fix this practice
Creating a Fair Environment
Rules and laws maintain order --even in a practice. See how.

By Richard S. Kattouf, O.D.

Q I've been practicing independent optometry for 20 years. I've tried to accommodate the whim of every employee and every patient, so I don't understand why my practice growth is flat.

Dr. E. Vargo via e-mail

A: You can't make all of the people happy all of the time. And that's why you can't manage your office as a democracy. As the owner of a practice, it's imperative that you set boundaries or standard operating procedures that are fair to your staff, your patients and yourself. Once you've established the boundaries and rules, you mustn't be guilty of breaking your own guidelines. Although this is common in many offices, it lowers morale. Just look at what happened in Dr. McGee's office.

Case in point

Dr. McGee's staff had dictated to him when they could, or would, work. Each staffer had special circumstances regarding her children, elderly parents and outside employment. Dr. McGee wanted his staff to see him as the good guy, so he let them create their own schedules, thinking it would build morale.

This situation created a scheduling nightmare and led to a need for even more part-time employees who had their own personal agendas. Unfortunately, they viewed his approach as a weakness and took further advantage of his "nice guy" mentality by arriving to work excessively late and sometimes not showing up at all.

The scene

I noticed that Dr. McGee had made another terrible error by giving vacation time and health and dental insurance to his part-time staffers. Also, Dr. McGee's percent of salaries to gross was 26%. The national norm is 18%. He also gave his staffers automatic reviews and raises annually.

When Dr. McGee hired me to consult for his practice, the staff was totally out of bounds. Cost of operation was at least 8% more than national norms. In working with the 13 staffers (five full time and eight part time) plus Dr. McGee, it became evident that seven dedicated employees were taking up the slack for the others.

Dr. McGee enabled the staff to behave this way because he gave them too much power by presenting them with suggestions and letting them decide which to accept.

Pulling in the reins

I explained to the staff that Dr. McGee had enabled their negative behavior. I established rules and consequences for not following them. We eventually terminated three employees after we'd placed them on probation for challenging the new rules.

We gave all new hires a schedule and replaced annual reviews with daily organizational meetings to allow for praise and critiquing. I advised Dr. McGee to freeze salaries and replace raises with commissions, which staffers had to earn.

Dr. McGee was also weak on collections and patients took advantage of him too. I sent a mailing out to patients explaining the new collection policy changes. As a result, accounts receivable decreased and cash flow and net increased.

The bottom line

You can't allow your staff and your patients to do as they choose. Structure, organization and consequences to unacceptable behavior are key to managing a successful practice.

DR. KATTOUF IS IN PRIVATE PRACTICE IN WARREN, OHIO, AND HE'S PRESIDENT AND FOUNDER OF TWO MANAGEMENT AND CONSULTING COMPANIES. FOR INFORMATION, CALL (800) 745-EYES OR E-MAIL HIM AT ADVANCEDEYECARE@HOTMAIL.COM.  THE INFORMATION IN THIS COLUMN IS BASED ON ACTUAL CONSULTING CASE FILES.