff members to take personal responsibility for their actions, and encourage them to succeed beyond their own expectations.
• When staff problems arise, don't accuse individuals. Fix the process, not the person.
• Seek out specific ways to make each of your employee's lives just a little better. Remember: They have the same needs, desires and dreams that you have.
• Prevent health problems and accidents. Make your practice a safe place for everyone to work.
• Celebrate personal diversity. Make it your job to identify each staff member's strengths and abilities and develop and exploit them to their fullest.
• Be there for your staff when they have personal problems. We've helped with auto repairs and during illness and family crises. We've given staff members weekend getaways and dinners as thank you's. When everyone's had a stressful week, we hire a massage therapist or manicurist to come into the office, or give everybody a $50 gift certificate. Sometimes we order pizza or hand out movie tickets.

We also support family concerns. We pay for our staff to attend a once-a-year marriage seminar, if they wish to -- including paying their hotel bill.

This sounds expensive, but it isn't. We're able to hire the best people, and they're intensely loyal. And that makes a big difference in our success.

Principle five: Be a good manager

You're not just a surgeon -- you're an employer. To keep things running smoothly:

• Don't try to micro-manage your business. Instead, encourage self-management within broad boundaries. Your employees are often better equipped to identify problems and propose solutions than any management op-erative or supervisor. This also heightens self-esteem, improves performance and productivity and encourages innovation.
• Reward team players. "Superstars" are never an asset for long.
• Choose your management software wisely. We use Fast Task, a resource-based scheduler and management tool that has worked wonders in our practice. It's given us the scalability and flexibility to seamlessly operate multiple office locations over an Internet-based wide area network.
  When we book an appointment, the system automatically generates tasks for appropriate personnel, and the tasks are displayed on their workstations. At each stage of the process, from initial contact to preoperative assessment, surgery and postoperative follow up, the system automatically coordinates the collection of both clinical and financial data.

Principle six: Meet your patients' high-tech expectations

The public thinks of LASIK as an exceedingly high-tech medical procedure that represents the leading edge of innovation and technological advancement in eye care. The more you support that perception, the happier your patients will be, and the more highly they'll speak of you to their friends.

To meet your patients' high-tech expectations:

• Showcase your technology. We designed our practice to look warm and friendly -- and high tech. For example, we placed our excimer laser in a room adjacent to the main reception area enveloped in floor-to-ceiling glass. This works extremely well for our weekly live surgery seminars, and it also projects the distinct impression that we have nothing to hide.
  We've also placed our topography and Orbscan units in a highly visible (and highly efficient) pre-test area. This not only lets us showcase the technology, it's very effective when performing screenings on the dozens of patients who attend our educational seminars.
• Upgrade your consent video. Rather than have our patients watch their consent video on something as mundane as a video player, we present ours in digital MPEG format. Patients can view it in the office on a personal DVD player or via a wireless handheld computer that streams the video files directly from our server.
• Let advanced technology help patients share their experience and promote your practice. Many patients would like to watch their surgery being done and be able to show it to their friends and family. In our experience, using videotape for this purpose is of little value. Videotape is accessible only on a "linear" basis; it's cumbersome and inefficient, particularly if you plan to add any potentially annoying marketing or promotional segments. Besides, video players aren't readily available where most of our patients work, so co-workers and colleagues can't see the tape.
  To circumvent these problems, we developed our own customized, personalized CD ROM that operates in any computer equipped with Windows 95 or later. It contains a multimedia production featuring a digitized copy of the patient's laser procedure, along with multiple educational segments that can be accessed directly and played in any order. The CD ROM:
  • highlights our center
  • describes and introduces each of our staff members
  • educates the viewer about the services we offer and the advantages of our excimer laser devices
  • provides answers to frequently asked questions
  • displays office addresses and maps, as well as our Web site information
  • contains vignettes of patient testimonials and television news briefs underscoring our center's accomplishments.
    This format is easily shared with friends and co-workers, and the CD ROMs invariably make the rounds in the patient's workplace. They serve as an high-impact informational and promotional piece, and they certainly leave a "high-tech" impression with the viewer.
• Create unique, high-tech promotional materials. In addition to the CD ROMs described above, we've created a credit card-sized interactive promotional compact disc for general patient distribution. Its content is completely different from the patient CD. It includes:
  • a virtual office tour that allows patients to enter various rooms (such as the laser suites) and rotate the room 360° around them. They can navigate from room to room using the computer mouse.
  • a virtual surgery experience in 3-D. Prospective patients can simulate walking into the laser suite, lying on the bed, looking at the fixation diode, hearing the laser fire, and then sitting up from the procedure and having their world suddenly burst into dynamic focus.
• Use the potential offered by your Web site. Patients who visit your Web site these days expect more than attractive artwork and your autobiography. Your Web site should be a true source of content and information, and it should convey your commitment to leading edge technology. Captivating content, such as a virtual tour using IPIX format and flash, will separate you from the pack. For example, we stream our weekly live surgery seminar onto the Internet to be viewed live by anyone who is logged on. We also archive a recent copy that can be viewed at any time. (You can visit us at www.willvision.com.)

Creating all this high-tech material may sound like an expensive proposition. However, we did it one step at a time. More important, we did it without help from any consultants. We simply looked around for a college student with a gift for working with computers and high-tech equipment.

Once we found him, he was happy to work for a reasonable wage, and created everything that we were able to think up. In fact, if he didn't know how to do any particular task, he was delighted to go out and learn to do it. (And most of what he's created for us is far better than comparable items I've seen that were created by highly paid computer consultants.)

Principle seven: Don't skimp on marketing

Reaching potential patients with your message is a key to success in refractive surgery. Practically speaking, marketing happens two ways:

• Word of mouth. In the world of refractive surgery, nothing can ever equal the marketing power of word-of-mouth referrals. Everything that you and your organization do for a patient -- or for your community -- is marketing. In fact, it's the most compelling promotional program under your direct control, and no external marketing program will be successful unless you consistently deliver high-quality, compassionate, service-oriented professional care.
• Media advertising. Don't ever "nickel and dime" your external marketing, and never underestimate the market strength of "branding." Market presence and impact requires high quality, high frequency and high connectivity. Keep your media presence both personal and professional; let it reflect your own individuality and passion for excellence.

Maintaining a successful external marketing program is a lot like driving an expensive, high-performance racecar. To win the race you have to keep your eyes focused straight ahead, keep your accelerator to the floorboards, avoid braking on corners and not be distracted by how fast the gasoline is being sucked through the engine. The only measure of your success is how fast you're going, how far behind your competition is, and whether you'll reach your intended destination given your current "mile per gallon" burn rate.

Doing it right pays off

If there's a moral to this story, it's that it pays to stay focused on making everything about your practice the best it can possibly be. Hire the best people and treat them better than any other employer would. Always buy the best, most advanced equipment and make sure your potential patients know you have it. Create protocols to eliminate the possibility of disastrous errors. Strive to improve something about your practice every single day. Be a good manager. Create a practice that's dazzling in both its warmth and its high technology. And then market the heck out of it!

Following these principles has made our practice a huge success. And it can do the same for yours. 

Brian R. Will, M.D., is president and chief executive officer of Will Vision & Laser Centers in Vancouver, Wash. He is former chief of refractive surgery at the Aker-Kasten Laser Vision Center in Boca Raton, Fla., and has served as a project director for the International Institute for Advanced Laser Surgery. He's certified by both the American Board of Ophthalmology and the American Board of Eye Surgeons.