By the Numbers

Coaching up and down the ranks to enhance practice performance

A quick test can show how well you are doing as the coach of your practice.

“Really, coaching is simplicity. It’s getting players to play better than they think that they can.”
– Tom Landry

Horace Greeley, famous in the 1800s for saying, “Go West, young man,” was a hard-working, rags-to-riches statesman and publisher who also said, “Common sense is very uncommon.” There is nothing more uncommon in the business of ophthalmology than a recognition that your practice is a sum of its parts — each of which must be groomed individually if you hope to provide superior patient care.

This does not just mean cultivating your tangible office facilities, testing equipment and website. As important as these are, they represent only about 30% of the typical practice’s operational outlays and an even smaller portion of your success as an ophthalmic enterprise.

More crucially, you have to chiefly improve the most expensive and delicate part of your practice: your people. Doctor and lay staff wages make up 70% of the typical practice’s cash flow, but a much larger portion of your success.

Your practice, at its root, is a team of people in which numerous individual doctor, manager and line staff careers are continuously offered up to be groomed (and not infrequently repaired) by you as a leader.

As a managing partner, administrator or department head in your practice, if you can improve the performance of each of these distinct individual teammates, the entire practice team improves. So let’s substitute the word “coaching” here for “managing” because the continuous improvement of human performance is central to ophthalmic business management. You may “manage” inventories. Or vendors. Or facilities. But you need to coach people.

What is coaching?

Whether you are coaching doctors or non-doctors, several generic principles of effective coaching apply. These principles are the same in business and medicine as in athletics. Let’s explore some of these.

First, as a coach in your practice, you need to understand baseline performance. In baseball, basketball and football, the coaching staff have a command of optimal performance to be expected in their respective sports. The very best players may be able to approach a .300 batting average in baseball or 20 points in a basketball game or a 50% pass completion ratio in football.

As an ophthalmology coach, you need to know what great performance looks like. For example, you should know that a technician should be able to work up the average new patient in less than 20 minutes. Or that a phone operator can easily handle 15 calls in an hour. Or that a motivated general ophthalmologist can readily see 20 patient encounters in a morning.

Although ophthalmology is hardly as competitive as the Super Bowl, you still need to know what “winning” means. This is easy in football: The team with the most points wins. How about in ophthalmology? Winning is a bit more diffuse and includes:

  • Patients being served pleasantly and on time;
  • Each patient’s chief complaints being addressed;
  • Treatment outcomes that equal or exceed contemporary professional standards;
  • Referring doctors getting needed feedback on the status of their patients; and
  • Providers and staff enjoying their day and earning a fair wage.

If you are not counting up your “points” in each of these dimensions, how do you know if it has been a great month? If you have won the World Series? Not only do you need to personally know how to read the scoreboard, but staff and doctors need to all agree on what constitutes a winning score. Post key practice stats (monthly visits, cases, no-show rates, etc) in the break room. Be sure to cover key performance indicators in monthly board meetings: financial statements, average collections per visit, etc.

When you win, everyone should celebrate. Does your practice call out its winning players and team wins? If not, start now with staff citations, bonuses and awards for most-improved player.

As importantly, when you lose the game because of poor profits, disgruntled patients or a clinic that runs behind, gather the involved players. Determine why you lost. What drove disappointing profits this quarter: Competition? Undue provider time away from the practice? Lags in the billing department? Unplanned expenses?

Great ophthalmic coaches realize that while most players are committed and eager to play hard, a few of your team members are not really engaged. You may need to cut the players who should not be on your team or who you find to be resistant and uncoachable.

As the managing doctor, administrator or department head, the most important person you have to learn to coach is yourself. Use the brief test below to score how well you are doing as the coach of your practice.

A practice leader’s coaching test

Mark the following 15 items on a 0 to 3 score.

0 = Never

1 = Occasionally

2 = Frequently

3 = Always

When you finish, select three items you are weakest at and write down a brief improvement plan. Then review your score and your plan monthly or quarterly to check for progress or regression.

  1. ___ I readily accept constructive, even negative, feedback from my team members.
  2. ___ When meeting with my team, I listen more than half of the time.
  3. ___ I assume that everyone on the team has hidden talents that I have not been able to bring out yet.
  4. ___ While always willing to make suggestions, I try first to help my players find their own solutions to their problems.
  5. ___ My coaching style is to catch my players doing things right and encouraging more rather than pointing out what has been done wrong.
  6. ___ I am unafraid of confrontation when it is necessary to correct poor performance.
  7. ___ I am as comfortable confronting subordinate staff about difficult issues as I am confronting peers and my superiors.
  8. ___ Before trying to coach a player, I first make sure that I understand their motivations and goals.
  9. ___ My style is most often to be “suggestive” rather than “directive” when I coach.
  10. ___ When I listen to a player, I also watch for nonverbal clues.
  11. ___ Before describing a desired new performance goal with a player, I make sure that we both agree on the strengths and weaknesses of their past performance.
  12. ___ After I have discussed a desired new performance standard with a player, I make sure they understand what is in it for them if they are able to reach this new standard.
  13. ___ At the end of a “coaching moment” with one of my staff or doctors, I make sure I have their commitment. When appropriate, we put things in writing and even have players sign off their commitment formally.
  14. ___ I make notes about the work that I do with my players, so I can refer back to our progress and we can all remember what the goals were.
  15. ___ Knowing that I cannot coach alone, when appropriate I enlist the help of other “co-coaches,” including other staff and doctors, outside advisers, a doctor’s spouse, etc.

“Really, coaching is simplicity. It’s getting players to play better than they think that they can.”
– Tom Landry

Horace Greeley, famous in the 1800s for saying, “Go West, young man,” was a hard-working, rags-to-riches statesman and publisher who also said, “Common sense is very uncommon.” There is nothing more uncommon in the business of ophthalmology than a recognition that your practice is a sum of its parts — each of which must be groomed individually if you hope to provide superior patient care.

This does not just mean cultivating your tangible office facilities, testing equipment and website. As important as these are, they represent only about 30% of the typical practice’s operational outlays and an even smaller portion of your success as an ophthalmic enterprise.

More crucially, you have to chiefly improve the most expensive and delicate part of your practice: your people. Doctor and lay staff wages make up 70% of the typical practice’s cash flow, but a much larger portion of your success.

Your practice, at its root, is a team of people in which numerous individual doctor, manager and line staff careers are continuously offered up to be groomed (and not infrequently repaired) by you as a leader.

As a managing partner, administrator or department head in your practice, if you can improve the performance of each of these distinct individual teammates, the entire practice team improves. So let’s substitute the word “coaching” here for “managing” because the continuous improvement of human performance is central to ophthalmic business management. You may “manage” inventories. Or vendors. Or facilities. But you need to coach people.

What is coaching?

Whether you are coaching doctors or non-doctors, several generic principles of effective coaching apply. These principles are the same in business and medicine as in athletics. Let’s explore some of these.

First, as a coach in your practice, you need to understand baseline performance. In baseball, basketball and football, the coaching staff have a command of optimal performance to be expected in their respective sports. The very best players may be able to approach a .300 batting average in baseball or 20 points in a basketball game or a 50% pass completion ratio in football.

As an ophthalmology coach, you need to know what great performance looks like. For example, you should know that a technician should be able to work up the average new patient in less than 20 minutes. Or that a phone operator can easily handle 15 calls in an hour. Or that a motivated general ophthalmologist can readily see 20 patient encounters in a morning.

PAGE BREAK

Although ophthalmology is hardly as competitive as the Super Bowl, you still need to know what “winning” means. This is easy in football: The team with the most points wins. How about in ophthalmology? Winning is a bit more diffuse and includes:

  • Patients being served pleasantly and on time;
  • Each patient’s chief complaints being addressed;
  • Treatment outcomes that equal or exceed contemporary professional standards;
  • Referring doctors getting needed feedback on the status of their patients; and
  • Providers and staff enjoying their day and earning a fair wage.

If you are not counting up your “points” in each of these dimensions, how do you know if it has been a great month? If you have won the World Series? Not only do you need to personally know how to read the scoreboard, but staff and doctors need to all agree on what constitutes a winning score. Post key practice stats (monthly visits, cases, no-show rates, etc) in the break room. Be sure to cover key performance indicators in monthly board meetings: financial statements, average collections per visit, etc.

When you win, everyone should celebrate. Does your practice call out its winning players and team wins? If not, start now with staff citations, bonuses and awards for most-improved player.

As importantly, when you lose the game because of poor profits, disgruntled patients or a clinic that runs behind, gather the involved players. Determine why you lost. What drove disappointing profits this quarter: Competition? Undue provider time away from the practice? Lags in the billing department? Unplanned expenses?

Great ophthalmic coaches realize that while most players are committed and eager to play hard, a few of your team members are not really engaged. You may need to cut the players who should not be on your team or who you find to be resistant and uncoachable.

As the managing doctor, administrator or department head, the most important person you have to learn to coach is yourself. Use the brief test below to score how well you are doing as the coach of your practice.

PAGE BREAK

A practice leader’s coaching test

Mark the following 15 items on a 0 to 3 score.

0 = Never

1 = Occasionally

2 = Frequently

3 = Always

When you finish, select three items you are weakest at and write down a brief improvement plan. Then review your score and your plan monthly or quarterly to check for progress or regression.

  1. ___ I readily accept constructive, even negative, feedback from my team members.
  2. ___ When meeting with my team, I listen more than half of the time.
  3. ___ I assume that everyone on the team has hidden talents that I have not been able to bring out yet.
  4. ___ While always willing to make suggestions, I try first to help my players find their own solutions to their problems.
  5. ___ My coaching style is to catch my players doing things right and encouraging more rather than pointing out what has been done wrong.
  6. ___ I am unafraid of confrontation when it is necessary to correct poor performance.
  7. ___ I am as comfortable confronting subordinate staff about difficult issues as I am confronting peers and my superiors.
  8. ___ Before trying to coach a player, I first make sure that I understand their motivations and goals.
  9. ___ My style is most often to be “suggestive” rather than “directive” when I coach.
  10. ___ When I listen to a player, I also watch for nonverbal clues.
  11. ___ Before describing a desired new performance goal with a player, I make sure that we both agree on the strengths and weaknesses of their past performance.
  12. ___ After I have discussed a desired new performance standard with a player, I make sure they understand what is in it for them if they are able to reach this new standard.
  13. ___ At the end of a “coaching moment” with one of my staff or doctors, I make sure I have their commitment. When appropriate, we put things in writing and even have players sign off their commitment formally.
  14. ___ I make notes about the work that I do with my players, so I can refer back to our progress and we can all remember what the goals were.
  15. ___ Knowing that I cannot coach alone, when appropriate I enlist the help of other “co-coaches,” including other staff and doctors, outside advisers, a doctor’s spouse, etc.