Resources to Remember
Generalists vs. Specialists debate the merits of each approach.
Thanh Mai, OD, pulled my heartstrings in his article debating the merits of the generalist approach to eye care. We call it comprehensive optometry here at PPP. My favorite line: "The dichotomy is something we made up." Bravo. Review of Optometric Business
Compare all topographers and all OCT units.
These two articles from Review of Optometry not only update the use of topography/tomography and OCT, but also include an excellent table comparing every device from every manufacturer and how they stack up in terms of features.
Articles to Apply
How do you grade and evaluate meibomian glands?
There has been very little standardization for grading meibomian glands...until (hopefully) now. Caleb Abbott, OD, who seems to have his hands on a bunch of practical research these days, wants to standardize our approach. He and his co-authors propose the Meibomian Gland Composite Score (MGCS), which combines several scales into one. Clinical Optometry
Quotes to Consider
"The accelerating pace of change means that we need to question our beliefs more readily than ever before. We're swift to recognize when other people need to think again. We question the judgment of experts whenever we seek out a second opinion on a medical diagnosis. Unfortunately, when it comes to our own knowledge and opinions, we often favor feeling right over being right. We need to develop the habit of forming our own second opinions." -Adam Grant, Think Again
My Observations
Should we be focusing more on processes or outcomes? Yes.
I've been watching ESPN's excellent documentary on Nick Saban, aptly titled Saban.
As a college football fan and a wannabe sports psychologist, I find it fascinating.
In short, Saban attributes his success to his focus on process, not results. He shifted his mentality from outcome-focused to process-focused midway through his coaching career, and that shift made all the difference.
James Clear makes a similar case in Atomic Habits: systems matter more than goals.
I agree. Mostly. I love systems. But a process with no target gets no feedback, so you have no way of knowing whether it’s actually a good process.
Somewhere along the way, “systems over goals” turned into “ignore outcomes entirely.” Ignoring the scoreboard sounds wise. It’s also convenient, because it lets you off the hook if you don't git your goal.
For a lot of high achievers, I suspect it’s a coping mechanism for perfectionism dressed up as philosophy.
The truth is less provocative: you need both. The work is learning to live in the tension between them. Here’s how I’m trying to do it.
1. Goals design the process.
You can’t know whether a process works unless you actually track and review the outcome. Say you build a workflow to identify more IPL candidates, and a month later IPL volume hasn’t moved. Either the process is broken, or the team isn’t adhering to it.
2. The process has to stand on its own.
Or, to put it another way, the process has to be satisfying in and of itself. A good process has rewards built in for just following the process.
If your dry eye protocol only works when the patient says yes to IPL, it’s a sales script, not a protocol. If your myopia program needs orthokeratology fits to pay the bills, it has the same problem. The same goes for optical.
This is the real value of full scope optometry. Disease care and optical together mean no single sale has to rescue the day. The IPL, the PAL, the Stellest all help. But we aren’t standing at the door hoping each patient bails us out.
When the process is good on its own terms, running it well becomes the reward. Some of that reward is internal, the satisfaction of doing it right. Some of it is external, recognition from the team for executing whether or not the patient said yes.
3. Process and outcome run on different clocks.
This is where football fits. Saban taught his players to ignore the scoreboard and win the next play, which lasts about six seconds. Then the next one. Stack enough winning plays and the scoreboard tends to take care of itself.
But I doubt he ignored the scoreboard at halftime, or at the end of the game. Those were the checkpoints that told him whether his team was executing, and whether the plan was the right one.
We can start doing the same thing. Perhaps you start tracking behaviors and actions daily and weekly, and reserve outcome-based metrics for the end of the month and quarterly.
- How many times did we recommend IPL yesterday?
- How many parents did we ask whether their kids have had an eye exam?
- How many times did we try to schedule an ocular surface or myopia evaluation, or recommend Stellest or Neurolens, regardless of what the patient decided?
Those are the six seconds. Revenue is the scoreboard.
So it’s not process over outcome. It’s process and outcome, held together. Goals shape the process. The process stands on its own. Each one gets its own clock.
What this means for you: Pull up your scorecard and circle every metric that measures what happened rather than what your team did. If everything is circled, add one process (behavior) metric for one service line this week, and review it daily for a month before you look at the outcome..