More Smoke Alarms

Earlier in the week, I shared with you our concept of "smoke alarms" that we set up to let us know  when things are not going the way that they should.  My favorite is our dirty sidewalk. Dr. Gina Wesley from Minnesota tells me that the light in her lab is her "dirty sidewalk."  She says, " sometimes I come in on Monday morning to see that it's been on since Friday evening. Sigh. Then, I start thinking, what else is being missed?"  

Now I want to share with you a few other "smoke alarms" we have set up.  I admit, the dirty sidewalk thing, as I am sure Gina's lab light, became a "smoke alarm" by accident.  But these we set up on purpose and they serve us well.

Low Daily Deposit (use with caution) This is the most common and arguably the most real "smoke alarm."  We all know the pain of not having enough money in the bank.  To determine how much you need to put in the bank every day, I simply divide my annual budget by 250 (5 days a week, 50 weeks a year).  It's not perfect, but plenty close enough.

But I argue that this "smoke alarm" comes way too late.  If your having cash flow problems now, it was caused by mistakes you made months ago.  This "smoke alarm" is easy to set up but a bad one to depend on.

That was weak, but here are some good ones:

Optical Scorecard Our mission statement clearly states that we provide value in the highest quality products.  We are also relationship based and sometimes find ourselves not recommending the best because we are worried more about the patients' pocketbooks.  We can't help it.

Sometimes, we lose a patient to an online provider or somebody yells at us about how much we charge them for glasses.  To avoid this, we start leaning toward the inexpensive stuff that makes sure we won't have to discuss money.  We know it is wrong, but like you, we do it.

Since we know that about ourselves, we complete an Optical Scorecard every Monday morning.  We count how many "good" frames we sold compared to how many "other" frames we sold.  We either pass or fail.

If we pass, pat on the back.  If we fail, a list needs to be completed where every person in the optical affirms whether she is following our routine in the optical.  Usually, just the conversation corrects the problem.

Take a look at our Optical Scorecard.

Number of Exams Eye Exams are what keeps our office alive.  But at the same time, we are very heavily medical.  We do so much medical testing that sometimes we let our schedule fill up with OCT's and Visual Fields that we turn away eye exams.  When we do that, we also are turning away glasses sales, contact fits and CRT patients.

And sometimes we are just slow.  Is that because we are behind on recall or another part of our marketing strategy?  Or are our no-shows up?  Or what?

Either way, we look at number of exams every week.  If we fail to hit our minimum number of exams in a week, we immediately initiate a spending freeze.  Because if this is not fixed now , we are going to have cash flow problems soon (See Daily Deposits).

If you would like to know how many eye exams we have to do every week, Click Here.

Exam Time When a patient walks into our office for an eye exam, we have 30 minutes to get them back into the optical, examined and happy.  We have determined that this is really important to our overall success.

Many people will say that 10 minutes in the "waiting room" is acceptable or a long wait is ok if the patient understands that they will get the same time and attention as the other patients.  These are all excuses we tend to use when we are failing to do it right.

Our target is 30 minutes.

To make it work, most of our patients need to fill out paperwork online and it needs to be entered into the record BEFORE the patient shows up.  We need to be ready for the patient and not make them wait at all.  We need to be efficient and thorough, address the patients needs, and get them out in the optical in a good mood.

We have a patient timer system so we can spot check ourselves to determine what part of our exams are breaking down.  We are used to being timed.  When a patient shows up, regardless of appointment time, we click the start button on the timer and at certain points in the exam, the time is recorded.  No math, or synchronized watches - just read it off the timer.  Here is a copy of the sheet we use.

How long is a typical patient in your office?  Have you timed it lately?


To set up some Smoke Alarms for you and your practice, just answer these questions.

  • What are the three parts of your practice that must be run well for overall success of your practice?
  • What is your standard level of performance in these areas?
  • What is the lowest acceptable level of performance?
  • What is a quick, easy and reliable way to regularly measure this performance item?
  • What are some of the things that may lead to decreasing performance?

Now you have 3 smoke alarms.  

That's all you really need.  Any more than that and alarms are sounding all the time and nobody pays attention to alarms that are always going off.

Until next time, Mike