Quick Fixes: What Bothers Your Patients Most–And How to Address It

Practice, Resources, The Patient Journey

Bad doctors and nurses aren’t the culprit for dissatisfied patients. Rather, it’s the patient experience that most point to when unhappy with a health-care experience, according to a study conducted by Vanguard Communications, and published last year in the Journal of Medical Practice Management.

Most patients rated their doctors highly, the study found: 61 percent gave five-star reviews, compared to only 23 percent who gave one-star reviews. When patients did leave negative comments, the researchers found that only 4 percent of their complaints were explicitly related to medical treatment. The other 96 percent focused on issues such as inadequate communication, wait times and disorganized operations.

It’s important we fix inadequate communication, unnecessary wait times and disorganized operations in the practice. Let’s consider them one at a time.

INADEQUATE COMMUNICATION
What is the main issue with inadequate communication? George Bernard Shaw nailed it when he said: “The single biggest problem in communication is the illusion that it has taken place.” Looking at malpractice claims shows that George’s statement is correct. A breakdown in communication between the doctor and patient is the “root cause” of malpractice claims. Right up there with this as a primary cause of malpractice lawsuits is the perception by the patient that the doctor is uncaring. It may not be that the doctor was actually uncaring; she may have just rushed the exam, and that led to a communication problem where the patient perceived the doctor was uncaring. Remember, from the patient’s perspective, perception is reality.

Getting patients to follow our treatment plan should be in our top goals for the exam. We are going to do a lot of exams over the course of our career. A doctor will have as many as 192,000 patient interactions over a 40-year career (20 patients/day x 5 days/week x 48 weeks/year x 40 years = 192,000).

With so many patient interactions, clear communication with patients is an essential tool for an effective doctor. There is a large body of research over the last 30 years showing the doctor’s ability to explain, listen and empathize has a significant effect on patient outcomes and patient satisfaction.

But how many doctors actually measure outcomes by measuring treatment plans completed? Practice management rule number one is measure to manage. If we want to improve our patient outcomes, then we should start measuring. Once we begin to measure, then we can begin to make changes to improve our outcomes. As we make changes, remember the importance of improving communications with patients as an effective way of improving outcomes. Work on what to say, how to say it, and in what order to say it.

UNNECESSARY WAIT TIMES
Is the doctor on time or routinely running 40 minutes behind? Where do the bottlenecks occur in the practice? What is the wait time in the optical? These are some of the questions that not only should we know the answer to, but we should also have active plans to fix when they are a problem. Patients hate waiting. Yet in most practices, patients wait. Let’s be honest, patients wait primarily because we do not want the doctor to wait. In most practices, the schedule is built to keep the doctor busy.

Patients also wait because we are inefficient or poorly staffed. Take a look this week at the efficiency of the flow of patients through the practice. Identify where and why patients wait, and fix the problems. It may take another piece of pre-testing equipment, an adjustment to the schedule, or another staff member to fix the flow. Make the fix to improve patient flow.

DISORGANIZED OPERATIONS
Analyzing the work flow in a practice is an important step for all practices because it improves efficiency and reduces disorganization. Here’s a simple process to follow to get this done:

1.   Break your work flow down into as many steps as possible. The more granular, the better.
2.   Lay these steps out using Post-it Notes.
3.   Look for exceptions, and create simple decision boxes to capture the variations.
4.   Look for ways to improve efficiency.
5.   Rearrange your Post-it Notes to show your new, efficient work flow.
6.   Implement your changes.
7.   Re-do this process every three months until you are satisfied you have the most efficient flow, then review it every six months to make sure it is still the best flow.

Focus this week on improving patient communications, reducing patient wait times, and making your practice operations more efficient to improve patient satisfaction and adherence to the practice.

References
i. http://ministry127.com/resources/illustration/the-biggest-problem-in-communication
ii. Huntington, B., & Kuhn, N. (2003). Communication gaffes: A root cause of malpractice claims. Baylor University Medical Center Proceedings, 16, 157-161.
iii. Beckman, H. B., Markakis, K. M., Suchman, A. L., & Frankel, R. M. (1994). The doctor-patient relationship and malpractice. Lessons from plaintiff depositions. Archives of Internal Medicine, 154(12) 1365-1370.
iv. http://healthcarecomm.org/about-us/impact-of-communication-in-healthcare/

MARK WRIGHT, OD, FCOVD

Dr. Wright is the founding partner of a nine-partner, three-location full-scope optometric practice. As CEO of Pathways to Success, an internet-based practice management firm, he works with practices of all sizes. He is faculty coordinator for Ohio State’s leading practice management program.

CAROLE BURNS, OD, FCOVD

Dr. Burns is the senior partner of a nine-doctor full-scope optometric practice that she built with her husband, Dr. Wright. She is also the COO of a state-wide nursing care optometry practice. Dr. Burns lectures nationally on practice management and staffing issues. Dr. Burns authored the Specialty Practice section of the textbook, Business Aspects of Optometry.

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Satisfy More Astigmatic Patients with New Toric Daily Disposable Technologies

Products | Services | Industry News, Resources

How would you explain to your patient the synergistic performance of the two significant design innovations delivered by ACUVUE OASYS® Brand Contact Lenses 1-Day for ASTIGMATISM lenses? Like wine and cheese, that’s how! Often times when you take one great idea and pair it with another the sum is greater than the parts. It takes the more consistent visual performance of BLINK STABILIZED® Design and combines it with the reduced frictional energy profile of HydraLuxe^TM Technology, and the result is a lens that is even more consistently clear and comfortable than anticipated. With each blink, the world is brought back into sharp focus and because of the tighter crosslinking meshwork the lens slides back into optimal position more effortlessly than ever before. Voila! What a magnificent pairing and what a remarkable way to share performance and innovation with your patients.
–Kent Prete, OD, Calgary Alberta

ACUVUE OASYS® Brand Contact Lenses 1-Day for ASTIGMATISM combine two unique technologies to deliver excellent comfort and clear, stable vision, with the widest parameter range.

Astigmatic patients achieve their best vision when both sphere and cylinder are corrected. However, toric contact lenses have historically been underprescribed relative to the prevalence of astigmatism. Barriers to prescribing toric lenses include limited parameter availability and difficulty achieving stable vision and comfort.

Among those who have been fit in toric lenses, 58% report declining lens performance over the course of a day, with those who experience more activities or more environments during the day being the most prone to declining lens performance.¹

A new daily disposable toric lens, ACUVUE OASYS® Brand Contact Lenses 1-Day for ASTIGMATISM, has been specifically designed to provide exceptional comfort and performance in challenging environments. It combines BLINK STABILIZED® Design, which works with the natural movements of the eyelids to settle the lens quickly and maintain stable vision, with HydraLuxe™ Technology, comprising an enhanced moisture network of tear-like molecules and a highly breathable, hydrated silicone that integrates with the patient’s own tears to help maintain tear film stability.

A subject-masked, one-week dispensing study of 162 habitual toric soft lens wearers (324 eyes) was conducted in the U.S.² Within just 3 minutes of lens insertion, almost all lenses (97%) settled within 10° of nominal orientation (toric lens markings exactly vertical at 12 and 6 o’clock). At 15 minutes, all 324 eyes showed less than 5° movement on blink, which is a key factor in providing stable, predictable vision.

Clinical performance

In a busy practice, I’m looking for a lens that stabilizes quickly. But what is even more impressive to me than fit and stability in the office is how well the lens performs in the patient’s world, during everyday tasks that can challenge vision. In the study, 99% of eyes were successful at one week in the first lens fit, and visual acuity was excellent, with 97% seeing 20/20 or better monocularly.

My patients also loved the comfort of these lenses. They have busy lives and spend a lot of time on digital devices, which tend to reduce the blink rate and increase discomfort. Because it works with the tear film to stay lubricated, ACUVUE OASYS® 1 Day for ASTIGMATISM helped my patients stay comfortable throughout the day.

ACUVUE OASYS® 1-Day for ASTIGMATISM

First-fit success rate of 99%

Settles within 10˚ of nominal orientation in just 3 minutes

All patients achieved 20/25 or better monocularly, and 97% achieved 20/20 or better

Available in 2,260 parameters–40% more than any other daily disposable toric lens

Widest parameter range
The parameter range, the widest of any daily disposable toric contact lens, makes this lens very easy to fit. In the past, the lack of oblique axes or plus powers meant that some patients had to accept a level of visual compromise, or forgo the benefits of a daily disposable lens.

With ACUVUE OASYS® 1-Day for ASTIGMATISM, all three cylinder powers (-0.75DC, -1.25DC and -1.75DC) are available in axes around the clock for sphere powers plano to -6.00DS. For patients with higher astigmatism, an additional -2.25DC option is available in the most common meridians. This allows us to bring the benefits of daily disposable toric lens wear to more of our astigmatic patients.

References
1. Mathews, K., et al. AAO poster presentation, Nov 2016. Market research survey on performance throughout the day with toric soft lens wearers. US, n=208, 12% daily disposable toric, 88% reusable toric.
2. Straker B, et al. Global Specialty Lens Conference Poster presentation, January 2017

ACUVUE® Brand Contact Lenses are indicated for vision correction. As with any contact lens, eye problems, including corneal ulcers, can develop. Some wearers may experience mild irritation, itching or discomfort. Lenses should not be prescribed if patients have any eye infection, or experience eye discomfort, excessive tearing, vision changes, redness or other eye problems. Consult the package insert for complete information. Complete information is also available from Johnson & Johnson Vision Care division of Johnson & Johnson Inc., by calling 1-800-267-5098 or by visiting acuvueprofessional.ca.

ACUVUE®, ACUVUE OASYS®, HydraLuxe™, BLINK STABILIZED®, and EYE-INSPIRED™ are trademarks of Johnson & Johnson, Inc.
©Johnson & Johnson, Inc. 2017

This article is sponsored by J&J Vision Care Canada.

ROXANNE ACHONG-COAN, OD, FAAO, FIAO

Dr. Coan received compensation for her work on this article.

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Insight with Dr. Riaz Ahmed

Insights

Dr Riaz Ahmed is the founder of Mission Eye Care located in downtown Calgary, AB.

Since opening his practice in 2005 he has shifted more towards medical eye care

with a special focus on Dry Eye treatment and Corneal Disease management.

Riaz is the Past-President of the Alberta Association of Optometrists,

and does charity eye care mission with Canadian Vision Care.

Dr. Riaz Ahmed

Optometrist

B.Sc., University of Alberta, 1993

OD degree University of Waterloo 1998

Mission Eye Care

Calgary, AB

Where do you see your practice / eye care in 10 years?

I look back at how I practiced optometry after graduation, and how I practice it now, almost 20 years later. It has only been in the last few years that I can truly say I practice the way I want to. For years we had been over-educated and under-utilized relative to our role in eye care. We are fortunate here in Alberta to now truly be able to practice primary eye care profitably and effectively. I do much more medical eye care relative to routine exams and I foresee this to continue to increase over the next decade. I see greater efficiencies through new technologies. With more patient encounters, comes more opportunity to present products and services, further fueling revenue that ultimately fund more practice building technologies. Our public and private reimbursement model along with scope changes have allowed us to stay profitable and I see this continuing to evolve. Quality medical eye care is something that patients’ value and trust, and I think it is our best way to survive and thrive despite further disruptive changes in the retail landscape.

What changes do you see coming down the pipe?

I see online refractive exams improving to the point of being reasonably accurate. The new iphoneX already promises to revolutionize 3D facial mapping, and with that will come better frame “fit” options, whether 3D printed, made to order, or a selection of mass market frames that will fit your face perfectly. The consumer values convenience, and optometrists will have to offer value beyond retail eyewear sales in order to make consumers take time out of their day to seek our services. I foresee our role continue to evolve as interpreting data rather than gathering it. Wearable health tech is in strong demand, and consumers will likely have a treasure trove of health data sitting in their phones, much of it likely relevant to us. Companies are already evolving contact lenses to both display data to the wearer, and gather it from them. I see the demise of the traditional exam lane, and a role for optometrists in a consultative environment with technologies different from those that will soon be ubiquitous at the consumer level.

What is something new you are implementing this year in your practice?

More in the way of myopia control. As a high myope, I am truly excited that there are now evidence based options for my patients (and my genetically doomed kids). We are already well established as a corneal disease /specialty lens clinic, so with increasing patient awareness of myopia control, I will be implementing more strategic marketing in this regard.

How do you define success?

My definition would be working because you want to, not because you have to. As a first generation immigrant with poor parents, my story is the same as many others. Like Drake says “started from the bottom…”. Going through school, I always equated success with wealth, and to some degree I was right, but I was wrong about what wealth actually is. Having passed my mid-life crisis (some would argue I am still in it), I now see that wealth is a combination of time, family, gratitude and health. Yes, being financially free gives you time, but to me, it is how you use that time that determines success.

Favorite Series?

Yes, I am late to the party but I finally started binge watching Game of Thrones. Call it FOMO, but I had to see what all the fuss was about and I was hooked at episode 1. Since I am terrible with names, I also look at it as a training exercise. I mean who can seriously keep all these people straight? Good thing they keep getting killed off.

Favourite food?

That’s easy – being born in East Africa, our family loved spicy grilled food. There is a place in Calgary that grills the most AMAZING Indo-African spiced short ribs. They are cut super thin and are the most delicious spicy and tangy carnivorous treat on the planet. I’m actually going to stop writing this and go get some.

What’s changed since high school?

Well, I am still quite nerdy, but I shaved that awful moustache I sported in grades 10 and 11. I would have had no chance at a prom date in grade 12 if I hadn’t (chances were slim regardless). Funny that all that facial hair now made a comeback, I would have been like super trendy by age 12 (in case some people don’t know, East Indians are hairy).

Tell me something you thought was true only to find out later you were wrong?

When I was younger, I looked at all “doctors” with awe and respect. To me, they were miracle workers that had some superhuman level of knowledge and skill. They always had the right answers, somehow guided by a higher power. To then go through school and see classmates (many of whom I thought were less than the sharpest tool in the shed) go on to practice some aspect of medicine was truly devastating. To think, all this time, I too could have had a moron for a doctor! Alas, we are all humans with the same level of infallibility and ineptitude as the general population. A sobering truth indeed, and one that constantly pushes me to be the kind of health care provider that I would want to have.

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Start Me Up – Webinar

Practice, Resources, Webinar

On Monday October 16, 2017 Canadian Eye Care Business Review, hosted a panel discussion on starting your own practice. The panelists shown below shared their experiences on starting the practice of their dreams. The webinar was recorded so you have the option to stream it or download it.

Topics covered included:

Choosing the right experts
Choosing the right location
Design & build
Marketing
Day to day operations including staffing
Joining a buying group and or hiring a practice consultant

A special thanks to our sponsors, without their support this webinar would not have been possible.

Download Now

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Artificial Intelligence: Will It Have a Major Impact On Eyecare?

Practice, Resources, Technology

Artificial intelligence is unlikely to produce a robo-eye-doc who will replace you, but it is likely to add a new dimension to the service we can provide to our patients.

AI-Powered Patient History Interview
I can foresee a future in which AI will be able to talk with patients about their reason for their visit when they book their appointment online. Advanced AI systems, with voice activation, would be able to talk to patients to take a case history, gathering the important information, analyzing it and then providing the doctor with a preliminary finding, which the doctor can explore in greater detail when the patient comes in for an in-person appointment.

Click the image above to view two videos on how artificial intelligence might impact eyecare from a presentation given at the 11th Annual VM Global Leadership Summit that took place at Vision Expo East 2017.

Before the Patient Ever Gets to Office

When the patient makes an appointment, AI technology could take information-finding to the next level. The patient would not just fill out a form online prior to their visit detailing their health history and eyecare needs. It would provide an interactive interview.

The system would have a “voice” that would ask the patient questions, such as family history of eye diseases like macular degeneration and glaucoma, and then would ask the next question based on the response it received. For instance, if the patient said “yes” to having a family history of a particular eye disease, the system would then ask which relative(s) in their family had the disease.

Or the system might ask the patient if they participate in sports, and then if the patient said “yes,” the system might ask the patient to say which sport. Then, the system might ask the patient if they were interested in learning more about the sports sunwear the practice sells specifically for that sport.

The key to effectiveness will be the ability of the doctor and optical staff to sit down together and come up with the most helpful questions to input into the system to ask. It’s like the old saying, “garbage in, garbage out.” AI systems are, by definition, “intelligent,” but not so intelligent that they don’t require the inputting of the right information to use as foundation for its interaction with patients.

Click the image above to watch Andy Karp of Vision Monday and 20/20 magazine share his preview of new and emerging technology presented at the 2017 Consumer Electronics Show.

Lay the Groundwork for a More Productive Visit
Before the patient gets to the office, the transcript, in both written and recorded form, would be sent to the patient’s EHR file, with the eyewear-related information sent to opticians.

In addition to giving the doctor detailed information about family history that they could use to ask more informed questions of the patient, opticians would get a jump start on the sales process. They would know ahead of time to have a tray of sunwear specific to that patient’s favored sport ready to show them during their visit.

Interactive Displays in the Optical
The opticians will be better armed with information about each patient’s needs, and the displays themselves could “talk” to patients.

A patient could pick up a frame to try on, and when they pick it up, and when they put it back on the board, an AI system could say: “We have that frame in other colors” or “If you liked that frame, you may also be interested in X frame.”

The system could have an “Ask me a Question” button for every section of the frame board in which the patient can ask questions about the merchandise like they would type a question into Google, and then the system would either give a response or summon an optician to answer the question.

Data Interpretation Help
Diagnostic equipment produces data that historically the doctor reviewed and interpreted. AI would be able to analyze the data and would provide the doctor with a working diagnosis and treatment plan.

AI might be able to run more in-depth analysis on the data than a human doctor could. AI may be better at looking at images than a human doctor both in terms of speed and precision. This would lead to better patient outcomes and the ability to process patients more efficiently.

For example, fundus imaging. AI would be able to track subtle changes to blood vessels, optic nerves and retinal lesions over time. AI would be able to alert the doctor to these changes earlier. This is essential as early intervention often leads to better patient outcomes.

Boost Marketing Efforts
AI would be able to tap into your EHR data and look for marketing opportunities. It would then be able to generate marketing content to take advantage of that information, and would be able to tell you the ideal channels to broadcast those marketing messages based on information stored in the system on what’s worked best in promotion efforts for your practice and other practices.

You and your staff can already use your EHR to mine data to use for marketing your products and services. What AI offers is a helping hand doing that work. Rather than you having to search for, and then look through the data, yourself, an AI system could do that work for you. It might be able to automatically conduct searches for marketing opportunities, and then analyze the data on its own, to let you know, without searching yourself, of needed products and services that your patients may not be receiving as much of as they should be.

This kind of advanced, data-driven marketing would help build practices. Patients would more easily be given marketing messages that were most relevant to them.

How Expensive Will This Technology Be?
With all the great promise of AI technology, a question still remains of how costly it will be to purchase and implement.

It may be that as the technology emerges, it will be prohibitive for all but the biggest, and most profitable, practices, but that five-to-10 years after its widespread availability, it will become affordable for smaller practices.

The important point is to be aware of the coming opportunities to better serve our patients–and to develop plans to eventually optimize that technology so patients are better served, and our practices get a springboard to growth and profitability.

Have you thought about the role AI could play in our practices? What ideas do you have of how you could use this technology in your own practice?

JUSTIN BAZAN, OD

is the owner of Park Slope Eye in Brooklyn, N.Y. To contact him: dr.bazan@parkslopeeye.com.

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How to Retain a Star Employee Who is Wooed by a Competitor

Human Resources, Managing Others

If you’re lucky, all of your employees are star performers. If you’re somewhat lucky, at least a few are. You may not be the only one who knows how good they are. Former employers, or others, may try hiring them out from under you.

You can hold onto a valued employee–if you have an employee-retention strategy in place, and move quickly. That strategy should include a discussion of benefits and the expression of how much you appreciate the employee. Sometimes it’s not just about money; it’s about being appreciated, challenged and empowered.

Renegotiate & Motivate with Pay & Long-Term Growth
The first employee whom I almost lost was contacted by a previous employer. She had wanted to work for me because that former employer had under-paid her and treated her poorly. After I hired the employee, I expanded her skill-set, increasing her value both to me, and, as it turns out, others. I paid the employee to match the additional skills she acquired.

The previous office got in touch with the employee, and tried to outbid her current pay rate to get her back into their office. The employee brought this offer to me, and wanted to discuss it, because she said she would rather stay in my office. We negotiated a higher pay rate, thereby keeping her on staff.

Another employee was approached by a recruiter for an internet start-up company (not optically related). She was offered an entry-level position with full benefits. She also brought the offer to me to discuss. After discussing her future goals, we created a plan to move her into an office manager position, in which she has been fantastic.

The last employee was contacted by a headhunter hired by another group practice in the area. They contacted my optician and tried to hire her away with more money. Again, my employee came to me with the offer, and wanted to discuss it. However, there was bait-and-switch to their offer, in which the final offer turned out to be disappointing, and ultimately, I was able to increase the employee’s pay to maintain her employment.

It Can Be Less Costly Over Time to Raise Pay & Retain
I recommend that you pay valued employees fairly, and even generously, and that you increase their pay if they receive a higher offer from another business.

Finding new staff is time-consuming and frustrating. It slows down work flow, and increases the potential for conflict, with the new employees you add not necessarily gelling as well with your other employees.

If an employee brings value to your office, you should value them in return by offering pay that reflects the revenues and contribution to patient care and service that they deliver. A great optometrist once told me: “Hire slow, fire fast.” I’ve carried that adage with me throughout my career, and it’s always been advice that I wish I had followed better.

Prevent Poaching Attempts With Generous Benefits
I learned that it is of paramount importance that you work toward offering a full panel of benefits to employees (401K matching program, insurance matching, profit sharing). It’s important to remember that the talented people you hire, and profit from, have many other opportunities in the job market. Your pay and benefits package needs to reflect that you understand that they can go elsewhere.

Create an Open-Door/Open-Dialog Culture
I never would have gotten the chance to keep my employees from leaving if they hadn’t felt comfortable enough with me to directly discuss the offers they had received.

If these employees hadn’t felt they were able to talk to me as both a respected friend, as well as an employer, they may not have felt secure enough to discuss with me. You always want to maintain a professional air with employees, but you never want them to feel that you are an authority figure they can’t share work-related struggles and aspirations with. When an employee joins the practice, it’s helpful to emphasize that you welcome ongoing conversations about their feelings working for your practice, and that you want to hear any suggestions they could offer on how you could help them do their job better, or be more happy at work.

It also helps to demonstrate in all your interactions with employees that you are the type of boss who has the patience to listen silently and then discuss in a helpful, how-about-this manner, rather than moving immediately into argument-and-debate mode. The productive, pleasant conversations my employees have had with me over the years led them to feel secure that if they explained the offers they had received, I could discuss it with them in a non-confrontational, non-argumentative, manner, and that I could even be helpful to them.

With that framework of trust laid, I was able to amicably talk through the offers they had received, and point out inconsistencies and downsides.

I learned that recruiters can be deceptive in their offers, or at least what they make their offers sound like. The headhunter who tried to snag my optician quoted crazy-high numbers initially, and then when my optician spoke with her potential new employer’s office manager about pay and benefits, she got a totally different story. If it sounds too good to be true, it probably is.

Set Goals With Employees: Show Them Long-Term Picture
It is helpful to set goals for employees, so they have something they are working toward. Rather than focusing solely on performance reviews, I like to talk in terms of goal-setting. It’s nice to have something to strive for, and look forward to.

For example, you might find that a back-office employee is interested in learning about opticianry, and eventually would like to move into a sales role, or you may find that an optician would like to transition to a supervisory role, such as office manager. It’s important to not just note the state of an employee’s work performance, but what their dream position in the practice would be, if it’s not the one they currently have.

I have set out goals for certain employees to move into management positions. They are aware of this, and it gives them something exciting to work toward.

Offer Help Achieving Certifications
Growth opportunities are only available commensurate with the growth of the practice. Until your practice gets to a certain size you may not be able to offer much growth other than financially. Certifications are a great way to motivate staff, and to offer more money for completion. I offer to reimburse staff for certification costs but only if they pass their testing. They are to pay for it upfront, and then will get reimbursed with an extra bonus once they show proof of passing.

Observe Level of Employee Engagement
Employee engagement is easy to observe–as long as you are paying attention to your practice. The practice owners who shift into cruise control, and act like bystanders, are the ones who won’t notice disengagement until it’s too late, and the best employees have left.

I like to explore new ways of improving our office, and I take a proactive role in discussing my ideas with staff, and hearing their ideas. We have weekly office meetings in which I have employees engage in learning activities and discussions.

I buy lunch for the whole staff during our weekly meetings, and we discuss challenges and examples of work well done from the previous week, along with new work systems we could implement, technologies we could be using better, and technology we may want to add to the office. Everyone is encouraged to speak freely with any idea they may have.

Encourage Learning Experiences Inside & Outside Your Office
I encourage shadowing to learn more about our profession in the offices of other healthcare practices we co-manage with and send patients to for consults. Employees whose minds are kept engaged with new information and experiences are less likely to become bored and restless. Encouraging employees to shadow in offices, such as that of eye surgeons, also benefits your own practice and patients, with employees able to better educate patients in what to expect when sent for a procedure like cataract surgery.

CASEY PACKER, OD

is a certified optometric glaucoma specialist and therapeutic optometrist, and owner of Lone Star Eye, in Austin, Texas. To contact him: docpacker@gmail.com

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Find Efficiencies in Toric Prescribing

Practice, Products | Services | Industry News, Resources

When was the last time a patient phoned you up and asked you, “I was wondering if you could tell me the difference between BLINK STABILIZED® Design and prism-ballast design and how that potentially affects the stability of my vision in eccentric positions of gaze?” It’s been a while, right? But why don’t astigmatic patients ask this question when inconsistency of vision with traditional toric lenses is historically one of the main reasons why they struggle with wearing contact lenses? The reason is people don’t know what they don’t know. BLINK STABILIZED® Design may be established technology to you but for your patient, if explained properly, it could be just the change that takes them from merely surviving with contact lenses to thriving. Sharing education about unique innovational EYE-INSPIRED™ Designs will make you the essential link between technology and better dynamic visual performance for your patients. The opportunity to let them know what you know, awaits you if you open the door by asking the right question: How consistent is your vision with your existing toric contact lenses?
-Kent Prete, OD, Calgary Alberta

With a design that is easy to fit and quick to stabilize, ACUVUE® Brand Contact Lenses with BLINK STABILIZED® Design can help your patients consistently see their best.

For the past 10 years, ACUVUE® Brand Contact Lenses for patients with astigmatism, including 1-DAY ACUVUE® MOIST Brand Contact Lenses for ASTIGMATISM and ACUVUE OASYS® Brand Contact Lenses for ASTIGMATISM, have relied on BLINK STABILIZED® Design to satisfy patient needs.

It’s more than just a catchy marketing term. BLINK STABILIZED® Design was inspired by the anatomy of the eyelids and their dynamic interaction with a contact lens during blinks. Scientists used high speed photography to better understand the lens-lid interaction and figure out how to use it as a force for good—stabilizing and repositioning the lens with every blink.

The result was a completely unique design that has four “active zones” or points of stabilization on the outer central periphery, and a minimal pressure zone under each lid. Symmetrical weighting limits the influence of gravity—and that is critical to how astigmatic patients experience these lenses in their daily activities.

Real-World Vision
Prism- or peri-ballasted lenses can perform well in the exam lane when the patient is upright and looking straight ahead, but these gravity-dependent designs are challenged by eye and head movements outside the office. When the head is tilted 90˚ degrees, for example, to align a golf ball or look under a bed, gravity-dependent lenses rotate about 2.5 times more than BLINK STABILIZED® Design lenses do.¹ BLINK STABILIZED® Design lenses have also been shown to provide greater stability than prism-ballasted lenses for large versional tasks such as looking at the rearview mirror and then back at the road while driving.²

These benefits help patients achieve consistent vision throughout the day, making them less vulnerable to visual discomfort and contact lens dropout.

Avoiding Prism
Due to their uneven thickness, toric lens designs that rely on prism- or peri-ballast can have residual prism in the optic zone. My colleagues and I measured the mean vertical prism in the central 6.0mm zone of eight commercially available soft toric lenses.

Lenses with BLINK STABILIZED® Design had virtually no vertical prism. The other seven lenses had mean vertical prism ranging from 0.5 ∆ to 1.2 ∆.³

This may be particularly undesirable for patients who wear a toric lens in only one eye. Eye Care Professionals should be aware that an imbalance in vertical prism may create or exacerbate disturbances in binocular vision function.

The Eye Care Professional Experience
Not only can BLINK STABILIZED® Design offer a better patient experience, it also makes it easy to fit
astigmats. ACUVUE® Brand lenses with this design are symmetrical, so they are easy to fit and settle quickly, within 3 minutes. With a high first-fit success rate and wide parameter coverage (more than 98% of spherical and astigmatic eyes can be accommodated by the stock prescription ranges of 1-DAY ACUVUE® MOIST Brand and ACUVUE OASYS® Brand), you can be confident that BLINK STABILIZED® Design lenses will help you meet the needs of your astigmatic patients.

BLINK STABILIZED® Design

Quick to settle—in just 3 minutes

Symmetrical weighting makes lenses quick to settle with each insertion and helps keep them stable during blinking

Eye/head movements minimally affect rotational stability

Available in reusable and daily disposable ACUVUE® Brand Lenses for ASTIGMATISM to suit a wide range of patient lifestyle and ocular needs

References
1. McIlraith R, Young G, Hunt C. Toric lens orientation and visual acuity in non-standard conditions. CLAE 2010; 33 (1): 23-26.
2. Zikos GA, Kang SS, Ciuffreda KJ, et al. Rotational stability of toric soft contact lenses during natural viewing conditions. Optom Vis Sci 2007;84:1039-45.
3. Sulley A, Hawke R, Lorenz KO, et al. Resultant vertical prism in toric soft contact lenses. Cont Lens Anterior Eye 2015;38(4):253-7.

ACUVUE®, ACUVUE OASYS®, 1-DAY ACUVUE® MOIST, EYE-ISNPIRED™ and BLINK STABILIZED® are trademarks of Johnson & Johnson, Inc.

©Johnson & Johnson, Inc. 2016

Dr. Hamada is Associate Director, Professional Affairs for Johnson & Johnson Vision Care, Inc.

This article is sponsored by J&J Vision Care Canada.

WESLIE M. HAMADA, OD, FAAO

Dr. Hamada is Associate Director, Professional Affairs for Johnson & Johnson Vision Care, Inc.

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Tips to Generate Positive Referrals from Friends & Family

Digital Marketing, Marketing, Resources

Generating positive referrals from patients is a key to practice growth. Since the inception of our practice in 1969, referrals of family and friends have been the greatest contributors to new patient growth.

Measure to Improve
Like any other marketing technique, measuring and quantifying is a must. Measuring enables us to see what works and what does not work. In the case of referrals, specifying who referred a new patient to our practice lets us further develop our “referral tree.”

Certain patients, whom I refer to as “mover and shakers,” will always be more likely to refer than others. Having a feel for this can help us and our staff cater our language and diction to capture more referrals, especially from our more vocal mover and shaker patients.

Consider a 1.4 million gross revenue per year. Average revenue of $350 per patient with 10% attrition = $140,000 or roughly 400 patients in loss.

We currently average five new patients a week: 5 patients x 52 weeks = 260 new patients x $350 = $91,000 in growth.

We can break this down further. Let’s say we have a mover and shaker patient who loves our practice, and gives us five new patient referrals a year (and in fact we have multiple patients that do this). And then let’s say we have a patient who is warm to the practice, but not as passionately supportive, who may give us one new patient referral a year.

Considering our average per patient in our area is about $350, if we have five patients generating five referrals each, that results in 25 new patients. So, 25 x $350 =$8,750 in extra revenue growth.

To get that growth with our other patients, we would need 25 non-mover and shaker patients to refer an average of one new patient. In addition, these patients would need significantly more resources invested into them to get that “push” to refer vs. our mover and shaker patients who only need the regular excellent service and care we give.

With that math in mind, you can see how quantifying and qualifying your referral sources is much more efficient and effective than blanket-marketing campaigns.

The thank-you letter Dr. Neufeld sends to patients after comprehensive exams. He says sending this type of letter encourages referrals.

Impress Patients with Service
We shy away from signage or incentives for referrals. In our opinion, this appears superficial, and thus, we believe patients may view it as superficial as well.

The process of making a good impression starts the second the patient enters our practice. The tone of our receptionist’s voice, the tidiness of the reception area, and the overall ambience of the practice instantly starts to mold the patient experience. This then continues into the exam room.

In fact, the experiences at the front desk, in the exam room, and in the optical, are paramount for satisfying the patient and starting the referral engine. If I have a pleasant patient (which tends to be the majority of my patients), I often mention that I would love to see more individuals like themselves, such as friends and family. I try to link a personal attribute to this, whether it be the ability to consistently arrive on time, pleasantness, or an interesting personality. Our opticians also will often compliment patients who are easy to work with, or have great taste in optical wear, saying that they wish to see more individuals like the patient.

Incentivizing a patient to refer comes down to appealing to the patient. This stems from allowing the patient to develop a deep appreciation for your services and you as an individual. Once this is established, referrals become second nature and nearly unconscious. To do this, both the staff and practitioners must regard the patient as the highest entity, and center their actions on the patient’s welfare. Most important in this – the patient must be aware that this is how the doctor feels about them.

We feel that generating a deep-seeded appreciation for our services and products produces the most genuine reaction from patients. Referrals “from the heart” are more likely to follow through. More so, we believe that incentivizing through discounts or free material may actually hinder an organic progression of referral due to its “gimmicky” nature.

Dale Carnegie’s “How to Win Friends and Influence People” and Robert Cialdini’s “Influence: The Psychology of Persuasion” are two fantastic books that I recommend every private practitioner read. Understanding the psychological science of how an individual develops fondness and appreciation for another is pertinent in developing a consistent patient who will bring their family and friends to see you.

Ask Patients to “Like” Your Practice Facebook Page
We have invited many of our patients and friends to like our Facebook page. We try to post updates twice a week on social media. Most of our updates are informative in nature or relate to community service. We have found that this style of social media posting (rather than just straight advertising) is most likely to inspire a positive interaction and get shared.

As with our other marketing tactics, we measure by survey how many patients we have seen who heard about our practice through Facebook. We have found that boosting informative posts has helped us gain new patients from social media. We recently had a new patient explain that she viewed us as the “most competent eye doctors in the neighborhood” because of the amount of informative material we publish on social media.

About 90 percent of posts are informative in the sense that they give education on eye conditions, eye health, ophthalmic materials or trivia related to optometry. A little less than 10 percent of our posts focus on local community service such as our work with the Rotary Club. By sending messages from both the educational and community service front, we believe that we can project a more well-rounded sense of caring and expertise to our audience

Send Welcome-to-the-Practice Letters
I send a “Welcome to the Practice” letter to every new patient whom we see. Many patients will respond, and a few have even come back in to tell me how nice and personal the letter was.

Turn Frame Selection Into Referral Generation
Our opticians ask the patient if they would like a family/friend “frame consultant,” when a patient is shopping for frames. This can happen one of two ways:

PUT FRAMES ON HOLD. A few frames are put on hold for the patient, and the optician tells the patient to come back with a trusted friend or family member to provide a second opinion and help make the final decision.

SEND FRAMES HOME TO DECIDE. A few frames are sent home with the patient in one of our boxes. The patient is to have a family/friend help them decide which looks the best. (If you do this, remember to always document thoroughly – we have never had a problem with loss doing this).

The frame consultant scenario enables that person to feel like they have an important role in choosing our patient’s glasses, and subsequently, their style. That transfer of authority and responsibility generates interest in our practice, and many times the person serving as a “consultant” will choose to schedule an appointment with us.

AARON NEUFELD, OD

is the owner of Los Altos Optometric Group in Los Altos, Calif. To contact: aneufeldod@gmail.com

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Dreaming of Starting Your Own Practice?

Webinar

Canadian Eye Care Business Review is hosting the “Start Me UP!” Webinar October 16, 8 PM.

Join a panel discussion of ODs in various stages of independent practice start-up from planning/building phase to the first
3-5 years in practice.

Hosts:
Drs. Jeff and Tina Goodhew,
Co-Editors of Canadian Eye Care Business Review will host the webinar with panelists.

Our Panelists Include:
Dr. Laurie Capogna, Family Eye Care, Niagara Falls, ON
Dr. Michael Kreuzer, Edmonton, AB Opening January 2018
Dr. Agata Majewski, Owl Optometry, Roncesvalles(Toronto), ON
Dr. Ritesh Patel, See & Be Seen Eye Care, Liberty Village, Toronto, ON
Dr. Todd Ruhl, Flamborough Family Eye Care, Waterdown, ON

By some accounts the glory days of independent Optometry have faded, yet the dream of professional independence and practice ownership persists. Learn from your colleagues as they share strategies, challenges and successes as they build the practice of their dreams.

Please reserve your virtual place by registering online.

There is no cost to register thanks to our Sponsors:

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Awesome Customer Experience is a Journey Worth Taking

Differentiation | Business Strategy, Human Resources, Practice, Training & Onboarding

At our practice in Fredericton, NB, achieving excellence in customer experience does not happen by accident, nor does it automatically happen by simply hiring friendly staff. It starts with an overarching philosophy on the customer experience, being open to change, and availing ourselves of the many training opportunities provided by our partners and others.

Don’t Sell, Educate and Provide Solutions
Every person who enters our clinic or optical area is looking for a solution and education to protect or improve their vision. Every encounter we have with a patient, be it on the phone, online or in the office, influences this customer experience. Having our team trained and consistently motivated to provide these solutions and to exceed expectations is the only way to create an awesome customer experience.

Our Team will tell you that we help people solve problems and fulfill their needs. We try not to just see to their vision needs but to really get to know people and find out what they require to optimize their visual experience in the world. Sometimes the absolute best solution is more than what their pocketbook can afford, but we pride ourselves on having options available for all budgets. As independents, we have a vast array of product options available and the professional and staff expertise to deliver; not always the case at retailers and box stores.

Training is Empowerment
Knowledge is power, and we give our team every opportunity for training. These opportunities may come from a third party outside the industry, from our buying group or from specific industry partners and suppliers. Providing those opportunities to our staff is incredibly important, as training serves to empower them to use their depth of knowledge and provide great customer service.

Don’t overlook the opportunities that are available to your team through your key suppliers. Each and every training session or customer experience can provide a new insight or action item. Arranging those opportunities is incredibly important. Essilor Canada offered our practice a Customer Journey Engineering program which we were able to benefit from. It was very comprehensive and didn’t require us to shut down the office or invest a lot of money.

Customer Journey Engineering
Our local Essilor Training and Development Consultant arranged a full 360⁰ practice assessment involving the entire team through their Customer Journey Engineering program.

The consultant spent a lot of time within the practice doing things that I just hadn’t taken the time to do. She sits in on every step of the customer journey listening, observing, and analyzing from the patient’s point of view. She also sits in our waiting room and uses all her senses to observe what people are experiencing when they walk through our door. She provides a report on specific improvement areas and training requirements. This gave us an opportunity to view our practice from a fresh perspective that we could not achieve on our own.

Uncovering Blind Spots
One of the big things that I would not have necessarily realized, but affected how people think about our practice, was at the front desk. We have a beautiful big desk; the control center in the front office. However, the desk was a mess! I know why the desk is a mess, they are being productive and busy, but a patient seeing the desk would say, “What’s going on here?” I never thought about it that way, and didn’t see it as a problem, but that was on top of the consultant’s list to fix! We deployed strategies to move and remove items to clear the space. The Customer Journey Engineering process provided by Essilor was enlightening.

Leadership Training for Associates

We go to school for many years to get our Optometry degree and then hone our skills to become experts at taking care of people’s eyes. Then, there’s this other part of independent practice: running a business and leading a team, for which we often don’t get training.

Reflecting on my own experience of not being provided with business and leadership training, when our Associate Optometrist expressed interest in becoming a partner in our practice we took the initiative to have her do an extensive 6-month leadership program. If you want someone to buy into your practice and they show promise, give them the tools to succeed and build confidence. Leadership training gave her insights and skills moving forward and makes it easier for her to give input in terms of practice processes and systems.

It’s a Team Approach

We try to create a positive team approach. None of it works if we are just out for ourselves. We like to try to lift our team up and educate them just as best as we can so that they can feel confident in their interactions with our patients and our customers.

We encourage our team to go the extra step, which serves to create trust. That emotional connection people develop to our practice hopefully brings them back time and time again, so we become their go-to for anything to do with their eyes or their eyewear.

I don’t think there will ever be a time when we have it all figured out and can’t learn new approaches or benefit from further training, we are all just works in progress. The more we educate ourselves, the better we can perform for our teams and our patients.

This message is sponsored by Essilor Canada.

BRONWYN MULHERIN, OD

graduated from the University of Waterloo School of Optometry in 2004. She practiced in several different retail and clinical settings in the Ottawa area before joining Downtown Optometry Clinic in Fredericton. She can be reached through downtownoptometryclinic.com

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Quick Fixes: What Bothers Your Patients Most–And How to Address It

MARK WRIGHT, OD, FCOVD

CAROLE BURNS, OD, FCOVD

Satisfy More Astigmatic Patients with New Toric Daily Disposable Technologies

ROXANNE ACHONG-COAN, OD, FAAO, FIAO

Insight with Dr. Riaz Ahmed

Dr. Riaz Ahmed

Start Me Up – Webinar

Artificial Intelligence: Will It Have a Major Impact On Eyecare?

JUSTIN BAZAN, OD

How to Retain a Star Employee Who is Wooed by a Competitor

CASEY PACKER, OD

Find Efficiencies in Toric Prescribing

WESLIE M. HAMADA, OD, FAAO

Tips to Generate Positive Referrals from Friends & Family

AARON NEUFELD, OD

Dreaming of Starting Your Own Practice?

Awesome Customer Experience is a Journey Worth Taking

BRONWYN MULHERIN, OD

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