This document discusses improving quality and excellence in refractive surgery practices. It argues that practices should establish standardized protocols and processes for all aspects of patient care, from initial contact through surgery and follow-up, in order to consistently deliver high quality results. It recommends using patient surveys to identify areas for improvement and establish benchmarks. A case example shows how implementing a standardized process for addressing no-shows reduced the no-show rate. Overall it promotes a systematic, process-oriented approach to patient care to improve satisfaction and practice performance.

1. TODAY’S PRACTICE
Mission: Control
Putting your business processes in order.
BY SHAREEF MAHDAVI
Most surgeons, I think, are pretty
happy with their refractive surgery “When we focus on improving
results. They have a process by which quality at the point of service between
they approach surgery, called surgical pro-
tocol, which at its core is designed to help a provider and a patient, we engage in
them execute the procedure the same a ruthless pursuit of excellence.”
way each time. Following protocol is a
means to achieving results that are predictable and that,
in virtually every case, lead to a successful outcome. THE PUR SUIT OF EXCELLENCE
Imagine for a moment that a surgeon got bad results When I use the word quality, I am referring to the use of
one-third or even one-half of the time. It’s unthinkable— defined processes (similar to protocols) in place in a
that surgeon would be out of business! Those are, howev- refractive practice. When we focus on improving quality
er, exactly the type of results being achieved on the front at the point of service between a provider and a patient,
end of the refractive surgery practice. I define the front end we engage in a ruthless pursuit of excellence. Over the
as those activities years, I have come
that lead up to a to see why such a
patient’s actually pursuit is vital: serv-
undergoing surgery. ice is the only true
These activities in- means of differenti-
clude exposure to ation for the refrac-
advertising, an initial tive surgeon.
phone call with Now it’s time to
someone at the begin exploring how
practice or center, to pursue excellence
and then a consulta- in all aspects of your
tion to determine practice. Two com-
the patient’s candi- pelling reasons make
dacy for surgery. this subject timely:
Similar to what (1) refractive surgery
happens in the today includes a
operating suite, multitude of treat-
each of these front- ments and proce-
end activitites dures, a list that is
should be thought only going to get
of as a process. That bigger and better,
is, each deserves the focus and attention required in order and (2) even after 10 years, most of the practices I have
to raise it to the same standards of excellence achieved encountered still perform poorly in basic service areas such
during surgery. The front-end process comprises the major as answering the telephone. The few practices that execute
service components of the LASIK procedure, and the busi- these tasks well are clearly on the path toward excellence in
ness staff should strive to improve their quality with the service. They have mastered telephone communications
same fervor that the ophthalmologist applies to eliminat- and expend similar efforts toward excelling in other areas of
ing surgical complications. service.
FEBRUARY 2006 I CATARACT & REFRACTIVE SURGERY TODAY I 57

2. TODAY’S PRACTICE
SURVEY SAYS? • We will reemphasize the importance of being on
The first step to bringing your service under control is time for the appointment and have alternative time slots
taking measurements. Evaluate one or more areas of your available in case they need to change their time.
practice by collecting data to understand your baseline of • If they resist setting an alternative time, we will invite
service activity. A good way to begin is to survey your them to share with us any lingering concerns that they
patients for an objective view of how well you are doing. may have about the procedure.
Restaurants, automobile dealerships, and hotels frequently • If they wish to speak to the doctor, we will schedule a
ask customers to complete a survey. They collect the data phone call.
and then analyze them for trends and areas in need of
improvement. You should do the same on a consistent “Customer surveys, strategic
basis. Greg Korneluk, Chairman of the International
Council on Quality Care, suggests having the surveys sent planning, implementation, and
to your home. The customer can then communicate reevaluation are all steps toward
directly with the “CEO” of the practice in a nonthreatening reducing errors in the daily activities
manner. Each survey you get is a nugget of information on
how you can improve what you do for your patients. of the practice.”
The consistent use of surveys will soon paint a picture
of what customers like and dislike about your practice. This process is assigned to one of the counselors.
This picture may be relatively healthy or rather sickly. During the next 2 months, the percentage of no-shows
Either way, you will need to discuss and solve the issues drops from 14% to 4%. Further, the staff formalizes the
raised in the surveys with your staff members. The appro- process by documenting it and adding it to binders that
priate forum is likely a staff meeting or, if the staff is too define all work processes. The document is also turned
large, an appointed “quality team” that includes represen- into a checklist, an important tool that is being used
tation from all areas of the practice and has the charter to increasingly in service-based industries. (You would be
find and implement solutions. In doing so, you will devise well served to convert most or all of the work duties
benchmarks (what other refractive practices do, what throughout your practice into checklists. They are
other businesses do) and then standards for your own another great tool for improving quality at the point of
practice. In a maternity ward, a common standard is “no service.)
dropped babies.” The Domino’s Pizza brand was built on
“delivery in 30 minutes, or it’s free.” FedEx makes sure your CONCLUSI ON
packages get there “absolutely, positively overnight.” Your You cannot and will not want to tackle every problem
standards do not need to be part of an advertising cam- at once. What is important is to choose areas that will
paign, but, if done well, they will gauge improvements in have an immediate, positive impact on the satisfaction of
daily operations. How quickly are phone calls answered? your patients, because without them you have no busi-
How long are people waiting before they are seen? How ness. Once these issues are resolved, you can move on to
long does someone need to stay on the day of the proce- the next most vital elements needing attention.
dure? What percentage of patients receives a thank-you Customer surveys, strategic planning, implementation,
note within 2 weeks of their surgery? and reevaluation are all steps toward reducing errors in
the daily activities of the practice. Fewer mistakes pro-
CA SE E XA MPLE duce more satisfied patients, staff, and surgeons, reduce
Let’s use no-shows as an example for measurement and the expense involved in correcting errors, and increase
improvement. Assume you have seven no-shows out of the profitability of the practice. Defining and measuring
every 50 consultations scheduled. Is this ratio good or bad? all workflow activities as processes is the first key step to
That depends on your standard. Either way, it becomes a turning your practice from the proverbial hockey match
baseline measurement on which you can improve. into an elegantly orchestrated ballet. ■
Based on a discussion at a staff meeting, you brain-
storm many ideas for reducing the number of no-shows Shareef Mahdavi draws on 20 years of medical device
and decide on a four-step process: marketing experience to help companies and providers
• We will call all patients scheduled for a consultation become more effective and creative in their marketing and
beginning 36 hours prior to the appointment until we sales efforts. Mr. Mahdavi welcomes comments at (925)
reach someone (instead of leaving messages on the 425-9963 or shareef@sm2consulting.com. Archives of his
answering machine or voicemail). monthly column may be found at www.crstoday.com.
58 I CATARACT & REFRACTIVE SURGERY TODAY I FEBRUARY 2006