PRACTICE STRATEGIES PRACTICE STRATEGIES

The 10 habits of highly successful optometristsWalter West, O.D.

oday more than ever, practicing optometrists need

Tgood business management skills, according to authorand practice management consultant Walter West,

O.D. New practitioners must be able to establish a practicein a timely manner in order to service student debt and meetliving expenses. Established practitioners face an increas-ingly competitive health care market as they attempt to

Author and practice managementconsultant Walter West, O.D., outlines10 ‘‘pulse points’’ critical to practicemanagement.

secure enough income to enjoy a nice life and work towarda comfortable retirement. However, it has been widely notedthat optometrists generally have far more clinical expertisethan business acumen on entering practice. America’sschools and colleges of optometry today offer excellentpractice management courses. However, optometry studentscannot hope to leave school with all the management andmarketing expertise of business school graduates. And whileestablished practitioners would often like to enhance theirbusiness skills, many feel they must devote continuing educa-tion hours to updates on clinical advancements and new healthcare regulatory requirements, Dr. West notes.For that reason, 2 years ago, Dr. West (who had devel-

oped a highly successful practice in Brentwood, Tennessee)released When Your Success Is On the Line, a book outlin-ing fundamental business management skills that all op-tometrists should have.1 ‘‘It is sort of a short M.B.A.course in basic business principles,’’ Dr. West says.However, he has since found that implementing even

basic business principles can be daunting for health carepractitioners who have little or no previous managementexperience. With that in mind, Dr. West last year releasedPulse Points of the Million Dollar Practice.2 Inspired inpart by works like Stephen R. Covey’s bestselling The

Walter West, O.D., is the chief optometric editor for Optometric Manage-

ment magazine and an adjunct professor at the Southern College of

Optometry. He can be contacted through his Web site at www.

PracticeManagementAcademy.com or by e-mail at walt@walterwest.com.

Opinions expressed are not necessarily those of the American Optometric

Association.

1529-1839/$ - see front matter � 2011 American Optometric Association. All r

doi:10.1016/j.optm.2011.03.008

Seven Habits of Highly Effective People, the program in-cludes a 2-hour instructional DVD and self-paced work-book intended to guide optometrists in developing basicskills, attitudes, and approaches that seem to be commonamong successful practitioners.Like other self-improvement programs, Pulse Points of

the Million Dollar Practice provides a series of lessonsdesigned to improve performance with self-assessmentquizzes, exercises, and suggested reading. This programcan be useful to established practitioners, as well as newoptometry school graduates, who are interested in enhanc-ing their business management skills, Dr. West hopes.

1 – Identify strengths and weaknessesThe first step any optometrist should take in developing asuccessful practice is to identify personal strengths onwhich to build and areas of weakness in which improve-ment may be warranted. Almost without exception, clinicalexpertise will be an optometrist’s greatest strength. How-ever, most optometrists, particularly upon entering practice,will generally need some work in various aspects of prac-tice management such as leadership, communications,decision-making, time-budgeting, risk management, orvarious forms of strategic planning.Dr.West recommends optometrists utilizewell-established

psychological assessment tools such as the Myers-BriggsType Indicator, new online resources such as Strengthsfinder(www.strengthsfinder.com), and a series of self-survey formsin his book to identify personality traits that could impactthe ability to manage a practice. Having taken the initialstep of identifying their management strengths and weak-nesses, optometrists can work to address them.

2 – Find the right mentorsMany new optometrists ‘‘shadow’’ a successful practitionerwho can demonstrate how to provide patient care. However,many optometrists have never found a good source ofguidance on practice management. In today’s complexpractice environment, it is actually a good idea to havemore than 1 practice management mentor in order to be as-sured good advice on a range of subjects. Dr. West findssuccessful optometrists generally seem to benefit from 3classes of advisors:

- Successful professionals – Well-established optom-etrists who have personally experienced the rigors of

ights reserved.

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establishing and maintaining a practice can oftenprovide a wealth of information on avoiding mis-takes and maximizing results. However, other healthcare professionals can be helpful as well. A localdentist helped Dr. West establish his practice. Infact, successful local business people from grocersto bankers can often provide valuable advice on lo-cation, marketing, and other key issues. Participationin the local chamber of commerce, civic clubs, orcommunity groups can provide a good way of meet-ing and developing relationships with such success-ful business people.

- Successful peers –Many optometrists stay in contactwith a circle of optometry school friends and, in thatway, find a support group through which they discusstheir overall practice development strategies, tradeexperiences, and exchange tips on day-to-day prac-tice issues. Some optometrists even convene formalstudy groups with scheduled annual meetings andparticipants assigned to give reports on specifictopics. (But beware, even in an informal setting,any discussion of fees or prices, and even dialogueon vendor selection or participation in insuranceprograms, can constitute a violation of federal orstate antitrust laws. Any such discussions should bestrictly prohibited. If a formal study group isconvened, establish an agenda of permissible topicsand stick to them. That will both help avoid any legalcomplications and make the most of the timeavailable.)

- ‘‘Reverse’’ mentors – In a rapidly changing world‘‘the student can often become the teacher,’’ Dr.West notes. It can also mean relying on younger peo-ple to provide assistance on various other aspects ofpractice management. With new instrumentation,health care systems, insurance regulations, and of-fice communication technologies seemingly alwayson the horizon, do not be afraid to ask younger prac-titioners or office staff to provide some assistance –or even take a leading role in some office projects.

Many practitioners retain management consultants (suchas Dr. West) to provide formal guidance on various aspectsof practice management. Every practice must have a goodattorney (specializing in health care practice) and a goodaccountant who can be relied on for advice. The AmericanOptometric Association (AOA) Practice Connect programoffers ‘‘practice coaches’’ who can offer assistance onvarious areas of practice management (www.aoa.org/14644.xml). To help office staff play a bigger role in thepractice, the AOA Paraoptometric Certification Programnow offers specialized programs on coding and billing aswell as general practice management.

3 – Develop leadership skillsLeaders need not necessarily be well-known, accomplished,or wear Armani suits. Leadership is a quality that others

recognize in a person, Dr. West believes. A good leader willunite an optometric practice by clearly communicatinggoals and explaining the rewards for meeting them. In theprocess, a true leader will both instill a sense of enthusiasmand calm any unnecessary fears or emotions. This isparticularly important when a practice is new or in a periodof change.‘‘Leadership is not so much a matter of imposing rules as

recognizing that others are seeking someone to place theirtrust in,’’ Dr. West said. He believes leadership is both aninherited talent and a set of skills. Not everyone is born aleader. However, natural leadership can always be enhancedand just about anyone can learn leadership skills. Variousstyles and components of leadership have been identified.Dr. West suggests a number of exercises to help optome-trists identify specific aspects of leadership in which theymay be strong or weak. But basically, Dr. West believes aleader must simply be 2 things, a good communicator andbetter listener. More on both subjects follow.

4 – Cultivate communications skillsGood communication skills are essential for patient edu-cation and community outreach as well as for managingstaff in the office, Dr. West notes. Probably few optome-trists have ever thought about their communications habitsor about developing a style of communication that isappropriate to a health care practice. Basically, communi-cation always comes down to either talking or listening. Foreach, Dr. West has identified 4 types.

The 4 basic styles of listening are:

– Passive– Selective– Attentive– Active

The 4 basic styles of speaking are:

– Nonassertive– Aggressive– Passive-aggressive– Assertive

The complementary skills of active listening and assertivespeaking are the most appropriate for a health care practice,Dr. West contends. An active listener makes steady eyecontact, projects patience, and provides feedback. Anassertive speaker proposes solutions to the problems iden-tified in the conversation. In addition to speaking andlistening style, optometrists should be aware of non-verbalelements such as proxemics – the distance between con-versing people, Dr. West says.

5 – Innovate‘‘If you are not innovating, you’re stagnating,’’ according toDr. West. Consider how many major American ‘‘blue chip’’corporations have fallen on hard times over recent years be-cause they relied too heavily on established product lines or

324 Practice Strategies

old business practices. Then consider how relatively newcompanies like Google and Facebook have become amongthe most powerful and successful in the nation through theintroduction of innovative new products or services. Eyeand vision care are changing just as quickly as any other as-pect of American life as the result of clinical and techno-logical advancements, regulatory reforms, and changes inthe overall health care market. Practitioners who anticipateand adapt quickly to such changes will prosper by ‘‘exceed-ing the expectations of patients, employees and the market-place,’’ Dr. West said. Those who do not may risk fallingbehind the expected eye care market norms. ‘‘If you arenot current, you are becoming obsolete,’’ Dr. West says.Unfortunately, many optometrists seem particularly re-

sistant to change, Dr. West believes. ‘‘In too many practicesthe motto is: We do it this way because that’s the way it hasalways been done and it has always been done that waybecause that is just the way we do it,’’ Dr. West said. Tofight such inertia, Dr. West recommends the periodicreevaluation of office operations and the development ofpractice improvement ideas through formal exercises in-cluding office staff ‘‘brainstorming sessions’’ and ‘‘ideamapping.’’ Periodic practice reevaluation will generally re-sult in ideas for new products or services, the updating ofinstrumentation or office systems, or physical improve-ments to the office itself. Dr. West also urges optometriststo study fields outside of health care for new ideas thatcould be adapted to eye care practice.

6 – Learn to make decisionsDr. West finds many optometrists tend to put off importantmanagement decisions. That is because they literally do notknow how to make a management decision, he contends.Decision making is a skill, he emphasizes; too many rely onflawed decision-making methodologies (i.e., guessing, in-tuition, making hasty judgments ‘‘on the spot’’ so they can‘‘get it over and be done with it,’’ taking the ‘‘middle of theroad’’ as a supposedly prudent default position). Lacking agood decision-making process, they tend to study decisionand gathering information for extended periods, resulting in‘‘paralysis by analysis,’’ Dr. West believes.Dr. West recommends optometrists adopt formal

decision-making processes. Several simple but effectivemethods have been developed to pinpoint solutions basedon objective criteria. Formulas can also be used to balancethe needs for quality, thoughtfulness and speed in thedecision-making process and determine when decisionslegitimately require further input. Among the best-known isSWOT analysis in which the ‘‘strengths, weaknesses,opportunities, and threats’’ associated with a decision arelisted and assessed. Other formal decision-making systemsinclude Pareto Principle analysis (which is based onidentifying the 20% of factors most critical to the successof a business and acting on them), Force Field charting (inwhich the motivating and countervailing factors pertinent toa decision are weighed) and grid analysis (through whichthe most important benefits of various options are listed and

rated). While many practitioners may agonize over the costof new equipment, a formal cost-benefit analysis (usingdata that is often easily available from manufacturers orother sources) can make it easier to determine whether apurchase is a smart move for a practice.Perhaps because they are health care practitioners who

are instructed to ‘‘first, do no harm,’’ optometrists generallytend to be cautious when making a decision. However,decisions ultimately have to be made, Dr. West notes. ‘‘Adecision deferred is a decision made (in favor of doingnothing),’’ he says.

7 – Budget timeMany practitioners today have a budget governing the useof their financial resources. However, there are probablyfew practitioners who formally budget their time; eventhough efficient use of practitioner and staff time hasbecome increasingly important in the age of managed care.Dr. West suggests a simple formula. List the variousactivities a practitioner (or a staff member) might performin the course of a day and classify them as one of thefollowing:

A. Imperative – Tasks that must be performed immedi-ately (e.g., attend to patients waiting for care, answerthe telephones).

B. Important – Tasks that must be performed in a timelymanner (e.g., pull files for scheduled patients, reviewcharts, make appropriate notes).

C. Optional – Tasks that are not time-sensitive but stillshould be on the practitioner’s agenda (e.g., outingswith prominent business people in the community).

8 – Learn to negotiateNegotiation is not as openly encouraged in Americanculture as it is in many nations around the world. In someplaces, it is practically considered mandatory. For example,shopping for a rug in the Middle East city of Dubai, Dr.West and his wife learned that local customs require themto first have a cup of tea with the carpet merchant and thenbicker over the price. Failure to do so would not only haveresulted in paying too much for the carpet, it would havebeen considered downright rude. In the United States,major corporations routinely negotiate for better deals fromtheir suppliers. Small business, such as optometricpractices, should be no different.Practitioners should be prepared to negotiate with busi-

ness partners from ophthalmic suppliers to equipmentvendors, Dr. West maintains. And in many cases, a littlecreativity can help, he adds. Back in his early years ofpractice, Dr. West determined his office probably needed asecond exam lane; however, he was not convinced that thepatient base was sufficient to justify the expense. Hecontacted his equipment supplier with a novel proposal.He would pay shipping and set-up fees if the companywould provide him some pre-owned, ‘‘trade-in’’ equipment

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for a temporary exam lane in his office. If he found thesecond exam lane was indeed justified, he would thenpurchase new equipment, with the set-up charge as a downpayment. The company agreed. Dr. West found the addi-tional exam lane was beneficial to the practice and, a fewmonths later, he purchased new equipment as promised.(Over the following years, he would purchase equipmentfor a total of 7 exam lanes from the company.)Optometrists should also be prepared to negotiate on

insurance plan provider contracts and reimbursementschedules when necessary, Dr. West contends. When reim-bursement will not be sufficient to meet the practice’s chaircosts or when contract terms do not coincide with the prac-tice’s standards (regarding prompt payment, provider par-ity, referral protocols, etc.) optometrists should beprepared to negotiate for more favorable terms. In manycases, insurance plan and practitioner will both benefit.3

9 – Risk managementOptometrists tend to be ‘‘risk-averse,’’ according toDr. West. However, the conducting of a business enterprisevirtually always involves taking some risks. That does notmean all optometrists must become self-proclaimed ‘‘risktakers.’’ On the contrary, it means they must master thescience of risk management. Risk management involves 4steps:

–Identify the risks faced by the practice.–Analyze and prioritize risks for potential impact.–Plan to reduce or eliminate risk or counter adverseevents resulting from risk.–Track the effectiveness of risk management measuresover time.

Any business faces 2 types of risk: internal (controllable)and external (uncontrollable). Risks can be encountered at4 levels: market (the field of eye care), community (factorsaffecting the location of the practice), business (within thepractice itself), and personal (the practitioners or staff).Methodologies exist to quantify risks through the use oftools such as a risk matrix. Once identified and ranked,risks can very often be mitigated through proper insurance,good financial planning, staff training, maintenance, emer-gency and contingency plans, or other measures. Optometryis a good profession for risk-averse individuals because,like other forms of health care, it is generally considered tobe less subject to fluctuations in the economy than manyother types of businesses. However, a practice can still be atrisk due to other changes at the market, community,business, or personal level. For this reason, lack of properplanning and risk management may pose the greatestdanger of all.

10 – Avoid complacencyOptometric practices, or for that matter most businesses,are seldom ‘‘static,’’ said Dr. West. They are always either

growing or in a state of decline. Optometrists, particularlythose in midcareer, often believe that once they haveestablished a practice with solid patient base and steadyrevenue stream, they can relax. Such practitioners have afalse sense of security. To remain competitive in the eyeand vision care market, practitioners must regularly reeval-uate their practices to determine what improvements inservices (such as the addition of vision rehabilitation orpediatric care), equipment (both ophthalmic instrumenta-tion and office systems), staffing (associate practitioners oradditional office staff), insurance plan participation, hoursof operation (weekends, evenings), community outreach, oroffice facilities (from redecorating to relocation) are inorder. Practitioners can then make any necessary changes ina timely and orderly manner. Practitioners who do notcould lose their place in the local eye and vision caremarket to competing providers who enter the market soonerwith new products or service or who are simply morepatient-friendly.Often, practices are caught off-guard by external factors

such as changes in patient preference or developments inthe community, Dr. West believes. For example, as com-munities grow, practice locations that were once fashion-able and convenient for patients may become less desirable.Many practitioners may not realize that a change in officelocation would benefit their practices. In other cases, theymay be hesitant to make such a move because they own thereal estate where the practice is located, Dr. West believes.One of the best ways to ensure a practice does not

stagnate is to regularly conduct focus groups with arandomly selected sample of patients. Such events can beheld at the office after hours or on weekends. Complimen-tary snacks and beverages can provide an inducement toparticipate. In many cases, the practitioner can serve as thefocus group facilitator; however, a third party could beretained for that function. The important thing is to ensurethat patients are forthcoming and provide usable informa-tion about what is right and wrong with the practice. Someoptometrists use patient mail or e-mail surveys to obtainguidance from patients. However, the trick once again is toensure patients are honest in their responses. For thatreason, patient surveys should allow for anonymousresponses. Mail surveys should be routed through a thirdparty so that patients feel free to answer questions honestly.E-mail surveys can be conducted through services such asZoomerang (www.zoomerang.com).

References

1. West W. When Your Success Is On the Line. Nashville, TN: Westview,

Inc., 2009.

2. West W. Pulse Points of the Million Dollar Practice. Nashville, TN:

Westview, Inc., 2009.

3. Brownlow CB. To sign on not to sign: recognizing insurance contracts

as business decisions. Optometry 2011:48-50.