New Years Resolution -- A "Stop Doing" List

Thanks to DeAnna McCall for sending this on to me.  Provides food for thought:

Best New Year's Resolution? A 'Stop Doing' List

USA Today

by Jim Collins

Each time the New Year rolls around and I sit down to do my annual resolutions, I reflect back to a lesson taught me by a remarkable teacher. In my mid-20s, I took a course on creativity and innovation from Rochelle Myers and Michael Ray at the Stanford Graduate School of Business, and I kept in touch with them after I graduated. 

One day, Rochelle pointed to my ferocious work pace and said, "I notice, Jim, that you are a rather undisciplined person."

I was stunned and confused. After all, I was the type of person who carefully laid out my BHAGs (big hairy audacious goals), top three objectives and priority activities at the start of each New Year. I prided myself on the ability to work relentlessly toward those objectives, applying the energy I'd inherited from my prairie- stock grandmother.

"Your genetic energy level enables your lack of discipline," Rochelle continued. "Instead of leading a disciplined life, you lead a busy life."

She then gave me what I came to call the 20-10 assignment. It goes like this: Suppose you woke up tomorrow and received two phone calls. The first phone call tells you that you have inherited $20 million, no strings attached. The second tells you that you have an incurable and terminal disease, and you have no more than 10 years to live. What would you do differently, and, in particular, what would you stop doing?

That assignment became a turning point in my life, and the "stop doing" list became an enduring cornerstone of my annual New Year resolutions — a mechanism for disciplined thought about how to allocate the most precious of all resources: time.

Rochelle's challenge forced me to see that I'd been plenty energetic, but on the wrong things. Indeed, I was on entirely the wrong path. After graduate school, I'd taken a job at Hewlett- Packard. I loved the company, but hated the job. Rochelle's assignment helped me to see I was cut out to be a professor, a researcher, a teacher — not a businessman — and I needed to make a right-angle turn. I had to stop doing my career, so that I could find my real work. I quit HP, migrated to the Stanford Business School faculty and eventually became — with some remarkable good luck along the way — a self-employed professor, happily toiling away on my research and writing.

Rochelle's lesson came back to me a number of years later while puzzling over the research data on 11 companies that turned themselves from mediocrity to excellence, from good to great. In cataloguing the key steps that ignited the transformations, my research team and I were struck by how many of the big decisions were not what to do, but what to stop doing.

In perhaps the most famous case, Darwin Smith of Kimberly-Clark — a man who had prevailed over throat cancer — said one day to his wife: "I learned something from my cancer. If you have a cancer in your arm, you've got to have the guts to cut off your own arm. I've made a decision: We're going to sell the mills."

At the time, Kimberly-Clark had the bulk of its revenues in the traditional paper business. But Smith began asking three important questions: Are we passionate about the paper business? Can we be the best in the world at it? Does the paper business best drive our economic engine?

The answers came up: no, no and no.

And so, Smith made the decision to stop doing the paper business — to sell off 100 years of corporate history — and throw all the resulting resources into the consumer business (building brands such as Kleenex), which came up yes, yes and yes to the same questions.

The start of the New Year is a perfect time to start a stop doing list and to make this the cornerstone of your New Year resolutions, be it for your company, your family or yourself. It also is a perfect time to clarify your three circles, mirroring at a personal level the three questions asked by Smith:

1) What are you deeply passionate about?
2) What are you are genetically encoded for — what activities do you feel just "made to do"?
3) What makes economic sense — what can you make a living at?

Those fortunate enough to find or create a practical intersection of the three circles have the basis for a great work life.

Think of the three circles as a personal guidance mechanism. As you navigate the twists and turns of a chaotic world, it acts like a compass. Am I on target? Do I need to adjust left, up, down, right? If you make an inventory of your activities today, what percentage of your time falls outside the three circles?

If it is more than 50%, then the stop doing list might be your most important tool. The question is: Will you accept good as good enough, or do you have the courage to sell the mills?

Looking back, I now see Rochelle Myers as one of the few people I've known to lead a great life, while doing truly great work. This stemmed largely from her remarkable simplicity. A simple home. A simple schedule. A simple frame for her work.

Rochelle spoke to me repeatedly about the idea of "making your life a creative work of art." A great piece of art is composed not just of what is in the final piece, but equally important, what is not. It is the discipline to discard what does not fit — to cut out what might have already cost days or even years of effort — that distinguishes the truly exceptional artist and marks the ideal piece of work, be it a symphony, a novel, a painting, a company or, most important of all, a life.

Think you are too young or too old to invest for retirement?

As bad as stock market returns were in the past decade its helps to know that you CAN make a positive influence on your retirement investment by taking a few easy steps and staying the course. 

See this interesting New York Times article:  Your Money - For Steady Savers, It Was Hardly a Lost Decade - NYTimes.com  

What I learned:

1. Diversify.  Stocks and Bonds
2. Unless you are better than 99% of the public at choosing stocks or bond funds use Index Funds
3. Invest regularly
4. Rebalance annually

4 steps to a secure retirement?

Who's the Captain of Your Ship?

In the Navy as ex-naval officers can tell you the captain is personally responsible for everything that happens on his (or her!) ship.  No matter what the issue, the captain will be held responsible.  So, teaching and leading the crew is a critical matter to a captain who wants to become an admiral and not a petty officer.  When someone has a major screw up a captain can lose his job.

As the Captain of our practices we too are ultimately responsible for everything that happens in the office.  Keeping a "pulse on the practice" so that you know what is happening (not what you assume to be happening), managing and leading your staff takes time and attention.  We have management, leadership, and mentoring tools that you can utilize to help you in these critical areas. 

A member of a Board that I served on was the CEO of a large hospital.  As a retired Marine he understood who the captain of his ship was -- him.  As a result of taking this responsibility seriously he had his business card with both his e-mail address and his cell phone number in each and every patient room.  Patients were invited to contact him personally if they had any issue, good or bad, with his hospital.  I asked him how often he was called or e-mailed.  His answer: "Not often, but that is not the point.  If a patient is not happy with us I need to know so that I can see to it that their issue is resolved." 

Would you be willing to give each patient your business card with your e-mail and cell phone number and ask them to respond to you if they have any issue with your practice? 

Who's the captain of YOUR ship?

S-E-R-V-E

You may think you are an OD or MD and your job is to solve patient problems.  And, in large part it is.  However, if you are REALLY engaged a large component of your job is to LEAD your employees as the CEO of your practice. Do this well and reap the benefits. Thanks to DeAnna McCall for send this (and many other posts!) to me. 

The Stabilizing Effect of Good Leadership

As the financial markets continue to see-saw and new companies announce layoffs, it's easy to feel anxious wondering what the future might hold for you and your company. It can seem as if matters are outside of our control, especially when companies point to economic conditions as the source of their problems. Yet some companies seem to deal with adversity better than others. What's their secret? That's something that The Ken Blanchard Companies has been studying for more than 30 years. In our experience, the companies that best deal with adversity are those that have

• A clear and compelling vision
• Passionate and engaged employees
• Strong servant leaders

In their book The Secret: What Great Leaders Know—And Do, authors Ken Blanchard and Mark Miller, vice president of training and development for Chick-fil-A, use the acronym SERVE to help readers remember these simple principles for success.
S stands for See the Future. This has to do with the important visionary role that leaders play in an organization. A compelling vision allows people to be proactive and move toward what they want rather than reactively moving away from what they don't want. A vision builds trust, collaboration, interdependence, motivation, and mutual responsibility for success. Vision helps people make smart choices, because their decisions are being made with the end result in mind.
Consider these questions as you think about Seeing the Future in your organization:

• Where do you want your team to be in five years?
• How many members of your team could tell you what the team is trying to achieve?

E stands for Engage and Develop People. As a leader, once the vision and direction are set, you have to focus on engaging and developing your people so that they can live according to the vision.
People need to be trained in self leadership. While many organizations teach managers how to delegate, there is less emphasis on developing individuals to pick up the ball and run with it. Organizations on the leading edge have learned that developing self leaders is a powerful way to positively impact the bottom line.
For example, one of our clients, Bandag Manufacturing, experienced the value of self leadership after a major equipment breakdown at its California plant. Rather than laying off the affected workforce, the company opted to train them in self leadership. When the plant's ramp-up time was compared to the company's other eight plants that had experienced similar breakdowns in the past, the California plant reached pre-breakdown production levels faster than any other. The manufacturer studied other measures, too, and concluded that the determining factor in the plant's successful rebound was primarily due to the proactive behavior of the workers, who were fully engaged and armed with the skills of self leadership.
Consider these questions as you think about Engaging and Developing People:

• To what extent have you successfully engaged each member of your team?
• How are you encouraging the development of your people?

R stands for Reinvent Continuously. Great leaders are always seeking answers to questions like these:

• How can we do the work better?
• How can we do it with fewer errors?
• How can we do it faster?
• How can we do it for less?
• What systems or processes can we change to enhance performance?

One of the biggest challenges leaders face when they look to re-invent processes to better serve the customer is inertia. Many people assume that an organizational structure is permanent. In many cases, the organizational structure no longer serves the business—the people are simply serving the structure.
It's good to have a plan; it's good to have your structure in place. But always be watchful and determine whether it's serving you, your customers, and your people well. If it's not, change it.
V stands for Value Results and Relationships. Great leaders—those who lead at a higher level—value both results and relationships. Both are critical for long-term survival. Not either/or, but both/and. For too long, many leaders have felt that they needed to choose. The way to maximize your results as a leader is to have high expectations for both results and relationships. If leaders can take care of their customers and create a motivating environment for their people, profits and financial strength are the applause they get for a job well done. Success is both results and relationships.
Consider these questions as you think about Valuing Results and Relationships:

• How much emphasis do you place on getting results?
• How many of your people would say that you have made a significant investment in their lives?
• What are the ways in which you have expressed appreciation for work well done in the last thirty days?

E stands for Embody the Values. All genuine leadership is built on trust. Embody the Values is all about walking your talk.
Many organizations—including The Ken Blanchard Companies—were negatively impacted by the events of September 11, 2001. In Blanchard's case, the company lost $1.5 million that month. To have any chance of ending the fiscal year in the black, the company would have to cut about $350,000 a month in expenses.
The leadership team had some tough decisions to make. One of the leaders suggested that the staffing level be cut by at least 10 percent to stem the losses and help get the company back in the black—a typical response in most companies.
As they do before making any major decision, members of the leadership team checked the decision to cut staff against the rank-ordered organizational values of ethical behavior, relationships, success, and learning. Was the decision to let people go at such a difficult time ethical? To many, the answer was no. There was a general feeling that the staff had made the company what it was; putting people out on the street at a time like this was not the right thing to do. Did the decision honor the high value that the organization placed on relationships? No, it did not. But what could be done? The company could not go on bleeding money and be successful.
The leadership team decided to draw on the knowledge and talents of the entire staff. At an all-company meeting, the books were opened to show everyone how much the company was losing, and from where. This open-book policy unleashed a torrent of ideas and commitment. Small task forces were organized to look for ways to increase revenues and cut costs. This participation resulted in departments throughout the company finding all kinds of ways to minimize spending and maximize income.
Things were tough for awhile, but over the next two years, the finances gradually turned around—as they will this time also. By 2004, the company produced the highest sales in its history.

The Importance of Good Leadership

Continually doing a good job in each of these areas is a significant task, yet it's worth it. We believe that servant leadership has never been more applicable to the world of leadership than it is today. Not only are people looking for deeper purpose and meaning as they meet the challenges of today's changing world, they are also looking for principles that actually work. Servant leadership works. Servant leadership is about getting people to a higher level by leading people at a higher level.

OM Tip - 5 Ways to Increase Profitability

A recent OM Tip of the Week on "Five Ways to Increase Profitability" got me thinking of a variety of things relating to Practice Profit.  We all work hard to make certain that while patient care is top notch, that the practices operate at maximum efficiency to return the greatest amount of profit for the time spent in the office. 

Something that occurred to me a while back and that I have witnessed many times since is that just providing great professional services guarantees you happy patients and an average income, if that great professional service is not coupled with great office management.  Getting the professional component of the practice right is perhaps the most pleasant and easiest component of practice.  But, its only half of the job.  Managing all other aspects of the practice is where the rubber meets the road in practice profitability. 

From Neil Gailmard's article linked above I have these comments on his recommendations:

1. See more patients per day.

As Gailmard says, and I have heard:  "This concept is often not received well by ECPs or staff members. Basically, the objection is that it sounds like more work and stress,........"  But, it IS true.  In running over practice statistics from many, many practices we find that the average practice sees about 10 full exams per day.  This always surprises the OD's who believe they see many more patients than an average of 10.  Most offices certainly have more slots than 10 -- usually at least 16 and often offices are booked in advance.  So, what happens to the 6 or so that may be booked but fail to show up?  Good question that you should be asking your front desk -- which has absolute control over how many patients you DO see.  From DVC's new office Goal Setting Form:

• Front Desk controls patient flow and thus exam count. The number of exams that you see is largely dependent on: proper phone quoting of exam fees, reminder calls, acceptance of work-in exams, pre-appoint, proper recall for exiting patients, working lapsed recalls,  and calling no shows. Convenient office hours (late PM and Saturdays) contribute greatly to increased exam counts. 
• Keep in mind that an empty exam chair generates zero dollars for the practice. Keep that chair full and watch your exam counts carefully. There is no more important statistic in your office.  
• We figure that an average practice increases practice income by about $25,000 NET for each additional patient seen per day.  Want a raise? See one more patient per day.  If you are at the practice average of 10 adding one more should not be a stretch but it does take your management to achieve. 
  

2. Sell more things to each patient.

Are you taking full advantage of your ability to anticipate patient needs and fill them?  This ranges from professional services to contact lens and optical services. 

• The main "drivers" of professional services are: OCT scans, Visual Fields, Routine Photos, Medical Photos, Gonioscopy Refractions as a % of routine exams. Watch your coding and documentation. Often 99213 or 92012 is justified with your documentation but many OD's undercode. Make certain that you charge for what you do and don't be afraid of and adverse audit with higher level exam codes if you have proper documentation.
• For anticipating patient needs  we have added Lifestyle questions to the Patient History in Examwriter. If you are not using a template that has these questions please see your PC to get them added. If you are using paper charts make sure that you include Lifestlyle questions in pre-test.  Lifestyle questions help you to identify not only patient intentions, but help to uncover opportunities for sales of goods and services that go well beyond the Chief Complaint. Selling in the chair (not a dirty word!) with phrases like "even a small change can make a big difference." are powerful motivators to patients. Set goals for optical conversion. A patient who does not make it to optical is not one who will purchase glasses -- at least not from your office!  Check the main "drivers" of Optical Sales for each of your Frame Stylists. Who's weak? Who's strong? What needs to change?
• Are your patients still wearing the same contact lens type that they were wearing 5 years ago?  Newer and better materials and wearing schedules are available and believe it or not most patients really like to be wearing the best technology that is available.  Change is good!

3. Raise your fees.

For the most part if you are following the DVC fee schedule our fees are fair and probably do not need to be raised.  However, if you prone to giving away office visits, not charging for refractions or other ancillary tests keep in mind that you denigrate the value of your services when you give professional care away for free.  This is especially crazy when you discount to an insurance company by undercharging.  Finally, you raise fees by properly billing the correct exam code rather than undercharging by using a code that is less than what you can charge given your documentation.  Make certain that your staff understands and can defend your fees. DO NOT discuss fees in the exam lane -- instead let your staff handle fee quotes.  A patient compliant about a fee usually means either a misunderstanding of the fee, a poor explanation by staff, or that they don't think that you are worth what you think you are.  That's a legitimate complaint but should not have you changing fees on the fly. Stick to you guns but make sure everyone in your office understands and can defend your fee structure.

4. Avoid costly errors

Train your staff properly in all areas of practice and your errors will be reduced to a manageable level.  Review your charts daily to make certain that not only that you have documented properly but that the charges have been properly added at checkout.  Reduce patient A/R by making certain that co-pays and deductibles are properly collected at checkout. Also make certain that a proper recall has been entered.  See Gailmard's comments for other ways to decrease errors. 

5. Reduce your expenses. 

In general you should keep a watch over office expense but no one is going to maximize practice profit by "saving their way to it".  You CAN save thousands of dollars in unnecessary practice expense by keeping a watch over your expense reports on a monthly basis -- and you should watch this.  However, by paying attention to items 1-4, above is where you will find the compensation you desire by working daily in your practice.

Comments Welcome.

Spectral Domain OCT -- Soon the Standard of Care?

What a way to get a great look at the posterior pole.  Even when the fundus image looks normal, the speed and resolution of the new Spectral Domain OCT's may tell a different story.

See my summary of this exciting technology.

The Eye Goes Electric

 

Current work at MIT for restoring site to those with retinal damage.