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Cover Stories | May 2019

Turning a Poor Practice Culture Into a Positive One

First and foremost, rebuild the foundation on trust.

Ophthalmology is an exciting field, with some of the most energetic, talented, and positive people practicing in this space. But even the most spirited individuals can show signs of discontent if they are placed in an unhealthy work environment. Going to work every day can be a real struggle if there are no strategies in place that promote a positive culture.

With a little bit of work, and by incorporating some of the tactics outlined in this article, any practice can succeed in creating and sustaining an inviting place to work—even a practice currently struggling with its culture. In the end, transforming your practice’s culture can help to bolster employee retention and to maximize the patient experience.


At Chu Vision, the foundation of our business is built upon the trust we create with our patients. We focus on creating a world-class patient journey and educational experience, and that requires us to foster a culture dedicated to caring and service.

The most important strategy we rely on to create that culture is hiring for personality. We believe in hiring staff members who inherently have the same core and cultural values as other members of our team. In the end, the skills required of a particular position can be learned, but personality cannot be changed.

From the gate, all employees should know the practice’s values and what is expected of them, not only in their specific roles but also on a larger scale in the organization. Therefore, on day 1 of employment with Chu Vision, all new employees meet with the practice administrator (that’s me) to overview the history and mission of the practice; to be introduced to the core values of the practice, including cultural values, employee values, and service values; and to receive and sign a copy of the company handbook.


Once the right staff is in place, it is time to focus on two of the main components of developing a positive culture: communication and collaboration. Cultural spirit starts from the top, and thus any initiatives put into place must start with the owner-physicians, the backbone of the organization. The managing partners and the leadership team must align with the owner-physicians and lead by the values set forth by them. Employees can quickly recognize when there is a lack of engagement. If the leadership team is not shining its light, then the team won’t either.

Communication. Trust is the principal way a leader can engage his or her team. A leader who micromanages and doesn't delegate well communicates the message that his or her employees may not be good enough to be trusted, but a leader who delegates conveys that he or she believes in the team as a whole.

Remember that communication is the foundation of trust. When communication slips, which can easily happen in a busy practice, there is increased tendency for paranoia and low morale among the staff. If too many closed-door meetings occur without reassurance that everything within the practice is going well, employees can start to feel that something is wrong.

Two strategies to boost communication are to (1) hold monthly all-staff meetings that include the doctors and (2) conduct daily clinic huddles. One of the main ambitions of the all-staff meetings should be to be transparent regarding the goals and directions of the company.

At Chu Vision, the leadership team creates new goals at the beginning of every year and updates the staff semiannually to keep everyone up to speed on what is happening in the practice and on where the practice is headed. Emphasizing future directions and disseminating these to the staff ensures that everyone shares the same vision and can work toward the common goals developed by the leadership team.

Also during the all-staff meetings, patients’ comments are shared—positive and negative—and possible ways to improve the patient experience are suggested and discussed. One sidenote: Whether the all-staff meeting is held in the early morning, at lunchtime, or in the afternoon, providing a meal or snack goes a long way toward motivating and engaging employees.

During daily huddles, the entire staff is prepped on what will happen in the clinic that day, such as if there will be any guests, if there will be patients with special requests, or if there is a special occasion to celebrate. In our practice, we hold two daily clinic huddles, one before the morning clinic and one before the afternoon clinic. We also hold weekly leadership meetings and require each leader to hold weekly meetings with his or her own team.

Collaboration. Staff feedback should be encouraged. Feedback can be shared publicly, such as at all-staff meetings, or anonymously through an online app. When employees feel that they are heard, they are more open to collaboration with their colleagues and the leadership team.

Sending out a monthly staff newsletter also promotes collaboration among staff members. In our practice, we include work anniversaries and birthdays in the newsletters, and we also promote upcoming team-building events.


Other tactics can also be used to empower and encourage the team and enhance the practice’s culture. For instance, we recognize employees and nominate them to our World Class Club when they go above and beyond their responsibilities to provide exceptional patient service. The nomination comes with a certificate of recognition, hung on our Wall of Fame in the employee lounge, and a gift card to celebrate the nomination.

Our employees love to celebrate one another’s accomplishments, which helps to foster a positive culture and work environment and leads to less staff turnover and increased productivity. Creating an environment of support and encouragement promotes a feeling of enjoyment in coming into work every day. We work in health care, so not every day is pleasant, but celebrating the things that make it positive and fun to come to work helps to boost morale.


A poor culture tends to foster negativity. Practices in this situation must learn to shift the narrative and to remain consistent in their new policies once that narrative has shifted. In addition to the points discussed previously, another way to rewrite the practice’s narrative is to praise publicly and criticize privately. Group settings tend to magnify emotions, so when someone is doing something great, that person should be praised in front of everyone. Save negative feedback for a one-on-one setting.

Additionally, once your practice makes a commitment, stick with it. It is far easier for staff to slack off, stop caring, and even give up if they feel that the leadership team is not behind them. Make all-staff meetings and daily huddles priorities at the regular intervals that have been established, so that the staff members realize that their voices are important and they matter to the bottom line.

If the strategies outlined in this article don’t work, or if they haven’t helped enough to shift the narrative, be open to bringing in a consultant. Consider hosting a retreat with either the leadership team or the whole staff to focus on the company culture and to commit to making improvements from the top down. Bringing in an impartial third party can be a way to springboard the changes and growth that are needed in a practice with a stagnant or poor culture.


Recognize and celebrate the wins, even small ones. Create a culture that encourages employees to reward each other for providing exceptional customer service to patients and outstanding lateral service to their own team members. Following these simple but effective suggestions can hopefully help a practice to strengthen its culture, promote healthy employee retention, and spark happiness throughout the team.

Carrie Jacobs, COE
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