Visionaries and Educators

Speak clearly, listen carefully

Managing different personalities is a major part of being an ophthalmic administrator. Regardless of the practice’s size, staff have different backgrounds, work ethics, desires and needs. Throw gender into the mix, and these differences could become more pronounced.

We have 92 employees, 91 of whom are female. These women, who range in age from their early 20s to their late 60s, can differ greatly on how they work and react to various situations; disagreeing employees can create problems without clear communication from middle management (meaning me). I have found that recognizing and understanding these differences are the most important skills to possess in running a successful ophthalmic practice.

My first experience, occurring early in my ophthalmic administrator career, taught me a valuable lesson in managing differences, especially as it relates to gender. It also shed light about the difference between managing numbers and managing people.

“What do you want to be when you grow up?” I had jokingly asked many people this question as a conversation starter, and most responses were good humored. One surgeon said, “A pilot!”

But when I asked a well respected technician, she replied, “an ophthalmic technician.” I thought nothing of her terse response until the managing partner asked for a chat.

As I entered his office, he awkwardly greeted me and made a few pleasantries before he began to question me about the exchange with the tech.

I was astonished my question had offended this employee, a person I’d clone in a minute. I didn’t want to offend any employees — and definitely not this one. But I couldn’t figure out why that question would upset anyone — but as I thought, I realized understanding the difference between genders wasn’t important but rather it was more vital to learn the skills necessary to practice effective communication and work together.

This experience, and others, forced the question: what is effective communication? I had always thought I could communicate clearly, but I found I could improve. This realization led me to a second question: which is more important, what you say or what they hear?

Obviously, men and woman normally communicate in different ways, which can lead to misunderstandings. My first inclination was to push off these miscommunications as gender differences. Instead, I came to realize that, regardless of gender, we have different goals, experiences, talents, perspectives and ideals for treatment in the workplace.

Managing to generalizations or stereotypes was impractical. If I wanted to lead and inspire my employees, I would need to dig deeper and look at individuals and ways that I could influence them.

I focused on three areas.


A key concept in the field of behavioral analysis and a vital employee motivator is positive reinforcement, by which management encourages the employee to repeat the same behavior in the likelihood it occurs again. But positive reinforcement is a personal thing: it must be tailored to the individual. The encouragement could be verbal, financial or a change in status.

But, for the stimulus to work, the positive reinforcement must occur as close to the behavior as possible. It does little to reward someone for a good deed that occurred a month ago, because the mind is not likely to connect the reward to the specific behavior; therefore, the employee would be less likely to repeat it. Stay engaged in continuous positive reinforcement for the best results. Additionally, appetitive stimulus (rewards for good behavior) has been shown to be much more powerful than aversive stimulus (punishments for bad behavior).

Positive reinforcement done well will greatly improve communication in the workplace in many ways. Most importantly, it provides a sense of self-worth for employees and can help alleviate self-doubt in their ability to do the job. Additionally, improvement of morale in the workplace will follow, which will increase the always-important teamwork in the office.

Initially, I assumed that the main motivating factor for employees would be financial. However, I was wrong. It was a factor, to be sure, but oftentimes not the main one. A 2014 study from the Boston Consulting Group coupled with my experience show the two most powerful re-enforcers are:

  1. I get to make a difference every day; and
  2. My boss thanked me for doing a good job.

These simple things go further in strengthening the workplace than any office-wide employee appreciation program could ever do. This study reported that 70% of employees report never hearing their boss say thank you. I think it is unlikely that bosses only express appreciation to 30% of their employees, but regardless of what we say, the important thing is what employees hear! And they are clearly not hearing our appreciation.


A flexible workplace can also improve communications. Workplace processes are changing rapidly to keep up with employee demands as businesses struggle to attract and retain top talent. Employees want more control of their jobs. Some employers are giving it to them, hence a major outgrowth in flexible workplaces.

How can you increase employee satisfaction and productivity in a medical office with set hours and patient confidentiality issues? More importantly, how can you create flexibility and communicate it effectively to your employees?

An individualized relationship requires you to walk a fine line to maintain discipline yet avoid the appearance of favoritism. But it is necessary. JP Morgan Chase conducted a study showing that 95% of employees feel motivated to exceed expectations when they work with a manager who is sensitive to work and personal issues. Employees need opportunities to express concerns. Management needs to be flexible to life’s demands, like sick kids or flooded basements.

Standardize flexibility, but provide clear policies. Get physician and management support. Find out what your employees need. Be creative in seeking opportunities to enhance a personal connection with all employees. Deloitte estimates that, by 2025, today’s 20-somethings will represent 75% of the workforce. For these workers, work-life “fit” is more important than money or gaining new skills.


The final area is to develop and maintain an effective training program. Obviously training should produce better employee performance, but how does it improve understanding and communication?

It seems easy to tell a technician to be quicker on a workup or a receptionist to accurately enter in all demographic information, but this can be a difficult task to accomplish. Regardless of the level of ownership an employee takes in the job, he won’t succeed without understanding his responsibility. This often includes the “why” of what we do.

For example, a seasoned technician might not think to explain, when training a new technician, of the importance of reviewing a visit summary for an existing patient. This oversight could lead to a new patient claims submission, which will be denied and hence resubmitted.

Or maybe a receptionist does not understand the importance of entering the policy number along with other critical data — that claim may be denied. These oversights, while affecting practice efficiency, are opportunities to strengthen communication

Training lets you individualize employee communication. The key to an effective training program is a clear, standardized process. If the baseline makes clear what is expected, then the employee can be empowered to grow in her ability to perform her job and see herself making a difference.

Next, frequent follow-up on training provides positive reinforcement; do it monthly, even weekly. More importantly, it creates opportunities for real communication between manager and employee.

Ongoing training improves consistency, and that reduces turnover, and that enhances your reputation as a practice. This will help you recruit the best candidates. What is your turnover?


Our so-called gender issues are no different than those in other practices and professions. I believe our higher ratio of X chromosomes is what has made us successful. About 80% of patient interaction occurs with these hard-working employees. There are stresses to be sure but as outlined above, the key is to recognize and adapt to individual needs. Make every effort to make sure that they hear what you say. OM