reflections - THE HUMAN SIDE OF OPTOMETRY
Far and Away
Dr. Shannon's West African adventure, Part I of II.
BERNARD J. SHANNON, O.D., SCOTTSDALE, ARIZ.
Click here to view Part II

I had been invited to Ho, Ghana, West Africa, to work with the Miracle Life Clinic on management issues. The manager of the facility was also the chief medical officer. Educated in England, Dr. Archibald Lesta, MPH (Masters of Public Health), had a vision to provide modern health care delivery and excellent patient care in his city near a rain forest. Like so many health care providers, Archie had received an outstanding education in his field, but very little education in business. I suspect he had some unspoken concern that an optometrist from the United States could be of much value to a clinic in Africa . . .

"How are you doing financially," I asked on the morning we met for the first time. "Great!" was his smiling reply. "Great!" echoed his office manager.

Proudly the doctor showed me his very expensive state-of-the art-equipment.

"How often do you use the Blood Analyzer?" I asked the technician. "About twice a month," was the reply. "And how often do you use the Ultra Sound?" "Maybe a little more often," he answered.

Neither Dr. Archie nor his accountant had a basic understanding of expense issues — that even though paid for, the equipment had a continuing financial impact on the practice: depreciation, useful life of the equipment, return on investment.

We discussed the basic business formula: Profit equals Revenue minus Expenses. They knew their daily revenue, but only assumed revenue was greater than expenses. I gave the accountant a list of typical business expenses and assigned him to determine all expenses of the clinic. He looked quizzically at Dr. Archie, who nodded.

Then I went to the office manager. "How often do you do staff training?" I asked. "We tried it once, but it didn't work," she replied.

The patients received prompt, quality health care, much better than in most of Africa, but when the accountant completed his expense calculations, it became obvious the financial health of the clinic soon would be terminal.

Bring in the staff

I spent the first days learning the practice, working with Dr. Archie and his staff. They were quick to grasp the issues and even quicker to implement solutions. Anything we discussed on Tuesday was put in practice on Wednesday.

The clinic included a pharmacy for frequently used medications. Everything was stocked in bulk, and I noted that when a new supply of pills arrived, they were poured in on top of what was already in the big bottle.

"How old are the pills left in the bottom of the bottle?" I asked. I explained the concept shelf-life and FIFO (first in, first out). A look of understanding crossed the nurse's face. "I will take care of it." And she did.

I stressed to Dr. Archie the need to communicate with the staff, to make them part of the decision-making process. From my private discussions with them, it was obvious that the staff knew how to improve things, but had no opportunity to do so.

Next month, doctor and staff begin to communicate — and the prognosis is excellent.

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