OASC | INNOVATION
Embracing Innovation
Two ASC entrepreneurs explain how they embrace risk, creativity, and change
By Erin Murphy, Contributing Editor
When we hear the term “innovation,” we often think of “technological innovation.” And technological innovations, from new intraocular lenses to better electronic medical record software, are certainly at the forefront of ophthalmic ASCs. But innovations in the ASC also can take the form of new ways to smooth patient flow, improve the patient experience, attract surgeons, and more.
Two ASC entrepreneurs who embrace innovation sat down with The Ophthalmic ASC to discuss how they generate innovative ideas and incorporate them into their practices. Maria C. Scott, MD, is the founder and medical director of Chesapeake Eye Care and Laser Center and the medical director of TLC Laser Eye Center in Annapolis, Md. She is also the vice president-elect of the Ophthalmic Outpatient Surgery Society (OOSS). Jeffrey Whitman, MD, is president and chief surgeon of the Key-Whitman Eye Center, which has five locations in North Texas, and is vice president and president-elect of OOSS.
You both own ASCs. What relationship do you see between being entrepreneurial and being innovative?
Dr. Scott: The entrepreneurial spirit and innovative spirit blend very well. Both traits make people willing to take calculated risks to try new things and improve the status quo. It is difficult for some people to take that initial leap. Dr. Whitman and I did that when we opened our ASCs. It can be daunting and scary, but I think both of us agree that it was a wonderful choice to improve efficiency and the patient experience as well as a good financial decision.
Dr. Whitman: A key part of being an entrepreneur is having an open mind. We’re open to new ideas and willing to try something new. We also like to tinker with things. Even when the business is running well, we continue to comb through the journals and listen to ideas for more efficient business practices, better surgical techniques, or new ways to improve patient flow. We have the power of mind to discard something good so we can do something better. When you succeed at making great changes, it’s very rewarding, both personally and financially.
What projects do you tackle with an innovative approach?
Dr. Whitman: We all have challenges. The innovation is in how we attack them. For example, we want to continually improve our services and keep physicians and staff working and happy. Today, we see patients as clients or customers who have choices in health care, so we try to appeal to them with a friendlier environment. We search for creative ways to meet these goals.
Dr. Scott: I’m looking for physicians, administrators, and staff to find innovative ways to address three things: new regulations, patient outcomes and satisfaction, and costs. If an idea scores well in one or all of those three areas, it will have a positive, measurable impact.
If an idea does not demonstrate those benefits, we pass on it. Regulations, for example, give us a context for innovation whether we agree or disagree with them. Innovative people look at the regulatory hand we’re dealt and say, “That’s what they want. How do we get there?”
If you “embrace innovation,” does that mean you’re frequently making major changes?
Dr. Whitman: We make changes when it benefits us. We weigh the pros and cons of new innovations, particularly with new technologies. For example, procedures with the femtosecond laser may take longer, but can produce a better result.
However, just because something is new doesn’t necessarily mean it’s an innovation — or even a positive change. For example, some new instruments are a lateral move in terms of outcomes, costs, or efficiency. They don’t give us a compelling reason to change.
Dr. Scott: Sometimes an innovation is worth it, even if it hurts efficiency. For instance, we’ve all taken a step back in efficiency for both cataract and laser surgery as new techniques and technologies have come along. They can slow down the surgical process, but they help us reach our ultimate goal, which is better outcomes.
How does innovation drive quality improvement?
Dr. Scott: Today, none of us would accept the outcomes we had 10 years ago. Innovations such as LenSx (Alcon), the ORA System (Alcon), and fourth-generation IOL calculation have driven better results, including 20/20, presbyopia-free patients. We incorporate new innovations with our years of experience in the ongoing effort to perfect outcomes.
Dr. Whitman: We all make incremental improvements in quality all the time, but incremental change has its limits. Without innovation, the drive for better-quality outcomes stagnates.
How do you create an environment that nurtures innovation in your ASC?
Dr. Scott: Dr. Whitman and I both have amazing administrators. When you’re an ASC entrepreneur and you find an administrator who shares your mindset, it’s second nature to hire staff with the same outlook and to nurture innovation in the practice.
Where Do You Look for Inspiration?
Journals and meetings: For in-depth coverage of innovations from techniques to technology to the business of health care, industry journals and professional meetings offer a great deal of inspiration. The information offered by authors and presenters also helps people determine if an innovation will fit their specific ASC.
Colleagues: Friends and medical colleagues are often open to discussing what works and doesn’t work in their practice or ASC. By visiting each other, colleagues can see new innovations at work and find inspiration for their own practices. “One thing I love about ophthalmologists is how much we share with each other,” Dr. Scott says. “In my opinion, more than any other specialty, we’re innovative, entrepreneurial, and willing to impart our experiences.”
Patients: “We ask for customer feedback in surveys all the time. I have received some wonderful ideas from patients to improve the experience,” says Dr. Scott. “The best idea was given to me by a patient's daughter 15 years ago. She made a check-off chart for every time the patient took her drops. We still incorporate a version of that chart in our post-op packets today.”
How Do You Inspire Your Staff?
In this discussion, both physicians explained how they create a work environment that nurtures innovation. But how can you take that a step further and actually spark innovation? According to Dr. Whitman, face-to-face meetings engage and energize his staff, while making him feel more connected as well.
“We can encourage feedback and productive dialog as a group,” he explains. “It doesn’t require a great deal of time — I meet with our ASC staff once a month for a half hour. We talk about what’s working and what isn’t working. If we have new surgeons, we talk about how we can help them be more efficient. People ask questions or make suggestions.
“Recently, I’ve shown videos of our surgeries. I explain what I’m doing and what I need at various points in the procedures, and that helps nurses anticipate those needs. For example, they better understand when I need a clear view, so they can irrigate without me telling them to do it. Staff who don’t work in the OR say the videos are interesting as well because they get to see our work and understand it better.”
Because the most efficient model for patient flow in his ASC means Dr. Whitman stays in the OR most of the time, these meetings are an opportunity for him to learn and connect, too. “If I didn’t have these face-to-face meetings, I wouldn’t hear directly from employees at all levels. I also wouldn’t learn about problems or potential problems. This keeps me in touch, and it keeps employees in touch with the larger picture. If physicians want to use their time to encourage innovation, I think this is a good way to do it.”
Dr. Whitman: When you want to innovate, you welcome ideas, wherever they come from. Our staff is knowledgeable and well trained, so I want their input. I want all of our technicians, nurses, or coding experts to question whatever they think is not right or speak up when they think of a better way to do something. And we do get that feedback. People push the envelope, doing extra work to improve our practice.
When staff go above and beyond to come up with innovations, how do you recognize their efforts?
Dr. Scott: It’s important to recognize those people. And they’re often our best help in bringing in other great employees. When a staff member recommends a new employee we love, the reward is a $500 check. It’s more than worth it to find someone with the personality traits we want.
Dr. Whitman: We recognize people’s ideas in front of their peers, but I money talks. So in our ASC, a good idea can earn employees a bonus. The idea often saves more in efficiency than the money we pay, and the bonus makes everybody want to think of something.
We also have a quarterly, goal-based bonus system, but employees don’t receive a bonus if the practice doesn’t perform well that quarter. We want everyone to receive regular feedback on their work and have a connection to the practice’s progress. This way, they have this sense that we’re all in it together, and I think that’s part of the reason our turnover is low.
What innovations have you implemented in your ASC?
Dr. Whitman: Our specialty is always changing. There are always new possibilities to consider for those of us who reach for them. We’re building a larger research area in our clinic to support our involvement in clinical trials. We’ve also begun using an infrared tracking system for doctors and patients. It lets us follow people through the system so we can analyze and improve bottlenecks. It’s helping us meet our bottom-line goals for efficiency. We’re instituting a free valet service to improve the customer experience as well.
Dr. Scott: We’ve just remodeled our ASC, and we incorporated 60-inch flat screen monitors to display patient charts in the OR. Instead of squinting in the darkened OR to see the biometry or the IOL calculations, I can see them very clearly at a glance. And staff can watch a screen in the LenSx room to know when we’re finishing, as well as in the kitchen/break area to know when to prep the next patient. That makes us more efficient. ■
INNOVATION IN FUTURE ISSUES
Future issues of The Ophthalmic ASC will explore this topic in more detail in a new column called ASC Innovation. In each issue, experts will share innovations they’ve implemented in their ASCs and offer tips on how colleagues can improve outcomes, efficiencies, patient and employee satisfaction, and other important elements of the ASC environment.
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