Enhancing Practice Performance

Diagnose and solve common practice challenges: part one

Although there are thousands of presenting conditions for you to be aware of, the majority of patients arrive with one of a handful of the most common maladies for you to fix. The same is true of business. Practices can suffer from thousands of different failings, but most managers and managing partners spend the majority of their time with the same basic issues over and over again.

As a practice leader, you may find yourself (and your management team) spending a majority of your time responding to daily crises rather than being proactive leaders who plan for and evaluate progress towards larger goals. This two-part column will help identify the often overlooked and embedded challenges of practice management that can be barriers for your practice to the reach the next level of success and profitability.


Begin by revisiting (or establishing) your annual and longer-term business goals.

This doesn’t have to be an over-worked chore. Simply answer these big picture questions in the context of your five-year goals:

  • What’s our service area — our natural geographic boundaries? How many locations will we have?
  • How fast do we want to grow? (The average practice grows about 4% annually, according to “John Pinto’s Little Green Book of Ophthalmology, 5th edition”)
  • What services will we add or subtract in the years ahead?
  • How many MDs/DOs and ODs will we have? How many patients will we serve each month?
  • What critical resources are missing? How will we pay for these?

With these questions out of the way, it’s easier to prioritize yearly tactics by answering questions such as:

  • Are we ramping up growth? What new marketing efforts will we launch?
  • Are we adding a new subspecialty? What new capital equipment must we buy?
  • Are we closing down a satellite? Who will be responsible for completing this project and getting patients matched with a remaining office?
  • Is a doctor retiring? How are we shifting her patients to other providers in the practice and preparing for a possible drop in revenue?

Many practices we come across don’t think with the larger picture in mind. They drift from one opportunity or emergency to the next, without a coherent, intentional plan. Practices that pursue long-term strategic planning and annual goal setting are the ones we see grow and improve at the fastest pace — with the most satisfied owners and the most in-control managers.


In thinking about your practice goals, realistically consider your weaknesses. For example, during the last year, what specifically held you back from improved patient care? (An inefficient template?) What drove any financial reversals? (Poor cost control?) Why did the management team’s skill develop at a slower-than-desired pace? (Not enough training time?)

Once you identify these barriers, the solutions become clearer.

Below are two of the six common practice challenges that can hold a practice back from its potential (we will cover the remaining four challenges in part two), along with ways to address and improve each one. Although they are typically considered secondary issues that go unaddressed, these types of problems inadvertently prevent good practices from becoming great ones or unintentionally lock the practice culture in a downward spiral.


The chief drivers for staff and doctors’ frustration with communication is the absence of regularly scheduled meetings and a scarcity of written communication. This includes insufficient written policies and procedures and deficiencies of meeting minutes. Consider these solutions:

  • Prioritize the use of written documentation throughout the practice. It may feel counterintuitive to spend the time it takes to do this well, but over the long run it is one of the best strengths of successful practices.
  • Schedule regular meetings. For an average two- to three-doctor practice with 20 or 25 staff, a typical meeting schedule is:
    • All staff — quarterly
    • Departments — monthly
    • Providers (MD/DO/OD) — monthly or bimonthly
    • Owner/board members — monthly
    • Administrators/managing partners — weekly or biweekly
    • Administrators/management team — weekly or biweekly
    • Administrators one-to-one with managers — weekly or biweekly


Tolerating mediocre manager performance — particularly from mid-level managers — is common. Middle managers are often the most loyal and long-term members of your team. It is easy to become accustomed to their weaknesses, appreciate their strengths and overlook the impact of their deficiencies. Consider these solutions:

  • Select mid-level managers with appropriate experience. It is a disservice to the company if you promote staff members who are great at their current job but have little interest in becoming star managers.
  • Provide coaching, education and training opportunities. Invest in your management team’s success, and they will return the rewards to the whole practice.
  • Prioritize time for shared goal setting, clarifying practice standards and providing performance feedback. Follow up with appreciation for great work and progressive consequences for poor performance.
  • Promote the importance of collaboration among management team members. This benefits the whole practice and every patient. Hold regular meetings. Be specific in pointing out examples of great collaboration. Establish your expectations that managers function collectively and not as individual departments in a silo.

In part two, we will discuss several more common practice challenges. OM