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Blog Series: Three Steps to your Ideal VT Practice: Envision it, Create it, Keep it!


Part Three: When Things go Wrong...Troubleshooting your VT Practice


By Thomas Lecoq


You made your plan, you worked your plan and now, everything is perfect. Running like a top. Right?


Of course not. Life always manages to toss curves our way, as Wm. Shakespeare said, “Like as waves make toward the pebbled shore…” This final section of the series is about practical ways to handle many of the issues that will wash up on the pebbled shore of your VT practice.


Let’s assume you have developed a flow chart, a map, of the steps in your practice system. When a breakdown appears, look for what changes have occurred in the steps leading up to where the breakdown manifests. In our experience, someone has made changes in their interactions with patients and the public.


Someone has taken a shortcut and altered something or are leaving something out. If what happens in a practice is a series of conversations, spoken or written, then it’s critical that every conversation advances the parent or patient toward the outcome of a happy graduation day at the end of vision therapy.


Building confidence in VT

Conversations build confidence in a parent that this is the right choice. That despite the cost and inconvenience, it is going to end the situation they have been wrestling with. So, the conversations are all for and about them. What the parent or adult patient is experiencing and the emotions surrounding those experiences.


The problem is usually that someone on staff has decided they already know what the parent is feeling, or how the issue is affecting the child, parents and family. But in fact, they do not. It’s different for every person who will make the choice to do VT or walk away. So, the conversation deteriorates into a “sales pitch.” Parents hate this and just want to leave.


In our method, the process of revealing the real concerns happens over a time. Step by step by step, each building upon the last. This gives the parent time to come to see for themselves that vision IS the problem and that you obviously have the solution. We find that typically takes from 90 minutes to three hours of communication. And it needs to stretch over enough time for the parent to work out money, time and transportation arrangements before signing up.


Rush that and they won’t, or can’t, manage those practical issues.


Rehearsing your show

Shakespeare observed that “All the world’s a stage,” and that applies to VT practices. And like any performance, with insufficient rehearsal the show will be a disaster. Rehearsal is how people learn their lines and work out the interactions with other characters. It is the same with training and staff development.


Rehearsal takes time. How much time do you devote to everyone learning their role in your system? In our consultation we spend up to 8 days in courses and on site work with doctor and staff, training and rehearsing the steps in our system. After a few run-throughs with the doctor in our Mastering the Art of Vision Therapy Communications, we find staff have learned along with the doctor. And we follow up with remote work over time to train and develop the more advanced aspects of our system.


Staff meetings are for education and rehearsal, they’re not gripe sessions. If an issue comes up, the person who brings it up should be assigned to find a way to resolve it within the system. Keep the system map at the center of all meetings and trainings. In a practice doing $1 million a year gross, we think 4 to 5 hours a week devoted to training and development (plus rehearsal), is appropriate. That’s about 10 percent of a doctor’s week, more in the early days of implementation, a little less as the system does its magic.


Hiring great people

Do you think you can hire someone who knows how to work your system without a significant training and rehearsal effort? Good luck with that.


Which brings us to a critical point: Hiring the right people. The biggest problem we find with hiring is that doctors hire for perceived talents of the individual rather than as “actors” to fill their role in your system.


The outgoing sales-oriented person who comes off as a go getter, may not be the right person to conduct that all important first phone call. One of our favorite clients, Rob Fox, a VT OD in upstate New York, and a leader in the profession, has one criteria. “I hire people who are nice, we can train them for the rest.”


We urge clients to find empty nest parents and develop them. Raising children counts for VT staff and therapists. Best of all are parents of patients who have had good VT results.


Do a complete visual evaluation of your serious candidates so they experience the process for themselves. And at the same time, you will get a sense of how patient they are, how interested they are, and their real personality will become apparent. When you hire anyone who would benefit from VT, put them through an intensive VT program. The changes will make them more effective, and they will “get it” about VT at a whole different level.


Hire for roles, not special talent

You want the personality to be appropriate for the role you will train and rehearse them to fill.

For therapists, you want a patient, engaged and cheerful person who loves the idea of working with children. They need not have a degree or certifications to qualify.


Many years ago, I met a woman who was manager of several fast-food locations. She was always pleasant, the others there (many young) liked working with her, and she was attentive to detail. She corrected quietly and praised in public. I would have hired her in a minute for the key role of Vision Therapy Administrator. This role has the majority of critical interactions with parents and adult patients.


I would have rehearsed her role and provided her with all necessary training and all the backup needed to learn and then master her role as the key community outreach person. And if I wasn’t sure how to do that, I’d hire us to teach and support her in the role.


In theater, long running plays go through ongoing rehearsals. It is necessary to keep the performance fresh. Same thing applies to keeping your system fresh and effective. The actors must be reminded that the audience is seeing their two hundredth performance for the first time. Staff need to reconnect with their “audience” as well.


Dealing with trouble from within

Sabotage: Every once in a while, we find an employee who does their best to stop the changes that doctors want to make. They always manage to make themselves appear indispensable. They are always full of reasons why they can’t get something done, and argue for not changing how things work. Some do this knowingly. Some recruit other staff to give the same excuses. But the outcome is always that the doctor cannot get them to do anything new. Lack of willpower or doctors who want their staff to be friends, keeps them from firing this staffer. So things don’t change, money gets tight, family time is traded for extra hours at work. Doctors feel stuck.


This person must go. Some doctors we’ve worked with were unable to bring themselves to dismiss the saboteur, and the doctor and family suffered. Debt to keep things going, no reserves to tide the practice over are clear signs. We can spot saboteurs within minutes of meeting staff, The culprit is obvious. They are the ones who hold back, won’t participate in the training, and refuse to rehearse their role. “I hate role playing” is a typical excuse for not participating. But rehearsal IS role playing. Some are blatant in their resistance to doing what the doctor wants.


Last is a delicate situation, nepotism. We are a family business ourselves, and we have seen some husband-wife or other family teams which are extremely effective and dedicated. But sometimes when a family member takes on a leadership role in the practice, they become a block to promotion in the eyes of the staff. Depending on the specific situation, we occasionally suggest the spouse take a back-office role with minimum staff involvement.


Handling any of these issues is very uncomfortable for many doctors. However, it is part of having a great practice. We’ve spent decades developing our system, and guided scores of VT ODs through implementation. You will have issues, but if you stick to your system, they will be minimal and your life will be better.


Take action now

If you are having issues in your practice, I invite you to complete a practice assessment here on our site, idealvt.com. There is one for existing VT practices and another for those planning to start VT. Fill it out and schedule a free initial phone consultation with Amee about issues and solutions.


Amee and I hope this series has helped you to move forward toward your own ideal VT practice. It requires work, but the rewards are enormous. Not just income for you, nor the joy therapists feel when they see children improving, but for the children and adult patients your expanding VT practice will be providing with entirely new futures never open to them before.


That’s what keeps Amee and me engaged in this magnificent specialty. In fact, our logo of dancing kids is all about this. The kids are dancing with joy because they finally got the vision therapy they needed. Consider that foremost as you pursue your ideal practice.








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