Feature, Ophthalmic education, Practice management, Report

Practice managers detail the inner workings of their eye clinics

Good management is essential for the effective operation of complex workplaces like optometry and ophthalmology practices. Insight speaks to three leading practice managers about their philosophies and daily practices that set them up for success. 

Ms Belinda Musitano owns and operates three independent optometry practices, a journey that began 18 years ago when she opened her first practice in Australind, Western Australia. Over time, her business has steadily expanded, with two more locations in Dalyellup and Falcon.

In addition to being the director of a three-practice business, Eyes @ Optometry, she doubles as an optical dispenser and practice manager. The ups and downs of independent practice ownership have armed her with a plethora of knowledge on how to manage successful businesses.  

In this article, Musitano describes the unique skillset she has obtained during her time as a business owner and manager. Later, Ms Lara Sullivan and Ms Lucy Peters detail how they navigate specialised equipment requirements, patient expectations and scaling of their ophthalmology practices. 

Musitano highlights the importance of rostering and monitoring the location of staff as one of the biggest challenges in managing several practices. Also, stock management, database maintenance and running effective and accurate marketing are other vital components, while ensuring recalls and record-keeping are properly managed. 

According to Musitano, transitioning from single practice management to multiple practices requires a scalability plan, with plenty of due diligence about what is required for a particular set of practices. 

“Things to be considered with scalability include choosing an on-site or remote database, setting up online appointments with ease of choosing location, rostering systems, purchasing stock in bulk and splitting to get better discounts, and having certain practices ‘specialise’ in different eye health areas to meet needs,” she says. 

In terms of rostering, Musitano was able to use an Excel spreadsheet to maintain and track staff. As the team grew, she moved across to Deputy which allows timesheet tracking, staff leave requests and rosters to be managed effectively and easily. She says that with expansion, business owners need to think laterally and find what works for their clinic dynamic. 

“In terms of our rostering, we had a very basic rostering system when we had just the one practice,” Musitano says. “I transitioned to Deputy as it integrates with Xero and allows seamless exporting for timesheets and payroll, as well as leave being allocated correctly.”

As the director of a three-practice business, Belinda Musitano doubles as an optical dispenser and practice manager. Image: Beliinda Musitano.

More strategically, a major driver of her success is dedicating time to define her goals and establishing a formal marketing plan. That way, she doesn’t have to improvise throughout the year. 

“It’s always about taking time out to set goals. I set annual goals at the beginning of each year and then work out a quarterly plan to meet those goals. These are reviewed monthly and relayed to the team at a staff meeting,” Musitano says.

The next important step is staff engagement to ensure everyone is united and behind the business’ philosophy. This is especially important during the scale-up. 

“It’s important to take time out of the practice or hold a management day where you’re sitting down and actually writing down what you’re hoping to achieve in that year and making a plan around that,” she says. “And when you’re wanting to take a different approach, you’ve got to carefully communicate that to your team, so that nothing’s missed.” 

The cornerstone of any well-oiled practice is a comprehensive IT system that integrates the most important aspects of management into a single location. When Musitano selects software, she looks for its data capabilities and the type of information it can hold. Her practice management software, Optomate, has consulting, dispensing, reporting and marketing capabilities. 

Accessibility, updating capabilities, and real-time reporting to determine how the practice is tracking against projected targets were among her most desired features. 

In terms of patient communication, she says it’s about ensuring SMS and emailing capabilities are integrated with the main database, as well as with Medicare and health insurance providers. 

One of the inevitable downsides of running an optometry practice is software failures. To mitigate this, Musitano backs up her clinics’ critical data every day and reverts to paper patient records if the system is not working that day. Her email database is exported to Mailchimp and the patient management system, HotDocs, is exported to maintain the ability to run recalls if systems are down. 

She also advises other practice managers to become proficient with their software systems, noting there are often untapped features within the software than can enhance the user experience. She urges managers to stay informed about new integrations and functions and capitalise on these functions. 

“Part of the problem is that software providers don’t actually provide that much training. Once you figure out these extra, little functions, it can make your life much easier,” she says. 

“At O=MEGA23, I realised some practices also don’t utilise follow up SMS to patients, to check how their new glasses are going or regarding contact lens trials. They’re also not using categories to mark patients with dry eye, online database functions for new stock/lens codes and easy Medicare claiming for private billing practices, among others.”

In retrospect, Musitano says she would have been more proactive in capturing more patient data from the outset.

“I would have ensured that the team were getting email addresses, marking patient categories, adding in ‘source/referred from’ details for every single patient. This can then be used to re-market new clinical advances and products that were targeted to those patients. We now capture all that data,” she says.

Managing patient expectations

Sullivan, with a background in nursing and human resources, co-founded Bayside Eye Specialists ophthalmology practice with her husband, Dr Laurence Sullivan, 18 years ago. The Melbourne-based practice began with just the two of them and has since undergone significant expansion, adding 10 associate doctors and 22 staff.

Sullivan wanted to create a multidisciplinary practice that covers a wide range of sub-specialities within ophthalmology. 

Managing an ophthalmology practice comes with its own specific set of challenges, says Sullivan, especially with the effects of the Melbourne lockdowns still lingering. 

“We’re still seeing a backlog of patients. We’re seeing more advanced disease that we wouldn’t have normally seen, so consultations can take longer. Currently, we’ve got waiting lists for three to four months for most of our doctors, but obviously we’ll always prioritise emergencies,” Sullivan says. 

Ophthalmology, as a specialty, entails high overhead costs.

“Ophthalmology has the second highest overheads, with radiology being the only other discipline that beats us. The equipment that we use is very expensive and we have more clinical staff who support our doctors compared to someone like a dermatologist or orthopaedic surgeon. There are considerably more expenses involved,” she says. 

Sullivan notes that staff retention is an ongoing industry issue. She therefore emphasises the importance of maintaining a positive workplace culture and to look beyond just the skillset during recruitment; this has contributed to a reduction in turnover in her practice. 

“We’ve got a great culture in our organisation. We work hard to support our doctors, patients, and referrers, which are our optometrists and GPs, and to also support each other,” she says. “We have a flat management structure. I don’t manage from the top down and everybody’s input is taken into account.

“I will always recruit for attitude. I can teach people most things and I think a lot of specialist practices do themselves a disservice by only looking for someone with experience. If you’ve got someone with a fabulous attitude and they’re willing to learn, and you give them an opportunity, they’re going to be grateful and return it to you in spades.”

Sullivan’s practice focuses on patient triage, ensuring patients see the most suitable doctor for their condition. Post-operative consultations are grouped at the beginning of the session and she avoids booking new patients together. 

At the same time, managing patient expectations is crucial, considering they may spend a long time in the clinic.

“For instance, undergoing scans and having your pupils dilated – all these things can take time. If we’ve managed to communicate that appropriately, then their expectations will be met,” she says. “I think managing expectations is probably the single biggest issue in ophthalmology.”

Sullivan notes the platforms she uses for patient communication. 

“We use Zedmed patient management software for admin and clinical, and are relatively paperless. Zedmed has an intra-mail component which links to the patient file which is great for documenting conversations or other notes. We send SMS reminders from Zedmed to patients and use HotDoc for patients to complete their initial registration form which reduces the risk of errors in data input.”  

Given the unique needs of the specialty, Sullivan’s practice uses niche software that helps manage images and specialised equipment. However, managing large data storage can be challenging, which is mitigated by an efficient IT support system. 

For example, the clinic has implemented ZEISS FORUM software that connects ophthalmic devices to provide access to all patient examination data. 

“We’re a ZEISS-heavy practice. We have the ZEISS visual field tester, IOL Master and OCT and, and with this being supported by the FORUM software, it allows the doctor to easily compare the visual fields and the OCTs to track what’s happening over time,” Sullivan says. 

“We also export data from the IOL Master to a thumb drive which the surgeon can insert in the Callisto operating microscope which streamlines surgery.”

In retrospect, Sullivan would have built a more substantial practice from the beginning to accommodate expansions. Despite undergoing renovations, space is still a concern. 

“I always say to younger ophthalmologists to allow for growth. The footprint for our equipment is significant,” she adds. 

Finally, Sullivan says she’d like to see more collaboration among practice managers to strengthen the industry.

“I’d love to see more practice managers coming along to the RANZCO Practice Manager’s Conference. Running alongside RANZCO, it’s a fabulous program, and allows for practice managers to network with each other,” she says. 

Collaboration and communication 

Peters manages the NSW ophthalmology practices Gordon Eye Surgery (GES) and Lane Cove Eye Surgery (LCES) with business manager Ms Donna Glenn. Established in 1993, the practice has expanded from an initial two doctors in five rooms and two receptionists and orthoptists, to 22 doctors in 15 rooms with 40 support staff.  

She emphasises the importance of communication across the business, while ensuring the team are familiar with the doctors’ needs. 

“This is to ensure that patients receive the best possible care and high-quality diagnostics and treatment; and continuing with ensuring patient expectations are managed expertly and with compassion, from their first contact throughout their visit and beyond,” Peters says. 

The clinic uses technology, including an online manual and Practice Hub, for efficient management. Peters also organises monthly staff meetings and an annual staff symposium to keep everyone updated and provide perspective, with the final session led by a patient. Peters suggests scaling the practice according to doctor-to-staff ratios while ensuring key staff can spread the right message across the practice.

Streamlining the typing, checking and sending of reports has also been crucial to provide quick turnaround for communicating patient letters. Dragon, Argus, Healthlink, GoFax, and off-site staff accessing their remote desktop using software setup by IT support, Solutions First, have all meant that letters are often received by health providers involved in a patient’s care the day after a consultation, if not on the day of consultation. 

“This communication between specialists and their referrers is key to ensuring best quality, continuity and timely patient care, as well as collaborative relationships and improved patient satisfaction,” Peters says. 

She says that space and support staff were primary challenges in scaling the practice. She would have introduced greater physical and digital storage capabilities early on as they have since had to double the consulting rooms to accommodate the growing number of doctors. Scalable servers and reliable IT support were essential to manage the large storage needs associated with digital records.

Communication underpins everything at Gordon Eye Surgery, which has significantly expanded since its foundation in 1993. Image: Gordon Eye Surgery.

The transition to digital-only management has also been a complex and tedious task at times, as the clinic – like all health providers – is obliged to maintain physical records for seven years. Scanning and shredding services provided by Activscan have also been an ideal way to convert files from paper to electronic records since 2014, ensuring patient information is readily available – even in an emergency. 

“We’re just getting to the end of scanning the existing files and making sure all the patient files are accessible,” Peters says. 

When choosing software, Peters emphasises the importance of security and cost-efficiency. Subscription-based software with fixed fees does not always align with the nature of its business, as fees are charged per head count. As some staff can only work one day per week or fortnight, this is largely cost-inefficient. She encourages vendors to offer full-time equivalent subscriptions for increased uptake.  

GES uses an online platform for new patient registration by Aura Health that integrates with VIP.net to ensure patients are ready to be seen as soon as they arrive at clinic, significantly reducing the time and anxiety surrounding their initial interaction with ophthalmology. However, given many patients have ocular disease, text-based reminders are not always effective. The clinic also uses appointment cards but is exploring ways to improve accessibility.

Peters says much of the patient demographic are also unfamiliar with digital platforms. In fact, the majority of inbound phone calls are for appointment confirmation.

“We are exploring ways to improve the inherent accessibility issues with text-based communications, including making text size malleability prominent on our website and improving speech-to-text functionality,” she says.  

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