Going Lean in Optometry

Practices across the country are increasing profitability by adopting "lean" principles with the help of a new program offered through The Vision Care Institute.

What if tomorrow your practice could run differently than it does today — more efficiently, more profitably and more focused on patient satisfaction? What if you could do this without adding staff, equipment, hours or space? This is the promise of ODLean, a new program offered through The Vision Care Institute, a Johnson & Johnson Company, and, in fact, practices are reporting measurable, positive results in a matter of weeks.

After successfully applying "lean" principles of efficiency and productivity at Johnson & Johnson Vision Care, experts at the company set out to adapt those same principles for use by their customers. Optometrists are the first beneficiaries of their efforts through the ODLean Consulting Group.

"It is exciting to see the Institute expand into this type of an offering," says Colleen Riley, OD, MS, FAAO, Vice President of Professional Development and Medical Affairs at Vistakon. "It will allow us to provide programming that can take the optometric office to the next level."

We talked to several optometrists who are working with ODLean, as well as to General Manager Scott Lovin, to learn what is different about this program and what impact it has had on these practices.

The ODLean Experience

Far from being a one-size-fits-all program or a compendium of general tips, ODLean is customized to individual practices. To begin, the practice gathers all pertinent information, including short- and long-term goals, financial statements, productivity reports, time studies and videos of patients' experiences "doorknob to doorknob." The consultants then review and analyze the data to understand the dynamics of the practice and identify opportunities to improve the flow of information, patients, products and revenue.

"Typically, we do the equivalent of 10 days of analytics for a practice," Mr. Lovin explains. "We marry the financials to the practice's operations, second by second, using the lean model, and we identify what is value-added and what is not. We break down every staff member's job into basic components. We know the doctor's load and patient-facing time. We know when his work spikes occur, and we know what is needed to streamline the operation."

Next, the consultants schedule an online meeting with key personnel from the practice. Once the practice aligns with the plan, the consultants schedule a site visit. They spend about a half day in the practice, observing and finalizing their calculations. The next day, the practice is closed, and the ODLean consultants facilitate a brainstorming session that involves all personnel, from receptionists to practice owners. "When they open the practice the next day, it runs differently," Mr. Lovin says. "We measure their results for the next 12 months, and we coach them every month on how they're doing."

So, how are they doing? Two practices that recently began implementing ODLean principles share their experiences with the program.

In-practice Consulting

Nathan R. Bjork, OD, and Cara Frasco, OD, MS, are partners in a 2-office, 3-doctor practice with an emphasis on pediatrics and ocular disease in Middletown, Ohio. The practice signed on for what ODLean calls the full engagement and began the information-gathering process, much of which was facilitated by the practice's electronic health records system. ODLean provided iPods to capture each patient's experience on video, which was uploaded to a secure website, and the staff kept a log of all patient encounters for 2 weeks. "It was quite a time commitment," Dr. Frasco says, "but once we saw the data analysis, we knew it was well worth the time investment."

Dr. Bjork and Dr. Frasco particularly appreciated how ODLean involved their employees. "The consultants identified problems and asked us to look at them from a patient's point of view to figure out what we could do to improve the experience," Dr. Bjork says. "With the staff participating in that discussion, as opposed to being told what to do, they understood why we were making the changes, and they were much more likely to implement them."

Did ODLean deliver on its promise to improve office productivity and patient satisfaction? "The consultants told us we would be seeing more patients, but that it would feel easier," Dr. Frasco says. "That has proven to be true. I am seeing more patients and spending more time with them, and they are having a better experience, yet no one in the office is feeling stressed with the added volume."

The practice began implementing ODLean changes at a time of transition, as one doctor had left the practice and his replacement had not yet come on board. "I was very concerned that our revenue for that month would be down significantly," Dr. Bjork says. "Instead, we were up 25% over the previous year. That was my ‘Aha!’ moment. Since then, over a 4-month period, revenues are up 21%. The year before, as a whole, we were up 5%. To go from a pace of a 5% increase to a 21% increase is a significant change and well worth the investment."

Workshop with Implementation Assistance

Isthmus Eye Care is a 2-office, 4-doctor primary eyecare practice in Madison, Wisc. The challenge in this practice was that one office was operating at about 110% of capacity, while the other was operating well below capacity.

"In our larger clinic, we were reaching a ceiling for patient volume," says Victor J. Connors, OD. "I suspected this was related to inefficient patient scheduling along with our non-patient care-related workload, such as telephone recall, insurance verification and the like. In the smaller office, we had the opposite problem. We were taking very good care of patients, but our volume was not growing."

After the partners heard about ODLean, Scott A. Jens, OD, and business manager Kim Zimmer gathered data from the practice and took it to a 1-day workshop at The Vision Care Institute in Jacksonville, Fla. They learned the mechanics and philosophies of the ODLean program, returned to the practice and shared this information with the other partners and business manager. Because of the different challenges at each office, the partners contracted with the ODLean consultants to provide full analytics and implementation assistance.

"So far, we have implemented a new plan for patient flow through the office," says partner Callie M. P. Maursetter, OD. "We are examining every aspect of our testing, analyzing our scheduling and evaluating our staff's non-patient care tasks."

Although Isthmus Eye Care has just begun implementing lean processes, the doctors already have received positive feedback from their patients. "Patients see that we are still doing a comprehensive evaluation, yet we are achieving the same results in much less time," Dr. Connors says. "They feel they now have time to stay here and fulfill their treatment plan in the same appointment period, whether it involves eyeglasses or contact lenses."

According to Dr. Connors, prior to implementing ODLean, both offices had been meeting or exceeding goal by 2% to 3%. For the month of July, however, after addressing flow issues and redundancies as revealed by the ODLean consultants, both offices exceeded their goals by double digits, the smaller office by 21%.

"What ODLean brought to the table was the organizational structure and the science behind it," Dr. Connors says. "They provided the technical know-how to analyze our practice and make changes that could be validated."

Total Practice Consulting

ODLean practices are posting some impressive numbers. According to Mr. Lovin, in the first full month after ODLean engagement, revenue per doctor per month in one practice rose from $57,000 to $95,000. The optical capture rate can increase by as much as 40%. What is the secret for this success?

The doctors we interviewed agree ODLean is not a magic bullet, and it requires the practice to be fully engaged, but the rewards become apparent quickly. "The ODLean program provides a unique look at your practice from the patient's perspective," Dr. Maursetter says. "You quickly learn what has value for your patients."