From Our Editors

From People to Process

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Bethany Fishbein, OD

Jan. 15, 2026

Process has been on my mind a lot lately.

As we grow from two practices to three this month (& hopefully four later this year), I’ve been taking a closer look at our systems and realizing how easily they can drift toward relying on people instead of design. When this happens, growth and expansion become far more difficult than they need to be.

I am acutely aware of this as we work to create shared processes across our two locations, in preparation to implement them in the third. As we began to look, it became immediately clear just how differently the same basic tasks were being done, not even 10 miles apart. Making an appointment in one office followed a completely different path than in the other. Our most experienced optical salesperson in one location couldn’t even figure out how to enter an order in the other. The process was completely different depending on which location the staff member worked in.

This made some of our growth ideas like centralized phone answering, shared staff, or even providing vacation coverage feel unrealistic, because people would essentially need to be trained on completely different systems.

But… when processes can be aligned, these same ideas suddenly become possible. Doctors and team members can move between locations and work with confidence. Support can be shared, coverage is easier, and growth feels manageable when we’re just plugging something into an existing system, and not reinventing the wheel each time a new office is added.

The Myth of “No Process”

When I ask staff to describe how something is done, I’ll sometimes hear “we don’t really have a process.” Generally this means that they don’t have step-by-step instructions written down. But if work is getting done, a process has to exist. Sometimes it’s just an unintentional one full of twists, exceptions and decision points that lead to a step like “ask the manager” which guarantees that the manager or doctor is constantly involved and becomes the limiting factor on growth.

But the issue isn’t the absence of process—it’s that the existing one is overly complex, dependent on specific people, and is difficult to follow. Often it lives only in peoples’ heads, passed along verbally from one person to the next like a game of telephone, being changed slightly and reinterpreted with each retelling until it bears little resemblance to what was originally intended.

What An Intentional Process Makes Possible

A successful process isn’t fancy, but it works. With a good process in place, it means that:

Someone else can execute the task successfully.
The outcome doesn’t depend on any individual.
The leader can step away without things falling apart.

Start By Finding Your Current Process

Your first job is to observe what’s already happening. Pick one task that seems unnecessarily complicated in your practice (for us, it’s scheduling an appointment). Start at the very beginning and ask your staff to walk you through every single step until the outcome is complete. You’re not trying to understand (yet!) what should happen—you’re trying to understand and document what actually happens.

The challenge is to stay curious and fight the urge to correct or fix. You’re not trying to improve anything yet—you just want to listen carefully and document what exists (which is not easy for fast thinkers!). Ask simple non-judgmental questions like “what happens next” or “what makes you stop and ask someone?” Pay attention to pauses, phrases like “it depends” and even giggles and eye rolls.

Capture the process in its full glory—bottlenecks, unwritten rules, exceptions and all. If you really want understanding, ask a second staff member to walk you through the same task. You’ll quickly see where things change based on who’s doing the work.

Fixing The Right Problem

As you document what’s happening, you will see patterns and pain points emerge pretty quickly. These are places where a staff member has to stop to ask someone else, waits for a doctor or manager’s input before the next step, or makes a decision they’re not sure of.

Most unintentional processes break down at these decision points, so as you see the issues come up, understand that they are flaws in the process, not reflections of individual performance of your team members.

You can correct these by replacing “stop and ask” with clear criteria that allow the person following the process to make a good decision. Understand what question is being asked or what decision is being made, and what information is being used by the person who makes it, to understand “what conditions would make this a yes,” “what conditions would make this a no” and “what would happen to leave us still unsure?”

Practice leaders often say they “don’t have time” to create a process, but in truth making these decisions once and documenting them will save a tremendous amount of time down the road, while giving confidence to your front-line staff.

Before finalizing anything, look at steps that exist only to compensate for lack of clarity or errors of others. Find ways to correct the lack of clarity and reduce the errors, so that these steps can be eliminated instead of “formalizing” a redundant and complicated process. Often the best processes are simple ones with fewer clearer steps instead of layers of documented complexity.

Putting Process Into Use

Work with the people doing the work to make sure the process is clear and in language they use and understand. Ask them to test it, and refine any spots where there is lack of clarity or confusion, and continue to refine until you have a “right way”—what happens, in what order, with what information or tools etc.

Once the process is clear, the only real mistake should be not following it. When it’s followed and problems arise, it’s a sign the process needs further revision (the reality is that most if not all processes can constantly be improved)

When The Process Is Clear–and It’s Still Not Followed

In businesses like ours, even perfect processes rely on human behavior. Sometimes a process is clear, documented and works well. Until—someone simply stops following it.

In our practice, we have a very clear process for uploading prescriptions to the patient portal after their exam. It’s straightforward, well known, and not controversial. For many months, it worked just fine. And then one day, seemingly out of nowhere, it just… stopped happening.

The temptation is to assume that the process is flawed—but in this case, we knew it wasn’t. The staff member had just stopped following it. I’m not totally sure why. But it was clear that the process wasn’t broken—the follow-through was. Because the expectations were clear, it was easy to address calmly: reiterate the process, explain why it matters, remind of the importance, and move on. No drama.

Without a clear process, every correction can feel overly personal to the team and the job can feel impossible to master. With a process in place, corrections are specific and focused on behavior, not character.

When a process is in place, your expectations are simple and singular. Follow the processes. If processes are consistently ignored, that’s a different conversation and often a clearer decision.

So my big professional resolution for 2026 is to focus on process—designing systems that don’t rely on constant intervention, so growth isn’t limited by any one individual, especially me!

Bethany Fishbein, OD, is a practice owner, practice management consultant and certified executive coach. She can be reached at bethany@leadersofvision.com