Although many of us may think that our practices deliver consistent, high-end quality eye care, when we dig deeper into this question, the findings can be quite revealing. This article outlines some of the bare essentials that must be in place in your refractive center for it to be considered a high-end practice, suggests ways to uncover existing flaws in your current setting, and offers straightforward implementation strategies to jump-start your endeavor to become a world-class provider.

BARE ESSENTIALS
No practice can be high-end without investing considerable time and resources into the most current and best technology available on a consistent basis. I do not endorse latching on to every gimmicky, latest-greatest technology but rather encourage taking a thoughtful approach to evaluating new devices, instruments, and techniques based primarily upon peer-reviewed literature and advice from experienced colleagues. Know what works and why. Attend professional meetings and listen intently to stay current in this rapidly changing field of ours. Be the expert that a high-end practice demands.

Carefully consider your office environment. Ten years ago, this may have meant a quick walk-through of the waiting area to ensure that the magazines were up-to-date. However, in 2009, this means giving consideration to eliminating the waiting room altogether. You must make every effort to cater to the needs of a clientele you will ask to write a check for a purely elective procedure.

Although not all of your staff can realistically be top performing all-stars, the mix of employees is crucial to the long-term success of any high-end refractive practice. Aside from balancing various skill sets (discussed later), high-end practices must only attract, hire, and retain people who truly have the service DNA, as described by renowned customer service consultant John DiJulius III, in his best-seller, What's the Secret? To Providing a World-Class Customer Experience.¹ Employees are the key to developing a world-class culture, one of the 10 commandments Mr. DiJulius outlines. For more information, see The 10 Commandments To Providing a World-Class Customer Experience, on page 57.

WAYS TO UNCOVER FLAWS
Mystery shopper. Have someone routinely call your office as a potential patient to determine the quality of how questions are being answered on the phone. The results of this simple tactic may surprise you. Call your office after hours or prior to opening and note how each phone call is handled. Perhaps most important, put yourself in the shoes of an established patient calling to schedule an enhancement or touch-up and evaluate the steps that are in place to have this scheduled.

Sit in your waiting room. Not for 1, 2, or 3 minutes but for a full 30 minutes. As endorsed by Shareef Mahdavi, an expert in the experience economy for eye surgeons worldwide, consider the way in which each one of your five senses is affected by your waiting room environment.² What do you see—another patient staring back at you or a beautiful painting? What do you hear—an elevator or peaceful music? What do you smell—cleaning solutions or freshly cut flowers? What do you feel—a cold plastic armchair or soft, comfortable leather? What taste is evoked—stale coffee or a zesty lemon?

Become a patient. Go through the same process the patient endures from start to finish, sitting in the waiting room (as odd as it may feel), asking questions while seated at a topographer, and having your eyes anesthetized for pachymetry measurement. Ask questions about price, financing, and follow-up visits. Inquire about the laser suite and technology used, listening closely to the responses. Pose the same specific questions to several employees. You may be surprised by the lack of consistency.

IMPLEMENTATION STRATEGIES
Notice everything. Eliminate negative cues, even the small ones, from your office. Be aware of any picture, chair, or tissue-holder around you that is inconsistent with your message—and do away with it.

Small things do matter. By way of example, Clotaire Rapaille, in his highly acclaimed Seven Secrets of Marketing in a Multi-Cultural World,³ points out that most Americans, if blindfolded, could tell the difference between a Target (Minneapolis) discount department store and an ultra high-end Nordstrom (Seattle), based solely on room temperature. Americans associate cool, air-conditioned places with luxury. Aspire to this level of scrutiny when considering your office setting. Be cognizant of the way in which your environment influences the opinion of your prospective patients at the core level.

Evaluate first impressions. The way in which questions are handled over the telephone is the most important first step for acquiring patients. Record these calls if possible and use them as a learning tool. In a group setting, have your employees listen to the way in which a particular call was handled and then critique it.

Be certain that your staff is fluent in the topics they are addressing and that everyone is speaking from the same script. Executives at FedEx (Memphis, Tennessee) figured out years ago that their most valuable employees were, and still are, the couriers who pick up and deliver packages because they have maximum exposure to customers.⁴

Enhance the enhancement process. Particularly if you consider word-of-mouth to be your greatest source of referrals, consider taking a second look at how your office deals with patients requiring enhancements. Are they given priority or reluctantly added at the end of a long day? Rapaille also references work that he has done for General Motors (Detroit) that should influence our approach to these patients (personal communication, May 2007). When analyzing a customer satisfaction survey, Rapaille noted that the small percentage of customers who had bought a car with a defect that required a return visit to the dealership were actually more satisfied than those customers purchasing a new car with no problems at all. He attributed this to the fact that the defect provided an additional point of contact with the dealership and, therefore, an additional opportunity to impress the customer with kindness, service, and efficiency. The message here is clear: Concentrate on enhancement patients and make them happy. They just might represent your greatest advocates.

Recruit all-stars. According to Chip Conley, a world-class hotelier at the pinnacle of the hospitality industry, the mixture of employees working for you is important.⁴ The author of Peak—a reference to providing a peak experience for all customers—Conley states that the majority of employees should be all-stars or those who are "overwhelming" in their work ethics and contributions.⁴

Although underwhelming employees are inevitable and should appropriately be kept to a minimum, it is the employees in the middle ground, the whelmers as Conley puts it, who are most vulnerable and need to be paid attention to.

The ability of this group to be pulled up into the overwhelming category and dragged down into the underwhelming category can have tremendous repercussions, particularly in a small office setting where one or two individuals can significantly influence the working dynamic.

CONCLUSION
As your practice progresses, you will likely find that determining the goals to aspire to when reaching for the high-end setting are quickly understood, and evaluating your practice objectively to identify flaws may take some time but can definitely be accomplished. However, it is the final step of implementing tangible changes to an existing culture that can be the most challenging and painful. I highly recommend reading the resources mentioned here and using them as a general outline and roadmap to get you started on this most satisfying journey. Additionally, an incredible subscription-based resource for detailed instruction specific to ophthalmic practices may be found at www.premiumeyesite.com.

Stephen C. Coleman, MD, is in private practice at ColemanVision, Albuquerque, New Mexico. Dr. Coleman states that he is a clinical investigator for Abbott Medical Optics Inc., but does not have any financial interest in the products or companies mentioned. He may be reached at e-mail: stephen@colemanvision.com.

1. DiJulius III, JR. What's the Secret to Providing a World-Class Customer Experience? Hoboken, New Jersey; John Wiley & Sons, Inc.; 2008.
2. Mahdavi S. The Experience is the Marketing. Cataract and Refractive Surgery Today. November/December 2007.
3. Rapaille GC. 7 Secrets of Marketing in a Multi-Cultural World. New York, New York; Tuxedo Productions; 2005.
4. Conley C. Peak. Hoboken, New Jersey; Jossey-Bass/John Wiley & Sons, Inc; 2007.