In sociology and criminology, the Broken Window Theory says that the visual blight of a broken window, left un-repaired, encourages others to break adjacent windows. The result, as more windows are broken, is an accelerating, downward spiral toward disrespect and lack of courtesy. The key to maintaining orderly conduct is to repair broken windows promptly. In an optometric practice, there are also susceptible “windows.”

Physical environment. If the front door is broken, the overhead light is burned out, the faucet drips and the carpet is stained, the collective impression to patients is that their eyecare and product will pattern the physical appearance of the practice. Deferring maintenance is never ideal, as it can encourage patients and staff to care less about your facility. So, promptly fix these problems as they arise. Of course, there comes a time when remodeling is appropriate, whether for aesthetics or better function. Make it look too cheap, and that sends the message of poor quality care. Yet make it too nice, and patients wonder where their money is going. A reasonable balance considers what your patient demographic will support along with function, aesthetics and your style.

Staff. We’re not perfect either, but staff may come to work late, do or say things incorrectly or display lack of courtesy and respect. While the work environment should tolerate the occasional mess-up to allow employees to admit and own their mistakes, rather than hiding them, there is a threshold where the frequency or severity of misbehaviors or mistakes is unacceptable. These issues can spread to co-workers if not promptly contained, like a wildfire. That is why it is important to give staff appropriate and timely feedback when they fail (criticize in private) or exceed expectations (commend in public). In cases of failure to meet expectations, sanctions should escalate up to the point of terminating their employment.

Patients. We’ve all experienced patients who cancel at the last minute, or worse, don’t show up at all. Your staff should call these patients within 15 minutes of their appointment expressing concern so they realize your practice will not tolerate a lackadaisical attitude toward their reserved time. There is a diversity of rude and inappropriate behaviors to the degree that it’s impossible to list them all. Yet having a policy on the common issues is a good idea, such as on appointment scheduling and product warranties (e.g. eyeglass redo’s, non-adaptation to progressive lenses, etc.) in order to prevent many of these issues and minimize their spread. With the worst patients, discharge them from your practice.

Vendors. If your outside spectacle lab “breaks” the eyeglass order for your picky patient for the third time, it’s understandable why the patient blames your practice even though the repeated problems stem from the lab. One strategy to manage these situations is to require your lab representative to send the patient an apology letter. Doing so lets the patient know that your practice is not the culprit while contemporaneously holding your lab rep’s feet to the fire. The lab rep should be on notice that any continued pattern of poor service provides grounds for your practice to fire them and reward your business to a competing lab. Without addressing this “broken window” promptly, the lab is free to continue its poor service without being mindful to your business needs. In a similar fashion, your other vendors also need your oversight and prompt correction when their service or products fail.

What small repairs or improvements have you made in your practice that have made a big difference?

Brian Chou, OD, FAAO

Brian Chou, OD, FAAO

directs a referral-based keratoconus clinic at EyeLux Optometry in San Diego, Calif. He also serves as an expert witness for medicolegal claims involving optometric standard of care. To contact him: To contact him: