In this month’s issue we feature the second in our two-part series on successfully integrating multi-focal IOLs into our practices, several surgeons, along with marketing consultant, Shareef Mahdavi, weighs-in on the “refractive shopping experience” and discusses which factors most influence a prospective patient’s choice. You may be very surprised by some of the research and anecdotal evidence we have to share. As always, your questions and comments are most welcome. -- Marguerite McDonald, MD, FACS

CLINICAL UPDATES
- Which has better outcomes, LASEK or LASIK?
- Tecnis multifocal IOL may provide better reading vision in low light
- Trauma several months or years after LASIK may cause flap injury
- DALK big-bubble technique appears a good alternative to PK in patients with keratoconus
- Younger age and poorer vision-related quality of life linked to increased risk of PK in keratoconus patients
- FDA trial finds Toric ICL safe and effective for moderate to high myopic astigmatism

ISRS/AAO INFORMATION
- Help us tell the story of ISRS/AAO, send us your photos
- ISRS/AAO now accepting abstract submissions to its 2007 meeting in Beijing

INDUSTRY NEWS
- FDA request expected to delay launch of the Tecnis multifocal IOL
- AMO to buy IntraLase for $808 million

CALENDAR
- Upcoming meetings

CLINICAL UPDATES

Which has better outcomes, LASEK or LASIK?
This retrospective review of 2,257 eyes gives LASEK a slight edge in visual and refractive results, but these differences were clinically insignificant. Both procedures seemed safe, effective and predictable for the treatment of low and moderate myopia. Nomogram adjustment may be necessary for LASIK surgeons adopting surface ablation.. American Journal of Ophthalmology, December 2006

Tecnis multifocal IOL may provide better reading vision in low light
Sixty cataract patients were randomized to receive the Tecnis ZM001, the ReSTOR SA60D3 or the Array SA40N. Under low-light conditions, the Tecnis group had the best reading acuity and reading speed. Under bright-conditions, the difference between groups was less striking. Journal of Cataract & Refractive Surgery, December 2006

Trauma several months or years after LASIK may cause flap injury
This cases series included nine eyes of eight patients whose flap dislocation was caused by direct trauma to the eye three months to six years after LASIK. Domestic repairs and traffic accidents were the main cause. Adequate and prompt treatment was usually successful. Vision in most of the eyes fully recovered. Although three eyes lost one line of BSCVA, vision was 20/30 or better. The authors advise that this potential complication be discussed with patient prior to surgery, and that patients be encouraged to use protective eyewear. Journal Refractive Surgery, December 2006

DALK big-bubble technique appears a good alternative to PK in patients with keratoconus
This prospective study of 81 patients with moderate to advanced keratoconus finds that 96 percent were completed as DALK, with the big-bubble achieved in 64 percent of patients, while 36 percent required manual intrastromal dissection. Mean UCVA was 20/60 two years after surgery. Average BSCVA was 20/30 at the end of follow-up. The authors conclude that exposure of Descemet membrane was achieved in a relevant percentage of cases. The risk of intraoperative complications was low, as was the need to convert to PK. American Journal of Ophthalmology, December 2006

Younger age and poorer vision-related quality of life linked to increased risk of PK in keratoconus patients
This prospective cohort of 1,065 keratoconus patients followed for eight years in the Collaborative Longitudinal Evaluation of Keratoconus Study confirms previously identified risk factors: corneal scarring, steeper keratometry values, poorer visual acuity, and poorer contact lens comfort. But this study is among the first to identify younger age, worse vision-related quality of life and flatter contact lens fits as risk factors. American Journal of Ophthalmology, December 2006

FDA trial finds Toric ICL safe and effective for moderate to high myopic astigmatism
At one year, 97.7 percent of 124 patients reported that they were very/extremely satisfied with their results, while 2.3 percent were moderately to fairly satisfied: 83.1 percent of eyes achieved 20/20 or better UCVA; 96.8 percent achieved 20/20 or better BSCVA. Three ICL removals were performed without significant loss of BSCVA, and one case of clinically significant lens opacity was observed. Ophthalmology, December 2006

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ISRS/AAO INFORMATION

Help us tell the story of ISRS/AAO, send us your photos
To honor ISRS’ 20th anniversary Jorge Alio, MD, has arranged to have published a history of our organization, from its formation and growth to its current status as the world’s largest and strongest eye care organization dedicated solely to refractive surgery. If you have photos that would help tell our story, please forward them to Annamarie Hastings at ahastings@aao.org. The book will be presented during the ISRS/AAO Gala Dinner & Dance during the Academy’s 2007 Annual Meeting in New Orleans. Photos need to be at least 300 dpi and no smaller than 4 X 4 inches. If you have many images or very large images, you may post them on our FTP site at ftp://ftp.aao.org (Username: isrsaao Password: isrsaao). To import your images, create a new folder labeled with your full name, and then drag and drop the images from your computer into the folder on the FTP site. Lastly, please e-mail ahastings@aao.org to let us know of your contribution. If you need assistance, call Annamarie at +1-415-447-0398.

ISRS/AAO now accepting abstract submissions to its 2007 meeting in Beijing
The deadline to submit an abstract for a paper or e-poster is Jan. 31, 2007. ISRS/AAO will present the meeting in partnership with the Chinese Ophthalmological Society and the Asia-Pacific Association of Cataract and Refractive Surgeons. It will be held May 26 - 27, 2007. Advance registration is from Jan. 24 to April 11, 2007.

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INDUSTRY NEWS

AMO to buy IntraLase for $808 million
AMO, which will acquire the femtosecond laser in the deal, says the purchase will establish it as the global refractive technology leader. The transaction is expected to be completed early in the second quarter of 2007.

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FEATURE

From Surviving to Thriving: The Importance of Quality, Teamwork, Communication and Customer Service in Your Practice

Elizabeth A. Davis, MD, FACS, Shareef Mahdavi, president, SM2 Consulting and Donna Suter, president, Suter Consulting Group

Defining the Patient Experience
Patients often choose a refractive surgeon based upon factors that can be surprising. Surgeons tend to focus on the quantitative aspects of the patient experience, using successful outcomes to define success, while patients often consider factors such as the surgeon’s demeanor, how engaging the front desk staff is, and the amount of time spent in a waiting room.

Marguerite McDonald, MD recently described a patient who chose her to perform LASIK not because of surgical skill, but because the patient was happy that Dr. McDonald washed her hands after entering the exam room. This visible demonstration of good hygiene practices put that patient at ease. While it may be impossible for surgeons and their staff to anticipate every patient reaction, surgeons can exert some measure of control by creating a quality “patient experience.”

Nordstrom versus….your local grocery store?
When patients walk into your waiting room, are they treated like a valued Nordstrom customer, or like they’re one of many in a long, slow-moving grocery check out line?

Nordstrom is a department store famous for delivering a “high touch” experience, with great selection, exceptional service, attentive staff, elegant ambience and clean restrooms. Some locations even offer espresso bars and restaurants.

One thing that Nordstrom does not do is make customers wait. Steve Coleman, MD, of Albuquerque, N.M. recently noted: “Imagine if Nordstrom invited customers to visit their store at 2 p.m., to spend thousands of dollars, and then expected those same customers to wait 45 minutes before spending their money.”

In the next 18 months, Dr. Coleman’s goal is to “abolish the waiting room.” He firmly believes that patients should receive attention promptly and efficiently, and has ideas on how to implement this.

Create It
Making the commitment to create a “culture of quality” in your own practice is an easy decision to make, yet it can be an arduous journey. Implementation requires you measure almost everything you do in order to create a baseline from which to improve.

Developing processes, which can be refined over time, is critical to the success of this effort. Only by regularly collecting data and gathering feedback from your customers, can you find out what you are doing well, and in what areas you can improve. Enhancing your quality will require some financial investment, but it will require more of your time, energy and commitment.

Some providers are reluctant to take on such a challenge because it is simply easier to be mediocre, even if the practice’s performance suffers. Just ask anyone who works in a company that is obsessed with delighting its customers, and you will learn that all the smiles and orchestration to make things go smoothly require a lot of process and practice.

Donna Suter: Communication and Teamwork
Good customer service naturally flows from good teamwork and positive staff attitudes. While we all think we understand what customer service and teamwork are, they are most clearly defined by comparing them with standards of acceptable behavior.

Without a map, it’s easy to get lost
It is never safe to assume that staff members – especially new employees – will automatically understand the meaning of “teamwork” and “customer service.” Differences in educational background, culture, age, and life experience can all determine how staff define both teamwork and customer service. All new hires should be provided with clearly defined standards and expectations on their first day to ensure that they understand what is expected.

It has been documented that efficiency increases when standards and expectations are clearly conveyed and reinforced, communication is clear, training programs are accepted, and staff members commit to engaging patients by watching for unspoken needs, and reacting with grace, patience and humor.

Customer Service: One surgeon’s perspective
There is often a real disconnect between the practice of medicine and the practice of business. Some surgeons would prefer to focus on surgical skills and not think about things like customer service and process development.

Essentially we are all customers and would like to be treated with respect and appreciation. For example, if I call a business and am left on hold, listening to music for too long, I will inevitably hang up and go elsewhere. It is really no different in an ophthalmic practice.

Good service begins with that first phone call. It may be your only opportunity to make a great impression. Patients are most frequently lost when their time is not taken into consideration – intentionally or unintentionally. It’s important to have enough staff to provide good phone coverage and to make sure that the first staff member to speak with patients is engaging, helpful, interested in the patient’s needs, knowledgeable about which procedures and services the practice offers, the surgeons and their specialties, and the differences between one practice and another.

When a patient first calls our office, our policy is to immediately send necessary forms and encourage them to visit our Web site for further information. A Web Site is a critical tool because everyone is online these days. I’m often astonished by the questions that patients ask when they call. We have had patients call and ask detailed questions about the laser vision correction technology we use or new types of IOLs. Staff members should be prepared to provide basic answers to these questions.

We also try to provide detailed information to patients about things like the exam, evaluation techniques and rationale for choosing one procedure over another. Patients appreciate this level of detail, and if they’ve visited another practice that does not offer comprehensive information, it does influence their decision-making process.

We also offer regular customer service seminars and speakers to our staff on a regular basis. I’m proud to say that we have an exceptional team. I’ve had patients tell me that they made an appointment to see me because I was “highly recommended.” When I query them about who referred me, I am exceptionally proud when they mention that one of my staff members, whom they spoke with on the phone, recommended me.

As Shareef pointed out, delivering excellent customer service is a journey, a continuous process that constantly must be reviewed, evaluated and adjusted. And as Donna suggested, a well-defined process does help staff members because established guidelines are a reminder of expectations. Also if you have staff turnover, a process is indeed a “roadmap.” It makes it easier to train new employees when you can say, “this is how we do things here, this is our culture.” With a process in place, everyone can be on the same page, working towards the same goal.

Practices will reap rewards from making patients feel appreciated. By delivering a good experience, patients can be walking advertisements, sharing their good experience with colleagues, family members and anyone else who will listen to why they should call your practice for an appointment.

SM2 Consulting is a firm dedicated to help increase consumer adoption of elective medical procedures. SM2’s Founder, Shareef Mahdavi, offers a quarterly e-newsletter with ideas to enhance the customer experience at www.sm2consulting.com.

Sign up for Donna Suter's monthly Change FAQs for busy eye care professionals by visiting www.donnasuterconsulting.com. Donna Suter, president of Suter Consulting Group, may be contacted at suter4pr@donnasuterconsulting.com.  

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