IN OTHER BUSINESS SETTINGS, using a word like “journey” to describe the customer experience might seem like overreach, straining for differentiation that isn’t there, but in the eyecare context it’s a totally appropriate way to describe a patient’s encounter with your practice. There are so many moving parts: appointments are made; health, insurance and payment information is collected; patients are tested, examined, educated and treated — and that’s before they even enter the optical, where a key retail and fashion experience awaits them, before they leave — if all goes according to plan — looking, seeing and feeling a whole lot better.
All of this takes place in the modern context of impatience, seemingly limitless choice and online ultra-convenience, and in which 1-star consumer dissatisfaction can be registered with a few taps of a thumb.
“Patient flow” is how we usually refer to the movement of people through this process, but the most successful eyecare practices know that it’s not a matter of speed; rather it’s about optimization and efficiency. Getting the patient through the journey in such a way that respects their time and makes them feel special, while also reducing revenue-killing bottlenecks and allowing your service to truly shine, is fundamental to success in this industry.
We looked around to get a sense of what successful eyecare businesses are doing to make the patient journey as seamless and profitable as possible and offer their wisdom here in the hope that it will help you piece together the patient flow puzzle in the way that best works for you. What follows is our guide to seamless patient flow; a journey in four stages.
1. Getting to Know You
These days, technology means the patient’s journey can begin long before they pull in to your parking lot. Investing in a digital check-in system saves time, lets staff prepare for special needs and reduces the chances of insurance headaches.
“Being prepared helps get the patient in and out without issue,” says Sophia Pray, office manager at Huntley Eye Care in Huntley, IL. “To create a seamless visit we use a [digital] platform for all our forms, no longer printing forms for patients to fill out. We send the forms prior to their appointment and when they arrive, we can take them straight back to see the doctor.” The practice uses Jotform for new patient registration, annual consent forms, eyewear policy, contact lens policy and even record release authorizations, with links provided on the website. Secure and HIPAA compliant, the platform allows you to create any type of form online. “You can either choose to pay monthly or annually depending on your needs. They have many customization options,” says Pray.
She rattles off a list of advantages to digital check-in: insurance already looked up and checked to make sure benefits are available and the office is in network; prior knowledge of whether the patient is interested in trying contacts for the first time, which means they know to have someone available for training; you can ask about diabetes or whether the patient wishes to be dilated. Bottom line: Staff know exactly why the patient is there and how they can help them.
“We have a couple tablets around the office so it’s easy for us to bring up the forms,” adds Pray. “It saves us time and creates less work for us to do as well. Less printing, less scanning, it’s great.”
For Dr. Matt Barber and his team at CHROMA Modern Eyewear + Eyecare in Forth Worth, TX, flow means getting the patient to the doctor as quickly as possible. This comes down to intel. “We want all the patient’s insurance information, previous records, and/or referral paperwork prior to the patient arriving. This gives our staff the confidence to answer patient coverage questions quickly and accurately,” he says. In addition to online scheduling, patients are often emailed, texted and/or called beforehand to gather as much information as possible prior to their appointment. For its scheduling, CHROMA uses the SolutionReach system.
2. Greeting, Waiting, Communicating…
Waiting. Patients don’t like it and they’ll let you — and the Google review-reading public — know about it. Obviously it depends on the services you offer, but in general a crowded waiting area is a marker of suboptimal efficiency, not to mention lost productivity, sales and profit.
One sign of a practice’s confidence in its ability to deliver seamless service is a minimal waiting area — or doing away with one altogether.
In Waynesville, NC, Haywood Family Eye Care has eight exams lanes and two ODs seeing patients at any given time. Most offices of this size would have a large waiting area, but Haywood has just two oversized chairs for the entire office, and “Our team ensures that customers don’t need those two chairs,” says co-owner Dr. Tommy Pinkston. “As soon as they walk in the door they are greeted by name and immediately checked in. As our patient coordinator addresses the patient, they immediately let another team member know who is needed for this customer. Our consistent, short wait time and internal seamless communication makes the experience as smooth as possible.”
Sometimes, of course, patients do have to wait. What to do with them is a question Dr. Cynthia Sayers, owner of EyeShop Optical Center in Lewis Center, OH — and a student of the fabled Disney approach to customer service and management — has given some thought to. “Think about waiting in line at a Disney ride. It’s not just a line. On Winnie the Pooh there is a wall of ‘honey’ to draw on. Peter Pan’s flight takes you through the Darling’s house on the way to Neverland. So a patient never just ‘waits’ at EyeShop, they are constantly engaged, whether it is looking at frames, grabbing a cup of coffee or just chatting with staff. So sometimes even when we aren’t necessarily ‘efficient’ the patient doesn’t even feel as if they have been left waiting. Avoid making patients feel like a number, having them wait in total silence with an outdated magazine to look at. Keep them engaged and the flow will take care of itself.” The takeaway here is that patient perception is all-important. If the patient feels well taken care of — even if they can’t quite say why — the actual time elapsed in minutes doesn’t matter so much.
The pandemic offered the counterintuitive lesson that reduced appointments can be good for business. “We keep our schedule at a slightly slower-than-average-pace so each patient has ample time to have all questions answered and shop for glasses,” says Kelsey Bredice at A Proper View in Winston-Salem, NC. “Our goal is for every patient to have a calm, pleasant experience from the moment they walk in to the moment they leave. We keep paperwork to a minimum and have most of it online. Patients are not left to their own devices because they tend to get overwhelmed in an optical environment. We tell our staff to pretend like this person is visiting your home and you want to make them as comfortable as possible so there is no confusion.”
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3. Life in the Fast (Exam) Lane…
This is where a skillful combination of investing in (the right) tech, integrating it efficiently, and properly training staff—staying on top of them to be vigilant in monitoring patients and knowing where they can be moved to free up space—comes into play.
At Vision Health Institute in Orlando, FL, owner Dr. Mark Perry says investing in the latest equipment with multiple pre-test stations and rooms has reduced bottle-necking, allowing up to five patients to be tested simultaneously. The key, he says, is for the technicians to be aware of the number of patients being pretested and where they all are in their workup tests. “Most stations take approximately the same amount of time, which is great, so moving from station to station is relatively easy. If and when there is a bottleneck, the staff can finish most of the pretesting in the exam room (we have color vision, depth perception, BP cuff and tonometry in the rooms). When things get hectic, staff communicate to coordinate patients’ movements.” It is critical, he adds, to ensure that when an exam room becomes available, it is quickly filled with the next patient. This is done by having a tech monitor the rooms and/or having the doctor notify the technician that the room is available.
A good inter-office communication system can really improve the collective ability of doctors, techs and opticians to keep tabs on which patients are where in the exam lane. “To improve efficiency,” CHROMA’s Barber advises, “set up different chat groups within your Weave, or whatever interoffice communication system you have, to alert specific staff when you need help.” At CHROMA, during the exam, the doctor will text the techs to grab a specific contact lens power or brand and have it ready for the patient when they walk out of the room. “Or, Optical will get an alert to meet the doctor/patient outside the exam room for a proper handoff to allow education and sale capture while also being extremely efficient with everyone’s time,” he says.
Weave’s Team Chat app seems to be particularly popular among eyecare businesses. The crew at Complete Eye Health in Holland, MI, find it facilitates patient flow well. According to Bethany Cassar, a typical chat exchange between staff might go something like this: “Patient pulled into parking lot, patient checking in, patient’s wearing glasses, patient ready for clinic.” She adds, “It keeps us on time and aware of the patient’s needs.” At Huntley Eye Care, team members rely on an intercom system that interfaces with their phones, while at McCulley Optix Gallery in Fargo, ND, the BlueNote paging system is the platform of choice, according to office manager Jenna Gilbertson. Other options include Comlite Systems or simple IM services like Slack.
Training staff to understand when the exam is done, when to clean the room and bring in the next patient has really helped at Huntley Eye Care. According to Pray, “We understand the cues from the doctor. And if they need to purchase glasses and/or contacts the handoff is great.
The doctor understands what information she needs to tell us, what conversations she had with the patients that will help us at check out. It’s taken a long time to get to where we are. Communication is key.”
Bakersfield Eye Care in Bakersfield, CA, have found that having a “formal patient care experience” in place as a kind of “gold standard” helps keep things flowing. According to optician Lorie Fox, “Just knowing what is expected by our opticians helps them to deliver our desired experience. We have folks deviate but we try to keep bringing them back to ‘the experience.’ We have a rotation every day so our opticians know who is assigned to what patient. They make sure they review their patient’s insurance and profile prior to the patient’s arrival.”
A truly innovative approach to patient flow and the optician’s role in it can be seen in the “verbal review” and “clinical opticians” concepts implemented at Elite Eye Care in Waukee, IA. According to owner Dr. Ethan Huisman, “We have eliminated all paperwork and review all history, medications, etc. verbally. Verbal review allows us to connect with our patients and have them feel heard and valued, instead of taking additional time to fill out paperwork and become less personable.” The “clinical opticians” are present in the exam room and hear exactly what the patient needs and what the doctor has prescribed. “They can move directly into frame styling and lens educating based upon the patient’s personal visit with the optometrist, which truly saves so much time and creates a safer environment for our patients to trust us,” says Huisman.
Whatever tech or methods you employ, old-fashioned human communication skills are still vital to keeping things moving. “In our office,” says McCulley Optix Gallery’s Gilbertson, “we huddle every morning and talk about who is coming in, why they are coming in, when is the last time they came in, when is the last time they bought glasses and contacts, who in their family needs to get in for eye exams. We are all on the same page for our flow of the day, which makes the patient experience seamless.”
A word of caution regarding equipment: Patients appreciate hi-tech gear, but it can actually hinder flow if onboarded without adequate preparation. Dr. Margie Recalde, owner of Lifetime Optometric in Fresno, CA, is an enthusiastic adopter of new equipment, but recalls that “One technology made the work-up too long, which made my schedule run behind. I decided to decrease the amount of tests to the absolute necessary for the initial work-up.” Any time you bring in new gear, she says, you need to think about return on investment, and patient flow is a critical component in this. “How many procedures are needed to pay off the equipment? Does it improve patient flow? Does it save time — which can help you open your schedule to see more patients? Work less days but see more patients per day?”
Optimal flow isn’t just about moving bodies through the office as fast as you can. It’s about getting as much value as possible from the time spent with them, while maintaining the highest possible standard of service. The eye doctor has a key role to play here. Here are some tips from Dr. Matt Barber of CHROMA:
DO: Spend time educating the patient on testing results, contact lens options, and how cool your frames are — and the “doctor recommended” lens technology options available to put in those stylish frames.
DON’T: Give your services/products away for free. “This may not seem like a ‘patient flow’ killer at first, but if patients know you’re quick to do follow-up exams at no charge and remake lenses after every complaint, your schedule and staff’s time may become taken up with non-revenue tasks.”
REMEMBER: Follow-ups and re-checks can oftentimes take longer than actual “real” exams. “Have a system/protocol in place to diagnose and fix patient complaints — say, a glasses complaint or that the contact lens Rx seems ‘off’ — before they land on your schedule and throw a monkey wrench into your day. Many complaints can be solved with education, measurements, and a great customer service culture within your practice.”
An illustration showing the office layout at Virginia optometric practice INVISION’s Salem office, based on a sketch provided by owner Dr. Scott Mann.
4. We’ll Meet Again…
When we asked our Brain Squad about the best office layout for optimal patient flow, many championed the circular or horseshoe design, citing reduced congestion for both patients and staff, and its ability to ensure that the optical is the last stage in the patient journey. It also generally creates a clean, uncluttered feel. At their custom-designed Salem office, Virginia optometric practice INVISION (no relation) uses a one-way circular flow around the outer office walls, with staff based in workstations grouped in the center. According to owner Dr. Scott Mann, “This allows for efficient staff movement and communication. In order to get to the checkout area the patients have to walk through the optical area. That serves as an introduction or orientation to the optical, which hopefully makes a good impression on the patient — in the future when they need optical products or services we want them to think of us first. Our thinking is if they are familiar with our optical area they will be comfortable coming back to see us.”
The McCulley Optix Gallery team also thrive on their circular layout. “Our new office [enables] a very circular patient flow,” says Gilbertson. “Our patients come in, wait less than two minutes if they have pre-filled out their paperwork: pretest, exam room, and all patients exit through the optical. They almost never run in to other patients in the exam hallway, which really makes them feel like they are our only patient in all the best ways.”
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According to eyecare practice design firm Eye Designs Group, it’s important to “consider foot traffic patterns and how people will move throughout your space.” Even if a circular design is not an option for you, at the very least, “Keep a transition area between the exam rooms and the optical displays and dispensing areas,” the company advises. At Corner Optical in Glenview, IL, owner Kevin Count prioritizes “linear movement — front to back to front — and wide areas to walk through and shop. ”
Just as the concept of check-in and the need for prominent reception areas has been rethought of late, the need for designated checkout or payment areas is also being reevaluated. According to Dr. Ben Thayil at Lifetime Vision and Eye Care in Miami, FL, the one change that had the biggest impact on their patient flow in recent times “was the ability to take payments at the sales table.” It’s an approach that resonates at Haywood Family Eye Care, where, says co-owner Pinkston, “During our new office design, we decided we wanted to completely remove the standard ‘checkout’ area as seen in most eyecare facilities. We wanted patients to be able to pay with ease quickly and where they are.” The goal was for every member of the team to be able to conclude a purchase or payment at any point. As a result, the new office does not have a formal “checkout” desk. Says Pinkston, “If a patient is in an exam room or in our optical department and their visit has concluded, the team member can facilitate their payment of any and all services or products. This has minimized wait time, patient frustration, and most importantly the loss of potential sales.”
You’d be hard pressed to find a practice that has more thoroughly and effectively thought through the patient journey than Taylor Eye Care in Carmi, IL. Office manager Morgan DiMaggio walked us through it: “Our office is an open concept space and set up in a big circle. We have ample staff to ensure our flow is consistent for each patient. We have two pre-testing rooms, five exam lanes, one doctor, one office manager who can work any position as needed, two techs, two opticians, and three front desk staff working at all times. The exam lanes and optical area are separate, but the flow is smooth. You can’t miss our check in area because our receptionist is right up front at all times greeting our patients by name. Our techs try to pick patients up from the waiting room within five minutes of the patient arriving. Once the tech has finished pre-testing, she will page our doctor to come and see the patient. Once the doctor has performed a thorough exam, he will page an optician to come to the room to do the handoff. When the optician enters the exam rooms to answer the doctor’s page, patients will often say, ‘You’re just in time!’ The optician will then guide the patient to our beautiful optical with over 500 frames in inventory to give them a personal shopping experience. We don’t ever send patients to our frame boards by themselves since that is intimidating for some! We strive to provide the ‘wow’ factor by allowing patients to take at least six frames home to show family and friends. We’re also extremely transparent with pricing so there aren’t any unknowns when the patient leaves.”
“I imagine our patient flow is slower-paced than most clinics,” Dr. Baureis says, “but we try to be the most polished and as efficient as possible, knowing that there are always going to be hiccups—i.e., late patients, technician difficulties, etc.” Uptown Eyes hosts an at least annual in-house event they call the “Polish”, in which the team works through each element of their patient flow from the phone call or initial digital contact through check-in, preliminary testing, exam, optical, and check out.
“This allows each member of the team to see how their role plays a part in the big picture—the patient experience,” Baureis says. “It reminds us of our mission of the best, unique, most personalized patient experience; allows us to brainstorm new ideas of how to make it special; reveals possible redundancies or inconsistencies in verbiage, etc.”
To ensure that the placement of furniture and fixtures was just right, Baureis actually had staff act as patients and pretend as if they were walking in the front door, checking in, shopping and doing all the usual activities. “We did that again this spring, actually, when doing another small remodel of our dispensing desk that we have turned into one full-length fixture, in order to maximize the surface area and storage of the desk, but not interfere with comfort of shopping at the optical displays. With a smaller space, every inch counts.”
