Heather Barbish, COE, founder of Magnolia Healthcare Consulting, presented “Operations: Getting Things Right the First Time” at the American Society of Ophthalmic Administrators meeting during ASCRS 2026 in Washington DC. Here, she shares key points from her presentation. The transcript below has been edited for clarity.
Hi everyone. My name is Heather Barbish, and this is a quick recap of what we discussed at ASCRS/ASOA this year in Washington, DC. One of the presentations was on operations and getting things right the first time. I think all of us watching know the importance of “getting things right the first time,” and how much it costs all of us in lost time, impact, and resources. We are repeatedly paying different people in our practices to do the same task. One of the key objectives for us should be to recognize where we are really spending those extra resources. We should look at the trends we are seeing as well as what we can do to monitor the data.
One of the key things I would love for you to take away from this quick recap is that it does not have to be this way. There are some simple maneuverable tactics that we can use to try to make our lives a bit easier.
One of the goals of our talk was to highlight proven strategies for success in getting things right the first time and as efficiently as possible. A few of the most important layers that we give our support staff and teams are adequate resources, education, and training to enable them to truly function at their highest and to do more of their tasks right the first time around. We also want to monitor simple metrics and performance. As we are making modifications, we want to ask ourselves, "Are the changes we are making having a positive impact?"
We should recognize where we are spending time in our practices. Some questions you want to ask yourself are: "Where are the breakdowns in the processes? Where do we hear about these issues?" Is it from team members, patients, or your providers? Look at where the breakdowns start from. An example of this would be, is it the same clinic team or the same doctor running behind? Are the front-office staff trying to gather a lot of information because it was not collected when the appointment was made, thus causing them to be unready when the patients come in?
You will want to review your office policies and who is responsible for handling those issues. Who is the first line of defense? How are these issues getting to you? And who is responsible for the different areas of your practice? As we talked about in our session, “Who owns it?” and “Where are those issues coming from?” The other thing I love to ask is, "How many times has the same ball dropped?" Am I picking up this basketball repeatedly? Or is it just a one-off? Another important question for your management/training team is, "Do we have best practices in place so the teams know what they need to be doing? Do they have clear operating procedures and forms?"
Some tools that may be available to you to gather information about where we may be missing opportunities include call recordings, if you have a phone system that has the capability. Patient reviews are a terrific way to see if there are consistent complaints or compliments about a specific area.
Another hot spot is the complaints that you are receiving from inside your clinics--from patients, staff, and providers. Patient satisfaction surveys are another option. That's mandatory reporting for those of us who have ASCs. So, it is a 2-for-1? You are hitting some measures and you are also getting some great feedback to use for your data collection. Other tools I suggest are standard operating procedures and best practices to ensure you have resources available for your teams.
Secondly, I would like to highlight some strategies that are geared toward the “first time right” process. If you do not have best practices or standard operating procedures, you will continually run into the same issue. You need to take the time to create them and make them specific to your practice. There are many resources out there for you, and I would recommend investing in those resources or in someone who really knows what those best practices should be. Another key point here is to simplify the process: boil it down to its simplest point. This will be best for your whole team. The goal is to create a thoughtful design to prevent those loopholes and issues before they occur, and that you start learning how to recognize those issues before they land on your desk.
Let us use an example that we talked about in the meeting. A patient, Mrs. Smith, calls and she demands to talk to you. She called in to complain about her bill. Some areas that may be affecting that issue are your call center, the referral department, your front desk at check-in, and your billing department. Think of which area of the practice did the patient touch, who touched her, who owned it, and did the procedures you had in place give your team the ability to take care of the patient. How many people did that process go through before it landed on your plate?
I also suggest looking at your internal resources. Does your practice management system have an automated verification process? Are you able to look at those issues while on the phone with the patient? Is somebody calling them back about their billing issues ahead of the visit or statement? Some of those things on the front line could really help you out.
Also, ask yourself, are the appropriate people trained to fix those issues when they come up? In our example of Mrs. Smith and her bill that she is not happy about. Did the person on the phone see the error message and did they know what the message meant? Did they know who to go to if not? Did they call the patient and get the correct insurance? On to the front desk, with Mrs. Smith's issue, are they reviewing their schedules? Did they check for verification? Do all your payers even go through your verification system? In the practice that I was at, one of them did not go through. So, we had to go online and process some of those payers.
With your billing processes, look at your clearinghouse, your practice management system, and again: training, training, training. Does everyone know what their position is and what to do about not letting things go until they get to the point that Mrs. Smith is calling you?
Another area we discussed at ASCRS/ASOA is support: training, accountability, and engagement by creating and developing best practices and education resources for our teams. Something to consider with best practices and standard operating procedures is, can everyone access them? Can everybody who needs them lay hands on them? Have you boiled it down to its simplest form, and does it flow from department to department?
I would ask people to review and read my SOP from a different department to see if it made sense to them and if it connected the dots. Also, are you using all the resources available to create those? There are so many resources out there, and they may be a bit of an investment, but it is worth it. You can tailor it to your specific practice and make it a living document. There are nationally recognized systems, like ASOA and VMG (formerly BSM), if you have memberships and subscriptions to them. There are also online templates; there are even AI tools that can be helpful. There are all kinds of information out there at our disposal.
Lastly, make sure that you are using metrics to monitor performance. You need to have the resources, but then you also need to measure them, use them, and go back to them. You're going to use an existing SOP or create a new one; you're going to see if it works as a trial; you're going to put it into practice; and then you're going to go back and evaluate it using reports and metrics. And then you are going to look for those trends. Is the issue getting better? If not, go back and try again.
The main point of this discussion is that we all know admins’ jobs are really tough already. Everybody knows the burden is heavy. We wear lots of different hats. At the same time, we really want our staff to feel empowered and that they can do the best job they can. No one intentionally does their job incorrectly No one feels good about not doing a great job. You want to use these metrics to make sure that you are fulfilling all those needs.
Additionally, before you reinvent the wheel, I would suggest that you go back and look at what your reporting systems can do for you. A lot of times there are layers in your practice management, clearinghouse, EMR, and other platform systems that you can use to track your clinic times, how doctors are running, etc. Other ideas for you to assess: What are your denial rates like for testing, diagnostics, all those things? You want to look at these so you can develop best policies and change what you need to. The only constant is change.
Payer audits: Nobody wants one, but they are a suitable place for metrics. Medicare just did one not too long ago for level fours, and it could be that they needed to be downcoded or upcoded. And that's useful information because it shows you how well your exams are going and how well they are being documented. Your MIPS and quality reporting are already at your fingertips. You can look at those metrics. If you do not know where to look, think of what your issue is, what you are trying to track. Call your vendor or rep, and say, “Hey, this is what I am wanting. Tell me the easiest way to get that.” Then see if it is accurate.
Also consider whether there are key performance indicators you should be looking at. Are there issues that are more important to your practice during a certain season? I would also suggest creating a dashboard, even if it is an Excel spreadsheet. I would suggest using a tool so that monthly, you can keep a bird's eye on it and track how those things are going. Meeting with your management team and your team members in the areas where you are implementing these changes. I would suggest starting with a baseline in each area. I cannot underline enough the importance of confirming whether what you're implementing is working.
One of my favorite Stephen Covey quotes [from The 7 Habits of Highly Effective People] is “Begin with the end in mind,” which is the whole point of getting things right the first time. You want your staff to feel successful, the patient to be well cared for. Enabling your providers to do what he or she does best, and that is providing care. Getting things right the first time more frequently allows your administrators and managers to do the important work they need to do, and that is moving the needle, not fixing issues that should have been caught five team members before.
Everybody has so much on their plates already. Balancing patient satisfaction and doing things right the first time is an area where we can really improve processes for our practices, our patients, and our staff. Everybody does such an amazing job and you all deserve that. We deserve to enjoy our days, and our patients to enjoy their experience. Thank you for your time and hope you enjoyed the recap.