Cultivate a successful high-volume center

Don’t just grow your practice — focus on your staff and leadership skills as well.

As many physicians have experienced, I found the lack of business preparation throughout medical training to become quite apparent when I started in private practice — especially a high- volume one. About one year ago, I had the opportunity to begin fellowship in refractive surgery at an elective-only vision correction practice where one surgeon and two optometrists performed about 4,000 procedures a year.

In addition to learning refractive surgery, I had the opportunity to obtain formal business training, which has been integral in shaping how I practice and manage my team. I am excited to now be in transition to becoming an associate surgeon and future partner in this same practice.

During this experience and formal business training, I learned several key factors that are important in cultivating a successful high-volume center.


One of the first things I learned to do was also the most crucial to be successful: Develop the leader of the practice. No organization can grow without a strong and focused foundation, and that foundation needs to be set by the surgeon. This does not just mean growing in medical knowledge with continuing education — it means personal and leadership growth.

There are many ways to accomplish this, but all of them require that the leader be willing to devote some time outside medical work. Reading books, listening to podcasts, attending conferences and going to classes are just a few ways to improve and grow personally. Many national meetings such as ASCRS have classes where you can begin and get direction. For books on leadership, I like ones by John Maxwell; I have also utilized leadership podcasts by Andy Stanley and Craig Groeschel.

An even better way to grow is through formal business and leadership education. Fortunately, many programs have been created for busy physicians. When researching these programs, be sure that they cover all of the following core topics: strategy, leadership, negotiations, marketing, operations, finance, corporate structures and legal. For me, the Physician CEO (PCEO) course through the Kellogg School of Management at Northwestern University in Chicago made the most sense and is what I am currently finishing. It has consisted of four intense modules over the course of a year that focused on the necessary leadership and business skills to start, maintain and grow a thriving private practice.

During my PCEO training, one of the most important aspects of leadership development has been to learn your style and to strategically modify it. According to the Life Styles Inventory through Human Synergistics International, there are several types of leadership styles that can affect a team’s effectiveness. Styles that create healthy and efficient relationships are known as “constructive styles” and include achievement, self-actualizing, humanistic-encouraging and affiliative. Opposing leadership styles can be necessary for immediate efficiency but can be a detriment to the creation of a positive culture.

Working my leadership style early on was something that was stressed both in the PCEO training as well as by the practice doctors and management team.


With your personal growth on track, it is also important to hone your interpersonal skills. Emotion can make or break a culture, and, to grow an organization effectively, you have to be aware of your own emotions as well as recognize the emotions of others. According to Steve Gutzler, president of the leader development company Leadership Quest, 83% of your day is typically smooth and routine while 17% of your day is stressful. How you handle yourself during the 17% indicates your personal emotional intelligence. During these trying times, the leader cannot be degrading, abrupt or condescending or the practice will suffer. The other important aspect of emotional intelligence is to recognize when your team members are experiencing these stressful times and to engage accordingly.


Business management educator and author Peter Drucker is famous for saying, “Culture eats strategy for breakfast,” and I have found this to be completely true. Working on culture and its core values is an extremely important part of this, because they are the fundamental beliefs on which your organization acts. We have spent significant time with our management team defining our core values and have determined them to be the following: quality, compassion, integrity, honesty and respect. They may change over time, but we do not allow any action that does not live up to these values.

It is important to realize that culture starts at the top of an organization and finishes at the bottom. Leaders have to live these defined core values. Nearly every successful organization, such as Google, Apple and Amazon, has specific core values that guide how team members interact with each other and with their customers. For example, a core value of Apple is, “We believe in the simple, not the complex.” These values can then be felt by patients and are a important differentiator of your practice.


For team members to follow you and your culture, they can’t follow just “the doctor.” They want to follow someone who they know, like and trust. They also need to feel cared for. This appreciation is key to retaining staff that is enthusiastic about what they do.

Other key motivators include autonomy, a sense of purpose, mastery of skill sets and a potential for progress. Many practices provide a high salary and expect that a team member will love his or her job and stay forever. In truth, most employees are not motivated financially in the long term, assuming they are paid a market rate. Many times, wages are used as a scapegoat when a team member is unhappy when, in fact, other factors are at play. As such, it is important to engage each team member on a personal level to determine what drives him or her, which will more likely result in a person going above and beyond expectations.


Staff turnover can be expensive, so be sure to “hire slowly and fire quickly.” This allows you to have the team members who are willing to buy into your culture and help you grow. Conversely, having a team member who has a poor attitude can affect the entire team negatively.

However, once you have the right staff, the job is not over. Investing in your team by providing the tools and training necessary for their professional growth is just as important. This boosts confidence, skill and productivity. This compassionate investment in them will also make it more likely that you will create a powerful, long-term bond with team members that will keep them on the team for years to come. One way to do this, which is both under- and over-utilized, is the team meeting. Regular but efficient meetings are important — just be sure not to meet just for the sake of meeting. Weekly team meetings are a must in order to plan and strategize day-to-day functions, while monthly practice meetings are more important to make sure your team stays aligned with the overall vision of your practice. Making these meetings interactive and fun with your staff allows them to feel like they are helping to create a culture they can relate to and feel a part of. Every team is different, but we’ve found what works best in our own practice is to create constructive competitions where the “winner” will receive small rewards like restaurant gift cards or trophies.


Communication is one of the most essential and difficult aspects in maintaining the culture you’ve created. Effective communication means knowing each person on your team, listening to them and understanding how each of them communicates — everyone has a different communication style. In fact, we require everyone takes one or even two personality tests to assist us in understanding their natural style of problem solving (also called “conation”) and communication. Two tests I’m familiar with are the Kolbe Index, which allows for a better understanding of how a person approaches problems, and the DISC, which provides a better understanding of personality.

Good leaders communicate in a way that is understood by most. Great leaders learn to adapt to each person and team in order to be effective and well understood.


Efficiency and customer experience can seem like opposing values, but they should not be. Efficiency is necessary for productivity but doesn’t have to be militaristic. It can come naturally with appropriate systems, staff training and the enthusiasm you already worked hard to create. It should be expected but should not be the only factor on which you evaluate performance.

Your reputation and ultimately your practice growth depend on the customer experience you provide. Patients have no idea how skilled of a surgeon you are, although good outcomes are expected. They want someone they can trust and who cares for them, and this is where you can shine. Patients are scared, and they want you to recognize that. In our practice, we strive to make each patients feel like they are at the Four Seasons rather than “just” at a medical office.

Consistently providing a first-class customer experience will make your patients feel like they are part of your practice family. This will bring referrals from their friends and relatives as well as positive online reviews. We believe that experience is so important that we provide personal contact information, including doctors’ cell numbers and email addresses to all of our surgical patients. It has proven to alleviate concerns, invoke a sense of trust and prevent delays in care by avoiding complex phone systems. The doctor is always at just a call or text away.

Another important way to provide excellent customer service and to grow your practice is to approach each patient as a long-term customer rather than just a one-time customer. This is not only the right thing to do, but it also works as a form of internal marketing. Your current and previous patients need to feel important, and this helps form that bond. Develop a relationship with them, learn about their hobbies, lifestyles and family. Many patients post their experience immediately on social media, which is an ever-increasing method of patient referral. It is the new “word of mouth,” and the patient’s friends and family can be future patients or a future potential referrers.

So, how do you know if you are doing a good job? Listening to patients is key to becoming more efficient and successful. Their perception of you matters and can be objectively tracked. We’ve done this in our practice through yearly surveys as well as daily net promoter scores (NPS). This score, which is used to measure customer experience and predicted business growth, is based on the following scale: 0-6 is a detractor; 7-8 is passive and 9-10 is a promotor. We have been able to grow to a consistent NPS in the 90th percentile, which is essentially an average score above 9. (Find more information on the NPS at .)

Of course, these data are useless unless you are willing to implement changes on short notice. As Benjamin Franklin once said, “Change is the only constant in life. One’s ability to adapt to those changes will determine your success in life.” OM

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