OASC | KEYS TO SUCCESS

Twelve Habits of Highly Effective Surgeons

EVERYDAY KEYS TO SUCCESS, FROM SHOWING HIGH-LEVEL LEADERSHIP TO PITCHING IN WITH OPERATION ROOM TURNOVER

By Erin Murphy, Contributing Editor

The Ophthalmic ASC posed this question to three successful surgeons: What are you doing that helps you, your practice and your surgery center thrive? Their answers ranged from punctuality to humility, laced with large doses of high standards and professional drive.

If you admire their success, you might consider adopting their successful habits.

POSITIONING THE PRACTICE

1 Show and share leadership According to Eric D. Donnenfeld, MD, medical director of TLC Laser Centers in New York and Connecticut and a founding partner with Ophthalmic Consultants of Long Island and Connecticut, when you’re building a practice or an ASC, success starts with strong leadership. “As part of the physician leadership, I’m committed to making the center a success not just for doctors, but also for our staff and everyone who walks through our doors. My colleagues and I are experienced in running large practices, and we work every day to make sure that everyone in our ASC understands and supports our priorities and participates in our strategies,” he explains.

Part of leadership is knowing when and how to delegate. Dr. Donnenfeld’s ASC has a full-time CEO who is committed to making it successful through careful oversight and analysis while building relationships with vendors, surgeons and staff. However, Dr. Donnenfeld feels that doctors need to drive decisions.

“We’re the ones who know what’s becoming available clinically, such as new technologies and medications. These innovations can impact patient care and improve the outcome of surgical procedures, which in turn may affect staffing and scheduling,” he says. “The physician leadership works hand-in-hand with our staff, and our CEO integrates the changes into our daily work flow.”

2 Leave the bubble. “When I started my practice, and every year or two since then, I’ve visited other practices and taken a few staff members with me,” says Larry E. Patterson, MD, medical director at Eye Centers of Tennessee in Crossville.

“Someone out there is doing something better than you are, and you can learn from them. Whether you want to learn the nuts and bolts of patient flow or how to set up the practice from a business perspective, just visit someone you know who’s not a direct competitor. You’ll pick up new ideas. Some surgeons or staff might even share their mistakes to help you avoid them.”

When surgeons want to visit Dr. Patterson’s practice or ASC, he agrees — but only if they bring their staff. “Folks from 30 states have come to watch us. I want to help, but only if the surgeon and staff learn together. That’s how change reaches their practice.”

3 Invest in the latest technologies. “When patients come to our practice, they have to feel that they’re in the right place to receive the best visual outcome,” says Dr. Donnenfeld. “That’s why I’ve always believed in having the best technology available in my practice and ASC.” Evaluating and embracing technologies early — interoperative aberrometry, MIGs, femtosecond lasers and toric and multifocal IOLs, to name a few, has really helped us grow. Improving patient care distinguishes us as a leader in our field.”

STAFFING STRATEGICALLY

4 Surround yourself with good, smart people. “It’s been said often – you have to surround yourself with the best people. We want technicians, assistants, nurses and administrators who are the very best,” explains Dr. Patterson. “When we need experience, we get it. When experience isn’t a necessity, we look for the right kind of positive, dedicated person — even if we find her working at a local supermarket — and train her to be a great member of our team.”

When Dr. Donnenfeld hires staff, he looks for specific traits that he says help his practice and ASC succeed. “Nurses and technicians make the practice run,” he says. “If they’re committed to excellence, to technology and to making the patient experience extraordinary, then things run seamlessly.”

5 Value an experienced, knowledgeable staff. Experienced employees are valuable to these physicians. To Steve Charles, MD, FACS, FICS, clinical professor of ophthalmology at the University of Tennessee College of Medicine in Memphis, staff experience in part drives his choice of where to perform retina surgery.

“I concentrate on working in one ASC, not in many different hospital ORs. It’s the difference between staff who only perform retina procedures once a week and those who do it 4 days a week. In an ASC, even the people who order supplies and maintain the OR are geared toward retina,” he explains. “A multifunctional hospital OR has hardworking people who mean well, but it’s a dysfunctional world for retina surgery. It could cost me in errors, outcomes and money.”

Dr. Patterson listens to what his experienced staff members are telling him.

“I have people who are so knowledgeable about what we’re doing and why we’re doing it that when I start to make a mistake, they catch it,” he says. “But that goes hand in hand with my duty to be open to what they’re saying. I want my nurses to feel confident and comfortable enough to say, ‘That’s not a good idea and here’s why….’ I can’t be lord and master so no one ever argues with me. People argue with me on a constant basis, and they’re usually right!”

6 Teach new technologies, but listen and learn how to implement them. “Whenever we embrace a new technology, we have our staff learn about it with us, and then we have CE dinners to train everyone,” Dr. Donnenfeld says. “I’ve been guilty of being impressed by new technology without knowing how to implement it into our practice. Now, rather than dictate what I’d like to do, I sit down with our staff and non-physician leadership and ask them how best to implement new technologies into our practice. Their valuable input is the reason we’ve been able to introduce so many new technologies with such success.”

PLANNING FOR SURGERY

7 Provide easy access to the information you need. When you’re in the OR, you may need access to a patient’s records and images. Dr. Charles makes sure that happens seamlessly.

“We have a strong relationship between my practice and the ASC, including crossover staff who travel with us to the OR,” he says. “We set up a virtual private network (VPN) to access patient records and images, such as OCT images we need before macular surgery. We also use the system to record what we really did in surgery. That’s important in complex retina cases, where we may have to do something we didn’t plan in advance.”

8 Prevent distractions. Surgery demands your full focus. Dr. Patterson gives explicit instructions to help prevent unnecessary distractions.

“I’ve had staff members deliver emotionally disturbing news to me during surgery, distracting everyone in the room and worrying the patient. Now I’ve made it clear that there is virtually no reason not to wait until after surgery to tell me something that could be disruptive. Once I start, I have to finish – it’s detrimental to add pressure to the situation. Even my family knows that they should only call in an emergency,” he says.

9 Review patient cases with staff before surgery. After seeing a patient in the practice, surgeons might not see the patient again until the day of surgery. Dr. Patterson takes time every day to review cases before surgery.

“Early every morning, two surgical coordinators and I gather around a computer for some advanced preparation and planning for a few patients. It takes just 2 to 5 minutes per patient to look over the biometrics, confirm the right lens choice and ask any questions we might have,” he says. “We save time and confusion on the day of surgery if we look in advance for anything that may have been missed, and it helps us avoid mistakes that could lead to inferior outcomes or litigation.”

EXCELLING IN THE OPERATING ROOM

10 Always be on time. “Surgeons who visit my practice often tell me they find it hard to keep the patient schedule running on time. Their staff tells me, ‘Please tell him that he’s late every day. We’re really stressed out from trying to cover for him and catch up,’ ” Dr. Patterson says. “Your staff has to be there on time and ready — don’t make them wait for you. I’m there at least 30 minutes before I’m scheduled for the first exam or surgery to answer questions and help, if needed. By being on time, I’m being respectful to patients and staff, and it contributes to a better work environment for all of us.”

11 Embrace new surgical techniques. Like technology purchases, surgical techniques eventually become outdated. Dr. Charles used to perform vitrectomy with buckles or vit-buckles but hasn’t used a scleral buckle in 15 years. Since 2003, he’s been performing only 25-gauge sutureless, trans-conjunctival vitrectomy and is converting to all 27-gauge procedures this month. He’s dismayed that not all of his colleagues have updated their approach.

“It’s arcane to combine buckle with vitrectomy. It causes additional pain, double vision and increased myopia, and you can’t use new-technology oils with that approach,” he explains. “Eventually, surgical techniques become obsolete — surgeons can’t keep doing what’s comfortable when a new approach is clearly better for patients.”

12 Operate as part of the team. To be a good leader, you have to be a participating member of the surgical team, Dr. Patterson believes.

“One of the easiest ways to lose the respect of your surgical team is to say, ‘Let me know when you’re ready,’ and go to the lounge,” he says. “I stay in the surgery center to be available for questions so no one has to hunt me down. When things are running behind, I jump in and help. I can move the microscope or foot pedals or a gurney, if needed. We all have the same goals, so we all work toward them together.” ■