Two case studies demonstrate how to overcome hurdles.

Jim Thorpe won multiple gold medals in the 1912 Olympics in track and field. On day one of the decathlon competition, his shoes were stolen. A lesser athlete would have said, “That’s it. I’m out of the race.” But Thorpe, undeterred, found two different shoes in a garbage can. One was too big, so he wore two pairs of thick socks.

Wearing those mismatched, wrong-sized shoes, he set records for the high jump and hurdles that stood for almost 40 years. (The controversy of him losing and regaining his medals posthumously is immaterial here.) The message gained from this extraordinary real-life story: Don’t let adversity hold you back.

As consultants, we are asked the usual questions on a daily basis: “What is the right way to do this or that?” and “What are the best ways to succeed in the business of ophthalmology?” With a combined 75 years of experience, we have as many answers as you do for your patients. Just as in medicine, the right answer may be different from one setting to the next, but there are general success factors present in the best-running practices and approaches that can be applied equally to all practices, boards, managing partners and your management team. As it turns out, thinking a little bit like Jim Thorpe helps.

Here are two brief case histories that can help you boost your team over the hurdles.

CASE 1: “SHE IS THE BEST TECHNICIAN WE HAVE”

An administrator from a practice in the Northeast calls with a common problem. The technically best technician they have is arriving late to work. Additionally, her cheerful persona has diminished over the years. As a senior staffer, this is having a negative influence on morale in the clinic. She works for one of the most productive and respected doctors and is protected by his seniority and value to the practice. No one wants to make him unhappy

This case feels like a nightmare to handle. The administrator and tech manager counseled this technician, set clear expectations and applied consistent follow-through but have not been permitted to apply reasonable consequences, up to and including termination. As a result, the other hard-working, reliable, skilled technicians are negatively influenced. They wonder why they should work so hard, arrive on time and have smiles for the patients when they don’t see that in their leader. A couple of skilled techs have already left the practice and others may be behind them. The result will be the less-skilled, less-admired techs remaining and a diminished service for doctors and patients alike.

As difficult a situation as this may be on many levels, “She is the best technician we have” is an excuse that should not be tolerated. By taking no action, it condones poor behavior and sends the wrong message. Inadvertently, this inaction creates more problems for the practice.

The steps taken to solve this issue were:

1. Administrator compiled data and factual details on how the problem impacted the practice. In this case, the financial impact of losing staff, working short-staffed, recruiting and training new employees was captured and presented in writing.
2. Administrator presented the financial and staff morale consequences (also a hidden cost), including frustrated management staff, to the managing partner, with the recommendation to apply practice policy consistently to this protected employee and all employees.
3. Managing partner supported the administrator and management team by approaching the doctor who was protecting the employee for his own benefit. (If it is the managing partner protecting staffers, senior board members need to address the problem with him/her.)
4. Numerous members of this practice had uncomfortable conversations to ultimately remove the previously protected technician and subsequently communicate what the practice would do moving forward by applying consistent policies to all employees.

With rare exception, practices that terminate a previously protected employee report back to us that they wished they had taken action sooner and that the consequences they feared were less or non-existent. In many cases, the employees are so happy a change was made, they step up and cover the feared potential gaps.

CASE 2: HOLD BACK ON TESTING BECAUSE SHORT-STAFFED

A practice operations evaluation reveals a lower than average revenue per patient visit, also called average ticket. With further investigation, the problem revealed is deeply multifaceted. Employee retention and recruitment of technicians is a frustration to the office manager and lead technician. There is an ongoing cycle of recruiting technicians, training them extensively and losing them in a year to competitor practices.

To accommodate for the ongoing short-staffing, the physicians have fallen into the habit of ordering minimal testing. Although additional testing would still be considered appropriately within norms compared to peer practices, increasing testing in the office creates staff and patient unhappiness. The staff miss lunch and go home late. The patients become dissatisfied with the waiting time in the office.

Steps taken to solve the problem:

1. Staffing ratios were evaluated by department, resulting in 1.5 technician FTEs being added to bring staffing levels in the clinic up to norms.
2. The onboarding and tech training processes were streamlined. Written protocols were added for clarity and consistency. Training time was reduced significantly.
3. Established a cross-training program for techs, scribes and testing staff to become competent to cover all the areas in the clinic.

Once staffing was normalized, staff turnover was reduced. For planned vacations or illness call-outs, the remaining technicians shifted to cover all areas adequately. The doctors felt more confident in the patient flow, and the patient appointment schedules and testing schedules were increased over time. The result was a more stable clinic schedule, less frazzled management and an increase in the patient revenue per hour.

In an attempt to be conservative with staffing (along with the frustration of constantly losing employees due to being understaffed), the practice misjudged the impact on revenue. Once they realized that appropriate staffing ratios lead to staff stability and an increased revenue flow that more than covered the increased payroll expense, the problem was eliminated.

CONCLUSION

Above are two common examples of excuses that may be holding your practice back unnecessarily. You can likely think of several more examples.

This is a great time, with the recent experiences of COVID-related impacts, to realize that the problems that used to feel insurmountable are much easier to solve, comparably, than you thought 8 months ago. Eliminate the old excuses. Set new expectations. Forge a new path with matching shoes. OM

Corinne Z. Wohl, MHSA, COE, is president of C. Wohl & Associates, Inc., a practice management consulting firm. Corinne earned her Masters of Health Services Administration degree at The George Washington University and has over 30 years of hospital, physician practice management and management consulting experience. Her latest book, co-authored with John Pinto, is “UP: Taking Ophthalmic Administrators and Their Management Teams to the Next Level of Skill, Performance and Career Satisfaction.” For information on how to purchase this book or other inquiries, she can be reached at czwohl@gmail.com or 609-410-2932.

John B. Pinto is the founder of J. Pinto & Associates, Inc., an ophthalmic practice consulting firm established in 1979. He is the most published author in the world on the subject of ophthalmic management and economics. The firm serves organizations worldwide, ranging from solo practices to high-volume market leaders, teaching centers and medical product companies, providing strategic planning, financial benchmarking and analysis, operations enhancement, and marketing counsel. He can be contacted at pintoinc@aol.com or 619-223-2233.