In part two, we apply Design to practice communication.

Meetings are an acquired taste. From the moment I began practicing medicine, I despised sitting around talking problems, budgets and projections. I didn’t mind the comfortable chairs in the conference room of the hospital-based faculty practice or the nice meal that sat on top of the long mahogany table. I even enjoyed the company of the people at this weekly meeting.

I minded meetings because I wanted to act, not sit and talk for 2 hours. Half the discussion had no relevance to my practice, and the other half was likely not going to be relevant in the immediate future. Best-case scenario was a committee would form to further discuss the issue at another meeting.

I vowed to abolish these horrible, no-good meetings a year later when I started my private practice. My mantra became “Let’s discuss as we work.” I set up protocols to guide the front desk and clinic area, and, as problems came up, they were dealt with in the hallway, on the spot. This worked great … until it stopped working at all.

MY MEETINGLESS PRACTICE

Over the next 7 years, the practice grew and the number of both employees and locations tripled … as did the number of issues that came up each day. My protocols increased, too, from just one page to an entire handbook. My solution was to let middle management handle the office while I hid from my practice in the exam room.

One day I came out of the exam room and, metaphorically, did not recognize my practice. Managers were handling patient concerns in a manner with which I did not agree. Staff turnover was unacceptably high and new employees were not demonstrating the work ethic and corporate culture necessary to grow the practice. Patients were complaining to me about these issues during exams.

At first, these complaints annoyed me because the exam room was supposed to be my safe space. But I realized these patient concerns were legitimate and needed to be fixed. I knew the solution required figuring out a way to communicate with patients and staff. And I knew that would require the hated word: meetings.

MEETINGS REIMAGINED

However, I realized it was possible to reinvent the meeting my way. The goal is to create meaningful interactions that result in solutions emphasizing patients’ best interests. Strategic establishment of communication eventually will allow for growth of the practice, while also creating a corporate culture that staff and patients come to value.

You have the power to improve and control information, so take the initiative. While this is obvious for a practice administrator, physician owner or chief executive officer, even a new physician or technician should create a meeting for their “bubble.” Set time aside to discuss clinic flow or workups with techs once in a while. A surgical coordinator should initiate meetings with OR staff. A member of the billing team should ask to meet with providers to review coding and rejections. Taking control to establish venues of communication, no matter how small your role is relative to the practice, will improve the facet of the practice in which you work.

DESIGN APPLICATION

In my prior column (www.ophthalmologymanagement.com/issues/2021/june-2021/financial-factor ), I introduced the four principles of Design; we can now apply them to create effective communication.

The first Design principle is to create specific ways to optimize a function so that it brings value to user and producer. This requires you to identify the user and producer — which is not always obvious. The problem may involve more complicated solutions, such as including the patient or the vendor in the conversation. Yes, sometimes to arrive at a solution it’s best to bring a live, talking patient to the table in your staff meeting. Or, you can use a patient’s data from patient surveys or outcomes.

Next, identifying how a meeting will bring value to the parties involves several elements: seek user and producer input to create the agenda, moderate the flow of the meeting for equal input and create a strategy to reassure those at the meeting that action items will get done.

The second Design principle in office communication is to create a process to focus on quality and total experience to reduce frustration for staff and patients. Incorporating this principle at my practice meant eliminating my previously favored method of communication — pulling staff aside during a clinic to change a policy on the fly. It took me years to stop (well, mostly stop). This behavior is reactionary, gives information piecemeal because there is always more to the story and does not allow for input from the staff. One approach I now use to prepare for a meeting is to record any ideas or concerns that arise as I go through clinic. Staff are less frustrated because I am not stopping clinic to share ideas, and knowing there is a meeting soon alleviates my anxiety. Send out meeting agendas in advance to allow others to come prepared with ideas.

The third Design principle guiding the establishment of effective communication is to have a process that works for patients, first and foremost. We cannot allow egos, seniority or the pull of the status quo to distract us from prioritizing patient care.

Recently, my practice met to discuss giving patients more notice for their arrival time for cataract surgery. Patients had the date but were not told the time until 2 days before surgery. Everyone had their reasons for objecting to various proposals. After a lengthy debate that went nowhere, I pulled an empty chair to the table and said we needed to imagine a patient sitting there. I told a story how this patient may need a working son or daughter to bring them and adjust their work schedules, or this patient may need to arrange for care for their sick spouse while coming to surgery. It shifted the focus from staffing, schedules and extra work and reminded the team that we need to compromise for the good of the patient.

Lastly, the fourth Design principle — use your own positive experiences as examples to create meaningful change. When you invite staff to be part of the solution and they see you using their ideas, you are also creating a positive experience for them. Once the staff sees their own ideas working, it will snowball and allow the practice to then build on each success. This management style drives the staff along with you toward a goal instead of dragging them. Recognition and creation of these positive experiences will accelerate the practice’s ability to advance positive change that is meaningful for all: management, staff, providers and patients.

At the end of the day, work is work. We might as well play our part to create a culture that all parties involved find pleasant and meaningful. My mantra with staff has always been “We have to be at work, so let’s be happy, darn it!”

Take time to plan effective communication in the office using Design principles to create the best version of “the meeting.” It will be worth the time. OM

Scott LaBorwit, MD, is a principal at Select Eye Care, with locations in Towson and Elkridge, Md., and is an assistant professor, part-time faculty, at Wilmer Eye Clinic of Johns Hopkins Hospital, Baltimore. His e-mail is Sel104@me.com.

Disclosures: Dr. LaBorwit is a consultant to and speaker for Alcon.