Managing your practice

Aidan Hanratty

Posted: Thursday, April 2, 2020

Photo by Foto Garage AG on Unsplash

First impressions last, as the saying goes. This counts as much for an ophthalmologist’s waiting room as anything else. “There has to be a ‘wow’ factor when you enter the waiting room. Because at that moment, the patient already has an idea about the professionalism of the practice,” said Guy Sallet MD, FEBO, Medical Director, Eye Institute Aalst, Belgium, in an interview with EuroTimes.

When establishing his own practice, Dr Sallet visited other clinics to gain inspiration, both in terms of what to do and what not to do. A doctor may have all the right equipment but if the waiting room is small and cramped, that’s not going to encourage the patient. Instead, things like high-end furniture and open space are important to make the patient feel at ease.

The Wellington Eye Clinic in Dublin, Ireland, is a private practice that offers a range of vision-correcting procedures including laser vision correction, orthokeratology, refractive lens exchange as well as cataract removal, corneal cross-linking for keratoconus, dry eye and so on.

The clinic recently had a design overhaul, which involved removing a large, bespoke front desk that was bolted to the floor.

“You could have someone signing in, you could have someone checking out, you could have someone discussing a payment, all standing within earshot of one another,” said Arthur Cummings MD, Consultant Ophthalmologist and Medical Director of the Wellington Eye Clinic. “And the ladies sitting at the front desk were on a computer, busy on a phone call and trying to deal with the patients standing in front of them!”

While the new setup featured input by an architect, it was ultimately designed by the practice staff: “They’re the ones who use it every day, they’re the ones who see the way things work,” Dr Cummings added.

Reception staff now see one patient at a time, while calls and other administrative issues are directed away from the front desk.

Liz Brennan, Clinical Support/Research Manager at the Wellington Eye Clinic, advised anyone starting out to buy an “off the shelf” desk, rather than a bespoke desk to start out with, as this allows you to determine what will work best for you in the long term.

Similarly, Paul Rosen MD suggests starting small. “You need to have all the basics there, start off small, but with potential for expansion.”

Having seen clinics start and fail thinking that they’ll be tackling thousands of cases from the word go, he stresses the importance of more realistic expectations. “If you’re building a clinic, you have two or three consulting rooms, but the potential to expand to six; one operating theatre, the potential to expand to two or three,” said Dr Rosen.

Multi-functional team
With a small team, it’s important to maximise the capability of staff. Dr Sallet has what he calls a “medium” group practice, where everyone is multi-functional.

“The optometrist can answer the phone, give consultation dates, give information about the operations, but is also aware about reimbursement policies,” he said. This multi-functionality makes it easier when people are on annual leave or maternity leave, for example.

At the Wellington Eye Clinic, the approach is similarly multidisciplinary, with several ophthalmologists on hand as well as optometrists working full- and part-time. “So, if one of them had to leave, there’s always a depth of knowledge within that team,” said Lisa McLoughlin, Clinic Manager. “It’s never a case that only one person knows how to do one thing.”

That comes with limits, however. Administration staff are clearly trained on when to answer questions and when to refer: “They would never give medical advice because they could be wrong. There might be some question that they’re not asking that could be very significant, and really to protect themselves, we just advise them not to answer any medical questions,” said Ms McLoughlin.

Patients expect results, and with elective procedures like laser surgery and premium IOL implantation the stakes are higher. This is where the interests of business and medicine can collide. “Some people want a 100% guarantee. And we can’t give that,” said Ms McLoughlin.
“If there’s a patient who is frustrated because they’ve done two or three contact lens trials, but they didn’t really like any of them, it’s not meeting their expectations – the culture within the team is to say ‘This isn’t for you, I think the best thing for you to do is to not have surgery’,” added Ms Brennan.

When it comes to negative online reviews, Dr Sallet has designated staff who respond to unhappy patients. “We never go into discussion on social media. If there’s a problem, [we ask patients] please come into our practice and we can have a closer look at how to solve it,” he said.
An important thing to remember is never to argue with the patient, never tell them that you are right. “You just have to listen to their problem and say ‘well, I believe in your problems’. Maybe you don’t have the solution, but at least you have said you believe in it and if you have a solution try to present it. If you don’t have a solution you will do a very close follow-up so the patient feels regarded and cared for,” said Dr Sallet.

If anyone at the Wellington Clinic feels that a patient is having a rough time or feels they are being ignored or mistreated, they are at liberty to give them a voucher for a high-end department store on behalf of the clinic.

“You would imagine in a place where there’s a lot of things going on, it’s a very nice way to calm people down if they’re upset or waiting too long or something’s upsetting. ‘We really apologise, here’s a voucher, go spoil yourself’,” said Dr Cummings.

Highest level of medicine
A tough aspect of owning your own practice is knowing what machines to buy and when. There are key questions at stake, as Dr Sallet puts it: “What gain can we have with our practice? Will it help us in making better diagnosis? Will it help us in making better therapy modules? If it’s just an extra tool to show off to the patient it’s not of interest to us.” What’s important, he said, is to give the patient the highest level of medicine as possible.

Dr Cummings agrees. “We only ever buy equipment that we think is going to give us value. Not monetary value, but equipment that will help us make better decisions so that we avoid problems down the line. Often, we’re quite early with acquiring technology and other times we sit back first and wait. Like the femtosecond laser for flaps, we only got involved after it had been released and proven in the market for a few years already, because we weren’t sure right at the start about its added value.”

“There could be a device that I think is really valuable,” he added, “but it takes twice as long to use and then it’s just 
not practical.”

“We try to look at it from the whole way through the patient journey,” added Ms Brennan. “Is it nice to use, do the patients like it, is the patient comfortable?” From the surgeon’s point of view, the quality of data and reports is also important, so all aspects of use are considered. And that works both ways.

All these issues and more will be discussed at the ESCRS Practice Management and Development Programme during the 38th Congress of the ESCRS in Amsterdam, the Netherlands.

Guy Sallet:
Arthur Cummings:
Liz Brennan:
Lisa McLoughlin:

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