Enhancing Practice Performance

It’s important to hold staff accountable as well

The concept of accountability is bred deep within the ophthalmologist. Surgeons are trained to be hyper-vigilant and to hold themselves accountable for their patient outcomes. They are proud to share their excellent outcome data … and the best surgeons lose sleep over the rare complication.

Why, then, do many ophthalmic business owners find it difficult to hold their management, employee doctors or even each other accountable?

It starts with the ophthalmic personality. As many of us have experienced, ophthalmologists tend to be non-confrontational in nature. These practice leaders tend to attract or be attracted to employees similar to themselves. This type of practice culture creates a rather vulnerable, non-confrontational environment, and it’s hard to hold someone accountable without being somewhat confrontational.

To feel more comfortable with confrontation, focus on the benefits and potential outcomes. Practices that consistently hold all employees and doctors accountable for their actions find problem solving clearer and solutions easier to implement. It also makes it easier to recognize and acknowledge individual and group success. Staff members want recognition for their work. By setting specific individual goals and deadlines for each task, the expectation is clearly communicated and outcome will be clear to all.

A recent internal Google research study on what makes company teams thrive showed that psychological trust and being able to depend on fellow team members getting their work done were two key components of highly effective teams. We can apply this concept of accountability and trust to your practice. The work environment must be supportive and staff must feel safe for them to take the risk of mild to major confrontation. They have to trust that their work environment tolerates errors and feel valued for their efforts.

A few examples of accountability standards in a practice:

  • An approved code of conduct for physicians that defines what behaviors are acceptable or unacceptable, such as showing up on time or following approved time-off limits.
  • Written annual goals for administrators and managers that set measurable expectations and provide a platform to review why they did or did not achieve the goals.
  • Written performance employee appraisals that include at least three specific goals for the following year, including language that explains how to meet the goals. Ideally, these appraisals are oriented around each employee’s anniversary date, and any salary increase is tied to performance and not the outdated “cost-of-living” increase.
  • A document for meeting agendas and minutes. This document keeps all meeting attendees aware of the status of projects, deadlines and who is responsible for the results.

While it has to start at the top, creating a culture of accountability takes more than you and your administrator simply modeling it yourselves.

Here are several specific ways to help your practice endorse the value of organizational accountability.


  1. Set clear performance expectations and specific goals for all practice employees and owners.
  2. Create and implement management systems that monitor the goals.
  3. Provide timely feedback on the achievement or lack of progress on the goals set — and teach your mid-level managers how to do this.
  4. Continue the cycle of monitoring and feedback. Use more monitoring while the issue still exists, and less when you successfully implement resolutions.


  1. Accountable communication includes:
    • No triangulation. Talk one-to-one. Don’t talk to one person about another.
    • No withholding. If it is on your mind, discuss it fearlessly and in a kind, professional manner.
    • No defensiveness. If you hear something you don’t like hearing, especially about yourself, say, “You may be right. Tell me more.”
    Reinforce this trio of guidelines, especially with less experienced managers who may be shy about confronting issues directly.
  2. Conduct focused meetings to increase the productivity and value of regular meetings. Require all meetings to have a written agenda shared with all invited attendees in advance and follow-up minutes.


Using accountability documents streamlines the time you spend following up on what has been accomplished (or not) and can prevent large and small projects from falling through the cracks. Accountability document examples include:

  • Meeting minutes
  • A project action grid document that lists the project, responsible party, deadline and progress notes
  • For large projects like a new office building or new practice, use of a Gantt chart, which shows planned activities against timelines, is effective.


The challenge of holding practice leaders and employees accountable can be temporarily uncomfortable, awkward and, at least in the moment, unrewarding. But delaying critical conversations rarely improves problems.

After nudging clients forward, we most often hear, “I wish I had done that sooner.” OM