The Enemy Within? Managing Change for a Better Practice

Eye care abounds with new technology, including new medications, surgical devices, and, more recently, software solutions to increase clinician efficiency and ensure better patient care. Innovation comes much more quickly to ophthalmology because, as a group, ophthalmologists tend to be more willing than others to adopt new ideas.

But even ophthalmologists can derail their own success in adopting new technology by subconsciously preserving a less optimal status quo, despite consciously agreeing to change. A good example is incorporating new software for planning cataract surgery. Multiple companies now offer outstanding solutions that can connect to diagnostic devices to collect preoperative data, apply the most modern IOL formulas, and allow surgeons to select an implant in a slick user interface, seamlessly communicating the lens information to the surgery center and setting the stage for rigorous outcomes-tracking and nomogram improvement. However, practices that start to adopt these surgery planning systems often stall at some point and go back to picking lenses on paper. Why?

Part of the problem is that certain multi-step processes require the cooperation of many people. Booking a patient for surgery, scheduling and collecting preoperative biometry, getting the surgeon to select a lens, and then communicating the implant information to the surgery center might involve five or six staff members. Any one person involved in that process has “veto power” over migrating to a new system; if they don’t do their part, the practice tends to revert to its old way of doing things. In the organization, this leads to a sentiment of self-defeat, and the new system never gets adopted.

Generally, this is not intentional, but situational. For example, if a patient is preparing for surgery, they would typically undergo biometry two weeks before the procedure. The technician performing the biometry would verify that the vital data has been automatically uploaded to the surgical planner. Next, it might be the surgical counselor's job to annotate the surgical planning software, before the surgeon themselves selects the lens power based on the software’s calculations, and so forth. Although this process is clearly more streamlined than shuffling paperwork between all the moving parts, what happens when the technician performing the biometry has trouble logging onto the surgical planning software? They might print off the reports and hand them to the counselor; the counselor, assuming that the new software is simply “not working,” may pass this message onto the surgeon, and every step that follows would revert to the pre-digital methods that are comfortable to everyone but far less efficient. Because no one is the champion of a new and better digital process and because the team is not aligned, the entire process of upgrading lens planning becomes a failure.

So, how do we best move forward with newer, better technology? Practices who succeed in implementing change say there are several important steps. First, get everyone together to discuss why a new technology is being adopted. Make sure all questions are answered and everyone understands the process being proposed. Agree on realistic timelines to change and a pathway to air concerns when they arise. Once everyone has agreed on the new process, every team member must take “ownership” over their part. Then, select one person to champion the change process. This “change champion” could be an office manager – someone who has enough knowledge of everyone’s work situation and has the credibility to ask them to stretch their limits. Make sure the change champion knows that change will not always be easy, but emphasize the value that will come when the new process is implemented fully. During the process change, ensure the champion is communicating with the team openly, celebrating each incremental step, and acknowledging the people responsible for it. Regularly remind everyone of the reasons for making the change.

The best part about adopting new ways of practicing is that it gets easier with each iteration. Looking back, you’ll ask yourself how you ever did things in such an archaic way.