The art of simplicity is a puzzle of complexity.
— Douglas Horton
INTRODUCTION
Eye care providers appreciate the importance of properly following procedures in an organized fashion to achieve the best results. These procedures represent a process. A classic example is refraction. The study of operations is the application of these processes in a business. It transforms the abstract company goals into concrete procedures with a carefully choreographed order of steps. Each planned step efficiently utilizes the available valuable resources to complete the given task. The process is then analyzed for waste, improvements are made, and the cycle starts again.
Many processes occur around the practitioner all day. Most go unnoticed because they have been maximized through trial and error over a long period of time. The most common procedure encountered in a practice is the patient experience. This includes all the steps taken from the moment a patient enters and leaves the office. However, many sub-processes must have been completed to make that patient encounter successful. A procedure was used to create the doctor’s template for when patients scheduled appointments. All of the staff members who interacted with the patient, from the front office to the technicians, went through training that involved a series of educational modules. The eye drops used to anesthetize and dilate the patient’s eyes were part of an inventory process to make sure they were available for use when needed.
To exemplify the theme of operations, this chapter will take a step-by-step approach to demonstrate the procedures on optimizing the many processes that surround us every day. It begins with an introduction to different process types and how they create the targeted purpose. The next step includes the methods used to assess the various steps and the overall procedures. This leads to strategies on identifying and changing the problem areas that create inefficiencies in the system. The culmination of these topics results in a systematic approach on how to continually improve the processes through an effective and repeatable cycle.
WHAT IS OPERATIONS?
Businesses are judged by the value of the final products created or the services provided. However, for each product or service that is sold to consumers, companies must first create and follow a series of steps in a process.1 The method used to perform these procedures have a significant impact on the end products. These include the cost of making the product, the time needed to create it, and the quality in which it is produced.
The inherent variability in these steps presents an opportunity. An elite company understands each step and how they are linked together from the beginning to end. This enables a productive cycle of continual evaluation and improvement for the critical processes in an organization. This procedure is strengthened when it aligns with the goals, mission, and overall vision of the business.1
Each company’s ambition should be to reach a level of process development where sustainable quality improvement is achieved. This occurs when each step is carefully examined and reviewed with the purpose of making changes that lead to incremental refinement. Achieving that high functional status in an organization is actually a process in itself. The initial step includes appreciating the variations that exist between and in each business. This realization illustrates the importance of flexibility when designing different processes based on needs.
The system is then permitted to function after selection of the process type. At the same time, evaluations are made using carefully guided metrics that produce reliable data to be analyzed. This information tags weak areas for improvement. The process then repeats itself for further examination and enhancement. Each step should ensure the pathway being taken is in alignment with the targeted business goals as the process becomes more refined. This exercise provides a strategic advantage to those companies that learn to adapt and improve themselves. In stark contrast, there will be other organizations that are content with being stagnant but will eventually find themselves obsolete.
OPERATIONS IN EYE CARE
The impact of operations for an eye care business is witnessed by taking a moment at the workplace to watch the employees carry out their duties. Everything being done is part of a process to accomplish a goal. All similar businesses perform the same activities. However, they greatly differ in efficiency. This is what separates great from average practices. The opportunistic companies realize this variability to create a meaningful advantage. They take time to fundamentally understand each step. They acquire knowledge that leads to the creation and implementation of a review process. This allows for perpetual improvement on the overall system while remaining optimal despite changing conditions. The fundamental competencies in operations for the successful eye care practitioner to possess are understanding process types, implementing process development, incorporating evaluation and metrics, and identifying problems and improving processes.1
Importance
Once a business has direction as described through its vision and mission statements, it needs to develop and exercise a plan on how to achieve these goals. The focus shifts to the practical applications of operations. The critical tasks at this junction are to identify and select a business model, then it needs to implement processes throughout the organization to facilitate the execution of this strategy. Thriving organizations efficiently execute the tasks required to convert their big dreams into reality.
The first difficulty is the selection of the correct model for implementation. The best approach on how to choose the right model, and its associated processes, is to remember the characteristics and goals of the organization as a whole. In the ideal setting, there is strategic alignment throughout the business. Each step along the journey builds on the prior one. The vision for the business outlines its mission. This, in turn, guides the model that leads the processes. The intended organizational culture acts as a safety check along the pathway to ensure quality control. When these different sections work in unison, a fundamentally strong and talented company exists that is primed to thrive.
Keywords
Operations: A discipline of business that focuses on the creation, utilization, and improvement of processes in a company
Process: The cumulative step-by-step procedure of creating a good or providing a service
Business model: A concept that is structured with guidelines on how to run the operations of a business
Business plan: The way in which a business model is executed
Process map: A description explaining the relationship of steps in a process
Outsourcing: The use of an outside entity to provide a necessary a step or an entire process in operations
Applications
The ability to run an eye care practice effectively is contingent on orchestrating a plethora of interwoven steps together to create a masterpiece of operations. Each of these steps represents a process. These processes contribute a part to the whole, with some being more essential than others. There are many benefits to this structured creation. It can be broken down to smaller sections, analyzed for efficiencies, reconfigured if needed, and then put back into its original position. The elite practices understand how each process functions and appreciate its individual value.
The blueprint for directing these activities is explained by the practice’s business model. It furnishes the intended structure and goals to be viewed at the 30,000-foot level. An example would be the creation of a large, multi-specialty eye care practice that provides excellent patient care. This includes maximizing economics of scale both medically by having many subspecialties and financially by employing the optimal number of providers. The finished products created by the business model should align with the company’s vision and mission statements. These fundamental components provide the pillars on which the desired culture rests.
The business plan outlines the steps required to execute these directives. It utilizes process maps to demonstrate the proper sequences of the individual segments. A sample would be to create and use an intricate organizational chart that provides leadership in key positions of the practice, such as Director of Operations and Director of Finance.
The best companies also realize there will be instances where the practice would be better off by allowing an outside expert entity to provide a step or an entire process. This is accomplished by strategic outsourcing. An extreme example of this would be outsourcing Human Resources or Information Technology from a practice to another professional company that specializes in those areas.
Immediate Action Items
Have you ever considered what one of your patients experience during a typical examination at the office? Does this match with your desired business model? The patient experience process is the most important of all the ones that take place as it represents your source of income and influences the ability to provide patient care. Take a moment to diagram out a routine appointment that represents what you think is the patient flow. Show that figure to several staff members and ask for their input to refine the sequence as you may not have subtle events that occur. If there is anything missing that you believe should be there or removed, take note of it. Keep this diagram as we work through this chapter together. The good news is we only have positive progress to make as we carefully evaluate and refine this important process in your practice.
Implementing Process Development
Importance
The ability to effectively execute a business model depends on the quality of processes that are utilized to achieve the goals. The benefit of understanding process management is the opportunity to customize each step to fit the needs of individual tasks throughout an organization. It provides different areas of a business the capacity to alter steps, which enables continuous assessment and subsequent improvement. Strong organizations capitalize on this flexibility to maximize production through the best use of their resources. This drives efficiency throughout the business that results in better outcomes for both the company and its customers.
The general strategy used for process management includes a series of steps that create, analyze, and refine its operations. A frequent mistake is the requirement to develop the perfect process the first time and have it completed before it is ever put into use. It is important to think ahead about what the best process would be to use. However, it is very uncommon to have all of the necessary information before starting a process. At some point, the first step needs to be taken. It should be done with the understanding that there will be the opportunity to fine-tune it later to improve its efficiency. The alternative to this option is to never initiate a process, but then nothing will ever be implemented. This leaves the organization with an undesirable label and culture of being static as opposed to adaptable with the changing environments.
Keywords
Logistics: The planning, managing, and executing of each step in a process
Critical path diagram: An algorithm that depicts how the order of steps in a process can be arranged with the goal of best optimizing time
Backward pass analysis: A critical path diagram evaluation that estimates time on the basis of when steps can occur at the latest moment without interfering with the timing of a process
Forward pass analysis: A critical path diagram evaluation that estimates time on the basis of when steps can occur at the earliest times to complete a process
Gantt chart: A schematic used to illustrate when each part of a process will start and end relative to each other
Idle time: An inefficient or wasted period of time in a process when available resources can do work but do not have the necessary materials to complete the step
Bottleneck: The rate-limiting step in a process
Lead time: A quantity of time needed before a required step or process can be initiated
Downtime: A time when either a step or the entire process cannot occur for a particular reason
Forecasting: An exercise in predicting the future based on historical data
Variability: An inconsistent or unpredictable quality of something
Bullwhip effect: A phenomenon that demonstrates inefficiencies in supply chain management based on forecasts of demand where the effects are most noted later in a process
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