Welcome to another edition of “Ophthalmology 360.” This is a monthly column put together by the members of CEDARS (Cornea, External Disease, and Refractive Surgery Society) and ASPENS (American Society of Progressive Enterprising Surgeons). One of the areas that we wish to focus on is practice management. Many of us have faced the frustration of trying to implement policies or procedures in our practices only to find that these initiatives do not go as expected. Often, physicians struggle to get their staff on board to follow through with the plan. This month, business consultant Michelle Beckman, JD, offers insight into this dynamic and suggests some techniques to change it. We hope you enjoy this discussion.
—Kenneth A. Beckman, MD, section editor
How many times have you tried to implement a treatment plan at your office only to find out that your staff did not complete the tasks required? If you want to be sure that your staff understands a process and will follow through with your patient care plan, do not take a superficial “yes” as a response to your request. That yes could be in lieu of far different internal feelings. If you are not aware of this dynamic, you could walk away thinking you have an agreement only to be frustrated and confused later when you do not get the outcome you were expecting.
LEARN TO DETECT CONFLUENCE
In your role as physician and employer, your patients and staff may be reluctant to disagree with you due to the power differential. What appears to be agreeability could actually be a type of resistance known as confluence, which is when individuals “go along to get along.” Employees will outwardly agree with you but internally have other thoughts or feelings. For example, when you ask a technician to follow a new protocol, he or she may look at you, nod his or her head, and say, “Yes, I’ll do that.” The truth is, there is no way of knowing what is really behind the technician’s statement. The technician could be thinking, “I have no idea how to do that test,” or “I’m too busy to do another test,” or any number of things other than what he or she said out loud.
We all love when people agree to a plan so we can check an item off the to-do list. Many clients ask me why they have to go to so much trouble to get people to “do their jobs.” They wonder, “shouldn’t you be able to just tell an employee what they need to do and they do it?” Of course, such a scenario would be ideal, but we humans often do not operate that way. If you can learn to detect when an employee is resistant and encourage him or her to tell you more about what he or she is really thinking or feeling in the moment, your effectiveness will increase exponentially. You need to open the person up to tell you the unsaid, the truth that lies behind the resistance.
ASK EXPLORATORY QUESTIONS
To get the unsaid out in the open, the first step is to notice whether the response is just a reflection of what you said or if it contains any original thought. When you ask an employee to do something new or difficult, it is unrealistic to believe that he or she has no questions, qualms, thoughts, etc. If you receive a superficial agreement, try to draw the person out. Avoid yes or no questions. Instead, ask exploratory questions such as “What concerns do you have with this test?” or “How do you feel about adding this test to your routine?” Just because you ask an employee to talk about his or her concerns, that does not mean you are going to change the task at hand. Drawing out the employee’s questions, concerns, and negativity allows you to understand what he or she is thinking and feeling. People tend to be more willing to comply if they feel heard and acknowledged. You cannot address what is unsaid, so getting the truth out in the open can dramatically improve your results and your staff’s follow through, not to mention your workplace relationships.
No doubt you are extremely busy, but if you do not think you have time to do anything other than give directives, you will pay a much higher price in the end with reworks, nagging, and even turnover. Slowing down in the moment may seem inefficient, but you will save time in the long run by making one key adjustment—not taking “yes” for an answer!
Section Editor Kenneth A. Beckman, MD
• director of corneal services at Comprehensive EyeCare of Central Ohio in Westerville, Ohio
• clinical assistant professor of ophthalmology at The Ohio State University in Columbus and president of CEDARS
• (614) 890-5692; firstname.lastname@example.org; Twitter: @KenBeckmanMD