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Creating systems and controls for optometry practices
By Mick Kling, OD
Sept. 18, 2024
In my last article, “Build a Business, Not a Job,” we discussed the importance of building a business that doesn’t need you. I refer to this as having achieved a “Stage 5” business.
Scaling to a Stage 5 business, one that is self-sustaining and capable of surviving without you, provides you with options. You can continue scaling it, sell it, or own it passively.
We also addressed the temptation of building your business around key employees, which can leave you vulnerable when these individuals leave your practice, often retaining critical knowledge of your business.
Here we will discuss the importance of building your business around Systems and Controls.
What are Systems?
Systems represent the step-by-step processes, procedures, set of rules or directions that work toward a common goal to produce a desired outcome. They are a series of steps that, when followed, produces a predictable outcome.
The best systems are easy to understand, transparent, automated and in a tangible, easily accessible format. They increase efficiency, reduce mistakes, increase scalability and create consistency, all necessary for a business to sustain itself without you.
Think about how your favorite Starbucks coffee drink is prepared. Regardless of what town you are in, or what time of day it is, you can count on (and expect) it to be prepared the same way every time. This is the result of a system Starbucks created, which all baristas follow. While the individual preparing the drink changes, the result doesn’t.
Systems do not replace people; they empower them to create the consistency that our patients and customers have come to expect from us.
There are two elements of every system: Process and Format.
- Process – represents the “how to” of a system. This is the actual process used to accomplish the task at hand. The process is the “what and how” to do something. It includes the steps or instructions required to accomplish the desired task.
- Format – represents how the system is stored or designed. It could be a checklist, spreadsheet, recipe, bullet points, an office form, a script, etc. The format is the form in which the system lives. It’s how you package the system to your team.
For clarification, systems are not a Policies and Procedures manual.
Several years ago, I spent an entire year writing a policies and procedures manual only to throw out the entire document once we implemented a new EHR system, realizing the entire manual was already outdated.
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In fact, most policy manuals are outdated the moment they are written. Systems, on the other hand, are intended to be living, breathing documents that are frequently amended and updated based on the changes that are occurring as your practice grows.
The best test of a system is to ask yourself: “Is my team using it? If not, it’s probably a bad system, or you have not effectively educated your team on the importance of utilizing the system.
I could share countless stories of the “great ideas” I implemented in my own practice over the years only to see them fail miserably.
In most cases, the idea was good, however the system we used to execute was not. In some cases, I simply threw out an idea and said “Go!” to my team with little-to-no thought to structure, organization or execution of what we were trying to accomplish.
Steps To Creating A New System
Whether you know it or not, you already have systems. Many of them are likely working well and require no effort on your part other than to document them so they can be easily referenced by your team when needed.
In other cases, things may be happening with no formal documented system and little-to-no structure or organization. These processes should be well documented and stored in the most logical format to allow your team to easily access and implement them.
Follow this step-by-step approach (system!) to create a new system or document the current systems within your practice.
Step 1: Clarify what you are trying to accomplish or what problem you are trying to solve.
Step 2: Determine the best method for capturing the Process and create it. Ask yourself the following questions:
- What really matters (From Step 1 above)?
- How can I reduce the number of steps?
- How can I reduce the number of resources needed?
- How can I make it more efficient?
- How can I automate or template it?
- How can I reduce costs?
- Can I outsource any of these steps in a cost effective way?
Step 3: Determine the Format. How will this system be captured? Package the process in an easy format so your team can follow it such as a checklist, spreadsheet, recipe, bullet points, office form, etc.
Step 4: Identify a System Champion and System Implementer. Determine the best person suited for managing and overseeing the system, the system champion. This does not necessarily need to be the person executing the system, rather, who will “own” the system. The system champion’s responsibility includes ensuring the system is being followed correctly, updates are being made when needed, and changes are communicated to the rest of the team.
Next, identify who will be responsible for executing the system (if not the system champion), the system implementer. When considering who this should be, consider your team’s level of expertise within your office.
Start by asking yourself: “Is this something that can be automated?” If automation is not possible, utilize a “hierarchy of expertise” strategy by assigning the responsibility of system implementation to the least-skilled worker first.
Then, move up the hierarchy of expertise as needed, always utilizing the least-skilled worker to accomplish the task, reserving the most complicated tasks to the most highly skilled individuals. It’s not uncommon for the most skilled individuals in the office (doctor or office manager) to perform the most mundane office tasks. This leads to unnecessary inefficiencies and added cost to the practice.
Step 5: Store the System in an easily accessible location for the team to access it. Create organized folders based on the departments of your practice. I found that Google Drive, Dropbox and OneDrive are good places to start, but have limitations. In our practice, we use Whale, an online platform that easily allows us to store our systems. There are others such as Trainual, Sweet Process, SystemHub, etc., so be sure and do some research to find the best platform for your practice.
What are Controls?
Scaling to a Stage 5 business requires the confidence of the owner to delegate tasks in the business. Years ago, I realized there were really only two things I needed to do in my practice: look inside the patient’s eyes and sign the chart, and that’s assuming I performed the exam.
Literally everything else could be delegated to other team members. You may be wondering: “How do I delegate without losing control of my business?”
Delegation often makes business owners feel vulnerable since it creates a feeling of loss of control. It’s important to resist the urge to maintain control. Instead, allow your business to control itself. Owners who attempt to maintain control limit their business to their own personal capabilities and limitations and will remain stuck at Stage 2 or 3, never breaking through to a business that sustains itself (Stage 5).
Control vs. Controls – While Control is often rooted in fear, Controls (plural) empower others to make decisions for the business. Your business has the potential to far outperform your own personal limitations and accomplishments. Maintaining personal control limits you to your own time, capability and capacity. On the other hand, Controls protect your company against careless and bad decisions.
Controls are the tools that safeguard your business and allow you and your team to monitor your systems, which include scoreboards, dashboards, spreadsheets, graphs and trend lines. Every system in your office should have a corresponding set of Controls to ensure the system is functioning properly and can alert you when you have a system breakdown.
The most common types of Controls that you may be familiar with include Key Performance Indicators (KPIs), which measure the performance of various aspects of your business. They are intended to provide a broad overview of your practice’s performance without getting stuck “in the weeds.”
In my office, we track 12 KPIs that allow me to better understand what’s happening with the business at any given time, which allows me to make better decisions. Since I travel frequently, this lets me keep an eye on the business regardless of where I am in the country.
In addition to KPIs, we also created Controls for things such as contact lens annual supply sales, measuring which progressive lens designs our opticians are using, and how we manage our accounts receivables with my billing and finance department.
Since I am frequently away from the office, I am always interested in knowing how well we are caring for our patients. I monitor our online reputation by utilizing a Slack channel where our marketing manager posts every online comment, both positive and negative, then tallies our results at the end of each month.
Our goal, of course, is 100 percent positive reviews. By simply monitoring the results monthly, I can easily track our reputation and get a sense of how we are caring for our patients from my laptop from anywhere.
Extracting Existing Systems From Key Employees
It’s likely that you have many more systems in place than you realize. After all, you have a functioning business. Things are getting done. Patients are being seen, you are selling glasses and contact lenses, and you are treating eye diseases. The problem is, many of these systems (if not most), are locked in the minds of your key employees. This information needs to be extracted from them and documented in a clear and efficient manner.
It’s important that we don’t make things too complicated here. Your team, after all, is busy and likely won’t be excited by the idea of carving out time to write down what they do all day. Also, you might encounter some resistance from a slightly different perspective: self-preservation.
Some of your team may feel threatened by your request and may be concerned that you may have an underlying agenda, namely that once they share their systems, you may no longer need them. At this point, it’s important to remind them that systems don’t replace people; they empower them. Encourage them that your goal is not to eliminate their position, but rather, to make life better, easier and more efficient for them.
Ask them to jot down notes as they perform their tasks, or have a co-worker record a video of them performing the task explaining as they go. This gives you the opportunity to later go back and document the critical steps required to perform the task.
By documenting this process, you have created the system. Don’t worry if it’s not perfect. The idea is not to create a perfect system, but to get it out of someone’s head and into written format. You can spend time later tweaking the system to improve it. Our goal here is to get it into a format that can be stored for others to access at some later date.
Getting Started
It may feel overwhelming and daunting to take on the task of documenting everything you do in your business, but it’s a critical step toward creating one that can function without you. Start by pulling together all of the systems you already have in written format and organizing them into folders on Google Drive, Dropbox or One Drive.
Title your folders in such a way that you can easily locate the information you need. For instance, your folders may be titled: Operations, HR, Finance, Scheduling, Clinical, Optical, etc.
Next, collect the information you extracted from your team and organize it into the appropriate folders. We are essentially just dumping all the information we have into one location so we can better manage it later.
Once you have everything stored in one place, you can begin deciding which systems need to be updated, improved, replaced, streamlined or deleted. Consider if each system process is documented correctly, and if it lives in the most efficient format.
Finally, assign a system champion and implementer to each system based on the strategy of “hierarchy of expertise,” and consider what Controls you will create to monitor how well each system is working.
The last step is to determine where your systems will eventually live. You will likely encounter limitations when storing on a local drive or online storage sites such as Google Drive, Dropbox and One Drive.
Explore the third-party online platforms designed for system storage previously mentioned such as Whale, Trainual, Sweet Process, SystemHub, etc. We found the added features with Whale, such as the search feature, quizzes and assignments, to be invaluable and worth the investment.
I was once asked by a colleague: “How long will it take to finish creating my systems and controls?” The answer is, you will never be finished.
It’s important to recognize this is not a one-time project. This is a perpetual strategy for creating a business that can function without you.
Get your team onboard and take your time. You will likely discover, as we have, a cultural shift from key employees performing tasks to a business run with well-documented systems and controls that can be monitored by anyone from anywhere.
M
ick Kling, OD, is the president of Impact Leadership and the founder and CEO of Invision Optometry in San Diego, Calif. Dr. Kling is also the Practice Management and Transition Advisor for Vision Source. To contact him: dr.kling@invisioncare.com
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
