Staff in a laser vision correction practice are in a unique position in ophthalmology, providing clinical consultation and surgical care to patients choosing an elective, and often expensive, surgical procedure. The refractive surgery staff has to learn what those in plastic surgery practices already know: Where elective refractive surgery is concerned, customer service, or as we prefer to call it, servanthood, must be the primary driver and not an afterthought. In educational presentations we give to clinical and surgical staff on behalf of refractive laser companies, we often hear questions on how to modify everything from record-keeping to payment to patient flow to satisfy patient-customer expectations. In this article, we'll share some of our recommendations with you.

Consumer-Directed Focus
Understand that creating a seamless procedure is a process, beginning with the initial contact on the phone and continuing up to and including the day of surgery. Your focus has to change a bit because you're dealing with the idea of treating pathology versus retail business; laser vision correction patients are voluntarily paying to be in your care. Now, in addition to doing your best to prepare everything perfectly for the surgeon, you and your staff must also focus on the patient and give her the value she expects. If you have everything prepared and organized, the patient's procedure will move seamlessly. You will appear professional and the patient will have no doubt that she has had the best surgery. But if the patient sees you running around, asking questions about where she must be and when, looking for charts, repeating tests that have already been done and making her endure long wait times, the patient will become nervous and have less confidence in you and the procedure.
To Serve the Elective Surgery Patient:
• Preparation and Organization
Take the time to prepare certain materials and paperwork and set up systems in your practice that anticipate any possible patient situation.
• Communication
Standardized forms and talking points can ensure that all patients and staff are getting — and giving — the same information.
• Accountability and Commitment
Make sure all staff members understand accountability. Create an environment where double- and triple-checking are routine.
• Efficiency and Foresight
Prepare and discuss everything in advance. Have all charts and materials ready for the surgeon. Don't bother the immediate postop patient with details.
• Servanthood
Every patient deserves excellent care; elective surgery patients expect more for their money.

We suggest that you set up systems in your office that allow you to be proactive rather than reactive to every patient situation. We've identified five main areas for you to review and perhaps restructure in your practice (See sidebar at right).

Preparation and Organization
Certain materials, paperwork and systems should be in place before patients are even seen as laser vision correction candidates. We believe that to be efficient on surgery day, coordination must start from the moment a patient calls your office to schedule a consultation. The proactive manager reviews areas such as LASIK projections, paperwork, supplies, charts, staff schedules and responsibilities and the patient schedule itself. For example, creating and monitoring the business office's LASIK projections will assist in:
• efficient budgeting and ordering of surgical supplies;
• organized and dedicated time slots for surgical procedures;
• justification of appropriate staffing needs; and
• decreasing unexpected overtime pay.

Make refractive paperwork simpler and more consistent by creating:
• color-coded forms for easy identification;
• color-coded charts for co-managed and in-house refractive patients;
• a dedicated laser vision questionnaire and consult form for first visits;
• standard follow-up letters for appointment confirmations, no-shows, and pre- and postoperative instructions;
• exam forms;
• preoperative checklists; and
• surgical status sheets.

Rest assured that the time you take now to prepare such materials and systems will pay off a hundredfold when they're implemented. For example, a checklist for incoming calls insures that every prospective patient gets the same information. With customized flow charts, there's no question about who does what. Practices that have put these items together now spend their days planning for future growth and not reacting to the unexpected.

Boost your communication efforts with patients and among staff members. Use the boilerplate sheets and forms you've created to accomplish this in confirming appointments and reviewing instructions over the phone with patients. If this process is standardized, there should be no more concern that a patient didn't know to remove her contact lenses the required amount of days before surgery or that the surgery takes place in a different location than the office exam.

On the day of surgery, communicate with the patient by checking (and double-checking) her date of birth, allergies, eye drops, eye(s) to be treated, and the procedure to be performed (LASIK, monovision LASIK, CK, etc).
You can also use standardized forms to create useful agendas for weekly staff meetings. For example, you can use them to call attention to hiccups in your internal system that must be discussed.

Accountability and Commitment
When all staff members are held accountable for their actions and are committed to patient care, an uneventful surgery day can be a reality. We suggest that you create:
•  a streamlined process for seeing patients that explains dedicated roles for each staff member;
• a preflight checklist. In a team effort, it's OK that everything gets double- and triple-checked and marked as such on the list. Use these on the day before surgery and on surgery day;
• a system of checks and balances that ensures all paperwork is signed, laser logs are completed and that all interactions with the patient have been completed (confirm that drops were given, note time valium administered, note vitals checked, informed consent signed, etc.);
• a postop list that includes calling the patient after surgery. This reassures the patient and may nip any postop problems in the bud.

In addition to streamlining patient flow, this type of system can easily reveal the responsible party if any steps are missed.

Efficiency and Foresight
In a proactive practice, everything is prepared or discussed in advance. Most patients are nervous when they arrive for surgery and don't want to deal with details. You can quickly move them into surgery if everything is ready for the surgeon beforehand. In a similar way, the immediate postop patient may not have the attention or the energy to understand instructions or deal with paperwork. We've found it helpful to:
• Get the surgery charts to the doctor two days prior to surgery. The doctor can review the chart completely and make any requests for retesting.
• Double check if additional testing is needed on each patient before preparing him for surgery
• Check on surgery supply levels two days in advance of scheduled procedures. This gives you enough time to place an order and get delivery.
• Ask patients to have their prescriptions filled prior to their surgery day. This is more convenient for the immediate postop patient and increases compliance.
• Take payment for the procedure before the surgery day (See "LASIK Preparation Pearls").

Making it Happen
For many practices, it will be a considerable undertaking to assess all of their systems, create standardized, colored forms and charts, create inclusive checklists and adopt an attitude of servanthood. Only the employees can make this happen. They need to be onboard and totally committed to the success of the practice. They must have a belief in the skill of the surgeon and the benefits of the procedure and have a genuine desire to work with patients. But how do you get everyone there?

LASIK Preparation Pearls
• Optimize space: Waiting-room time can serve double duty as an educational opportunity. Invest in a portable DVD player that can be used with headphones for viewing laser surgery or informed-consent videos.
• Personalize videos: In a multiple-physician practice, create informed-consent videos starring each surgeon. This way, the patient can view a presentation from the doctor who will be working with her and feel that personal touch.
• Complete paperwork by mail: Mail paperwork to a new patient so that she can complete it before the initial visit, reducing time spent in the office.
• Payment: Require payment for the procedure prior to the day of surgery. Glitches with credit cards can hold up your surgery schedule, as can additional paperwork for a patient who decides at the last moment to apply for financing. Advise your patients that some debit cards have a daily limit on charges, so their bank might not approve $4,000 on the morning of their surgery.

We believe the message has to come from the surgeon. He sets the tone and makes expectations and goals clear. He must have high principles and hold people accountable. Most importantly, he must appreciate and recognize good performance from his team. If he doesn't do these things, the practice will flounder. The patient who is a smart consumer will see this. A great surgeon with a poor staff won't get a lot of business. Along these lines, you have to be aware of the types of people you bring onboard. Look at the needs of the practice and move people into positions where they show promise and will succeed. Outgoing, salesperson types may do better as laser vision coordinators or front-desk personnel. Thorough, detail-oriented technicians should be offered the opportunity to learn and work with new technologies such as the wavefront analyzer. It will take some time, but the payoff is huge.

Servanthood, our term for customer service, goes one step beyond ordinary customer service and exceeding expectations. We like J. Van Rose Jr.'s definition of servanthood in All About People: "unselfish commitment to others provided out of genuine unconditional concern for people, which produces customers for life." When we are talking to staff about this idea, we ask them to remember that the refractive surgery patient is spending her disposable income on an elective procedure. She has options to go to another office, or to spend her money on something else. We also remind staff that every patient deserves excellent care, no matter why she is in your office. If any staff member who touches the patient isn't onboard with these concepts, servanthood will never occur. 

Ms. Lapointe is a marketing and  practice development specialist with IntraLase Corporation. Reach her at Ms. Watson is a clinical applications specialist with Alcon Laboratories. Reach her at