Pathway to Your Perfect Practice is a monthly feature section in CRST designed to help facilitate the realization of personal and business success through the delivery
of exceptional patient experiences.

This is the second installment in CRST's new section, “Pathway to Your Perfect Practice.” This article builds on information presented in the previous issue.

In the first article in this section of CRST, I introduced the concept of the vision quest, a Native American tradition of communing with nature to determine one's purpose and destiny in life. Given that you have already invested significant time and money into your chosen specialty, you may think this topic is arriving a little too late in your life cycle.

Yes, the hard part of your journey is complete. You have chosen medicine, and if you are reading this, you have likely selected your subspecialty area of focus. Regardless of your stage of practice development, pathways to success are rarely linear, concrete interstate highways with no exits, so the use of the vision quest concept is relevant to helping you envision the pathway to your perfect practice. Despite the common misconception that, to achieve such a vision, you need to set out into the wilderness in a peyote-induced state to receive divine direction, it is really as simple as asking some basic questions of yourself. In reality, most Native American cultures discourage the use of hallucinogens in the search for meaning. More appropriately, a clear mind and some peace and quiet are key ingredients.

I suggest that you find a physical location that provides some uninterrupted solitude, get out your recording device of choice, start asking yourself some important questions, and think about your answers. Whether you are just beginning your journey or are well down a selected path, understanding yourself is a necessary step in the continual process of professional development. Whether you are a solo practitioner, a member of a large group, or somewhere in between, the process is applicable. A group setting with multiple partners just requires more cooperative interaction.

Stephen Weinstock, MD, (see Lessons Learned) points out that “Opportunities arise, and changes occur in multiple unpredictable ways. Have a willingness to embrace opportunities, relish them, and take risks to cultivate and achieve a continually changing pattern of growth and goals.” As you envision your perfect practice, remember that external forces will likely interrupt your journey. The degree to which you deeply understand your vision will determine how likely you are to continue toward it despite a changing landscape and obstacles. Sir Isaac Newton stated that a body in motion stays in motion and will remain in motion at a constant velocity until acted on by an external force. In my nonscientific interpretation, I feel that a deep understanding of your vision provides increased mass to your body in motion, propelling you toward your vision.

ASK YOURSELF THESE 10 QUESTIONS TO find THE PATHWAY TO YOUR PERFECT PRACTICE

No. 1. Have I ever experienced the “perfect” workday? If so, can I describe that perfect day in a few sentences?

Most of us have a passion and have experienced being “in the zone.” It may be the perfect downhill ski run, the descent down a radical single track, the perfect drive into the middle of the fairway, or maybe a perfect day on the water that you wish would never end. If you have experienced it, you know it. Now, imagine that feeling in the OR and the clinic: that day when everything just goes right—happy patients, happy staff. You are finished on time and heading home for some quality family time. How long has it been since you have felt that way during a workday? Take the time to write down your personal description of that perfect workday.

No. 2. What key elements existed during my perfect day?

Now that you have recalled or envisioned the experience, get specific about the key elements of the day that made it so special. As an endurance athlete, there are times on the bike when I feel like I could ride all day. How would I describe that feeling? The pedal stroke is fluid, and my heart rate is steady; I can actually feel the oxygen-rich blood circulating through my legs. When these moments happen, I try to bottle them in my mind to memorialize the experience so that I can recreate it again and again. Not surprisingly, I find that the more I train and prepare for the rides, the more often that feeling occurs.

Once you have visualized your perfect workday, you must face the fact that, to create a replicable experience, you must prepare, practice, and, in many cases, be willing to change your normal way of doing things. If you have ever changed your grip on a golf club to improve your swing, you understand that change is often painful. As humans, we are hard-wired to avoid pain. Many times, we find it is easier to return to our old habits. Change for the sake of change is rarely worthwhile. C. S. Lewis stated, “Mere change is not growth. Growth is the synthesis of change and continuity, and where there is no continuity, there is no growth.” (See Creating Your Vision.)

No. 3. What are the elements of my routine workdays that frustrate me or create an environment that is less than perfect?

Assuming you are now able to see the beginnings of a path toward your perfect practice, you will quickly start to identify the obstacles that stand in your way. I have found that many physicians are able to clearly envision how they want their surgery or clinic days to flow seamlessly from one patient to the next. When they walk into their practices, however, they are knocked off course by any number of obstacles. It is easy to blame these impediments for our inability to achieve a particular goal. We could all fill in the blanks to the following thought process: “I'd love to [blank] if only I weren't held back by [blank].” Those blanks could be any number of undesirable conditions such as a weak economy, limited capital, lack of talented staff, or competitive market forces. Obstacles can quickly become excuses, however, and all too often, we define our inability to achieve our goals by all of the things in our way. One of my favorite comments by Walt Disney is, “All the adversity I've had in my life, all my troubles and obstacles, have strengthened me. … You may not realize it when it happens, but a kick in the teeth may be the best thing in the world for you.”

No. 4. Of those things that need to change in my environment to allow me to experience a perfect day, which are within my control?

Let's face it: not all things are within our control, and many are not even within our sphere of influence. The recession that occurred a few years ago or the devastating effects of the 9/11 terrorist attacks are examples. What I have observed about most obstacles of this type is that nearly all of your colleagues and competitors are facing them as well. So, we must ask ourselves, “Of the challenges in my path, what can I have an impact on most immediately and most directly?”

We often limit ourselves by not exploring all possibilities. By way of example, I give you the Fosbury flop. In 1965, Dick Fosbury developed a new technique for high jumping, and in the 1968 Summer Olympics, he turned that new style into a gold medal. Before the Fosbury flop, high jumpers used a number of different techniques, mostly in straightforward jumping motions. Today, nearly every elite high jumper uses the Fosbury flop. Dick Fosbury simply took advantage of the foam mat's improved technology and devised a better way to overcome the same obstacles that other high jumpers had faced for years.

The declining reimbursements for many of the procedures you perform have become a near certainty. Your ability to control this phenomenon is very limited, but patient-shared billing in cataract procedures has spawned what we commonly refer to as refractive cataract surgery. Much like Dick Fosbury, refractive cataract surgeons are overcoming reimbursement challenges by enhancing the value of the procedure to the patient by improving outcomes and the experience.

No. 5. How much risk am I willing to accept to achieve my vision?

Not all obstacles are external. We each have a limited amount of risk we are willing to take on to achieve our vision. One of the most courageous risk takers in sports was Muhammad Ali. Not only was he willing to boldly confront his competitors, but he was willing to give up his championship status to maintain his moral code. In the words of Ali, “He who is not courageous enough to take risks will accomplish nothing in life.” This is a bold statement from a unique man who redefined athletic competition, entertainment, and political action for a generation.

The pathway to your perfect practice will no doubt carry some risks, some greater than others but risk nonetheless. You must understand the boundaries of your own risk tolerance.

No. 6. How much of my personal and professional resources am I willing to invest to achieve my vision?

I encourage you to search your soul; discuss the matter with your family, spouse, mentors, and partners; and help them to understand your vision and to ensure you have the support you need to make the journey. As I mentioned previously, change is difficult and can be painful for all those involved. Depending on the magnitude of change required to achieve your vision, a proportionate amount of resources will have to be dedicated to the endeavor. This may mean time away from family, substantial capital investment, and support from your professional colleagues and partners. You might consider this step your gut check—the moment when you stand on your front doorstep on the first day of marathon training and ask yourself, am I ready? I hope your answer will be a resounding yes!

No. 7. How will I prioritize my actions to produce the greatest impact on achieving my vision?

Let us shift from the macro level to the micro level. The two specific questions are, what do I need to do, and when do I need to do it? Now that I am firmly planted in middle age, I find that my friends and I regularly lay out a goal such as completing a marathon or an Ironman or winning the tennis club championship. In actuality, few of us ever follow through on these midlife crisis-inspired endeavors. Those of us who succeed are the ones that actually define a training plan and execute it.

The Internet is full of marathon training plans, and if the average human were to follow most of these plans, he or she could complete a marathon. If you want to run 26.2 miles, you must begin preparing months ahead of time and lace up your shoes and hit the streets even on the cold, rainy days. What these training plans provide the average runner is pretty simple: how far to run today, tomorrow, and several more days every week over several months. This sounds like a daunting task, but of course, every marathon begins with one step.

Let us apply this concept to a refractive cataract practice. A young surgeon sets the goal of performing 2,500 cases per year. She analyzes her position in the market, competitors, technology, facilities, staffing, and referral sources. She realizes that she simply does not have the facilities or staff to handle this desired volume and that her current referral base will not produce the targeted case volume. She then develops a business plan for a new facility, defines the team members, and creates a target list of referring physicians. Now, she has to take that first step in the journey. She has to start somewhere, and it only makes sense to begin with the actions that will yield the greatest return in the shortest amount of time. I commonly refer to this as the “low-hanging fruit.” There is no need to wait until the team and facilities are in place to start developing an expanded referral network, which has the potential to have an immediate impact on case volume. Some actions simply take more resources and time than others. Focusing first on the ones that require the least investment builds confidence and momentum.

No. 8. Do I have a clearly articulated vision with defined action steps toward it?

I have spent a considerable amount of time here and in my previous article setting the stage for future development. After contemplating and responding to the questions herein, you should be able to articulate your vision in a few simple sentences, the “elevator pitch.” Assuming that you are able to quickly articulate your vision to others, you will likely hear, “Wow, that's ambitious. How do you plan to do it?” Keep your action steps limited and simple.

No. 9. How will I measure my progress in achieving these action steps?

If you know where you are going and how to get there, you will need some way to measure your success. For example, refractive surgeons often tell me that they want to increase the cash-pay or elective components of their practice. My logical next question for them is, what is your current percentage of cash/elective revenue versus overall revenue, and what do you want it to be? Not surprisingly, many individuals cannot answer.

If you plan to reach a specific goal, metrics and milestones are valuable tools by which to assess your progress and adjust your steps as external forces act on your body in motion. Each action step must be accompanied by a quantitative measurement. Let's say you want to provide exceptional customer service, which is a somewhat subjective measurement. You must gather quantitative data from your patients to understand if you are progressing toward that goal. There are many ways to obtain this information. Fortunately, most physicians are well schooled in data gathering and compilation. Unfortunately, many rarely apply that knowledge to the quantification of patients' satisfaction. Keep your data gathering simple. My favorite metric by which to measure patients' satisfaction is their willingness to make a referral. If a patient expresses a willingness to refer you or your practice to friends and family, you have some measurement toward your goal of exceptional customer service.

No. 10. Am I committed to executing my action steps to achieve my vision in spite of a changing landscape and internal and external forces?

Michael Jordan, one of the greatest basketball players of all time, said, “If you're trying to achieve, there will be roadblocks. I've had them; everybody has had them. But obstacles don't have to stop you. If you run into a wall, don't turn around and give up. Figure out how to climb it, go through it, or work around it.”

This gut-check question forces you to remember that you will face challenges on your path and asks you to confirm your commitment to your vision. On your journey, you will have to continually assess your progress and obstacles. To move forward on the pathway to your perfect practice will require discipline and commitment. Are you committed?

CONCLUSION

In the next installment of this series, we will look in depth at the power of possibilities, which will help you see past traditional practice management solutions as we explore creative and nontraditional methods of problem solving applied to the refractive surgery practice. In my nearly 3 decades of working with hospitals, ambulatory facilities, and physicians, I have often been asked to examine operational processes to achieve greater efficiency. When I ask organizations, physicians, and team members why a certain process is in place, I continually hear them say, “Well, that's how we've always done it.” My next step is to take out a blank sheet of paper and ask, “If you could start from scratch, how would you design the process?” I look forward to exploring all the possibilities of how you can achieve your vision as we collectively move forward down the pathway to your perfect practice. n

Section Editor James D. Dawes
• president and founder, J. Dawes Group
• principal and director, BK Ventures Group
• chief development officer, Vold Vision, Fayetteville, Arkansas
• registered member of the Cherokee Nation
• (941) 928-2589; jdawes@jdawesgroup.com