Whether it’s addressing a staff member’s underperformance or an unhappy patient, difficult conversations are a daily reality in private eyecare practices. Experienced healthcare leader Scott Bell provides some useful pointers.
Few of us are naturally comfortable with difficult conversations. The thought of providing tough feedback to a colleague, or telling a patient about a difficult diagnosis or unexpected surgical outcome, is not only unpleasant but stressful. It often leads to procrastination, anxiety and poor execution which can make the situation worse.
But a well-timed, well-delivered difficult conversation with staff can improve clarity, understanding and alignment among your team. And a challenging conversation handled well with a patient shows empathy and respect, which will in turn build trust and support informed decision making.
Knowing the principles of handling difficult conversations will not only serve you well professionally, but in life generally.
Below we discuss two broad types of challenging conversations.
1. Addressing under-performance in staff
In a busy ophthalmology clinic, efficiency and accuracy are critical – whether it’s administrative staff managing your appointment schedule and surgical bookings, or orthoptists conducting pre-operative workups. When a staff member fails to meet expectations, ignoring the issue not only perpetuates the problem, it can impact patient flow, safety, and culture.
Research published in the Harvard Business Review (2016) found nearly seven in 10 managers avoid difficult conversations about performance. In healthcare, this avoidance can lead to resentment among high-performing colleagues and erode your practice’s standard of care and reputation with referrers.
A 2020 study in the Journal of Healthcare Leadership similarly reported inconsistent or unclear feedback was a leading cause of disengagement among clinical and administrative staff.
To effectively address staff under-performance, clarity, accountability, and culture should be front of mind:
• Clarify roles and expectations upfront. Ensure each team member understands their responsibilities. This includes clear position descriptions and written policy and procedures.
• Give timely, specific feedback. Nothing should be a surprise for a staff member at an annual performance review. If someone isn’t meeting expectations, provide feedback promptly.
• Adopt a coaching mindset. Begin with curiosity and support: “I’ve noticed you’ve had few patients where the full workup wasn’t completed – can we talk about what’s going on and how I can help?”
• Document and follow through. If improvements aren’t made, document discussions and follow formal performance management processes to uphold fairness and clarity.
• Encourage reflection. Ask open questions: “How do you feel things are going in your role?” or “What could help you improve in this area?”
Creating a practice culture where regular feedback is expected and welcomed – both upward and downward – can make these conversations feel less personal and more about alignment and growth.
You may want to look into the SBI feedback model (Situation-Behaviour-Impact) as a useful framework for feedback.
2. Difficult conversations with patients
Ophthalmology is highly satisfying specialty, but complications happen. Whether it’s a refractive surprise, a complication, or dissatisfaction with their experience, patients in private ophthalmology settings can feel particularly vulnerable – especially when out-of-pocket costs are involved.
According to a 2021 BMJ Open study, patients who felt heard, acknowledged, and kept informed were far more likely to remain loyal to a practice – even if they had experienced complications – than those who felt dismissed.
When addressing an unhappy patient, trust and transparency matter:
• Lead with empathy. Begin by acknowledging emotion: “I understand this has been upsetting for you, and I appreciate you taking the time to discuss your concern.”
• Avoid rushing to justify. Allow the patient to speak fully before offering a clinical explanation. This signals respect and will make them feel ‘heard’.
• Validate their feelings. Even if the issue is a known risk of surgery, show you understand their perspective: “It’s reasonable to feel disappointed, this wasn’t the result either of us hoped for.”
• Be clear and honest. Avoid jargon. Explain what happened, what the expected recovery now looks like, and what support will be provided.
• Offer solutions and next steps. Reassure them that you’re committed to achieving the best possible outcome from this point forward.
Of course, in incidents that could give rise to a complaint, speak to your medical indemnifier early for advice and practical support.
Interestingly, a 2018 review in the Journal of Patient Safety found clinicians trained in empathy and apology techniques maintained higher trust levels after adverse events.
Whether you’re an ophthalmologist or a practice manager, difficult conversations aren’t an interruption to your day – they are a fundamental part of your role as a leader.
The way you handle staff performance or concerns, or respond to patient dissatisfaction, will impact the reputation of your clinic, team culture, and even clinical outcomes.
By setting clear expectations and providing feedback, fostering open communication, and approaching each conversation with empathy and professionalism, you can turn difficult conversations into defining moments.
About the author: Scott Bell is the CEO of SMS Healthcare, with 14 ophthalmology clinics and eight refractive laser centres across the east coast of Australia. He’s previously been a director of Day Hospitals Australia, co-founded Nexus Hospitals and is a director at Sapphire Eye Care, a leading UK private ophthalmology group.
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