At Focus Clinic in central London, we have committed ourselves to being a highly successful practice, both clinically and commercially. Our past financial year was our best ever, even in the midst of a major global economic downturn. Clinically, we have consistently achieved binocular visual acuity outcomes of 20/20 or better in 100% of patients with up to -9.00 D of myopia and up to 2.00 D of cylinder for more than 2 years.

REQUIRED SKILL SET

What are the secrets to building and growing a successful practice? Surgeons are, in effect, highly trained technicians with in-depth and specialized knowledge in particular areas. We have a general medical background, which we then go on to mainly forget as we expand our knowledge about the eye and vision.

We narrow-field experts often find ourselves running our own medical small business, be it a clinic or a private practice. Indeed, most small businesses are set up by individuals who excel in a specific area and want to make a living using those particular skills. Yet a successful business, office, or clinic requires more than we physicians were ever taught. Skills that are essential but were noticeably absent from our training include:

• People management and leadership;
• Communication, influencing, and negotiation;
• Marketing, advertising, and publicity;
• Management of websites, blogs, and social media and search engine optimization;
• Business development and strategic growth;
• Accounting, maximizing cash flow, and raising finance; and
• Business metrics and determining the economic health of a clinic.

This list could run on and on. In fact, what we do not know is at least as much as what we do know. The webrelated subjects did not even exist when some of us went through our training. But take heart from Henry Ford, the American industrialist, who said, “I don’t need to know everything, I just need to know people who do.”

A highly successful practice does need all of the skills listed above—and more. As a physician, your choice is either to learn them or, far better, recruit those who are already skilled in them. However, you must know enough about each topic so that you can discuss, analyze, and understand what your staff or advisers are telling you.

As surgical specialists, we may also run the risk of arrogance. As author Robert A. Heinlein warned, “Expertise in one field does not carry over into other fields. But experts often think so. The narrower their field of knowledge, the more likely they are to think so.”¹ We must have enough humility to listen to other experts but know enough about their subjects to make judgment as to whether their advice is sound.

It is your team—the people around and supporting you—who determine how far you and your clinic can go. This includes management, marketing, sales, training, patient front line, clinical, technical, nursing, and accounting staffs. Having you as a great surgeon and clinician is the starting point. But it is the people you bring on board to assist with the dozens of tasks that you are not trained to do, have little experience with, and probably have little desire to get involved with, who will determine your future success.

Your team will also make a huge difference in the quality of your work life, which also bleeds into your personal time. A problematic staff member can take up a disproportionate amount of your attention, make your stress levels soar, and have you reaching for your prescription pad to relieve that tension headache. Factor in the disruption that this person will inevitably cause to team dynamics, harmony, and morale, and you have a good reason to stay home in bed.

Hiring the right people and knowing how to bring out the best in them will boost your efficiency, mood, and profits. These employees will create a positive and rewarding atmosphere, which helps everyone act and feel better. They also make you look better to your patients, which never hurts.

LEADERSHIP

The personality of the founder or current leadership is a key component in setting the personality of the clinic, strongly influencing organizational culture and, in turn, linked to the financial performance of the enterprise. This is true in medical and nonmedical businesses.

Researchers at Stanford University showed that the personality of a chief executive officer affects that firm’s culture, and that culture is subsequently related to a broad set of organizational outcomes including the firm’s financial performance, reputation, and employee attitudes.² Always be mindful of your behavior, mood, and approach to your staff. It will influence how your team behaves, thinks, and feels, and, ultimately, how much is in your account at year-end.

OFFICE MANAGER

With a strong team in place, you are in a good position to devote most of your time to doing what you do best: the clinical work. The single most important person in that team, the one who will ensure that you are freed from other tasks and hassles, is the office manager.

It is the manager who will be there every day, morning to evening, where all the machinery, the engine of your clinic, keeps turning. If it is a surgeon-led or -owned center, then the surgeon will be in the laser suite or operating room or out fulfilling separate hospital-based duties. The person who keeps the engine running and serviced is the manager. When evaluating candidates, you should follow the sentiment of the old proverb, “Marry in haste, repent at leisure,” and spend considerable time choosing who will sit in the manager’s chair.

An important aspect of the office manager’s role is to act as a conduit of information between the surgeon(s) and other clinical staff and between the clinical and nonclinical team members. Only relevant information should be passed between the various departments. As owner of the clinic, you rely on the office manager to update you on only the important clinical or business information, and you trust him or her to handle most other administrative issues.

The office manager acts as the heart, receiving from all parts of the body and supplying everything that is needed to ensure that the various organs and structures can fulfill their roles. As the central hub of the clinic, staff can provide feedback to and gain information from the manager to help fulfill his or her roles. If this is done well, all departments can work harmoniously and smoothly. The office or clinic manager carries out several other duties, including:

• Ensuring the safety of patients and staff and compliance with current health care standards and legislation;
• Providing a point of authority and responsibility, which ensures that the team feels supported and motivated;
• Implementing all protocols and procedures needed to make the clinic work;
• Setting the tone and the mood for the team as a whole—or, more accurately, influencing the mood set by the surgeon or clinic head. When this is done, patients can enjoy a relaxed, happy, professional atmosphere that should filter down from the office manager through the rest of the team;
• Keeping the staff aware of business and targets, such as conversion rates, and how the team is doing toward achieving them;
• Overseeing the personal development of each team member, with plans in place that form a basis for ongoing feedback, training, and skill building, as well as annual or more frequent appraisals; and
• Being a mentor to the team.

CONCLUSION

The clinic leader and the clinic manager form the core of how a practice will deliver patient care, setting the tone and direction for all other in-house staff. Once you know you can consistently deliver high-quality treatments, you can maximize how other people linked to the business, staff, and consulting advisors contribute to the overall success of the enterprise.

Of course, this is not the only approach. Some centers target income rather than the highest clinical quality. Our strategy has been to build on clinical outcomes and customer service, with organic growth arising as a natural, secondary effect from patient recommendations and word of mouth. At your location, you should aim to be not just the best choice but, realistically, the only choice for prospective patients. It is impossible to do this alone. Having the best people supporting you will make the journey much easier, help your bottom line, and have you up and out of bed in the morning.

Of course, this is not the only approach. Some centers target income rather than the highest clinical quality. Our strategy has been to build on clinical outcomes and customer service, with organic growth arising as a natural, secondary effect from patient recommendations and word of mouth. At your location, you should aim to be not just the best choice but, realistically, the only choice for prospective patients. It is impossible to do this alone. Having the best people supporting you will make the journey much easier, help your bottom line, and have you up and out of bed in the morning.

David Allamby, MD, is the Director of Focus Clinic, London. He may be reached at e-mail: david.allamby@ focusclinics.com.

Hannah Wingate is the Clinic Manager of Focus Clinic, London.

1. Heinlein RA. Time Enough for Love. New York, NY: G.P. Putnam’s Sons; 1973.
2. O’Reilly III CA, Caldwell DF, Chatman JA, Doerr B. The promise and problems of organizational culture: CEO personality, culture, and firm performance. http://haas.berkeley.edu/faculty/papers/chatman_ceo.pdf. Accessed December 21, 2012.