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How to Dream Backward

By starting with the end in mind, you can work backward to achieve goals.

Gary Gerber, O.D.

What does your dream practice look like? More specifically, how does your perfect employee perform, and what does your dream schedule look like? At the end of the year, what does your idyllic financial statement look like?

If you're like most doctors, your dreams might be summed up by: “I'd like to make more money and work less.” Pushing that to a quantified extreme, you might say: “I'd like to work one minute per year and generate $1 million.” If that's your goal, one management approach would be to ask: “How will you get there?” A different technique is to ask: “Assuming you're already there, how did you do it?”

A saying goes: “Begin with the end in mind.” Using this sort of thinking, applied to individual segments of your practice, you can start to work backward to achieve your goals.

Getting from there to here

Let's use your schedule as an example. Assume that right now you're working 40 hours per week and want to cut that to 30 hours per week with no loss (and hopefully a gain) of income. If you're currently earning (on average) $100 per hour working a 40-hour week ($200,000), you'll have to increase that to about $133 per hour to hit your goal. If you take out your crystal ball and assume you hit the goal, how did you do it?

Did you cut your expenses, raise your fees, see more patients or offer new services? You've probably heard suggestions already. But unlike conventional management paradigms, as you work through your plan now you are strategizing in reverse in an attempt to land on your goal, which forces you to pick at least one tactic and implement it.

Take the topic of raising your fees. In the example above, you have to do something to generate an additional $33/hour. That might mean changing your appointment schedule, raising non-insurance reimbursed fees or evaluating whether you can drop a poor-paying vision plan.

Or, if you chose to add a service (for example, generating more pediatric visits), you must accurately forecast how many patients you'll need to see, when you'll schedule them, which patients they'll replace (if you don't want to increase patient volume), etc.

One dream one quarter

Tackle one backward dream each quarter. Share your dream with staff, and ask for their input. While you may think your dreams will be perceived by your staff as self-serving, you'll probably be surprised to find that their dreams are usually similar to yours—and once you solicit those, you can come up with team dreams. For example, most staff would be aligned with your goal of working less and making at least the same amount of money. The same goes for structuring things to attract the “perfect” patient or employee.

At the end of each quarter, assess your performance. If you hit your goal, consider raising the bar even higher for the next quarter. If you missed it, make an honest appraisal as to why, and decide whether you'll try again or move on to something else.

Backward thinking can be used with long- or short-term goals—even daily goals. A daily goal might be: “We will be out the door by 5 p.m. today instead of our usual 5:45 p.m. Starting with our first patient at 9:00 a.m., here's how we'll do it.”

If you start with the end in mind, you have a higher likelihood of actually ending up there. OM