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“There is nothing so useless as doing efficiently that which should not be done at all.”
– Peter Drucker
“There’s a way to do it better — find it.”
– Thomas A. Edison
We recently finished a small consulting project in a suburban Paris eye clinic. Opportunities like this to evaluate and improve clinics around the world surface from time to time. We end up learning much more than we ever teach, most of it applicable to our mainstay clients in North America.
But France is a special case.
You may have heard of the “French paradox.” In the 1980s, it was observed that cardiovascular disease was seemingly lower in France than in America despite a national diet famously rich in saturated fat: hundreds of cheese varieties … duck fat-fried pommes frites … foie gras. It is a long, delicious list.
For years we have observed a similar service business paradox between the U.S. and France. Although France is famous for worker discontent (despite a 35-hour workweek and a standard retirement age of 62 years), French employees, culturally, work faster, more intensively and more efficiently than their American counterparts.
A couple of examples from personal experience:
A casual dining American restaurant with around 20 tables and a capacity for 60 guests at a time will typically have about three or four servers on the floor. The same grade of restaurant in France will cover the floor with one or two servers.
A “nothing too fancy” men’s haircut in America takes about 30 minutes. The same haircut in France will be complete in under 15 minutes.
In our experience in several French eye clinics through the years, this French vs. American labor efficiency applies in ophthalmology:
In American eye clinics, practices pay about $70 in labor costs per patient visit; in France, that figure is typically under $40.
In America, we employ about six lay staff full-time equivalents per full-time ophthalmologist. A practice with four doctors will have a payroll of about 24 or more non-provider workers. Contrast that with our most recent French client: Their four MD equivalents are supported by 12 staff, just three workers per doctor.
Our typical American general ophthalmology clinic employs about 1 hour of technician staff time (inclusive of techs, scribes and special testing staff) for every patient visit. In France, that figure is closer to 0.5 hour of tech time per visit.
With the advent of electronic medical records, a majority of U.S. ophthalmologists use in-room scribes; few French ophthalmologists do.
And efficiency and productivity are not limited to lay staff. We routinely observe French ophthalmologists (Canadians, Singaporeans, Aussies, too) seeing more than 750 patient visits per month while their average American colleagues peak at about 500.
What is driving this? Is it just the espresso? Are there French labor management ideas we can apply in America? Some thoughts:
1. First, it should be recognized that patient accounts and medical records management in France are somewhat more streamlined than in America. A swipe of the patient’s insurance card launches the payment process with little additional work required.
2. Labor laws in France, although now somewhat more employer-friendly, still make it much more difficult and expensive to terminate staff. As a result, based on conversations we have had, bosses feel highly committed to each new hire and try their utmost to bond the worker to the practice for the long run. Perhaps in America our readily-disposed-of staff not only feel less appreciated and more vulnerable, but our managers and clinic owners underinvest in competency development for their “here today, gone tomorrow” staff.
3. Because of this, our impression and discovery are that French ophthalmic staff stay at their jobs longer and learn more so they can eventually get more done in a day’s work. French clinic employers, instead of churn, optimize existing staff over time, leading to higher competence and more team output.
4. Overall labor costs per hour are higher in France. High labor costs and legal job protections push employers to invest more in training and retention.
5. Because French staff work 35 hours per week, they put in 12.5% fewer hours per week (or per year) than their American counterparts. Perhaps they have more vigor to put into every hour worked. We have certainly seen this in American practices that adopt a 4-day schedule or that close the office at noon on Fridays.
Out of this, here are some practical actions for American ophthalmic clinic owners and managers to consider:
1. Shift your mindset from “busyness” to deliberate, visible productivity. How many minutes does it take your operator to clear an inbound call? How many minutes does it take a tech to work up a new patient?
2. Experiment with deliberate lean staffing. If you ordinarily work with four techs, work with three for a morning and see what you learn about potential efficiencies. (We often do this in client offices, leading to many cost-saving “aha!” moments.)
3. Train, train, train. Not only should you teach staff how to do their jobs, but they should know how to safely cut corners and get more done in less time. You should arrange at least one formal staff training hour for every 2 weeks worked.
4. Foster each worker’s pride in their career. Celebrate their advances. Help them overcome their weaknesses.
5. Measure efficiency: Divide total staff hours in a month by total patient visits (aim for 2.5 hours per visit or less). Divide total monthly patient visits by the number of exam room-hours available in a month (aim for at least one patient visit per available exam room hour). Divide total staffing costs by total practice collections (aim for a figure of not more than 32%).
6. Reduce turnover through wise hires and intensive attention to onboarding, training and workplace enjoyment.
7. Remember that staff work for respect and money. Give abundant positive feedback. Openly praise each person’s contribution to patient care.
8. Simplify. If you have a multi-doctor practice, develop one best agreed way to do everything. Don’t make staff memorize customized doctor routines.
9. Consider working shorter, more intensive hours each week.
10. Buy an espresso machine. No kidding.
For more information:
John B. Pinto is president of J. Pinto & Associates, Inc., an ophthalmic practice management consulting firm established in 1979. He is the country’s most published author on ophthalmology management topics, including John Pinto’s Little Green Book of Ophthalmology, Simple: The Inner Game of Ophthalmic Practice Success and Ophthalmic Leadership. He can be reached at 619-223-2233; email: pintoinc@aol.com; website: www.pintoinc.com.
Corinne Z. Wohl, MHSA, COE, is president of C. Wohl & Associates, Inc., a practice management consulting firm. With 35 years’ experience, her firm specializes in leadership, operations enhancement, financial benchmarking, executive and provider coaching, and management team development. Her book, co-authored with Pinto, is UP: Taking Ophthalmic Administrators and Their Management Teams to the Next Level of Skill, Performance and Career Satisfaction. She can be reached at 609-410-2932; email: czwohl@gmail.com.
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Disclosures:
Pinto reports being president of J. Pinto & Associates, Inc. Wohl reports being president of C. Wohl & Associates, Inc.
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